I'm sorry. This morning our our indication of be given by Doug Sanders, who's administrative for correctional health and pledges to be led by Michael Tobie-Olo, and our construction manager will you please stand. Our Heavenly Father, I have my father, holy is your name. And first we thank you, dear Lord, for this day that you have made. And we ask that you will bless this day for each and every one of us. There is injury in our land, there is pain and hurt in our land, and Lord will ask you to bring that healing and bring that comfort and use us as your tool in your day-to-day affairs of love and looking over this world. We ask Lord that you will bring wisdom to us all and bear over the leaders of our community as they make the decisions that will affect us all and from their hearts the best interest of all. We thank you for the strength to face our challenges and we ask you to bless us with the faith of Gideon as we move forward. Through your name, all things are possible and through your Son Jesus Christ, we pray. Amen. in the budget, I pledge allegiance to the world by the United States of America and to the Republic for which it stands, one nation under God, being visible with liberty and justice for all. I am the Texas player. I pledge allegiance to the Texas one state under God, one in indivisible. This is one shade under God, one in mid-delizment. Thank you, gentlemen. Item one is for public input. For items not posted on the agenda, if there's any member of the public that would like to address Commissioner's Court, we ask that you please complete a public comment form that available on the side table. I want to remind everyone to please turn off your cell phones and pages. on the side table. I want to remind everyone to please turn off your cell phones and pages. In consideration of some of our guests that are here with us today, let's see, Michael, I'm assuming all of you are here for 13B, correct? Let's go to 13B first on the agenda, which is approval of change order number two in the amount of $55,085 for the DIN kind of jail expansion project for the distributed antenna system pathway installation and a 52 day time extension to be funded from the construction budget auditor line at him 6 6 7 5 2 0 9 0 1 5 With that will call'll call him Michael. Good morning, Michael. Good morning, commissioners. This change order, what this is, the DAS system, distributed antenna system is for the radios to be able to work throughout the building. And some, a lot of buildings, you don't need this extensive of system, but because this building is full of steel and concrete and stuff, the antenna signals just don't travel. So the plan was for initially was for the Sheriff's Department to go back in after it's built and install a distributed antenna system, which they're still going to do. But the problem is that it's going to be very difficult to get that work done after we're in there with the ceilings and all that stuff. So what we decided to do was change order of this amount in, which is going to get all the pathways for them. While the contractor has lifts there while the sealings are open, they're going to drill all the holes that they need to do and get the Conduots in so that way when they go back and do their antenna system, they can easily more easily pull the stuff through. So it's more convenient thing and it actually costs savings by doing it now rather than later. So that's what this change orders for. I have any questions from members of court? Do we have a motion? Second. The motion by Commissioner Coleman, seconded by Commissioner Mitchell. Carrying the questions or comments on favor, please say aye. Aye. Aye opposed to the need. Motion does carry, thank you. Okay, let's see here. I'm sorry. Oh, yeah. We go to 13C also, which is approval of schematic design package and program verification for the kind of jail pretrial booking renovations and authorizations to move forward with a construction document phase of the project and the give a column. Thank you. This is for the pretrial booking renovation project. HDRs here they have a short presentation to kind of run through the design of where we've been. We've been through the Stern Committee and they approved it. You don't see any problems with it. Sheriff Travis is here with any questions. Halventali, Jeff Forrest and David Bosphock are here from HDR. And David's going to run through the presentation. So. Good morning. Good to see you all. Thank you. First of all, I just wanted to say what a pleasure it's been to work with the folks at Ditton County. The staff has been very helpful in putting together the design that I'm going to present today. Great. I think I'm challenged here. I'm challenged here. Okay. A few years back, HDR did a master plan for the jail campus. And one of the things that we recognized as that to the booking area was somewhat inadequate. And especially in terms of the fact that the campus was gonna grow by about 3,000 inmates at some point in time. And since the booking area is such a crucial hub for the activities of the jail, it was important to remedy that problem and then also create a booking area that would last for about 30 years into the future and to accommodate to those 3,000 inmates. We went through a very methodical design process. We looked at things like data, key operational concepts, we spend a lot of time with the sheriff staff going over how we were gonna operate the booking area. And so I'll just run through some of the key things that we found. Okay. Okay. I guess on your screen, this is the existing booking area that you currently have. And in addition to the booking area here, we were able to take some adjacent spaces, for example, the auditorium that's on the right hand side. We were able to incorporate that into the square footage that we needed for the booking area. Also, we were able to take advantage of some segregation cells that are along the south side. And overall, we were given about 14,000 square feet to renovate for a new and improved booking area. Okay. So, like I said, our long-term goals and objectives were to make this intake release area last for 30 years. And one of the things that we noticed when we looked at the booking area was that we had problems and issues with flow because we had inmates, arrestees coming in the same door as people who were leaving the facility to go to court or to go to the Department of Corrections And so there were some some flow issues that we wanted to solve We also wanted to bring in the idea of a direct supervision and as you know on the jail Edition that you're doing right now, we are utilizing direct supervision where the officer is in the housing unit with the inmates. And so to bring that down to a booking area, that meant that we were going to create open waiting areas. So the resties that come into the facility wouldn't necessarily end up in a holding cell, but they would sit in a waiting area just like they would if they were waiting on the doctor. concept about this open waiting areas that we wanted it to be a calm area. So we wanted to introduce natural light and normalize materials. At some of the data that we looked at was the number of bookings that we have at the facility. And right now we're averaging about 14,000 bookings a year. And that trend has gone down since about 2008, but that's typical as across the country. The number of