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Home My WebLink About2013- December File Copy • Jefferson County Board of aLeaCthi .Agenda & .BVI inutes • December 19, 2013 0 • JEFFERSON COUNTY BOARD OF HEALTH December 19,2013 Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of October 17, 2013 Board of Health Meeting III. Public Comment IV. Old Business and Informational Items 1. Report on NACHHO Leadership in WA DC 2. Updates: Main Street Project; SmileMobile and WIC 3. Affordable Care Act Comments Washington State Association of Local Public Health Officials (WSALPHO) & State Association of Counties (WSAC) • 4. ACA Enrollment 5. The Healthiest Next Generation Initiative Governor Inslee 6. Broken Promises to Our Children, Tobacco Funding 7. Update on Homeowner Inspections O&M V. New Business 1. Jefferson County Substance Abuse Advisory Board Re-appointment 2. STD/Chlamydia Update 3. Environmental Health Proposed Fees for Cost Recovery • Food Program • O & M • Water Recreation Facilities 4. JHC/JCPH Community Health Partnership VI. Activity Update VII. Public Comment VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: January 16, 2014 • 2:30—4:30 PM Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 98368 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, October 17, 2013 Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Vice Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Dir Roberta Frissell,citizen at large(County) Jared Keefer,Env. Health Services Dir Catharine Robinson,Port Townsend City Council Veronica Shaw,Public Health Deputy Dir Sheila Westerman, Citizen at large(City) Jill Buhler, Chair,Hospital Commissioner,District#2 Chair Buhler called the October 17, 2013 meeting of the Jefferson County Board of Health to order at 2:35 PM. A quorum was present. Members Present: Jill Buhler, Sheila Westerman, Roberta Frissell, Catharine Robinson, David Sullivan, Phil Johnson, John Austin Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw • Members Excused: None APPROVAL OF AGENDA Chair Buhler called for review and approval of agenda. Member Westerman moved to approve the agenda as presented; the motion was seconded by Member Frissell. No further discussion. The motion passed unanimously. APPROVAL OF MINUTES Chair Buhler called for review and approval of the minutes. Member Frissell moved to approve the minutes as presented; the motion was seconded by Member Austin. No further discussion. The motion passed unanimously. PUBLIC COMMENT No public comment. 111 1 BOH Minutes—October 17,2013 OLD BUSINESS AND INFORMATIONAL ITEMS • Affordable Care Act Update: Health Exchange Enrollment Julia Danskin reports that there are complications with implementation of the Affordable Care Act(ACA) and the Health Exchange enrollments, however staff is working through them. One complication is the newly qualified, who would qualify for Medicaid under the expansion, are no longer being processed through DSHS, and are instead being directed by DSHS CSO to JCPH and Jefferson Healthcare. There are programmatic overlaps with Breast and Cervical Health program and with the Take Charge program where there are gaps in income eligibility between program limits and ACA limits. There are glitches in the website signup,which is taking anywhere from 15 minutes to 3 weeks, and the call center lines are at capacity, with very long wait times. Girls Night Out: Breast Cancer Prevention Julia Danskin reported that Girls Night Out 2013 was a very successful evening. Main Street Project puts together gift bags to be sold, and each bag included information about healthcare reform, and breast health. Almost$6,000 was raised through sale of the bags, and funds (after expenses)will partially benefit the Jefferson County Breast and.Cervical Health Program. Jefferson County Public Health WIC Newsletter Julia Danskin reviewed the WIC client newsletter included in the Board's agenda packet. WIC is no longer in danger of being cut now that Federal government shutdown has ended. WIC is becoming a services coordination hub, serving 830 individuals a year in Jefferson County. Other programs highlighted for WIC clients (which are also inclusive of other populations) are Smile- . Mobile, Farmers Market produce purchase, and the Breastfeeding Tea. JHC Meeting with JCPH Dr. Locke discussed the second in a series of meetings between Jefferson Health Care and Jefferson County Public Health, focused on Community Health Needs Assessments (CHNA), a survey of the major health needs of the community. This process addresses services provided and needs, where the gaps are, and how to mobilize improvements. JCPH currently has assessment data that can be updated. There was a consensus that CHNA planning is important and will be implemented locally. Mental health inclusion issue was discussed—identifying a solution for treatment, and prevention and maintenance. NEW BUSINESS Environmental Health Fee Schedule: Proposed Adoption Schedule Jean Baldwin reviewed discussion from the September meeting of the Board of Health, which included addressing water recreation fees. Subsequent to that meeting, staff found that there are changes in the temporary food fees, and in solid waste fees. With the inclusion of all fee needs, it's suggested that the December discussion be postponed until an all-inclusive fee schedule change discussion can occur in January or February. 4111 2 BOH Minutes—October 17,2013 • Member Robinson moved to postpone the hearing on fees which was to occur during the regular December Board of Health meeting. Member Austin seconded the motion. No further discussion. The motion passed unanimously. Environmental Health Proposal for Enforcement Cost Recovery Linda Atkins presented information on the possible placement of notice to title and charging a fee for rescission of the notice for certain violations. She included review of how it would intersect with our current compliance efforts and how other jurisdictions utilize this tool. It is a way to alert future owners of existing violations and recoup costs associated with the noticing process. It is also an incentive for the owner to correct the issue, and is a way for interested parties to be aware of important and lasting land issues, although currently the tool is used infrequently because of the cost. Three jurisdictions that use this tool are Okanogan, Seattle-King,Tacoma/Pierce counties. JC Civil Deputy Prosecuting Attorney David Alvarez has reviewed those programs. The jurisdictions utilizing a cost recovery fee are finding that with the fee, many violations see a response before filing the Notice to Title. Costs which might be included in a Notice to Title fee include:recording fees, administrative costs,time spent creating the site specific notice and rescission, and communicating with current and future interested parties about the notice, or rescission. This issue will be presented to the Board again with subsequent all-inclusive fee schedule change discussions. Member Westerman suggests adding a per-hour fee description and an additional per hour fee (for overage) included • with this fee structure in order to adjust for outliers, and recoup all costs. Temporary Food Program Permit Activity Report Susan Porto recognizes Food Program staff member Mina Kwanza's diligence in tracking information on the day to day activities associated with implementing the food safety program. The information tracked allowed us to represent accurately the time spent in the temporary food permit process, which is becoming a year-round program. The hand-out in the Board's agenda packet includes time studies, take-away's related to the time studies, and comparisons with past data. Member Westerman recommended the addition of a per-hour fee description and an additional per hour fee (for overage) included in the fee structure. 2014 Jefferson County Public Health Budget Jean Baldwin reviewed impacts to the Jefferson County Public Health Budget. JCPH budgeting has included a budget carryover yearly through the recession, this is diminishing. JCPH programs will be changing, and Federal and State programs are making changes that may or may not be affecting JCPH programs. JCPH has asked for budget appropriations, and is budgeting on a three month basis to adjust quickly and appropriately. The annual County budget process was completed in July but did an October budget review and November all appear similar. Budget reviews will be completed in January, and again in April. JCPH may have to use program cuts, policy shifts, staff adjustments, and layoffs in order to meet any further budget shortfalls. There have been programmatic and policy adjustments and one layoff since October of 2013. This budget shortfall will be continuing through the coming year. • 3 BOH Minutes—October 17,2013 JCPH has been notified that CPS will no longer be contracting with us for court observations, • and low risk families. The Affordable Care Act (ACA) enrollment stops in March,but how the ACA will financially impact the department is unknown. Our electronic medical records (EMR) system has problems, and contracts are changing—this will have financial implications for JCPH. Ms. Baldwin will be coming to the Board for guidance about shortfalls,programmatic and policy adjustments as the need arises. A Board retreat may be advisable to address these issues. Federal Government Shutdown: Public Health Program Impacts Dr. Locke reported that the Federal government shutdown has ended. In the long run, the cost to the American public in terms of loss in Gross National Product will likely be in the billions. JCPH was prepared to respond to the program cuts with furlough notices, and the first victims of this reduction would have been children—Head Start, TANF and WIC. The issue may arise again in January 2014. ACTIVITY UPDATE Ms. Joswick noted that a national drug take-back day event will take place a week from Saturday 10-2 at Safeway,under the auspices of the Port Townsend Police Department. Volunteers are needed, and Ms. Joswick encourages members to spread the word. PUBLIC COMMENT No public comment. AGENDA PLANNING CALENDAR The November Jefferson County Board of Health meeting will be canceled due to the WASAC meeting and other scheduling conflicts. Notice of the cancellation will be given according to public meeting procedures. NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, December 19, 2013 from 2:30— 4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 ADJOURNMENT Chair Buhler adjourned the September 19,2013 Jefferson County Board of Health meeting at 4:20 PM. 4 BOH Minutes—October 17,2013 T • JEFFERSON COUNTY BOARD OF HEALTH Phil Johnson, Member Jill Buhler, Chair Roberta Frissell, Member David Sullivan, Vice Chair Catharine Robinson, Member John Austin, Member Sheila Westerman, Member Respectfully Submitted Cara Leckenby • 5 BOH Minutes—October 17,2013 . } • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, October 17, 2013 Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Vice Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Dir Roberta Frissell, citizen at large(County) Jared Keefer,Env.Health Services Dir Catharine Robinson,Port Townsend City Council Veronica Shaw,Public Health Deputy Dir Sheila Westerman, Citizen at large(City) Jill Buhler, Chair,Hospital Commissioner,District#2 Chair Buhler called the October 17, 2013 meeting of the Jefferson County Board of Health to order at 2:35 PM. A quorum was present. Members Present: Jill Buhler, Sheila Westerman, Roberta Frissell, Catharine Robinson, David Sullivan, Phil Johnson, John Austin Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw • Members Excused: None APPROVAL OF AGENDA Chair Buhler called for review and approval of agenda. Member Westerman moved to approve the agenda as presented; the motion was seconded by Member Frissell. No further discussion. The motion passed unanimously. APPROVAL OF MINUTES Chair Buhler called for review and approval of the minutes. Member Frissell moved to approve the minutes as presented; the motion was seconded by Member Austin. No further discussion. The motion passed unanimously. PUBLIC COMMENT No public comment. 111 1 BOH Minutes—October 17,2013 • OLD BUSINESS AND INFORMATIONAL ITEMS Affordable Care Act Update: Health Exchange Enrollment Julia Danskin reports that there are complications with implementation of the Affordable Care Act (ACA) and the Health Exchange enrollments, however staff is working through them. One complication is the newly qualified, who would qualify for Medicaid under the expansion, are no longer being processed through DSHS, and are instead being directed by DSHS CSO to JCPH and Jefferson Healthcare. There are programmatic overlaps with Breast and Cervical Health program and with the Take Charge program where there are gaps in income eligibility between program limits and ACA limits. There are glitches in the website signup,which is taking anywhere from 15 minutes to 3 weeks, and the call center lines are at capacity, with very long wait times. Girls Night Out: Breast Cancer Prevention Julia Danskin reported that Girls Night Out 2013 was a very successful evening. Main Street Project puts together gift bags to be sold, and each bag included information about healthcare reform, and breast health. Almost $6,000 was raised through sale of the bags, and funds (after expenses)will partially benefit the Jefferson County Breast and Cervical Health Program. Jefferson County Public Health WIC Newsletter Julia Danskin reviewed the WIC client newsletter included in the Board's agenda packet. WIC is no longer in danger of being cut now that Federal government shutdown has ended. WIC is becoming a services coordination hub, serving 830 individuals a year in Jefferson County. Other • programs highlighted for WIC clients (which are also inclusive of other populations)are Smile- Mobile, Farmers Market produce purchase, and the Breastfeeding Tea. JHC Meeting with JCPH Dr. Locke discussed the second in a series of meetings between Jefferson Health Care and Jefferson County Public Health, focused on Community Health Needs Assessments (CHNA), a survey of the major health needs of the community. This process addresses services provided and needs, where the gaps are, and how to mobilize improvements. JCPH currently has assessment data that can be updated. There was a consensus that CRNA planning is important and will be implemented locally. Mental health inclusion issue was discussed—identifying a solution for treatment, and prevention and maintenance. NEW BUSINESS Environmental Health Fee Schedule: Proposed Adoption Schedule Jean Baldwin reviewed discussion from the September meeting of the Board of Health, which included addressing water recreation fees. Subsequent to that meeting, staff found that there are changes in the temporary food fees, and in solid waste fees. With the inclusion of all fee needs, it's suggested that the December discussion be postponed until an all-inclusive fee schedule change discussion can occur in January or February. • 2 BOH Minutes—October 17,2013 • Member Robinson moved to postpone the hearing on fees which was to occur during the regular December Board of Health meeting. Member Austin seconded the motion. No further discussion. The motion passed unanimously. Environmental Health Proposal for Enforcement Cost Recovery Linda Atkins presented information on the possible placement of notice to title and charging a fee for rescission of the notice for certain violations. She included review of how it would intersect with our current compliance efforts and how other jurisdictions utilize this tool. It is a way to alert future owners of existing violations and recoup costs associated with the noticing process. It is also an incentive for the owner to correct the issue, and is a way for interested parties to be aware of important and lasting land issues, although currently the tool is used infrequently because of the cost. Three jurisdictions that use this tool are Okanogan, Seattle-King, Tacoma/Pierce counties. JC Civil Deputy Prosecuting Attorney David Alvarez has reviewed those programs. The jurisdictions utilizing a cost recovery fee are finding that with the fee, many violations see a response before filing the Notice to Title. Costs which might be included in a Notice to Title fee include: recording fees, administrative costs,time spent creating the site specific notice and rescission, and communicating with current and future interested parties about the notice, or rescission. This issue will be presented to the Board again with subsequent all-inclusive fee schedule change discussions. Member Westerman suggests adding a per-hour fee description and an additional per hour fee (for overage) included • with this fee structure in order to adjust for outliers, and recoup all costs. Temporary Food Program Permit Activity Report Susan Porto recognizes Food Program staff member Mina Kwanza's diligence in tracking information on the day to day activities associated with implementing the food safety program. The information tracked allowed us to represent accurately the time spent in the temporary food permit process, which is becoming a year-round program. The hand-out in the Board's agenda packet includes time studies, take-away's related to the time studies, and comparisons with past data. Member Westerman recommended the addition of a per-hour fee description and an additional per hour fee (for overage) included in the fee structure. 2014 Jefferson County Public Health Budget Jean Baldwin reviewed impacts to the Jefferson County Public Health Budget. JCPH budgeting has included a budget carryover yearly through the recession, this is diminishing. JCPH programs will be changing, and Federal and State programs are making changes that may or may not be affecting JCPH programs. JCPH has asked for budget appropriations, and is budgeting on a three month basis to adjust quickly and appropriately. The annual County budget process was completed in July but did an October budget review and November all appear similar. Budget reviews will be completed in January, and again in April. JCPH may have to use program cuts, policy shifts, staff adjustments, and layoffs in order to meet any further budget shortfalls. There have been programmatic and policy adjustments and one layoff since October of 2013. This budget shortfall will be continuing through the coming year. • 3 BOH Minutes—October 17,2013 . • • JCPH has been notified that CPS will no longer be contracting with us for court observations, and low risk families. The Affordable Care Act (ACA) enrollment stops in March, but how the ACA will financially impact the department is unknown. Our electronic medical records (EMR) system has problems, and contracts are changing—this will have financial implications for JCPH. Ms. Baldwin will be coming to the Board for guidance about shortfalls, programmatic and policy adjustments as the need arises. A Board retreat may be advisable to address these issues. Federal Government Shutdown: Public Health Program Impacts Dr. Locke reported that the Federal government shutdown has ended. In the long run, the cost to the American public in terms of loss in Gross National Product will likely be in the billions. JCPH was prepared to respond to the program cuts with furlough notices, and the first victims of this reduction would have been children—Head Start, TANF and WIC. The issue may arise again in January 2014. ACTIVITY UPDATE Ms. Joswick noted that a national drug take-back day event will take place a week from Saturday 10-2 at Safeway, under the auspices of the Port Townsend Police Department. Volunteers are needed, and Ms. Joswick encourages members to spread the word. PUBLIC COMMENT No public comment. AGENDA PLANNING CALENDAR The November Jefferson County Board of Health meeting will be canceled due to the WASAC meeting and other scheduling conflicts. Notice of the cancellation will be given according to public meeting procedures. NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, December 19, 2013 from 2:30— 4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 ADJOURNMENT Chair Buhler adjourned the September 19, 2013 Jefferson County Board of Health meeting at 4:20 PM. S 4 BOH Minutes—October 17,2013 s . 