HomeMy WebLinkAboutHealth & Human Services 09-15-10 w
Alfred Schrank will review vouchers.
Revised: 09/10/10
NOTICE OF ME &TING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
DATE AND TIME. September 15, 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 - 08/18/10
DATE OF NEXT MEETING — 10/20/10 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. Nursing Home Administrator's Report
4. 4% Rate Increase for Nursing Home Private Pay
5. Ad Hoc Facility Planning Report
6. Financial Analysis and Market Study for St. Croix Health Center Planning
7. Personnel Issues
a. New employees /vacancies
8. National Rehabilitation Association Conference in New Orleans, Louisiana
9. ECHO Conference **
10. Voluntary Accreditation of State and Local Health Department
11. Obesity Prevention Work by St. Croix County Youth Nutrition and Activity Coalition
12. Multi - Systemic Planning Contract Funding Request **
13. 2011 Budget Request
a. Fund 225: Health and Human Services
b. Fund 205: Aging
c. Fund 230: ADRC
d. Fund 625: St. Croix Industries
e. Fund 600: St. Croix Health Center
14. 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.
9/10/2010 7:46 AM
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
September 15, 2010
The St. Croix County Health and Human Services Board met on September 15, 2010 at the St.
Croix County Health and Human Services/Health Center complex.
i
MEMBERS PRESENT: Esther Wentz, Chair
Leon Berenschot
Frederick Horne
Roger Larson
Linda Luckey
Richard Marzolf
Dr. Lisa Ramsay
Deb Rasmussen
Alfred Schrank
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Frank Robinson, Nursing Home Administrator
Tonya Kusmirek, Financial Manager
Ron Kiesler, Behavioral Health Coordinator
Ronda Brown - Anderson, Economic Support Supervisor
Fay Strenke, Accounts Receivable Supervisor
Tammy Wilson, HIS Supervisor
Kathy Dunlap, Family and Children's Coordinator
Kim Dupre, Information Systems Analyst
Teresa Kvam, Nutritionist
Sonya Skramstad, Job Placement Specialist
Wendy Kramer, Public Health Officer/Public Health Coordinator
Malva Sirek, Secretary
OTHERS PRESENT: Chuck Whiting, Administrative Coordinator
Daryl Standafer, County Board Chair
Sharon Norton - Bauman, County Board Member
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, October 20, 2010 at 8:30 AM. Rasmussen will review vouchers. Johnson reminded
the Department of Health and Human Services (HHS) Board members that ADRC meets on
September 16 and Administration Committee meets on September 20 and that it is possible the
HHS Board may have to meet again before September 20' due to budget concerns.
St. Croix County Health and Human Services Board
Page 2
September 15, 2010
AGENDA Motion A motion was introduced by Larson, seconded by Berenschot, and
unanimously adopted: That the agenda be approved as distributed.
MINUTES Motion A motion was introduced by Schrank, seconded by Larson, and
unanimously adopted: That the minutes of the 08/18/10 Health and Human Services Board
meeting be approved as distributed
CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Schrank
reviewed the vouchers.
Motion A motion was introduced by Schrank, seconded by Berenschot, and unanimously
adopted: That the following vouchers be approved and be made a part of the supplemental
minute book:
Human Services, Nursing Home, St. Croix Industries and Government Center vouchers 179509
through 179672, dated August 18, 2010 in the amount of $142,041.16.
Human Services vouchers 179673 through 179674, dated August 18, 2010 in the amount of
$ 12,857.25.
Human Services vouchers 179939, dated August 20, 2010 in the amount of $25,782.00.
Department of Aging and ADRC vouchers 179940 through 179969, dated August 25, 2010 in
the amount of $7,525.07.
Human Services, Nursing Home, Government Center, and St. Croix Industries vouchers 179970
through 180068, dated August 25, 2010 in the amount of $132,367.05.
Department of Aging and ADRC vouchers 180341 through 180358, dated September 01, 2010 in
the amount of $1,986.22.
Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 180359
through 180469, dated August 01, 2010, in the amount of $51,317.24.
Human Services vouchers 180695 through 180735, dated September 07, 2010, in the amount of
$33,201.93.
Department of Aging and ADRC vouchers 180867 through 180902, dated September 07, 2010 in
the amount of $4,571.68.
Human Services, Nursing Home, St. Croix Industries, and Government Center vouchers 180903
through 180977, dated September 07, 2010 in the amount of $86,591.48.
Nursing Home vouchers 180978 through 181018, dated September 07, 2010, in the amount of
$22,298.74.
St. Croix County Health and Human Services Board
Page 3
September 15, 2010
Human Services, Nursing Home, and St. Croix Industries vouchers 180736 through 180866,
dated September 07, 2010 in the amount of $39,020.78.
