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HomeMy WebLinkAboutHealth & Human Services 07-16-08 Rasmussen will review vouchers. Revised 07/10/08 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 16, 2008 at 8:30 (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 06/18/08 DATE OF NEXT MEETING — 08/20/08 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report 3. Replacement of physician on the Health and Human Services Board 4. Nursing Home Report 5. Personnel Issues a. New employees /vacancies b. 2009 new position requests c. 2009 position modifications d. 4x 10 work schedule 6. Long Term Support-Long Term Care Reform/ADRC 7. Aging and Disability Resource Center office expansion/remodel ** 8. Health and Human Services Governing Body By -laws Review 9. Birth to Three program review. 10. County census growth 11. 2009 budget planning update 12. Economic Support program report- Badgercare Plus expansion and distant learning training model ADJOURN (Items maybe taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerks office by Wednesday morning preceding a County Board meeting. 7/10/2008 10:38 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 16, 2008 The St. Croix County Health and Human Services Board met on July 16, 2008 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Linda Luckey Richard Marzolf Gerald Peterson Deb Rasmussen MEMBERS ABSENT: None STAFF PRESENT: Fred Johnson, Health and Human," ervices Director Jennifer Pempek, Financial Manager Kathy Dunlap, Family and Children's Coordinator Ron Kiesler, Behavioral Health Coordinator Harold Morris, Contracted Nursing Home Administrator Ron Lockwood, Long Term `Support Coordinator Norma Vrieze, Birth to Three Coordinator Kathy Huston, AC$S_Clinical Coordinator Brad Beckman, ADRC Manager Malva Sirek,cretar OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Roger.,Rebholz,'"County Board Chair Tammy Funk, Human,,Resource Administrator Kim Dupre, Information Systems Analyst Norm Matzek Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEE.TING The next.._Health and Human Services Board meeting is scheduled for Wednesday,, August 20, '008 at 8:30 AM. Berenschot will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Peterson, seconded by Berenschot, and unanimously adopted: That the minutes of the 06/18/08 Health and Human Services Board meeting and Open Budget Hearing be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services Board member Rasmussen reviewed the vouchers. Motion A motion was introduced by Rasmussen, seconded by Peterson, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 128675 through 128677, dated June 16, 2008, in the amount of $22,926.67. St. Croix County Health and Human Services Board Page 2 July 16, 2008 Human Services vouchers 128959 through 129005, dated July 10, 2008, in the amount of $60,299.89. Human Services voucher 129572, dated July 10, 2008, in the amount of $11,273.07. Human Services and Nursing Home vouchers 128187 through 128223, dated June 19, 2008, in the amount of $42,356.41. Human Services and Nursing Home vouchers 128224 through 128273, dated June 19, 2008 in the amount of $17,206.02. Human Services and Nursing Home vouchers 128537 through 12.8:674, dated June 16, 2008 in the amount of $419,885.76. Human Services and Nursing Home vouchers 128835 through 128956, dated July 03, 2008 in the amount of $138,731.27. Human Services and Nursing Home vouchers 129387.through 129535, dated July 10, 2008 in the amount of $66,153.00. Human Services and Nursing Home vouchers:129279 through 129386, dated July 10, 2008 in the amount of $262,712.53. Human Services and Nursing Home vouchers 129573 through 129588, dated July 10, 2008 in the amount of $4,375.52: Nursing Home voucher 128533, dated June 19, 2008 in the amount of $350.00. Nursing Home vouchers 129536 129571, dated July 10, 2008 in the amount of $30,987.12. Human Services, Workshop, Public Health, Social Services vouchers 376 through 405, dated June 26, 2008 in the amour t'of $392,417.78. Human Services, Workshop, Public Health, Social Services vouchers 406 through 435, dated July 10, 2008 in the amount of $394,691.77. Human Services and Nursing Home vouchers 358 through 386, dated June 26, 2007 in the amount of, $15.7,458.194. Human Services and Nursing Home vouchers 387 through 416, dated July 10, 2008 in the, of $159,701.52. Workshop vouchers 74 through 79, dated June 26, 2008 in the amount of $11,919.34.' Workshop vouchers 80 through 85, dated July 10, 2008 in the amount of $12,450.83. REPLACEMENT OF PHYSICIAN ON THE HEALTH AND HUMAN SERVICES BOARD: Johnson said Dr. Hoberg has resigned from the Health and Human Services Board. Johnson said the Bylaws state, "...a good faith effort shall be made to appoint a registered nurse and a licensed physician." Rebholz has been in touch