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HomeMy WebLinkAboutHealth & Human Services 01-20-10 Larson will review vouchers. Revised 01/15/2010 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: January 20, 2010 at 8:30 LOCATION: (Board Room, St. Croix County DHHS Building, 1445 N. Fourth Street, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 12/16/09 DATE OF NEXT MEETING — 02/17/10 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. Review Department summary document for claims and vouchers 3. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report 4. Medical Assistance Maximization Study Report 5. Nursing Home Administrator's Report 6. Update regarding Spring Valley Health Care Campus project 7. Personnel Issues a. New employees /vacancies 8. H 1N 1 update 9. St. Croix Industries Pathways grant application 10. 2010 Routine Meeting Dates 11. Possible agenda items for next meeting 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. 1/19/2010 7:58 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD January 20, 2010 The St. Croix County Health and Human Services Board met on January 20, 2010 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 Dr. Lisa Ramsay Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Frank Robinson, Nursing Home Administrator Wendy Kramer, Public Health Officer /Public Health Coordinator Tammy Wilson, HIS Supervisor Kim Dupre, Information Systems Analyst Clark Schroeder, St. Croix Industries Director Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Roger Rebholz, County Board Chair Loyla Waskul Chair Wentz called the meeting 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 Wednesday, February 17, 2010 at 8:30 AM. Rasmussen will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the agenda be approved MINUTES Motion A motion was introduced by Peterson, seconded by Larson, and unanimously adopted: That the minutes of the 12/16/09 Health and Human Services Board meeting be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Larson reviewed the vouchers. Motion A motion was introduced by Larson, seconded by Marzolf, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services and Department on Aging vouchers 163578 through 163615, dated December 16, 2009 in the amount of $64,234.39. Human Services vouchers 163717 through 163718, dated December 16, 2009 in the amount of $12,930.00. St. Croix County Health and Human Services Board Page 2 January 20, 2010 Human Services vouchers 164851 through 164852, dated January 06, 2010 in the amount of $364.00. Human Services vouchers 165125 through 165165, dated January 06, 2010 in the amount of $41,338.47. Human Services vouchers 165997 through 165999, dated January 06, 2010 in the amount of $13,719.60. Human Services, Nursing Home, St. Croix Industries, and Government Center vouchers 163616 through 163716, dated December 16, 2009 in the amount of $120,795.30. Human Services, Nursing Home, Government Center and St. Croix Industries vouchers 163994 through 164051, dated December 22, 2009 in the amount of $73,201.18. ADRC and Department on Aging vouchers 164052 through 164069, dated December 22, 2009, in the amount of $18,097.46. ADRC and Department on Aging vouchers 164121 through 164132, dated December 29, 2009, in the amount of $2,986.61. Human Services, Nursing Home, St. Croix Industries, Government Center, Department on Aging, and ADRC vouchers 164133 through 164225, dated December 29, 2009 in the amount of $1,865,213.78. Department on Aging and ADRC, vouchers 164233 through 164235, dated December 29, 2009 in the amount of $1,634.56. Human Services, Department on Aging, and ADRC, vouchers 164853 through 164881, dated January 06, 2010 in the amount of $11,443.72. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 164882 through 164966, dated January 06, 2010 in the amount of $76,639.11. Nursing Home voucher 163985, dated December 16, 2009 in the amount of $53,022.50. Nursing Home and Government Center vouchers 164967 through 164992, dated January 06, 2010 in the amount of $9,701.58. Human Services, Nursing Home, and St. Croix Industries vouchers 164993 through 165124, dated January 06, 2010 in the amount of $47,417.93. Human Services and Nursing Home vouchers 166000 through 166013, dated January 06, 2010 in the amount of $16,238.55. Human Services, Department on Aging, and ADRC, vouchers 165828 through 165914, dated January 06, 2010 in the amount of $20,999.19. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 165915 through 165996, dated January 06, 2010 in the amount of $168,801.14. St. Croix County Health and Human Services Board Page 3 January 20, 2010 Human Services, Workshop, Public Health, Social Services vouchers 724 through 752, dated December 23, 2009 in the amount of $407,962.73. Human Services and Nursing Home vouchers 669 through 693, dated December 23, 2009 in the amount of $159,003.69. Workshop vouchers 152 through 157, dated December 23, 2009 in the amount of $13,613.18. Human Services, Workshop, Public Health, Social Services vouchers 1 through 31, dated January 07, 2010 in the amount of $414,422.42. Human Services and Nursing Home vouchers 1 through 28, dated January 07, 2010 in the amount of $180,107.51. Workshop vouchers 1 through 6, dated January 07, 2010 in the amount of $12,972.54. Human Services, Workshop, Public Health, Social Services vouchers 32 through 37, dated January 14, 2010 in the amount of $5,709.79. Human Services and Nursing Home vouchers 29 through 35, dated January 11, 2010 in the amount of $25,675.85. REVIEW DEPARTMENT SUMMARY DOCUMENT FOR CLAIMS AND VOUCHERS Wentz announced the per diem sheet will go into affect after the April