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Pawlenty veto puts county health plan at risk

Fri, May 30th, 2008
Posted in Government

PRESTON - Commissioner Chuck Amunrud, Fillmore County's commissioner who sits on the Joint Powers Board, requested the opinion of the other commissioners at their May 27 meeting. Five counties including Olmsted, Fillmore, Houston, Mower, and Winona together were to enter into managed care county based purchasing (CBP). The SteadFast Health Plan was developed by Olmsted County. The other four counties were invited to join in order to get sufficient enrollment to spread the risk and to share the cost, especially of the initial setup. SteadFast was to begin enrollment in October of 2008.

The intention was to bring any profits back to the counties and to use those dollars to provide early intervention and prevention services and reduce the need for expensive emergency care. The plan would contract with the Minnesota Department of Human Services, which provides a fixed payment. If the CBP plan could provide services for less than the fixed payment, it would make money; if not, it would lose money.

The five counties had hoped to be the "default" plan or be assigned those individuals who don't have a preference for a specific managed health care plan. According to a letter from the governor addressed to Margaret Kelliher, speaker of the Minnesota house, dated May 23, 2008, he vetoed the bill since, "the bill provides a preference for one county based purchasing health plan," meaning SteadFast. Pawlenty suggests that about 30% of people enrolled in managed care plans through Minnesota Health Care Programs fail to designate a particular plan. He sees this lack of competition as diminishing the pressure to keep administrative costs down.

Social Service Director Thomas Boyd noted that the SteadFast Plan has many good things going in its favor as it is not just medical but includes mental health, long term care and more.

Amunrud explained that at the last Joint Powers meeting in Rochester, the group obtained a 60 day extension for a purchase agreement on a building in Rochester to be used for the offices for the CBP group. The extension was obtained to give time for the legislature to act. They were hoping to operate as the only plan in the county area as other CBP groups have done. Since that didn't happen, they tried to have a "default" plan where they would serve those who did not choose another plan like Blue Cross or U-Care. With the governor's veto, the SteadFast Plan would be one choice among others.

Amunrud said that the Joint Powers Board was to meet on Friday, May 30. He expects the discussion to be whether they should continue to execute the SteadFast Plan or to end the attempt to establish county based purchasing. Amunrud is concerned that the SteadFast Plan may not attract enough individuals to make a go of it, especially with the governor's property tax cap. He expects the group may move to suspend the effort.

Boyd commented that the five county effort wouldn't have been fought by other health insurance interests if there wasn't money to be made. Amunrud remarked that it may be that they could try again if the state would get a new administration. The bill had passed both houses with large majorities. Commissioner Duane Bakke noted that the governor had suggested that CBP's have higher administrative costs than other health plans. Chairman Randy Dahl insisted that Blue Cross and U-Care won't even divulge their administrative costs. Boyd asked what Blue Cross and U-Care do with the profits that aren't coming back for services. Dahl said that people who sign up with SteadFast could go to any provider they choose.

Bakke asked Boyd if individuals have to come to the Social Service office first. Boyd agreed that they do but that his office has to be neutral and not sell a health plan. Their job is to explain what is available. Boyd added that the other CBP groups that have started have been single source and without competition. He acknowledged that the lack of competition would make a big difference as the fledgling plan tries to get up and running.

Dahl asked which direction will be most beneficial to the property owners of Fillmore County ten years down the road. In his opinion, Blue Cross and U-Care have crossed the line of a nonprofit with the huge salaries paid to their CEO's.

Boyd maintained that all five members of the Joint Powers Board will need to go ahead with it together to make it work. Commissioner Marc Prestby commented that he thought that without the "default" language the SteadFast Plan would be in financial trouble. Boyd suggested that it would take longer for the counties to get their initial investment back without the "default" language, but the plan would be a positive wave for the future.

Bakke warned that the county could have lower Local Government Aid in the next few years along with levy limits. It would be necessary to come up with the funds to keep it going forward.

Amunrud said that he does not know where the other counties are in their thinking. If they decide as a board to disband, most of the money the county has put into this effort will come back. Bakke suggested that there should be actuarial reports to give the counties more information.

Cell Phones

Sheriff Daryl Jensen asked the board to consider an amendment to the personnel policy for cell phones. He said that many of his staff carry two cell phones, the county's and their own. He said that the policy hopefully will put the county 95% out of the cell phone business. Contracts are being phased out. It should make it less complicated. Jensen noted that much of the communication his deputies do is over a cell phone.

Stipends would be paid only to employees who are required to carry a cell phone and according to the usage. Employees will use their personal phone getting a monthly stipend which will include $5 for a device replacement payment. Jensen expects most to get a stipend of $20 for minutes used plus the $5, which will also help pay the taxes.

Jensen said that department heads will need to monitor their employees. This will be a county wide policy for county employees. The policy also includes language for smart devices or PDA's. The amendment to the personnel policy was approved.

Emergency Management

Emergency Management Director Deborah Teske asked the board to consider purchasing radios for an alternate Emergency Operations Center. She hopes the equipment can be installed in a mobile unit so that in an emergency like the recent tornados where power may be wiped out, the unit can be used to interface directly with the Sheriff's Department and the First Responders. She suggested installing the radios in one of the old travel trailers behind the highway department.

Questions about the condition of the trailers and storage possibilities for the trailer raised concerns about security and the feasibility of using the trailer.

The money for the purchases are from grant funds to be used for this purpose. Teske also asked for approval to install an 800 MHz radio for the primary Emergency Operations Center (Conference Room 108). Bakke questioned whether the purchase is necessary as the sheriff and his deputies communicate mostly with cell phones. Teske said that the radio is already paid for. Dahl noted that Rushford did not have cell phone use the day of the flood last August.

Commissioners were concerned about maintenance and the responsibility for it whether it should lie with the Sheriff's Department or the Emergency Management Department.

Dahl suggested that the board should go ahead and procure the equipment. It would all be purchased with grant funds. The board approved purchase of the radios for the alternate center. The installation of the 800 MHz radio was approved in the primary center with the room being secured. The purchase and installation of a VHF and ham radio for the primary center was approved. Teske is a licensed ham radio operator.

Other Business

• Highway Engineer John Grindeland said that there were four bidders to build the Airport Fixed Base Operator building at the county airport. The low bid was made by Northland Builders, Eau Claire, Wisconsin, in the amount of $163,954. Dahl asked about the cost share money from the state. Grindeland said that it was last year's money and still available. The low quote was approved.

• A CUP was approved for the Country Inn, Jordan Township for Ed and Lisa Retterath.

A CUP was approved for a campground, Preston Township for Tom Kraetsch. This is just a change of ownership and name change for an existing campground.

• Auditor Treasurer Shirl Boelter and County Recorder David Kiehne asked for the hire of a part time clerk to update parcel data using unallocated funds. The clerk would update property tax addresses for city parcels. Prestby insisted that there is a need for a hiring freeze.

Bakke asked if there is something in place so that this need would not come up again. Kiehne suggested that once the properties are entered by address, the address shouldn't change and the need shouldn't come up again. Boelter said that property owners could find their tax statement on line.

The part time hire was approved not to exceed $5,000. Prestby voted against.

• Peter Hartman, US Natural Resources Conservation Service, and Greg Larson, Minnesota Board of Water and Soil Resources, presented information on the updated Fillmore County Soil Survey. The data is on the web and provides access to the most current data. The Web Soil Survey (WSS) can be found on the Internet at http://websoilsurvey.nrcs.usda.gov.

• The board unanimously passed a resolution endorsing the candidacy of Duane Bakke for 2nd Vice President of the Association of Minnesota Counties.

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