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Home My WebLink About06-07-2005 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 - 10:00 AM - Council Conference Room MINUTES I. CALL TO ORDER Chair Jim Kelly called the meeting to order at 10:00 a.m. in the Council Conference Room located at Auburn City Hall, 25 West Main Street in Auburn. Chair Kelly and the following Board members were present: Chair Pro Tem Bud Larson (member-at-Iarge), Member Bill Peloza, Member Roger Thordarson, and Member Russ Vandver. Also present were Board Attorney Joseph Beck and Board Secretary Danielle Daskam. II. APPROVAL OF MINUTES A. Minutes of the Mav 3. 2005 LEOFF Board Meetina Motion by Member Peloza, second by Member Thordarson to approve the May 3, 2005 minutes as distributed. MOTION CARRIED UNANIMOUSLY. 5-0. III. UNFINISHED BUSINESS A. Pendina Disabilitv Leave/Retirement Applications There was no pending disability leave/retirement application. B. Medical/HearinaNision Claims 1. Rav Ooden Request for pre-approval of medic alert service. Mr. Ogden's claim was tabled April 5 and May 3, 2005 pending the receipt of additional information including the type of device, the vendor name, the cost of the service and a letter from the treating physician supporting the medical necessity. Mr. Ogden submitted several documents in response to the Board's request. Board members discussed the claim process for a Board approved service that is on-going. Chair Kelly explained that if the Board chooses to approve the medic alert services for Mr. Ogden, the claimant will be required to submit a claim for payment in the same manner as for a pharmacy reimbursement claim. LEOFF Board Minutes June 7, 2005 Page 1 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 - 10:00 AM - Council Conference Room Motion by Chair Pro Tem Larson, second by Member Thordarson to approve reimbursement for medic alert services received by Mr. Ogden in the amount of $72.00 (for March and April 2005) and approve the monthly medical service as requested in the amount of $36.00 per month. MOTION CARRIED UNANIMOUSLY. 5-0. 2. Ed Henderson Request for reimbursement of (Medicare) claim #11-05025-241- 830 (no Regence EOB submitted) for medical services received on January 21, 2005 and processed by Medicare on February 11, 2005 in the amount of $23.30. Mr. Henderson's claim was tabled on April 5 and May 3, 2005, pending the receipt of the Regence Explanation of Benefits statement. No additional information was received from Mr. Henderson. Motion by Chair Pro Tem Larson, second by Member Thordarson to table the claim for an additional month pending the receipt of the requested documentation. Member Peloza directed the Board's attention to page 29, paragraph G of the LEOFF Policy and Procedure Manual, which states in part: "Claims which do not have complete documentation shall be tabled until the next LEOFF Board meeting or until the required documentation is provided so it is crucial to have the required paperwork." Member Peloza suggested amending the policy to include a specific time limit for tabled claims. Chair Kelly stated that it has been the Board's practice to table the claim for three Board meetings. If after the third Board meeting, the Claimant has not submitted the required documentation, the claim is rejected and returned to the claimant. MOTION CARRIED UNANIMOUSLY. 5-0. 3. John T. Calkins Request for reimbursement of Regence Claim #0500432571900 for medical services received on December 8, 2004 and processed by Regence on January 21,2005 in the amount of $274.00. LEOFF Board Minutes June 7, 2005 Page 2 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 -10:00 AM - Council Conference Room On April 5 and May 3, 2005, the Board tabled Mr. Calkins' claim. Mr. Calkins was requested to have his physician resubmit the claim to Regence with supporting medical data that medical services received were non-routine/preventative. No further information was received. Motion by Chair Pro Tem Larson, second by Member Vandver to table the claim for an additional month pending receipt of further documentation. Chair Kelly requested that the Secretary send a follow-up letter to Mr. Calkins. MOTION CARRIED UNANIMOUSLY. 5-0. IV. NEW BUSINESS A. Disability Leave/Retirement Applications There was no new disability leave/retirement application. B. Appeals/Requests for Reconsideration No appeal or request for reconsideration was filed. C. Medical/HearinQNision Claims 1. Edward Sluys Claim for payment for the purchase of two hearing aids at $1,699.00 each for a total of $3,398.00 from the Board's preferred provider, Costco Hearing Aid Center. LEOFF Board members reviewed the documentation submitted by Mr. Sluys. Mr. Sluys has not submitted a request for hearing aids in the past. Motion by Member Peloza, second by Chair Pro Tem Larson to approve the claim for hearing aids in the amount of $3,398.00. MOTION CARRIED UNANIMOUSLY. 5-0. 2. Fred Fisher Claim for payment in the amount of $117.54 for medical services received on October 18, 2004. LEOFF Board Minutes June 7, 2005 Page 3 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 - 10:00 AM - Council Conference Room It was noted that the claim was not accompanied by a Regence Explanation of Benefits statement. Motion by Member Peloza, second by Chair Pro Tem Larson to table the claim pending receipt of the Regence (insurance) Explanation of Benefits Statement. MOTION CARRIED UNANIMOUSLY. 5-0. 3. David Jaroer Claim for Regence Explanation of Benefits Statement #0509420499300 processed on April 11, 2005 and Medicare Claim #11-05048-378-290 in the amount of $53.00 for medical Services received on February 14, 2005. Motion by Member Peloza, second by Chair Pro Tem Larson to approve the claim in the amount of $53.00. MOTION CARRIED UNANIMOUSLY. 