Managed Risk Medical Insurance Board

Minutes of September 10, 2002, Meeting




Board Members Present:††††††††††††††††††††† Cliff Allenby, Areta Crowell, Ph.D.,

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Virginia Gotlieb


Ex-Officio Board Members Present:††† Martin Gallegos, D.C.,

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Elizabeth Stanley-Salazar


Staff Present:†††††††††††††††††††††††††††††††††††††††††† Lesley Cummings, Lorraine Brown, Irma Michel, Bob Olson, Richard Popper, Laura Rosenthal, Stuart Busby, Dennis Gilliam, Ernesto Sanchez, JoAnne French, Monica Martinez, Thien Lam



The meeting was held at the State Personnel Board Auditorium in Sacramento.


Chairman Allenby called the meeting to order.




Virginia Gotlieb made a motion to approve the minutes from the June 26, 2002, meeting.The motion was unanimously approved.




Bob Olson presented a summary of the 2002 State Budget Act (ďBudgetĒ) regarding MRMIBís programs.The Governor signed the Budget on September 5 and is expected to sign the trailer bills.


The Budget includes $672.2 million to fully fund the Healthy Families Program (HFP) caseload which is projected to reach 624,000 by June 30, 2003.The funds include the CHDP Gateway to be implemented in April 2003.Trailer bill language associated with the CHDP Gateway was adopted that (1) eliminates retroactive disenrollment of children from HFP, (2) eliminates the six-month waiting period for HFP children who are disenrolled, and (3) requires payment of outstanding premium balances if a child disenrolled for nonpayment of premiums re-enrolls within 12 months.


The Budget includes a $4.3 million augmentation for the Rural Health Demonstration Project, bringing the total funding to $4.6 million.


Although the Governor is supportive of parental expansion, he vetoed the legislatureís $143.3 million augmentation due to the fiscal situation.The Director of Finance stated that HFP parental coverage expansion is under consideration for the 2003-04 budget.


The Governor vetoed the Legislatureís $22.1 million augmentation in the Department of Health Serviceís Medi-Cal budget for the two-month bridge from Medi-Cal to HFP for parents and children, but left funding for the one-month bridge for children.MRMIB will implement a two-month bridge for children from HFP to Medi-Cal.


Trailer bill language implements three changes to the HFP program:a two-month bridge from HFP to Medi-Cal for Children; a 25 percent discount on monthly premiums if paid by electronic fund transfer; and expansion of the ďfamily contribution sponsorĒ period from the first 12 months to any consecutive 12-month period.


For education and outreach activities for HFP and Medi-Cal for Families, the Budget includes $7.1 million for payments to certified applicant assistants (CAAs) and $2.7 million for outreach support and training.There is no funding for advertising campaigns, public relations, or school- and community-based outreach contracts.


The Budget includes $83.2 million to fully fund the projected enrollment of approximately 6,700 new uninsured pregnant women in the Access for Infants and Mothers Program (AIM).


The Budget includes the historical $40 million base funding from Proposition 99 funds for the Major Risk Medical Insurance Program (MRMIP).


The Budget also requires the elimination of 6,000 positions identified as being vacant on June 30, 2002.MRMIB has two vacant positions that could be eliminated.Trailer bill AB 593 requires the abolishment of an additional 1,000 positions by June 30, 2004, and an across-the-board reduction in operations of up to five percent ($750 million).


The Chairman asked if there were any questions or public comment; there were none.




HFP Enrollment and Single Point of Entry (SPE) Reports


Ernesto Sanchez reported that as of September 10, 2002, there are 592,000 children enrolled in HFP.He briefly reviewed the HFP enrollment data, detailing the ethnicity and gender of subscribers, the top five counties in enrollment, and the Single Point of Entry (SPE) statistics.For more information, visit the MRMIB web site at www.mrmib.ca.gov.Mr. Sanchez reviewed history of the HFP enrollment and the monthly disenrollment rate from June 1998 through July 2002.