0 JEFFERSON COUNTY BOARD OF HEALTH <7/1/. 6//. (6,1„t Phil Johnson, Me r ill Buhler, Chair 77 Roberta Frissell, Member David'Cl , ice air '2.Ca-4...,_.. ,„____ -,'A-,,,--e-------_ i .• gN- , ,,A,,,,,,,,..t_ Catharine Robinson, Member Jo Austin, Member C-)It6' 144 , in., Sheila Westerman, Member • Respectfully Submitted: Cara Leckenby • 5 BOH Minutes—October 17,2013 • Board of.9 LeaCth. OCdBusiness & Informational Items Agenda Item #1T., 2 • Updates: Main Street Project, SmiCelvlobite, & l�VIc December 19, 2013 • • .420EIRSONEWEaciataffgiliNSMWKiatgata-WAX-f-M,4 , . Jefferson County Public Health PUBLIC HEALTH MAYS WORKNNG A SAHA AK) HEALTHIER commumry 10/31/13 o-4-Pori-To-vv-vt-seAnot,fria St-e -Program', Yo-wr ge-ktero-s.i,ty avid Cow,w4).4AA:4-9-tivui,049Lat'54,99-pori-C-014-1 1"0" 12-e,Cuet,ZA/typt,ra04.4,0.0144,110-vt, Lo-cat ereayi-cu,L4{,Ctrviza,t, HeabflA,Program.--eAto-19-1..i,A43 Jeffe,rso-K,Co-/A4,49 P &-4c,Flezalth,-to- offe-r ywio-part-OA $e-rvy for-Hao-st, Kzeot.. 71,Lavvic.you,mo-3.4-sirely for yo-ur imx.r&oLi,b-1..e,&Harts', for yo-wr olo-vut,iio-vt,of-$3,18 6.50 Iv-tke,ereas,1-aktd-Cerv-it.at, H Pro— gra avvol,for a very fv eAre.41.4-.1 Pourt-skikv, NursiArt.g Serv-ix.e,s, i-rWtrrr O w b-&ka-Lf o-f-cat,of ut6, cut-Je.ffe-rso-vt,Co-tA-0.4-9 pt.A-b-ux,Hcat,i+L. • OCTOBER ,• 2 0 1 3 Get Covered Jefferson County- Smile Mobile Health Insurance for Everyone The Washington Dental Service Foundation Smile Mobile is The Patient Protection and Affordable Care Act will take full coming to Jefferson County effect in January, 2014. This means that all individuals are Public Health, November 12-14, required to have health insurance. Starting in October, 2013. S2013, uninsured Washingtonians can shop for affordable This fully equipped mobile health coverage options through a website called dental clinic is coming to WAHealthplanfinder.org, the new online insurance provide dental care to children marketplace. They may also be reached by calling 1-855- with a limited family income. 923-4633. Washington Healthplanfinder will have a network The MedicaidSmMobile does accept (ProviderOne), and of customer support professionals available to assist you in also offers a sliding fee scale obtaining the information you need to register for your new based on family income. health plan. If you want to be assisted in person, contact Appointments must be one of these three local agencies for an appointment: scheduled before November 12. Jefferson County Public Health at 385-9400, Jefferson Walk-in patients cannot be Healthcare (Patient Services office) at 385-2200, seen. To schedule an ext. 2267 or the Olympic Area Agency on appointment or for more Aging, at 385-5064. Healthy students are information, please call: 1-888- 286-9105. If you are on better learners! Medicaid, please have your ProviderOne card ready when Stay Informed on PTHS News & Events scheduling the appointment. Protect your child's smile. www.ptsd.wednet.edu/highschool/default.html Schedule an appointment with Our website is updated daily. Find important and current the Smile Mobile today! IPinformation regarding our school for parents, students and community. Check it out! _ Healthy/HAPPENINGS ai 9*,---- ....,,,-;.. .. t . . Jefferson County Public Health WIC JEFFERSON COUNTY PUBLIC HEALTH WIC 4 �¢1 L+ 3r it 4111Z g 615 Sheridan St4ort Townsend,IA 98368 ..,• r .,,,, 1 111117 e T to November 2013 "Christmas for Children " now taking applications 41- iSil � r �� i ...•.. . itImportant 40 ig • E healthe • are 1V WS (see reverse) Families in need this holiday season living in Port Townsend, Irondale,Port Had- lock,Norland or Chimacum may submit applications for assistance. Application forms for assistance are available at: • Port Townsend Food Bank,Mountain View Commons, 1925 Blaine St.,Port Townsend • Tri-Area Food Bank, 10 W.Valley Road,Chimacum;and Want to be featured • First Federal Bank, 1321 W. Sims Way,Port Townsend in our next The forms are also available online at ptkiwanis.org WIC Newsletter? To be considered,applications must be returned b�vyNove ber 30th to one of the locations listed above or emailed to christmas4children(hotmail.com We'd love for you uestions? Contact"Christmas for Children"volunteers by email at c ristmas4children@hotmail.com or by leaving a message at 379 4207. to share your story with us! v.,t,,,,,,,,,, Does your food budget need a boost? r-: - : ::: WIC has openings! ! : _ Call 385-9400 .:.,-1. '.,i 11: ,. to sign up! A WIC Clients Breastfeeding Success Story . My name is Lynne and I have a one year old named Isabelle. When I found out I was pregnant I knew I wanted to breastfeed. I had complications in the beginning. Isabelle was having trouble latching on. I stuck with it and when she was around 3 months old she was latching on just fine. I recently quit breastfeeding when she ) .1, turned one. It was a great experience and the best thing for my daughter. —Lynne Kennedy— h cs-f -r . IIv Lyrune � re& �s x3e``e v`P NEWS Flash _NEWS Flash_ NEWS Flash SmileMobile returns November 12th ¶ 1 - Get Covered! a FREE OR AFFORDABLE HEALTH INSURAI. NW ---e for you and your family t The Affordable Care Act(ACA) means that the millions of uninsured Americans will now have free or affordable options to get health insurance! After a very successful visit to Port Townsend in July,the SmileMobile will return to Port Townsend the week of November 12-15 and Chi- • Even if you were denied Medicaid before, you might be newly eligible! macum November 18-26. • October 1,2013 you can apply at the new online For more information or to schedule an appointment call: insurance marketplace! Julie at SmileMobile: 1-888-286-9105 • January 1,2014 use your new coverage to visit the doctor and get healthy! -• � ' ccess to Bab i •d r� Child Learn more and apply enttstr • To apply at the new online insurance marketplace: gi1R::, IN Ii) www.wahealthplanfinder.org • To learn basic information on the law visit: www.kfforg/health-reform/ Children ages 0-6 years old who are on Medicaid living in Jefferson • For in-person help contact Jefferson County County are eligible for free services,which helps connect the child with Public Health,Jefferson Healthcare,or a local dentist. Olympic Area Agency on Aging. Program benefits: Coverage Dental exams IS He re • Restorative care as needed Contact Susan Giles 360-460-3007 j`E e lllltplxyfilder 4,.Rec,. Breastfeeding Tea Family Fun Night at the Rec Center a 91 I L Fee: 51.ao per participant atter door Nov 1st Nov 8th Nov 15th Nov 22nd = A.' = !; , ,. Bouncy Castle Roller Skate Night FREE Movie Night Rec Kid Fit a. ► 11;11 ; iP±"r ,,„ .4 firqp It : \1.- \ , - „, ,r. 4- ' ki — -- r,_` .. - eiiiitia4- 1 t. licci• • a I NV. . Come join the breastfeeding tea fun! *Family Friendly 'Family Friendly `Family Friendly *Family Friendly Wednesdays 1:30 pm Roller Skate,Scooter Harry Potter and the or Roller blades Sorcerer's Stone Jefferson County Public Health (Rated PG) • Visit with other moms • Relax&have tea For more information contact Kaylie Webber at • All breastfeeding,pregnant women, 4111/ children&babies welcome (360) 385-2221 or kwebber@countyrec.com • Ask a breastfeeding expert WWW.COUNTYREC.COM Questions:385-9400 -.` PUBLIC HEALTH In accordance with Federal Law and U.S.Department of Agriculture policy,this institution is prohibited from ,,k7.7._ ALWAYS WORNINGFORASAFFR ANo discriminating on the basis of race,color,national origin,sex age,or disability. >% NEAL'I!#ER JEFFERSON 0 Board of Health Old Business & InformationaCltems .agenda Item # IT., 3 1 Affordable Care .pct Comments ANSALPiCO & 1NSAC December 19, 2013 • ***DRAFT*** Please note, ACHS additions are still forthcoming... December 2, 2013 Karen Merrikin, Director State Health Care Innovation Project Washington State Health Care Authority Dear Ms. Merrikin: We are writing on behalf of the Washington State Association of Local Public Health Officials (WSALPHO) and the Association of County Human Services (ACHS), and as affiliates of the Washington State Association of Counties (WSAC) to offer comments on the draft State Health Care Improvement Plan/State Innovation Model (SHCIP/SIM). Our organizations represent the local governmental public health and human service operations of all 39 counties in Washington State, where local governments truly serves as the backbone of health and human services program and service delivery. WSALPHO and ACHS certainly appreciate the underlying goals and strategies articulated in the SHCIP/SIM proposal as well as the considerable time and effort that has clearly gone into creating these proposals. We share a vision of local, State and regional partnerships to innovate, create accountability and transparency, and to achieve results and improved health outcomes for our citizens. Additionally, at its core, public and behavioral health is essentially a local endeavor and without that framework little will change. Likewise, a coherent statewide vision, policy, and infrastructure are essential building blocks for the major effort it will take to transform our public/behavioral health and medical care systems. • Among the key matters highlighted in the proposal we would reference: • The critical need to integrate public, physical and behavioral health systems and the readiness of both systems to pursue this path • The importance of accountability and transparency of all kinds of health services information as essential to transformation; in our case we also have strong recommendations for true HIE • The recognition, that the social determinants of health impact desired health outcomes and are far more influenced by non-medical factors; therefore health improvement must involve stronger health prevention and education efforts and integration of these into mainstream practices within and outside the traditional medical system • Clear articulation of the centrality of evidence based care management approaches and systems as the most promising avenue for improving chronic disease care which also strikes at the heart of total cost'of care problems since a small number of people drive the total PMPM expense for large populations • Understanding and supporting the fact that primary care capacity and practice transformation into effective medical homes are necessary but not sufficient components of an effective system • Involvement of all interests and all sectors of the public in creating and maintaining accountability for health and medical care We recognize that much more work remains ahead of us as we push this process and the plans to greater levels of detail and as we work through the inevitable complications of implementing change on a large scale. To that end, WSALPHO and ACHS also offers several comments and questions about the SHCIP/SIM proposal: 41111 • The Accountable Community of Health (ACH) is an interesting concept. The literature has several examples of ACHs that are based in local communities at the city/county level. The question remains as to the feasibility and effectiveness of this model on a regional level, for precisely the reasons cited, i.e., "health and health care are local", and "place matters when it • comes to achieving better health". The proposal mentions that the regional concept will build on experiences with the Community Transformation Grant(CTG) regional hub model. While the CTG project design envisioned the development of Regional Coalitions with shared agendas and multiple cross-sector partners, that has not always been the case in reality. In a decentralized State like Washington, this top down'regionalized approach, as laid out by the current draft proposal, without taking into consideration local capacities, strengths, partnerships, political relationships, and structures that already exist within local communities, will only result in a poor functioning and fractured service delivery structure. It is our hope that as conversations on this issue move forward, local governments of varied demographics will be invited to the table to help work towards a realistic and long term solution. • We have questions about the exact relationship of the existing public health structure and the ACCs (particularly the potential usurpation of current local board of health authority); and in a related vein, while we support the concept of a public/ private partnership, the relationship of the new ACC structure to local elected officials may need to be further negotiated to achieve greater comfort that elected officials retain a strong voice. • Finally the relationship of the ACCs and the risk bearing entities, if any, feels overly imprecise and unclear within this draft. As currently proposed we see a system where locals have little control, while retaining a significant portion of the risk. We believe that a close and clear relationship will best serve our citizens given our shared goals for accountability, transparency, and improved outcomes, but again, local voices must be at the table in order to achieve this. Thank you for the opportunity to comment. WSALPHO and ACHS stand ready to help improve these proposals as we work together to transform the State's-pubic/behavioral health and medical care systems. Sincerely, • Brad Banks, WSALPHO Managing Director Abby Murphy, ACHS Policy Director S • Board of Cealth Old Business & Informational Items .agenda Item # 117., 4 • ACA. Enrollment December 19, 2013 • CO nO . : To CC-19n •0 m * fl' < V7 C 7c 1- Li1 °� a ami °�' Via, °� W D Sn � S vl OPV) v n '� n o =-0 = ro, v 2- n ,_r v Cc o n (" = O < o -o v D n = c o Q+ W. a o: 3 ro v _-3 N- �_• o v 3 oo o .=t D' *. 0' o v m 000 v — 3 v i °' o v - v o_" o m 0 o 0.' c m 0 3 v rr Q 7 7 'G v 7 y N 7 N v (n S 7 7c Q r-t (n rD cn 7 ro 3 7 r-' 7 0'q "O 0' n 7 rp 3 7 7 3 2 V 1 N F+ N A I--. nO D N — ' W N F+ rii (D W A N o W N A tA C) to W Cl o0 co A V N I--� A W O O> i- N Ql A l'Y W (11A V, A V, 00 CF- 1 . F-+ F-+ F.. W VD 0 of N CO 00 V NJ 1-+ tN O V -COo0 A N C D C1 A C1 0 W N NJ' W1-' I N CV A V V l0 00 Vi W CO l0 V N. 0 1--� W V 00 V, 0 l0 A A W W 01 0 V V NJ O Ito n F-W` OVi A- WV1 N C10 tV1 z 1o Hil Cl_ eo• mil P, O :-:,:l °N :41:1 N rc o o (N N N NJ M \ 0 N sO m o .1R. V N ea N..) s....11 e w W W0111 1�1�/ \ 01 V D3 43 p A A \oF+ NA • al: o \ A N A A DJ o o p (!1 (A V1 ds N 0 0 o Wo p DJ x • S G1 oN Lo ° o\° 01 • c m C N / to 01 3 3 000 V b d � � v N ,� O 0 0- to. 2 Et 47 Plkilikr 0. is F N 00 w m 01 m tu 3 hi to, crq 0- 0 74- oi °,°. o S Liar C o 1 11 x w = m pip H N c � N 3 O fl O O T N N 2 C CUCn fD G1 N o mgyOt C ,■ CD �.(p D 1-P • O v, y et 1 in rt O O > 41111 0- o r- 3 Li, 0 m 411, g. 0_ e o a * N N rII W , ? vooS am 'm_ = O q 2 _ _Fir WA U.) NR 013-050 November 26, 2013 Health Care Authority FOR MORE INFORMATION Wash. c n Jim Stevenson 360-725-1915 Apple Health jim.stevenson@hca.wa.gov Apple Health enrollment report: Tuesday, Nov. 26, 2013 As an addendum to other enrollment totals in today's Health Benefit Exchange news release, here are the detailed enrollment numbers for October 1 through November 21 in five Medicaid categories: new adult, children, CHIP, family medical and pregnancy. Medicaid Enrollment, October 1 - November 21 60,000 56,879 f 55,000 50,000 45,000 • 40,000 39,279 35,000 30,000 25,000 20,000 . 15,000 10,000 8,376 5,000 3,826 3,548 0143 4, Family Medical Pregnancy Medical New Adults Children's Medical CHIP The Medicaid enrollment figures include some individuals whose eligibility is being re-determined or renewed as opposed to newly determined. This occurs when individuals and families come to the HealthPlanFinder to make application for coverage and are either themselves already enrolled in Medicaid or perhaps have family members in the program. In these cases, their eligibility is processed under the new modified adjusted gross income (MAGI) standard and they are reflected as new enrollments in the totals above. On Page 2, we have provided a further detailed breakdown that identifies this population. • Category Had previous coverage No previous coverage • Family Medical 4,872 3,504 Pregnancy Medical 1,760 2,066 Newly eligible adults 2,242 54,637 Children's Medical 32,443 6,836 CHIP 2,282 1,266 TOTALS 43,599 68,309 Here is a county-by-county tabulation of the newly eligible population, whose coverage begins on Jan. 1, 2014. Adams Grays Pierce 149 Harbor 729 6,054 Asotin 201 Island 573 San Juan 250 411 Benton 1,179 Jefferson 504 Skagit 969 Chelan 774 King 15,189 Skamania 65 Clallam 773 Kitsap 1,926 Snohomish 4,639 Clark 3,422 Kittitas 427 Spokane 5,673 Columbia 37 Klickitat 248 Stevens 487 Cowlitz 1,064 Lewis 862 Thurston 2,415 Douglas 347 Lincoln 81 Wahkiakum 67 Ferry 62 Mason 499 Walla Walla 420 Franklin 566 Okanogan 494 Whatcom 2,238 Garfield 8 Pacific 313 Whitman 292 Grant 595 Pend Oreille 143 Yakima 2,128 • • Board of CeaCth Oki Business & Informational-Items .agenda Item #IV., 5 • The Healthiest Next Generation Initiative Governor Inslee December 19, 2013 (-4,„ oe1>U,,r e iA Washington State Department of - ,_� 7�� "I'� Washington State Department of ),,� �,�/ oo Early Learnr`ng 73, 1i1!! 