CHAIRPERSON HUMAN SERVICES COMMITTEE VICTOR G. CELENTINO MARK GREBNER, CHAIR REBECCA BAHAR-COOK VICE-CHAIRPERSON CURTIS HERTEL, JR. LISA DEDDEN LISA DEDDEN ANDY SCHOR VICE-CHAIRPERSON PRO-TEM MIKE SEVERINO MIKE SEVERINO

INGHAM COUNTY BOARD OF COMMISSIONERS P.O. Box 319. Mason, Michigan 48854 Telephone (517) 676-7200 Fax (517) 676-7264

THE HUMAN SERVICES COMMITTEE WILL MEET ON MONDAY, JUNE 5, 2006 AT 7:00 PM, IN THE PERSONNEL CONFERENCE ROOM (D & E) OF THE HUMAN SERVICES BUILDING, 5303 S. CEDAR, LANSING.

Agenda

Call to Order Approval of the May 15, 2006 Minutes Additions to the Agenda Limited Public Comment 1. Interviews - Capital Area District Library

2. Health Department

a. Report from Gary Packingham, Vice President – Community Health Ventures b. Community Meeting on Health and Social Justice c. Presentation and Dialogue Regarding Food Safety Program – Dr. Dean Sienko and Jim

Wilson – no material d. Resolution to Amend Resolution #05-307 (Resolution to Authorize an Agreement

with the National Association of Child Care Resources and Referral Agencies) e. Resolution to Authorize a Child Care Training Agreement with the Michigan 4C

Association f. Resolution Appointing Suganda Lowhim, M.D. as Deputy Medical Examiner g. Resolution to Authorize Subcontracts to the Infant Health Disparities Initiative Grant h. Resolution to Establish Positions to Implement the Point of Sale Regulation i. Communication - Possible Lease Agreement with Lansing Community College

3. Controller’s Office – Resolution Updating Various Fees for County Services 4. Board Referral – Resolution from Bay County Addressing the Need for Congress to Prioritize Health Care for Uninsured Americans Announcements PLEASE TURN OFF CELL PHONES OR OTHER ELECTRONIC Public Comment DEVICES OR SET TO MUTE OR VIBRATE TO AVOID Adjournment DISRUPTION DURING THE MEETING The County of Ingham will provide necessary reasonable auxiliary aids and services, such as interpreters for the hearing impaired and audio tapes of printed materials being considered at the meeting for the visually impaired, for individuals with disabilities at the meeting upon five (5) working days notice to the County of Ingham. Individuals with disabilities requiring auxiliary aids or services should contact the County of Ingham in writing or by calling the following: Ingham County Board of Commissioners, P.O. Box 319, Mason, MI 48854 Phone: (517) 676-7200. A quorum of the Board of Commissioners may be in attendance at this meeting. Meeting information is also available on line at www.ingham.org

HUMAN SERVICES May 15, 2006

Minutes Members Present: Mark Grebner, Rebecca Bahar-Cook, Curtis Hertel, Lisa Dedden, Andy

Schor and Mike Severino Members Absent: None Others Present: John Neilsen, Bruce Bragg, Dr. Sienko and Robin Turner The meeting was called to order by Chairperson Grebner at 7:04 p.m. in the Personnel Conference Room of the Human Services Building, 5303 S. Cedar, Lansing. Approval of the May 1, 2006 Minutes The May 1 Minutes were approved as submitted. Absent: Comm. Severino Additions to the Agenda 1.5 Update – Bravo Restaurant Limited Public Comment: None 1. Interviews – Community Health Center Board The Committee interviewed Sarah Steele and Lacretia Bruner for a position on the Community Health Center Board. (Comm. Severino arrived at 7:09 p.m.) Ms. Turner, Community Health Center Board, informed the Committee that Ms. Bruner has not yet been interviewed by the Community Health Center Board. After a brief discussion, the Committee decided to postpone making a recommendation until it receives a recommendation from the Community Health Center Board regarding Ms. Bruner. MOVED BY COMM. BAHAR-COOK, SUPPORTED BY COMM. HERTEL, TO TABLE THIS COMMITTEE’S APPOINTMENT RECOMMENDATION TO THE COMMUNITY HEALTH CENTER BOARD TO A FUTURE MEETING. Chairperson Schor stated Ms. Bruner should be interviewed by the Community Health Center Board so that this Committee’s appointment recommendation will be made through an equitable process. Comm. Bahar-Cook withdrew her motion. Comm. Hertel withdrew his support of the motion. MOVED BY COMM. BAHAR-COOK, SUPPORTED BY COMM. HERTEL, TO REFER LACRETIA BRUNER’S APPLICATION TO THE COMMUNITY HEALTH CENTER

BOARD FOR AN INTERVIEW AND A RECOMMENDATION. THIS COMMITTEE WILL MAKE ITS RECOMMENDATION ONCE IT RECEIVES THE COMMUNITY HEALTH CENTER BOARD’S RECOMMENDATION. MOTION CARRIED UNANIMOUSLY. 1.5 Bravo Restaurant – Update Dr. Sienko updated the Committee regarding the Bravo restaurant recent food-born illness situation. The Health Department received a few phone calls on May 8, 2006 from people who had been to Bravo and then became ill. MSU had graduation ceremonies that same weekend so there were many people dining out at restaurants. Symptoms appeared 24 to 48 hours after dining at Bravo. The symptoms lasted one to two days. Approximately 50 phone calls from Bravo diners were received by May 11. Dr. Sienko explained the diners experienced a Norwalk-like virus, the same virus which affected diners at Carabbas. Dr. Sienko explained the illness was caused by an ill restaurant employee. These employees do not have health insurance or paid sick leave. The Department made a determination to have Bravo close its restaurant to determine what had happened to make the diners ill. Once this incident was made public, over 300 more phone calls were received by the Health Department. Three diners were hospitalized due to dehydration. Dr. Sienko stated Bravo had not faired well during its last few inspections. Bravo is following up on the Departments recommendations. Test results should be available in a few days. Comm. Schor asked who made the initial call to the Health Department regarding the illness. Dr. Sienko stated restaurant diners reported the illness to the Department. Comm. Severino asked about the placebo affect in these situations. Dr. Sienko explained a few of the calls could have resulted from a placebo affect. Comm. Hertel asked if the ill diners ordered the same meals. Dr. Sienko explained the Department is not that far into its investigation to make those determinations. More time and effort will be needed to determine which restaurant employee was ill and then the actual food item(s) involved in the incident. Chairperson Grebner asked if Bravo is cooperating with the Department at this time. Dr. Sienko explained that once Bravo’s corporate people became involved, the cooperation level increased. Chairperson Grebner asked if the Department held private interviews with the restaurant employees. Dr. Sienko stated he would have to check into that issue. Chairperson Grebner suggested the Department consider conducting off-site employee interviews in the future. Chairperson Grebner asked why the ill diners did not pass the illness on to their families. Dr. Sienko explained the illness does spread through the families, the schools and the diners’ places of employment. Many illnesses such as the Norwalk virus remain under the Department’s radar. 2. Health Department – Resolution to Authorize Amendment No. 2 and Amendment No. 3

to the 2006 Comprehensive Plan Budget and Contract with the Michigan Department of Community Health

