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HomeMy WebLinkAboutHealth & Human Services 11-17-10 - Larson will review vouchers. Revised 11/15/10 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: November 17, 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 - 10/20/10 DATE OF NEXT MEETING — 12/15/10 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. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report 3. Updated business plan report from LarsonAllen for St. Croix Health Center ** 4. Health Center Budget adjustments for $320,813 reduction in revenue 5. Rate increase for Nursing Home Private Pay to eliminate subsidy 6. Health and Human Services Budget adjustment for $100,000 increase in revenue 7. 2011 Budget summary updates 8. Nursing Home Administrator's Report 9. Personnel Issues a. New employees /vacancies 10. Health and Human Services Bylaws 11. Substance Abuse Committee structure 12. Resolution regarding the anticipated decreased utilization of prevocational services 13. Fiscal impact calculation on St. Croix Industries for anticipated decrease in utilization of services 14. Community Health Improvement Process planning update 15. Reproductive Health program report 16. Possible agenda items for next meeting NOTE: A quorum of the St. Croix County Board of Supervisors (County Board) may be present at this meeting. Therefore, this notice also serves as notice of a meeting of the County Board for the purpose of obtaining information relating to subjects listed above for use at future County Board meetings. 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. 11/15/2010 7:50 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD November 17, 2010 The St. Croix County Health and Human Services Board met on November 17, 2010 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Frederick Horne Roger Larson Linda Luckey Richard Marzolf Dr. Lisa Ramsay Deb Rasmussen Alfred Schrank (arrived at 9:50) STAFF PRESENT: Fred Johnson, Health and Human Services Director Frank Robinson, Nursing Home Administrator Tonya Kusmirek, Financial Manager Wendy Kramer, Public Health Officer/Public Health Coordinator Jaye Hay, Public Health RN, Reproductive Health Clark Schroeder, Director, St. Croix Industries Malva Sirek, Secretary OTHERS PRESENT: Michelle Pietrick, Finance Director Tammy Funk, Human Resource Coordinator Chuck Whiting, Administrative Coordinator Kim Dupre, Information Systems Analyst Sharon Norton - Bauman, County Board Member Jeff Holmquist, New Richmond News Thor Backus, AFSCME Shaela Leibfried Brady Benedict Julie Benedict Norm Matzek Dave Ostness 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, December 15, 2010 at 8:30 AM. Marzolf will review vouchers. St. Croix County Health and Human Services Board Page 2 November 17, 2010 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 Larson, seconded by Berenschot, and unanimously adopted: That the minutes of the 10/20/10 Health and Human Services Board meetings be approved as distributed CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Larson reviewed the vouchers. There may be a change on how vouchers are handled and reviewed in the future. Currently, Pietrick e -mails registers weekly to members of the Administration Committee so that questions can be answered weekly versus monthly. When the scanner is installed, this will be done on an electronic basis. This process has gone well with the Administration Committee and will be a 2011 process for Health and Human Services Board members. Motion A motion was introduced by Larson, seconded by Rasmussen, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 183476 through 183477, dated October 13, 2010 in the amount of $7,990.00. Human Services, Nursing Home, St. Croix Industries, and ADRC vouchers 183752 through 183824, dated October 20, 2010 in the amount of $108,637.45. Department of Aging and ADRC vouchers 183825 through 183851, dated October 20, 2010 in the amount of $16,051.46. Department of Aging and ADRC vouchers 184077 through 184087, dated October 27, 2010 in the amount of $3,681.21. Human Services, Nursing Home, and St. Croix Industries vouchers 184088 through 184160, dated October 27, 2010 in the amount of $40,137.81. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 184250 through 184343, dated November 03, 2010, in the amount of $74,461.39. Human Services vouchers 184468 through 184507, dated November 08, 2010 in the amount of $32,684.12. Human Services voucher 184508, dated November 08, 2010 in the amount of $686.50. Human Services voucher 184962, dated November 10, 2010 in the amount of $7,812.00. St. Croix County Health and Human Services Board Page 3 November 17, 2010 Nursing Home vouchers 184963 through 184996, dated November 10, 2010, in the amount of $56,461.69. Human Services, Nursing Home, St. Croix Industries, Government Center, Department of Aging, and ADRC vouchers 184997 through 185166, dated November 10, 2010 in the amount of $128,693.05. Human Services, Nursing Home, and St. Croix Industries, vouchers 184900 through 184961, dated November 10, 2010 in the amount of $6,281.23. FINANCIAL REPORTS The following financial report for Health and Human Services through September, 2010 was distributed. Kusmirek said staff are going through the financial reports step - by -step and basically recreating the reports from January, 2010 as issues are resolved. This has been very time consuming. There are Department of Health and Human Services (DHHS) monies in the transit account that have not been distributed. Revenues need to be reviewed before transferring these monies to the appropriate accounts. Kusmirek indicated it may also take an additional two to three months to complete expenditure reconciliation back to the first of the year. She said State level reports also need to be reconciled and the finance staff are working to assure we have appropriate documentation to reconcile monthly. A team from LarsonAllen is scheduled to come in to assist in this process the week of November 29 The issues lie mainly with HHS fund 225. Kusmirek indicated ADRC and Aging are now up to date and the focus is now on other departments. I St. Croix County Health and Human Services Board Page 4 November 17, 2010 Health & Human Services - Fund 225 September 2010 Annual September Budget % of Revenue by Service Budget Actuals Balance Budget Administration $ 187,070 $ (735,425) $ 922,495 -393.1% AODA Services 768,662 494,893 273,769 64.4% Mental Health 3,702,935 2,810,174 892,761 75.9% Family & Children's 3,188,401 2,378,557 809,844 74.6% Public Health 2,035,641 1,713,686 321,955 84.2% Economic Support 1,020,270 821,210 199,060 80.5% General Relief 3,000 1,125 1,875 37.5% Coordinated Services /SED 2,802,917 1,939,567 863,350 69.2% Carryover Funds 1,049,211 786,908 262,303 75.0% Service Revenue $ 14,758,107 $ 10,210,696 $ 4,547,411 69.2% Annual September Budget % of Expenditure by Service Budget Actuals Balance Budget Administration $ 1,236,281 $ 925,906 $ 310,375 74.9% Alcohol -Drug Abuse 768,662 581,344 187,318 75.6% Mental Health 3,702,935 2,488,080 1,214,855 67.2% Family & Children's 3,188,401 1,914,973 1,273,428 60.1% Public Health 2,035,641 1,510,579 525,062 74.2% Economic Support 1,020,270 879,723 140,547 86.2% General Relief 3,000 - 3,000 0.0% Coordinated Service /SED 2,802,917 1,969,736 833,181 70.3% Service Expenditures $ 14,758,107 $ 10,270,341 $ 4,487,766 69.6% Revenues Over (Under) Expenditures $ ( 59,645) The following financial report for St. Croix Industries through September, 2010 was distributed. St. Croix Industries is doing well. Some portion of the money in the transit account belongs to St. Croix Industries. Transit monies are not reflected on the financial reports. Kusmirek hopes to have the reports finalized by the end of December. LarsonAllen will do pre -audit work when they are here on 11/29. The assistance from LarsonAllen is considered part of the overall 2010 audit. St. Croix County Health and Human Services Board Page 5 November 17, 2010 St. Croix Industries - Fund 625 September 2070 Annual September Budget % of Revenues Budget Actuals Balance Budget WS Operations $ 1,375,209 $ 1,201,474 $ 173,735 87.4% WS Production 306,513 284,177 22,336 92.7% WS Helping Hands 86,500 92,615 (6,115) 107.1% WS PopNending 6,300 9,983 (3,683) 158.5% WS Ram 3,350 5,155 (1,805) 153.9% WS Vocational Placement 341,488 291,686 49,802 85.4% WS Comm Based Day Prog 197,730 92,731 104,999 46.9% Total Revenue $ 2,317,094 $1,977 $ 339,270 85.4% Annual September Budget % of Expenditures Budget Actuals Balance Budget WS Operations $ 1,375,209 $ 910,272 $ 464,937 66.2% WS Production 306,513 267,717 38,796 87.3% WS Helping Hands 86,500 68,727 17,773 79.5% WS PopNending 6,300 4,938 1,362 78.4% WS Ram 3,350 1,962 1,388 58.6% WS Vocational Placement 341,488 230,615 110,873 67.5% WS Comm Based Day Prog 197,730 109,539 88,191 55.4% Total Expenditures $ 2,317,090 $1,593,771 $ 723,319 68.8% Revenues Over (Under) Expenditures $ 384,049 The following financial report for the Nursing Home through September, 2010 was distributed. There are very little Nursing Home monies in the transit account. Kusmirek indicated the projection for year -end figures for the Nursing Home currently indicate it will be close