with two Hudson physicians regarding their interest in serving on the Board. He will report more information as it is received. PERSONNEL ISSUES Kiesler and Dunlap brought forward a request for re- organization of staff of Behavioral Health (BH) and Youth and Community Support St. Croix County Health and Human Services Board Page 3 July 16, 2008 Services (YCSS). Kiesler explained a Behavioral Health Therapist has submitted his resignation and there is a need to fill this vacancy in a timely manner to reduce disruption of outpatient services to clients. He went on to explain there has been a reduction in need for Adult Community Support Services but an increased need for Youth Community Support Services. The 2008 -2009 BH Strategic Plan initiative is to develop a centralized intake and assessment position /unit. The 2008 -2009 Youth Community Support Services Strategic Plan initiative is to centralize information flow. This re- organization proposal is close to cost neutral with a savings of $1,330 and no positions will be added nor will position levels be increased. It is being proposed to better serve clients. An outline of proposed changes was presented. Kiesler would like the therapist position to be filled by August 15 with the balance of the reorganization to take place by mid - September. He reported staff experiencing a reduction from full time to .875 (or 35 hours /week) support this move. A letter of intent will be signed by these employees to reduce: their hours to 35 /week and it will be the County's decision to move, .back to 40 .hours /week if needed. Motion A motion was introduced by Berenschot; seconded.by Rasmussen, and unanimously adopted: That the Board allow Behavioral Health and Youth Community Support Services to proceed with the reorganization of the units as proposed. Whiting recommended that the Finance Committee be advised` - „of the reorganization plan for Behavioral Health and Youth” Community Support °Services at their July 22 meeting. meeting. "`,. Kiesler reported Behavioral ;Health will be meeting with the Sheriff's department on July 17 regarding utilization of mobile crisis and the potential of increased hours of coverage. PERSONNEL ISSUES NEW. EMPLOYEES /VACANCIES Johnson announced Carl Gaede has resigned his position as Behavioral Health Therapist to manage a trauma center in Uganda. Johnson also announced that the staff for the Aging and Disability Resource Center (ADRC )..have }been hired. They are as follows: • Marion Mottaz - Disability Specialist • Cia Westphal Information and Assistance Specialist • Kelly Weber - Informati'on and Assistance Specialist • Denise Gillen Information and Assistance Specialist Transition of staff to ADRC functions will be coordinated with Long Term Support.as cases are = transferred to the Care Management Organization. FINANCIAL REPORT - The following financial report for Nursing Home through May, 2008 was distributed. Pempek indicated Nursing Home carryover funds of $533,231 will not be applied until year end. St. Croix County Health and Human Services Board Page 4 July 16, 2008 St. Croix Health Center May 2008 Budget Actual Difference Percentag4 Census 0 Operating Revemie Medicare $842,975.00 $374,440.14 $468,534.86 44.42% Medicaid $2,431,627.00 $1,049,041.38 $1,382,585.62 43.14% Private Pay $760,413.00 $323,809.50 $436,603.50 42.58% All Other Sources $217,774.00 $93,430.93 $124,343.07 42.90% .Total 0 erating Revenue $4,252,789.00 $1,840,721.95 $2,112,067.05 43.28 °to Operating Expenses Daily Patient Services $3,081,764.76 $1,400,917.76 $1,680,847.00 45.46% Special Services $284,516.00 $110,603.40 $173,912.60 38.87% General Services $1,167,643.63 $438,641.18 $729,002.45 37.57% Administrative Services $547,561.00 $295,126.32 $252,434.68 53.90% Unassigned: Depreciation ( %° Based) $0.00 Others: $294,394.00 $100,206.09 $194,167.91 34.04 %' Utilities $62,384.63 Workers Comp, Computer Tech $14,890.46 Insurance $22,931.00 Total Operating Expenses $5,375,879.39 $2,345,494.75 $3,030,384.64 43.63% Net From Operations ($504,772.80 (Cost of doing business prior to applying levy & outstanding rev) 0i tstanding Revenues Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGT Funds $318,000.00 $114,314.00 % of Outstanding IGT Rev $0.00 $0.00 ' #DIV/O! Co Allocations (% Based) $259,859.39. $108,275.00 $151,584.39 41.67% Nursing Home Carry Over $533,231.00, $0.00 in $222,589.00 Total Clutstar�cl g $1,123,090.0 $163,584.39 Net from, all Sources _$282,183.80 The following financial report for Health and Human Services through May, 2008 was distributed`. Johnson informed the Board that supplemental payments for the Nursing Home will change with Long Term Care Reform. Staff will know more information by month's end and are working with the Wisconsin Association of Homes and Services for the Aging