2

MOVED BY COMM. SEVERINO, SUPPORTED BY COMM. DEDDEN, TO APPROVE THE RESOLUTION TO AUTHORIZE AMENDMENT NO. 2 AND AMENDMENT NO. 3 TO THE 2006 COMPREHENSIVE PLAN BUDGET AND CONTRACT WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH. Disclosure: Comm. Hertel stated he works with the Department of Community Health. MOTION CARRIED UNANIMOUSLY. 3. Controller’s Office – Discussion – 2007 Update on Fees: Draft – Resolution Updating

Various Fees for County Services Mr. Neilsen stated the annual review of the Fees has been completed and some adjustment recommendations have been made for consideration by the liaison Committees. The Committees will consider a resolution to adopt the new Fee schedule at their next meetings. Mr. Neilsen stated the Health Department is a major contributor to the County’s fees. Comm. Bahar-Cook asked why the proposed fees are rounded down from the calculated fees. Mr. Neilsen explained the Board of Commissioners adopted this methodology. Comm. Dedden asked if the department concerns have been resolved. Mr. Neilsen stated he will update the Committee regarding this issue at its next meeting. Announcements: None Public Comment: None The meeting adjourned at 7:46 p.m. Respectfully submitted, Debra Neff

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Agenda Item 2a MEMORANDUM

To: Human Services Committee From: Bruce Bragg Date: May 30, 2006 Subject: Report from Gary Packingham – Community Health Ventures Gary Packingham, Vice President of Community Health Ventures, Inc. made a presentation at the May 1, 2006, Human Services Committee meeting regarding the challenges of marketing the Ingham County Advantage (third-share) product. Community Health Ventures has been contracted by the Ingham Health Plan Corporation to develop and implement a marketing plan for the Ingham County Advantage product. At the end of the presentation, several Commissioners asked Mr. Packingham to put his observations and recommendations in writing. He has done that and his communication is attached. His report will also be provided to the Ingham Health Plan Corporation Board for consideration. You will note that Mr. Packingham does not make specific recommendations. Rather, he identifies a set of challenges he has found as he attempts to market Ingham County Advantage, and similar third-share products around Michigan. In his summary statement, Mr. Packingham suggests that the third-share programs are not insurance products and that they can be modified. The Ingham County Advantage product is an insurance product, while the Muskegon and Wayne County models are not. Ingham Advantage can only be modified by negotiating with U.S. Health and Life Insurance Company. I will be happy to convey recommendations of the Committee to the IHP Board. Attachment

Agenda Item 2a

Memo To: Ingham County Advantage Laura Peterson, Director Bruce Bragg From: Gary Packingham, Vice President – Community Health Ventures, Inc Date: 5-12-06 Re: Criteria Change Opportunities In response to the request from the Ingham County Board, Health and Human Services Committee, CHV has prepared the following suggestions on changes to eligibility criteria that would likely improve sales. These are all reflections of barriers to sales that we have encountered in Ingham County. The solutions proposed here reflect comments on similar changes to eligibility criteria implemented in other Michigan three share programs. This also includes comments from the ICA sales personnel. Each of the relevant criteria is reviewed with comments on what the sales barrier issues are, and follows with a proposed solution. In addition to these eligibility criteria that have handicapped some sales opportunity, there has also been a discussion on the cost of the program to the business owner. There is not a consensus on what a price point should be, when other programs are surveyed and asked this question. Ingham County does have the highest monthly cost at $67. Wayne County Four Star is priced at $56 per month, and Muskegon’s Access Health is priced at $46 per month. Access Health’s growth was primarily during better economic times. They have maintained about 1,100 members as they have become a known and trusted product that is sustaining harder economic times. Wayne County Four Star has been on the market for just less than one year and has witnessed very slow growth, despite heavy investments into advertising (above $200,000 now.) Four Star has about 100 members and all data indicates that the primary problem is the overall economic concerns in the small group market. According to the staff at the Detroit Chamber of Commerce, the number one Chamber in the country, no small group insurance products are selling in Michigan. Price point may be secondary to the larger issue of economic uncertainty. Nonetheless, it is worth reviewing and testing the market for the impact of a lower price point in Ingham County. More importantly, the eligibility barrier issues could do much in opening up access to ICA. These must be balanced with sound actuarial considerations. The list of issues and solutions discussed below attempt to provide the decision makers of ICA with the data to improve the prospects of ICA and better serve to small business and uninsured working populations of Ingham County. 1099 Employees: The Plan requires that eligible employees be W-2 employees.

DISCUSSION: Approximately 16% of the uninsured businesses contacted by the ICA call center operation were employers with 1099 employees (contract labor.) Typically these are businesses like hair salons, realtors, landscaping, or small construction firms. They represent a significant portion of the uninsured market in communities. The Health and Human Services Committee asked about expanding enrollment to include 1099 employees.

BARRIER ISSUES 1) Administrative burden of verifying income to meet Plan eligibility criteria: In the case of

W-2 employees a business can readily provide documentation to support the hourly pay rate. 1099 employees do not always receive weekly paychecks (realtors, consultants, etc.) Expansion of criteria to include 1099 employees creates an administrative burden in verifying the income eligibility.

2) Lack of Workers Comp Coverage: Typically 1099 employees do not participate in Workers Comp programs. While there is not a current ICA requirement for a participating business to carry Workers Comp, other three-share programs do require this. In the case of roofing contractors who are 1099 employees, for example, the plan would be at-risk for work related accidents if these employees did not carry their own Workers Comp Coverage. If the underwriter were to require that participating businesses have Workers Comp, then this may become a prohibiting issue. At present, it is not a barrier in Ingham County.

SOLUTIONS

1) Income Verification: Just like a home mortgage lender, verification can be done by requiring that the member provide a copy of last year’s tax return (top page of Form 1040) annually. Based on an average work week of 40 hours, the income test can be met if a 1099 employee earns less than $24,000 annually, for example.