to breakeven to approximately $2,000 loss after tax levy is applied, along with the insurance dividend revenue. St. Croix County Health and Human Services Board Page 6 November 17, 2010 St. Croix Health Center - Fund 600 September 2010 Operating Revenue: Budget Actuals Di ference of Budget Projections Medicare $ 2,223,908 $ 1,073,739 $ 1,150,169 48.3% $ 1,431,652 Medicaid 2,043,172 1,535,555 507,617 75.2% 2,047,406 Private Pay 975,919 1,094,318 (118,399) 112.1% 1,459,090 Revenue - IGTISupplemental Funds 469,000 501,170 (32,170) 106.9% 501,170 Out Patient Therapy 16,191 (16,191) 0.0% 21,191 All Other Sources 18,458 10,491 7,967 56.8% 13,844 Total Operating Revenue $ 5,730,457 $ 4,231,463 $ 1,498,994 73.8% $ 5,474,353 Operating Expenses Daily Patient Services $ 3,827,182 $ 2,951,738 $ 875,444 77.1% $ 3,935,651 Special Services 287,498 211,881 75,617 73.7% 282,508 General Services 1,239,492 886,839 352,653 71.5% 1,182,452 Administrative Services 610,305 456,760 153,545 748% 609,014 Sub Total $ 5,964,477 $ 4,507,218 $ 1.457,259 75.6% $ 6,009,625 Unassigned: Depreciation (% Based) Others: Utilities $ 208,461 $ 87,406 $ 121,055 41.9% $ 130,000 Workers Comp, Computer Tech 264,602 116,129 148,473 43.9% 115,000 Insurance 55,000 75,533 (20,533) 137.3% 75,533 Unassigned Sub Total $ 528,063 $ 279,067 $ 248,996 52.8% $ 320,533 Total Operating Expenses $ 6,492,540 $ 4,786,286 $ 1,706,255 73.7% $ 6,330,158 Revenues Over (Under Fxpenddures) from Operations $ ( 554,822) $ (855,805) County Revenues Insurance Dividend - unexpected revenue not result of Ope $ 9,160 $ 100,858 $ (91,698) 11011% $ 100,858 Co Allocations - Levy (% Based) 616,131 462,096 154,035 75.0% 616,131 Nursing Home Carry Over 136,792 102,594 34,198 75.0% 136,792 Total Outstanding $ 762,083 $ 665,548 $ 96,536 87.33% $ 853,781 Revenues Over (Under) Expenditures Including County Contributions $ 110,725 $ (2,024) AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through September was briefly reviewed. Kusmirek indicated the figures on the report are skewed due to monies being held in the transit account. She indicated it is possible the October statements will more accurately reflect financial position. Thor Backus, AFSCME Organizer, asked to address the Board. He questioned the following details: • The public voted via advisory referendum in 2008 to support the St. Croix Health Center even though it may take county levy dollars, and • A five -year business plan was created in July, 2009 to wean the Nursing Home off the levy. Wentz indicated these details are correct. Kusmirek and Pietrick will update and modify the financial reports. Kusmirek reviewed some changes with financial department personnel. Three financial assistants (FA) from New Richmond St. Croix County Health and Human Services Board Page 7 November 17, 2010 will move to Hudson, two by 12/06/10 and one later, and Kusmirek will spend part of her time in Hudson. This will allow for cross training and ensure financial processes are consistent between Hudson and New Richmond. The Account Receivables team will remain in New Richmond as they work directly with the clients. Johnson indicated there may be ripple effects to clients and the agency and meetings will be set up with managers to discuss financials. Wentz requested the Board be updated in the future on the changes in the financial department both in New Richmond and Hudson. UPDATED BUSINESS PLAN REPORT FROM LARSONALLEN FOR ST. CROIX HEALTH CENTER The updated plan is not available from LarsonAllen; however, some updates have been received from Trenton Fast. Johnson distributed a projection for 50 -bed nursing home with 30 -units for assisted living. Johnson said preliminary projections were reviewed and with additional adjustments, could get levy figures to zero. Some assumptions were updated for the projections such as supplemental payment revenue, increased private pay rates 25 %, increased insurance rates to 12% per year, zero county levy by 2015. Occupancy was figured at 93% on a 50 -bed facility. It is assumed the private pay occupancy will hold steady for 2011 and beyond. Johnson questioned the Board's desire to remain with a 72 -bed facility or go to 50 beds or less facility. Many different possible scenarios could be created, but direction is needed so staff can address the plan to get off the levy by 2015. If we are going to consider a 50 beds or less facility, we will also need to work to complete planning to see if the State would approve enhanced Medicaid rates for a smaller facility. A cost of approximately $150,000/bed has been used as an assumption if a new nursing facility is