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HomeMy WebLinkAboutHealth & Human Services 09-10-08 Esther Wentz will review vouchers. REVISED 09/08/08 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 10, 2008 at 8:30 (NOTE: DATE CHANGE) (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 - 08/20/08 DATE OF NEXT MEETING — 10/15/08 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. Economic Support program report- Badgercare Plus expansion and distant learning training model (delayed from last two meetings) 4. Personnel Issues a. New employees /vacancies b. 4x10 work schedule- Economic Support 5. 2009 Nursing Home/Health and Human Services Budget Review 6. County Farm land request for proposals, oversight responsibilities, and use of revenue 7. Nursing Home Report 8. Long Term Support-Long Term Care Reform transition report 9. Health and Human Services/Nursing Home Safety and Security Committee Report** ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 9/8/2008 9:03 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD. September 10, 2008 The St. Croix County Health and Human Services Board met on September 10, 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 Services Director Harold Morris, Contracted Nursing Home Administrator Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor Pat Haeny, Family and Children's Supervisor Ron Kiesler, Behavioral Coordinator Fay Strenke, Accounts Receivable Supervisor Brad Beckman, ADRC Manager Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Roger Rebholz, County Board Chair Tammy Funk, Human Resource Administrator Chair Wentz called the' eeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Friday, October 17, 2008 at 8s - -30 AM due to a scheduling conflict with several members. Rasmussen 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 Luckey, seconded by Berenschot, and unanimously adopted: That the minutes of the 08/20/08 Health and Human Services Board `meeting be approved with the following changes: Page 4, second paragraph, delete the last part of the sentence to read: The Finance Committee approved removing `pilot' from the altered schedule for Behavioral Health staff and to continue as the schedule allows for more evening coverage for groups and increased client hours. have been � -eal4zed. Page 4, last paragraph, change to read the following: Johnson distributed an article on telecommuting and allowing flexible schedules. Tammy Funk indicated • conversation began at the last Finance Committee meeting and it is hoped that • revised policy will be completed to present at the Finance meeting on September 17, 2008. CONSIDERATION OF CLAIMS Due to the early meeting date, Wentz will review vouchers after the meeting and vouchers will be approved at the October meeting. St. Croix County Health and Human Services Board Page 2 September 10, 2008 AGED RECEIVABLE REPORT: The Accounts Receivable aging report for Health and Human Services through July was reviewed. Strenke reported the unit has been reorganized due to one of the temporary staff leaving. She indicated the auditors requested an allowance for doubtful accounts be established for accounts prior to 2005. These accounts will not be written off but staff will not be actively collecting on these accounts. This will be done within the next month and will provide a more accurate picture of account status. Strenke reported when she accepted her position, approximately 2,600 statements were being mailed monthly. That number has been reduced to approximately 2,100 due to cleaning up accounts and this will reduce even further when the accounts are moved to doubtful accounts this month. This will result in less postage costs. Johnson reported three Health and Human Services staff are going to attend the annual ECHO conference with Kim Dupre giving a presentation at the conference. Strenke provided an agenda of the conference. FINANCIAL REPORT The following financial report for Nursing Home through July, 2008 was distributed. Johnson indicated to be on:-target for the budget, the percentage should be 58 %. He reported the cost °for the Pathways contract for the Administrator is under the Administrative Services line, which is at 77 %. He reported there was an increase in salary and,fringe noted in 'the 2009 budget and this is being investigated. He is questioning if salary and fringe was under budgeted in 2008, so the percentage of increase would be higher than expected. Johnson indicated we are spending more on contracting for the administrator and director of nursing°position. than if the positions were filled with regular County employees, but has not made a move to fill the positions with a County employee due to the uncertainty regarding the future of the Nursing Home. This may be -able to be addressed after the referendum question scheduled for November,. Johnson reported IGT monies were received in 2008, which were for earmarked for 2007. These funds stayed in 2008 funds with the approval