MINUTES. Date: August 18, 2015 Opened: 1:30pm Place: Willmar, MN Closed: 3:32pm Attendance: LaMont Jacobson Andrea Carruthers

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1 Kandiyohi-Renville Community Health Board Tuesday, August 18, 2015, 1:30 to 3:30 p.m. Location: Kandiyohi County Health & Human Services Building rd Street NE, Room 2055, Willmar, MN MINUTES Date: August 18, 2015 Opened: 1:30pm Place: Willmar, MN Closed: 3:32pm Attendance: LaMont Jacobson Andrea Carruthers Rollie Nissen Harlan Madsen Sandy Miller John Stahl Absent: Lynettte Blem Staff Present: Ann Stehn, Jill Bruns, Mary La Patka, recorder Welcome and Introduction of Members John Stahl, Chair, called the meeting to order at 1:30pm Approval of Agenda Additions to Agenda: Ms. Stehn requested the addition of the Correctional Health Update in Kandiyohi and Renville Counties. Sandy Miller moved to approve the agenda with the addition of the Correctional Health Update, LaMont Jacobson seconded. Carried. Approval of May 19, 2015 Minutes Andrea Carruthers moved to approve the minutes as written, LaMont Jacobson seconded. Carried. State CHS Advisory Committee Report - Harlan Madsen At the last SCHSAC meeting, Mr. Madsen brought forward the avian influenza and the economic impact and other concerns related to this outbreak. Discussion on the avian influenza local impact followed. Ann Stehn requested to add a MIIC Update to the SCHSAC report section. Ms. Stehn received a response to the letter that was sent to Commissioner Edward Ehlinger regarding MIIC software issues. The issue: MIIC system is down afterhours (4:30pm) and there isn't sufficient MDH IT Support to get the system up and running. Commissioner Ehlinger responded that since early May, the MIIC software has had stability and functionality issues. Their IT staff are working to resolve these issues. The Board members expressed concerns that MDH may possibly moving away from a regional registry. Ms. Burns noted that MDH staff have stated that they are in support of regional registries. Ms. Stehn commented that in the past, the regional role was software development and implementation, now it is support to those who use the registry Community Health Conference - October 7-9, Cragun's The focus of this year's conference is "Public Health: Everyone, Every Day, Everywhere" Everyone Decisions made in every sector shape the opportunities people have to live longer, healthier lives. Improving health for those who have the worst health outcomes generates better health for all. Everyone does better together.

2 Every Day Public Health does important work to protect, maintain, and improve the health of all people in Minnesota. Public health departments, however, cannot create health by acting alone; working with and alongside the community makes it happen! Everywhere Public Health is all around us. Our world is interconnected and so is our health. We can work together to build environments that create health. Health is a resource that multiplies the more it is shared. Mr. Madsen noted the CHS Conference allows for local officials and staff to attend workshops and network. SCHSAC Health Equity Workgroup - Jill Bruns Ms. Bruns presented information on the activities of the Health Equity Workgroup. See presentation. Environmental Health / Licensing Updates 2016 Environmental Health Budget: Ms. Stehn reviewed the proposed 2016 Budget. (See left) The percent of total program costs covered by the proposed fees would be 74%. The "Share" is relative to where the expenses are being paid out Proposed Fees (See below): Reviewed the proposed 2016 fees which include increases around 7%. LaMont Jacobson motioned to approve the 2016 Proposed Fee Schedule as written, seconded by Andrea Carruthers. With no further discussion, motion carried. See Addendum A: Licensed Establishments Categories and Fees on the following pages. Follow-up on Variance Procedures. The Board reviewed the "Variances" Procedure as presented. The Variance Committee would review the variance requests and either approve or deny. Committee reports would be provided to the Board at their quarterly meetings. One requirement of issuing a variance is that MDH receive notification within 30 days of issuance.