64 The Healthiest Next Generation Initiative We want the next generation to be the healthiest ever.To accomplish that we must make sure our kids have a healthy weight,enjoy active lives,eat well,live in safe and stable homes,and have less contact with environmental toxins.Every child deserves to grow up healthy and enjoy the beauty and benefits of Washington. Unfortunately,some experts believe the current generation of children in our country may have shorter lives than their parents,for the first time in our nation's history.' Problem: Too many children are not at a healthy weight for their age.Children aren't as active as they used to be.The number of children walking to school has dropped from 41 percent in 1969 to 11.7 percent in 2009.2'.3 About 83 percent of children under six-years-old use screen media daily(i.e.television,videos,computers,or video games).' In addition,children are consuming more calories now than they were 30 years ago. Solution: A child's weight is determined by many things that we can change,including their mother's weight before and during pregnancy,how long they are breastfed as infants,how active they are,and what they eat and drink growing up.Healthy children learn better and grow up to become productive members of the workforce. The Governor's"Healthiest Next Generation"initiative is an innovative public-private partnership to improve children's health. It includes the creation of a special Governor's Council composed of legislative members, state agency heads,and community and business leaders who are invested in protecting and improving our children's health.The group will recommend state policy that supports community-led changes and oversee the efforts of a strategic workgroup focused on providing choices for getting children more active and eating better. • Focus Areas of the Initiative r a;�afiliWito al ..lit tt ea , r New mothers are supported to Children cared for in early learning h Children in school are: breastfeed by: ,,environments are: • Active every day ti• Hospitals that follow the 10 steps to • Active every day „• Playing in safe places successful breastfeeding • Playing in safe places 1• Eating healthy meals • Early learning facilities that safely • Spending little time in front of screens . Drinking clean water instead of store and use their breast milk 4• Eating healthy snacks and meals sugar sweetened drinks • Employers that provide a safe place . Drinking clean water instead of sugar to pump and store breast milk sweetened drinks • Health care providers that encourage breastfeedin• Increase percentage of infants�who Increase percentage of children ages 2-4 Increase percentage of 10th breastfeed for at least six months. with a healthy weight. graders with a healthy weight. Proposed Legislation 1) Establishes the Governor's Council for the Healthiest Next Generation a) Identifies policy and budget changes based on data and expert opinion that save money,protect children's health,and support community-level changes already underway. b) Oversees the strategic workgroup focused on getting children more active and eating better. c) Membership is limited to the following members: • 'SI Olshansky et al.(2005)A Potential Decline in Life Expectancy in the United States in the 21"Century.The New England Journal of Medicine,352:1138-1145. 'McDonald NC(2007)Active Transportation to School;Trends Among U.S.Schoolchildren,1969-2001.American Journal of Preventive Medicine,32(6):509-516. 'National Center for Safe Routes to School(2011)How Children Get to School,School Travel Patters from 1969 to 2009. 'Kaiser Family Foundation(2006)The Media Family:Electronic Media in the Lives of Infants,Toddlers,Preschoolers and Their Parents. November 22, 2013 460V, 1,04.44 Washington Stale Department of ) I a • ®` r Washington State Department of z �l 0 HealthRpm® Early Learning � _11 fl AING� i) The chairs of legislative health and education committees, ii) Agency heads of the Office of Superintendent of Public Instruction(OSP1),Department of Early Learning(DEL),Department of Health(Health),Health Care Authority(HCA),Department of Agriculture(AGR),Department of Transportation(DOT),and the Department of Social and Health Services(DSHS), iii) Community and business leaders appointed by the governor. 2) Establishes a strategic workgroup of experts from Health,DEL,and OSPI a) Advised by existing agency stakeholder groups from each sector. b) Requires the following resources in each agency(funded by a complimentary decision package): i) A full-time expert on school strategies to improve children's health at OSPI.This person is also an expert on the relationship between health and academic achievement. ii) A full-time licensed health professional at DEL.This person is also an expert on early learning strategies to improve children's health. iii) A full-time expert on childhood obesity prevention housed at Health.This person will staff the council,lead the development of a legislative report,and coordinate the workgroup to ensure it stays on track and completes required actions. iv) A half-time evaluator at Health.This person will track the success of the workgroup by developing performance metrics and monitoring statewide measures.This person will also propose additional measures of success for the initiative. 3) Requires the workgroup to take the following actions to improve children's health a) Support comprehensive breastfeeding policies in worksites,schools,and early learning facilities. • b) Use and make available toolkits with recommended strategies to ensure all children are active,eating healthy food,and drinking clean water in early learning facilities and schools. c) Create a mentoring program to help early learning teachers and caregivers implement these strategies. d) Facilitate the inclusion of healthy eating and active living goals in the Quality Rating and Improvement System for participating early learning facilities. e) Develop a system to award Merit/Stars credit to early learning teachers and caregivers for completing the online obesity prevention course. f) Revise statewide health and fitness standards for schools. The Healthiest Next Generation Initiative tive will advance and support good ideas already underway,like... • Sequential start times in Skagit County's Mount Vernon School District.Through this program the bus fleet has dropped from 27 to 12,reducing traffic around schools.Along with a new one-mile walk zone around each j school,this change allows children to walk to school safely and saved the district almost a quarter-million dollars. • The transformation of a convenience store in the impoverished West Central neighborhood of Spokane County. Parkside Grocery now sells locally grown produce,and is the only WIC-authorized corner store in the county. • Improving school meals in King County's Auburn School District by sending more than 500 cafeteria staff to certified culinary training through the Washington School Nutrition Association. For More Information Drew Bouton,Director Kelly Cooper,Assistant Director Policy,Legislative and Constituent Relations Policy,Legislative and Constituent Relations Department of Health Department of Health 360-236-4048 or Drew.Bouton@doh.wa.eov 360-236-4046 or Kellv.Cooper@doh.wa.gov November 22, 2013 Revenue collections are at historically low levels when comparIll ed to the overall economy 7,5% 7.0% General Fund-State Revenue as Percentage of Washington Personal Income 6.0% 13 5.5% � � � � q e Projected > In 199 General Fund State revenue equaled about .—� 101,04 ialle �,,.v 7 percent oftoral persona!income, .i r, 1f Percent e'`'°a etrue<toda�y, ' e' oudit e= b ` f `,t ��a $ Ia �iio ry eorhe re ° i,, 4.0° e t lrl. xt � . 1983 1987 1991 1995 1999 2003 2001 2011 2015 0,1AFiscal Year Washington State Economic and Revenue Forecast Council,September 2013 • Washington ranks low in tax collections State and Local Tax Collections Per$1,000 Personal Income Fiscal Year 2011 $230 Source Bureau of Economic Analysis and Census Bureau U.S.Department of Commerce $210 _# $190 $170 $150 U.S.Average=$108.31 Ai $130 A . . , _ _ , , .. , ,, _ , Washington$98.95 fl i,r r t � �il 'i gilli ' llgr + r � •„, t $70 il It do r s .. iii a vc. ~ October 2013 Washington's slow economic recovery is reflected III in our projected revenue growth PJ 92500 Real Per Capita General Fund-State' Revenue 3.9% (2009 Dollars) 4.6% ', 3 1�, Forecast 0.7% f'rii 1.1% 2.9% •2.0% 2.0% 139' f o 37% •2.3% ott 13/ 1.5/0 o -0 6%0.6% 5.4% 1.83 �.' 71 11 Gf 4.9% 35/ -2.2% �`t 4, x 19� 14 $2,000 � ,0 a �< '' ,, - pe. a i °I.t,, '4,. vr, 41 raj I 41.Tt 4. - T., fil Am 44i 9i) . tt, ',..% .11. v a x ,fig , 1 500 71 pi oi r -,* .,' x R . * . XPi. , 51,000 1995 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2G14 2015 2016 2017 Fiscal Year 'Reflects General Fund and related funds for fiscal years 1995-2009;General Fund,new definition for fiscal years 2010-17 Washington Stale Economic Revenue Forecast • Demand for services has significantly outpaced revenue growth in recent years 23.6 F. Percent change since FY 2008 ,. 15,6 ` � 8.6 R" &'-= Sy 45 - , General Fund- : 4.;-1'4'- .",; .0. ' ,,,,,..-- _,estold-4 mrovt*-4-- ,. .. State revenue" 0.9 6 '1 d ."A , ' - , K-12 Statewide TANF Long-term Medical Assistance < .' enrollment population caseload care caseload caseload -6.6 °Adjusted for inflation III • Better Health Care Purchasing • Washington is home to high-performing health organizations and best-in-class quality improvement initiatives,regional entrepreneurship,community collaboration and the innovative use of data.Yet our state has much room for improvement in lowering costs,improving health and health care,and linking the health care delivery system with community supports,particularly for the state's most vulnerable residents,especially in the following areas: Cost Health care services can cost a family of four as much as a house payment.But services fail to efficiently and effectively resolve health needs due to fragmentation (having to visit multiple providers for the same issue),wasteful care delivery (such as visiting a consultant with no records so information is collected multiple times)and little evidence of what works to help your doctor care for you. . Data Providers,purchasers (such as employers and the state) and consumers lack access to price and quality information.Not knowing the cost and quality of care makes it difficult for individuals to spend their health dollars efficiently and for purchasers to set up benefits that are best for consumers. • Coordination • The current health system,in most cases,has wide gaps in coordination between primary care and specialty practices, ambulatory and hospital settings,and primary care and behavioral health. Consumers lose time and money seeking treatment and bear extra cost because of this poor coordination as similar forms are filled out multiple times and tests need to be repeated. Washington needs to purchase health care in a more effective way,using the best available information,integrating and encouraging coordinated care and ensuring resources go to the actions that most improve health outcomes. Our state has completed a yearlong planning process looking at ways to make our health care system more effective,efficient and sensitive to local needs. While the state applies for a testing grant,we • will start improvements in these key areas: ► State-purchased health care: Work with purchasers,consumers and providers to get the best available care at an affordable price.To be effective,we need to: Develop and implement performance measures: Lead the development of a set of standardized performance measures for cost and quality that the state will use and can be applied statewide with payers and providers.Working with other purchasers,consumers and providers,choose from nationally specified measures that support and demonstrate improvements in care quality and cost containment. Office of the Governor _ November 2013 • Y Health data: Partner with the Puget Sound Health Alliance,private payers and other health organizations to address the long-term needs for cost and clinical health data to support consumer choice,care coordication and treatment decisions between the provider and patient.The data will support better decision making by the state for smarter purchasing,thus boosting quality and cutting cost. i Integrate behavioral health purchasing: One of the most effective ways to improve care and save costs is to integrate mental health,substance abuse and medical care.We will develop purchasing strategies that complement the behavioral health changes that are underway. ► Improve health outcomes by integrating purchased health care with local needs: Create locally governed,public-private partnership organizations called"accountable communities of health"EACH): S Pilot in three willing communities to refine the concept.These organizations will bring together key stakeholders,establish local health priorities,use community assets to reach health improvement goals developed by the community,support local innovation and encourage cross-sector resource sharing and investment in community health. Y The ACI I in each region will develop its own governing structure but should include diverse representation from county government,local public health organizations,risk- bearing entities in the region,hospitals,health care and mental health providers,housing providers,tribes,business,labor and social support providers. > The state would provide seed funding in the form of grants to assist communities in the • development of ACHs.While ACHs can receive assistance during the formative phase of development,their ongoing financial support will be largely self-determined through private capital,philanthropic sources and shared savings. In addition, flexible financing from Medicaid for such services such as intensive care/case management and other supportive elements is a possibility. Office of the Governor November 2013 1111 • Board of Health Old Business & InformationaCltems ,agenda Item # IV., 6 • Broken Promises to Our Children l'o6acco Funding December 19, 2013 / 4 Broken P rom is e s toOurChlidren The 1998 tate /01114., .-,,. To „,...,.... bacc. o Settlement 15 Years Later ,.':,:',"'A';',4,',„‘c.".-,',;:i‘,,,,,,, .. ,..„ .„.... „,„„.... „... ..... ... . , , .. ... --'t 7::;:‘,....!0:=4,450,r01,:,,;,,,i.:,'"','',',L.--.-.1,...;-i...,...•> .:,k, f „-_,,,,,* „';„,-,-','F"- .„, ...,,„:•.,. . ' , .J. - - , ,..,., - ' -;,,,,,l'', .sg,,,,,''?5,'*#e*.ir,• , - 7 7,,?:,',':,!..X-'!=''',W,'-',4';,,,:•.>e,';: , ,,,,„ a•,,,, 4, ., ...„..„. ,,,...,. --6. December 9, 2013 'ica n 0 Amer% sANR''',`,?!,',,,, Fizi, t e Hear:t : n. Asoctatio 've AME z SMOKE RS AsS0,0C,ITAA,, km okrfi..,,sii, 47c.T.:rtv-- LIJIIN ALumNERGicANioN, RtCAN.S,,,, s FY2014 Rankings of Funding for State Tobacco Prevention Programs (Annual funding amounts only include state funds.) FY2014 Current CDC Annual FY2014 Percent of State Annual Funding Recommendation CDC's Current Rank (millions) (millions) Recommendation North Dakota $9.5 $9.3 102.3% 1 Alaska* $10.1 $10.7 94.8% 2 Delaware $8.3 $13.9 59.9% 3 Wyoming $5.1 $9.0 56 7% 4 Hawaii $7.9 $15.2 51:7% 5 Oklahoma $22.7 $45.0 50.5% 6 Arkansas $17.5 $36.4 48.0% 7 Colorado $26.0 $54.4 47.8% 8 Maine $8.1 $18.5 43.6% 9 • Montana $5.4 $13.9 38.8% 10 Vermont $3.9 $10.4 37.5% 11 Minnesota $21 3 $58.4 36.4% 12 South Dakota $4.0 $11.3 35.4% 13 Utah $7.5 $23.6 31.9% 14 Florida $65.6 $210.9 31.1% 15 Mississippi $10 9 $39.2 27.8% 16 Arizona $18.6 $68.1 27.3% 17 New Mexico $5 9 $23.4 25.3% 18 Oregon $9.9 $43.0 23.0% 19 West Virginia $5.3 $27.8 18.9% 20 New York $39.3 $254.3 15.5% 21 Louisiana $8.0 $53.5 15.0% 22 California $64.8 $441.9 14.7% 23 Iowa $5.1 $36.7 14.0% 24 Maryland $8.5 $63.3 13.5% 25 Idaho $2.2 $16.9 13.0% 26 Nebraska $2.4 $21.5 11.1% 27 Virginia $9.5 $103.2 9.2% 28 vii s ` FY2014 Current CDC Annual FY2014 Percent of State Annual Funding Recommendation CDC's Current Rank (millions) (millions) Recommendation •Wisconsin $5.3 $64.3 8.2% 29 South Carolina $5.0 $62.2 8.0% 30 Indiana $5.8 $78.8 7.3% 31 Illinois $11.1 $157.0 7.1% 32 • Tennessee $5.0 $71.7 7.0% 33 Connecticut $3.0 $43.9 6.8% 34 District of Columbia $495,000 $10.5 4:7% 35 Massachusetts $4.0 $90.0 4.4% 36 Texas $11.2 $266.3 4.2% 37 Kentucky $2.1 $57.2 3 7% 38 Pennsylvania* $5.0 $155.5 3.2% 39 Nevada $1.0 $32.5 3.1% 40 • Kansas $946,671 $32.1 2.9% 41 Rhode Island $388,027 $15.2 2.6% 42 Georgia $2.2 $116.5 1.9% 43 Michigan $1.5 $121.2 1.2% 44 North Carolina $1.2 $106.8 1.1% 45 Washington $756,000 $67 3 1 1% 45III Ohio $1.5 $145.0 1.0% 47 New Hampshire $125,000 $19.2 0.7% 48 Alabama $275,000 $56.7 0.5% 49 Missouri $76,364 $73.2 0.1% 50 ~ New Jersey $0.0 $119.8 0.0% 51 *Alaska currently funds tobacco prevention programs at CDC-recommended levels when a federal grant of$1.1 million is added to state funding of$10.1 million. ** Pennsylvania's current annual spending is estimated, not confirmed. r viii • Board of 3Cealt( Netiv Business .agenda Item #17.,1 • . Tefferson County Substance .A6use .advisory BoardR.e-appointment December 19, 2013 • Frances C. Joswick, MSW PO Box 486 Quilcene, WA, 98376 (808) 214-2079 wwbat(c embargmail.com December 7, 2013 Jefferson County Commissioners Jefferson County, Wa. • Dear Commissioners, My term on the Jefferson County Substance Abuse Board expires December 20, 2013. This letter is to request an appointment of another three year term. The Board has been able to make some significant impact on several fronts but there is a great deal more that needs to be done. I would like to continue to be part of that effort. Thank you for your consideration of my request. Sincerely, Frances C. Joswick • • Board of feaCth Netiv Business Agenda Item #17., 2 • SSD/Chlamydia Update December 19, 2013 Washington State Department of Health PHIMS-STD Web lb Jefferson County Chlamydia Cases January, 2013 Through November, 2013 Clinics By 10- 15- 20- 25- 30- 35- 40- Five-Year Age Groups 0-9 14 19 24 29 34 39 44 45+ Missing Capital Medical Center, Olympia 0 0 0 0 0 0 1 0 0 0 x' Chimacum High School, School ,. Based Health Center, Chimacum 0 0 4 0 0 0 0 0 0 0 Group Health Poulsbo, Poulsbo 0 0 1 0 0 0 0 0 0 0 Harrison Medical Center, Bremerton 0 0 0 1 1 0 0 0 1 0 Jefferson County Public Health- Family Planning, Port Townsend 0 0 10 12 2 3 0 1 0 1 ''-y:',41'-'11'.:, Jefferson Healthcare Family 0 0 2 1 1 0 0 0 0 0 Medicine, Port Townsend Jefferson Healthcare Primary Care, 0 0 2 1 2 0 1 0 0 0 Port Townsend ' Jefferson Healthcare Walk In Clinic, 0 0 1 2 2 2 0 0 0 0 Port Townsend Jefferson Healthcare, Portownsend 0 0 0 2 1 0 0 0 0 0 Kitsap County Health District- Juvenile Detention, Bremerton 0 0 1 0 0 0 0 0 0 0 - Madrona Hill Urgent Care, Port 0 0 0 0 1 0 0 0 0 0 � Townsend Monroe Street Medical Clinic, Port 0 0 1 0 0 0 0 0 0 0 ; Po Townsend Pacific Medical Center-Lynnwood, 0 0 0 0 1 0 0 0 0 0 Lynnwood Port Townsend High School-School 0 0 2 0 0 0 0 0 0 0 Based Health Ctr, Port Townsend PP Bremerton Planned Parenthood, 0 0 0 0 1 0 0 0 0 0 ,t;7443A Bremerton PP Everett Planned Parenthood, 0 0 0 0 1 0 0 0 0 0 ° Everett PP Tacoma Planned Parenthood, '1/41T '-,--,50:1/4:734:1/4:1 p 0 2 0 0 0 0 0 0 0 Tacoma Private Provider- No Clinic, 0 0 1 0 0 0 0 0 0 0 unspecified 410 .., Pullman/Moscow OB/GYN, Pullman 0 0 1 0 0 0 0 0 0 0 SEATTLE MEDICAL & WELLNESS .,LINK, Seattle 0 0 1 0 0 0 0 0 0 041 4�, VMMC Virginia Mason Medical 0 0 0 1 0 0 0 0 0 0 Center, Seattle i;0077771,,MR7V:777,7771,11PISTrerirriiirriilVitilfigtr:Triaji:,i;,,'A:VP , , Washington State Department of Health PHIMS-STD Web Jefferson County Chlamydia Cases January, 2013 Through November, 2013 ill Clinics . '[..-7 ..174r.° By . None Trans. Female Trans.Male-> Gender Female Male Specified ->Male Female Capital Medical Center, Olympia 1 0 0 0 0 Chimacum High School, School Based4 0 0 0 0 Health Center, Chimacum Group Health Poulsbo, Poulsbo 1 0 0 0 0 Harrison Medical Center, Bremerton 3 0 0 0 0 ..,... "4,4.„,...'::ss: ' � Jefferson County Public Health-Family 24 4 0 0 0 Planning, Port Townsend Jefferson Healthcare Family Medicine, Port 4 0 0 0 0 .. Townsend Vie. Jefferson Healthcare Primary Care, Port 6 0 0 0 0 Townsend F ,44 Jefferson Healthcare Walk In Clinic, Port1444.