built. Marzolf requested seriously looking at a non - conventional solar, electric, geo- thermal heating and cooling system if a new facility is built which would mean higher up front costs with lower end costs. There are some state incentives in the application process for a facility that is 50 beds or less. Staff will review these projected expenses with LarsonAllen. Marzolf offered to contact Durand regarding the geo - thermal heating system they installed. The market study shows a need for 48 assisted living beds. The need in St. Croix County is for lower cost assisted living for lower income people. The range would be in the $2,500 range. Other HUD housing in New Richmond has a waiting list over a year long. An assisted living is a profit center and would help the nursing home with a better bottom line. The therapy piece is part of the assumption of the business plan being prepared by LarsonAllen and would be an income of $75,000 to $100,000 per year in partnering with Sundance. Home health is not part of the business plan and is not being explored due a loss for one to two years if home health services were implemented. Community Health Partners (CHP) will pay for assisted living. CHP previously provided home health care and last spring laid off 93 staff and withdrew from the home health market. Most of those staff are now private contractors. Robinson said the nursing home currently provides hospice care. Consensus of the Board was to bring back an updated cost projection for the current facility and a model of nursing home and assisted living that would get the Health Center off the levy. Johnson St. Croix County Health and Human Services Board Page 8 November 17, 2010 questioned if a joint meeting should be planned with the Ad Hoc Facility Planning Committee, Administration Committee or Committee of the Whole as the next step when the Board has a plan to recommend? Johnson also questioned if the issue of getting the facility off the levy included debt service. It was the consensus of the Board a joint meeting with Administration and Ad Hoc Facility Planning Committee should be planned when a viable plan is developed. Input will be given at the next HHS meeting to come to a consensus. Rasmussen questioned if the County Board supports the referendum passed for the Nursing Home. The Board recessed from 9:45 — 9:52 AM. HEALTH CENTER BUDGET ADJUSTMENTS FOR $320,813 REDUCTION IN REVENUE On October 26"' the County Board, on a 13 to 5 vote, reduced the Nursing Home's budgeted revenue by $320,813. This figure was determined by eliminating private pay subsidy in the 2011 budget as the actual costs of operations are higher than the private pay rate at this time. Of the $320,813 sum, $100,000 was re- allocated to each the Sheriff's Department, Highway, and Health and Human Services with the remaining $20,813 being placed in the county general fund. RATE INCREASE FOR NURSING HOME PRIVATE PAY TO ELIMINATE SUBSIDY Robinson surveyed private pay rates for local nursing homes again. The only home indicating an anticipated rate increase for 2011 in the second survey was Kinnic Home in River Falls. Survey results were shared with the Board. Private pay rates were increased November 1, 2010 to $185.38 and $200.38 for a private pay private room. To address the private pay subsidy, Robinson handed out a calculation worksheet that increased private pay rates to cover actual audited expenses for 2009. He said St. Croix Health Center would now have the highest private pay rate in the area. Robinson said the private pay census has been around 18 residents for the last year and a half. Motion A motion was introduced by Marzolf, seconded by Rasmussen, and unanimously adopted: That the Board approves the proposal to increase the Nursing Home private pay rates to $224.00 private room and $239.00 for private pay private room effective 01/01/2011. Robinson suggested looking at cost report data for the nursing home yearly to determine future private pay rates. The economy should also be considered along with the consumer price index (CPI). Kusmirek indicated cost reports are one year behind so the board may want to consider the audited expenses plus a percentage increase above the amount listed in the cost report. Private pay rates and the methodology to develop the rates will be reviewed again in mid -2011. Robinson indicated the Nursing Home is a 5 -star facility that offers good care. This rating information is shared at monthly resident council meetings and in family newsletters. NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census for September was 65, with 9 Medicare, 