September 28, 2012 - Texas Health Insurance Risk Pool

Texas Health Insurance Pool
Board of Directors Meeting
September 28, 2012
The meeting of the Board of Directors of the Texas Health Insurance Pool was held Friday, September 28,
2012 at 4140 Governor’s Row, Room Southpark A, Austin, Texas. Notice of the meeting was filed
electronically with the Secretary of State’s office on Wednesday, September 19, 2012 and published
immediately on the Texas Register web site (TRD#2012006540).
Board members present: Gary Cole, Chair; Rick Ott, Vice-Chair; Greg Barbutti, Secretary/Treasurer;
Robert Emmick, M.D.; Pati McCandless; Maureen Milligan, Ph.D.; Vicky Paparelli, APRN; and Bill
Rainey, M.D. Marinan Williams was unable to attend. Steven Browning, Pool Executive Director, Denise
Haidet, Pool Office Manager, and Betty DeLargy, General Counsel to the Pool, were also in attendance.
Meeting Called to Order
With a quorum of the Board present, Chairman Cole called the meeting to order at 8:30 a.m.
I. Approval of Minutes
Dr. Rainey moved to approve the minutes of the May 24, 2012 Board of Directors meeting.
The motion was seconded by Dr. Emmick and unanimously approved.
II.
Financial Report
Mr. Browning presented the Pool’s unaudited monthly financial reports for the period April through July
2012. All assessments invoiced in June have been collected. The Pool’s $61 million net loss through July
is nearly twice the deficit for the same period last year. This ±$30 million deviation from July 2011 results
is due to: $10 million less in premium collections, attributable to lower enrollment and member selection of
higher deductible plans; $9 million increase in medical claims; $5 million increase in pharmacy claims; and
$7 million higher year-to-date reserve adjustments.
After further discussion, Dr. Emmick moved to approve the April, May, June, and July 2012 Financial
Statements. The motion was seconded by Mr. Barbutti and unanimously approved.
Mr. Browning reviewed the mid-year Budget vs. Actual expense report, which reflects a +$128,000 overall
favorable variance through July, due largely to lower-than-projected legal and actuarial services fees. He
anticipates that the variance will narrow by year-end, but the budget is in very good shape at this point in
time.
Mr. Browning presented the TDI statement filing, which is a reformatted version of previously approved
Pool financial statements. After further discussion, Mr. Ott moved to ratify the TDI 2 nd Quarter 2012
Statement. The motion was seconded by Dr. Rainey and unanimously approved.
Mr. Browning presented the Pool’s investments report, as of September 17, 2012. Excess Pool funds were
invested in government money market funds and a FNMA repurchase note. Mr. Browning noted that
periodically during the month, as premiums are collected, investment amounts by category may temporarily
exceed internal concentration of risk targets.
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III.
Executive Director’s Report
Mr. Browning presented the Board of Directors Summary key metrics report, with updated results through
July 2012. Comparing YTD2012 to the same period last year, the average premium per member per month
(PMPM) increased only 2%, to $713. In contrast, claims expense PMPM increased 24%, to $1048. As
Pool enrollment declines, enrollees with higher claim costs are remaining in the Pool, applying upward
pressure on the PMPM claims figure. Application volumes continue to drop. Mr. Browning reported that
the Pool is losing a net ±150 members monthly, due largely to an increasing number of members attaining
age 65. In the last three months alone, the Pool lost 600 members because they turned 65. Upward
deductible migration continues, with 25% of Pool policyholders now enrolled in the $7,500 plan.
Mr. Browning reviewed the updated timeline and noted that the 83 rd legislative session begins January 8,
2013. Discussion ensued about the best timing for the possible filing of a bill to revise the Pool statute to
reflect changes required by the Affordable Care Act. Ms. McCandless suggested filing the bill as early as
possible, certainly by January.
Mr. Browning provided an update for the low-income premium subsidy program, and discussed the chart
that tracks penalty collections and enrollment in the program. Since March of this year, premium subsidy
applications have been mailed on a weekly basis to new enrollees, immediately after their enrollment in the
Pool. This process puts the subsidy application into new enrollees’ hands within ±10 days of Pool
enrollment. In addition, a copy of the subsidy application was posted to the Pool website, and is inserted
into each mailed Pool application packet, so that Pool applicants can prequalify their eligibility for the
subsidy program. Prompt pay penalty amounts remitted by the carriers still vary widely, but have increased
to a monthly average of $1.4 million this year, with a couple of large carriers accounting for the increased
penalty volume.