* :4 3 0 0 0 Townsend " Jefferson Healthcare, Port Townsend 3 0 0 0 0 Kitsap County Health District-Juvenile 0 1 0 0 0 .4.!: V0144,4::: 411) • Detention, Bremerton Madrona Hill Urgent Care, Port Townsend 0 1 0 0 0 Monroe Street Medical Clinic, Port 0 1 0 0 0 Townsend Pacific Medical Center-Lynnwood, 1 0 0 0 0 Lynnwood .0 Port Townsend High School-School Based 1 1 0 0 0 Health Ctr, Port Townsend PP Bremerton Planned Parenthood, 1 0 0 0 0 4 Bremerton PP Everett Planned Parenthood, Everett 1 0 0 0 0 PP Tacoma Planned Parenthood,Tacoma 2 0 0 0 0 <,,,,< Private Provider -No Clinic, unspecified 1 0 0 0 0 Pullman/Moscow OB/GYN, Pullman 1 0 0 0 0 �'. SEATTLE MEDICAL&WELLNESS CLINIC, 1 0 0 0 0 Seattle , k VMMC Virginia Mason Medical Center, 1 0 0 0 0 : Seattle C � • Board of Health Netiv Business .agenda Item #lV., 3 • Environmental3feaCth Proposed Tees for Cost Recovery *Food Program *O & .9Vl *Water Recreation Facilities December 19, 2013 Temp Food Establishment Detailed Permitting and Inspection Activities IIIIntroduction Last BOH meeting we presented general data regarding 2013 Temporary Food Establishment Program Activities. This month we will be presenting more detailed information on the permits issued and inspections done. Following this presentation we will propose a strategy to address the data observations. As a refresher, these are the highlights from the information presented at the last meeting: • The 2013 study is much more detailed and accurate than the one preformed 2011 (more activities tracked, not all activities occur for each permit received) • When grouped operationally, major time inputs have shifted in 2013 compared to 2011 observations — 58% reduction in time spent in fieldwork (travel and inspections) — Time input shifted from field work to pre-application and application — Shift in emphasis on education and compliance prior to the event rather than during the event (phone calls, writing, in person, more comprehensive application, etc.) — Goal is to only spend extra inspection time if a food safety issue arises due to poor food operations • On average,the three most expensive activities conducted in 2013 are: — Applicant Education & Compliance via phone ($23.06) — Permit Administrative Processing ($22.23) — Applicant Education & Compliance in person ($20.56) • On average, all inspections took approximately the same amount of time regardless of permit • type (single–18min vs. recurring–17min; full price–19min vs. subsidized (additional events with reduced fees on the schedule)-15min) • Approximately 3%of temp food activity was spent for situations where a permit was not issued and $0.00 revenue was generated Today's Takeaways • 203 single event permits were issued for 203 food service events. 52 recurring event permits were issued for approximately 1455 possible food service events (Avg. of 1 permit/28 events). • Approximately the same proportions of permits are issued for both Initial permits and subsidized (additional events with reduced fees on the schedule) permits (50%). — Subsidized permits(additional events with reduced fees on the schedule) account for 50%of all permits issued, but only contributes approximately 10%of the revenue. — 100% initial permitted establishments were inspected — 29%of subsidized permitted establishments were inspected (primarily due to poor initial inspections) • For single events, more subsidized permits were issued than initial permits — Approximately 82%of all subsidized permits issued are for single events. — The#of subsidized permits issued to a single entity ranges from 1 to 39. • On average,the same amount of time was spent on both Limited and Complex single events, 83 minutes and 80 minutes respectively. II • Approximate 43% reduction in time spent for single event subsidized permits vs. single event initial permits. — A corresponding reduction was not observed for recurring events Temp Food Establishment Detailed Permitting and Inspection Activities 2013 Findings* ill *all permit activity up to September 2013 2013 TFS Permits Issued (YTD) 255 2013 Permit Exemptions Issued (YTD) 18 2013 Vendors Obtained permits(YTD) 139 Permits received Late 34 (12.50%) 2013 Detail Single Event Permits Issued 203 79.6% 203 Events Full Price 99 48.77% Subsidized 104 51.23% Avg. time spent for Limited Event 83 Minutes Avg. time spent for Complex Event 80 Minutes Single Event Permits Inspected 126 62.07% 1455 possible food Recurring Event Permits Issued 52 20.39% service events Full Price 29 55.77% 4110 Subsidized 23 44.23% Recurring Event Permits Inspected 39 75.00% Full Price Permit 128 50.20% Inspections Done 128 100.00% Subsidized Permit 127 49.80% Inspections Done 37 29.13% 2013 Vendors Obtained Subsidized permits (YTD) 38 27.34% Single Event Vendors 25 24.04% Recurring Event Vendors 13 56.52% 2013 Financial Information %of Total Program Revenue (YTD) $20,960.50 Revenue from Full Price Permit $16,534.00 78.88% Revenue from Subsidized Permit $2,032.00 9.69% Revenue from Late Fee $1,656.50 7.90% Revenue from Exemption $738.00 3.52% 12-2013 Environmental Health proposed enforcement cost recovery Description of Issue: Setting a fee to recoup our costs where enforcement actions call for the need to file a notice of non-compliance to the property title. It is used to inform interested parties that there is an unresolved violation of state or local code on the property. Interested parties include the public, current and future property owners and lending institutions. Background: We operate from policies and procedures adopted by the BOCC, BOH, the Health Officer and JCPH Director. We have also been working over the last several years to develop standard operating procedures to assist staff in maintaining consistency and effectively utilizing the available tools. Our tools include: • Verbal and written communication supplements by educational materials and technical assistance • Notice and Order to Correct • Compliance Agreements—generally include timelines for correction and may include temporary mitigation measures • Civil Infraction (ticket) • Referral to JC Prosecuting Attorney • Notice to Title for Non-Compliance • Warrant of Abatement In many cases these tools overlap, i.e. after a civil infraction is written the client requests or is ordered to do a •ompliance agreement. Most enforcement cases require many months or years to resolve. Internally we use the Tidemark database to document our actions. The notice to title aids in reducing the chance that identified violations do not 'fall through the cracks' due to a change in ownership or staff. We view it as part of the strategy to obtain movement toward corrective action. For example, if a client is unresponsive to the standard written notices requiring action a letter would be sent stating that"if no response within 30 days a notice will be filed to the property and $XX (adopted fee)will be charged to rescind the notice after the corrections are completed". We use the notice to property title for a variety of other programs to document conditions that exists such as the requirement to monitor a septic system, the use of a water supply that requires treatment to meet bacteriological standards,the presence of a meth lab, long term unresolved violations. This tool has been under utilized to date because of the prohibitive costs to manage. Specific Request: Each notice is based on the individual case. It must identify the specific conditions that have been observed and actions taken by JCPH with dates. Costs include administrative time to process (send for recording, file, etc),creating the notice and the rescission by EH Specialist, communicating with the current or future interested parties about the notice options to correct/resolve),fees for recording the initial notice and the rescission. We estimate approximately 5.5 staff hours to process, record and rescind plus the recording costs of$72/document times 2 for a total of$517.00. Water Recreation Facilities Operating Permit Fees • 12-2013 BOH report WAC 246-260-001 Purpose and authority. (1) The purpose of this chapter is to protect the health, safety, and welfare of users of water recreation facilities (WRF). This chapter is established per RCW 70.90.120. (2) This chapter does not apply to: (a) Any water recreation facility for the sole use of residents and invited guests at a single-family dwelling; (b) Any water recreation facility for the sole use of residents and invited guests of a duplex owned by the residents; (c) Therapeutic water facilities operated exclusively for physical therapy or rehabilitation under the supervision of a licensed medical practitioner; and (d) Steam baths and saunas. (3) Requirements for recreational water contact facilities, including water slides, speed slides and wave pools are contained in chapter 246-262 WAC. WAC 246-260-9901 Fees. (2) OPERATING PERMIT FEES The department establishes the fees listed in Table 990.2 for operating permits for carrying out its duties under WAC 246-260-101. TABLE 990.2 FEE SCHEDULE OPERATING PERMITS Type+Number of Facilities Each Additional Single Single Spa Single Wading Spray Pool Swim, Spa, or Swim Pool Pool Pool or Pools Wading Pool Operating Permit 0-6 month $291.00 $255.00 $211.00 $ 105.00 $63.00 Operating Permit 6112 $477.00 $424.00 $ 371.00 $ 159.00 $ 84.00 months (3) Other Terms and Conditions: (b)The department may charge an alternate annual fee for an operating permit based on direct and indirect costs associated with issuance of the permit when arrangements are made with local health jurisdictions to administer all or portions of the duties associated with the operating permit. Except, that the fee for this operating permit cannot exceed 111 the cost established by the previous portions of this regulation, but the fee may be less. 1 Water Recreation Facilities Operating Permit Fees • Fee Facility JCPH 2014 according Change Fees integrating Total Change Facility Type operation Fee annual to WAC in Fee WAC and JCC new Fee in Fee 1 pool 0-6 mo. $294 $291 ($3) $291 WAC $291 ($3) 2 pool 0-6 mo. $294 $291 ($3) $291 WAC $291 ($3) 3 spa 12 mo. $294 $424 $130 $294JCC $294 $0 4 pool 12 mo. $294 $477 $183 $294JCC $294 $0 5 pool 12 mo. $294 $477 $183 $294JCC $294 $0 6 pool&spa 0-6 mo. $401 $354 ($47) $291 +$63.00 WAC $354 ($47) 7 pool&spa 0-6 mo. $401 $354 ($47) $291 +$63.00 WAC $354 ($47) 8 pool&spa 0-6 mo. $401 $354 ($47) $291+$63.00 WAC $354 ($47) 9 pool&spa 12 mo. $401 $561 $160 $294+$84.00 Both $378 ($23) 10 pool&spa 12 mo. $401 $561 $160 $294+$84.00 Both $378 ($23) 11 pool&spa 12 mo. $401 $561 $160 $294+$84.00 Both $378 ($23) 12 pool&spa 12 mo. $401 $561 $160 $294+$84.00 Both $378 ($23) Total Change $989 ($239) 4111 0 2 Temp Food Establishment Permit Revision Strategy • Introduction For the last couple of months we have been discussing program activity data generated through the first 9 months of 2013. This data has illuminated many different programmatic takeaways. Using said data, and some client feedback of the current permitting regime,we will present the strategy for permitting reform and the recommended permitting regime to support that reform. Permit Reform Strategy Accomplish three main strategic goals: 1. Develop a more transparent and simplified permitting structure. Action Items: A. Delete the "Additional Events" fees from the fee schedule in the "Organized Recurring Events" section. • Too similar to the single event permitting regime. Generates confusion to the prospective client. • • This also meets goal#2 below as Recurring Event Permit Application fees would more fully cover their proportion of programmatic expenses incurred. B. Consolidate the two single event fee types (Limited and Complex) into one single event permit. • Based upon data, comparable time was spent for each application type, on average. • This also meets goal#2 below as the Single Event Permit Application fee would better align with programmatic expenses incurred. Comments and Data: Client Comment:The current system is way too confusing; both permit types have the same costs and structures but are separate and independent? Why? • Very wide range of time spent on permitting Temp Food Establishments (from 20 minutes to 8.92 hours/ permit) • On average, the same amount of time was spent on both Limited and Complex single events, 83 minutes and 80 minutes respectively. • On average, all inspections took approximately the same amount of time regardless of permit type (single—18min vs. recurring— 17min; full price—19min vs. subsidized —15min) • Minimum permit expenditure—Approx. $22.33* (20 minutes), minimum permit revenue— $16.00 (Additional event permit fee) • Maximum permit expenditure—Approx. $597.00*, maximum permit revenue—$208.50 (Complex Single Event and late fee) • *Expenditures are estimated at the current hourly rate-$67.00 Temp Food Establishment Permit Revision Strategy 2. Create a more equitable permitting structure. Action Item: A. Reduce the fee for single event, initial applications. • Reduces the initial barrier for business to conduct temporary food service. B. Increase the fee for single event, additional event applications. • Current fee does not cover time expenditure. • Encourages those who are at the more frequent permit applicants to annual permits instead. Saves time and expense for all parties and provides for safer food service to the public. • This also meets goal #3 below as Single Event, Additional Event Permit Application fees would more fully cover programmatic expenses incurred. Comments and Data: Client Comment: The Initial permit fee is so high that it is a real barrier to entry for a small business. Then, to subsidize the established businesses further with subsequent permits really inhibits competition in the marketplace. Client Comment: The Initial permit fee is too high. • Approximately the same proportions of permits are issued for both Initial permits and subsidized permits (50%). — 100% initial permitted establishments were inspected — 29%of subsidized permitted establishments were inspected (primarily due to poor initial inspections) • Subsidized permits account for 50%of all permits issued, but only contributes approximately • 10%of the revenue. • 203 single event permits were issued for 203 food service events. 52 recurring event permits were issued for approximately 1455 possible food service events (Avg. of 1 permit/28 events). • The#of subsidized permits issued to a single entity ranges from 1 to 39. • For single events, more subsidized permits were issued than initial permits. — Approximately 82%of all subsidized permits issued are for single events. • Approximate 43% reduction in time spent for single event subsidized permits vs. single event initial permits. — A corresponding reduction was not observed for recurring events 3. Facilitate greater program cost recovery. Action Item: A. Adjust fees to more fully cover programmatic expenses in conjunction with the items listed goals 1 and 2. Comments and Data: • Revenue covers approximately 71%of expenditures (29%gap) • Approximate 73% increase in Temp Food Permits issued (will be greater by the end of the year) • Approximate 39% reduction in average staff time spent per permit issued • Approximately 3%of temp food activity was spent where a permit was not issued and $0.00 revenue was generated • • On average, the three most expensive activities conducted in 2013 are: — Applicant Education & Compliance via phone ($23.06*) — Permit Administrative Processing ($22.23*) — Applicant Education & Compliance in person ($20.56*) *Expenditures are estimated at the current hourly rate-$67.00 Temp Food Establishment Permit Revision Strategy S Reformed Permit Structure Single Event • Everything remains the same except that clients would only obtain one permit type (no more differentiation between Limited and Complex). • Different application fee amounts than currently on the fee schedule Recurring Event • Everything remains the same except that clients can no longer obtain additional event permits for recurring events. Anyone wishing to operate a recurring event at a new site must submit a new application The reformed structure would work to meet all three goals above. • The resulting structure would have 5 different permit types instead of the current 12. • The resulting structure would not alter the current inspection program. Any increase or • decrease in inspections would be the result of application types received and satisfactory performance of client food safety operations. • Two distinct permitting regimes would be in place for Temporary Food Service Events. This will reduce applicant confusion and the need to have added staff involvement in order to explain the permitting regime. • The single event, initial application fee would be reduced to lower the barrier to entry for Adjusting the single event fees to be more equitable and better account for programmatic expenses. • The single event, additional event application fee would be increased to be more equitable and better account for programmatic expenses. • Recurring event permits would more fully cover programmatic expenses and be more equitable when compared to single-event and annual permit application fees by removing the "Additional Events" permit type.They would be limited to fixed site activities such as Farmer's Markets. 411 *Expenditures are estimated at the current hourly rate-$67.00 Board of 3-feaCth Netiv Business .agenda Item #Y, 4 � . 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"Jefferson County a leader in signing people up for Obamacare," Port Townsend Leader, October 30th, 2013. 3. "Code Gray at Jefferson Healthcare," Port Townsend Leader, October 30th, 2013. 4. "Septic system classes offered Nov. 13-14, Nov. 21," Port Townsend Leader, November 6th, 2013. 5. "Jefferson employee honored for her environmental efforts," Peninsula Daily News, November 7th, 2013. 6. "Get Covered Jefferson County— Health Insurance for Everyone," Port Townsend High School Fall Parent Newsletter, October 2013. 7. "Smile Mobile," Port Townsend High School Fall Parent Newsletter, October 2013. 8. "Big Donation for Cancer Awareness," Peninsula Daily News, November 13th, 2013. 9. "Shocking-pink success," Port Townsend Leader, November 13th, 2013. 10. "LETTER: PT water safe or not?, Editor's note and PTCC meeting announcement," Port Townsend Leader, November 20th, 2013. 11. "Tarboo forest project gaining land, support," Port Townsend Leader, November 27th 2013. 12. "Mill, county start mediating over landfill," Port Townsend Leader, December 11th, 2013. 13. "Getting married for health-care insurance," Port Townsend Leader, December 11th 2013. • Jefferson easing into affordable health care signups, chamber told By Charlie Bermant, Peninsula Daily News, October 29th, 2013 diki, sW:':''',*-N:', 1, ;1!� 0 �, ':':,,.p...,,, , ::',ii,,::::::::,.: '.."-1,:.!:':.: :fka tip'"erVlh;.,.vc,i,..,..,,. ,, ,,, .,, .:1;:',4,,K,:‘,.4.-.tiiVidi:17S,:X.,- o s e, rc W;'yl jar 'T i 7f z,1.