election. Johnson reviewed the new summary document for claims and vouchers that was created to clarify reading the summary report. Johnson said the document tracks with budget summary documents also. FINANCIAL REPORT The following financial report for Health and Human Services through November, 2009 was distributed. Pempek reported the take back from the state will show up on the December report in an adjustment to the Long Term Support revenue line. She said the County obligation for Long Term Support has been paid. Next year the County obligation for Long Term Support will show up in the ADRC budget. St. Croix County Health and Human Services Board Page 4 January 20, 2010 HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget November 30, 2009 Balance % Administration (282,648.48) 909,960.43 (1,192,608.91) - 321.9% AODA Services 755,822.52 724,916.02 30,906.50 95.9% Long Term Support 2,631,098.96 3,663,263.57 (1,032,164.61) 139.2% Mental Health 3,445,706.61 2,640,295.98 605,410.63 62.4% Family & Children's 2,908,835.69 2,523,911.87 384,923.82 86. Public Health 2,103,809.13 1,950,190.24 153,618.89 92.7% Economic Support 1,140,696.47 1,034,206.20 106,490.27 90.7% General Relief 0.00 0.00 0.00 0.0% Coordinated Services/SED 3,106,279.19 1,264,142.45 1,842,136.74 40.7% ARDC 632,000.00 422.075.00 209,925.00 66.8% Department on Aging 846,623.00 760,510.00 86,113.00 89.6% Carryover Funds 1,312,360.00 1,202,996.74 109,363.26 91.7% REVENUES HUMAN SERVICES PROGRAMS 16,600,563.09 17,296,468.50 1,304,114.59 93.0% SUMMARY Total OF EXPENDITURES Budget November 30, 2009 Balance % Administration 1.029,711.52 920,357.27 109,354.25 89.4% Alcohol -Drug Abuse 755,822.52 650,216.71 105,605.81 86.0% Long Term Support 2.631,098.96 2,150,976.88 460,122.06 81.8% Mental Health 3,445,706.61 3,030,767.38 414,939.23 88.0% Family BChildren's 2,908,835.69 2,511,095.73 397,739.96 86.3% Public Health 2,103,809.13 1,663,743.26 420,065.87 80.0% Economic Support 1,140,696.47 1.060,704.20 79,992.27 93.0% General Relief 0.00 29.59 (29.59) D.0% Coordinated Service /SED 3,1 06,279.19 2.111,811.61 994,467.58 68.0 %. ARDC 632,000.00 439,956.87 192,043.13 69.6% Department on Aging 846,623.00 600,246.73 246,376.27 70.9% EXPENDITURES HUMAN SERVICES PROGRAMS 18,600,583.09 15,159.906.23 3,440,676.86 81.5% Total # 2A W562.27 The following financial report for St. Croix Industries through November was distributed. Johnson reported St. Croix Industries will prepay the worker's compensation account in December. This will apply to St. Croix Industries only. St. Croix County Health and Human Services Board Page 5 January 20, 2010 St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget November 30, 2009 Balance % INS Operations 1,342,664.56 1,309,808.99 32,855.57 97.6% INS Production 422,286.64 278,344.08 143,942.76 65.9/ WS Helping Hands 71,726.26 99,013.59 (27,287.33) 138.0'° WS Pop/Vending 7,250.00 9,453.15 (2,203.15) 130.4% WS Ram 77,443.00 27,745.05 49,697.95 35.8° WS Vocational Placement 371,831.60 313,371.73 58,459.87 84.3'°. WS Comm Based Day Prog 183,214.95 143,756.75 39,458.20 78.5' REVENUES 2,476,417.21 2,181,493.34 294,923.87 88.1'% SUMMARY Total OF EXPENDITURES Budget November 30, 2009 Balance % WS Operations 1,342,664.56 1,131,245.61 211,418.95 84.3% WS Production 422,286.84 287,775.09 134.51115 60.1% WS Helping Hands 71,726.26 66,442.65 5,283.61 92.6% WS Pop/Vending 7,250.00 5,551.77 1,698.23 76.6% INS Ram 77,443.00 20,542.28 56,900.72 26.5° WS Vocational Placement 371,831.60 286,787.78 85,04332 77.1 WS Comm Based Day Prog 183,214.95 160,604.66 22,610.29 87.7% EXPENDITURES 2,476,417.21 1,958,949.84 517,467.37 79.1% Total x 222.543.50 The following financial report for the Nursing Home through November, 2009 was distributed. Robinson reported the Nursing Home is over approximately $176,000 in revenue in November mostly due to additional Medicare residents. He also reported the Nursing Home is under approximately $303,000 in expenditures due to lower overtime use, lower pool staff use and staffing being managed on a daily basis. Wentz commended Robinson and the staff for their efforts. St. Croix County Health and Human Services Board Page 6 January 20, 2010 St. Croix Health Center November 2009 Budget Actual Difference Percentag4 Census 0 Operating Revenue: Medicare $903,252.00 $1,104,230.04 - $200,97B.04 122.25% Medicaid $2,481,432.00 $2,083,126.28 $39B,305.72 83.95% Private Pay $760,413.00 $B36,949.68 - $78,536.68 110.33% Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGTfSupplemental Funds $445,448.00 $348,738.00 $96,710.00 76.29% All Other Sources $216,041.00 $214,308.07 $1,732.93 99.20% Total Operating Revenue $4,818,586.00 $4,589,352.07 $229.233.93 95.24% Operating Expenses Daily Patient Services $3,397,317.36 $3,054,676.64 $342,640.72 69.91% Special Services $284,262.00 $236,202.82 $48,059.18 83.09% General Services $1,148,672.04 $988,263.60 $160,408.24 86.04% Administrative Services $628,277.68 $660,864.66 - $32,586.98 105.19% Unassigned: Depreciation (% Based) $0.00 Others: $498,371.00 $217,210.25 $281,160.75 43.58% Utilities $202,0B0.00 $92,712.33 Workers Comp, Computer Tech $228,848.00 $33,840.92 Insurance $67,443.00 $90,657.00 Total Operating Expenses $5,956,900.08 $5,157,218.17 $799.681.91 86.58% Net From Operations ($567,866.10) (Cost of doing business prior to applying levy .& outstanding rev) County Revenues Co Allocations (% Based) $947,314.08 $868,371.24 $78,942.84 91.67% Nursing Home Carry Over $191,000.00 $1763437 $15,916.63. 