Mr. Browning presented a rolling two-month customer service report, prepared by Blue Cross Blue Shield
of Texas (BCBSTX), that provides a weekly update of key service categories, including speed of answer,
claim processing, and application volumes.
IV.
Board Issues and Administrative Matters
Mr. Browning presented the recommendations of the joint Benefits Review & Y2014 Planning Work
Group, which met several times. The group was comprised of Mr. Barbutti, Mr. Cole, Ms. McCandless,
and Ms. Milligan. The Group’s final recommendations for Board approval are as follows:
1) Deductible Reduction Opportunity: This item is an administrative recommendation to allow an open
enrollment period later this year for members to elect a lower deductible plan. This opportunity was last
offered by the Board in 2006, when ±300 Pool members elected to lower their deductibles. Because
financial circumstances change over time, the Pool receives periodic requests from members to lower their
deductibles. Milliman priced the cost of the exception, and concluded there would be minimal impact on
the Pool’s annual net loss, likely no more than ±$200,000. If approved, the election period would run from
November through year-end, with a January 1, 2013 effective date. Members who elect to lower deductible
during this option period must remain in that lower deductible, higher premium plan throughout Y2013.
2) Revision to Claim Filing Deadline: The Work Group spent time discussing possible discontinuation of
Pool operations, and the importance of compressing timelines for claim and lawsuit filings, so that
dissolution could occur in a reasonable time frame. The Pool policy currently allows members to file
claims up to one year plus 90 days after the date of service, but with an incompetency clause that is
completely open-ended. The Work Group recommends shortening the claim filing deadline to one year
after the incurred service date and eliminating the open-ended incompetency clause. Providers, who file the
majority of claims, already submit a very high percentage of claims within a short time frame. The
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proposed change would still provide a reasonable time period to file.
3) Revision to Legal Actions Deadline: The Work Group also discussed the Pool’s lawsuit filing deadline.
The current policy provision allows filing of a legal action against the Pool up to three years after a claim is
denied. The recommendation is to shorten the Pool’s legal action filing deadline to correspond to Texas
contract law, which requires a minimum of two years after the date a cause of action arises. This
compressed time frame would still provide a reasonable period of time for a legal action filing. Mr.
Browning observed that, until the claim and lawsuit filing provisions are revised, the potential for a much
later filed suit could extend the period of Pool run-out; reasonable compression of the time frames will
expedite the future dissolution process. Discussion ensued about the likelihood that, even with these
revisions, there could be some sort of final public notice to provide a definite cut-off date for all claims and
causes of action against the Pool.
After further discussion, Ms. McCandless moved to approve the Work Group’s recommendation to
allow enrollees to lower their deductibles, as an administrative exception to the Pool policy, during an
election period ending 12/31/2012. The reduction would be effective 1/1/2013, and those electing to
lower their deductibles would not be permitted to increase their deductibles during 2013. Dr.
Emmick seconded the motion and it was unanimously approved.
After further discussion, Dr. Emmick moved to approve the Work Group’s recommendations to: 1)
require claim filing within one year of the incurred date and remove the incompetency clause; and 2)
require legal actions to be filed within 2 years of the cause of action date. Both revisions are subject
to Commissioner approval. Mr. Barbutti seconded the motion and it was unanimously approved.
Mr. Browning presented the elements of a bill considered by the Work Group, which would be filed in the
next legislative session to address the possible wind down of the Pool, assuming the Affordable Care Act is
not repealed. Without repeal, availability of coverage in the individual health insurance market will be
guaranteed, without medical underwriting, beginning January 1, 2014, and therefore it is anticipated that the
Pool would discontinue new enrollment at that time.
Another issue, likely to be addressed by the Legislature, is the date the Pool will terminate in-force policies.
The open enrollment period for purchase of individual coverage through the Exchange is October 2013
through March 2014; unless an individual qualifies for special enrollment, coverage is not available again
until January 1, 2015. The Pool will need to educate its membership about the Exchange and the
enrollment deadlines. There was discussion about the possibility of maintaining Pool coverage through
2014 for members enrolled as of December 31, 2013, to mitigate some of the impact on premium rates of
the transition of so many high-cost claimants into the commercial market. Extensive discussion ensued
about the planning now taking place in other states regarding risk pools, and what may happen to premium
rates in the individual health insurance market after December 31, 2013. Mr. Barbutti observed that he
would want the Pool to either offer continued coverage to in-force enrollees throughout 2014 or,
alternatively, cancel all coverage effective January 1, 2014, so that insureds do not face two deductibles
within the same calendar year.