`a nt Julia Danskin, left, and Erin Brown, representing Jefferson County Public Health and Jefferson Healthcare, respectively, address the Jefferson County Chamber of Commerce. --Photo by Charlie Bermant/Peninsula Daily News •PORT TOWNSEND—The implementation of the Affordable Care Act is causing confusion in parts of the nation, but Jefferson County is further along in the process, the Jefferson County Chamber of Commerce was told Monday. "As of Friday, Jefferson County has reached 32 percent of our goal to enroll people in the program," said Jefferson Healthcare CEO Mike Glenn during a question-and-answer period at Monday's chamber luncheon meeting attended by about 50 at the Elks Lodge. "These are people who likely didn't have insurance before and now do, and on Jan. 1 when it goes into effect, it will make a huge difference." Glenn credited the luncheon keynote speakers, Jefferson County Public Health Supervisor Julia Danskin and Jefferson Healthcare Compliance Officer Erin Brown, for the county's success in getting the message out to the target audience. "The goal of the [Affordable Care Act] is to decrease the cost of health care and what our prices are to the consumer." Brown said. "As more people become insured, the cost will come down." Brown said many health care customers are caught in a "vicious circle" where they cancel or delay needed health procedures because they can't afford them. When the problem becomes life-threatening, they go to the emergency room, which costs more and has a greater bad •ffect on patient health. Brown said the substance of the act, aka "Obamacare," is nothing new and was first proposed in 1912 by President Theodore Roosevelt. "A huge part of this is how the act covers pre-existing conditions," Brown said. "Previously, insurance companies were allowed to deny or delay your coverage and still make you pay for the plan. • "That's all going away, which is excellent." Danskin said website problems to enroll the uninsured are not as much an issue in Washington state as in other parts of the nation. "It is working a lot better than it was two weeks ago, and 100 percent better than on Oct. 1. A lot of issues have been resolved in the last few days," Danskin said. "Before going on the site, I heard how user friendly it was and everyone can just sign up easily, but it turned out that just getting a user name and a password and answering the first three questions is a challenge." [The Washington Healthplanfinder is online at www.wahealthplanfinder.orq. Or applicants can phone 855-923-4633 weekdays from 7:30 a.m. to 8 p.m.] The health care act requires that all legal residents have health care by Jan. 1. Those who already have health care through their employer or an independent insurance agency and are satisfied with that coverage don't need to do anything. Brown said that about 4,000 people in Jefferson County do not have health insurance, according to the latest available figures. The high risk groups for being uninsured are single males, rural residents and those between ages 21 to 30, she said. Those who don't sign up for health care can be penalized with an amount to be assessed on their 2014 income tax form. The penalties are $95 per adult and $47.50 per child with a $285 per-family maximum or 1 percent of the total family income, whichever is greater. A lot of issues are yet to be resolved with answers provided over the next few months, and the consumer cost could decrease, Glenn said. "The invisible hand of the free market will bring costs down because it's a hard sell to force people to buy health care that isn't as good as what they have today," Glenn said. "The charity care and bad debt is way higher[at Jefferson Healthcare] than other hospitals in the area," Brown said. "People are having emergent conditions because they aren't getting health care [coverage]. This is why we need to get more people involved. "We need to have a healthier community. Otherwise, we aren't going to have a community." Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermantpeninsuladailynews.com. e Jefferson County a leader in signing people up for Obamacare By Allison Arthur, Port Townsend Leader I Posted: Wednesday, October 30, 2013 •efferson ('ount i a the tate when it comes to signing people i ip for health-rare vvUi��y is a leaderin .� insurance through the Affordable Care Act, also known as Obamacare. It's doing so well that Jefferson County's Public Health Department has switched from offering walk-in service to asking people to make appointments for help. As of Oct. 21 , Jefferson County had signed up 166 people, roughly 32 percent of the 520 people it is targeted to enroll in a plan by Jan. 1 . Jefferson County was second only to Wahkiakum County, which had signed up 27 people of the 62 it was targeted to enroll, giving it a 43 percent enrollment score to date. Overall, the state has enrolled 17,980 people in plans, which is only 15 percent of its goal to enroll 121 ,764 people, according to a report by the Washington State Association of Counties. "Good news to us, awesome news to the 166 (soon to be more than 200) residents of Jefferson County who now have health insurance," said Jefferson Healthcare CEO Mike Glenn. At the Jefferson County Chamber of Commerce luncheon Monday Glenn applauded the work deif the hospital, Jefferson County Public Health and insurance agents like Kristin Manwaring, ho have been helping people sign up for insurance. WORKING OUT KINKS Julia Danskin, public health nursing director, acknowledged Monday that it has not been easy. "They told us it would be user friendly," she said, "But just creating a user name and password and answering the first three questions can be challenging," Danskin said. Danskin told the Leader last week that she doesn't think she has enough staff to handle walk- ins. So she's asking that people now call 385-9400 to make an appointment. "Most of the people coming in are people who have tried to go to the website and have had problems," Danskin said. "And I have some people who don't have Internet access and who just need help." Danskin also said she had seen improvement in the online system even in the last few days last week. Erin Brown, financial counseling supervisor and compliance officer, was delighted last week Ago learn that Jefferson County was well on its way to achieving its year-end goal because it riad been slow going. "For every one successful application, we've had one or two applications that didn't go through because of error codes," Brown said last week. Brown told the Jefferson County Chamber of Commerce Monday that things have improved • since the enrollment began Oct. 1 , but that the system has been challenging. Brown noted that more than 4,000 people in Jefferson County currently do not have insurance. She said men, particularly young men, often do not have insurance and so that is a group being targeted to enroll. Nationally, people in rural areas and young people between the ages of 19 and 30 are the people who have been identified as most often not having insurance, she said. WAIT TIMES Brown told the Leader last week that the hospital is still accommodating walk-ins. But that courtesy had led to longer-than-average wait times for people coming in to talk about their bills, she said. In one case, Brown said she was able to help a 56-year-old woman who had come in to talk about a bill that had gone to collections. "We had a conversation not about what's going on right now, but about the future. She happened to have all her information. She didn't have any money so it was easy to do. The application for her was 10 minutes. She was thrilled." • "I've never had a conversation with a patient coming in to discuss a collection and leaving so happy," Brown said of the woman qualifying for help buying insurance. The woman still has a bill in collections, Brown said, adding that bills go to collections when people don't contact the hospital and don't pay anything. Brown said she was seeing a variety of people coming in seeking help getting insurance. In addition to the 56-year-old woman, Brown had signed up a 24-year-old woman for insurance. The insurance can go into effect Jan. 1 , 2014 if people sign up and pay for the premiums by Dec. 15. The deadline previously had been announced as Dec. 23. The deadline to buy insurance, however, is March 31 of next year in order to be covered for the year. After that deadline, the next enrollment period doesn't start again until October 2014. IT DOES NOT COVER While people who do not have insurance are being required to get insurance now — or face a fine — people who do have insurance can't drop their insurance to buy cheaper insurance through what is called the Washington Health Benefit Exchange, the system the hospital and health department use to help people sign up for insurance. Small businesses in Jefferson County also won't have new options in 2014, but might see options available in 2015. Orivate insurance agents can offer plans outside the exchange, and both Brown and Danskin said they work closely with Kristin Manwaring's insurance office in Port Townsend. Young people 19 and older can apply for insurance separate from their parents, although if they are on their parents' insurance plan, they can be kept on that plan until they are 26 years old, Danskin said. WHO PAYS FOR IT? Cost of the new insurance — and who is paying for it — also rose at the chamber meeting. Manwaring said there were several new taxes on insurance premiums that were being imposed to help offset the cost of subsidies to the poor to pay for their plans. People who are significantly above the federal poverty guidelines also are finding that their insurance premiums have gone up, several people said. Glenn said the cost of caring for new people also is being borne by health-care systems because reimbursements for care will be going down. At the beginning of her presentation to the chamber, Brown said that she discovered resident Teddy Roosevelt had actually proposed insurance for all in 1912 — more than 100 years ago. • Code Gray at Jefferson Healthcare By Tristan Hiegler, Port townsend Leader I Posted: Wednesday, October 30, 2013 Sometimes, these things just happen. A male patient, without a history of mental illness, suffered a complete psychotic break in 2011 while visiting Port Townsend. He became divorced from reality, acting strangely and violently. By the time he was brought to the Emergency Department (ED) at Jefferson Healthcare Hospital in Port Townsend, he had to be restrained immediately. According to ED Director Paula Sorbel, these kinds of patients sometimes require staff to send out a "Code Gray" alert or call the police. Code Grays come down to a show of force, in a sense, Sorbel said. It's a procedure for keeping patients and staff safe by going in with enough people to restrain a violent patient and de-escalate their behavior. When a Code Gray is called, Sorbel said the staff members devise a plan outside the patient's room. Each person is assigned a limb on the patient to grab onto and restrain, while one person, usually a nurse, is tasked with talking the patient down and giving them directions. "When a patient can't be in control, we need to be in control for them," Sorbel said. Code Grays sometimes are called to help deal with patients who suffer from a variety of mental illnesses, she said. When a psychiatric patient is brought in voluntarily or against their will by a law enforcement officer, a ariety of situations can unfold. Sometimes the patient is fine, but other times their perception of reality is so oisconnected by their mental illness that they become a danger to themselves and hospital workers. While protocols like Code Grays, restraints and sedatives are the last resort, Sorbel said they are sometimes necessary. One patient, while hallucinating he was some kind of animal, injured a nurse while trying to escape the fierce hallucination. "They'll get violent, because they're just so sure they're in another reality," Sorbel said. "Nurses have been hurt by the demented [patients] before, who are frightened and confused." ASSISTING PATIENTS Several systems come into play when a psychiatric patient is brought in against their will. Legally, they must be evaluated and can only be held for 72 hours before being hospitalized or released. Sam Markow, executive director of the nonprofit Jefferson Mental Health Services (JMHS), said his staff of designated mental health professionals evaluate patients brought in to the hospital's ER with possible mental health issues. He said a patient can be held for up to 72 hours, and if they are deemed a threat to themselves or others, JMHS and the hospital work to find them space in an inpatient treatment facility. The harsh reality in those situations is that Jefferson County has no mental health beds, according to Markow. •ny patient grappling with mental health issues has to be transported out of county, or they are held until a psychiatric treatment bed is found in a non-psychiatric setting. Hospitalizing a patient costs money and in some cases, patients hospitalized for mental health issues outside of Jefferson County can still rack up bills for local agencies. From January to October 2013, Markow said JMHS was charged a total of$237,539 for involuntary • hospitalizations, as well as co-pays for detained Medicaid patients. "If a Medicaid recipient has residency in Jefferson County and is hospitalized in or by another county, JMHS is charged for that hospitalization," Markow said. "We are supposed to be notified, but [we] may never have known or authorized the hospitalization, yet still be charged." He said 57 patients— including four voluntary cases —were hospitalized during the past year. Joyce Cardinal, chief nursing officer for Jefferson Healthcare, said finding beds in other counties is problematic because of limited space and funding throughout the state. "Finding beds is extremely difficult. Our social worker works with the mental health counselors to find a bed that is appropriate," Cardinal said. "We do not have enough mental health beds in this state to be able to accommodate all of the patients," she added. "There are times where we hold the patient for the 72-hour hold and then they are discharged without them going to another facility because there aren't enough facilities in the state to accommodate [them all.]" INCREASE Markow said JMHS has seen an increase in patients over the past several years. Part of that he attributes to the aging population in Jefferson County. In 2010, when Markow joined the organization, he said they were serving about 700 unique patients a year. For their fiscal year stretching from 2012-2013, they served 1,450, he said. "A lot of that has been us increasing our ability to accept third party payers," Markow noted. Around 280 juvenile patients were served during the 2012-2013 fiscal year, and about 300 seniors. "That's becoming a growing concern for us and the community," Markow said. "We have an aging population ... the rate of depression and [suicide] in the elderly is quite large. Many do not engage in mental health services." SAFETY ISSUES According to Cardinal, mental health patients can be put up in the hospital if they need medical care beyond their psychiatric symptoms. "If the patient needs to be hospitalized and they can't find a bed, the patient is put up in our nursing unit. Generally, those kinds of patients are put into our critical care unit so they can be watched very closely," she said. Cardinal said procedures like Code Grays are designed to protect both patients and hospital personnel. She • said at least four minor injuries to staff members were reported this year, with one employee missing work as a result. "There is a safety issue, often, for doing this. We have had injuries in the emergency department and up in our nursing department because we haven't been able to find a bed for patients that need intense psychiatric tare," she said. Jefferson Healthcare saw 21 psychiatric patients in July of this year, Cardinal said, with 21 psychiatric patients walking through the doors in August and 30 in September. "Health care has become a much more dangerous place to work than it used to be. It's become one of the least safe professions now; in my early career you would have never seen that," Cardinal said. "I want to recognize that patients that come in with these, they're ill. Most of what happens with a patient with a psychiatric disease, it's not intentional, it's part of their illness," she added. "I always fear that we will lose people from the medical profession if this problem continues to get worse, and I do think a big part of it is the lack of services for these individuals that do need help." There currently isn't a hospital room dedicated to mental health patients, Cardinal noted. She said that creating safer rooms for psychiatric patients is something the hospital's administration is considering with their upcoming facility expansion. LONG-TERM TREATMENT The key in responding to patients with mental health problems is getting them in long-term care, Markow said. Illi'atients often cycle in and out of the Jefferson County Jail and the emergency room because they've ommitted minor nuisance crimes, according to Markow. "When we go into the jail, more than 50 percent of the people have some kind of mental illness," he said. "A lot of them are nuisance crimes, harassment, trespassing, things like that, so they go in and out of the jail, the court system." The challenge is getting patients to volunteer for treatment and engaging them in a system of outpatient services. "For the most part, those who we've engaged are doing amazingly well. The treatments work, it's a matter of convincing them ... they have a need for services, and making the services attractive enough," Markow said. JMHS offers adult, older adult and youth-family outpatient services, as well as general psychiatric services and school-based counseling services. "These people need long term admissions... to get fully stabilized, healthy," Sorbel, the ED director, said. For more information on JMHS, visit jeffersonmhs.org or call 385-0321. • . Septic system classes offered Nov. 13-14, Nov. 21 Port Townsend Leader - Wednesday, November 6, 2013 In 2012, the Jefferson County Board of Health (JCPH) authorized homeowners to complete most required septic system monitoring inspections. Those who complete a series of free septic system classes may apply for authorization to inspect their own septic systems. Three classes are offered this month: from 9:30 a.m. to 1 :30 p.m. on Wednesday, Nov. 13 and Thursday, Nov. 14; and from 4-8 p.m. on Thursday, Nov. 21 . Septics 101 teaches the basics of septic system operation and maintenance, including how the system works and how to protect it. Septics 201 covers step-by-step inspection of the septic system and how to report results, how to identify warning signs and when to call professionals. Pre-registration is required and space is limited. To sign up, call 385-9407. m to e p yee honored Jefferson for her environmental effortsf ,,,,,,,,„17.7074"...„,wolli-A.,,Iffpia,.i.F4,,,t,„:„.,..11;41 „..,,,,,,,,,w.,74„5::,„,4 rzi,,,,..„.„..4014,.,04,:„154,,.0,..,..ceti,447,,,,,,,.31A0zal PENINSULA DAILYNEWS ,, P :,,:7,,,,,... 4,,kcwam.isit*,, ,ig,ta::,,,Tii,.,,, 1,1474:izio.... .1,3,..1.,i.:::::::: --QRT TOWNSEND— nt Tauri Pokorny,a nine year 4:14 ` '�? t ' ,:: k Y.� `�i. �'h��R.dr Y b 1-� veteran of Jefferson County 4� Public Health's water qual- ,�ir .1 k4 ,�,yy 4 , �,c p3E g'Y ,, ity division,received an x � •, Environmental Achieve fi «{ ment Award recently from 1_� , . ' t , ,:„,,,,,,,,,,,,x,1 t I the Hood Canal Coordinat- 5„,,3,-,, ,,,,,,I,,,,,,,..,2,„.,'. , ` �, ing Council,or HCCC,fory • •° her conservation work in �;. '' Jefferson County. ry ' • „ The ceremony took place in Port Gamble and wasp �� r4.: attended by residents, i tribes and state and local �� agencies from Kitsap,Jef - ,7,.:•., ,.,•.•.::•;.i.,,•_ � ' ferson and Mason counties ' ' < . ; that work together for thex�, te, ,,,,,,,,„4„,,,. • restoration and protection = 3 r of Hood Canal. • .. 