on contract language. Pempek said carryover funds and WIMCR funds are included in Administration revenue line. WIMCR funds are a way to capture some Medicaid losses. She mentioned that revenues are close to budget; however, expenses are slightly behind budget. Pempek reported staff are working with Larson /Allen to complete the 2007 audit. Steve Tracey is scheduled to be in -house today. St. Croix County Health and Human Services Board Page 5 July 16, 2008 - HEALTH AND HUMAN SERVICES-2008 SUMMARY Total OF REVENUES Budget May 31, 2008 Balance Administration 1,117,400.00 (34,112.57) 1,151,512.57 -3.1% AODA SerWices 772,986.95 345,419.23 427,567.72 44.7% Long Term Support 17,681,645.51 7,236,53 10 40.9% Mental Health 3,303,479.98 1,512,011.13 1,791,468.85 45.8 %' Family &Children's 3,037,821.28 1,461,19$.78 1,576,622.50 48.1 Public Health 1,678,621.37 696,979.69 981,641.68 41.5 Economic Support 1,227,133.10 369,012.35 858,120.75 30.1% General Relief 15,000.00 6,250100 8,750.00 41.7% Coordinated Services /SED 2,500,931.96 901,507.50 1,599,424.46 36.0% REVENUES HUMAN SERVICES PROGRAMS 31,335,020.15 12,494,797.85 18,840,222.30 39.9% SUMMARY Total OF EXPENDITURES Budget May 31, 2008 Balance Administration - 1,117,400.00 424 391.01 693,008.99 38.0% Alcohol -Drug Abuse 772,986.95 313,507.50 459,479.45 40.6% Long Term Support 17,681,645.51 7,211,195.88 10,470,449.63 40.8% Mental Health 3,303,479.98 1,210,249.01 2,093,230.97 36.6% Family & Children's 3,037,821.28 1,147,005.98 1,890,815.30 37.8% Public Health 1,678,621.37 689,694.81 988:926.56 41.1% Economic Support 1,227,133.10 466,449.16 760,683.94 38.0% General Relief 15,000.00 2,238.29 12,761.71 14.9% Coordinated Service /SED 2,500,931.96 515,500.71 1,985,431.25 20.6 %' EXPENDITURES HUMAN SERVICES PROGRAMS 31,335,020.15: 11,980,232.35 19,354,787.80 38.2% Excess Rev over Expenses t 514.565.50 AGED RECEIVABLE REPORT: The aging Accounts Receivable report through May was reviewed. Pempek reported 2005 accounts will soon be moved into doubtful accounts. Staff will not stop trying to collect on these accounts, but this will give a more accurate_ picture of the status of accounts. The system does not allow for mass write off of accounts so write offs need to be done by individual accounts. Pempek said the self -pay portion is the part that needs to be worked ori.now. Bad addresses are the largest issue on these accounts. ECHO training is scheduled to take place in September in New Hampshire. Kim Dupre has been asked to present at this training. The agenda will be reviewed when it is issued to determine if other HHS (Health and Human Service) staff should attend the training. Wentz expressed appreciation to staff for the extra time spent to update Accounts Receivable. LONG TERM SUPPORT -LONG TERM CARE REFORM /ADRC: Notices have been sent to all current adult waiver participants and all individuals on the waiting list for long -term care services explaining the changes that will occur in the next few months. Lockwood indicated the state is pressuring to complete the conversion this year as it would facilitate reconciliation and simplify the process for the state. Accelerating the conversion may create a burden on CHP; however, the decision has been made to convert 60 clients /month versus 50. Lockwood St.,Croix County Health and Human Services Board Page 6 July 16, 2008 reported the State plan is to convert clients based on expense to average out costs rather than by caseload. This may result in clients having different case managers. Staff are scheduled to begin transition to ADRC August 1 st . Lockwood reported a lot of calls are coming in from consumers as a result of the notices that were sent. A meeting will be scheduled in August for planners and discharge planners to help resolve confusion with conversion. All clients are planned to be converted in four months or by the end of 2008. However, the waiting list will be reduced over a two year period and consumers on the list will not necessarily be served immediately. A plan for self- directed care called IRIS (Include, Respect, I -Self Direct) was just issued from the State. It is a plan to opt out from managed care and for consumers to do their own self - directed care. It was - developed to give consumers a choice for care management. Lockwood reported that allocations for IRIS have been low when the functional screen was completed. Two trainings are coming up for the ADRC Council. Beckman reported ADRC is getting organized and memoranda of understanding are getting signed. He reported there will be a training in Hudson on 6` for consumers and staff. Johnson reported the corrected ADRC application submission to the state was accepted. Staff will begin billing the, state when the final contract is received. AGING AND DISABILITY RESOURCE CENTER '= (ADRC)'' OFFICE