After further discussion, Mr. Barbutti moved to recommend seeking legislative support for filing a bill
during the 83 rd session, as generally outlined in the Work Group recommendation, to prepare for
possible dissolution of the Pool in 2014. Mr. Ott seconded the motion and it was unanimously
approved.
Ms. Sue Hart presented Milliman’s financial projections for the Pool, which serve as the basis for
developing carrier assessments. She noted that the projections cover a 15-month time period; therefore, a
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wide range of assessment projection results are possible, varying from ±$140 million to ±$192 million,
depending on the claim trend and enrollment assumptions applied. The mid-range estimate to maintain a
positive cash balance through December 2013 is $165.1 million. To be conservative, no premium increases
are assumed. Last year’s interim assessment was only $125.5 million, but in hindsight it should have been
±$135 million to fully cover the Pool’s costs through the end of this year. Therefore, ±$10 million of the
proposed $165.1 million interim amount is attributable to a shortfall in last year’s assessment amount.
Further discussion ensued regarding cost trends anticipated next year.
After further discussion, Mr. Barbutti moved to approve the Y2012 Interim Assessment in the amount
of $165.1 million. The assessment will be payable in two installments, with the first installment of
$82,550,000 due within 30 days of the final invoice date and the remainder due six months thereafter.
Dr. Emmick seconded the motion and it was unanimously approved.
Mr. Browning noted that at each Fall meeting the Board authorizes him to obtain a line of credit, if required
to maintain a positive cash balance before the assessments are collected. He estimates the Pool will have at
least $5 million in cash on hand by the end of November, based on projected timing of claim payments.
Therefore, he does not anticipate needing to draw funds under the line of credit, but agreed it is a good idea
to have the authority in place as a backstop. After further discussion, Dr. Emmick moved to authorize the
Executive Director to obtain up to a $7.5 million Line of Credit, if required to maintain a positive
cash balance. The motion was seconded by Ms. Milligan and unanimously approved.
Mr. Browning presented an update regarding the situation with the Walgreens pharmacy chain. As a
reminder, he noted that, effective January 1, 2012, Express Scripts (ESI) dropped Walgreens from its
pharmacy network. In April, ESI acquired Medco. At the May meeting, the Pool Board voted to drop
Walgreens from the Pool’s network effective September 1, unless “some agreement” was reached between
Walgreens and ESI. The Board’s decision in May was fully consistent with the ESI corporate position at
that time, and there was a strategic timing advantage to the proposed carve-out, which was estimated to
save the Pool ±$1.6 million annually. But on July 19 th , ESI and Walgreens reached an agreement for
Walgreens to rejoin the ESI network, effective September 15 th . At that point in July, the Walgreens
termination notice, scheduled for release to nearly 7,000 Pool members, was pended, and the Pool awaited a
decision from Walgreens about the Pool’s revised drug pricing. The May Board motion had been approved
with the assumption that any agreement between ESI and Walgreens would improve the Pool’s pricing. In
August, however, Walgreens informed the Pool that its drug pricing would not improve, despite the
ESI/Walgreens agreement. In fact, the Walgreens pricing the Pool obtained previously through the existing
legacy Medco contract was better than the new pricing Walgreens negotiated with ESI in July.
Mr. Browning asked the ESI account team to confirm that a Walgreens carve-out decision, if reaffirmed
today by the Board, could still be effectively communicated to Pool enrollees, at the same time that
Walgreens pharmacies are advertising to bring back ESI customers, and ESI is educating our members that
Medco is now ESI. The ESI staff confirmed that the carve-out, though more challenging, could still be
effectively implemented. The updated analysis indicates that ±6,700 Pool members will be affected, but
only ±50 will have to drive farther to find a network alternative. Some of these 6,700 are already using
another pharmacy in addition to Walgreens; approximately 5,000 use Walgreens exclusively.