2) Workers Comp Coverage: Absent a prohibition regarding Workers Comp, ICA could follow the example of Priority Health with pre-existing conditions. During Open Enrollment, Priority opens eligibility to a limited number of new members with pre-existing conditions. This expands coverage to the uninsured and minimizes the risk exposure with a cap on this classification of enrollees. ICA may want to open enrollment up to 1099 employees, capped at 30 members, until the program grows to 200 members, for example.

75% Enrollment Criteria: The Plan’s underwriter requires that a minimum of 75% of uninsured, eligible employees participate before a business can qualify for membership in the Plan. DISCUSSION: The intent of these minimum participation rules is to maximize enrollment in small

group markets. This practice mitigates the adverse selection possibilities and, for commercial products, maximizes the commission opportunities for products sold through brokers. In the case of three share products that specifically target micro sized businesses, it has the unintended consequence of handicapping enrollment.

BARRIER ISSUES

1) All or nothing participation: Many micro-sized businesses have three or fewer uninsured employees. To meet the 75% rule, this would require that all three, in this example, would need to enroll. If only two opted to join, that’s only 66%.

2) Compliance Problems: After a business enrolls, it is possible that an employee dis-enrolls from the plan due to job or lifestyle changes (marriage to an insured spouse.) These changes may result in the firm’s inability to meet the 75% rule and cause the contract to no longer be valid.

SOLUTIONS

1) Change to 50% eligibility: Muskegon encountered these problems earlier and adopted a change to a 50% eligibility rule for businesses with fewer than 4 uninsured, eligible employees. The ICA underwriter may not initially agree to this change for actuarial reasons, however, the nature of three-share models is that they are not commercial plans. They are, instead, hybrid models with some commercial features and some self-insured features. As a hybrid model they have the flexibility of making rules to test actuarial assumptions. In the case of Muskegon where the threshold of eligibility has been lowered, the actuarial results have not been compromised.

Existing Coverage Criteria: Businesses that currently, or have in the past 12 months, offered insurance to employees are not eligible for ICA.

DISCUSSION: When three-share products were developed in Michigan in the mid 1990s, one concern among policy makers was that they would compete with commercial products, resulting in business decisions to “dump” commercial coverage and enroll in three share programs. With double digit premium increases through much of the 1990s, many in the small group market have been forced to either drop coverage or convert to a high deductible product. For many, high deductible plans are the same as no coverage at all. Generally, the target employee market for three-share products cannot afford high deductible plans offered by an employer and remain uninsured just as much as if the business were not offering any form of coverage at all. BARRIER ISSUES

1) Unintended Consequences: In reality, the goal of reducing the number of uninsured is adversely impacted by the effort to avoid competing with commercial products where those products are high deductible plans. In this case, the ICA eligibility criteria has the unintended consequence of preventing some low income workers from having access to affordable health coverage. Where a business can only offer a high deductible plan, those employees are not eligible for ICA even though they cannot afford the high deductible offered.

SOLUTIONS

1) Leveling the playing field: ICA may want to explore a variation of the criteria adopted by Muskegon’s Access Health. In recognizing the need to level the playing field in the small group market, Access Health allows businesses with uninsured workers to enroll in the plan if their only other option is a high deductible plan where the deductible is greater than $3,000 annually for an individual or $5,000 for a family. The business owner is not forced to drop the other high deductible coverage, but could have that option (in fairness to those employees who are insured by the high deductible plans.) This approach gives ICA an improved opportunity to reach those workers in small businesses who are uninsured only because of ICA’s restrictive eligibility criteria.

Length of time in Business: Presently, a firm must be in business at least two years before becoming eligible for ICA coverage.

DISCUSSION: Three-share programs, when originally discussed in the State Legislature, were promoted as both a mechanism to reduce the number of working uninsured, but also as an economic development tool for small businesses that compete with national chains stores for skilled labor. While much of the recent focus has been on the need to address the problem of the working uninsured (paying taxes and yet earning too much to qualify for Medicaid), the opportunity to address the economic develop of small businesses must not be over looked. This week ICA was contacted by a day care center that had originally sought ICA coverage two years ago when the program was first announced. Since they were a new start up business, they were not eligible. When they saw the billboards this month, it reminded the owner that they now were about to celebrate their two-year anniversary and would now be eligible for coverage. The owner contacted the ICA sales staff and has begun the application process. BARRIER ISSUES

1) Restrictive eligibility time: The intent of the 2-year waiting period criteria is to have assurances that the member business will have sufficient capability to pay the premium, much like a credit check by a lender. The problem here is that it prevents ICA from being offered as an economic development tool to new businesses that most need this type of assistance. Start up businesses, like day care centers, have the most difficulty in being able to afford

commercial coverage and are in need of an economic development tool like ICA. The 2-year eligibility criteria punishes, rather than assists, these small entrepreneurs in the community.

SOLUTIONS 1) Proactive eligibility waiting period: Changing the employer’s “length of time in business”

criteria to be analogous to the waiting period for a new employee would mean that a new business could be eligible for coverage in three months, for example. This change was made in Muskegon a couple years ago in recognition that new small businesses benefited from this in terms of economic development. Having health benefits enabled start up businesses to attract the type of employee needed to make a business successful.

2) Moderating the eligibility time: The downside of the statistics in Muskegon has been that 80% of those businesses no longer participating in Access Health have dropped out because they went out of business. It is a well-accepted fact that most small businesses fail in the first year. Based on the liberal criteria of Muskegon, it would appear that the lack of health coverage is not a primary reason for small business failures. A six-month waiting period for new businesses may actually be long enough to both help start up businesses and to mitigate against the high failure rate.

3) Working with economic development: in Wayne County the Four Star program is aggressively working with local Chambers and government economic development staff to make certain that every new business has a packet of information on the affordable health coverage. In Muskegon the information is provided to new businesses moving to the community as an economic development incentive (the ability to locate in a community where health costs can be lower.)

Business Size: The current criteria limit the eligibility to those businesses with fewer than 20 employees. Some flexible interpretation of these criteria enables larger groups to participate, if the uninsured category of employees is less than 20.

DISCUSSION: The intent of these criteria was to insure that larger businesses would not end up taking advantage of the subsidy nature of the three-share program. However there are problems associated with a cap of 20 on the business size eligibility criteria. BARRIER ISSUES:

1) Double constraints - In combination with the 75% rule mentioned above, the net effect of the size limiting criteria is that fewer businesses can meet the test of both criteria. The cap on 20 employees forces the plan to market to predominantly micro-sized businesses. The constraint of the 75% rule then eliminates many of these micro-sized businesses from having enough eligible employees. The double constraint of capping the top and raising the bottom end threshold reduces the overall number of businesses that could participate.