arrests have gone down. And I think it's due in part because of budget cuts for law enforcement agencies across the country. So we saw the same thing here. But anyway, we're looking at about 14,000 intakes a year and about 22% of those intakes are females and about 78% of those intakes are males. We also looked at the number of court transports that we have going across the street into the courthouse and those average about 38 a day. And we wanted to quantify that so that we have enough room and space in the booking area in order to assemble those folks and then transport them over into the courthouse. And basically we have two transports every day. We have one in the morning, and then we have one in the afternoon. We noticed a few problems with the existing booking area. One was at the vehicle Sally Quort, was too slow, or I'm sorry too small, it was congested. And in order for a booking area to operate efficiently, we need to have that vehicular traffic work well. We also had blind spots that were concerned because the location of the central control area. And so those red spots indicate where the booking officers don't have good views. And a particular concern is that the booking officers don't have a view of the security vestibule that separates the vehicle satellite port and the booking area. So they can't see people who are actually coming in to the booking area. We also have the issue of officers coming in to the booking area. This is Rube Tural officers coming off the street and that was something that we wanted to eliminate and then we only have one way in and out of the episode. One of the things that we did with the staff was we went over to Colin County to take a look at their booking area and to look at this concept of open waiting. And so the picture you see here is people in open waiting, these are resties off the street. And you see that they are sharing the males and the females are sharing an open waiting area. They're looking in opposite directions. They have their own TV, their own restroom. But, you know, they're sharing the same space and then we have an officer in the center there that can observe the space. Also notice that there's lots of natural light in this space. And again, it goes back to that idea that when people are coming in to a geophacility, their stress levels are really high. And so natural light helps to calm them down with some. The other thing that we saw there was that the booking officers had good views of everything within the booking area including open waiting, the holding cells, and the law enforcement lobby. And then this is the law enforcement lobby where resting agencies will bring in a resties. And this is all the further that they go inside the facility. They do not go past this point into the booking area. And that was something that we wanted to have here in Dinten County. And then we also have some open waiting in the law enforcement lobby there. So like I said before, we went through very methodical process looking, you know, developing operational scenarios, key adjacencies, and the proper sizes of the space. Like I said, these are some of the things that we wanted to achieve in our design, and we were able to do all these things. And then we developed a space list of all the spaces that we needed for the facility, how those spaces interrelated with one another. And also we were able to figure out exactly how much square feet that we need. And luckily we came up with, we ended up needing 14,000 square feet, which is exactly how much square feet we had to be able to work out really well. And then here is our first test fit. And one of the things that you'll notice right away is that over on the left hand side, the vehicle Sally Port is much bigger. We are envisioning a vehicle saliport that has a shade over the top, so it's basically open, but that shade provides a barrier from contraband being thrown over into the vehicle saliport. We have parking for 10 cars and also a dry by lane. So again, we're wanting to keep that traffic flow moving inside the vehicle's satellite port. It's also large enough for a Greyhound bus. So if a DOC ever decides they are moving towards Greyhound buses, then we have the space for it. Now, Jason to the vehicle's satellite port, at the top is a large law enforcement lobby. And this is where the arresting officers will conduct their paperwork and where the booking officers will do their screenings or mental health screenings, medical screenings and pat down searches before they accept inmates into the facility. Now Jason to that in a dark blue, is the booking area. And that's where we have the open waiting, holding cells, and the booking counter. And that's where we do our fingerprints and mug shots and take care of any other paperwork that we have to do. And then the green to the right of that is our bond area and that's where if people bond out they will utilize the existing lobby that you currently have and bond out there. And then we have, then we utilize the auditorium for the property storage and change out room. So if we have people who are going to be housed in the jail, that's where they go and get their uniform and that's where we take their property. Now the arrow that's going out on the bottom, that's for court transports. And so what we've done is we've separated the intake that's on the top from the transports that's going along the bottom. And so that's going to make things work a lot better because the transport is totally bypassing the booking area. And this is the final design that we came up with. Pretty much the same concepts. We tweaked a few things, it changed the sizes of a few different spaces, but this is the design that we have currently. Now one of the things to remember about this is that right now you have a capacity of 56 in your holding area, and this design increases the capacity to 118. So I think that's going to help you out quite a bit down the road. We also have property storage for 3,000 inmates which was what we were trying to achieve. And again we were able to improve the flow in this area and also create that law enforcement lobby that I think is going to make things work a lot better. Now in terms of construction, one of the things that we're going to do is, well, the Sheriff's Department is going to abandon this area for a short time and utilize the intake area of the old of the main jail. Am I saying that right, Chair? The main jail for a short term basis. So that will allow us to come in here, gut this, and do the renovation as quickly as possible. And that saves money because that means that we're spending less money on general conditions if we can get the job done faster. And so the sheriff has agreed to relocate the intake operation for short period of time. And so that's going to allow us to do this all in one phase, and which will save money, but it will also make the renovation safer. Because one of the things that you're always concerned about when you do a renovation inside of a jail is things like, basically you're trying to create a surgical field to separate this area, the construction area from the rest of the facility, and we'll be able to do that with this approach. So with that, I want to see if there's any questions or sheriff, or is there anything that you would like to add? Thank you, sir. Members, are there questions from the court? Members, are there