APPROVED MINUTES

SW Virginia Health AuthoritySouthwest Virginia Higher Education Center, Room 240, Abingdon, VA

August 11, 2015, 4:00 PM

Members Present/Absent: Present/Absent f & m name last name Degree jurisdiction/org

p Susan Copeland Coalfield Economic Development Authority

- VACANT VACANT Russell County

A Edward A. Carlton Pharm D. Lee County

p Sue Cantrell B. Pharm. ,M.D. Director Lenowisco Health District

p Charles W. Carrico, SR Senator Virginia Senate

p Wendy Welch Ph.D. Southwest Virginia GMEC

p Mark Leonard CEO Norton Community Hospital, Mountain States Health Alliance

p Stephen K. Givens CEO Russell County Medical Center, Mountain States Health Alliance

p Teresa Kidd Ph.D. Pres & CEO Frontier Health

p Donna Henry Ph.D. University of Virginia’s College at Wise

P Donna Murray Tazewell County

p Terry Kilgore CHAIR Virginia House of Delegates

P Susan Mayhew Pharm.D Appalachian College of Pharmacy

A Will Morefield Delegate Virginia House of Delegates

- VACANT VACANT Buchanan County

p Malcolm Perdue Virginia Community Healthcare Association

A Ben Chaffin Senator Virginia Senate

A Karen Rheuban M.D. The University of Virginia School of Medicine

p Debbie Ward City of Norton

A David Sarrett D.M.D., M.S. Virginia Commonwealth University Dental School

A Dixie Tooke-Rawlins D.O. Edward Via Virginia College of Osteopathic Medicine

p Mark Vanover Dickenson County

A J. Michael Wieting D.O. Med LMU-DeBusk College of Osteopathic Medicine

- VACANT VACANT Scott County

p Melody Counts M.D. Director Cumberland Plateau Health District

A Ron Prewitt Wise County

p Dale Clark C00 Wellmont Health System

p Robert T. Means, Jr. M.D., FACP ETSU, Quillen College of Medicine

P Tabitha Crowder City of Bristol

P Danny Counts Smyth County

P Sam Neese Washington County

P Peter Mulkey Pharm D, M.H.A. Clinch Valley Medical Center

Others in attendance: Betsy Grossman (UVA Cancer Center patient navigator), Shannon Blevins (Assoc. VC Economic Development UVA-Wise), Margie Tomann (Healthy Appalachia Institute), Steve Darnell (Anthem BCBS) and Delilah McFadden (VDH).

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CALL TO ORDER:Call to Order by Delegate Kilgore at 4:02 pm. Quorum was verified by roll call.

REVIEW OF DRAFT AGENDA The previously distributed draft Agenda was reviewed and Dr. Cantrell asked to amend the agenda by adding an announcement of an upcoming public hearing in the Authority area related to development of VDH Regulations for review of applications. Senator Carrico made a motion and seconded by Dr. Robert Means, unanimous voice vote to approve the agenda as amended.

REVIEW OF MINUTES – JUNE 10, 2015 MEETING:The previously distributed Minutes of the June 10, 2015 meeting were reviewed and approved by unanimous vote following a motion by Mark Leonard, seconded by Senator Carrico.

INITIAL TERMS OF OFFICE FOR NEW JURISDICTIONAL APPOINTEES:Representatives of the City of Bristol and the Counties of Washington and Smyth were added to the Authority Board of Directors, Bristol in 2015 and Washington and Smyth Counties in 2014 however no representatives from Washington or Smyth were appointed until 2015. HB 2316 states that the delegates of these jurisdictions shall serve initial terms as determined by the board of directors. Consideration of initial terms of appointment for the three new jurisdictions, assigned alphabetically after the same manner as original assignment of terms for the initial eight jurisdictions, was suggested, with subsequent terms following the expiration of the initial terms being four (4) years. Initial terms proposed were City of Bristol 2 years, Smyth County 3 years and Washington County 4 years. Approved by unanimous vote following motion by Donna Henry and second by Senator Carrico.

EXECUTIVE COMMITTEE MAKE-UP:Discussed the need for a larger Executive Committee than the current 3 members and noted the Code permitting election of either a Secretary/Treasurer or separate Secretary and Treasurer positions. Discussion of the make-up of Executive Committee ensued but was tabled until later in the meeting.

LANGUAGE CHANGE IN BLUEPRINT GOALS/OBJECTIVES OF THE AUTHORITY:Two goals in the Blueprint for Health Improvement and Health-Enabled Prosperity 2009 and 2011 contain specific reference to a Regional Health Information Organization (RHIO) that existed to enable regional health information exchange between provider groups in the area at that time but has since declared bankruptcy and no longer exists; motion to delete the reference to “Carespark” leaving the intent of the objective intact by substituting “(regional) health information exchange” for Carespark references (Goals E # 3 and I # 4).