SOLUTIONS:

1) Relaxing the size constraint - Wayne County Four Star addressed the business size problem by increasing the cap to 50 employees. Muskegon opted to define the business size as small to mid-sized, without setting a quantitative criteria. In both cases, the objective was to increase the number of eligible businesses to increase enrollment with larger firms (as opposed to micro-sized businesses.) They considered that the same level of effort and resource expenses are required for mid sized businesses as are required for micro-sized ones. The difference being the take up per business enabled faster growth and spread costs over more members.

2) Easing the 75% rule - In tandem with changing the cap limit, a change of the 75% rule would not have to impact the mid-sized businesses. As with Muskegon, any business with more than 4 employees would have to meet the 75% rule. Only the micro-sized businesses would benefit from a more flexible standard at the low end of the eligibility criteria.

SUMMARY

As the marketplace for health coverage has changed with the entry of several new forms of health products, the opportunity exists to change the three-share program criteria. These changes should remain consistent with the goals of reducing the numbers of uninsured and providing economic development to small businesses. They should also retain characteristics that “fill the gap” in affordability between commercial products and eligibility for public programs (Medicaid programs.) Changes to the ICA eligibility noted above are all consistent with these goals. Beyond the objective of staying true to the original intent of three-share programs, these changes respond appropriately to the changing environment of the small group market. The small group market has been squeezed by higher cost on one side, and poor economic conditions (in Michigan) on the other side. Business owners are very concerned about taking on obligations for health coverage in this economic climate. Still, there are businesses that want to provide health coverage. And the commercial market is not yet providing affordable options. High deductible plans and HSAs are not affordable to those earning $8 to $12 per hour. A $3,000 deductible for an individual plan is equivalent to $1.50 per hour, after taxes, for a fulltime employee. By contrast the ICA plan cost about 40¢ per hour with no deductible and low co-pays. This example best illustrates the need to consider a host of changes to the eligibility rules to achieve the goal of helping small businesses and working uninsured gain better access to affordable health coverage. Finally, it is worth noting that three share programs, while they bear some resemblance to insurance, they are not traditional insurance products. The three-share design was intended to be an alternative to commercial insurance from the beginning. Typically these programs have been crafted as County programs. In this manner they resemble a community “self-insurance” model where the community is the governing body, not an insurance corporation. The concept for this self-governance of community plans recognized the need to make adjustments in the best interest of the community as opposed to the best interest of an insurance carrier, provider, or other commercial interest. This hybrid product blended some features of the insurance industry with aspects of community self-governance. The community self-governance is granted the ability to make changes where necessary, but must adhere to some basic principals of the insurance industry to assure sound financial management. Communities are, however, free to determine what the rules will be. They are not subject to insurance rules. That’s where the power to change the 75% rule comes from. If these sorts of changes cannot be implemented, then the end product will always be just another insurance product and the only issue will be, “How much can the public subsidize?” The success of three share programs will ultimately rest on the degree to which communities decide what best suits the community needs.

Agenda Item 2b

MEMORANDUM To: Human Services Committee From: Bruce Bragg Date: May 23, 2006 Subject: Community Meeting on Health and Social Justice This is an invitation to a community meeting on health and social justice. Ingham County, through the Health Department, has been administering a Health Equity through Social Justice Grant from the W. K. Kellogg for the last two years. The major portion of the grant is subcontracted to the National Association of County and City Health Officials to develop a guidebook for use in public health agencies across the Country. Ingham County retained funding to support the development of a Social Justice Team within the Health Department. The Social Justice Team has been meeting periodically for the last year to learn about root causes of different rates of disease and disability in different population groups. And, they have been working to determine what a public health agency can do to affect the root causes. What we have learned is that unequal access to resources is a major cause of different rates of disease and disability among different population groups. It is not just a persons own behavior that affects her/his health status. Health status is also impacted by access to jobs, access to education, the effects of discrimination, etc. On Wednesday evening, June 14, 2006, the Health Department’s Social Justice Team and the Greater Lansing Area Commission on Race and Diversity are sponsoring a community conversation on Health and Social Justice at the Gier Community Center. I encourage you all to attend. We anticipate 200 – 300 people. A flyer is attached. Attachment c: Doak Bloss

Agenda Item 2d RESOLUTION STAFF REVIEW DATE: May 23, 2006 Agenda Item Title: Resolution to Amend Resolution #05-307 (Resolution to Authorize

an Agreement with the National Association of Child Care Resources and Referral Agencies)

Submitted by: Health Department Committees: LE ___, JD ___, HS * , CS , Finance * Summary of Proposed Action: This resolution will authorize amending an existing Memorandum of Agreement with the National Association of Child Care Resources and Referral Agencies to provide child care services through the Office for Young Children to active duty military families living within the OYC’s four county service area. The attached resolution will amend Resolution #05-307 to establish the period of the Agreement as May 15, 2006 through June 30, 2007. It also eliminates the opportunity for automatic annual renewal. All other terms and conditions of Resolution #05-307 shall remain in effect. Financial: No change. Other Implications: None. Staff Recommendation: JN * HH ___ TM JC This resolution should be approved.

Agenda Item 2d

MEMORANDUM To: Human Services Committee Finance Committee From: Bruce Bragg Date: May 30, 2006 Subject: Amendment to OYC Military Services Agreement In November 2005, the Board of Commissioners adopted Resolution No. 05-307 and authorized a Memorandum of Agreement with the National Association of Child Care Resources and Referral Agencies to provide child care services through the Office for Young Children to active duty military families living within the OYC’s four county service area. The NACCRRA has now advised us that the period of the agreement should be changed and that the agreement will not be automatically renewed from year to year. The attached resolution will amend Resolution No. 05-307 to establish the period of the Agreement as May 15, 2006 through June 30, 2007. It also eliminates the opportunity for automatic annual renewal. The amended language will be: The term of this MOA will be from May 15, 2006 through June 30, 2007, or until amended or terminated at any time for cause or convenience by either party with thirty (30) days written notification to the other, and is subject to availability of funds. The rationale for entering into the agreement remains valid. I recommend that the Board adopt the attached resolution and authorize the amendment to Resolution No. 05-307. Attachment c: Laura Peterson w/attachment John Jacobs w/attachment

Agenda Item 2d Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AMEND RESOLUTION #05-307 (Resolution to Authorize an Agreement with the National Association of Child Care

Resources and Referral Agencies)

WHEREAS, the Board of Commissioners authorized a Memorandum of Agreement with the National Association of Child Care Resources and Referral Agencies to provide enhanced child care referrals to military families; and WHEREAS, Resolution #05-307 authorized an agreement period of November 15, 2005 through November 14, 2006, and authorized the automatic renewal on a year by year basis; and WHEREAS, the National Association of Child Care Resources and Referral Agencies has now proposed a Memorandum of Agreement for the period May 15, 2006 through June 30, 2007, with no automatic renewal; and WHEREAS, the Health Officer has recommended that the Board of Commissioners amend Resolution #05-307 in order to accommodate the changes proposed by the National Association of Child Care Resources and Referral Agencies. THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes an amendment to Resolution #05-307. BE IT FURTHER RESOLVED, that the second resolved clause “that the period of the Agreement shall be November 15, 2005 through November 14, 2006, and that the Agreement shall automatically renew each year according to the same terms and conditions unless terminated by either party” shall be amended to read “that the term of this Memorandum of Agreement will be from May 15, 2006 through June 30, 2007, or until amended or terminated at any time for cause or convenience by either party with thirty (30) days written notification to the other, and is subject to availability of funds.” BE IT FURTHER RESOLVED, that all other terms and conditions of Resolution #05-307 shall remain unchanged. BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign the amendment after review by the County Attorney.