The revised annual savings estimate for the carve-out is $1,436,000, which would be guaranteed through a
contract amendment. Discussion ensued about the proposal to move ahead with the carve-out, despite the
complexity created by the ESI/Walgreens agreement. Several board members indicated that the Pool
should proceed with the carve-out to improve the Pool’s drug pricing, particularly given the significant
increase in the assessment. Mr. Alan Kellogg confirmed that transferring scripts to a new pharmacy is not
difficult. The suggestion was made to send two notices to Pool members about the Walgreens carve-out
before its effective date. Mr. Browning asked if the Board wanted to consider a motion that would rescind
the carve-out if Walgreens offers an acceptable improvement in their drug pricing before the first member
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notice letter is mailed. Consensus was reached, however, to move ahead without such a provision because
Walgreens had already been given adequate time to respond. Several board members commented that
health plan insureds are very accustomed to these types of changes with their coverage.
After additional discussion, Dr. Rainey moved to authorize Express-Scripts to restrict the Pool’s
pharmacy network to exclude Walgreens, effective January 1, 2013. The motion was seconded by
Ms. Paparelli and unanimously approved.
At 10:48 a.m. Mr. Cole announced a break. At 11:05 a.m. Mr. Cole brought the meeting back to order. Ms.
Paparelli, who had previously informed Mr. Cole that she would have to leave the meeting early, departed
during the break.
Professional services contract proposals for 2013 were discussed and approved, as follows:
• Mr. Barbutti moved to approve the 2013 Milliman actuarial services proposal. The motion
was seconded by Dr. Emmick and unanimously approved.
• Mr. Barbutti moved to approve Ms. DeLargy’s proposal for 2013 & 2014 legal services. The
motion was seconded by Dr. Rainey, and approved, with Ms. McCandless abstaining.
• Ms. McCandless moved to approve the HealthLinX Y2013 pharmacy consulting services
proposal. The motion was seconded by Mr. Ott and unanimously approved.
• Dr. Rainey moved to approve the PBM Helin Donovan financial audit proposal for the year
ending December 31, 2012. The motion was seconded by Mr. Barbutti and unanimously
approved.
V. Third Party Administrator & Consultant Reports
A. Report from MedWatch
Ms. Sally-Ann Polson, President of MedWatch, presented her company’s report about the Pool’s disease
management program. MedWatch targets participation of the 5% of Pool enrollees who generate the
highest levels of medical services, medication utilization, and unnecessary emergency room visits. The
MedWatch nurses work to coordinate and manage medical care for these enrollees. Ms. Polson confirmed
that MedWatch is now receiving medical and pharmacy claims data from BCBSTX and ESI. The nurses
make numerous attempts to contact Pool members who may benefit from the program. Out of 1,373
members contacted, only 7 have been unwilling to participate thus far. It is common to encounter some
resistance from members initially, but the nurses are very skilled at persuading members to participate. As
expected, Pool enrollees are generally more challenging than individuals associated with other MedWatch
accounts. The nurses’ health assessments of Pool members average more than an hour, while the
company’s average assessment time for other clients typically runs just 30 minutes. Since February, there
have been 24,067 interactions with Pool members and 1,527 educational mailings. More than 700 Pool
enrollees are now actively engaged with MedWatch nurse counselors. Another 366 members who were
contacted are no longer enrolled in Pool; 53 were already enrolled in case management with BCBSTX; and
MedWatch has referred 20 patients to BCBSTX case management. A total of 1,373 Pool members have
been contacted by MedWatch this year. At the next board meeting, Ms. Polson will present a report that
compares emergency room visit data in 2011 versus activity in 2012.
Ms. Polson reported that the Pool’s MedWatch nurses are also focused on achieving reductions in
hemoglobin A1C values for Pool diabetic members; she will present results about that initiative at the next
meeting. She anticipates that Pool participants’ weight loss savings alone will generate more than $500,000
in annual savings, and she is also collecting data about reductions in blood pressure.
Ms. Polson presented several representative success stories about Pool members whose MedWatch nurses
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got involved with their medical care, including one patient who avoided dialysis due to lifestyle changes.
She presented a table that compares participant claims incurred during the last half of Y2011 to the first half
of this year. Aggregate medical costs for participants are dropping as they remain in the MedWatch
program. After she has compiled a full year of cost data, she will provide a more accurate analysis, but the
preliminary cost trend is favorable.