35 Medicaid, 18 private pay, 1 insurance and 1 Family St. Croix County Health and Human Services Board Page 9 November 17, 2010 Care resident. The Medicare average daily rate paid is $454.00 compared to the budgeted amount of $426.00, which reflects the high acuity residents being admitted. The Nursing Home has been discussing the possibility of starting a soup /salad bar for staff meals. It could be a profit center for the facility and is anticipated it will begin in mid - December. Motion A motion was introduced by Berenschot, seconded by Horne, and unanimously adopted: That the Board approves providing soup and salad bar for staff and families. HEALTH AND HUMAN SERVICES BUDGET ADJUSTMENT FOR $100,000 INCREASE IN REVENUE Johnson recommends putting the $100,000 in a holding account as a reserve for unanticipated expenses and not earmark the money for a specific program at this time. Horne questioned capital expenses that were cut as part of the budget process. Johnson indicated if there is an urgent need for capital expenses he can contact Wentz for approval. These funds will be invested as part of the pool of general county funds until needed. Motion A motion was introduced by Horne, seconded by Marzolf, and unanimously adopted: That the Board approves putting the $100,000 in a holding account until it is needed. 2011 BUDGET SUMMARY UPDATES Updated 2011 budget summary changes from August to November were distributed. The Nursing Home summary was not included and will be forwarded next month. PERSONNEL ISSUES NEW EMPLOYEESNACANCIES Johnson distributed a vacancy report for November. Four positions were reviewed. Nursing Home 30% LPN/RN: After answering questions posed by Human Resources to determine whether or not positions should be filled, Johnson recommended filling this position versus filling with on -call or pool staff. Robinson indicated the position would be posted as a LPN position and if no one fills the position, then the position would be filled with a RN according to union rules. AODA Counselor: Johnson answered questions posed by Human Resources to determine whether or not the position should be filled. Some items reported with this position is that the AODA client waiting list is currently at six weeks out and will continue to grow if the position is not filled; one less AODA group will be held; because of the extended wait list, clients with pay sources will seek treatment elsewhere; the agency will risk losing $60,000 State and $45,000 Department of Correction monies. Johnson recommends filling this position. He indicated in the past a direct mailing to recruit qualified staff for AODA Counselor openings has occurred to fill the position. Job Coach/Cleaning Supervisor: Johnson reported this is a 4 hour /day position. He recommends this union position be filled with temporary staff. Johnson does not recommend moving forward with this position and to keep it as a temporary position until future funding for St. Croix Industries can be determined. ACSS Program Aide: Johnson reported this is a 25/hour per week position. There are currently St. Croix County Health and Human Services Board Page 10 November 17, 2010 three other Program Aids who work part time. Each position has a benefit package that is prorated based on the number of hours they work. Johnson recommends reorganizing by eliminating this Program Aide position and increasing the hours of the other three Program Aide positions from 25 to 33 hours /week. There would be an approximately $1,500 savings due to consolidating positions. It was the consensus of the Board to approve reorganization and that this change does not need to go to the Administration Committee. Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the Board approves moving forward with the hiring process of the 30% LPN/RN Nursing Home position and AODA Counselor position to the Administration Committee and County Board. Johnson announced the retirement of Mary Rosauer, Program Aide, effective 12/02/10, and the retirement of Sue Knutson, AODA Counselor, effective 01/03/11. HEALTH AND HUMAN SERVICES BYLAWS Revised Bylaws were distributed to members. Luckey questioned the statement under Article 11, Section A. Membership regarding members being appointed as members are now elected by the County Board. Johnson will review with Greg Timmerman and bring revised Bylaws back to the Board next month. Motion A motion was introduced by Berenschot, seconded by Rasmussen, to approve the Bylaws. Rasmussen and Berenschot withdrew the second and motion until further revisions to the Bylaws are investigated. SUBSTANCE ABUSE COMMMEE STRUCTURE