of the auditors. There may be possible additional IGT monies for 2009 given some of the discussion Supervisor "Marzolf has had with Representative Rhodes; however, no definite answer has been given _thus far. IGT funds in the amount of $428,153 have been received so far this year. Johnson indicated carryover funds from 2006 in the amount of approximately $533,231 will not be applied until year end of 2008. St. Croix County Health and Human Services Board Page 3 September 10, 2008 St. Croix Health) enter July 2008 Budget Actual Difference Percentag Census 0 Operating Reveiure: Medicare $842,975.00: $542,829.66 $300,145.34 64.39% Medicaid $2,431,627.00 $1,499,409.65 $932,217.35 61.66% Private Pay $760,413.00` $412,833.75 $347,579.25 54.29% All Other Sources $217,774.00, $128,643.58 $89,130.42 59.07% Total Operating Revenue $4,252,789.00 $2,583,716.64 $1,669,072.36 60.75% Operating Expenses Daily Patient Services $3,081,764.76 $1,979,211.55 $1,102,553.21 64.22% Special Services $284,516.00 $153,049.32 $131,466.68 53.79% General Services $1,167,643.63 $619,010.89 $548,632.74 53.01% Administrative Services $547,561.00 $421,686.91 $125,874.09 77.01% Unassigned: - — - _ _ Depreciation (% Based) $0.00 Others: $294,394.00, $166,583.68 $125,810.32 57.26% Utilities $82,543.38 Workers Comp, Computer Tech $15,634.30 Insurance $70,406.00 Total Operating Expenses $5,375.879.39 $3,341.542.35 $2.034,337.04 62.16% Net Front Operations {$757,825.71} ,,(Cost of doing business prior to applying levy & outstanding rev) Outstanding Revenues _ Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00 % Revenue - IGT Funds $318,000.00 $428,153.00 % of Outstanding IGT Rev $0.00 $0.00 #DIV/O! Co Allocations (% Based) $259,859.39 $151,585.00 $108,274.39 58.33% Nursing Home Carry Over $533,231.00 $0.00 Total Outstanding $1,123,090.39 $579,738.00 $120,274.39 Net from all Sources 4178,087.71 The following financial report for Health and Human Services through July, 2008 was distributed. Johnson indicated carryover funds of approximately $951,000 will be applied to Health and Human Services at year end of 2008. Johnson explained Long Term Support receives advances and at this time of year the state begins take backs of funds. Johnson reported the balance of allocations from the State for Income Maintenance will be received at year end. St. Croix County Health and Human Services Board Page 4 September 10, 2008 HEALTH AND HUMAN SERVICES - 2008 SUMMARY Total OF REVENUES Budget July 31, 2008 Balance Administration 1,117,400.00 (48,241.41) 1,165,641.41 -4.3% AO DA Services 772,986.95 459,405.83 313,581.12 59.4% Long Term Support 17,681,645.51 9,613,141 78 8,068,503.73 54.4% Mental Health 3,303,479.98 1,886,540.84 1,416,939.14 57.1 Family & Children's 3,037,821.28 1,934,558.27 1,103,263.01 63.7% Public Health 1,678,621.37 997,527.02 681,094.35 59.4%' Economic Support 1,227,133.10 586,752.06 640,381.04 47.8% General Relief 15,000.00 8,750.00 6,250.00 58.3% Coordinated Services /SED 2,500,931.96 1,089,610.61 1,411,321.35 43.6% REVENUES HUMAN SERVICES PROGRAMS 31,335,020.15 16,528,045.00 14,806,975.15 52.7% SUMMARY Total OF EXPENDITURES Budget July 31, 2008 Balance % Administration 1,117,400.00 617,415.91 499,984.09 55.3% Alcohol -Drug Abuse_ 772,986.95 440,478.03 332,508.92 57.0% Long Term Support 17,681,645.51 10,561,590.27 7,120,055.24 59.7 Mental Health 3,303,479.98 1,727,608.40 1,575,871.58 52.3%! Family & Children's 3,037,821.28 1,624,781.57 1,413,039.71 53.5% Public Health 1,678,621.37 ' 991,055.52 687,565.85 59.0% Economic Support 1,227,133.10 670,917.20 556,215.90 54.7% General Relief 15,000.00 3,621.23 11,378.77 - 24.1% Coordinated Service /SED 2,500,931.96 851,026.34 1,649,905.62 34.0% EXPENDITURES HUMAN SERVICES PROGRAMS 31,335,020.15 17,488,494.47 13,846,525.68 55.8% Excess Rev over Expenses S (960.449.47) ECONOMIC SUPPORT PROGRAM REPORT- BADGERCARE PLUS EXPANSION AND DISTANT LEARNING TRAINING MODEL The 'new phase of Badgercare Plus expansion for childless adults over 19 and under 65 who are not disabled will be called Badger Choice -• °_Statewide it is estimated to service an additional 71,000 people and is "' hticipated be implemented by an enrollment broker (not the county). Clients pay a premium for this coverage and there are higher income limits at 200% of the Federal poverty level. The targeted start date at this time is April. This plan is expected to be provided by a managed care organization. Application for - Badgercare will be on -line, not through Economic Support. It will cost '$60/person /year to apply for the program and the money will be collected when people are determined eligible for the program. This program is being implemented in an effort to provide every person in Wisconsin access to health coverage. A new distance training model was recently forwarded to our department. Economic Support workers are mandated to have State training; however, the State has not had training available. Training for a new worker costs