B. Report from Blue Cross Blue Shield of Texas (BCBSTX)
Ms. Cyrus Walker informed the Board that she has been promoted to a Senior Director position within the
product development division at Health Care Service Corporation. She expressed her appreciation to the
Board for the opportunity to work on the Pool account.
Mr. Naiser discussed other account team changes and introduced Mr. Joe Malinowski, who has been
working on the Pool account for many years. Mr. Naiser also reported that Health Care Service
Corporation recently announced its acquisition of BCBS Montana.
Mr. Naiser presented several key Pool indicators, comparing YTD 2012 to YTD 2011. Network discounts
are now averaging 59.1%, up from 58.6% last year. The patient share of total costs dropped 2.4%, as
medical costs have increased.
While the Pool’s total number of high-cost claimants has dropped, the number with claims above $100,000
has increased. Pool enrollment has fallen 7.9% this year, but the Pool’s PMPM medical costs have
increased by 7.8% during the same period. Discussion ensued about increasing inpatient costs and the trend
toward employment of physicians by hospitals. Mr. Naiser discussed Pool cost savings generated by
various BCBSTX programs, including case and utilization management.
Mr. Malinowski reviewed the analysis of Pool contract guarantees for minimum Y2011 network discounts
and utilization, both of which were met with comfortable margins. BlueChoice and ParPlan networks have
grown by more than 7% since last year. The loss of the ERS account this year has not adversely affected
the networks.
Mr. Garcia presented year-to-date application activity metrics. Application volumes are down 17% from
last year and total enrollment is down 8.4%. From January through September of this year, 1,600 Pool
members have aged out of the program. Of all who cancelled coverage this year, 29% did so because they
turned 65. Two categories of contract performance standards were out of compliance for April and May
and administrative fee penalties were deducted accordingly.
Mr. Don Irby, BCBSTX Actuarial Division, presented his Pool medical claim trend analysis. Although
there has been a 3.4% decline in Pool membership this year, the average age is increasing, which is part of
the reason that PMPM claim spend is increasing. The Pool’s overall 12-month PMPM trend stands at 10%.
Inpatient claim trend is the highest-cost category, now at 15% year over year. Utilization of services is
down, but the services received are more expensive than before. Those members remaining in the Pool are
getting older and consuming more expensive services. Nearly all trend is attributable to an increase in
claimants with more than $50,000 in claims. Most of the 10% annual trend is attributable to the aging
population, and an increase in high-cost claimants with cancers, circulatory, and infectious/parasitic
diagnoses.
Mr. Naiser discussed the actions being taken by BCBS Case Management to address the high-cost claimant
issue. The Pool policy contains a mandatory case management participation provision, which is helpful and
which BCBSTX does not have with any other account. BCBSTX case managers are sharing data with the
Pool’s disease management vendor to enhance early identification. New BCBSTX enterprise-wide
programs for early case management identification include the: 1) Care Coordination Early Identification
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(CCEI) program, launched last month, which focuses on intervention before the patient’s condition
worsens, reduction of inpatient costs due to preadmission calls by nurses to prepare the patient, and postdischarge
calls to ensure patient adherence to avoid readmissions/complications; 2) Weekly High Dollar
claimant report, which a BCBSTX clinical team reviews to identify potential high-cost claimants; and 3)
Integrated Grand Rounds program, which utilizes an interdisciplinary team approach to review high-cost
claimant files to identify very complicated cases. Mr. Naiser agreed to supply Mr. Browning with
information about Pool members who are evaluated by the Grand Rounds team.
C. Report from HealthLinX
Mr. Kellogg reviewed his presentation. He analyzed five state risk pools, including the Texas Pool, and
studied their drug spend in six categories. Rebates, however, are not factored out, which overstates costs
for some of the pools, including Texas. He looked first at the antiretroviral drug category. Mail service
levels, formulary placement, and prescribing practices affect this category, but the Texas Pool’s costs are
the next-to-lowest of the pools surveyed. Mr. Kellogg said he will continue to work with the pharmacy
benefit managers of the 5 pools to analyze additional drug categories.
Mr. Kellogg spent some time discussing emerging issues, including the increased use of drug maker
coupons for medications that often offer no clinical advantage, but are more expensive than their preferred
alternatives. The coupon reduces the patient’s cost to a lower copayment, but the plan is still responsible
for the higher cost above the undiscounted copayment. Solodyn was singled out by Mr. Kellogg as an
example. Fortunately, the Pool has a clinical step therapy rule in place for Solodyn, which screens out most
coverage requests. Mr. Kellogg will continue to work with ESI to identify couponed drugs the Pool may
need to remove from the formulary. Consensus was reached not to amend the Pool’s coverage document at
this time to address the coupon issue.