questions from the court? The floor plan of the original existing to the beginning. Okay. Okay. We're there. Okay. The auditorium is going to be the new property room? Yes, it is. Okay. Are those uses going to be, is that building, is the auditorium presently being used? Is that going to be in the ultimate jail or what I'm just curious? Part of the problem with that auditorium, it's behind the secure perimeter. So if you have any outsiders that come in, have to get searched they're going to get you know turn in license they've been there. So that's really not a great location in the law enforcement center when we start that project there's an auditorium planned in there in the training room so that's all going to move over there temporarily I know the sheriff's department is used our admin complex for training and things that we already have so they've been been moving out there. So that's really underutilized because of the location. So that's why we're able to take that over and make it a property room. Okay. Lane to direct supervision for the booking. I don't know that there's, and the booking, any manpower savings. I think we did a quick staffing review and it looks like the existing staff will be able to function here without new staff. But we've changed some of the roles so some of it's more efficient but there's. I don't know that there's a huge staff savings. We. Now that we're going to have to hire quite a few employees to staff the new jail that we're opening. I didn't know if we could say find some savings because I know direct supervision requires a lot less people than the way that we're doing it now. Well, in a direct supervision for the booking, the only difference is that they're in a open waiting versus a holding cell. But we do have holding cells in there also, so if somebody's acting up, they can be in a holding cell. In a jail situation, it's different than your booking as far as it's the same term, but it's a little bit different. It shows different from the jail standards. It's not one to 48. Like I don't think you have the ratios in booking. No, not with booking. There's no ratios. It's just, no, but I think over time you'll realize staff savings because you'll be able to supervise more people with the same number of staff. One of the things I wanted to correct is I noticed when you talked at the opening that there was law enforcement cuts. We haven't cut any funds for law enforcement. Yeah, you were talking about the day we was talking about basically trends for across the United States. But ours, I don't have any. We haven't done any of that. As a matter of fact, but ours, I don't know. I don't have a none in it. As a matter of fact, I think the budget's gone up. We've been considerable amount of money on new facility. And I get, oh, yeah, I don't know what this circumstance here is here in Den County. And that would have to do with all the resting agencies too. I don't know whether they've ever cut in here or not. Yeah, because that that that number does include all the arresting agencies in that county. So you showed some images of calling county. So you feel confident that the methodologies you're going to in practices that this is floor plans on a Linda self-to is not just something that fits calling county, but it's a state of art industry. The new industry standard as far as intake. Yes, it is a new industry standard. We went to Colin County because it's adjacent. Right. And the other thing too about looking at Colin County is that it's been in operation for 20 years now. And so it's a good example to look at and see, does it work? And it does. It's been tested. Yeah. We also had the opportunity to talk to, you know, a dozen or so different staff members about what you like, what you don't like, what isn't working. And we'd be able to tweak that. So we took the best of what they had, but we actually made it, we think a little bit better. And it fits our needs a little bit more. So there is it's not a replica. It's just the basic concept of the one-way flow is what we copied. Like I stated in our committee I hope this one lasts a lot longer than the last one because I think the pre-trial center is only what 12, 13 years old. How are we completely remodeling it? About 12. Because the court moved over there when they did the renovation here. We office didn't the jail, didn't we? Yeah. I just, to me, you know, he said it's going to last for 30 years. We'll ask your hopes up because this stuff ain't cheap. You're right. Any other questions or comments? Yes, ma'am. I just wanted to clarify by taking this action, the court will be agreeing to issue additional tax nets in 2014, 2015, and perhaps use some contingency funds, because what we have on hand now is $3.5 million. So we'll need another $1 million, $260,000 for this project. So I just wanted to clarify by taking this action, we're committing for the architects to proceed with the design based on that cost. Operational, they've assured me that they're not gonna have any problems opening up the new jail and closing this portion down at the same time. That was a concern. That was a concern I had and expressed it at the committee and I think Captain Ganser, I don't know if he's the new acting and chief administrator for the jail, but he assured me that they'd be able to handle it. I sure hope so. I mean, I know I'm known Captain Ganzer for a long time. He's very competent, but it seems it's going to be a difficult proposition to shut one old place down and then open a completely new deal at the same time I'm trusted will be successful All right, is there anything else anybody would like to ask about or any other comments? You good Do we have a motion Motion by commissioner marchin Motion by Commissioner Marchant. I'll second. Seconded by Commissioner Coleman. Here are no further questions or comments. All in favor, please say aye. Aye. Opposed, aye. Motion is carried. Thank you, gentlemen. Appreciate your time. Okay. Now, I would like to go to item 3a on the agenda. 3a on the agenda is a presentation of the Global PBC Wellness Program by Diana Conjurek, Executive Director of the Public Employees Benefit Cooperative. Do we need a moment to set this up, Kate? Okay. While she's doing that, let's, oh, did you need to go ahead and do the consent agenda. Members of the items on the consent agenda that you need to have some discussion on. Or do we have a motion for approval? Good for approval. Motion by Commissioner Coleman. Seconded by Commissioner Marchant. All in favor, please say aye. Aye. Aye. Opposed, Ceneen. Motion does carry. Consent agenda today consists of approval of the order making appointments. That's 2A. We have a new hire in the County Clark's office. We have two new hires in the County jail and one new hire and juvenile probation that's juvenile posted adjudication. 2B is approval of department, interim departmentudication. 2B is approval department, inter-departmental transfers to C is approval payroll. 2D is approval budget amendment request 100770 to transfer funds from Sanger, government center to Lee Walker, government center at $1,000 in CPS Lewisville at $1,000 for gas service for a total amount of $2,000. 