1- � ; ' `Dedicated passion' A. 1 ` " _ Pokorny was awardedit,5k.;,, ,,....,, i . �, ..,.,„.,1,:,,::_:....,.,,,,.,.,,,.,,,,,„,,,,,.,.,., ,,,,,,,,, , for her"dedicated passion �-"'” 7 ....... ,,,,, .,.,,,i,[,,,,:,,:.,,,,,::,::,,,,:;:,,,.;,,‘ 3 for conservation and pres • ervation." The award recognizes ror, those who protect,enhance sv and restore the natural rrtti %> resources and water qual ity of Hood Canal water- shed. Pokorny has worked to Muck D,WsoN protect Hood Canal Jefferson County Commissioner David Sullivan presents an through the Conservation Environmental Achievement Award to county Public Health staff member Futures,Watershed Tauri Pokorny at a meeting of the Hood Canal Coordinating Council. Resource Inventory Area 16,HCCC,field work,edusalmon- ual- cation materials,commit had managenuumerousbush rivers, he corridor protection,floodlife ty imp ovements through tee and board work. g. plain land conservancy and out the watershed. Along the Dosewallips land acquisitions for • • iji)/1/ /7/5 .rt t a y rcY,S ,�i 2 .C.i�i,a`• •fr�1.�'••,%'^. a'''y "'s..,ua.u.,s=.c,',a�"�'��*,>a�i 3.,,��;.�a`-a`3a`,z,�"`. ��.�":`c:� i ,a'�`�Y*.. Ev k•ya°vCa.`,t,;",ar�.•aa •�v �•:y"sF ff , ,,as " a�ti �3s ; i.; S a� x . �„,, 3 ' Y �M� > C � � '��3�� 'x�� :,, e . : y ,....,,,,,,,,',-4:•g14, y� fi ? �: �c?, ., 0 � `c. r. C w �a a,*:,:•A,'''' ,::• s� � ..w kiS µ � • 1,' qatnirtt3inllfgAt*wals,k014,4110*41itt k7141,„LtitAtititiA14,tRtitriti:alit,j!::,ttWj4's,f4p4,kfzfi4Liiirr'>:eNftriearqsa "+'vl 3 P , gyp. -11 -..i,,,,,"`- mL } �$ a� e . N` �ad� ^ °`, sa ,- Ekr ,,- � ,714bt,�. ys .rt� r ' �4 { p,U N „" ', sty * ' s Trk i semF4: ` 4�w ! t t rl:.: 1 E ' : ,-4k k Y '4,,,,,i",:-.,,,t--4.--','„;:e17,,,'" ,)` ', . ax VC - i • r ri le on County for Every 11 The Washington Dental Service Foundation Smile Mobile is nnve The Patient Protection and Affordable Care alth Ins Act will take Ur anG full coming to Jefferson County effect in January, 2014. This means that all individuals are Public Health, November 12-14, He required to have health insurance. Starting in October, 2013. • 2013, uninsured Washingtonians can shop for affordable This fully equipped mobile health coverage options through a website called dente! clinic is coming to WAHealthplanfinder.org, the new online insurance provide dental care to children with a limited family income. marketplace. They may also be reached by calling 1- Medicaid 855_ 55 The Smile Mobile does accept 923_4633- Was 23 4633. Washington Healthplanfinderwlll have a network Medica d (provider scale and of customer support professionals available to assist you in also offers a sliding fee scale • obtaining the information you need to register for your new based an family income. health plan. If you want to be assisted in person, contact Appointments must be one of these three local agencies for an appointment: scheduled before November 12 Jefferson County Public Health at 385-9400, Jefferson Walk-in patients cannot be Healthcare (Patient Services office) at 385-2200, seen. To schedule an appe,int-Ment or for more ext. 2267 or the Olympic Area Agency on . , informtiC�n, phase calf 1�$88_ Aging, at 385 5064. Healthy students are 288-91 3 if you are ort better learners! Medicaid, please:have your l?rc vi lerOn ard:ready when :� ., a y.°a " scheduling tt e appointment as �E'e * a ,�.. �n e. .... ,.=r . ka. Fad Ari �� atl�`.`� h § Pr.tec SU r el r .; smile :' ,L a WW�. °� >_)t ' du/h ,I 1.,, f i IL.1 t l .kms µ m t Our website is updated daily. Find important and current �' ` gi information regarding our school for parents, students and uN Mr community. Check it out! , t • T -14-"114:”T'''-'6'-''''''''''''-'''''' �""kS�A��k. zwkxvrfm;w PENINSULA DAILY NEWS S for Wednesday, November 13, '26f7-.-'',-':::•7:-,4,- poi „v . , , . , . , , . .. 4,..,, . . , .. . ..„. .... , , . „. . _.. t. _.:,. ,,. ., _ , , . .. ,, , „. , .. lcos„ a ,an,„‘..,'e.(111 ,. - . : ,-, ..„ a '� .,., . .... „, , _ . . . . . .. . ........,... ,.... .,..„,„tik.,::...,„„,i4.41-.._:,,,,,`,41A-,,,,i-lz',•.-....,.., .;-.',,,,,,,,,7.-,-:-..„: ..r.:,.,;...1; i S1'a b f sA,,...: ‘,'t F ;3 • y x Ix i i ?mar E'i "�"3""' ,, ,i;:.5" ..i':,, 1-time.stock fr i ; , f � £, &n ...„tions at113: I 1 f z 4 q 1, erg , ��4 ufadailynews:comig. - i ] 1 '' ��' „,,,,::::: :;,,,,,,w,,,,, d i ^' '' `.g1z Asx i m t� .,: x_ - 4�, arket watch � � `` Y Nov.12 2013 _ t z $ay _. k4. ^ { f .�i' �” .t L r m ;.'. ,. rials 15.750 67 la I .. r .�` ',' N. aww` '� _� 11 : r �+l p - „ `_ � ;�.r,w"" ,4+ gild $ k sem. site 3,919.92 �, i � a• �'� `°'�"�.. �y_ 500 1,767.69•Vr- .w � �.'.� e ° 6: b w4 ell ' ,m ....ter .. 4 .k; ,,�� ; ^.s,; sit{ ° s fc' d +? 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Shocking-pink success Julia Danskin(second from left),community health supervisor for Jefferson County Public Health(JCPH),accepts a check for$3,186.50 on behalf of the JCPH Breast and Cervical Health Program.Presenting the check are Miko Crosland(left)of the Clothes Horse, Sue Arthur of the Port Townsend Main Street Program promotion committee,and Dawn Pierson (right), Main Street administrative assistant.Main Street's 10th annual Girls Night Out on Oct.3 raised$6,260 from sales of goodie bags and raffle tickets.Submitted photo 0 111, //////.5 LETTER: PT water safe or not? Port Townsend Leader: Wednesday, November 20, 2013 What does it mean to live in a city where the state Department of Health declares that the city water system does not have an adequate level of watershed control, does not meet department expectations and that for drinking-water regulatory purposes, the system is considered to be out of treatment compliance? A fix for this sorry state of affairs cannot be accomplished until 2016. The report continues, saying that "inadequately treated water may contain disease-causing organisms that include bacteria, viruses and parasites that can cause symptoms such as nausea, cramps, diarrhea and associated headaches." What does this mean? It means that someone should be held responsible for this. Who? Perhaps start with the local officials who are responsible for the filtration system used for city water. These officials are currently hashing over a budget. Even more shocking is that only those who receive a City of Port Townsend newsletter with their water bill know anything about this. There are no public warnings posted anywhere, no public meetings held, and in the Nov. 6 Leader, there is absolutely no mention of it except for a reference concerning the budget being discussed by the City Council. Where will it fall in order of importance in the spending future? Who knows? If this doesn't upset the populace, it would be safe to say that they are in a deep sleep. There • are those of us who stand to be compromised with health concerns, such as the elderly, the young and those who have compromised immune systems. This news might wake everyone up long enough to ask for explanations. KATHLEEN JACKSON Crypto in the'watershed,but we only test samples so there is no way to be Port Townsend absolutely certain that no oocysts are gettingthrough unless filtration is in Editor's note: A story on the city lace and physically stops them. water notice was in the Oct. 30 issue p Cryptosporidiosis is unpleas- of the Leader.We asked Mayor David King to respond to other concerns: ant but usually clears up on "The quality and safety of the its own in healthy individuals. port Townsend City Council Immunocompromised people, as well holds a special meeting 6:30 City's water supply have not changed as the veryyoungor veryold, can since the modifications that we 8:30 p.m. at.City Hall council develop a more severe and dangerous chambers to discuss water- installed in the 1990s to increase the form of the disease. In other words, treatment plan adoption and the contact time for chlorine. Chlorine protects us against all but one of the though our exposure is not increas- agreement with PT Paper Corp., those of us who are livinglonger and for a public forum on water g pathogens that occur in our water- ing, use efficiency goals. shed—the oocysts of Cryptosporidium or surviving with compromised or are highly resistant to chlorine disin underdeveloped immune systems are more susceptible to harm from this fection. pathogen. This is the reason for the We tested for the presence of equired(and alarming)language in Crypto from February 2007 through the notice. January 2010 and have been testing The City will spend $12 million- • monthly since March of 2013. One plus to add filtration to our system. sample in February of 2009 included We will continue to test for Crypto a single oocyst of Crypto. No case until filtration is in place in 2016. I of Cryptosporidiosis has ever been will be 65 in December and plan to traced to city water, and there is no continue to enjoy drinking City water indication of increasing amounts of as I have for the past 36 years." • Tarboo forest project aainina land, support Port Townsend Leader, November 27, 2013 Northwest Watershed Institute is close to completing its goal of protecting 78 acres of forestland adjacent to the Tarboo Wildife Preserve. The effort is part of a joint conservation project to preserve a total of 236 acres of forestland for wildlife, clean water, and sustainable forestry in partnership with Jefferson Land Trust and Leopold-Freeman Forests LLC. The project is one of the largest private forestland conservation efforts to date in East Jefferson County, according to Peter Bahls, executive director of the Port Townsend-based nonprofit Northwest Watershed Institute (NWI). With a loan from supporters, NWI purchased the 78-acre parcel in 2011 from ANE Forests Inc., a Danish corporation that was planning to clearcut the property and sell it for development, Bahls said. If the parcel can be successfully funded and conserved by NWI, Leopold-Freeman Forests LLC has agreed to donate a conservation easement to Jefferson Land Trust (JLT) that would permanently safeguard the adjoining 158 acres of forestland for wildlife habitat and sustainable • forestry. The LLC forestland is owned by the Scott and Susan Freeman family, who named the tract in honor of Susan's father, Carl Leopold, son of renowned conservationist Aldo Leopold, who had an abiding love for forests and conservation work,his'family says. "We are delighted to be working with NWI and JLT to protect a large tract of forestland in the Tarboo valley," Susan Freeman said in a statement. With funding in sight to protect the NWI parcel, the LLC is preparing to donate a conservation easement before the end of the year, Freeman said. Since 2011, NWI has been raising funds to pay off the loans for the original purchase of the 78 acres and allow transfer of a conservation easement to JLT. If successful, the parcel, which is one of the few remaining large tracts of older forest in the Tarboo valley, will be permanently preserved for wildlife habitat, carbon sequestration and sustainable, selective forestry, Bahls said. Sarah Spaeth, executive director of JLT, said the project "fits well with the goal of conserving working forests, which was identified by the community as they helped us develop our 100-year- vision conservation plan for Jefferson County." • Fifty-one private donors and foundations, most of whom are residents of Jefferson County, have • donated $237,000 to date. Jefferson County's Conservation Futures Program has committed $334,000 toward the purchase of a conservation easement on NWI's 78 acres by the Land Trust. NWI is now seeking donations from additional local supporters for the last $49,000 of the $620,000 needed before the end of the year to implement the project. One of the highlights of fundraising has been walking the forest trails with many people over the past two years in all seasons," said Bahls. NWI also recently hosted a nature photography workshop taught by three professional photographers: Stephen Cunliffe, David Gluckman, and Keith Lazelle, who donated all of their time to the cause. "I'm extremely grateful for the support of many residents of the Tarboo watershed, and people throughout east Jefferson County," said Bahls. "I'm hoping that those who know about the project, but haven't contributed yet, can chip in now and help to make the project a reality." Bahls plans to give another tour on Dec. 7 for potential donors, and he hopes it will also give people a chance to see colo salmon spawning in Yarr Creek, a stream running through the forest and into the Tarboo Wildlife Preserve. Yarr Creek is named for the late Daniel Yarr, who . sold his land to NWI in 2006 to start the Preserve. The 236-acre Tarboo Forest includes seven tributaries to Tarboo Creek. All of these streams and surrounding forests drain into the main stem of Tarboo Creek and then into Tarboo-Dabob Bay two miles downstream. "Conserving these forestlands is key to protecting the water quality for wild coho and chum salmon in Tarboo Creek, as well as the valuable oyster and clam beds of Tarboo-Dabob Bay," said Judith Rubin, stewardship director for NWI. To date, more than 500 acres along Tarboo Creek and more than 2,000 acres within the Dabob Bay Natural Area have been protected by a large coalition of conservation organizations, landowners and public agencies. Donors can learn more about the project at nwwatershed.org or by contacting Bahls at 385-6786 or Peter@nwwatershed.org. Mill, county start mediating over landfill • By Allison Arthur of the Leader I Posted: Wednesday, December 11, 2013 The Port Townsend Paper Corp. and Jefferson County have stopped litigating —for now— and are mediating over details of a permit for the mill's controversial 25-acre landfill. A hearing before the state Pollution Control Hearings Board that was set for Dec. 12 and Dec. 13 has been postponed and the mill and the county are now apparently talking about what a limited-purpose landfill (LPL) designation might look like. The mill had been insisting it did not need an LPL permit and it wanted its landfill to fall under an "inert" designation, which would be subject to less stringent regulations than an LPL designation. "Now they have said that for the purposes of mediation, they will consider an LPL," chief civil deputy prosecuting attorney David Alvarez said Monday in acknowledging that mediation is under way and the litigation process is on hold. "I'm very pleased. I think it's a success for the county to get them to agree the foundation should be an LPL," Alvarez said. "I think it's a quicker way to a new permit." Kevin Scott, environmental director for the mill, confirmed by email Tuesday that, "PTPC has agreed to the mediation process in order to settle the pending litigation over the proposed renewal of our landfill permit." Scott said the scheduled hearing before the Pollution Control Hearings Board "is being continued to a later date and if the parties are unable to reach a mutually acceptable resolution, the appeal process will proceed to litigation at that time." • LPL or not? However, Scott did not answer a followup question on whether the mill had, in fact, agreed to talk about an LPL. Scott has been adamant in the past about the issue saying that since the waste stream has not changed and neither have the laws, "so the landfill designation should not change either." Both the county and the state Department of Ecology (DOE) told the mill this year and last year to file for that more stringent permit. When county public health officer Dr. Tom Locke insisted on the permit, the mill filed an appeal with the Pollution Control Hearings Board. Locke said last week that from the county's standpoint, "it has to be an LPL permit." An LPL permit could require monitoring of groundwater and could require the mill to prove it has the financial means to close the landfill once the landfill is full. The mill continues to operate under an inert permit until "there is some sort of definitive legal decision," Locke said. Trees and details Alvarez said Dec. 9 that what happens next is that the mill and the county will work for 150 days to write up what an LPL permit would look like, then spend another 150 days actually writing the • permit. "Basically, what's going to happen is we're going to break it [the permit] into pieces. You can have a gold-plated version or you can get an exemption," Alvarez said. Alvarez indicated that the county might accept variances. "We haven't gotten into the trees, into the fine details. We've been looking into the forest," Alvarez said. 1111 For now, all the documents about the mediation process are not subject to the state Open Public Records laws, Alvarez said of the process. When the county and the mill reach an agreement, that would be open to the public and any permit agreed upon would then be subject to public scrutiny, and potential appeal, Alvarez said. Delays on biomass The landfill dispute is related but not directly connected to the mill's controversial $55 million cogeneration project. In November of 2012, the DOE gave the mill an 18-month extension to make progress on the biomass project and cited appeals of the mill's proposal as a reason for the extension. Mill officials also noted the market for the green povver the project would create also had fallen. The DOE originally approved the mill's notice of construction for the biomass project on Oct. 20, 2010. That order allowed the mill to pursue its biomass project plans without doing a full environmental impact statement. The landfill and the biomass project are related because the biomass project is expected to add more ash and lime grits to the landfill. Mill officials say the landfill still has a lifespan of some three decades. • • Getting married for health-care insurance epy Allison Arthur of the Leader ( Posted: Wednesday, December 11, 2013 3:45 am Gary Balhorn listened, smiling as Sofia Prins stood in the hallway of the Jefferson County Courthouse, sharing what she's learned about Apple Health in the last few months. Then the two walked into the auditor's office Dec. 2 and filed for a marriage license. They're calling their big day on Dec. 15 a "Medicaid marriage." "You've heard of shotgun marriages? Well, now there's Medicaid marriages," Prins said. "We don't want to risk losing our property because individually, we only qualify for Washington Apple Health, thereby falling under the estate recovery laws due to our ages." Separately, Prins, 62, and Balhorn, also 62, both qualify for free Apple Healthcare insurance through the state's Medicaid expansion under the new Affordable Care Act (ACA). That seemed like a good option since Prins had been paying $326 a month and was told recently by Regence that her policy had been canceled and a new policy would cost her $602 a month. They revised that down to $577. But then Prins, a self-employed artist, started reading the fine print when Balhorn's application for Apple Health came in the mail. A phrase caught her eye: estate recovery. Prins was familiar with it. She's been around elderly people where the state sought to recover the cost of caring for a person who had exhausted their personal resources and who needed long-term care and was on Medicaid. What she discovered is that people between the ages of 55 and 64 who sign up for Apple Health, insurance onromoted as "free," would also be subjected to the estate recovery laws just like those elderly people. mediately she thought that was blatant age