County Board committees were restructured due to the reduction in size of the County Board. Previously the Substance Abuse Committee membership had three County Board supervisors and 13 non - voting ex officio members. The Committee was then designated a subcommittee of the Health and Human Services Board and renamed Substance Abuse Subcommittee and membership included three County Board supervisors and 14 representatives from various County departments and other organizations. A quorum of nine members is needed to conduct a meeting. Because it is difficult to get a quorum of nine members, the Subcommittee recommends membership be restructured so that three County Board members be the voting group and non - member representatives from County departments and other organizations be encouraged to actively participate in meetings and programs. The Substance Abuse Subcommittee is an Ad Hoc Committee of the Health and Human Services Board. Motion A motion was introduced by Schrank, seconded by Larson, and unanimously adopted: That the Board approves the following resolution as presented: RESOLUTION RESTRUCTURING THE SUBSTANCE ABUSE SUBCOMMITTEE Resolution No. St. Croix County, Wisconsin WHEREAS, in April, 2010, the County Board of St. Croix County went from 31 members to 19 members; and St. Croix County Health and Human Services Board Page 11 November 17, 2010 WHEREAS, as a result of the reduction in size, County Board committees were restructured; and WHEREAS, prior to restructuring, the Substance Abuse Committee was a standing committee and its membership was comprised of 3 County Board supervisors and 13 non - voting ex officio members; and WHEREAS, after restructuring the Substance Abuse Committee was designated a subcommittee of the Health and Human Services Board, was renamed the Substance Abuse Subcommittee and the membership of the Substance Abuse Subcommittee was comprised of 17 voting members; 3 County Board supervisors and 14 representatives from various County departments and other organizations; and WHEREAS, the previous Substance Abuse Committee needed a quorum of 2 members (2 of the 3 County Board supervisors) to conduct a meeting; the present Substance Abuse Subcommittee needs a quorum of 9 members to conduct a meeting; and WHEREAS, it is likely a quorum of 9 members will not be attainable due to difficulty for members from County departments and other organizations to attend; and WHEREAS, the Substance Abuse Subcommittee recommends that it be restructured so that it has 3 members — County Board supervisors — and encourage nonmember representatives from County departments and other organizations to actively participate in its meetings and programs; and WHEREAS, the Health and Human Services Board approves this recommendation; and WHEREAS, the Administration Committee approves the language of the amendments to the County Board Rules and Bylaws as shown below. THEREFORE, be it resolved by the St. Croix County Board of Supervisors that the Substance Abuse Subcommittee be restructured as shown below. i FURTHER, be it resolved that the County Board Rules and Bylaws be amended as follows: Article V, Subcommittees, Section B. 2. b. be rewritten as: St. Croix County Health and Human Services Board Page 12 November 17, 2010 b. The membership of the Substance Abuse Subcommittee shall be 3 supervisors. The Substance Abuse Subcommittee shall make all reasonable efforts to gain continuous, active participation in Substance Abuse Subcommittee meetings and programs from the following persons: the County Health and Human Services (HHS) Director or designee; the Sheriff or designee; the District Attorney or designee; the County Drug Court Coordinator; the County Family Living Agent, University of Wisconsin — Extension Service (UWEX); a person from the County jail alcohol and other drug abuse counseling service; persons from other alcohol and drug treatment services and programs; a person from the Behavioral Health Division of HHS; a person from the Public Health Division of HHS; a person from the Public Defender's Office; persons from the faith community; persons from youth - serving organizations; student or youth representatives; persons from homeless shelter organizations; a pharmacist; a person from Moms and Dads Against Meth (MADAM); persons from local law enforcement agencies. Article V, Subcommittees, Section B. 2. c. be rewritten as: c. The 3 supervisor members are appointed by the County Board Chair in consultation with the Vice - Chair. Other participants shall be approved by the committee. Only the supervisor members of the committee are entitled to