discussions with the candidates for County Commissioner since he and Commissioner Reedy would be replaced January 2013.

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1 APPROVED ON AUGUST 1, 2012 BY THE BOARD OF COUNTY COMMISSIONERS AT THE WEEKLY BUSINESS SESSION Coordinated Care Organization Meeting; July 5, : 30 p.m. Options for Southern Oregon Commissioners: Don Reedy Transcriber. Vice Chair Reedy called the meeting to order at 3: 30 p.m. and Harold Haugen ( Commissioner Hare was unavailable); Terri Wharton, Introductions were made and the following people were in attendance: Linda Stohlman, Josephine County Public Health Jackie Walden, Board of Health Patty Beeler, Community Member Rick Jones, OHMS/ Choice Counsel Pat Garoutte, NAMI of Southern Oregon Debbie Garoutte, Options PSS Amara Thelen, Options Case Management Kurt Higuera, Siskiyou Community Health Center Jim Bryson, Options Lance Dickison, Options Jill Jackson, AllCare CCO Joann Gillyatt, Options HR Director Bob Lieberman, Kairos CEO Doug Flow, AllCare CCO Cynthia Ackerman, AllCare CCO Nikki Pethtel, AllCare CCO Heddy Sennhouse, AllCare CCO Susana Alvarez, DHS Residential Recource Darci Nichols, DHS Child Welfare Karla McCafferty, Options Diane Hoover, Josephine County Public Health Director Maggie Rollins, Oregon Health Management Services Roylene Dalke, Oregon Health Management Service Jennifer Johnston, Oregon Health Management Service Margot Nelle, Care Oregon Shelly Uhrig, Options Commissioner Haugen explained this was an opportunity for all parties to explain how they are functioning and issues they could be facing when moving forward with Coordinated Care Organizations. He described the eight questions that were developed( ExhibitA) and asked the participants to take turns answering questions. Commissioner Haugen suggested this group meet again in November or December to evaluate what has been going on and how possible issues could be addressed to the State. He encouraged all participants to have discussions with the candidates for County Commissioner since he and Commissioner Reedy would be replaced January Meeting adjourned at 5: 06 p. m.

2 Cft7JT CC() ttlch A QUESTIONS FOR CCO ORGANIZATIONS 1. CCO' S WILL BE EXPECTED TO MAINTAIN AND THEN INCREASE THEIR CAPACITY TO PROVIDE MENTAL HEALTH, DENTAL, PHYSICAL, AND ADDICTIONS SERVICES TO A VARIETY OF POPULATIONS. EACH CCO WILL BE EXPECTED TO WORK WITH THOSE WHO HAVE HIGH HEALTH CARE NEEDS, MULTIPLE CHRONIC CONDITIONS SUCH AS DIABETES AND COPD, IN ADDITION TO MENTAL ILLNESS AND CHEMICAL DEPENDENCY. A) QUESTION: ARE YOU PRESENTLY OFFERING THESE SAME SERVICES TO THE SAME NUMBER OF PEOPLE YOU WILL BE REQUIRED TO SERVE AS A CCO? B) QUESTION: IS YOUR CCO READY TO HANDLE AN INFLUX OF SERVICES YOU HAVE NOT BEEN RESPONBLE FOR BEFORE AND POTENTIALLY PATIENTS THAT YOU HAVE NOT CARED FOR BEFORE? 2. THERE ARE MANY PEOPLE ON MEDICAID WHO HAVE " OPEN CARD" STATUS, WHICH MEANS THEY DO NOT BELONG TO A MANAGED CARE PLAN THAT ASSIGNS A PRIMARY CARE PHYSICIAN. QUESTION: HOW WILL YOU MAKE SURE THAT EACH OF THESE PATIENTS HAS A PRIMARY CARE PHYSICIAN? 3. IT HAS BEEN REPORTED THAT ANOTHER 20, 000 PATIENTS WILL BE ADDED TO OHP STATEWIDE WHICH COULD MEAN AN INCREASE OF SEVERAL HUNDRED PATIENTS IN JOSEPHINE COUNTY. QUESTION: WILL YOUR ORGANIZATION BE ABLE TO HANDLE THIS INCREASE? 4. BY STATUTE, THE COUNTY, VIA ITS COMMISSIONERS, IS THE LOCAL MENTAL AND PUBLIC HEALTH AUTHORITY. THIS INCLUDES ENSURING THAT SAFETY NET SERVICES SUCH AS PSYCHIATRIC ACUTE CARE HOSPITALIZION FOR BOTH OHP AND INDIGENT INDIVIDUALS IS FUNDED. HOWEVER, UNDER THE CCO STRUCTURE IN JOSEPHINE COUNTY, THE COMMISSIONERS WILL NO LONGER HAVE FINANCIAL OR OPERATIONAL RESPONSIBILITY FOR HOW OHP DOLLARS ARE SPENT. COUNTIES CANNOT

3 BECOME THE PROVIDER OF " LAST RESORT" FOR THOSE WHOSE NEEDS ARE NOT BEING ADEQUATELY ADDRESSED BY THE CCO. A) QUESTION: HOW WILL YOUR ORGANIZATION ADDRESS COUNTY INVOLVEMENT AND INPUT TO ENSURE THAT THE CURRENT SAFETY NET IS NOT ADVERSELY AFFECTED? B) QUESTION: AT THE END OF EACH BUDGET YEAR, IF THERE IS A SURPLUS OF REVENUE IN THE CCO, HOW WILL IT BE ALLOCATED? DOES IT GO BACK INTO PROGRAMS AND PATIENT CARE, OR ARE BONUSES PAID OUT TO SHAREHOLDERS, PHYSICIANS, OR HOSPITALS? 5. QUESTION: PLEASE OFFER AN EXPLANTION ON WHAT MONIES WILL STAY LOCALLY AND WHAT AMOUNT WILL NOT. 6. QUESTION: EACH OF YOU HAS STRENGTHS IN A PARTICULAR AREA. HOW WILL YOU HANDLE THE EXPERTISE IN THE AREAS THAT HAVE NOT BEEN A PART OF YOUR ORGANIZATIONAL STRENGTHS? 7. QUESTION: IF YOU ARE NOT SELECTED BY THE STATE OF OREGON TO BE THE CCO OF JOSEPHINE COUNTY, WILL YOU AND THOSE ASSOCIATED WITH YOUR ORGANIZATION, SUCH AS PHYSICIANS AND HOSPITALS, STILL BE WILLING TO PARTNER WITH THE SELECTED CCO? 8. QUESTION: WHAT HAPPENS TO YOUR ENROLLEES IF THEY NEED SPECIALIZED CARE OTHER THAN WHAT YOU PROVIDE?

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