Agenda Item 2e RESOLUTION STAFF REVIEW DATE: May 23, 2006 Agenda Item Title: Resolution to Authorize a Child Care Training Agreement

with the Michigan 4C Association Submitted by: Health Department Committees: LE ___, JD ___, HS * , CS , Finance * __ Summary of Proposed Action: This resolution will authorize a subcontract with the Michigan Community Coordinated Child Care Association for child care training services delivered by the Office for Young Children, at a reduced funding level, due to reorganizations by the State created Early Childhood Investment Corporation on how they allocate the funds. Financial: In the Fiscal Year 2006, the County will receive $75,800 for child care training services when $135,000 was budgeted. The Department has already made the staffing adjustments necessary to operate with the lower level of funding in 2006 to stay within this revised budget. The lower funding level is also anticipated in the 2007 budget. Other Implications: None. Staff Recommendation: JN * HH ___ TM JC This resolution should be approved.

Agenda Item 2e

MEMORANDUM To: Human Services Committee Finance Committee From: Bruce Bragg Date: May 30, 2006 Subject: Child Care Training Agreement This is a recommendation to authorize a subcontract with the Michigan Community Coordinated Child Care Association for child care training services delivered by the Office for Young Children. The OYC has provided these services for many years as a subcontractor of the Michigan 4C Association. The 4C Association has held a statewide contract with the Michigan Department of Social Services/Family Independence Agency/Department of Human Services. During 2005, the Early Childhood Investment Corporation was formed and given fiduciary responsibility over several funding sources that serve young children and child development, including at least two of the major contracts for the OYC: child care training and child care information and referral. The ECIC decided to put these contracts out for bid, rather than reissue them to existing contractors. The FY 2005 contract was amended to extend through December 31, 2005, our funding for the three-month period was $33,800. The Michigan 4C Association submitted bids for both the training and the information and referral contracts; it proposed to serve as the statewide agent for the eleven regional 4C agencies, including the OYC. The Michigan 4C Association was awarded the information and referral contract, but MSU Extension was awarded a portion of the child care training contract, sharing that service with the 4C Association. Therefore the funding through the child care training subcontract to the OYC is less than was anticipated in the 2006 budget, $42,000 for the nine month period January 1, 2006 through September 30, 2006. We expect the lower level of funding to continue in 2007. In the full Fiscal Year 2006, the County will receive $75,800 for child care training services when we anticipated earning $135,000. The Department has already made the staffing adjustments necessary to operate with the lower level of funding in 2006. The 2007 budget is being prepared with the lower funding level. I recommend that the Board adopt the attached resolution and authorize the subcontract. Attachment

Agenda Item 2e Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE A CHILD CARE TRAINING AGREEMENT WITH THE MICHIGAN 4C ASSOCIATION

WHEREAS, the Office for Young Children has provided training for child care providers and supported the recruitment and training of potential child care providers for many years; and WHEREAS, the Michigan 4C Association has been awarded a contract from the Early Childhood Development Corporation to deliver such services statewide and proposes to subcontract for OYC services in the four county Ingham Region for the period January 1, 2006 through September 30, 2006; and WHEREAS, the Health Officer has advised that these funds have been anticipated in the 2006 budget and has recommended that the Board of Commissioners authorize the subcontract with the Michigan 4C Association. THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes a subcontract with the Michigan Community Coordinated Child Care (4C) Association for the purpose of delivering child care training services through the Office for Young Children. BE IT FURTHER RESOLVED, that the period of the subcontract shall be January 1, 2006 through September 30, 2006. BE IT FURTHER RESOLVED, that the Michigan 4C Association shall pay Ingham County up to $42,000 for child care training services. BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign the subcontract after review by the County Attorney.

Agenda Item 2f RESOLUTION STAFF REVIEW DATE: May 23, 2006 Agenda Item Title: Resolution Appointing Suganda Lowhim, M.D. as Deputy Medical

Examiner Submitted by: Health Department Committees: LE ___, JD ___, HS * , CS , Finance * _ Summary of Proposed Action: This resolution will appoint Suganda Lowhim, as a Deputy Medical Examiner to a term of office expiring December 31, 2007. Financial: As a County Manager, Dr. Lowhim will receive no additional compensation for these duties. Other Implications: None. Staff Recommendation: JN * HH ___ TM JC This resolution should be approved.

Agenda Item 2f

MEMORANDUM TO: Human Services Committee

Finance Committee FROM: Dean G. Sienko, M.D.

Medical Examiner DATE: May 23, 2006 RE: Appointment of Dr. Suganda Lowhim, M.D. as a Deputy Medical Examiner This is a recommendation to appoint Dr. Suganda Lowhim, M.D. as a Deputy Medical Examiner. This appointment will expire with the other Deputy Medical Examiner appointments on December 31, 2007.

Agenda Item 2f Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION APPOINTING SUGANDA LOWHIM, M.D.

AS DEPUTY MEDICAL EXAMINER

WHEREAS, the Ingham County Board of Commissioners, under the authority of Public Act 181 of 1953, as amended, is responsible for appointing the County Medical Examiner, and with the approval of the Medical Examiner, may appoint Deputy Medical Examiners; and WHEREAS, the Board of Commissioners has granted authority to contract with physicians appointed as Deputy Medical Examiners and has set out certain contractual terms and conditions including the term of office and method and rate of compensation, in Resolutions #03-273 and #03-274; and WHEREAS, the Ingham County Board of Commissioners has appointed Dean G. Sienko, M.D. as the Medical Examiner in Ingham County to a term expiring December 31, 2007; and WHEREAS, Dr. Sienko is requesting that the Board of Commissioners hereby appoint Dr. Suganda Lowhim, M.D., a County employee who serves as a Primary Care Physician and as a Deputy Medical Director, as a Deputy Medical Examiner. THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners hereby appoints Dr. Suganda Lowhim, M.D., a County employee, as a Deputy Medical Examiner to a term of office expiring December 31, 2007.