EXPANSION /REMODEL: A current floor plan for the ADRC area was distributed and discussion was held on possible renovations. Johnson - reported a plan has been given to Finance that would create a conference room and try to accommodate all ADRC staff; however, this plan does not appear to provide enough room for staff. Johnson said concerns have been raised regarding limited meeting rooms in the Government Center, so an attempt 'was made in this design to accommodate both. Additional planning will be done to'u -lorok I at alternatives which would include moving the conference room. - °Ilepartment on Aging is changing over to ADRC; however, much of Aging will stay.. the same. Aging has a high presence and it is important that the unit be located in the same location. No aging staff have been eliminated in process'': Wentz requested the plan to renovate also be brought back to the 'Health and Human Services Board after it is approved by Finance.- NURSING HOME ADMINISTRATOR'S REPORT Morris distributed the Nursing Home newsletter entitled: Happenings on the Hill. He said this newsletter will be limited to two pages and will go out to residents and families monthly. Morris reps 'r ted 'the oxygen provider has been changed and the change has been positive. He said podiatry services will change by the end of July. Changes in service providers are being made as the services work better for the facility. An update and training are scheduled for ECS, the electronic records system for the Nursing Home. Morris said the training will be taped and utilized as training for new employees. Morris reported visiting hours were discussed at the last QA meeting. He said normal visiting hours will be posted as 7:00 AM to 9:00 PM; however, families are welcome to come any time, day or night, if needed. The Nursing Home average census in June was 66.73 and in May it was 64.90. St. Croix County Health and Human Services Board Page 7 July 16, 2008 Morris reported the census today is 67; however, it ranged from 63 to 71 during June. He said there are currently three to five inquiries for admission. He reported four new residents were relocated from the Osceola nursing home, which is scheduled to close the end of July. The State Ombudsman visited the facility on July 15 to follow up on those four admissions from Osceola. He said a different Ombudsman is scheduled for another visit on July 17. The first Ombudsman was very pleased with the results of the visit. Morris announced the annual family /resident picnic is scheduled for August 14 beginning at 4:00 PM. The theme this year is garden party. Weather permitting the dinner is scheduled to be served outside at 5:00 PM. A silent basket auction to benefit the resident fund account will also be held from 4:00 to 6:00 PM. All Board members were invited to attend. Marzolf officially thanked all the staff of the Nursing Home for the excellent care he received during his 12 -day stay in the Nursing,Home. - Discussion was held whether or not to hold a special Health and Human Services Board meeting before the next County Board meeting scheduled' for,August 20 to discuss the action of the County Board at the July 15 meeting I to table the Nursing Home resolution. The wording of the referendum question is due by August. Johnson said capital improvements°�for the Nursing" Home cannot be delayed any longer. Larson said maintenance issues in the buildings needs to be addressed. The Board recessed from 10:25 to 1:0:30. HEALTH AND HUMAN SERVICES GOVERNING BODE_ BY -LAWS REVIEW: Johnson recommended the following changes to the by -laws: delete any reference to "buildings" in regards to farm land and buildings in the document, add Aging and Disability Resource Center (ADRC) and -add wording th�}t unless otherwise indicated, the word "Board" in the document wi reference the Health and Human Services Board. Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That Board approves the By -laws with revisions recommended. Johnson revise 'the By-laws and provide copies to Board members. By -laws will also be created to for Aging and Disability Resource Center Council. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson reported the following staff have been hired for the ADRC: Marian Mottaz as Disability Benefit Specialist, Cia Westphal as Information and Assistance Specialist, Kelly Weber as Information and Assistance Specialist, and Denise Gillen as Information and Assistance Specialist. Johnson reported 2.5 (social worker) positions will be eliminated no Pater than the end of 2008 and staff have been notified. 