E. Improve health entity collaboration and encourage regional integration where appropriate. 1. Enhance the Collaboration of the Authority with the Healthy Appalachia Institute (N,I)2. Complete Health Authority Organizational Goals (N,I)3. Foster regional electronic health information sharing to include prescription information exchange (N,I)*

I. Improve access and portability of patient health information, and encourage health information exchange and e-health services including telemedicine [Overall Health, Economic Benefit, Information]

1. Foster “last mile” of broadband infrastructure to enable access to 90 percent of regional households and businesses (I)*2. Advocate for mandated insurance coverage for telehealth services (N)*

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3. Obtain resources to subsidize regional health provider adoption of electronic health records (N,I)*

4. Obtain resources to enable regional health information exchange to connect regional providers (N)

Motion to make changes to the Goals of the Authority contained in the Blueprint to delete Carespark and substitute “regional health information exchange”. Approved by unanimous vote following motion by Dr. Susan Mayhew and second by Sam Neese.

FOIA TRAINING/REVIEW:Maria Everett conducted training and provided a presentation on Virginia Freedom of Information Act, to include discussion of participation in meetings by telephone or electronic means and consideration/vote on policy related to same. Maria Everett, Esq is the Executive Director FOIA Council.

Ms. Everett used a powerpoint presentation to guide members in learning compliance with key provisions of FOIA. Following the presentation, Authority Board members viewed an 8 minute video on FOIA; Ms. Everett responded to questions from the Board members. The powerpoint is attached to these minutes and the link to the 8 minute video is provided here: https://www.youtube.com/watch?v=50oddI3nUe0&feature=youtu.be

Dr. Cantrell asked, “Can individuals participate in meetings remotely if their location is greater than 60 miles from the meeting location?” Answer: A quorum must be physically assembled at the advertised meeting location, but others may participate remotely per the policy of the public body. A regional entity such as the Authority must have a policy in place addressing this issue that applies to all members equally if we wish to implement this; there are no limitations on a regional Authority preventing this. Members joining remotely can vote, but do not count toward quorum. Dr. Cantrell will draft a policy on electronic meetings. If you have any comments or concerns, send them to her directly. Discussion regarding the limitation on remote participation to no more than 2 meetings per year or 25% of meetings whichever is less was clarified by Ms. Everett to apply to state bodies, not regional bodies such as the Authority.

CONFLICT OF INTEREST TRAINING:Board members of the SWVHA are required to complete Conflict of Interest training per Code of Virginia Section 2.2-3115; Board members received an email last week from Sue Cantrell informing members of this requirement and the course necessary to fulfill the requirement and an email from Tracy Hall in the Commonwealth OAG office providing each member with a log-in and temporary password (which is time limited) to access the Commonwealth of Virginia Knowledge Center where the course OAG2014 COI may be found; members must complete this course (not required to complete the last portion of the course related to state procurement law only the first 100 slides on conflict of interest) upon appointment and every two years, print the certificate of completion at the conclusion of the course, and scan/email the certificate to either Delilah.Long@vdh.virginia.gov or Sue.Cantrell@vdh.virginia.gov by 8/31/15. Board members are also required to submit a financial disclosure statement (sent to all members by email last week and also on the Secretary of the Commonwealth website) no later than 8/31/15 unless the Board member is required by virtue of other positions held, to submit a Statement of Economic Interest or General Assembly’s Statement of Economic Interest; either of the latter two documents suffice for the financial disclosure requirement. If you have any questions about completing the financial disclosure statement, consult the Secretary of the Commonwealth website or contact Margaret Sacks at ConflictofInterest@governor.virginia.gov. Financial disclosure statements are required upon appointment to the Board and annually by Dec 15.

DRAFT OF POLICY For Receipt and Review of Cooperative Agreement Applications

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Dr. Cantrell stated that she modeled the draft Authority policy after the requirements of the Code of Virginia, the policy and procedures of the Tennessee Department of Health as published and the Virginia Department of Health draft regulations for review of proposed cooperative agreements ( in development) attempting to make the Authority application requirements parallel to the extent possible while assuring that relevant and critical information that the Authority would require in our review was required. This policy was emailed to Board members on Friday August 7, 2015, for your review and consideration prior to the meeting.

Delegate Kilgore asked that Dr. Cantrell review the draft policy. (following is not a complete narrative of the review of the policy and related discussion)

Definitions: In both the Authority policy and VDH draft regulations, “day” or “days” is defined as business days;

Tennessee does not define days.Letter of recommendation is a definition unique to the Authority and pertains to our written

communication to the Commissioner of Health regarding the Authority’s recommendation relative to an application for a cooperative agreement.