Agenda Item 2g RESOLUTION STAFF REVIEW DATE: May 23, 2006 Agenda Item Title: Resolution to Authorize Subcontracts to the Infant Health

Disparities Initiative Grant Submitted by: Health Department Committees: LE ___, JD ___, HS * , CS , Finance * __ Summary of Proposed Action: This resolution will authorize subcontracts for the period May 1, 2006 through September 30, 2006 with community agencies and individuals to implement the Ingham County Infant Health Disparities Community Action Plan. Financial: $130,000 was allocated in the 2005-2006 CPBC Agreement to implement this plan; this resolution will authorize the following subcontracts: $12,500 NorthWest Initiative 125 W. Main, Lansing (formerly NorthWest Lansing

Healthy Community Initiative) $12,500 Allen Neighborhood Center1619 E Kalamazoo, Lansing $12,500 South Side Community Coalition, 2101 W Holmes Road, Lansing $12,500 Baker Donora Focus Center, 840 Baker, Lansing (via MSU Extension) $10,000 Christian Services LOVE, Inc., P.O. Box 22112, Lansing 48909 $10,000 Black Child and Family Institute, 835 W Genesee, Lansing $ 5,000 Celestine Starks, 2400 Belaire Dr., Lansing $75,000 TOTAL Other Implications: None. Staff Recommendation: JN * HH ___ TM JC This resolution should be approved.

Agenda Item 2g

MEMORANDUM To: Human Services Committee Finance Committee From: Bruce Bragg Date: May 30, 2006 Subject: Recommendation to Authorize Infant Health Disparities Initiative Grant

Subcontracts This is a recommendation to authorize several subcontracts with community agencies to implement activities of the Ingham County Infant Health Disparities Community Action Plan. The Action Plan was developed through a community engagement process during 2004-2005. Ingham County is one of the counties receiving funds because of the dramatic difference in infant death rates between African Americans and Caucasians (about 15 deaths/1000 live birth in the African American community and 5 deaths/1000 live births in the Caucasian community). In 2004-2005 the County implemented a planning process. The process was focused on engaging diverse elements of the community in dialogue and planning. The result is the Ingham County Infant Health Disparities Community Action Plan. The goal of the Action Plan is “To keep mothers and infants alive and well before, during, and after birth, and to reduce disparities in survival among population groups.” The Action Plan has the following six objectives: Objective 1: Public Awareness and Outreach Strategy 1. Increase Community Awareness. Strategy 2. Educate young men and women about healthy pregnancies and infant health. Objective 2: Address Underlying Causes of Infant Mortality Strategy 1. Focus on social, economic and environmental conditions. Strategy 2. Address internalized oppression and racism through a coordinated initiative

among all neighborhood network centers. Objective 3: Build continuum of Supports at Neighborhood Level Strategy 1. Start work to build the entire continuum, beginning with prior to pregnancy. Strategy 2. Deliver and expand programs and services in neighborhoods, both universal

(outreach to all new parents) and targeted, continuing one-on-one support in high-risk areas/populations.

Objective 4: High-quality Health Care Strategy Reduce barriers (“red tape,” lack of respect and judgmental treatment). Objective 5: Strengthen Role of Fathers Strategy Promote volunteerism and enhance the role and responsibilities of fathers. Objective 6: Establish Oversight and Monitor Progress by the Power of We Consortium Strategy 1. Oversee the implementation of the Action Plan. Strategy 2. Monitor progress of the objectives. Strategy 3. Set targets for reducing infant mortality rates. Many of the activities to implement the Action Plan will be implemented by community and neighborhood agencies subcontracting with Ingham County. The Action Plan and budget anticipate these arrangements. I recommend that the Board of Commissioners adopt the attached resolution and authorize subcontracts with the following community agencies and individuals to implement the Ingham County Infant Health Disparities Community Action Plan: $12,500 NorthWest Lansing Healthy Community Initiative $12,500 Allen Neighborhood Center $12,500 South Side Community Coalition $12,500 Baker Donora Focus Center (via MSU Extension) This group of agencies will engage in a number of activities from the Action Plan including:

• Participating in monthly Coalition meetings and work groups • Expanding the role of community outreach workers to engage neighborhood residents in

peer outreach to young families and provide avenues for resident advocacy with institutions and providers

• Improving infant health through outreach connecting parents to resources and supports • Increasing home visitation, using peer outreach workers • Convening groups of new fathers to find more effective ways of helping them prepare for

fatherhood & strengthening their roles as caretakers • Working to construct and provide volunteer and mentoring programs for young fathers • Providing outreach to expectant and new parents so they are aware of an connected to

resources • Increasing home visitation for all parents of newborns • Replicating the community-wide summit at the neighborhood level, particularly in high-

risk areas. $10,000 Christian Services LOVE, Inc. It will provide the following:

• Distributing Infant Health Disparities and Safe Sleep information through ongoing programs and church banks that serve families with children including the READ Program, River Terrace Church's Cribs, Layettes at Pilgrim, Pilgrim Small Children's Closet, Judson's Love Clothing Center, IMAGE and QualityLiving Classes and Olivet Baptist's Emergency Diapers and Formula Program

• Working with and training the African American churches which are currently part of the Christian Services Church network to mobilize their congregations to recognize and address infant health disparity needs.

• Using the existing core group of churches to connect with other African American congregations to continue the education and mobilization around infant health disparities

$10,000 Black Child and Family Institute. It will:

• Conduct workshops on Safe Sleep and other topics related to infant health disparities • Train BCFI staff on infant health disparity issues in order to include this information in

future programming materials • Use existing programs such as the Summer Educational Enrichment Institute, Music

Camp, HOPE Scholars, and Upward Bound to educate and inform young men and women of child bearing age about issues related to infant health disparities

$ 5,000 Celestine Starks 48911. She will:

• Compile a list of all young mothers with infants and children at three Lansing Housing Commission developments and develop targeted outreach strategies to engage them in activities related to the Infant Health Disparities Initiative

• Convene focus groups at each of the 3 public housing developments • Assist Ingham County Health Department staff in building relationships with staff and

residents in each of the 3 public housing developments • Assist with the development of strategies to effectively engage young women of

childbearing age in the housing developments The period of the subcontracts will be May 1, 2006 through September 30, 2006. Attachment c: John Jacobs w/attachment, Melany Mack w/attachment