5-0. 4. Bruce Caldwell a. Claim for Regence Explanation of Benefits Statement #0512332888900 processed on May 11, 2005 for medical services received on April 26, 2005 in the amount of $127.01. Motion by Chair Pro Tem Larson, second by Member Peloza to approve the claim in the amount of $127.01. MOTION CARRIED UNANIMOUSLY. 5-0. b. Claim for payment for hearing aid repairs in the amount of $270.00. Board members noted that the claim's supporting documentation indicates the expenses are for normal maintenance and not for repairs. Motion by Chair Pro Tem Larson, second by Member Vandver to deny the claim for hearing aid maintenance pursuant to LEOFF Policy and Procedure Section 9.03. MOTION CARRIED UNANIMOUSLY. 5-0. LEOFF Board Minutes June 7,2005 Page 4 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 -10:00 AM - Council Conference Room 5. Victor Shively Claim for reimbursement of vision expenses (including eye exam not covered by Group Health) in the amount of $54.00 for the exam and $264.14 for lenses and frames. Mr. Shively has not received reimbursement for vision expenses in the last year. It was noted that Mr. Shively has Group Health insurance coverage which does not provide for a yearly eye exam. Board members discussed Section 9.02 relating to claims for corrective lenses and frames and limits on reimbursement for eye examinations. Motion by Chair Pro Tem Larson, second by Member Peloza to approve reimbursement in the amount of $254.00. The amount of reimbursement represents $200.00 for lenses and frames and $54.00 for the vision exam. MOTION CARRIED UNANIMOUSLY. 5-0. Member Peloza requested that Board Attorney Beck research RCW 41.26.150 as it relates to eye examinations for LEOFF members. 6. Marion Dukes Claim for reimbursement of vision expenses for lenses and frames in the amount of $180.00. Mr. Dukes has not received reimbursement of vision expenses in the last year. Motion by Member Thordarson, second by Member Vandver to approve the claim for reimbursement in the amount of $180.00. MOTION CARRIED UNANIMOUSLY. 5-0. 7. Ray Ooden Claim for reimbursement of vision expenses in the amount of $377.00. Mr. Ogden's last reimbursement for vision expenses were approved on July 6, 2004 in the amount of $200.00 for a claim received June 10, 2004 for services received on February 11, 2004. LEOFF Board Minutes June 7, 2005 Page 5 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 -10:00 AM - Council Conference Room Motion by Member Thordarson, second by Member Peloza to table the claim pending further research as the claim may have been previously processed. MOTION CARRIED UNANIMOUSLY. 5-0. 8. Don Casselman Claim for reimbursement of vision expenses in the amount of $329.00. Mr. Casselman's claim was added to the agenda as an agenda modification. Motion by Member Peloza, second by Member Thordarson to table the claim pending receipt of the Regence Explanation of Benefits Statement for the eye examination portion of the claim. MOTION CARRIED UNANIMOUSLY. 5-0. D. Discussion 1. Medical Claims Procedure Member Peloza suggested the LEOFF Board amend Section 9.01 (G) of the LEOFF Policy and Procedure Manual to include a timeline for claims when the claim is received without the proper documentation. Chair Kelly noted that it has been the Board's past practice to table any claim with incomplete documentation for three meetings pending the receipt of the requested documentation. Chair Kelly suggested that a proposed amendment to Section 9.01 (G) be considered as part of the Board's biennial review of the Policies and Procedures beginning in October 2005. Board Attorney Beck suggested methods for amending the Board Policies and Procedures outside the Board's biennial review. One option would be for the Board to suspend Section 10.01 Biennial Review and adopt an amendment outside the provisions of Chapter 10 or adopt a motion to be reflected in the minutes articulating Board's intent. Chair Kelly offered to draft proposed language to amend Section 9.01 to provide a time limit for submitting supporting documentation LEOFF Board Minutes June 7, 2005 Page 6 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday, June 7, 2005 -10:00 AM - Council Conference Room for a claim that has been submitted and tabled by the Board pending receipt of additional information. The proposed amendment will be presented at the next LEOFF Board meeting. 2. Annual Eye Examination Board members requested Board Attorney Beck research RCW 41.26.150 as to its relevance to LEOFF members eye examinations. 3. LEOFF Conference Member Vandver reported on his attendance at the annual LEOFF Conference. Items covered at the LEOFF conference include changes made to Medicare and the Medicare prescription enrollment period. Member Vandver reported that if a Medicare eligible member does not enroll during the prescription enrollment period (which begins in November 2005) benefits may be penalized. Chair Kelly requested the Board Secretary coordinate with the Human Resources Department in developing a notice to LEOFF Board members regarding the new Medicare prescription enrollment. Other items discussed at the LEOFF Conference included an update of the Snohomish County lawsuit relating to LEOFF member dental coverage, long-term care, and alternatives to nursing home care. 4. Follow-up from May 3. 2005 LEOFF Board Meetino In response to Board discussion on May 3, 2005, Board Attorney Beck reported that LEOFF 1 members are not covered by industrial insurance. Worker's compensation is not available to LEOFF 1 members. V. ADJOURNMENT There being no further business, the meeting adjourned at 11 :06 a.m. APPROVED THIS ç:,~DAY OF JULY 2005. ~",r~ K~~ Jim elly, Board Chao '~Û4~-' DanTélle Daskam, Board Secretary LEOFF Board Minutes June 7, 2005 Page 7