91.67% Total Outstanding $1,138,314.08 $1,043,454.61 $94,859.47 Net from all Sources $475.588.51 AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through November was reviewed. Pempek reported write offs of accounts were done between October to November. These accounts were moved to a doubtful account. Board members questioned some of the acronyms used and Johnson will further define commonly used acronyms at future meetings. MEDICAL ASSISTANCE MAXIMIZATION STUDY REPORT Open Minds shared the findings of the Medical Assistance Maximization Study Report. The following items were highlighted from the findings: St. Croix County Health and Human Services Board Page 7 January 20, 2010 • Move responsibility for documentation and coding compliance, quality and error management on claims to program department heads. • Centralize billing AR for all Department of Health and Human Services programs, including Public Health. • Establish a Prior Authorization (PA) and Re- Authorization (RA) process that insures completion of the authorizations and tract for compliance. • Institute a billing and collection risk management team to meet monthly to review billing and collection issues, develop policy and practice, and increase efficiencies. The report outlined several items that can be addressed, but the above noted items are likely to be priorities. Work on these items will be fine tuned as the medical records and financial departments develop action plans for 2010 operations. Johnson further reported that the report focused more on operational efficiencies and did not find areas where we were losing Medical Assistance dollars. NURSING HOME ADMINISTRATOR'S REPORT Robinson said the Nursing Home is heading in the right direction as a facility. He said the following information reinforces that the Nursing Home will get off the levy. Robinson said the average monthly census for November was 67, with 10 Medicare, 37 Medicaid, 19 private pay and 1 Family Care resident. The budget was built on a census of 6 Medicare residents. The Medicare revenue was above budget by $51,120. He also pointed out that documentation has improved and we are getting credit for the work being done. The average Medicare rate was $426 when the budget was created and now with the documentation improvement and the acuity level of the residents we are admitting, the average daily rate is $479. Robinson distributed a revenue sheet showing Medicare A and B revenue received for therapies. Sundance is the Nursing Home's therapy provider. As resident acuity level increases, more therapy is provided to residents. Robinson said the contract with Sundance was revised to be based on minutes seen versus the number of residents they see, which is done with most other facilities. Be said there is a contracted therapist available seven days a week, which is a huge benefit to the Nursing Home and residents. Robinson explained the therapy department performance which financially contributes to the Nursing Home. He said the amount contributed in the last quarter of 2009 has increased dramatically from the first three quarters, which benefits the Nursing Home. Peterson recommended sharing information regarding the Nursing Home with the Finance Committee so they can see that tangible steps are being taken to get the Nursing Home off the levy. It was the consensus this should be done in March after the year end figures are completed. Robinson distributed the new Nursing Home brochure that has been sent to area hospitals along with personal phone calls placed to discharge planners as follow up. Robinson reiterated that therapy is available seven days a week. He said Sundance does a limited amount of outpatient therapy due to no outdoor entrance directly to the therapy unit. Robinson said with the higher acuity of residents, staffing levels needed to be adjusted to meet care needs and detailed staffing changes made. The increased positions have been trialed for two months and Robinson would like permission to post the positions. Johnson said he is willing to work with Finance and Human Resources to adjust staffing. It is possible staffing levels may need to be adjusted again as residents with higher acuity levels St. Croix County Health and Human Services Board Page 8 January 20, 2010 are admitted. Whiting indicated the union may also have a role with staffing adjustments. Motion A motion was introduced by Berenschot, seconded by Larson and unanimously adopted: That the Board supports proceeding with changing the budget paradigm to allow Johnson and Robinson to make changes in staffing levels as it meets resident needs. Rasmussen complimented Robinson on listening to staff regarding staffing needs. It was the consensus of the Board that Johnson and Robinson need the tools to get the job done. Waskul thanked Robinson as the extra staffing was needed. Robinson reported on the furniture that was ordered after it was approved at the last meeting. Robinson has been working with Art Tobin and Dave Simmons regarding some room renovation. It was decided to table any action on this until more detail from the facility assessment is completed which is part of the Phase II report of the Long Range Planning Study. Staff have been doing some touch up in the rooms and painting some walls but will not do a full renovation at this time. The new bus for the Nursing Home has been delivered. A news release regarding the bus was published in the New Richmond News. Berenschot suggested sharing the news release with all of the papers in the County. Robinson distributed an updated brochure regarding the Nursing Home. This brochure has been shared with local discharge planners. Robinson reported an article regarding the Nursing Home was featured in the SCAN paper, which is distributed by ADRC. Robinson highlighted some areas of