2E is approval budget amendment request 100780 for training and education for jail health, any amount of $3,857. To F is approval of building use requests from Gabriel Burkhart to use the courthouse on the square and law for a wedding in pictures on Saturday, September 27, 2014 from 430 to 7pm. How we do it? Okay, well let's go ahead and I think we can do 5A. 5A is approval of bill report payments from CSCD, Community Corrections, CAI, P, Sheriff's Training, Sheriff's, Forfeiture, V VIP, Interest, DA, Check V and DA, Forfeiture Funds are all presented for recording purposes only. And we also have the auditor's monthly financial report for the month of February that is presented for recording purposes. Good morning, James Wells. Good morning, Judge and commissioners. I'd ask approval of bills that's presented with the one edition that I'm on separate page to some old toway fees that need to be taken care of. Are there any questions? Do we have a motion? Motion by Commissioner March and seconded by Commissioner Mitchell. All in favor, please say aye. Aye. Opposed, Cine? Motion does carry. Are we up and running? Okay, we'll go now to Diana Conjurek and this is item 3A. Good morning, Diana. Good morning, Judge. Good morning. Commissioner, thank you for allowing me to come talk to you about a project that was recently approved by the PBC Board of Governors. And I think I've been here before mentioning a little bit about that we'll be talking about these things for the coming months. The project that was approved on March 26 was a joint project between the PBC and Towers Watson to develop a rigorous global PBC on this plan already and up and running for January 1, 2015. And we're talking about a three year phase rollout, meaning the first year will not be the most rigorous that you have to comply with in year one. But we do want folks to know before year one what will be happening in the next three years. So there are no surprises along the way. We are planning on allowing each PVC group to opt in or opt out of the wellness program. And the wellness committee that we have formed is forming the presentation and the Wellness Plan recommendation for our PVC Board. So the reason I'm here today is to just brief you on what we're talking about and what we think is coming and what we think the benefit will be, particularly in your case to Denton County. Now each PVC member group has representation on our wellness committee and certainly Denton County does too. And our wellness committee serves as the voice to your organization to keep you up to date about discussions or things that are happening along the way. I'll be here again, probably late June or late July to talk with you about here's the final deal. This is what it looks like and then ask you for your decision. You'll have some time to determine if you want to opt in or opt out. So I wanted to in this discussion. And by the way, I'm not going to read every single slide to you or go over every single point. You can look at some of these later. But I'm just going to go over the key points that I want to make sure you have an opportunity to ask questions about if you like. Certainly all PBC groups today have some various level of a wellness program. And in fact, if you ask most people today what is a wellness program, you'll get everything from posters on the wall to we have a gym on the third floor to everything in between. There is no common definition of a wellness program. We do know at the PBC that if we can administer one common program for everybody, there are a lot of benefits that will talk about in just a second. One model program is what we're aiming for to be consistently administered with a menu of compliant incentives and I'll talk about that in a minute. And again, each PBC member group will be able to either opt in or opt out, but you can't cherry pick. You opt out in the entirety. If you want the wellness program opt in, if you don't, that's fine. Just keep going like you are. And that's fine. We have going like you are. And that's fine. We have no issues with any of that. But some of the key considerations you might think about with the PVC handling this for all of our groups. There are a couple of key things. Well, there's more than a few, but I'm just gonna go over a few. One of the biggest that employees are always interested in is how much is my employer going to know about my medical condition, my health, what I'm doing, all these private things. And the answer is the employer, if you go through a PVC unified plan, the employer will not have any of that information. Now you will have information showing how many people met certain levels, how many people in a combined manner have met certain incentives, but you will not have by name which employees have, which medical condition, what labs they've had run, anything like that. And you know, believe it or not, that is one of the biggest concerns about a wellness program having to give information to an employer, there are folks who won't do it. Whether or not there's an incentive just because they don't want to share that private information. The cost, similar to how we handle other things for the P.D.C. groups, we use economies of scale. There's power in numbers and group negotiation. scale, there's power in numbers and group negotiation. We do know that we have cost-shared pricing, we have shared resources, and it really does make the cost for such a program much more affordable. The compliance of a program has become much more difficult because of the changes with the Affordable Care Act, with HIPAA, and other considerations. One of the things with a PDC administration is it's a standard program under constant review, so there's never going to be a concern whether or not what we're doing today is something that's even allowed. You won't have to have those resources reviewing, we'll do that and run it through our standard processes for ensuring that everything is handled the way it should be. Plan documentation will integrate that with our other plan resources. And measurement, measurement is something that is one of the most difficult things with the wellness program. How do you have consistent measurements? One of the values of the PBC is that we have built-in benchmarks. I mean, here we are, five employer groups, all with the same medical plans. And so, I'm pretty much the same as far as population, female, male, age. And so, we can compare from one plan to the next pretty easily. And not only that, we've already talked to some of our PVC groups about the potential for competitions. One department in York County taking on another department in another county. We've had some competition already as far as registering for myUHC.com. And that was our little litmus test to see, do people really get excited about that? And the answer is, oh yes they do. So we know there are ways that we can really help build some excitement and promote engagement. Whether or not we'll find the magic bullet, I doubt it, but I think that we'll do everything we can to at least engage as many people as we can. Our goal for a wellness program, just so you know, is to create a culture of better health. We know there are people who will never reach perfect health, no matter what the wellness program is. We all go through different stages in life. We all have different genetics. We all have different environments. So we know tomorrow everybody is not automatically going to show up healthy because of a wellness program. But we also know that everybody can probably take at least one step to improve their health