Agenda Item 2g Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE SUBCONTRACTS TO THE INFANT HEALTH DISPARITIES INITIATIVE GRANT

WHEREAS, Ingham County is one of eleven counties to receive funds through the Infant Health Disparities Initiative; and WHEREAS, $130,000 was allocated in the 2005-2006 CPBC Agreement to implement the Ingham County Infant Health Disparities Community Action Plan developed during the 2004-2005 planning process; and WHEREAS, the goal of the Action Plan is “To keep mothers and infants alive and well before, during, and after birth, and to reduce disparities in survival among population groups”; and WHEREAS, the major activities to implement the Action Plan will be conducted by community agencies subcontracting with Ingham County; and WHEREAS, the Health Officer has recommended that subcontracts be authorized with a number of community agencies to implement the Ingham County Infant Health Disparity Community Action Plan. THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes subcontracts with the following community agencies to implement the activities identified in the Ingham County Infant Health Disparities Community Action Plan: $12,500 NorthWest Initiative 125 W. Main, Lansing (formerly NorthWest Lansing

Healthy Community Initiative) $12,500 Allen Neighborhood Center, 1619 E Kalamazoo, Lansing $12,500 South Side Community Coalition, 2101 W Holmes Road, Lansing $12,500 Baker Donora Focus Center, 840 Baker, Lansing (via MSU Extension) $10,000 Christian Services LOVE, Inc., P.O. Box 22112, Lansing 48909 $10,000 Black Child and Family Institute, 835 W Genesee, Lansing $ 5,000 Celestine Starks, 2400 Belaire Dr., Lansing BE IT FURTHER RESOLVED, that the subcontracts shall be for the period May 1, 2006 through September 30, 2006. BE IT FURTHER RESOLVED, that the County Board Chairperson is authorized to sign the subcontracts after review by the County Attorney.

Agenda Item 2h RESOLUTION STAFF REVIEW DATE: May 23, 2006 Agenda Item Title: Resolution to Establish Positions to Implement the Point of Sale

Regulation Submitted by: Health Department Committees: LE ___, JD ___, HS * , CS * , Finance * Summary of Proposed Action: This resolution will establish the two additional staff positions (Sanitarian II and a new Community Health Rep II) effective July 2006, which are required to implement the Point of Sale Program previously approved by the Board of Commissioners. Financial: The Board of Commissioners previously established a $150 application fee for the Point of Sale Program. The Department estimates that between 800 and 1,000 applications will be taken each year, which should generate between $120,000 and $150,000 to support the costs of the two positions. The long term cost of two positions recommended is about $130,000 annually, at the top of the scale. Other Implications: None. Staff Recommendation: JN * HH ___ TM JC This resolution should be approved.

Agenda Item 2h

MEMORANDUM To: Human Services Committee County Services Committee Finance Committee From: Bruce Bragg Date: May 30, 2006 Subject: Adjust Environmental Health Staffing – Point of Sale Program This is a recommendation to establish two positions in the Bureau of Environmental Health to support the implementation of the Point of Sale Regulation. This will be accomplished by adjusting the Environmental Health staffing allocation established by Resolution #05-115. The Board of Commissioners has approved the Point of Sale Regulation which will be effective in June, 2006. We anticipate that most of the inspection of on-site sewage and water supply systems will be conducted by private, certified inspectors. However, the Department must oversee the program, certify the inspectors, record the inspection reports, assure quality within the program, assure that home owners make any required improvements and are notified of the status of their sewage and water systems. The Board of Commissioners established a $150 application fee for the Point of Sale Program. The Department estimates that between 800 and 1,000 applications will be taken each year, so the Program should generate between $120,000 and $150,000. The long term cost of two positions (using the Grebner method) recommended is about $130,000. The comparison of existing and recommended staffing follows: Classification Resolution 05-115 Recommended Director 1 1 Programs Supervisor 2 2 Sanitarian I 7 7 Sanitarian II 5 6 Sanitarian III 2 2 E.H. Specialist 6 6 Community Health Rep III 1 1 Community Health Rep II 0 1 Health Program Assistant 1.5 1.5 Total 25.5 27.5

The assignment of a Sanitarian II to oversee the Point of Sale Program will be made from the existing group of Sanitarians II. We currently have nine Sanitarians II and only six (with the adoption of the attached resolution) Sanitarian II positions. I recommend that the Board adopt the attached resolution and establish the two additional staff positions required to implement the Point of Sale Program. Attachment c: Dean Sienko w/attachment Jim Wilson w/attachment Jaeson Welter w/attachment Tom Larkins w/attachment

Agenda Item 2h Introduced by the Human Services, County Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO ESTABLISH POSITIONS TO IMPLEMENT THE POINT OF SALE REGULATION

WHEREAS, the Board of Commissioners established the staffing for the Bureau of Environmental Health in Resolution #05-115; and WHEREAS, the Board of Commissioners has promulgated a Point of Sale Regulation intended to evaluate on-site sewage and water supply systems at the time of property sale; and WHEREAS, the administration of the Point of Sale Program will require the establishment of two positions in the Bureau of Environmental Health; and WHEREAS, the Health Officer has recommended that the Board of Commissioners adjust the staffing within the Bureau of Environmental Health in order to implement the Point of Sale Program; and WHEREAS, the Health Officer has advised that the fees established to administer the Point of Sale Program are adequate to support the cost of the two new positions. THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners hereby adjusts the staffing within the Bureau of Environmental Health by adding two positions to help implement the Point of Sale Program. BE IT FURTHER RESOLVED, that the allocation of positions within the Bureau of Environmental Health, established in Resolution #05-115, shall be modified as recommended below:

Classification Resolution #05-115 Recommended

Director 1 1 Programs Supervisor 2 2 Sanitarian I 7 7 Sanitarian II 5 6 Sanitarian III 2 2 E.H. Specialist 6 6 Community Health Rep III 1 1

Community Health Rep II 0 1 Health Program Assistant 1.5 1.5 Total 25.5 27.5

BE IT FURTHER RESOLVED, that the changes shall be effective July 1, 2006.