Mr. Kellogg discussed compounded drugs, which are often mispriced by the compounding pharmacy. He is
monitoring the Pool’s compounded drug scripts to look for trends that may need to be addressed by the
Board through benefit design adjustments.
D. Report from Express-Scripts (ESI)
Mr. Craig Kessler noted he will be filling the position created by Ms. Jill Stearns’ retirement from ESI. He
has worked at Medco for 13 years and worked at ESI before joining Medco. He is involved exclusively
with government accounts, including three other state risk pools, Alaska, Washington State, and Kansas.
Mr. Ajay Dalal provided updates for open items from the last claims audit. In response to audit results, two
gender-driven system edits were implemented to exclude coverage for: 1) prostate-treatment drugs
prescribed to females; and 2) contraceptives prescribed to males. For the other categories of drugs cited by
the auditor, there can be off-label utility for the opposite gender, so they will be left alone. ESI will
continue to address the overlapping therapy issue, also cited, with alerts to prescribers. Last year 97% of the
overlapping therapy alerts generated by RationalMed were acted upon by the prescribers.
Mr. Patrick Fiduccia presented Pool financial results for the first half of 2012. The Pool’s PMPM net drug
cost trend was only 4.1%, which compares favorably to ESI’s governmental book of business, at 4.8%, and
ESI’s other state risk pools, at 12%. This good result for the Texas Pool was attributable to the January 1,
2012 contract renewal, which established better rebates and discounted pricing.
Discussion ensued about the new hepatitis drugs on the market, which are very effective and will be widely
utilized. Incivek and Victrelis are now available and others are in the pipeline.
During the reporting period, 87.4% of Pool enrollees filled a prescription; the average patient age was 52.
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Psychotherapeutic and blood pressure medications experienced large utilization increases. The Pool’s
generic dispensing rate increased to 70%, up 5 points from the first half of 2011. When a generic
equivalent is available, Pool members are choosing the generic 99.4% of the time; the rest are obtaining
clinical exceptions or paying the brand copayment penalty. Mail service penetration rose a percentage
point to 38%. Mr. Fiduccia confirmed that Pool members on maintenance drugs at retail receive periodic
mailings regarding the benefits of mail service.
Pool member cost share, as a percentage of drug costs, continues to erode, due to the flat copayment
structure, combined with rising drug prices. Pool member cost share dropped from 20.7% to 19.4%.
Mr. Dalal discussed the Top 25 Drugs by Plan Cost report. These 25 costliest drugs represented 36% of
Pool drug costs. The Pool’s highest cost drugs continue to be Enbrel and Humira, both rheumatoid arthritis
medications, followed by Copaxone.
ESI’s clinical management programs saved $11.2 million during this reporting period, equal to 20% of plan
costs, down slightly from the prior comparison period.
Mr. Fiduccia announced that he has been promoted by ESI to Senior Account Executive and will manage a
large national labor organization account. He thanked the Board for the opportunity to work on the Pool
account. His replacement has not yet been named.
VI.
Public Comment
Mr. Cole requested public comment, but none was offered.
VII.
Executive Session
At 12:50 p.m. Mr. Cole announced that the Board would go into Executive Session in accordance with the
Texas Open Meetings Act to discuss personnel and litigation matters. He asked Board members, Pool staff,
and counsel to remain, and invited all others to rejoin the meeting upon conclusion of the Executive
Session.
VIII.
Approval of Executive Session Actions
At 1:25 p.m. Mr. Cole reopened the meeting to the public. Mr. Barbutti moved to approve a 2%
increase in the Executive Director’s salary effective October 1, 2012. The motion was seconded by
Mr. Ott and unanimously approved.
Mr. Browning and the Board thanked Ms. Denise Haidet, Pool office manager, for her service. She is
retiring after 14 years with the Pool.
IX.
Adjournment
There being no further business, Ms. McCandless moved to adjourn the meeting. Ms. Milligan
seconded the motion and it was unanimously approved. Mr. Cole adjourned the meeting at 1:30 p.m.
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