the Centers for Medicare & Medicaid Services (CMS) report. This is a nursing home rating system. St. Croix Health Center received the highest rating on overall quality, which is five stars. H1N1 UPDATE Kramer reported H1N1 activity is low throughout Wisconsin; however, three additional H1N1 related deaths were reported in January in Wisconsin. She reported approximately 5,500 doses of H1N1 have been administered by St. Croix County. She said there have also been sporadic seasonal influenza cases identified throughout the state. Kramer reported there is now an ample supply of H1N1 for everyone to get vaccinated. She outlined the school and community clinics that have been planned and one community clinic that will be held in Hudson on January 23 rd . ST. CROIX INDUSTRIES PATHWAYS GRANT APPLICATION Schroeder said there are incentives to place more client workers in community jobs. Staff are in the process of applying for a $30,000 grant through Pathways that will be effective 04/01/10 through 12/31/10 to make this happen. He said job coaches will be hired and work until the end of the grant monies. It is his intention to reapply for the grant in 2011. Motion A motion was introduced by Peterson, seconded by Grant, and unanimously adopted: That the Board approves St. Croix Industries making application for the monies available through the Pathways grant. St. Croix County Health and Human Services Board Page 9 January 20, 2010 Schroeder said community based work is good for client workers and in the future there will be less emphasis on sheltered workshops and more on community -based work. He said the costs are higher on the front -end to move client workers into a community job. The Board recessed from 9:50 - 10:03 AM. UPDATE REGARDING SPRING VALLEY HEALTH CARE CAMPUS PROJECT Robinson and Johnson visited Kevin Larson of the Spring Valley Health Care campus on 01/19/10. There are two phases of the Spring Valley project. Phase I is a 20- bed assisted living apartment complex, which is currently under construction. It is approximately a $3 million project with $2 million coming from a Federal tax credit program and another $1 million from a Bremer Bank loan. Four apartments will be available at market value and the balance will be for person at the 40- 60 -80% of median income. The assisted living should be ready to go this summer. Application will be made for the accelerated Medicaid rate from the state to build a new 50 -bed nursing home. The nursing home will consist of two 25 -bed houses in a triangle with a main street approach. Phase II for the nursing home is anticipated to start this summer. Spring Valley donated the land for the new assisted living and nursing home and the land at the current structure will go back to the city when the new facilities are operational. Marzolf said the Nursing Home needs to find a niche and suggested a day care incorporated in the Nursing Home with joint programming. Johnson said diversification of revenue will be pursued and is part of the nursing home strategic plan. The results of Phase II of the Building Ad Hoc study needs to be completed before diversification of revenue proceeds beyond the rehab unit. Berenschot said Dunn County is building an assisting living and nursing home facility also. Robinson has met with the administrator from Dunn County. Dunn County is following a different concept than Spring Valley. Dunn County nursing home was cited with a life safety issue, which is forcing them to look at a new nursing home and assisted living facility. Robinson reported Dave Simmons did a walk through of St. Croix Health Center Nursing Home last week with an architect and engineer. Robinson did not get any preliminary findings, the results are pending and he will receive more detail soon. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson reported Deb Willink resigned from the YCSS unit effective 02/05/10. This position was filled with an internal posting by Sarah Van Driel, which left an opening in juvenile supervision. After review of these positions with the department manager, staff will plan to move forward in filling this position. In part, filling this juvenile supervision position will help support continuation of the good work being done to keep youth from entering out of home placement, implement evidence based work, and support the development of juvenile treatment court. Johnson reported Dr. Pat Spoentgen submitted a letter of retirement as a Behavioral Health Therapist. She sees between 80 to 90 consumers and it is necessary to fill her position. Also, Johnson reported Lisa Waalen posted into the Medical Records position, which then resulted in a vacated Economic Support worker position. This position has been posted with the union and will be filled given the increase St. Croix County Health and Human Services Board Page 10 January 20, 2010 in caseloads. Rachel Johnson has moved into a Family and Children's Social Work position and Anne Powers has posted into the Family and Children's parent aid position. 2010 ROUTINE MEETING DATES A schedule has been developed through April, 2010. The revised By -laws were passed at County Board yesterday and meeting schedules will be addressed at the County Board meeting in March. The meeting schedule after April will be tentative until further notice. POSSIBLE AGENDA ITEMS FOR NEXT MEETING Rasmussen suggested evaluating how ADRC is working and if CHP is meeting clients' and the county's needs. It was also suggested evaluating if group homes are providing clients what they are paid for. Wentz said the Director's evaluation would be done next month. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 10:50 AM Chair: Attest: (Secretary) Larson will review vouchers. Revised 01/15/2010 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: January 20, 2010 at 8:30 LOCATION: (Board Room, St. Croix County DHHS Building, 1445 N. Fourth Street, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 12/16/09 DATE OF NEXT MEETING — 02/17/10 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. Review Department summary document for claims and vouchers 3. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report 4. Medical Assistance Maximization Study Report 5. Nursing Home Administrator's Report 6. Update regarding Spring Valley Health Care Campus project 7. Personnel Issues a. New employees /vacancies 8. H 1N 1 update 9. St. Croix Industries Pathways grant application 10. 2010 Routine Meeting Dates 11. Possible agenda items for next meeting 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. 1/19/2010 7:58 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD January 20, 2010 The St. Croix County Health and Human Services Board met on January 20, 2010 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 Dr. Lisa Ramsay Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Frank Robinson, Nursing Home Administrator Wendy Kramer, Public Health Officer /Public Health Coordinator Tammy Wilson, HIS Supervisor Kim Dupre, Information Systems Analyst Clark Schroeder, St. Croix Industries Director Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Roger Rebholz, County Board Chair Loyla Waskul Chair Wentz called the meeting 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 Wednesday, February 17, 2010 at 8:30 AM. Rasmussen will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the agenda be approved MINUTES Motion A motion was introduced by Peterson, seconded by Larson, and unanimously adopted: That the minutes of the 12/16/09 Health and Human Services Board meeting be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Larson reviewed the vouchers. Motion A motion was introduced by Larson, seconded by Marzolf, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services and Department on Aging vouchers 163578 through 163615, dated December 16, 2009 in the amount of $64,234.39. Human Services vouchers 163717 through 163718, dated December 16, 2009 in the amount of $12,930.00. St. Croix County Health and Human Services Board Page 2 January 20, 2010 Human Services vouchers 164851 through 164852, dated January 06, 2010 in the amount of $364.00. Human Services vouchers 165125 through 165165, dated January 06, 2010 in the amount of $41,338.47. Human Services vouchers 165997 through 165999, dated January 06, 2010 in the amount of $13,719.60. Human Services, Nursing Home, St. Croix Industries, and Government Center vouchers 163616 through 163716, dated December 16, 2009 in the amount of $120,795.30. Human Services, Nursing Home, Government Center and St. Croix Industries vouchers 163994 through 164051, dated December 22, 2009 in the amount of $73,201.18. ADRC and Department on Aging vouchers 164052 through 164069, dated December 22, 2009, in the amount of $18,097.46. ADRC and Department on Aging vouchers 164121 through 164132, dated December 29, 2009, in the amount of $2,986.61. Human Services, Nursing Home, St. Croix Industries, Government Center, Department on Aging, and ADRC vouchers 164133 through 164225, dated December 29, 2009 in the amount of $1,865,213.78. Department on Aging and ADRC, vouchers 164233 through 164235, dated December 29, 2009 in the amount of $1,634.56. Human Services, Department on Aging, and ADRC, vouchers 164853 through 164881, dated January 06, 2010 in the amount of $11,443.72. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 164882 through 164966, dated January 06, 2010 in the amount of $76,639.11. Nursing Home voucher 163985, dated December 16, 2009 in the amount of $53,022.50. Nursing Home and Government Center vouchers 164967 through 164992, dated January 06, 2010 in the amount of $9,701.58. Human Services, Nursing Home, and St. Croix Industries vouchers 164993 through 165124, dated January 06, 2010 in the amount of $47,417.93. Human Services and Nursing Home vouchers 166000 through 166013, dated January 06, 2010 in the amount of $16,238.55. Human Services, Department on Aging, and ADRC, vouchers 165828 through 165914, dated January 06, 2010 in the amount of $20,999.19. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 165915 through 165996, dated January 06, 2010 in the amount of $168,801.14. St. Croix County Health and Human Services Board Page 3 January 20, 2010 Human Services, Workshop, Public Health, Social Services vouchers 724 through 752, dated December 23, 2009 in the amount of $407,962.73. Human Services and Nursing Home vouchers 669 through 693, dated December 23, 2009 in the amount of $159,003.69. Workshop vouchers 152 through 157, dated December 23, 2009 in the amount of $13,613.18. Human Services, Workshop, Public Health, Social Services vouchers 1 through 31, dated January 07, 2010 in the amount of $414,422.42. Human Services and Nursing Home vouchers 1 through 28, dated January 07, 2010 in the amount of $180,107.51. Workshop vouchers 1 through 6, dated January 07, 2010 in the amount of $12,972.54. Human Services, Workshop, Public Health, Social Services vouchers 32 through 37, dated January 14, 2010 in the amount of $5,709.79. Human Services and Nursing Home vouchers 29 through 35, dated January 11, 2010 in the amount of $25,675.85. REVIEW DEPARTMENT SUMMARY DOCUMENT FOR CLAIMS AND VOUCHERS Wentz announced the per diem sheet will go into affect after the April election. Johnson reviewed the new summary document for