3 Kandiyohi-Renville Community Health Services Environmental Health Licensing Policies Addendum A LICENSED ESTABLISHMENTS CATEGORIES AND FEES Effective January 2016 FOOD ESTABLISHMENTS Limited Food Menu ($150) - Food service is to pre-packaged food that receives heat treatment and is served in the package, continental breakfast, soft drinks, coffee, non-alcoholic beverages, and/or dishwashing (Ex. Senior dining sites.) Small Establishment ($285) - Food service with no salad bar and equipment not exceeding one deep fat fryer, one grill, two hot holding containers, and microwaves or service of dipped ice cream/soft serve frozen desserts. Establishments which do not provide catering service and which meet "Medium Establishment" equipment criteria but have a total seating capacity of 50 or less people are "Small Establishments". Establishments that only cater and are not open regular hours are "Small Establishments". Medium Establishment ($475) - Food service seating over 50 and using a range, oven, steam table, salad bar, or salad preparation area, more than one deep fat fryer or grill, more than two hot holding containers, or provides catering. Large Establishment ($650) - Food service that meets medium establishment definition and seats more than 175 people, serves a full menu selection an average of five or more days per week or caters 500 or more meals per day. ALCOHOL SERVING ESTABLISHMENTS Alcohol Service From Bar ($160) -Alcoholic mixed drinks are served or where beer or wine are served from a bar. LODGING ESTABLISHMENTS Lodging ($135 base fee plus $5.00 per room) - A building, structure, enclosure, or any part thereof used as, maintained as, advertised as, or held out to be a place where sleeping accommodations are furnished to the public as regular roomers. Bed and Breakfast ($285) - Owner occupied residence with five or less rooms for overnight accommodations. Serves only breakfast to guests. TEMPORARY I SEASONAL ESTABLISHMENTS Mobile Food Unit ($190) - Food and beverage service establishment that is a vehicle mounted unit, either motorized or trailered, operating no more than 21 days annually at any one place or is operated in conjunction with a permanent business licensed under this chapter at the site of the permanent business by the same individual or company, and readily movable, without disassembling, for transport to another location. Food Cart ($190) - Food and beverage service establishment that is a non-motorized unit, operating no more than 21 days annually at any one place or is operated in conjunction with a permanent business licensed under this chapter at the site of the permanent business by the same individual or company, and readily movable, without disassembling, for transport to another location. Seasonal Permanent Food Stand ($190) - A food and beverage service establishment which is a permanent food service stand or building, but which operates no more than 21 days annually. (Ex. Baseball concession stand) Seasonal Temporary Food Stand ($190) - A food and beverage service establishment that is a food stand which is disassembled and moved from location to location, but which operates no more than 21 days annually at any one location. POOLS Public Pool ($320 pool plus $75 for each additional pool.)a pool is any public pool including but not limited to a swimming pool, spa, wading pool, and zero depth pool which is not a private residential pool. MANUFACTURED HOME PARK I RECREATIONAL CAMPING AREAS Manufactured Home Park/Recreational Camping Area ($135 base fee plus $6.00 per site) Manufactured Home Park means any tract of land which two or more manufactured homes are located. Recreational Camping Area means any tract of land which five or more tents or recreational camping vehicles are located. SCHOOLS $450 per school building. $105 for school service kitchen satellite. The charge applies to public and non-public schools providing food and beverage service and includes two inspections per year. Institutions participating in National School Lunch Program are required by federal law, section (9) of US Child Nutrition and WIC Reauthorization Act of 2004, to have two food inspections annually. SPECIAL EVENTS One Day Special Event ($10) -A special event food stand which is limited to operating no more than one day for each event. Two Day Special Event ($25) -- A special event food stand which is limited to operating no more than two days for an event. Three Day Special Event ($60) -- A special event food stand operating three or more days for an event Special Event Campground ($60 base fee plus $2.00 per site) - A recreational camping area used for 14 consecutive days or less.