Dr. Crowell asked what provisions could be made if HFP reached its projected enrollment before the end of the fiscal year.Lesley Cummings said MRMIB could submit a request to the Department of Finance for continuing funds.Dr. Crowell asked if there is an obligation to stop enrollment if there were no continuing funds, to which Ms. Cummings replied that there is.Chairman Allenby reminded the Board that one year AIM had to be closed to new enrollment and that it had been a difficult experience.Virginia Gotlieb asked what impact on enrollment the reduction in outreach has had.Irma Michel replied that as of now enrollment continues to maintain.Ms. Cummings noted that, despite this, there could be negative consequences on enrollment and retention due to the advertising and outreach reductions.She reported that the California Health Information Survey (CHIS) found that only 25 percent of parents whose children were eligible for, but not enrolled in, HFP were unaware of the program.This was a great level of awareness given that the HFP is only four years old, but indicated that more families need information on the program.Chairman Allenby noticed that the California Teachers Association had formed a partnership with the California Association of Health Plans to provide information to teachers so they can notify parents about HFP.They will be providing a toll-free phone number and a web site.Dr. Crowell said that MRMIB appreciated those who are stepping forward to fill in the gaps left by the reduction in outreach funds.She suggested that staff work with those entities.


Dr. Gallegos asked if staff keeps track of how applicants heard about HFP so it is known what types of outreach are effective.Ms. Michel said when applicants call the toll-free phone number they are asked how they heard about HFP.She offered to provide the statistics at the next Board meeting.


Chairman Allenby asked if there were any further questions or public comment; there were none.


HFP Administrative Vendor Performance Report


Ernesto Sanchez presented the June and July 2002 Administrative Vendor Performance Report.Electronic Data Systems (EDS) is the administrative vendor for the HFP and the SPE.The report lists the performance standards contained in the contract between MRMIB and EDS and reports on EDSí performance in each category.Mr. Sanchez stated that effective July 1, EDS changed phone companies from AT&T to MCI, and that MCI has not been able to provide statistics for the toll-free lines.However, the data will be available for the October meeting.In addition, on July 1 significant system changes to SPE were implemented including CIN assignment, acceleration of enrollment for Medi-Cal screened children, and tracking of applications forwarded to county welfare departments (CWDs).During the first part of July, EDS did not send out applications to CWDs consistent with performance time frames.MRMIB staff anticipated that there would be a transitional period during which EDS might not be able to meet all performance standards.By the end of July, these issues were resolved and EDS was able to meet the performance standards.


Chairman Allenby asked if there were any questions or public comment; there were none.


HFP Parental Coverage Expansion Implementation Status Report


Lesley Cummings stated that since the Budget did not allow for parental coverage expansion at this time a detailed report on implementation was not necessary.She pointed out that MRMIB was, in fact, ready to implement parental coverage had policy-makers agreed on implementing it.She acknowledge that it taken a tremendous amount of work on the part of both staff and the vendors to accomplish all the milestones to be ready and she expressed appreciation to the staff and all others who had worked so hard.


Chairman Allenby asked if there were any questions or public comment; there were none.


Status of Federal SCHIP Funding


Richard Popper reported on the status of federal Stateís Childrenís Health Insurance Program (SCHIP) funding for HFP.Federal rules governing how states retain or receive unused SCHIP allotments sunset on October 1, after which Californiaís unspent funds of $700 million would be distributed to approximately 13 states.There have been three major developments since the June Board meeting.


At the end of July S 2860 (Rockefeller, Chafee, Hatch, Kennedy), the Childrenís Health Improvement and Protection Act of 2002, was introduced to address SCHIP funding issues.The bill (1) fixes the SCHIP-dip (the decrease in SCHIP funding that occurs in the middle years of the program) by augmenting total allotments by $1.125 million in both FY 2003 and FY 2004; (2) allows states with unspent funds (like California) to retain 40 percent of unspent FY 2000 and FY 2001 allotments, distributing the remaining 60 percent to states that have spent their funding; and (3) limits the availability of redistribution and retention of unspent funds for one additional fiscal year.If enacted, the bill would provide California with over $600 million.However, some of the funding would displace Californiaís existing allotments, which would then be redistributed to other states.Approximately $300 million of the estimated additional funding for California would be available through FY 2006 (the amount associated with the SCHIP-dip fix).


Mr. Popper also reported on the SCHIP position adopted by the National Governorsí Association (NGA).In July, the NGA formally adopted compromise principles on expiring SCHIP funding.Representative Hill of Indiana is circulating a draft bill that would implement most of the NGA compromise principles.Of the two solutions, S 2860 would provide California with access to more SCHIP funds compared to the NGA principles.However, up to half of the funding under S 2860 would only be available for one additional year, and then could either be redistributed or cause existing allotments to expire.Further, S 2860 exceeds the NGA proposal by approximately $2 billion, which is notable given that the Bush Administrationís proposal for expiring SCHIP funds cost only $500 million and this springís House budget resolution contained no additional SCHIP funding.Some states prefer the greater short-term certainty of the NGA principles.