claims and vouchers that was created to clarify reading the summary report. Johnson said the document tracks with budget summary documents also. FINANCIAL REPORT The following financial report for Health and Human Services through November, 2009 was distributed. Pempek reported the take back from the state will show up on the December report in an adjustment to the Long Term Support revenue line. She said the County obligation for Long Term Support has been paid. Next year the County obligation for Long Term Support will show up in the ADRC budget. St. Croix County Health and Human Services Board Page 4 January 20, 2010 HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget November 30, 2009 Balance % Administration (282,648.48) 909,960.43 (1,192,608.91) - 321.9% AODA Services 755,822.52 724,916.02 30,906.50 95.9% Long Term Support 2,631,098.96 3,663,263.57 (1,032,164.61) 139.2% Mental Health 3,445,706.61 2,640,295.98 605,410.63 62.4% Family & Children's 2,908,835.69 2,523,911.87 384,923.82 86. Public Health 2,103,809.13 1,950,190.24 153,618.89 92.7% Economic Support 1,140,696.47 1,034,206.20 106,490.27 90.7% General Relief 0.00 0.00 0.00 0.0% Coordinated Services/SED 3,106,279.19 1,264,142.45 1,842,136.74 40.7% ARDC 632,000.00 422.075.00 209,925.00 66.8% Department on Aging 846,623.00 760,510.00 86,113.00 89.6% Carryover Funds 1,312,360.00 1,202,996.74 109,363.26 91.7% REVENUES HUMAN SERVICES PROGRAMS 16,600,563.09 17,296,468.50 1,304,114.59 93.0% SUMMARY Total OF EXPENDITURES Budget November 30, 2009 Balance % Administration 1.029,711.52 920,357.27 109,354.25 89.4% Alcohol -Drug Abuse 755,822.52 650,216.71 105,605.81 86.0% Long Term Support 2.631,098.96 2,150,976.88 460,122.06 81.8% Mental Health 3,445,706.61 3,030,767.38 414,939.23 88.0% Family BChildren's 2,908,835.69 2,511,095.73 397,739.96 86.3% Public Health 2,103,809.13 1,663,743.26 420,065.87 80.0% Economic Support 1,140,696.47 1.060,704.20 79,992.27 93.0% General Relief 0.00 29.59 (29.59) D.0% Coordinated Service /SED 3,1 06,279.19 2.111,811.61 994,467.58 68.0 %. ARDC 632,000.00 439,956.87 192,043.13 69.6% Department on Aging 846,623.00 600,246.73 246,376.27 70.9% EXPENDITURES HUMAN SERVICES PROGRAMS 18,600,583.09 15,159.906.23 3,440,676.86 81.5% Total # 2A W562.27 The following financial report for St. Croix Industries through November was distributed. Johnson reported St. Croix Industries will prepay the worker's compensation account in December. This will apply to St. Croix Industries only. St. Croix County Health and Human Services Board Page 5 January 20, 2010 St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget November 30, 2009 Balance % INS Operations 1,342,664.56 1,309,808.99 32,855.57 97.6% INS Production 422,286.64 278,344.08 143,942.76 65.9/ WS Helping Hands 71,726.26 99,013.59 (27,287.33) 138.0'° WS Pop/Vending 7,250.00 9,453.15 (2,203.15) 130.4% WS Ram 77,443.00 27,745.05 49,697.95 35.8° WS Vocational Placement 371,831.60 313,371.73 58,459.87 84.3'°. WS Comm Based Day Prog 183,214.95 143,756.75 39,458.20 78.5' REVENUES 2,476,417.21 2,181,493.34 294,923.87 88.1'% SUMMARY Total OF EXPENDITURES Budget November 30, 2009 Balance % WS Operations 1,342,664.56 1,131,245.61 211,418.95 84.3% WS Production 422,286.84 287,775.09 134.51115 60.1% WS Helping Hands 71,726.26 66,442.65 5,283.61 92.6% WS Pop/Vending 7,250.00 5,551.77 1,698.23 76.6% INS Ram 77,443.00 20,542.28 56,900.72 26.5° WS Vocational Placement 371,831.60 286,787.78 85,04332 77.1 WS Comm Based Day Prog 183,214.95 160,604.66 22,610.29 87.7% EXPENDITURES 2,476,417.21 1,958,949.84 517,467.37 79.1% Total x 222.543.50 The following financial report for the Nursing Home through November, 2009 was distributed. Robinson reported the Nursing Home is over approximately $176,000 in revenue in November mostly due to additional Medicare residents. He also reported the Nursing Home is under approximately $303,000 in expenditures due to lower overtime use, lower pool staff use and staffing being managed on a daily basis. Wentz commended Robinson and the staff for their efforts. St. Croix County Health and Human Services Board Page 6 January 20, 2010 St. Croix Health Center November 2009 Budget Actual Difference Percentag4 Census 0 Operating Revenue: Medicare $903,252.00 $1,104,230.04 - $200,97B.04 122.25% Medicaid $2,481,432.00 $2,083,126.28 $39B,305.72 83.95% Private Pay $760,413.00 $B36,949.68 - $78,536.68 110.33% Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGTfSupplemental Funds $445,448.00 $348,738.00 $96,710.00 76.29% All Other Sources $216,041.00 $214,308.07 $1,732.93 99.20% Total Operating Revenue $4,818,586.00 $4,589,352.07 $229.233.93 95.24% Operating Expenses Daily Patient Services $3,397,317.36 $3,054,676.64 $342,640.72 69.91% Special Services $284,262.00 $236,202.82 $48,059.18 83.09% General Services $1,148,672.04 $988,263.60 $160,408.24 86.04% Administrative Services $628,277.68 $660,864.66 - $32,586.98 105.19% Unassigned: Depreciation (% Based) $0.00 Others: $498,371.00 $217,210.25 $281,160.75 43.58% Utilities $202,0B0.00 $92,712.33 Workers Comp, Computer Tech $228,848.00 $33,840.92 Insurance $67,443.00 $90,657.00 Total Operating Expenses $5,956,900.08 $5,157,218.17 $799.681.91 86.58% Net From Operations ($567,866.10) (Cost of doing business prior to applying levy .& outstanding rev) County Revenues Co Allocations (% Based) $947,314.08 $868,371.24 $78,942.84 91.67% Nursing Home Carry Over $191,000.00 $1763437 $15,916.63. 