SWVH Authority policy requires an applicant to file a letter of intent no less than 30 days prior to filing an application (Tennessee requires a letter of intent no less than 45 days prior to filing an application)

The authority shall post letters of intent on the Authority website until a completed application is filed or until the letter of intent expires (6 months).

Discussed assessment of an application for completeness and receipt of a completed application being required before the review begins.

The requirements for an application focus on several broad areas: impact on population health; access to care; quality of care; health workforce and economic impact; and cost.

Noted edits in the document made since mailing out on Friday on pages 11-13:

Page 11 – items N, O, and P were only rearranged in order, but nothing else changed. Section in green font was moved from the end of the document (original location) earlier in the document, to page 11, however the content was unchanged.

Additionally, the portion of the policy relating to the actual review of an application was expanded in edits on pages 12-13 including the addition of consideration of input from the public both written and oral comments, in developing the Authority’s recommendation to the Commissioner.

Fees: The application fee to the Authority is established in this policy as $50,000 and shall be due to the Authority with the application.

Dale Clark asked, “Can you make it completely parallel to VDH’s application?” Dr. Cantrell responded, “Yes, it is very much like VDH draft regulations however the Authority application requests more detail related to economic and workforce impact in the region and the VDH regulations are still draft, not final”.

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Danny Counts asked, “What if Virginia approves and Tennessee does not? No conclusive next steps are known in that scenario.

Mark Leonard commented that Dr. Cantrell has done a great job. He asked, “Do we have the infrastructure to do this?” Delegate Kilgore responded, “No. We will have to establish this.” Dr. Cantrell said being able to contract for additional assistance with the review would be helpful if not essential. That ability is in the policy.

Dale Clark suggested that there not be a requirement for a written submission, but that submission be electronic; after discussion, page 2 – was amended to read “…shall do so in writing and electronically”. Motion to amend by Dale Clark and second by Dr. Robert Means approved by unanimous vote.

Page 12 – Section R (added after draft policy sent to Board members on August 7) – Parties to an approved cooperative agreement must report impact in four general areas to the Authority Board with the frequency of reporting to the Authority amended by the Board to “a minimum of every six months.” Motion made by Teresa Kidd and second by Mark Leonard to change the language requiring reporting every 6 months to a minimum of every six months. Motion approved by unanimous vote.

Motion to adopt policy and procedures for Receipt and Review of Cooperative Agreement Applications as amended, made by Dr. Wendy Welch and seconded by Senator Carrico. Motion to adopt policy approved by unanimous vote.

FINANCIAL POLICY/PROCEDURES:

Dr. Cantrell presented a draft Fiscal policy for the Authority Board’s consideration. The Executive Director can spend up to $250 without prior approval, if aligned with prior approved budget. $250 - $3,000 shall be reviewed by the SWVHA Treasurer or Board Chair. Over $3,000 requires approval of the full board. Discussed hiring a wage Executive Director. Fiscal policy establishes payroll once per month.

Reimbursement for travel and mileage at Federal rates for mileage and state guidelines for overnight and per diem. Four signatories will be on the Authority corporate bank accounts: The Executive Director, The Board Treasurer, The Board Chair and a designated Board Member. All checks will be signed by two of the approved signatories.

Authority’s Conflict of Interest Policy is contained in section 6 of the financial policy.Motion to adopt Financial Policy/Procedures made by Dr. Robert Means and seconded by Malcolm Perdue. Motion approved by unanimous vote.

After hearing the FOIA presentation, the Board revisited the executive make-up and Senator Carrico suggested that there be seven members on the Executive Committee. The seven members will be:

Delegate Kilgore – ChairDr. Sue Cantrell – Vice ChairSenator Carrico – SecretaryDonna Henry- TreasurerDr. Robert MeansDr. Wendy Welch

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Sam Neese

Draft position for Executive Director Position tabled until next meeting.

PUBLIC COMMENT: No public comment.

The next meeting will be September 9, 2015 at 3:00 p.m. at the Southwest Virginia Higher Education Center, room to be announced.

Dr. Cantrell announced that a public hearing regarding the regulations governing VDH review of proposed cooperative agreements and the Health Authority recommendations to the Commissioner will be held in late August or early September in southwest Virginia. When the date and location is set, an email to the Board will be sent with that information. Delegate Kilgore encouraged Board members to attend.

Physical positing of meeting notices was suggested and agreed to be on the health department bulletin boards in the following locations: Wise County Health Department, Russell County Health Dept and Washington County Health Dept.

ADJOURNMENT:The meeting adjourned by consensus at 6:10 p.m.

MINUTES APPROVED BY: _____________________________________BOARD MEMBER POSITION: __________________________________

Respectfully submitted,Delilah McFadden

Final Approval: 8/12/2015

Powerpoint on following pages:

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