2009 NEW POSITION REQUESTS 2009 POSITION MODIFICATIONS Johnson requested modification the Long Term Support Coordinator position due to the implementation of ADRC. The change would occur in early 2009. Johnson would like to create a new position possibly entitled Program Development Specialist. Johnson listed some of the duties this position would perform which included writing and managing grants, increase utilization of volunteers, coordinating time limited projects, measuring and developing performance outcomes, review and revision of ECHO, manage consumer grievances, etc. Wentz requested a job description and indicated that the position should go through Springsted for analysis. Luckey expressed concern asking for this position when cuts in the budget are occurring. St. .Croix County Health and Human Services Board Page 8 July 16, 2008 Johnson said a request for Medical Records technician was received but recommended this position continue as a contracted position. A request for an additional Economic Support Specialist was received. Additional staff are needed in Economic Support as the unit is out of compliance with timelines to process applications and this will continue with the addition of ADRC implementation, additional implementation of Badgercare Plus, etc. Johnson noted the backlog of processing cases is a concern statewide. Pempek indicated the Department receives $.50 on the dollar back from the State on monies spent on Economic Support salaries. A request for an ADRC Prevention /Nutrition Coordinator at, 19 hours /week was received. Johnson indicated these duties cannot be handled by Beckman in addition to all his other duties. A request for a Public Health RN was received and Johnson recommended inclusion as a half -time position. Motion A motion was introduced by Larson, by Peterson, and unanimously adopted: That the Board approves bringing the following positions forward in the budget process: • Program Development Specialist • Economic Support Specialist • ADRC Prevention /Nutrition Coordinator • 50% Public Health RN 4X10 WORK SCHEDULE Johnson reported a pilo of a 4x10 work schedule for counselors /therapists in Behavioral Health has been followed for the past few months. The employee handbook states work schedule changes outside the usual workday /work week._mus.t be able to show public demand for the extended service time, improved service delivery to the citizens of St. Croix County, market factors that impact �,employee scheduling, significant cost savings for the new schedule and efficiencies that can only be captured with revised scheduling. Johnson indicated he supports the 4x10 schedule as it is a benefit to the consumer and to staff. Whiting encouraged record keeping of any schedule changes as to why the change is beneficial to the county or will it cost the county additional money, i.e. extended cooling /heating hours, extended staff coverage in- other areas, etc. Johnson said the 4x10 schedule would only apply; to line staff=a6 he would expect management staff to be here five days a week at this point. This item is scheduled to be discussed at the Finance meeting -� - on July 22. BIRTH TO THREE PROGRAM REVIEW Vrieze reported on the recent on -site State review for Birth to 3. Birth to 3 services are mandated. She gave a brief overview of previous reviews. The first review in 1998 focused on compliance, the second in 2003 focused on community collaboration, and this review in 2008 focused on data to prove that this is a program that is working. Staff in Birth to 3 are required to see children in their natural environment. Also, staff are required to do a transition plan for each client as they move toward the age of 3. Steps are being taken to improve documentation and ensure data is accurate and timely for child count for the program. She reported HSRS reporting is being revamped so information can be viewed more timely along with the ability to query and run reports on the system. Vrieze reported her unit also works collaboratively with Family Resource St.,Croix County Health and Human Services Board a Page 9 July 16, 2008 Center. Vrieze reported 92 referrals have been received thus far this year. Of that number 67 children were screened with 28 being eligible for services. The current number of clients enrolled in the program is 75. ECONOMIC SUPPORT PROGRAM REPORT - BADGERCARE PLUS EXPANSION AND DISTANT LEARNING TRAINING MODEL This item will be delayed until the next meeting. COUNTY CENSUS GROWTH Johnson will detail this information more in the future. He will work with the applied population lab to possibly assess the impact of population on the demand for services. Wentz asked if there were any other issues to bring before the Board. Wentz questioned the Board's desire to schedule an additional meeting before the August 20 County Board meeting to discuss the Nursing Home referendum. It was the consensus of the Board an additional meeting-,,was not necessary at this time. Wentz adjourned the meeting. Time: 11:40 Chair:: Attest: (Secretary)