a little bit. And so that's really what our goal is with this wellness program. One of the things that I really want you to be aware of is that healthcare reform really did change the playing field for wellness programs. Beginning January 1, 2014 this year, you know, now the Affordable Care Act tells us how you can incense an employee based on their health status and their behaviors. Department Treasury Labor, Health and Human Services, they've all got rules now and had input on final rules that you termine how these programs should be run and what these incentives can be to avoid non-discrimination. So here you can see that the maximum permissible incentive or penalty if you want to look at it that way increased from 20 to 30% of the total plan costs that's employer plus employee, the total plan costs, and you can go to 50% for programs, designs, prevent, or reduce tobacco use. Sometimes I'm asked how come you can do that for tobacco, but they don't talk about other things. Well, they certainly do in that 20 to 30% range. However, tobacco is very well documented. The federal government has very clear statistics. And so it certainly is the one proven item that they know goes across so many different diagnoses and can help people become healthier if they reduce or prevent it. We do know that now there are reasonable alternative standards that have to be very specific, have to allow folks to at least have a chance to earn an incentive, even if they don't achieve the final goal, even if they make an attempt to participate. And again, these are rules based on healthcare reform. And then we have other compliance concerns that we constantly look at. Wellness programs have to also be compliant with the Americans with Disabilities Act. And the EEOC has yet to really come out and specify what level of incentive they believe might be problematic or be fine. So that remains an open issue. But I think you can kind of get the flavor for all these organizations, all these rules blended together. We want to make sure we have a wellness plan that's compliant and that you don't have to be changing in centers every few weeks, every few months. They can stand the test of time. When I mentioned that it's a new world of employer-sponsored wellness programs, it's nothing compared with the new world of employer-sponsored health programs, it's nothing compared with the new world of employer-sponsored health plans that we have today. We know, and you know firsthand, over the years, the cost share of ever increasing plant cost is off balance. That's because the more the cost goes up, as your cost goes up, your employees are not paying the same percentage that you are. In fact, it's off. And there's very good reason for that. I mean, each group may have salary concerns and they have budget concerns, but the fact of the matter is it's off. It's very difficult to incent employees when they don't see that the cost is going up like it really is, and they're really not paying the true cost. So for a planned, remains sustainable, which we want to make sure this is sustainable. We know the value matters that if the bar is raised for everybody that the spend is managed with the same rigor that we know that it can help keep that plan sustainable. So reform has also given us some new tools and to try some new things, case in point wellness programs and the increased incentives that employers can offer. And this is all being looked at not essentially for the only reason of the looming excise tax or Cadillac tax, but that's certainly on every employer's mind today because it's just around the corner. And we know that none of the P.A.B.C. employers, our goal is that nobody pays an excise tax. That would be a very difficult thing to do. And so the things that you're doing today, decisions we're making today, are going to have some impact on that. And just so you know, that's not the sole reason for a wellness plan. And in fact, it may not cut your spend enough to make it all up for the Cadillac tax. But it's around the corner and we know we need to make sure that the decisions you make will manage your investment in a lot of different ways. It will impact how you attract and retain employees, the benefit plan that you have and what you charge for it, the health and productivity of your employees, how you organize and deploy your workforce, and also your sustainable cost. I'm not going to go over all these slides but they're really a nice graphic to show you just what can happen. This particular slide is from Tower's Watson's National Business Group on Health, staying at work survey. And the question was, so what are the companies that have the most effective health and productivity programs? What do they look like? What are their results? And you can see here what they are. And so we are going to be looking at, so what are they doing to get there? Obesity cannot be overlooked. We talk about tobacco a lot. We know that employers are looking at best, how to best approach this issue, but you can see the impact of that issue. And this is taken from the Northeast Business Group on health just a few months ago. Smoking employers are raising the bar on smoking. You know the PBC had an incentive for folks who did not smoke or used tobacco products. But we had to push it to our wellness program for 2014 because the new rules that are in place, we did not have sustainable alternative for those folks and we didn't want to start out being non-compliant. So we will be looking a great deal at how we can help folks prevent, avoid smoking, treat smoking. And again, there are lots of rules that tell us now it's not enough that they take a class, they have to quit smoking, but what happens if they complete the class and they don't quit smoking? Those are the hard questions. Do they still get an incentive? Those are the hard questions. So when we go through our wellness program, we actually had a pretty good test run with that program among PBC groups and know where the issues were. So I think that we'll have a really good chance at finding something that's not only affordable that fair to help with that issue. One of the problems with wellness programs is that many employers have them in place, but the participation rate lags. So if you say, for example, a health risk assessment or a preysal, which means people just take a snapshot of their own health, if you incense somebody to do that, look at your own health. There's a constant employee in your thing. You can see here that 84% of all employers that have wellness programs do that, but only have their employees do it. If you look at biometric screening, which I promise, you're going to probably see that term disappear in the coming months, because employees, I think, get a little intimidated by that term, biometric. All it means is go to your doctor, get your labs, get on the scale, get measured, and do it regularly. And those are the kinds of things that we want to do, make this less intimidating and more user-friendly. But you can see here 76% of employers that offer wellness programs, less than half participate in those screenings. And preventive screenings, mammography, you can see how many employers offer that. 41% participate and I need to point out that most of the items on this page are at zero cost to employees today. So we're not talking about cost being a barrier. day. So when I'm talking