approximately $10,000 /worker and takes about 12 weeks. With distance training, about half of the training can be accomplished on -line at the local office. Many counties in Wisconsin are short of staff in Economic Support and the issue with training will continue to be addressed with the State. Counties are out of compliance and the possibility of fines and lawsuits exists. A management evaluation review of Economic Support is done by the State every three years. • St. Croix County Health and Human Services Board Page 5 September 10, 2008 The review is currently being performed in Pierce County and St. Croix County's review will occur soon. Squyer reported one additional staff person in Economic Support will not be enough to cover the transition to Aging and Disability Resource Center (ADRC) caseload. Squyer reported there has been an increase of approximately an additional 2200 cases from 2004, with the current caseload being approximately 3580. Whiting requested staff to draft a resolution to present at the next County Board meeting and to consider presenting at the Wisconsin Counties conference next month. The Board recessed from 9:50 to 9:55. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson reported Wendy Kramer has been appointed Interim Health Officer after the resignation of Charlotte Sortedahl. This change has been reported to Lieske Giese at the regional office. Johnson reported there has been one applicant for the vacant Nurse Practitioner position and an interview will take place soon. Johnson reported there was one open position ter the recent re= organization in Behavioral Health and Beth Anez has been hired to fill the social worker position. 4X10 WORK SCHEDULE - ECONOMIC SUPPORT Squyer reported" in March of 1994, Economic Support did a pilot of fl- exible-scheduling to meet the needs of clients as many clients are working the same hours we work. In 1994 eight staff opted to work the 4x10 schedule and this worked well with meeting the needs of the clients. However, it was later decided by the county that staff working the 4x10 schedule could continue, but no new people would be allowed to work this schedule. Squyer outlined guidelines ti� be followed during the 4x10 schedule along with the benefits to the clients. Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously adopted: That the Board approves the request for the proposal for Economic Support staff to move to a 4x10 schedule with the buddy system' being utilized for personal safety. This request will be forwarded to the Finance Committee. Funk will put this item on the agenda for the Finance Committee meeting. LONG TERM. SUPPORT-LONG TERM CARE REFORM TRANSITION REPORT Lockwood reported the home and community. based waiver programs are moving to Community Health Partners (CHP). A brochure describing the services offered under family care and CHP was distributed. Lockwood said 294 clients will be transitioned from the waiver, programs to CHP, which started September 1, and an additional one - sixth of the clients will be transitioned each following month plus CHP will begin to serve people on the waiting list. Clients are not locked into choice and can choose from CHP, Family Care or IRIS (Include, Respect, I - Self Direct), a self - directed approach. Clients are able to move between plans but have to go back to the Aging and Disability Resource Center (ADRC) to change. The change does not happen through CHP. CHP is paid a monthly rate and the capitation is higher in CHP partnership plan versus the Family Care model. If clients are in Family Care they get a Forward card; if clients receive services through CHP, they get an insurance card. Beckman reported more clients are approaching the ADRC as has been the experience in other counties. He indicated Economic Support plays a vital role in the transition to ADRC and would eventually like Economic Support unit to have hours and a presence at ADRC. Thus far, more clients have chosen IRIS St. Croix County Health and Human Services Board Page 6 September 10, 2008 than any other county in Wisconsin so the State is coming to St. Croix County to discuss this trend. Beckman distributed a floor plan for the proposed office set up for ADRC. $39,000 was received from the state for office set up and $39,000 was included in the budget for office set up. Attempts are being made to make the office a customer and consumer friendly set up. The unit is also doing some fund raising activities for aging services. HEALTH AND HUMAN SERVICES /NURSING HOME SAFETY AND SECURITY COMMITTEE REPORT Johnson said the building will go to a single point of access October 6, 2008 as a way to provide more security for employees and clients. Pat Haney indicated a recent security trainer indicated places that have no obvious security are targeted. Basic security measures are being considered. Security cameras will be installed. New signage is being posted both inside and outside; including signage stating surveillance is in use in the building. During a recent staff security survey, a common concern was the lighting in the parking lots. When tested, it was found that the lighting is not even close to industry standard; however, the cost to bring the lighting up to standards would be considerable. 