discrimination. Why were people 55 to 64 being targeted eted and younger people not?Were people being told of this? She started asking questions and she started looking for a solution. As a married couple, when their incomes are combined, Prins and Balhorn are eligible for subsidized insurance that is not subject to the estate recovery laws. So they decided to solve what the two see as a serious problem with Apple Health by getting married — not just because they love each other, but to protect their private property from being subject to being taken in the future. Surprise for many Prins isn't the only one who was surprised by the discovery. "Yes, it was a surprise to me," said Julia Danskin, public health care nursing director for Jefferson County Public Health, who has been trained to assist people obtain insurance through the new law, better known as Obamacare. "If I would have read the Rights and Responsibilities in detail I would have seen it listed on page V, 'Things you should know for the Washington Apple Health only.' I have to thank Sofia for bringing my attention to it." "What's interesting is that when I talked to some of my counterparts at Olympic Area Agency on Aging (O3A), they said this [law] has been around for a long time. And I said, but we're talking about a new healthcare reform and all these newly eligible people.' anskin acknowledges that not everyone reads that rights and responsibilities section as they are going rough the process —whether they do it with an in-person assister or on their own, so it is unlikely they grasp the significance of the "estate recovery" law. • "During the application process, no one lists their assets, but if they read the fine print in the rights and responsibilities section, if you fall in the age range, the cost for your health care that the state pays for could eventually be billed against your estate if you die and your spouse dies." "I really think the Estate Recovery law will have to be"changed because it is in conflict with the Affordable Care • Act," Danskin said, noting other people don't have to,report their assets to qualify for free insurance. Danskin says it's surprising how many people do qualify for free care in that age range in Jefferson County, which has the oldest population in the state. In fact the median age in Jefferson County in 2011 was 54.7 years. "Now, when I sign people up, I highlight that for them," Danskin said. Danskin said it's also true that there are people who are 55 to 64 who "are so poor that estate recovery means nothing for them because they don't have an estate." "For them, it makes sense to get free health care. It's the 55 to 64 people who qualified based on their incomes but they have estates they may want to protect, and for them, it may not make sense." Ambiguity, long-term care Jim Stevenson, spokesman for the Health Care Authority, the agency that is overseeing the state's implementation of the Affordable Care Act (ACA), said the state Department of Social and Health Services has always had a practice of trying to recover the cost of long-term care, such as nursing home care, and associated costs of dying, through its Office of Financial Recovery (OFR). And that practice isn't going to change for those on Medicaid who are getting long-term care. "I think there is concern that there are plans to broaden what we've traditionally pursued and as far as I know there are no changes," Stevenson said. He acknowledged that there is ambiguity with the law and some people — including Prins — are reacting to what . appears to be lack of clarity on what the state OFR would try to recover. Would the OFR try to recover the costs of premiums and health-care expenses related to wellness checkups, for example? "It's being reviewed by an attorney, and I'm sure we'll have some kind of solution that will put people's minds at rest," Stevenson said, reiterating that the law allows recovery of the cost of long-term care. "The idea that we would be going after premiums would be a change." Stevenson also said Dec. 4 that the 2,000 community-based volunteers who were trained to help people enroll in the various insurance options "were trained on the recovery practices." A few weeks earlier, however, Stevenson told Prins in an email that there was concern about whether recovery should be continued or expanded, "and with the recent changes under health care reform, we've received some feedback suggesting clients are not receiving adequate warning about this practice." "To my knowledge, the practice [estate recovery] has not changed substantially over the years, and clients are alerted at age 55 and when they apply to Medicaid that recovery is a possibility under the law," he wrote to Prins. Prins said that when she first broached the subject with the OR, "They had no clue." When they researched it further, she said officials with OFR confirmed that they would, in fact, recover costs of care for people 55 to 64. Brice Montgomery, chief of the OFR, said his office does the collections but it does what "the Health Care Authority tell us to do." His spokeswoman, Kathy Spears, also said "This is a Health Care Authority issue." RCW 41.05A.090 states that it is Apple Health's responsibility to "fully disclose in advance verbally and in writing, in easy to understand language, the terms and conditions of estate recovery to all persons offered care subject to recovery of payments." An OFR spokeswoman indicated by email Monday that the agency was not actively involved in any discussions with the Authority but that other arms of DSHS, "are talking with the Health Care Authority about any possible changes to the WAC." •!aking the rounds Since she started pursuing the questions in September, Prins has communicated with almost a dozen state officials from at least three different agencies, trying to get the answers to her questions and clarify the intention of the state regarding the phrase "estate recovery." She's also pressed forward with contacting the state AARP and others. "It's just this totally hidden piece of information," she said. "It's not obvious. It just caught my eye because I know about it." On Dec. 4, two days after she and Balhorn filed for a marriage license, Prins asked a Health Care Authority official whether any effort is being made to suspend the use of estate recovery for those who are 55 to 64 and qualify for Apple Health. Like Stevenson, MaryAnne Lindeblad of the Healthcare Authority told her the agency is reviewing the concerns. "We are reviewing both internally and with the CMS [Centers for Medicare & Medicaid Services] the options to eliminate the requirement (except for long term care costs)," Lindeblad wrote in response to Prins' question. Prins wrote a three-page single-spaced letter a month ago outlining the issue to get a grip on the subject herself. She's been talking to a lot of people, on the ferry, by email to friends. Her discovery has made its way to Seattle and media there. "What I think is interesting about this is that they didn't get a huge protest from a large number of people," she said. "They couldn't because there aren't many people who know about it. It's hidden. A few people have Ooticed it along the way, but it's not been in the mainstream newspapers." Prins still questions whether people who have signed up really know the risks. By law, she says, people should be informed both verbally and in writing about that "estate recovery" law. Asking questions, she said, "I absolutely think has made a difference. I said something and Julia [Danskin] joined in the fight, which is good because she's on the inside." Marriage solution Now that the issue is in the open and being discussed, Prins still is not taking a chance that anything will change overnight. She's still planning to get married. Balhorn, a retired fisherman, has lived frugally throughout his life, she says, and the two don't want to risk his property being lost —to healthcare that is advertised as "free." "No one else is being forced to give up their property to get healthcare," she said of the age discrimination she sees. As for her determination on the issue, Bullhorn listened to Prins in the hallway of the courthouse and said, "One of the best features of Sofia is that she has to figure something out all the way to the roots. She doesn't just say, oh, well, we can get by by doing this. She says 'How does this relate to the rest of the world? She doesn't just pass over stuff." "We're happy to be getting married, not so happy about the rush," Sofia said of a looming Dec. 23 deadline to pay for insurance in order to be insured Jan. 1, 2014. Unfortunately, not everyone has such an elegant solution to:the problem," Prins wrote of getting married in eir home come Dec. 15 —to avoid Medicaid laws that could;strip them of that property in the future. e. r G. - * INCIDENT ,. 'COMMAIER JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street o Port Townsend o Washington o 98368 Is,,„,,c,x0 www.jeffersoncountypublichealth.org Who Are We? We are responsible for ensuring and improving the health of all 30,000 citizens in our community. We serve a large rural county on the Olympic Peninsula that encompasses the Olympic National Park and consists of miles of marine shoreline including the Straits of Juan de Fuca, Puget Sound and Hood Canal. We serve the oldest mean population is the state (57 years old)and our population is the 7th oldest county in the nation. Our largest single funding source is the Federal Government and only 12.5%of funding originates from the local government. We are overseen by a diverse Board of Health that includes city, county, hospital and citizen representatives. a What is Our Role in the Community? What We Do? We are the front lines of public health. The public may not Our Successes '• Respond to and track always see the work we do, but communities are safer, IIIILead the state in ACA Health outbreaks of infectious healthier and spend less on health care costs because of us. Exchange target enrollment iseases like influenza and g rood-borne illnesses Getting regular checkups and having health insurance are omplete 30—50 disease Test for and treat infectious important, but as much as 90%of what influences health investigations annually diseases including HIV, STDs happens outside of the doctor's office. • • Directly serve 30%—41%of high and tuberculosis From implementing smoke-free laws that promote employee schools students annually(750 • Conduct programs health to inspecting community farmers markets that make medical visits & 1036 mental Conduct tobacco toiation fresh, nutritious produce safe and accessible. We create health visits) dmoea youth and help adults healthy environments and empower citizens to make healthy • quit choices. Found and corrected over 200 sources of water pollution to • Educate food service In order to accomplish our work,we partner throughout our protect and grow local shellfish employees on safe food- community to ensure the safety of the water we drink, the food and agriculture industries handling practices we eat, and the air we breathe.We respond to emergencies • Provided safe food handling that threaten health and safety as well as support systems, • Prepare communities for policies and environments that ensure our communities health. education to over 14% of our disease outbreaks, natural population • disasters, and acts of W. �f-T �. • Oversee all vaccination delivery terrorism, respond when in our county and directly emergencies occur, and len: vaccinate approximately 10% of support throughout the our population annually recovery process `` We improve health a., • Inspect 100%of all food service for at-risk children. Support families with in-home chlld,enbornt°i°w-mWme, establishments annually education programs and hot time mothers are at • breastfeeding promotion n°9nerrhar°rpo«heaith `, Deliver family planning services outcomes.The Nurse-Family Partnership lNFPI connects t to over 4% of our poorest Mobilize community partners ese others to public health nurses who offer education and ! k` population to develop safe places for support so children can have a '." kids to playoutside healthy ealthinn life.northwestern • Provide WIC services to 850 j Public Health{n notthwestern Washington „ ., �1' __ State has offered NFP since 1999. { families !liver physical and mental'; G Norm s �Q+R2l Public . nealth services through • Provide a 5 to 1 return on `- school-based health center; expenditures for Nurse Farris Partnership since 1999 Link the uninsured with PUBLIC HEALTH healthcare services Cleaned up over 574 solid waste ALWAYS WORKING FOR A SAFER AND sites as well as 220 illegal dump HEALTHIER COMMUNITY ci+Pc in th,s iact 5 vPars . .......,... i, . . II ;,, it p ` ,7,...", ii ��SON r,0 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street o Port Townsend o Washington o 98368 it9syr trco www-jeffersoncountypublichealth.org Federal Support for Jefferson County Public Health While the majority of federal funding for public health goes to state health departments, the federal government is the largest source of funds for us due to our unique location on Puget Sound and the priority of protecting our pristine water conditions. Primarily, we receive funding from three federal agencies:the Centers for Disease Control and Prevention, the Health Resources and Services Administration and the Environmental Protection Agency. The following chart illustrates our funding sources. The federal grants also include federal funds passed through state agencies. Our highest Priorities for Federal Funding 2014 Funding Sources of Public Health 2.30% 0.62% 1. Prevention and Public Health Fund (PPHF) ,"s Puget Sound Protection and Restoration funds from the EPA louFees for Goods and Services Section 317 Immunization Program ■Fede al Grnts State Grants 4. Community Transformation Grants (CTG) ■County Funding 5. Public Health Emergency Preparedness Cooperative ■licenses and Permits Agreements (PNEP) Taxes Local Effects of Cuts to Services that Protect State Entitlements the Public's Health Miscellaneous°ndoti Federal monies are used to support actions that are not being addressed by others. Federal cuts are disproportionately affecting children, seniors,women and the working poor in our community. _ — • Family Planning clinics continue to receive reduced funds limiting citizen access to care s.44.1. FAST FACT:Of the more than$1.7 trillion in • Nursing staff have been reduced by 43%due to cuts in Section healthcare spent nationally every year, less 317 Immunization Program - than four cents out of every dollar are spent on • The Safe Drinking Water program has been cut and may be sl disease prevention and public health.' discontinued 'J.M.Lambrew.A Wellness Trust to Prioritize Disease Prevention.(2007). • Biotoxin monitoring reduced by 50%putting people who use water Washington,DC:Brookings Institution.Available at fish industry http://www.brookings.edu/papers/2007/04useconomics_lambrew.aspx for recreation at greater risk as well as the shellfish • Funding requirements are becoming too restrictive as funding agencies look to prioritize. This leaves small rural health agencies unable to meet requirements, deliverables or demonstrate need For more information, contact: •fficient to compete with urban areas. Jean Baldwin We cannot adequately maintain partnerships needed to effectively (360)38or - Public0Health • respond to emergency calls for help from the community, partner (360)385 9408 agencies, etc. PUBLIC HEALTH Jared Keefer, MPH, RS ALWAYS WORKING FOR A SAFER AND Director of Environmental Health and Water Quality HEALTHIER COMMUNITY (360)385-9411 Suffering Public Health Departments Putting People at Risk • BY: Chris Kardish I December 17, 2013 After years of cutting public health, states are falling behind on vaccinating their residents and guarding against the possibility of disease outbreaks, food-borne illness and other threats, a new study released Tuesday concluded. The Trust for America's Health and the Robert Wood Johnson Foundation rated states on 10 measures, including public health spending in recent years, the percentage of their populations receiving vaccinations for preventable diseases, how recently they've tested their emergency plans, whether they have the capacity to handle a surge in testing and whether they require medical facilities to report infections that arise from patients during their treatment. Among the report's findings: • Two-thirds of states have decreased public health funding over the last two fiscal years, significantly impacting workforces and lab capacity. In total, 40,000 public health jobs have vanished in the last five years. • Only one quarter of states vaccinate at least half of their residents against the flu, despite Centers for Disease Control and Prevention recommendations that nearly all Americans get vaccinated. • More than half of public health departments didn't test emergency plans to deal with food-borne illness, an outbreak or biological weapon attack last year • Fewer than half of states require human papillomavirus vaccinations (HPV), education about the vaccine or funding for it, despite risks of cancer and scientific consensus against the conclusion that it increases sexual activity among the young adolescents who receive it. • Only two states and the District of Columbia meet the U.S. Department of Health and Human • Services benchmark of providing whooping cough vaccinations to at least 90 percent of preschool children. "There's been a widespread mistaken belief that we have... infectious diseases under control, and I think this has led to not just complacency but letting our guard down," said Tom Inglesby, director of the UPMC Center for Health Security. The risks are real, the report's authors conclude. Food-borne and water-borne illnesses result in 128,000 hospitalizations and around 3,000 deaths each year, for example. Diseases that were considered either eradicated or no threat to the U.S., such as dengue fever and tuberculosis, which racked up nearly 10,000 cases in the U.S. last year, have been rebounding. And each year more than two million Americans develop antibiotic-resistant infections to diseases like Salmonella, and at least 23,000 die. Jeffrey Levi, the executive director of Trust for America's Health, put the cost of infectious diseases to taxpayers at$120 billion a year. States received a point for meeting each objective measured. On a ten-point scale, a majority of states scored five or lower. New Hampshire performed the highest at eight. Seven states, including New York, North Carolina and Oregon, scored seven points. A total of 15 states scored five points, the most of any category. Georgia, Nebraska and New Jersey scored the lowest at two points. • 0°. , MAJOR INFECTIOUS THREATS AND KEY FINDINGS .x ,.s 01 • sv N. OR r. srr�' wy i ,,,,.va N.\ FE 11 NWMill :1 ce. 11FAMWriifc ri jal �,.,* 61 Ta ` -� jjj ' �J 5 S4.1.v--r"– . 7 4 a ii SCOW BY MATE 1 7 5 —441111. 2 (i die) (I them) (15 states) (3 deems) Neva-lamps-ire Conner cur C;t=race Alaska Alabama Arizona Georgia 1e-aware D.C. California Indiana Arkansas Nebraska New York Haws i i Florida Kansas Idaho New;ersey Noon Carolina Mania'.: Illinois Kentucky Montana C?egon M--escta :.a Mississiooi Nevada Rhode Island M ssouri __Lisiana North Daiota Wyoming Washington I<--.