4 OTHER FEES & FINES Private Well -- ($110 plus $50.00 for each additional well). Any establishment that has a private well service not from a municipal drinking water source. Annual License Late Fee - All license payments are due on or before December 31st. Any payment received, delivered, or postmarked after February 1st will be assessed a $110 penalty. Any payment received, delivered, or postmarked after March 1st will be assessed a $190 penalty. If no payment is received as of March 31st, the establishment will be closed. Reduced Fee - When opening after October 1st and before December 31si, a new business is required only to pay half of the normal annual fee. Plan Review ($ Equal to License Fee) Review of plans and specifications for the construction of a new licensed establishment, conversion of an existing structure for use as a licenses establishment, or the extensive remodeling of a licensed establishment to ensure compliance with the Code. Plan Reviews must be paid in full prior to the plans being reviewed. Reinspection ($290) - Is charged when an establishment fails an inspection and a re-inspection occurs. Reinspection fees are assessed upon completion of the reinspection. Reinspection Late Fee - Any re-inspections not paid on the day of the reinspection will be assessed an $80 late fee. The establishment will be closed if not paid after 30 days of the reinspection. In-Office Hearing ($290) -Is charged when an establishment fails a re-inspection and an in-office hearing occurs. In-Office Hearing fees are due the day of the hearing. In-Office Hearing Late Fee - Any In-Office Hearing not paid within thirty (30) days of the In- Office Hearing will be assessed an $80 late fee. If no payment is received as of 31 days after the date of the hearing, the establishment or facility will be closed. Special Event Late Fee - Any Special Event Licensee will be assessed a late fee of $15.00 if the request is received in the Kandiyohi or Renville office less than 4 days prior to the date of the event. If during an inspection a special event is found to have no license, the late fee equal to the amount of the original license fee will be added to the special event license fee. Emerging Issue: Minnesota's Medical Cannabis - Jill Bruns Ms. Bruns presented information on the Minnesota's Medical Cannabis Program. Starting in July 2015, Minnesotans on the patient registry eligible to purchase medical cannabis once it becomes available at distribution facilities set up by medical cannabis manufacturers. Medical cannabis will be available to Minnesota residents whose health care provider certifies them to be suffering from conditions including: Cancer associated with severe/chronic pain, nausea or severe vomiting, or cachexia or severe wasting. Glaucoma. HIV/AIDS. Tourette Syndrome. Amyotrophic Lateral Sclerosis (ALS). Seizures, including those characteristic of epilepsy. Severe and persistent muscle spasms, including those characteristic of multiple sclerosis. Crohn s Disease. Terminal illness, with a life expectancy of less than one year, if the illness or treatment produces severe/chronic pain, nausea or severe vomiting, cachexia or severe wasting. The Commissioner of Health will consider the addition of other conditions, particularly intractable pain (as defined in statute) by July 1, Medical cannabis will be provided to patients as a liquid, pill or vaporized delivery method that does not require the use of dried leaves or plant form. With regard to safety and security, there are a number of precautions built into the program. For example, registered manufacturers must contract with a laboratory for testing the quality and consistency of the medical cannabis products. Manufacturers facilities are also subject to state inspection. With regard to effectiveness, one important feature of the program is a process for monitoring and evaluating the health impacts experienced by patients taking medical cannabis. This information will help patients and health professionals build their understanding of the benefits, risks and side effects of medical cannabis.

5 Re-Procurement of Health Plans - Ann Stehn Ms. Stehn presented information related to the 2016 Statewide Managed Care Procurement Request and Awards. In Renville County, PrimeWest Health is still in place. In Kandiyohi County, beginning January 1, Managed Care providers will be BluePlus and Medica. UCare, one of Kandiyohi County's current Managed Care providers, did not receive a contract award. Ms. Stehn noted that at today's Kandiyohi County Board of Commissioners' Meeting, she did not recommend to pursue an appeal of UCare's denial at this point in time. Neither Ms. Stehn or Ms. Bruns is able to provide any information as the entire procurement process is confidential and all paperwork has been destroyed per MN DHS. Ms. Stehn and Ms. Bruns noted that UCare has had top notch public health initiatives in the past. We will start negotiations with Medica as soon as possible. It is hoped that Medica will increase their fees and activities in the area of Public Health as other health plans have done. Correctional Health Update Both Kandiyohi and Renville Counties are experiencing staffing changes (resignation and a retirement) in their Correctional Health Units. It is noted that in both Units, the medical needs of the inmates are high. Renville is staffed at 48 hours per week and Kandiyohi has 2 full time nurses (Monday through Friday). Both county Sheriff's Departments are pursuing the possibility of contracting Correctional Health nursing to a private provider, MeND. MeND is currently active in 23 Minnesota Counties and would be able to provide nursing staff plus a medical provider with 24/7 access. The cost would increase, however the services would also increase. MeND would be able to provide: Regional services, therefore good ability to cover staff positions Well trained, experienced staff Less liability to the county The understanding is that MeND hires staff locally when possible Andrea Carruthers asked what MeND's working relationships with local providers has been. She noted that it is extremely important to keep local provider connections. Timely Topics/Issues From Members Sandy Miller: The Atwater Area Help for Seniors (Living at Home Block Nurse Program) Director has resigned. Their Board will be starting the interview process on Friday. John Stahl: The RC Hospital and Clinic facility has their ribbon cutting on September 21 st and will accept its first patients on September 28 th. The facility maintenance training has started this week. Mr. Stahl also noted that Woodland Centers has agreed to provide services at the clinic (five days a week) Meeting Dates: November 17, 2015 Olivia 2016 Meeting Dates: February 16, 2016-Willmar (Rm 2075) May 17, 2016-Olivia (Rm 116) August 16, 2015-Willmar (Rm 2075) November 15, 2015 Olivia (Rm 116) There being no further business, the meeting was adjourned at 3:32 p.m. Respectfully submitted, Jill Bruns, CHS Administrator