2009 NURSING HOME /HEALTH AND HUMAN SERVICES BUDGET REVIEW The Finance Committee has requested Health and Human "Services (HHS) to, consider additional cuts of $500,000. Options for reductions were discussed. The Program Development Specialist position will be cut. The department is looking at purchasing two vehicles in 2009. Fleet vehicles received hail damage during a recent hail storm. The decision..was made to not .repair the vehicles and accept a 50% payout in lieu of not rewiring the vehicles. The net result was $13,000, which will be used to purchase a fleet vehicle and would reduce the capital outlay expense. About 20,000 miles per year are put on each fleet vehicle and vehicles are run for about .._seven „years. Johnson indicated concern with cuts from the Nursing Home capital outlay budget. Johnson was hesitant to suggest any cuts in the Building Services capital outlay budget without Tobin being present. Johnson said the operational efficiencies in Nursing Home staffing have been made. - Johnson said the director of nursing and nursing home administrator positions could ,be moved to County positions versus contracted positions to save money in-the Nursing Home. Whiting briefly talked about health retirement savings accounts and health reimbursement accounts. Insurance rates are not available at this time. These items wit -1 be discussed at next week's County Board session. Long Term Care Reform resulted in a reduction to Health and Human Services but did not impact the County levy. The Nursing Home referendum question will go to the public on November, 4 th . ' The budget will go to the County Board on November 11 th , so there is a short turn around time for any changes to occur. COUNTY FARM LAND REQUEST FOR PROPOSALS, OVERSIGHT RESPONSIBILITIES, AND USE OF REVENUE Farm revenue amounts to approximately $40,000 per year, which is used by Health and Human Services to offset the County levy. Questions have been raised as to the responsibility for monitoring the farm land and where the revenue generated from the land rent should go. Part of the land contract calls for monitoring soil levels. Bob Heise, Land and Water Conservation, will be responsible for the day -to -day management of the soil. The Bylaws will remain the same for now and operations will continue as is. A longer term rental agreement is being explored and Johnson will continue to work with Heise, Timmerman, Baker and Building Services. Peterson expressed the opinion that jurisdiction should fall under the Finance Committee. NURSING HOME ADMINISTRATOR'S REPORT Morris distributed the most recent Nursing • St. Croix County Health and Human Services Board Page 7 September 10, 2008 Home newsletter. Morris reported the census in the Nursing Home today is 68, with one resident anticipated to return this afternoon, resulting in a census of 69. The average daily census for July was 67.81 and for August was 67.90. Morris reported the garden party held for Nursing Home residents was a success with good socialization and a good time had by all. The basket raffle resulted in funds of $3,247 for the resident fund account. Morris report a major update was done to the ECS system, the electronic records for the Nursing Home. Morris reported the annual Nursing Home report has been submitted in the last month, which is done every year. The Nursing Home has a new x ray contract, which started this month. He felt the new vendor is offering better service and better x rays. The State surveyors were in the Nursing Home on July" 27 after,, receiving an anonymous incident complaint regarding a resident going to the hospital.' Three surveyors were here and reported staff were doing everything we'll. The surveyors also reviewed the last 30 incidents .° and reported staff` are doing everything well. A notice has been sent to Nursing Home families regarding standard visiting hours. Morris reported a bathing lift chair not" working" right. A technician from Arjo will be here to investigate the problem with the chair this week; however, it is possible a new chair may need to "'be purchased -for approximately $5,000 to $6,000. Morris reported the van us, "ed for Nursing Home activities is wearing out and has rusted through one of the' steps. Staff are the possibility of a fundraiser to purchase a van. Discussion was held regarding possibility of coordinating van use with St. Croix Industries, Department on Aging and the Nursing Home. Donations need to be approved by the County Board. Johnson will work with Timmerman on.details for fund raising and solicitations. Wentz asked if "there were any other issues to bring before the Board. Wentz adj,aurned the meeting.' Time: 12:10 Chair: Attest: (Secretary)