Agenda Item 2i MEMORANDUM

To: Human Services Committee From: Bruce Bragg Date: May 23, 2006 Subject: Possible Lease Agreement with Lansing Community College This will advise that the Lansing Community College Board of Trustees will consider a lease agreement with Ingham County at its June 19, 2006, meeting. I reported on this possibility at the May 1, 2006, Human Services Committee meeting. There are still things to be worked out before the Department will present a recommendation to enter into the lease agreement. However, the fact that we are considering such an action may well be reported in the media after the LCC Board acts on it. In short, the Department is seeking to consolidate two of its community health centers into a single site in the area of central Lansing. LCC has proposed that we utilize about 8,000 square feet of space in the new Health and Human Services Building. If issues such as parking can be worked out, the Department will present a recommendation to enter into a lease agreement. c: Jaeson Fournier Barb Mastin

Agenda Item 3 RESOLUTION STAFF REVIEW DATE: May 26, 2006 Agenda Item Title: Resolution Updating Various Fees for County Services Submitted by: Controller’s Office Committees: LE * , JD * , HS * , CS * , Finance * Summary of Proposed Action: This resolution will authorize the adjustment of various fees for county services to be effective January 1, 2007. These adjustments are based on an update of the “Cost of Services Analysis” completed by Maximus in 2002. Updated costs were then multiplied by the target percent of cost to be recovered by the fee for services as identified by the Board of Commissioners. Input was solicited from county departments and offices as part of the process of making these recommended adjustments. A full analysis of each fee, except for the Commercial Soil Erosion and the Freedom of Information Act (FOIA) requests, was presented to all committees at the previous round of meetings. The Drain Commissioner is in the process of implementing a more comprehensive program that will comply with new Federal II guidelines and Part 91 as amended. Therefore, new fees will be submitted to the Board for review later, along with the cost and fees related to Commercial Soil Erosion. The fees for FOIA requests have also been added onto the attached schedule. These fees have not been adjusted since 1998, and the current cost is based on information received from our Print Shop. As stated in the attached memo from the Health Department and in this Resolution, many of the Health Department fees have been determined using the Board authorized methodology per Resolution #05-166 and are no longer necessary to establish per the fee schedule. In the last round of meetings, some additional information was requested: (1) An explanation of the current cost of Dog Kennel inspections for licensing (attached). (2) An analysis of actual total cost of services provided vs. the total fee revenue (attached). (3) A comparison of the budgeted fee revenue vs. the actual fee revenue. In 2005, fee revenue was budgeted at $3.358 million. The 2005 actual collection was $3.487 million. Financial Implications: If the fee adjustments are passed as proposed, additional annual revenue would total approximately $163,016. Any additional revenue will be recognized in the 2007 Controller Recommended Budget. Other Implications: As directed by the Board of Commissioners, the Controller’s Office has incorporated the update of county fees into the annual budget process. This will allow the County to annually and incrementally adjust fees based on changing costs, rather than to make large adjustments at one time. Staff Recommendation: JN HH TM X JC Staff recommends approval of the resolution.

MEMORANDUM

To: Budget Office From: Bruce Bragg Date: May 30, 2006 Subject: Health Department Fee Schedules and Policies In addition to the fee schedules attached, fees within major Health Department services are set according to the following policies: From Resolution No. 05-166

- the Health Department shall establish a charge for vaccines based on the cost of the immunizing agent rounded to the nearest whole dollar ……

- the Health Department shall establish a charge for family planning supplies based on the cost of supplies rounded to the nearest whole dollar ……

- the fees charged by the Ingham Community Health Centers (Ingham County Health Department) for medical services shall be 135% of the Medicare Fee Screen as published by the Center for Medicaid and Medicare Services (http://www.cms.hhs.gov) by procedural code (HCPCS) and specific to locality (Rest of Michigan).

- the fees charged by the Ingham County Health Department for dental services shall be 115% of the Delta Prudent Purchaser Agreement Fee Schedule for General Practitioner.

- the attached FQHC Schedule of Discounts for medical and dental services shall remain in effect for 2007.

- the attached Title X Schedule of Discounts for family planning services shall remain in effect for 2007.

From Resolution No. 05-242

- it is the intent of the Ingham County Board of Commissioners not to subsidize public health services to residents of other counties, except as provided for in this resolution.

- it is the intent of the Ingham County Board of Commissioners not to subsidize vaccine and vaccine administration services provided to adults, except as provided for in this resolution.

- In situations related to disease transmission, including disease outbreaks, the Health Department shall attempt to provide vaccines and vaccine administration services to address the needs of the at-risk population.

- In situations of disease outbreaks, the Health Department shall administer vaccines to persons who live, work or study in Ingham County based on the criteria established in the discount schedule adopted in Resolution No. 05-166.

- The Health Officer may identify a broader group of persons eligible for discounted services, in situations of disease outbreaks when he/she determines it necessary to protect the broader Ingham County community; any action by the Health Officer under this clause must be communicated immediately to the Board of Commissioners.

These policies should be included in the resolution that adopts the 2007 Health Department’s fee schedules.

Agenda Item 3Introduced by the Finance Committee of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION UPDATING VARIOUS FEES FOR COUNTY SERVICES

WHEREAS, the Board of Commissioners set various fees for county services in Resolution #02-155 based on information and recommendations of the Maximus Cost of Services Analysis completed in 2002; and WHEREAS, the Board of Commissioners also established the percent of the cost of providing the services which should be covered by such fees, referred to in this process as a “target percent”; and WHEREAS, the Board of Commissioners has directed the Controller’s Office to establish a process for the annual review of these fees and target percents; and WHEREAS, this process begins with the calculation of a cost increase factor, which is equal to the previous three year average increase in the General Fund adopted budget for the appropriate departments; and WHEREAS, this cost increase factor is applied to the previous year’s calculated cost and multiplied by the target percent and in most cases rounded to the lower full dollar amount in order to arrive at a preliminary recommended fee for the upcoming year; and WHEREAS, in cases where the calculated cost multiplied by target percent is much higher than the current fee, the fee will be recommended to increase gradually each year until the full cost multiplied by target percent is reached, in order to avoid any drastic increases in fees; and WHEREAS, in cases where the calculated cost multiplied by target percent is lower than the current fee, no fee increase will be recommended for that year; and WHEREAS, after initial recommendations are made by the Controller, these recommendations are distributed to the affected offices and departments, in order to receive their input; and WHEREAS, after reviewing the input from the affected offices and departments, the Controller makes final recommendations to the Board of Commissioners; and WHEREAS, the Controller’s Office has finished its annual review of these fees and recommended increases where appropriate, based on increased costs of providing services supported by these fees and the percent of the cost of providing the services which should be covered by such fees as established by the Board of Commissioners; and

WHEREAS, the Board of Commissioners has reviewed the Controller’s recommendations including the target percentages, along with recommendations of the various county offices, departments, and staff. THEREFORE BE IT RESOLVED, that the Board of Commissioners authorizes or encourages the following fee increases in Attachments A and B at the rates established effective January 1, 2007 with the exception of the Health Department, where new rates will be effective October 1, 2006. BE IT FURTHER RESOLVED, that the fees within major Health Department services are not included on the attachments and were not set by the policy above, but rather through Resolutions #05-166 and #05-242.