Dahl Memorial Clinic board adopts multiple policy updates, approves contracts and directs letter of intent to Skagway Municipality

Dahl Memorial Clinic board members on April 24 approved a slate of policy updates and staff contracts, voted to send a letter of intent to the Skagway borough manager and directed staff to explore a different method for setting the clinic’s fee schedule.

The board, acting as the clinic’s governing body, approved amendments to the federal cash-management and grant drawdowns policy; adopted changes to billing and collections (including a late amendment that removed a named collection firm from the policy); confirmed several internal policies on employee charges and donor recognition; and approved three behavioral-health contracts and a residential lease. The board also voted to direct Executive Director Albert Wall to present a letter of intent to the borough manager so the matter can be placed on the assembly agenda.

Those steps move several administrative items forward as the clinic continues work on separating from municipal oversight and preparing a memorandum of agreement and lease with the borough.

Board action and why it matters

The actions approved on April 24 streamline the clinic’s grant-management and billing practices and authorize staff hires and a facility lease the clinic says it needs for operations. The board’s direction to submit a letter of intent to the Skagway borough manager initiates an item the borough assembly must consider before the clinic’s governance language in the municipal code can be changed.

Among the votes: - Federal cash-management and grant drawdown policy (8a1): approved by roll call (9 yes, 0 no). The motion was made by Director Simmons and carried without further amendment. - Billing and collections policy (8a2): the board approved an amended billing-and-collections policy. During debate members moved and passed an amendment to replace the named vendor “Cornerstone Credit Services” with the generic term “a collection agency” (amendment passed by roll call; tally recorded as 7 yes, amendment passed). The amended policy then passed on final vote (9 yes, 0 no). - Legislative mandate policy and attached bulletin (8a5/8a5.1): the board approved the legislative mandate policy and reviewed the HRSA bulletin attachment. The policy passed by roll call (8 yes, 1 no recorded). - Multiple first readings (policy drafts): the board approved first readings of several draft policies, including hours of operation, protected health information, scope of project, access to care, ancillary services, safety and health, quality improvement and peer review; each first reading passed by roll call (the recorded votes were unanimous among members present). - Contracts and personnel: the board approved a certified medical assistant contract, a licensed professional counselor contract and a licensed clinical social worker contract (each approved by roll call, recorded as 9 yes). The board also approved the donor-wall equipment fund policy and the Dahl employee charges policy (each approved by roll call). - Apartment 4402 State Street lease (8c4): the lease was approved (recorded vote: 8 yes; one member stated an abstention because of a professional relationship with the tenant). - Letter of intent to Skagway borough manager: the board directed Executive Director Albert Wall to deliver a corrected letter of intent to the borough manager so it can be included in the next assembly packet; the motion passed by roll call (9 yes, 0 no). The letter outlines a phased transition toward independent nonprofit governance, and identifies steps that must precede a municipal-code amendment, including a memorandum of agreement, a lease, and insurance naming the borough as an additional insured.

Key discussion points and staff directions

- Fee schedule: Director Albert Wall recommended the finance committee consider tying the clinic’s fee schedule to relative value units (RVUs) rather than continuing to manage a long list of specific CPT and HCPCS codes. Wall summarized the coding counts as: “There are, at this time, around 11,000 CPT codes, and there are around 8,000 HCPCS codes,” and said many providers and states use RVUs with a multiplying factor rather than an exhaustive code-by-code list. The board asked that Melanie (billing and coding manager) join a future finance-committee meeting to explain options.

- Collections vendor: board members questioned whether a named collection company should be listed in policy. The board voted to replace the vendor name with the generic term “a collection agency” and asked the director to return with a staff recommendation on procurement and contract duration.

- Sliding fee scale and dental services: Director Wall clarified that preventative and routine dental services are set on a flat-fee basis under the proposed policy, while restorative dental work is charged on a percentage (sliding-fee) basis; the item remains under committee review where needed.

- Organizational transition and next steps: board members and staff reported a recent working session with the borough manager’s office to coordinate the clinic’s transition away from municipal code oversight. The board was told changes to the municipal code would come after a lease and memorandum of agreement are in place and after insurance arrangements are finalized. The board directed the executive director to submit the letter of intent to the borough manager the next morning so it can appear on the assembly agenda.

- Grants and short-term needs: staff noted an immediate, modest need for a financial consultant with federally qualified health center experience (estimated at about $5,000) to help set up accounting policies and, possibly, a financial software tool. Staff plan to submit a municipal grant application after the board approves a budget package to accompany the request.

What did not change

Most draft policies received only first-reading approval and will return to committee for further review before final confirmation. The board did not make final code changes; a municipal-code amendment remains contingent on a memorandum of agreement, lease and insurance arrangements.

Ending

The board adjourned after assigning follow-up work to staff and committees, including a finance-committee session with Melanie on RVU-based fee-setting, and directing Albert Wall to deliver the letter of intent to the borough manager. The board’s next committee meeting dates were listed on the agenda; members noted the finance committee may adjust scheduling so billing staff can present in person.

Votes at a glance

- Federal cash-management policy (8a1): approved (9 yes). - Billing and collections policy (8a2): amendment to remove named vendor approved (amendment passed); final policy approved (9 yes). - Legislative mandate policy (8a5): approved (8 yes, 1 no recorded). - Donor wall equipment fund policy (8a3): approved (9 yes). - Dahl Memorial Clinic employee charges policy: approved (9 yes). - Certified medical assistant contract: approved (9 yes). - Licensed professional counselor contract: approved (9 yes). - Licensed clinical social worker contract: approved (9 yes). - Apartment 4402 State Street lease: approved (8 yes, 1 abstention reported). - Letter of intent to borough manager: motion to submit approved (9 yes).