about cost being a barrier. I'm not going to go over this chart other than to show you the ban and the now the bottom right shows you what has changed in how we categorize things. Now we have to have for those that have activity only health contingent wellness plans. There has to be a reasonable alternative and an outcome base we always have to have a reasonable alternative which is a little bit new. Now the rules have changed for wellness programs. If you just have a participatory program meaning we just want to know that you participated in a plan that has you to do two or three things, and we'll give you an incentive. You can insent whatever you want. There's no limit according to healthy form. Now, is that the best practice? Probably not. But you certainly do it. And this slide basically goes over what I mentioned earlier about the incentives, how much they can be, and how health care reform has now made it a little bit more attractive to incentive employees and try to get behavior changes mostly as felt in premium, but there's also cash rewards that can occur. I only include this on-site clinic slide because you may talk to folks who have on-site clinics and we're not judging anybody's on-site clinic when I share this with you, but I can tell you that on-site clinics, depending on what the services are that they provide, could have potential Cadillac tax impact. And so, you know, we have this term called diminimus care, preventive, diminimus care, like a flu shot or workplace health, like an occupational physical or a fit for duty physical. Those you're really not gonna have a problem with. But if you have an onsite clinic that, you know, treats people's illness, that is going to be a problem with. But if you have an on-site clinic that treats people's illness, that is going to be something that has potential excise tax impact. And most groups now are just realizing this. So they may just now be starting to look at it since there are a couple years away from when this would kick in. So I mentioned this in case you have those kinds of discussions. Slide 12 basically shows the phases, when we talk about phase one, two and three. And this is not the final approach, but I want you to see the phase one is awareness and education, health risk assessments. Phase two is trying to get some behavior change, some action change, and phase three is the result. What happens if you met the result? What happens if you didn't? And by the way, on that particular slide, we want people to know at phase one what will happen in phase three so that we know people will get on something that hopefully they can sustain. Now, when we talk about incentives, I just want to be sure everybody's clear. It doesn't mean it's a no-tax deal. A cash incentive through a wellness program is a compensation practice. And so there are some ways that you don't have to make a compensation, but in this first bullet, you should give kids gift cards, coupons, that's all subject to employment tax and withholding. Incentives linked to an otherwise non-taxable benefit, like a non-taxable today, I should say, like a reduced healthcare premium or an employer contribution to a flexible spending arrangement or health savings account, that still may be tax rate. And so we're looking at those things that would have those kinds of impact first to make sure that folks aren't going to have a penalty just for becoming healthier and participating in these programs. We know that guidance on the excess, excise tax and connection with wellness incentives, we don't have that yet, it's not out there yet. It's going to be interesting to see if all these incentives that are now approved to try to help people get a control over that. It will be interesting to see if there's tax impact of that. But, um, the minimum value items like a T-shirt, a coffee mug, a picnic, those are still no problem. This is just timing. Um, the thing to note on here is that during the month of April you're the first one's actually I'm out talking to letting them know what are brought approved and what we're working on right now and why we're doing it. I'm going to admit it sort of this is where we are this is where you are Denton County and this is why we're thinking about doing what we're doing and I'll be back again in Probably sometime in July with information about what the program looks like Now I'm gonna give you just a few quick slides about your plan as of 2013 into 2013 United health care Actually was going to be here with me today and there was an emergency that prevented that, so I'm here United Health Care voice this morning. We do know though that one of the reasons P.D.C. contracted with United Health Care is they truly do have a mission that helps people live healthier lives, lots of information, lots of innovation, lots of things that can help people make better health decisions. But what we know for sure is that lifestyle behaviors have a direct correlation to health. And 50-85% of all diseases are associated with some health risks that could be modified, or maybe even preventable. For example, 80% of heart disease strokes, tattoo diabetes, up to 40% of cancer could be preventative people. Aid healthier, exercise more, and stop using tobacco. Now that's the stuff nobody wants to hear. I know that. And I just don't know if we're going to have the magic solution, how to make that a message that everybody will jump up and down over. But we think commitment by an employer at the top all the way down. We want you happier, healthier, more productive. Well, not only being more sustainable will result in a more effective workforce for you. This is kind of a cost situation. You can kind of see the potential impact on health care costs over time won't happen in year one if folks lost weight, managed a chronic illness more effectively, stopped smoking, or even selected a specialist rated on quality and efficiency. And by the way, folks can go on the United Health Care website and you can select a physician and see their quality ratings. And all that means is there's experience that shows us it may take only one visit instead of three to help you and that's definitely a cost savings or they have fewer interventions to help people get healthier. But this is a slide I wanted to show you. If you started the left, the light blue shaded bar, you can see what 2012 medical only cost with the cost was per member per month in Denton County. And then if you look at 2013, it came down a bit. And remember, 2013, what you're seeing is the result of maybe a year or two in United Healthcare instead of a prior plan. The next bar, the one that shows 333, that's where we make an age, gender, adjustment, to say what if everybody that we're looking at measuring you against was the same age as your group, what would your costs look like? So you can see that would be $333. You compare that to a peer, which is we use United Health Care's public sector customers in Texas. That's 220,000 self-funded members. You're included in there. It's about $10 less per member per month. And then if you look at, you know, add private sector to it, just United Health Care members, public and private, you can see it goes back up a little bit. But then if you look at PVC combined, it's a whopping 402. And I can tell you the biggest impact there is the plan design, the rich benefit plan. Because we had, and we still