Mr. Popper also summarized a General Accounting Office (GAO) report which questions the authority of the Department of Health and Human Services (HHS) to allow states to use SCHIP funds to cover parents of SCHIP- and Medicaid-eligible children.The GAO was also critical of HHS procedures in connection with section 1115 SCHIP waiver applications.However, the GAO did not find fault with Californiaís parental coverage waiver.


Dr. Crowell asked about MRMIB staffís involvement with the negotiations regarding SCHIP funding.Mr. Popper replied that staff is monitoring them very closely, having discussions almost every other day with the Governorís representatives in Washington, D.C.Senator Feinsteinís office is also involved.He said that there is concern about the overall cost, and that the NGA proposal would be less costly.Dr. Crowell suggested a need for advocacy groups to be involved and a need for active involvement by the Davis Administration, particularly in the House.


Chairman Allenby asked if the NGA proposal represented a compromise among the states.Mr. Popper replied that it is a compromise between the two groups of states, those with unspent SCHIP allotment and those that have exceeded their allotment.


Chairman Allenby asked if there were any further questions or public comment; there were none.


HFP Group Needs Assessment Report


Lorraine Brown presented the Group Needs Assessment (GNA) report.The GNA is one of four cultural and linguistic requirements that exist in MRMIBís health, dental, and vision contracts.Each plan contracting with MRMIB was required to conduct a GNA to identify the health risks, beliefs, and practices of their HFP subscribers.They were also required to develop a workplan in response to identified needs, along with a timeline for implementing the workplan.Ms. Brown highlighted the key points contained within the report.She noted that the Department of Health Services (DHS) has been a nationwide pioneer in developing an approach to working with plans on cultural and linguistic competency.She noted that MRMIB had adopted this approach, including the requirement for a GNA.


Ms. Brown described the methodology used for conducting the GNAs, the major findings that plans made, and the major types of activities plans proposed in their work plans. She concluded that the conduct of the GNA had focused plans efforts on developing culturally and linguistically appropriate services for subscribers in key areas. The variety of activities plans will implement to address the needs will allow MRMIB to look for best practices than can result in program-wide enhancements in the provision of culturally and linguistically appropriate care.


Ms. Brown noted that legislation (AB 2739 - Chan) sent to the Governor would codify the cultural and linguistic requirements of HFP contracts and require that GNAs be conducted every three years.At MRMIBís request, the sponsor of the bill had agreed to language that would have given the Board greater flexibility to improve the requirements.However, these changes could not get incorporated in the bill given legislative deadlines. The sponsor agreed to introduce clean-up legislation next session.


Ms. Brown suggested that whenever the next round of GNAs occurs, MRMIB would seek to facilitate a broader collaboration among health plans.Also, staff will hold discussions with experts to ensure that GNA requirements reflect the latest thinking in the field.


Dr. Crowell said she thought the summary was excellent and commended staff for their work.She asked if DHS had prepared a similar summary of its GNAs.Ms. Brown replied that she was not aware of one.Dr. Crowell said she was disappointed that in their literature review plans had not referenced the Surgeon Generalís report on mental health services and the supplemental report on the needs of Latino children.She would like MRMIB to send a letter to health plans informing them of this resource.


Elizabeth Stanley-Salazar concurred with Dr. Crowell regarding mental health and added that the National Household Survey on substance abuse contains important information on the need for substance abuse services.She thought plans should also be aware of this information.


Martin Gallegos echoed the comments of Dr. Crowell and Ms. Stanley-Salazar on the excellence of the report.He suggested MRMIB staff identify the best plan practices and put those into the contract requirements.Dr. Gallegos stated that DMHC is working on cultural and linguistic competence standards for commercial plans.He suggested that since this work is being done for HFP and Medi-Cal, it would be good to coordinate the work among the various agencies concerned so there would be standardized criteria.


Chairman Allenby asked if there were any questions or public comment; there were none.