91.67% Total Outstanding $1,138,314.08 $1,043,454.61 $94,859.47 Net from all Sources $475.588.51 AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through November was reviewed. Pempek reported write offs of accounts were done between October to November. These accounts were moved to a doubtful account. Board members questioned some of the acronyms used and Johnson will further define commonly used acronyms at future meetings. MEDICAL ASSISTANCE MAXIMIZATION STUDY REPORT Open Minds shared the findings of the Medical Assistance Maximization Study Report. The following items were highlighted from the findings: St. Croix County Health and Human Services Board Page 7 January 20, 2010 • Move responsibility for documentation and coding compliance, quality and error management on claims to program department heads. • Centralize billing AR for all Department of Health and Human Services programs, including Public Health. • Establish a Prior Authorization (PA) and Re- Authorization (RA) process that insures completion of the authorizations and tract for compliance. • Institute a billing and collection risk management team to meet monthly to review billing and collection issues, develop policy and practice, and increase efficiencies. The report outlined several items that can be addressed, but the above noted items are likely to be priorities. Work on these items will be fine tuned as the medical records and financial departments develop action plans for 2010 operations. Johnson further reported that the report focused more on operational efficiencies and did not find areas where we were losing Medical Assistance dollars. NURSING HOME ADMINISTRATOR'S REPORT Robinson said the Nursing Home is heading in the right direction as a facility. He said the following information reinforces that the Nursing Home will get off the levy. Robinson said the average monthly census for November was 67, with 10 Medicare, 37 Medicaid, 19 private pay and 1 Family Care resident. The budget was built on a census of 6 Medicare residents. The Medicare revenue was above budget by $51,120. He also pointed out that documentation has improved and we are getting credit for the work being done. The average Medicare rate was $426 when the budget was created and now with the documentation improvement and the acuity level of the residents we are admitting, the average daily rate is $479. Robinson distributed a revenue sheet showing Medicare A and B revenue received for therapies. Sundance is the Nursing Home's therapy provider. As resident acuity level increases, more therapy is provided to residents. Robinson said the contract with Sundance was revised to be based on minutes seen versus the number of residents they see, which is done with most other facilities. Be said there is a contracted therapist available seven days a week, which is a huge benefit to the Nursing Home and residents. Robinson explained the therapy department performance which financially contributes to the Nursing Home. He said the amount contributed in the last quarter of 2009 has increased dramatically from the first three quarters, which benefits the Nursing Home. Peterson recommended sharing information regarding the Nursing Home with the Finance Committee so they can see that tangible steps are being taken to get the Nursing Home off the levy. It was the consensus this should be done in March after the year end figures are completed. Robinson distributed the new Nursing Home brochure that has been sent to area hospitals along with personal phone calls placed to discharge planners as follow up. Robinson reiterated that therapy is available seven days a week. He said Sundance does a limited amount of outpatient therapy due to no outdoor entrance directly to the therapy unit. Robinson said with the higher acuity of residents, staffing levels needed to be adjusted to meet care needs and detailed staffing changes made. The increased positions have been trialed for two months and Robinson would like permission to post the positions. Johnson said he is willing to work with Finance and Human Resources to adjust staffing. It is possible staffing levels may need to be adjusted again as residents with higher acuity levels St. Croix County Health and Human Services Board Page 8 January 20, 2010 are admitted. Whiting indicated the union may also have a role with staffing adjustments. Motion A motion was introduced by Berenschot, seconded by Larson and unanimously adopted: That the Board supports proceeding with changing the budget paradigm to allow Johnson and Robinson to make changes in staffing levels as it meets resident needs. Rasmussen complimented Robinson on listening to staff regarding staffing needs. It was the consensus of the Board that Johnson and Robinson need the tools to get the job done. Waskul thanked Robinson as the extra staffing was needed. Robinson reported on the furniture that was ordered after it was approved at the last meeting. Robinson has been working with Art Tobin and Dave Simmons regarding some room renovation. It was decided to table any action on this until more detail from the facility assessment is completed which is part of the Phase II report of the Long Range Planning Study. Staff have been doing some touch up in the rooms and painting some walls but will not do a full renovation at this time. The new bus for the Nursing Home has been delivered. A news release regarding the bus was published in the New Richmond News. Berenschot suggested sharing the news release with all of the papers in the County. Robinson distributed an updated brochure regarding the Nursing Home. This brochure has been shared with local discharge planners. Robinson reported an article regarding the Nursing Home was featured in the SCAN paper, which is distributed by ADRC. Robinson highlighted some areas of the Centers for Medicare & Medicaid Services (CMS) report. This is a nursing home rating system. St. Croix Health Center received the highest rating on overall quality, which is five stars. H1N1 UPDATE Kramer reported H1N1 activity is low throughout Wisconsin; however, three additional H1N1 related deaths were reported in January in Wisconsin. She reported approximately 5,500 doses of H1N1 have been administered by St. Croix County. She said there have also been sporadic seasonal influenza cases identified throughout the state. Kramer reported there is now an ample supply of H1N1 for everyone to get vaccinated. She outlined the school and community clinics that have been planned and one community clinic that will be held in Hudson on January 23 rd . ST. CROIX INDUSTRIES PATHWAYS GRANT APPLICATION Schroeder said there are incentives to place more client workers in community jobs. Staff are in the process of applying for a $30,000 grant through Pathways that will be effective 04/01/10 through 12/31/10 to make this happen. He said job coaches will be hired and work until the end of the grant monies. It is his intention to reapply for the grant in 2011. Motion A motion was introduced by Peterson, seconded by Grant, and unanimously adopted: That the Board approves St. Croix Industries making application for the monies available through the Pathways grant. St. Croix County Health and Human Services Board Page 9 January 20, 2010 Schroeder said community based work is good for client workers and in the future there will be less emphasis on sheltered workshops and more on community -based work. He said the costs are higher on the front -end to move client workers into a community job. The Board recessed from 9:50 - 10:03 AM. UPDATE REGARDING SPRING VALLEY HEALTH CARE CAMPUS PROJECT Robinson and Johnson visited Kevin Larson of the Spring Valley Health Care campus on 01/19/10. There are two phases of the Spring Valley project. Phase I is a 20- bed assisted living apartment complex, which is currently under construction. It is approximately a $3 million project with $2 million coming from a Federal tax credit program and another $1 million from a Bremer Bank loan. Four apartments will be available at market value and the balance will be for person at the 40- 60 -80% of median income. The assisted living should be ready to go this summer. Application will be made for the accelerated Medicaid rate from the state to build a new 50 -bed nursing home. The nursing home will consist of two 25 -bed houses in a triangle with a main street approach. Phase II for the nursing home is anticipated to start this summer. Spring Valley donated the land for the new assisted living and nursing home and the land at the current structure will go back to the city when the new facilities are operational. Marzolf said the Nursing Home needs to find a niche and suggested a day care incorporated in the Nursing Home with joint programming. Johnson said diversification of revenue will be pursued and is part of the nursing home strategic plan. The results of Phase II of the Building Ad Hoc study needs to be completed before diversification of revenue proceeds beyond the rehab unit. Berenschot said Dunn County is building an assisting living and nursing home facility also. Robinson has met with the administrator from Dunn County. Dunn County is following a different concept than Spring Valley. Dunn County nursing home was cited with a life safety issue, which is forcing them to look at a new nursing home and assisted living facility. Robinson reported Dave Simmons did a walk through of St. Croix Health Center Nursing Home last week with an architect and engineer. Robinson did not get any preliminary findings, the results are pending and he will receive more detail soon. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson reported Deb Willink resigned from the YCSS unit effective 02/05/10. This position was filled with an internal posting by Sarah Van Driel, which left an opening in juvenile supervision. After review of these positions with the department manager, staff will plan to move forward in filling this position. In part, filling this juvenile supervision position will help support continuation of the good work being done to keep youth from entering out of home placement, implement evidence based work, and support the development of juvenile treatment court. Johnson reported Dr. Pat Spoentgen submitted a letter of retirement as a Behavioral Health Therapist. She sees between 80 to 90 consumers and it is necessary to fill her position. Also, Johnson reported Lisa Waalen posted into the Medical Records position, which then resulted in a vacated Economic Support worker position. This position has been posted with the union and will be filled given the increase St. Croix County Health and Human Services Board Page 10 January 20, 2010 in caseloads. Rachel Johnson has moved into a Family and Children's Social Work position and Anne Powers has posted into the Family and Children's parent aid position. 2010 ROUTINE MEETING DATES A schedule has been developed through April, 2010. The revised By -laws were passed at County Board yesterday and meeting schedules will be addressed at the County Board meeting in March. The meeting schedule after April will be tentative until further notice. POSSIBLE AGENDA ITEMS FOR NEXT MEETING Rasmussen suggested evaluating how ADRC is working and if CHP is meeting clients' and the county's needs. It was also suggested evaluating if group homes are providing clients what they are paid for. Wentz said the Director's evaluation would be done next month. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 10:50 AM Chair: Attest: (Secretary)