have excellent benefit plans, but in 2013, we had, you know, Cadillac plans. And in 2013, we had, you know, Cadillac plans. Now in 2014, we have a high deductible plan with the health savings account. As your folks are learning more about that, they're actually making better decisions, making decisions that help them. Now this is what that money is spent on for Denton County and if you kind of start at the bottom the musculoskeletal what we're doing here is taking the top five diagnoses. Now there could be more than one diagnosis in each of these categories but the top five and one percent of your population has these items. So musculoskeletal, you know, is back pain, joint knee, and hip, and you might think, well, what does that have to do with wellness? It has a lot to do with wellness. Arthritis, weight bearing, knees, hips, it's not all injuries. We're talking about arthritis and non-movement type issues that all contribute to that. So that is your biggest client cost driver is Musco-Skeleton issues. Next is anything else that's like a screening or rehabilitation, that's 1.4 million at state about the same from the prior year. The next one is circulatory. Last year was 2 million this year's about 1.3. That's coronary issues, bypass, surgery, block arteries, non-specific chest pain. The next item are cancers, breast cancer, chemo radiation. And then we have digestive systems. Those are like gastro, you know, bird issues or esophageal issues. You can see where that causes coming from. But if you put all together in any of these diagnoses, how many people have a diagnosis of diabetes? It contributes about 1.8 million to your total spend. And so we know that that's an overwhelming issue that we want to target in a big way is to help people with diabetes concerns. These are the potential modifiable health risks that we know we can help with. We mentioned a moment ago back pain, high blood pressure, diabetes. Those are the three most prevalent diagnoses here in Denton County. And the highest risk factors, physical in activity, will be seen in tobacco use. Now, I didn't have a slide for this, but I have to say we're also seeing a lot of information about the impact of stress on health costs. And stress is often translated anymore that we're seeing to employes lack of control over certain things in life. Wouldn't it be wonderful if we could control everything in life, you know, but we can't. But how lack of control, it may be driving so much stress that it could be actually contributing to some of this cost. And so one of the things we're going to be focusing on is the message of if you can't control anything else, you can't control this. You can do one thing to get control over something in your life, and we hope you choose something healthy. And those kinds of messages, you know, just the fact that you acknowledge it is a big thing. It's a huge thing. We do know that behavior change and personal decisions impact everybody. In a good way, the optimal 59%, people who choose to stop smoking, people who have early mammograms or do things that doctors suggest, the sub-optimal, look how many 41%. They go to the emergency room for primary care or they don't have a primary care doctor or a family doctor or they don't have time for the diabetes testing. And maybe they don't know just how easy it is anymore. And in the old days, it was an event, not anymore, not like it used to be. So that's really my story. I just wanted to come and let you know what we're working on. We appreciate Denton County's participation in our wellness committee and their comments. And they'll be bringing questions you have back to our committee or comments they may hear back to you before I come back again and tell you more about the final program. Any questions? Thank you Diana. Are there any questions from members of court? So, can you clarify one more time, Dan, at the, we cannot, if someone goes through any type of incentive program and doesn't achieve their goal, we still have to. There's a difference between Commissioner and if I heard you correctly, you're saying we can't, if they don't go through the incentive program, we still have to reward them. Was there any question? Do not meet the goal. But they don't meet the goal. They go through it but don't meet the goal. But we reward the attempt or the... Yeah, there's two things we have to look at. One is, did they complete the participation? So let's just use a tobacco cessation program. Did they complete it? Then it doesn't really have as big an impact if they met their goal. The law now says you can't really penalize them for not meeting their goal of quitting smoking as long as they participate. That's true. And that's the law? That's under affordable care. You know, you're looking at me the same way, when I first read this, I thought that could hear me all the way in Dallas County from Arlington because I thought, seriously, I don't get that. Well, the reality is, it's sort of like addiction. Everybody knows now, most people know I should say that with addiction, part of addiction. Everybody knows now, most people know, I should say, that with addiction, part of addiction is relapse planning, because everybody typically has at least one relapse dealing with an addiction. If tobacco is an addiction and similar to that, completing at least under medical guidelines, completing a tobacco cessation class and making the attempts, will you quit? We certainly hope so and you will have some sort of incentive for completing it. At least you have to be offered the same incentive as anybody else. And then if you complete it, you know, you can certainly give an incentive, but you can't penalize people for not completing, for not achieving the goal. Correct? I understand that. And so I finally had to reconcile it myself by saying, okay, so is there any harm in somebody going through it two, three or four times before they quit smoking. Maybe not so much. But it's certainly something now we have to look at and make sure a wellness plan can clearly identify. So there's absolutely no doubt what has to happen before certain incentives are earned. And that's a hot topic. You mentioned smoking a lot. Is weight part of this equation? Absolutely. Obesity is certainly something that we have built in and we will be having built into the wellness program. Compliance, consistency, printing. I thought you'd mention it earlier so I want to make sure you were. Absolutely. And there's actually a slide in here you can go back to and look at the impact of that to the workplace. So you can see why it's such an important part. Absolutely. Okay, thank you, Diana. Thank you. Thank you. Appreciate your driving over here. No problem. Okay. Appreciate your driving over here. No problem. Okay, let's go now to item 4A on the agenda, which is a public hearing approval for the reply of council tractor editions lot 11 are in 12 are this is Commissioner preaching forward. We have a motion for our public hearing Motion by commissioner Ead seconded by commissioner Mitchell all in favor. please say aye. Aye. Aye, opposed, sitting. Motion does carry. Stephen, good morning. Aye, just commissioners. The public hearing is considering a replat of the KELSO track or addition. The owner of LOTS 11 and 12 is reconfigured in a lot lines, a lot line between those two LOTS. Both new LOTS will continue to conform to the Denton County