HFP Fraud Prevention Report


Richard Popper introduced the fraud prevention and risk assessment report.Staff at MRMIB began this endeavor in light of a requirement for fraud prevention in the federal SCHIP regulations and in response to the Davis Administrationís focus on preventing fraud in Medi-Cal.Pursuant to the Boardís authorization at the February 2002 meeting, MRMIB selected Mintz, Levin, Cohn, Geris, Glovsky and Popeo (Mintz Levin) to conduct an independent fraud risk assessment of HFP.Mr. Popper introduced Ms. Carolyn J. McElroy of the Mintz Levin firm who highlighted the findings from their report.Ms. McElroy explained that her firm focused on enrollment and eligibility processes and she described the methods used to arrive at their conclusions.They found that the procedures and controls established by MRMIB appear to be highly effective in deterring and detecting abusive practices.Mintz Levin estimated that the potential loss to the State for undetected abusive enrollment practices was minimal and that additional safeguards would not be cost effective.Mintz Levinís assessment identified three areas where requirements could be modified to enhance protections against abuse:(1)  the two percent of applicants who submit profit and loss statements to document income should also provide copies of their most recently filed tax returns and schedules, both at enrollment and AER; (2) MRMIB should establish formal procedures for reporting and investigating abuse; and (3) MRMIB should develop additional ad hoc reports to monitor enrollment by certified application assistants (CAAs).There was discussion among the Board, Ms. McElroy, and MRMIB staff concerning reaching a balance between the most cost- and time-effective ways for fraud to be deterred, and the ways in which fraud prevention might be conducted without making people reluctant to apply.


Ms. Gotlieb expressed support for recommendations to train CAAs on where to report suspected fraudulent behavior and setting up use of a toll-free line for the purpose.She asked if the knowledge that income documentation might be checked, in conjunction with occasional random checks, would provide more cost-effective prevention than checking all persons submitting profit and loss statements.


Dr. Gallegos expressed concern that taking additional steps to prevent fraud could come at the cost of deterring enrollment, particularly among immigrant populations.He also expressed concerns about CAAs taking on fraud enforcement tasks.


Dr. Crowell noted that the program has been criticized for the onerousness of its present income documentation requirements and said she shared Dr. Gallegosí concern about deterring applications.


Ms. Stanley-Salazar expressed support for Ms. Gotliebís suggestion about using random checks, saying that this might come closer to establishing a balance.


Kristen Testa, representing 100% Campaign, expressed appreciation for the Boardís comments on the need for balance.She commented that program integrity is important to keep HFP going, but California already has many procedures in place.She expressed concern that there not be any more barriers to enrollment, and noted that advocates have been seeking ways to reduce documentation.


The Chairman indicated that finding the balance between appropriate fraud prevention without making the program difficult to apply for was the goal.He said the Board was interested in getting more information on how to set the right balance and would continue to explore the issue.


Mr. Popper said staff would like to present to the Board regulations for implementing the reportís suggestions in January.In the interim, staff will obtain information needed to conduct a cost benefit analysis of the recommendations and work to develop a formal process for responding to fraud concerns, as required by federal law.


Chairman Allenby asked if there were any questions or any further public comment; there were none.


HFP Substitution of Coverage Report


Lesley Cummings presented the Substitution of Coverage (crowd-out) report undertaken by the Institute for Health Policy Studies at UCSF.She explained that crowd-out occurs when workers who have access to health insurance coverage apply for public programs because of the escalating cost of their share of the premium or when their employers stop offering insurance, forcing employees to apply for government-assisted coverage.She explained that HFP applicants cannot apply within three months of having access to employer-sponsored insurance.


Ms. Cummings indicated that some research had been done on crowd-out in Medicaid and a couple of state-sponsored coverage programs.However, no studies were available on crowd-out in state SCHIP programs.††She said that the UCSF report she was presenting to the Board was the first study on crowd-out in a state SCHIP program of which she was aware.


Researchers at UCSF conducted a survey of parents of 525 HFP children to determine how many children had employer-sponsored coverage within three months of enrollment in the program.


The researchers found that eight percent of the children had employer-sponsored coverage within the three-month time frame.This is below the ten percent level that the Board had indicated to the Centers for Medicaid and Medicare Services (CMS) would trigger an increase in the crowd-out prevention features of HFP.


The researchers also found that lower-income families (incomes below 200 percent of the federal poverty level (fpl)) had a much higher crowd-out rate (68 percent) than those with income between 200-250 percent fpl (32 percent).As more employer-sponsored coverage is available at the higher income, this seems surprising.However, the researchers found that the biggest reason parents reported for dropping their employer-sponsored coverage was that the cost of coverage was unaffordable (75 percent of the total population, 45 percent for lower-income families, and 30 percent for the higher-income families).The researchers found that nearly half of the crowd-out group paid more than $50 per month for prior coverage of their children.