per diems and expense reimbursement for attending committee meetings. RESOLUTION REGARDING THE ANTICIPATED DECREASED UTILIZATION OF PREVOCATIONAL SERVICES Schroeder reported Community Health Partners (CHP) has sent letters out to consumers and providers regarding reduction in utilization by members and payment rates to providers. Department of Health Services (DHS) has directed CHP to develop a plan to reduce the cost of vocational and pre - vocational services in order to become more fiscally stable. Meetings are being held in the area for consumers and providers with one meeting scheduled for this evening and again on November 18, 22 and 23, 2010. Board members were invited to attend. Schroeder reported CHP wants to cut utilization as CHP budget predictions are they will lose over $10 million in 2010 and over $4 million in 2011. In 2011 St. Croix County has budgeted over $1.4 million in contributions to the State for support of long term care services for the citizens of St. Croix County. A letter from Lisa Mills from Department of Health Services (DHS) was shared with the Board. Mills praised the exemplary performance on the part of a MCO with regards to increasing integrated employment opportunities and outcomes for its members with developmental disabilities. CHP has achieved participation levels in supported employment that are substantially higher than the apparent statewide average in Family Care and nearly four times higher than the apparent statewide average for IRIS. Schroeder anticipates the five counties served by CHP will have uniform rates starting in January. St. Croix County's utilization of IRIS is high and this affects CHP business model. DHS has told CHP that its utilization rate for vocational and prevocational services are 65% higher than the pilot counties and these are the counties which the capitation rates are based on. St. Croix County Health and Human Services Board Page 13 November 17, 2010 Motion A motion was introduced by Larson, seconded by Schrank, and unanimously adopted: That the Board approves the following resolution: RESOLUTION SUPPORTING SERVICES FOR PERSONS WITH DISABILITIES Resolution No. St. Croix County, Wisconsin WHEREAS, St. Croix County joined the statewide managed long term care system for frail elderly and adults with disabilities in 2008 that reflected the following values: choice, access, cost effectiveness and quality; and WHEREAS, The Department of Health Services (DHS) for the State of Wisconsin contracts with Community Health Partners (CHP) to carry out long term care services within St. Croix County; and WHEREAS, CHP receives a capitated rate from the State of Wisconsin to provide long term care services to persons with disabilities in St. Croix County; and WHEREAS, In 2011 St. Croix County has budgeted $1,412,497 to pay the State for the support of long term care services for the citizens of St. Croix County; and WHEREAS, DHS has commended CHP for achieving participation levels in supported employment that are substantially higher than the apparent statewide average for family care counties; and WHEREAS, DHS has told CHP that its service utilization rate for vocational and prevocational services are 65% higher than the pilot counties, these are the counties which the capitation rates are based on; and WHEREAS, CHP has indicated that DHS has directed it to reduce the cost of vocational and prevocational programming for persons with disabilities in order to be more fiscally stable; and WHEREAS, reducing the utilization rate of services to the pilot counties level would constitute as much as a 40% reduction in services for persons with disabilities; and WHEREAS, these service cuts would likely require persons with disabilities to reduce their hours /days worked per week, or eliminate work altogether; and WHEREAS, this will reduce the overall quality of life for these citizens of St. Croix County. NOW, THEREFORE BE IT RESOLVED, that the St. Croix County Board of Supervisors recommends that the outcome based goals of persons with disabilities not be impacted or compromised in order to balance the budget of CHP; and St. Croix County Health and Human Services Board Page 14 November 17, 2010 BE IT FURTHER RESOLVED, that the St. Croix County Board of Supervisors encourages The Wisconsin Department of Health Services and Community Health Partners to work cooperatively with St. Croix Industries and guardians/ parents to ensure that any changes in services do not adversely affect the quality of life of persons with disabilities in St. Croix County. FISCAL IMPACT CALCULATION ON ST. CROIX INDUSTRIES FOR ANTICIPATED