Standards. We issued 24 public notices, we received four responses, all those in favor. This reply is recommended for approval by the DSE. Okay. Any questions or comments from anybody in the audience? Anyone who wishes to address the Mr. Scord on the issue of the approval of the reply of council tractor additions, a lot lot 11R and 12R. Anyone in attendance that would like to address Mr. Scort on this issue? Hearing none, do we have a motion to close our public hearing? Thank you. We have a motion by Commissioner Marchandt, seconded by Commissioner Eads. I'll in favor, please say aye. Aye. Opposed to the name? Motion carries. Any questions or memories recorded? Do we have a motion? I move for approval. Thank you. I have a motion by Commissioner Ead, seconded by Commissioner Mitchell. All in favor, please say aye. Aye. Opposed to name? Motion does carry. We'll go now to item 13a, which is acceptance of certification of completion for our 2013 continuing education credit hours for Commissioner Ron Marchant in accordance to the Texas local government code article 81.0025 Motion by Commissioner Ease Seconded by Commissioner Mitchell on favor please say aye. Aye opposed, sen. Motion does carry 13D is approval of the preliminary acceptance of segment one of the Copper Canyon Road South project is shown in the attached map. I will gladly move for approval. Motion made commissioner Eid, seconded by Commissioner Marchin. I'll in favor, please say aye. Aye. Opposed, aye. Motion does carry. We can take 13 E F and G together because they're all reappointments. 13 E is the reappointment of Donna Kernsch to the Louisville Teres number one. 13 F is reappointment of Jean Carrey to the Louisville Teres two and 13 G is approved of the reappointment of Ronnie K to the Louisville Teres two. All in pressing three motion by Commissioner Mitchell. All in seconded by Commissioner Eads. All in favor please say aye. Aye. Opposed, aye. Motion does carry. 13-H is approval of reappointment of Mr. Larry Lipscomb to the Den County Transportation Committee. Motion by Commissioner Mitchell, seconded by Commissioner Eads. I'll in favor, please say aye. Aye. Opposed, aye. Motion does carry 14a is approval to exercise didn't county's option to renew the contract for collection of delinquent court fines and fees. It says by the district county and justice courts are didn't county Texas between didn't county Texas and recorrect the South Cabragnale and PC. Charyl moved for approval. Seconded by Commissioner Mitchell, questions or comments? Hearing none, all in favor, please say aye. Aye. Opposed, aye. Nane. Motion carries for in favor, one opposed. 14 B is Commissioner E. Coleman opposed. 14 B is approved in a local corporation agreement between Denton County, Texas and the town of Arga, Texas, for the Country Club Road and Permanent Project with Dent County Green to contribute an amount which will not exceed $5,552,420. Funding for this project will come from the following Commissioner Prissy for funding sources, $500,000, which will be used to reimburse the town for utility relocations will come from trip o8 funds, old Justin Road Project auditor line item 66675959035. One million five hundred and five hundred dollars will come from the country club road north and south auditor line item 8574109060. One million six hundred and fifty five thousand seven dollars will come from the country club road north south auditor Item 857-41090, 7.0, 1,896, $9,913, will come from Country Club Road. North and South Auditor Line Item 667-4109035. This is all in the Commissioner Priscing for. Move for approval. Thank you. Motion by commissioner is. All these other projects are not going to need the money. And we have a second by commissioner March. And I believe I heard. So the other projects are not going to need the money that you move in. Right. We did a savings because we did the old Justin wrote in house for the town of Argo and saved us money. We're able to reallocate that money and put it over on Country Club. All right, we have any further questions or comments? Here none. All in favor, please say aye. I oppose the name. Motion does carry 14C. Is approval local project fund, advanced funding agreement in the amount of $570,800 between state of Texas acting through the Texas Department of Transportation and Denton County, Texas for a right away acquisition and reimbursal utility adjustments for the state highway 114 FM 156 interchange project to Denton County, Pursing 4 with Denton County green to fund 10% of the right away acquisition in the estimated amount of $520,800. And 10% of the reimburseable utility adjustments in the estimated amount of $50,000 for a total Dent County contribution in the estimated amount of $570,800. So the funding to be transferred from the Dantin County Commissioner of Precinct 4. Smith, Schleeder, County Roads Fund, Auditor line item 617-388030 to Commissioner of Precinct 4, AAA State Highway 114, right away funds, Auditor line item 617-4549060. This is all Commissioner of Precinct 4. I'll move for approval. And this is our participation in how we won 14 our local match. Motion by commissioner Ead seconded by commissioner Marchant questions or comments hearing none all in favor please say aye. Aye opposed sitting motion does carry item 15 is executive session, 15A is pursuant to Texas Government Code 551.0711A consultation with Attorney in the closed meeting. When the Government will body 60 advice if it's attorney about potential or contemplating the litigation with regard to the claim by Larry Lynn Herring and Lewis Wayne Austin Jr. against it in county 15B is pursuant to Government code 551.0711A consultation with attorney in the closed meeting when the government will obviously see advice if it's attorney about pending litigation. This is style Synthia or Clementson aka CC Clementson currently pending the United States District Court Eastern District of Texas Sherman Division. And lastly 15C is under government code 501.074A1 personnel matters, close meeting to deliberate the appointment and appointment evaluation of applicants for the position of health department director and your interview set applicants. We will take item 13A and B first will come out and take any necessary action on that in open session and then go back and do the interviews. Okay, with that we are in executive session. Executive session under item 15A, the BNO action. Under Item 15B, this is my motion to assign legal representation in several action-styled Cynthia R. Clementson-AKA, a CC Clementson versus Denton, Cony Texas, and currently pending in the US District Court for the Eastern District of Texas Sherman Division to the law, office of Matthews, sign in shields, Pierce, not Eden and Add. Davis, LLP, and authorized it and kind of judge to sign a contract of employment with Matthews, sign in shields. Pierce, not in Eden, Davis, LLP, that is my motion, deserves second. Seconded by Commissioner Marchand, all in favor, please say aye. Aye, opposed to any. Motion does carry. And we're gonna come back and do 15C here in just a minute, but we're gonna take about a five minute break. And then we'll start our interview process and we appreciate your patience. So we're taking a five minute. Commissioner's Court is reconvened from executive session. There will be no action on 15C. And with that we're adjourned, everybody have a great day.