The researchers suggested that California consider revising its definition of crowd-out to exclude from the definition those that dropped unaffordable coverage as at least one other state has done.They also recommended that California find ways to assist low-income families in purchasing and maintaining employment-related insurance.


Chairman Allenby asked if there were any questions or public comment; there were none.


HFP Update on AB 495 (Diaz) Implementation


Richard Popper presented an update on the status of implementing AB 495 (Diaz).This bill, signed last July by Governor Davis, authorizes MRMIB to establish a mechanism for county agencies and local initiatives to use SCHIP funds not needed by the State for coverage of children or parents in the HFP, to expand childrenís coverage to families above 250 percent of the fpl or to provide health services for children eligible for, but not enrolled in, HFP or Medi-Cal.


At the June meeting, the Board directed MRMIB staff to develop proposals for the Davis administration to submit to the CMS.Staff, along with a representative from DHS, conducted conference calls throughout the month of July with the 17 local public entities who responded and began discussions with CMS.CMS requested specific information on the proposals.Of particular interest was detail on the source of the matching funds.Staff coordinated the responses from the proposers and sent the information to CMS in late August, and is now waiting for a response.MRMIB staff has requested guidance from CMS on how to present the proposals for consideration.


Dr. Crowell asked what the total cost of this proposal would be.Mr. Popper replied that the proposals received would be approximately $80 million in local funds which would match $160 million in federal funds, for a total of $240 million.He said this is a liberal estimate and that the longer it takes to implement the process, the less funds would be available to draw down from the federal government.


Chairman Allenby asked if there were any questions or public comment; there were none.




AIM Enrollment and Fiscal Reports


Ernesto Sanchez presented the AIM Subscriber and Health Plan Data for July and August 2002.The number of new uninsured pregnant women enrolled was 474 for June and 580 for July.The number of new infants enrolled was 609 for June and 511 for July.Mr. Sanchez briefly reviewed the enrollment data by ethnicity, by selected counties, and by health plans.


Stuart Busby presented the AIM Fiscal Summary for the period of July 1, 2001, through June 30, 2002.Total revenues were $71,927,921 and total expenditures were $69,455,111.


Chairman Allenby asked if there were any questions or public comment; there were none.


Presentation to John L. Geesman


Chairman Allenby noted that John Geesman, former chair of MRMIB, had joined the meeting, and asked Mr. Geesman to come forward, whereupon Mr. Allenby presented Mr. Geesman with an award for his service to MRMIB.Mr. Geesman expressed his gratitude for having been a part of the programs MRMIB administers, stating that he takes more pride in what MRMIB was able to accomplish in the short two and one-half years he served than anything else he has done in public service.


AIM Final Report on Administrative Vendor Transition


Ernesto Sanchez gave the final report on the administrative vendor transition from Maxicare to Care 1st.He said that the vendorís hours expanded from 8:30 a.m. to 4:30 p.m. to 8:30 a.m. to 7:00 p.m. effective August 5.This completes the successful transition to Care 1st Health Plan.


Chairman Allenby asked if there were any questions or public comment; there were none.




MRMIP Enrollment and Fiscal Reports


Ernesto Sanchez presented the MRMIP Subscriber and Health Plan Data through August 2002.Currently, there are 16,773 people enrolled and, as of September 10, there are 1,632 on the waiting list.This is a reduction in enrollment and an increase in the number of people on the waiting list.


Stuart Busby presented the MRMIP Cost Summary.The cost of the program from July 1, 2001, through June 30, 2002, was $120,457,560, of which $119,564,872 were subscriber contributions.


Chairman Allenby asked if there were any questions or public comment; there were none.


MRMIP Federal Act Funding for High Risk Pools


Richard Popper reported on the Federal Trade Act Funding for High Risk Pools.This funding is a provision of the Trade Act of 2002 (HR 3009) which provides funding assistance to states to establish new, as well as subsidize existing, health insurance high-risk pools.The Act provides $20 million in seed money for new pools and $40 million in matching funds for each of the two fiscal years 2003 and 2004 for existing pools meting certain criteria. Mr. Popper highlighted key points of the Trade Act especially as they relate to Californiaís eligibility and the structure of MRMIP.CMS will most likely develop and administer regulations for Trade Act funding and is planning to unveil an implementation proposal at the NASCHIP annual conference in October.Mr. Popper also highlighted provisions of the Trade Act that provide for grants to fund certain services (including health insurance) to workers displaced due to trade agreements.