DECREASE IN UTILIZATION OF SERVICES Schroeder indicated St. Croix Industries 2011 budget is over $2.4 million. Of the $2.4 million, $1.6 million is CHP revenue or 69% of the revenue. A 40% cut would amount to approximately $660,000 and Schroeder is not sure where the monies would be cut. Possible cuts could include a four -day week, five -day week with fewer hours, etc. If fiscal goals are not met, CHP could be decommissioned and the state will go to the back up plan. More details will be provided to the Board as received. Schroeder will work with Human Resources on how to address issues with staff as cuts are received. If necessary, a budget amendment will be brought to the Board as cuts are received. Horne left the meeting at 11:15. COMMUNITY HEALTH IMPROVEMENT PROCESS PLANNING UPDATE The October 27, 2010 St. Croix County Community Health Improvement Progress meeting minutes were distributed to Board members. The Committee and task force members have been meeting regularly to address the identified five health priorities. The steering committee gives oversight, needed resources and support to the work groups as they move from problems to solutions. Rasmussen commented there is a lot of community involvement compared to previous years. The hope is to have objectives and goals in place by year end and to move to implementation in 2011. Kramer reported on the status of the five identified health priorities: • Access to primary and preventative health service for mental health, oral health, and access to primary care. • Overweight, obesity and lack of physical activity. • Adequate and appropriate nutrition. • Alcohol and other substance abuse and addiction. • Tobacco use and exposure. Dr. Ramsay reported Southside Community Health Clinics are federally supported clinics. A grant has been received and there is interest in expanding into western Wisconsin. Johnson said ADRC funds may be used for grant writing as this would increase access to preventative care, which is part of the ADRC charge. Finalized plans will be brought back to the Board when completed. COMMUNICABLE DISEASE REPORT Kramer reported a newly diagnosed TB disease case in a female that has traveled extensively in the Pacific Islands. The individual is currently in isolation and Public Health is doing directly observed medication therapy. Public Health has begun case contact investigation to identify close contacts and have these individuals tested for TB disease. f St. Croix County Health and Human Services, Board Page 15 November 17, 2010 REPRODUCTIVE HEALTH PROGRAM REPORT Jaye Hay reported that each county h' must provide reproductive health services as mandated by state statute. She noted the program has experienced a 2.5% increase in contraceptive clients and 7% increase in pregnancy visits in 2009 most likely due to the state of the economy. The agency just received confirmation of a Title V state grant funding of $65,000 for each of the next five years to help provide services for clients. Hay reported the net program income for 2009 was $120,339. Reproductive Health has four main focus areas: contraception, STD/HIV, women's health, and pregnancy. Beginning 11/01/10, family planning Medicaid (MA) services will be available to anyone with an income under 300% of Federal poverty levels. In July, Family Planning Only Services also started covering male services. Reproductive Health has sliding fee scale for clients not eligible for Family Planning Only Services MA. Reproductive Health also has a contract to provide services with Blue Cross/Blue Shield private insurance. Hay reported an increase in reportable STDs in St. Croix County from 74 cases in 2009 to 114 so far in 2010. She reported an additional $16,000 grant from Wisconsin Well Woman Program for Breast and Cervical Cancer Screening and case management of women with abnormal screening results. That program covers low income women ages 45 to 64. POSSIBLE AGENDA ITEMS FOR NEXT MEETING • Health and Human Services Bylaws • Community Health Partnership utilization update for St. Croix Industries services • Business Plan report from LarsonAllen for St. Croix Health Center Wentz asked if there were any other issues to bring before the Board. Johnson mentioned a request was received last month for a donation of a computer from the County for NAMI. Dr. Ramsay donated a computer to the Castle. Wentz attended the Castle's open house, which is located in the basement of the Century 21 building and encouraged members to stop and visit the program. It is open on Thursday afternoons. Wentz adjourned the meeting. Time: 11:48 AM Chair: Attest: (Secretary)