=.Y..an:a Maine Ohio Tennessee Massachusetts Texas V rginia Michigan Utah New Mexico West.Virginia Oklahoma SoCarotica • South Dakota Vermont Wisconsin The budget picture for public health in recent years has been bleak. A total of 33 states cut funding for public health over the past two fiscal years, some by as much as 30 percent. Sixty percent of state programs have laid off staff and more than 90 percent have lost staff through attrition. The report notes that public health is funded on a year-by-year basis, so it's especially vulnerable to the kinds of cuts that have been a staple of the years following the Great Recession. State public health departments also depend on funding from the federal government and the CDC, and both sources have decreased in recent years. 17 stabs i.neased ar mearialedpialk ieelli 33 Haus and D.C.cot miic badti Percentage of State and Territorial brim free Fr 21111 to 2012 kat 2012-*ilia 8 hoe Ff 2011.le 2012 to Fr 2012 to 2013 Health Agencies Experiencing Reduced (1 vim). (atErb). Workforce Capacity and Programs. Alaska(14.1%) Alabama(-7.1%) Missouri(5.3%). December 2012 and Cumulatively Colorado(20.7%) Arizona(-1.3%)A Montana(-1.8%)A (since July 2008) Connecticut(9.9%) Arkansas(-4.0%)* Nebraska(-LS%)" Georga(6.0%) California(-6.2%) Nevada(-0.5%)A Reou:ed Iowa y1.8%; Delaware(-0.7%) New Jersey(-562%)A Services MI 20% Louis s a(2.6%) O.C.(-1.8%) New Mexico(4.1%)A Michi6,+a'(6.3%) Honda(-8.8%)' New York(-3.9%) EntireMississippi(22.6%) Hawaii(-8.2%) North Carolina(-17.1%) Programs Cut 646 New Hampshire(8.4%) Idaho(-2.3%) Ohio(-2.3%)• North Dakota(32.5%) Illinois(-4.0%)" Oklahoma(-4.1%) MemoryMIR° Oregon(18-1%) Indiana y-1.13%) South Dakota(-1.494)" Furlough 646 Pennsylvania(1.6%) Kansas y-3.9%)^ Tennessee(-0.9%)' Rhode Island(6.3%) Kentucky(-3.1%)A Virginia(4.4%)A Lass of Staff South Carolina(0.9%) Maine(-10.6%)* Washington(-29.5%)x oy Attrition223 Texas(2.7%) Maryland(-1.1%)^ West Virilia(-18.6%)" Utah(12.6%) Massachusetts(-0.6%) Wisconsin(-1.2%) Layoffs X24 Vermont;14.8%) Minnesota(-1.2%) Wyoming(-0.6%) • 20% Lo% oo 100% NOTES:Bolded states did not respond to the reply by that date were assumeda�o to be in car- data check?FAH coordinated with ASTHO that dance with the findings. ■CurLlative lz ■G ec-12 was sent out October 24,2013. States were 'Budget decreased for second year in a row even unto December 3.2013 to confirm or cur- "Budget decreased for third year in a row rest the information. The states that cid not A recent National Association of State Budget Officers study put revenue growth at less than one percent in the next fiscal year. State spending is expected to increase 3.8 percent, and with so many competing 10 demands following years of cuts, carving out space for public health is far from a given. States should still take a hard look at their current levels of spending, ask what more they can do and whether they're spending existing support in the most efficient way, Levi said. For instance, providing vaccinations is now the responsibility of insurers under the Affordable Care Act, which frees up money in local health departments for other initiatives. "Some of the delivery dollars that have been spent in the past can be reoriented to educate the public to take advantage," he said. Find the full report here. This article was printed from: http://www.governing.com/topics/health-human-services/gov-public- health-departments-falling-behind.html • A. JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION GREEN=NEW/ADDED IN 2014 RED=DELETED/REMOVED IN 2014 ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information iliERAL Ith Officer Administrative Hearing 309.00 Administrative Hearing Appeal 309.00 Technical Assistance/Plan Review-Minimum 67.00 Technical Assistance/Plan Review- Per Hour 67.00 Filing Fee 53.00_ Notice to Title Rescissic,. ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 561.00 Valid for 3 years New Alternative 668.00 Valid for 3 years New septic tank and/or pump chamber only 266.00 Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D. (base fee) 561.00 Plus$88 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 668.00 Valid for 3 years Alternative 715.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 124.00 Applies to existing installed sewage disposal system Expansion 418.00 Redesign 124.00 Applies to pending or active but not installed Reinspection 155.00 Evaluation of Existing System/Monitoring Inspection Septic system only 309.00 Septic system plus water sample 322.00 Retest/Reinspection 108.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 309.00 Septic Permit with SPAAD(conventional) 302.00 Septic Permit with SPAAD(alternative) 418.00 Subdivision Review Base Fee 401.00 Plus$79.00 Per Lot aka ndary line adjustment review fee 158.00 Plus$79.00 Per Lot _ MIIPE application meeting fee 158.00 Planned rural residential development review fee 158.00 Density exemption review fee 79.00 Density exemption review fee requiring field work 158.00 Other WaiverNariance Application 186.00 WaiverNariance Hearing 309.00 Wet season evaluation 418.00 Revised building application review fee 158.00 New building application review fee: Residential 79.00 Commercial 158.00 General environmental health review fee 79.00 Licenses Installer, Pumper, Operator(maintenance person) 418.00 Retest 170.00 Homeowner Authorization 10.00 Annual Renewal 294.00 Delinquent Renewal after January 31 418.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit) Restaurants/Take-Out(Based on menu complexity&seating-menu changes may change category) 0-25 seats(Limited Menu) 188.00 No cooling or reheating 0-25 seats(Complex Menu) 334.00 Cooling and reheating allowed 26-50 seats 334.00 51-100 seats 401.00 101-150 seats 455.00 Withlirih Lounge, add 147.00 Separate lounge area B ry Business 147.00 188.00 C er w/commissary or catering-only kitchen 334.00 w/restaurant, additional fee for catering 188.00 Concession/Commercial Kitchen/Church 147.00 Espresso Stand 147.00 1 of 3 GREEN=NEW/ADDED IN 2014 REG=DELETED/REMOVED IN 2014 ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information Grocery 1-3 checkouts 188.00 May serve pre-packaged baked goods >3 checkouts 455.00 • Meat/Fish Market 334.00 Mobile Unit • Limited Menu 188.00 No cooling or reheating Complex Menu 334.00 Cooling&reheating allowed School Cafeteria Central Kitchen 334.00 Warming Kitchen 188.00 Tavern w/food(see Restaurants) Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee Temporary Permits Single Event, Limited-Menu Initial Application(First Event) 106.00 Not to exceed 21 days at your location Additional Events(Same Menu Only) 60.00 Not to exceed 21 days at your location 46499 --146-.00 ' - _ ___- -- - - --- •- • • Cemplex-PAGnu -440-90 • - - _ _==e -- - - - • -X16.00 - _ -__- - - e. -- - �1"�^�w • - - _ _ - -- Organized Recurring Events(e.g. Farmers Markets) Limited-Meng' Limited Menu 106.00 Not to exceed 3 days a week at a single location X00 - 6.09 Complex-Menu Complex Menu 140.00 Not to exceed 3 days a week at a single location -140-00 Not to exceed 3 days a week Late Fee for Temporary Permits +50%of fee Additional(Paid when application is submitted less tha • days prior to the event) Other Food Fees Permit Exemption 40.00 WaiverNariance 67.00 Per Hour Reopening Fee 67.00 Per Hour Manager's Course 227.00 Plan Review Pre-opening inspection 67.00 Per Hour Minimum 67.00 Per Hour 67.00 Reinspection First Inspection 94.00 Each inspection after first 160.00 • Food Handler Card Reissue Unexpired Food Handler Card 10.00 SOLID WASTE Annual Permit Fees Landfills requiring environmental monitoring 548.00 Biosolid/Composting Facilities 481.00 Inert Waste Landfills 348.00 Other Solid Waste Facilities 348.00 Drop Boxes 160.00 Miscellaneous Fees New Facility Application 441.00 Exempt Facility Inspection 348.00 Facility Reinspection 50%of fee Plan, Document and WaiverNariance Review 271.00 +$67.00/hour for>4 hours • WATER Application Fee 160.00 Inspection of well construction, decommission& • reconstruction Determination of Adequate Water Supply 67.00 Building Permit Process Well Inspection&Water Sample for Loan 135.00 Well Site Inspection-Proposed public water supply 321.00 2 of 3 GREWN=NEW/ADDED IN 2014 RED=DELETED/REMOVED IN 2014 ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information LIVING ENVIRONMENTS Water Recreation Facilities Operation Permit Single Swim Pool(in operation for<6 months of the year) 291.00 (as described in WAC 246-260) Single Swim Pool(in operation for>_6 months of the year) 294.00 Single Spa Pool(in operation for<6 months of the year) 255.00 (as described in WAC 246-260) Spa Single Spa Pool(in operation for>_months of the year) 294.00 Single Wading Pool(in operation for<6 months of the year) 211.00 (as described in WAC 246-260) Single Wading Pool(in operation for>_6 months of the year) 371.00 (as described in WAC 246-260) Spray Pool or Pools(in operation for<6 months of the year) 105.00 (as described in WAC 246-260) Spray Pool or Pools(in operation for a 6 months of the year) 159.00 Each Additional Swim, Spa, or Wading Pool(in operation for<6 months of the year) 63.00 Each Additional Swim, Spa, or Wading Pool(in operation for>_6 (as described in WAC 246-260) months of the year) 84.00 (as described in WAC 246-260) 40-1-00 Reinspection 67.00 Per Hour plus associated lab costs Plan Review 67.00 Per Hour Indoor Air(Tobacco) Compliance Enforcement 67.00 Per Hour Reinspection 79.00 Rebuttal Application 158.00 Note: 2013 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW). The CPIW is the Consumer Price Index-US City Average for All Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adjustment shall be calculated as follows: each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases wit be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. • • 3 of 3 • Statement to Jefferson Co. Board of Health December 19, 2013 Peter Lauritzen 325 33rd St Port Townsend, WA 98368 I am asking the Board of Health to stop allowing the Port Townsend Paper Mill to continue to stall and stall in renewing their landfill permit. The Mill has been operating without a valid permit now for many years and they appear to be manipulating the permit process to continually extend the period before they are required to comply with State Law. They tried a series of litigation steps and that extended the need to comply for a year and a half. Now, they are starting mediation, giving them almost another year to comply. Why can't the Mill become a responsible member of our community and simply comply with the state- mandated requirements for a Limited Purpose Landfill? We need assurance from the Board of Health that they will hold the Mill to • 1) assume financial responsibility for the landfill if it closes, and to 2) provide state-MANDATED groundwater monitoring around the landfill site. • State plan from today's BOH This email is being sent on behalf of Karen Merrikin,State Health Care Innovation Planning Project Director. Dear Feedback Network Member, Eight months ago, Washington State accepted the challenge of outlining a plan to transform health and health care delivery for its residents and communities with the support of a nearly$1 million grant from the federal Center for Medicare and Medicaid Innovation (CMMI). Today, it is our pleasure to share with you the result of months of discovery and engagement with hundreds of public and private thought leaders: Washington State's Health Care Innovation Plan. This five-year strategic vision for the state charts a bold course for transformative change that links clinical and community factors that support health, spreads effective payment and care delivery models, and has the potential to generate more than $730 million in return on investment over the first three years. Washington's plan is a living document, intended to be adjusted and informed through ongoing collaborative work. It builds on excellent innovations already initiated in our state by private and public organizations and creates a framework for spreading that work in order to achieve system-wide change. While the plan outlines specific aims, strategies and tactics,the path and methods to achieve them are ready to be more fully developed through a collaborative approach that relies heavily on the continued input of Washington's public and private thought leaders. • • Executive Summary (5 pages) • Full Innovation Plan (110 pages plus appendices) We are sharing the Innovation Plan with you, as a Feedback Network member, prior to its broader public release later today. The Innovation Plan is intended as a state plan—not a Health Care Authority or Governor's office plan—and we enthusiastically welcome your ongoing feedback and dialogue as we look toward implementation activities and the anticipated CMMI testing grant opportunity early next year. As we move forward, we will continue to use the Feedback Network to share and gather information. If you know others who would like to be added to that list, please invite them to submit a request to simquestions@hca.wa.gov. With appreciation and warmest regards, Karen Merrikin Project Director State Health Care Innovation Plan (SHCIP) Correspondence to: simquestions@hca.wa.gov 360-725-1447 • em Please note - ALL events on city property require proof of liability insurance and a damage deposit 411/ CITY OF PORT TOWNSEND o�QORr rosy FACILITY USE PERMIT ,� ��: y11% Pope Marine Park Building, Chetzemoka Park Gazebo/Shelter, Cotton Building Submit application to: City of Port Townsend Phone: (360)379.5047 . = f.1 250 Madison St., Suite 2 Fax: (360)385-4290 ` vtras ' Port Townsend,WA 98368 This is a Facility Use Permit and does not substitute for,or replace a City of Port Townsend Special Event Permit. l'IP3/13 APPLICATION DATE: Resident ✓ Non-Profit Non-Resident For Profit REQUESTED RESERVATION DATE: 17 t to f I y" APPLICANT NAME: IVERy CAT-14\i L' LAST FIRST MIDDLE ADDRESS: 11:16- 5 - A ST R012-1" TbwtJSEND , WA STREET CITY ZIP CODE TELEPHONE NUMBER: 3v5 3S —� HOME fin WORK CELLULAR E-MAIL: C-C-VP�r y °'• Co . t e-Ner-3o ri . W A. lel S ORGANIZATION REPRESENTED BY APPLICANT: St✓.FEE.P-5c51`1 COLA NTY 3 uC El EA EVENT: bQ6cA Q- b e ►-1 E Fa t T W FACILITY REQUESTED:(circle your requested facility) Pope Marine Building Cotton Buildin Chetzemoka Gazebo ONLY Chetzemoka Kitchen Shelter ONLY Gazebo AND Shelter EVENT TIME: Time In A' 60 Time Out ' 67)(Chetzemoka may be reserved for no more than five hours per day by any one group) ESTIMATED NUMBER OF PEOPLE ATTENDING: Comments/Details: NAME OF INSURANCE COMPANY,TELEPHONE NUMBER AND POLICY NUMBER(Attach copy of policy to this application): K1S t)WL. FOOD SERVED? ❑YES 140 ALCOHOL SERVED? ❑YES(ATTACH WSLCB LICENSE&LIQUOR LIABILITY INSURANCE ENDORSEMENT) �0 AMPLIFIED SOUND? ❑YES '0 (No amplified sound is allowed without prior approval by City of Port Townsend) Facility Use Permit 2011 1 40 INSURANCE—Commercial General Liability required for all events held on City property with 50 or more people or alcohol I food or open to the general public. Proof of liability I homeowners insurance for all other events. lioThe City does not maintain insurance that will respond to claims against the applicant arising out of the event. Evidence of insurance acceptable to the City of Port Townsend must be provided no less than 15 days prior to the event,covering the activities and dates of the event. "City of Port Townsend" must be named"additional insured". Coverage shall be primary for the City. Minimum limits as applicable: $1,000,000 Commercial General Liability(and coverage for liquor liability if alcohol is sold or available at the event). Insurance shall state it cannot be cancelled without 10 days written notice to the City. Limits and coverage may be adjusted to meet exposure as determined by the City Manager. Facilities Reservation will not be finalized until insurance has been approved. initials PICK UP KEY AT ADMINISTRATION OFFICE DURING REGULAR BUSINESS HOURS Administration is located on the second floor of City Hall,250 Madison St. Regular business hours are Monday through Friday,8 a.m.to 5 p.m. Some holiday closures may apply. CONDITION OF FACILITY AFTER USE AND MAINTENANCE/DAMAGE DEPOSIT All chairs and tables cleaned,stacked and stored/picnic tables wiped clean. Floors swept. All garbage in proper receptacles or hauled away. All decorations removed. The key must be returned to City Hall or deposited in the Utility Drop Box in a timely manner.When the key is returned and Parks or Maintenance is satisfied with the condition of the facility,then we will start the reimbursement process for your Maintenance/Damage Deposit. If the key is lost,replacement costs will be deducted from the Maintenance/Damage Deposit. If any maintenanceldamage occurs that is not covered by the deposit,a claim may be made against your insurance. initials INSPECTION Applicant consents to entry and inspection during event by City employees or officers,or their representatives,for purposes of determining compliance with the terms of permit and regulations. HOLD HARMLESS Applicant/Permittee/User shall defend,indemnify and hold harmless the City of Port Townsend,its officials,employees and volunteers from and against any and all claims,suits,actions or liabilities for injury or death of any person,or for loss or damage to property,which arises out of or in connection with the Applicant/Permittee/User's activity or event,including use of any premises,or from any activity,work or thing done,permitted,or suffered by ApplicantlPermitteelUser in connection with the Applicant/Permittee/User's activity or event,including use of any premises,except only such injury or damage as shall have been occasioned by the sole negligence of the City of Port Townsend. initials AGREEMENT AND ACKNOWLEDGEMENT This application must be completed,signed and submitted to the City Manager's Office. Applicant by signing below agrees and acknowledges that applicantlorganization is bound by the terms and representations of this Application and that it will comply with the Conditions of Approval set forth,and the terms of any other required permit. Applicant further agrees on behalf of the reserving group to abide by the general use regulations of PTMC •Chapters 3.37 and 3.38 PTMC as a condition to reserving the facility. Any misrepresentation in this application or deviation from the final agreed upon method of operation described in this application,or failure to comply with conditions,may result in the immediate revocation of facility use permit. This application does not constitute an approval until the City below grants Final Approval in writing. Upon approval,a copy of this Application and signed FINAL APPROVAL must be pr- :nt at th• event. APPLICANT SIGNATURE l 0 "" DATE: 1'2 ) 3 ) 1 See"Fees and Policies"for fee and ,, .•osit schedul . City Use Below This Line Please attach copies and receipts as needed Reservation date: -=Proof of Insurance-Due date: Date received: _;WSLCB Permit obtained—Due date Date received: E Facility Use Fee Amount Due date: Date received: i Maintenance/Damage Deposit Amount Due date: Date received: L!Maintenance/Damage Deposit refund requested from Finance -1 Key Number Issued Date Issued Issued To Key Returned Date Returned Reservation Granted Yes No City Personnel Signature 11111 Facility Use Permit 2011 2