Chairman Allenby asked if there would be a requirement to demonstrate the grant funds received from the Trade Act are being used solely for displaced workers.Mr. Popper said yes.Ms. Gotlieb asked if the state could match the federal funds with existing MRMIP funds.Mr. Popper indicated that it could.


Chairman Allenby asked if there were any questions or public comment; there were none.


MRMIP AB 1401 (Thomson) Workplan


Richard Popper reported on the AB 1401 (Thomson) Workplan.AB 1401 was approved by the California Legislature on August 31, 2002, and is now before the Governor for consideration.There is a good indication the Governor will endorse the bill.Mr. Popper explained some of the minor modifications to the bill since the last Board meeting, including a request by the Department of Insurance (DOI) to make the effective date September 2003 instead of July 2002.He went over the timeline MRMIB will follow to begin implementing the workplan, beginning with notifying subscribers who will lose coverage in September 2003.The workplan includes, among other tasks, working with DOI, the Department of Managed Health Care (DMHC), and impacted California insurance carriers, as well as developing the systems and procedures needed to assure successful transition in health coverage.


Chairman Allenby asked if there were any questions or public comment; there were none.


MRMIP Disenrollment Survey


Ernesto Sanchez presented the 2002 MRMIP Disenrollment Survey, briefly explaining the reasons why the subscribers who were interviewed disenrolled.Thirty-eight percent of said they could no longer afford the premium.Over 55 percent had obtained coverage from some other source.


Chairman Allenby asked if there were any questions or public comment; there were none.


MRMIP Administrative Vendor


Ernesto Sanchez presented the MRMIP Administrative Vendor Contracting Options.Due to implementation of AB 1401, MRMIPís administrative vendor services will need to be significantly modified.Mr. Sanchez discussed the key pros and cons of the four options outlined by MRMIB staff.These included:


        Option 1 - Consolidate administrative services for all MRMIB programs in one vendor.

        Option 2 - Separation of administrative services from the health plan contract and separate competitive procurement process.

        Option 3 - Extend contract for eighteen months through December 31, 2004.

        Option 4 - Competitive procurement process, maintaining administrative services as part of MRMIP health plan contract.


Staff recommended Option 4.Ms. Cummings stated that staff would be bringing the MRMIP model contract to the Board at its next meeting and wanted guidance on it before proceeding with drafting the administrative vendor portions of the contract.After discussion among the Board members, Chairman Allenby stated they agree with staffís recommendation to proceed with Option 4.


Chairman Allenby asked if there were any questions or public comment; there were none.




Summary of Bills


Richard Popper gave an overview of state legislation being tracked by MRMIB staff.


Chairman Allenby asked if there were any questions or public comment; there were none.


Federal Legislation Update


Richard Popper reported on HR 4737, which was passed by the House.The Senate version of the bill includes a provision allowing SCHIP to cover legal immigrants who entered the U.S. after August 1996.Both the House and the President have expressed concerns.Mr. Popper said he will continue to update the Board.


Chairman Allenby asked if there were any questions or public comment; there were none.




Dennis Gilliam asked the Board to renew MRMIBís contract with House of Travel in the amount of $7,000 for the period of July 1, 2002, to June 30, 2003.Ms. Gotlieb made a motion which was unanimously approved.


Chairman Allenby asked if there were any questions or public comment; there were none.




Dennis Gilliam asked the Board to approve MRMIBís interagency agreement with HHSA for administrative services in the amount of $11,843 for July 1, 2002, to June 30, 2003.Dr. Crowell made a motion which was unanimously approved.


Chairman Allenby asked if there were any questions or public comment; there were none.




Dennis Gilliam asked the Board to approve extension of MRMIBís contract with Dinkydo, Inc., for computer consulting on its Sybase system for an additional amount of $55,000 for the period April 1, 2002, to December 31, 2002.Ms. Gotlieb made a motion which was unanimously approved.


Chairman Allenby asked if there were any questions or public comment; there were none.


The meeting recessed for the Executive Session.


Chairman Allenby reconvened the meeting.There being no further business to come before the Board, the meeting was adjourned.