Minutes 10-12-2010 - Laserfiche WebLink

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•However, with new revenues and other spending cuts, PPACA is estimated to reduce the federal deficit by $124 billion over 10 years.* 4. Discussion Annissa Vines said that there will be a lot of things coming from the reform that the Health Department will have to think forward on. Commissioner Yuhasz asked about money available for prevention programs. He asked about the anticipation of Orange County's share of State-distributed revenues. He thinks that the Health Department will have to take more responsibility for prevention programs. He asked if Orange County will get sufficient money from the State to fulfill those responsibilities. Rosemary Summers said that it is unclear. Based on past performance, she would say that the money will not be sufficient. She said that when the State looks for a county that can improve a program, it often looks to Orange County to be able to do that. She thinks that Orange County will be able to get demonstration grants that are testing evidence-based programs. None of the funding will be permanent, but it is all within the prevention area. There is no infrastructure support mentioned in the reform to maintain those prevention programs. She said that the thought is probably that the prevention programs will result in less high-cost hospital admissions, and the money saved will be turned into prevention "dollars." She does not know how this will occur, but that is the thought. Prevention is not a reimbursable service. Frank Clifton said that there is a need to be cautious as to how to proceed since the problem is much bigger than Orange County. Chris Harlan said that they cannot rest decisions on a purely business mind. There will always be people in the community who need service who will never be able to pay for it. A lot of these people will be seeking health services in health departments and community health centers. There has to be a balance with the reimbursable services. Commissioner Pelissier said that her concern is regarding the sliding scales —to expect someone at the poverty level to pay up to 8% for insurance and medical needs is unreasonable. She made reference to Medicaid and asked if there are any provisions in the healthcare reform to require more providers to serve Medicaid and Medicare patients. This is a huge problem now. Rosemary Summers said that there are no provisions at this time, but the reimbursable rates will be higher in this model. Hopefully, this will entice more providers to serve these patients. North Carolina, through the Community Care Network System, has a managed care model for Medicaid patients. Patients do not have to agree to be in the managed care area, but most patients are ok with it. Patients still get to select their preferred provider. This will be like an HMO for Medicare and Medicaid patients and this will be converting the payment to a per-member per-month reimbursement, rather than a reimbursement for services over time. Anissa Vines said that they may need to talk about some changes in terms of facilities, such as Piedmont Health Services. There is language in the reform about these types of facilities. Frank Clifton said that part of the issue is that when the State gets in a financial pinch, they always lower the Medicaid reimbursement rates. He asked if there were opportunities for more significant formulated partnerships within the community such as UNC and Piedmont Health Services so that there is not a competitive market. Rosemary Summers said that she has had several discussions with Piedmont about collaboration and several other Health Directors. There was a very cordial discussion and