FINANCIAL REPORT The following financial report for Health and Human Services through
July, 2010 was distributed. Johnson said work is being done so that monthly financial reports will
be available to the Board in a more timely manner rather than six to eight weeks old. Kusmirek
reported we are behind in CARS reporting. Kusmirek is working with the State on reporting
revenues. She said the monies will be coming in, they will just be late. The State will work with
Kusmirek to audit and clean up the reports. Kusmirek is working towards reporting by revenue
streams by department, grant funding, etc. for 2010 -2011 to better provide detail behind the
financial report. Johnson said a large State payment was made out of the ADRC account due to the
transition to Long Term Care Reform. Economic Support has added salary for a new staff person
which will be covered by expenditure reduction, etc.
St. Croix County Health and Human Services Board
Page 4
September 15, 2010
HEALTH AND HUMAN SERVICES - 2010
SUMMARY Total
OF REVENUES Budget July 31, 2010 Balance %
Administration $187,070.00 ($691,582.49) $878,652.49 - 369.71
AODA Services $768,662.00 $398,256.81 $370,405.19 51.8
Long Term Support $0.00 $787.13 ($787.13) 0.0%
Mental Health $3,702,935.00 $2,370,111.98 $1,332,823.02 64.0%
Family & Children's $3,188,401.00 $2,067,229.97 $1,121,171.03 64.8%
Public Health $2.035,641.00 $1,434,929.20 $600,711.80 70.5%
Economic Support $1,020,270.00 $628,539.35 $391,730.65 61.6%
General Relief $3,000.00 $875.00 $2,125.00 29.2%
Coordinated Services/SED $2,802,917.00 $1,448,629.78 $1,354,287.22 51.7%
ARDC $2,457,878.00 $1,410,605.17 $1,047,272.83 57.4%
Department on Aging $924,053.00 $803,031.78 $121,021.22 86.9%
Carryover Funds $1,049,211.00 $612,039.75 $437,171.25 58.3✓
REVENUES HUMAN
SERVICES PROGRAMS $18,140,038.00 $10,483.453.43 $7,656,584.57 57.8%
SUMMARY Total
OF EXPENDITURES Budget July 31, 2010 Balance %
Administration $1,236,281.00 $687,111.42 $549,169.58 55.6/
Alcohol -Drug Abuse $768,662.00 $444,276.45 $324,385.55 57.8%
Long Term Support $0.00 $0.00 $0.00 0.0%
Mental Health $3,702,935.00 $1,947,834.09 $1,755,100.91 52.6%
Family & Children's $3,188,401.00 $1,501,364.44 $1,687,036.56 47.1%
Public Health $2,035,641.00 $1,171,212.93 $864,428.07 57.5%
Economic Support $1,020,270.00 $691,508.37 $328,761.63 67.B
General Relief $3,000.00 $0.00 $3,000.00 0.0%
Coordinated Service /SED $2,802,917.00 $1,397,849.38 $1,405,067.62 49.9%
ARDC $2,457,878.00 $2,138,130.45 $319,747.55 87.0%
Department on Aging $924,053.00 $414,972.07 $509,080.93 44.9%
EXPENDITURES HUMAN
SERVICES PROGRAMS $18,140,038.00 $10,394,259.60 $7,745,778.40 57.3%
Total # 89,193.83
The following financial report for St. Croix Industries through July, 2010 was distributed. Some
trending changes are happening at the State level and how the revenue stream comes in. The figures
today show a positive cash flow.
St. Croix County Health and Human Services Board
Page 5
September 15, 2010
St. Croix Industries - 2010
SUMMARY Total
OF REVENUES Budget July 31, 2010 Balance %
WS Operations $1,375,209.00 $810,953.16 $564,255.84 59.0%
WS Production $306,513.00 $206,879.98 $99,633.02 67.5%
WS Helping Hands $86,500.00 $65,724.00 $20.776.00 76.0%
WS Pop/Vending $6,300.00 $7,430.85 ($1,130.85) 118.0%
WS Ram $3,350.00 $3,602.12 ($252.12) 107.5%
WS Vocational Placement $341,488.00 $201,646.37 $139,841.63 59.0%
WS Comm Based Day Prog $197,730.00 $64,001.73 $133,728.27 32.4 °i
REVENUES $2,317,090.00 $1,360,238.21 $956,851.79 58.7%
SUMMARY Total
OF EXPENDITURES Budget July 31, 2010 Balance %
WS Operations $1,375,209.00 $706,405.80 $668,803.20 51.4%
WS Production $306,513.00 $206,873.84 $99,639.16 67.5%
WS Helping Hands $86,500.00 $46,627.30 $39,872.70 53.9%
WS Pop/Vending $6,300.00 $3,198.84 $3,101.16 50.8%
WS Ram $3,350.00 $1,491.48 $1,858.52 44.5%
WS Vocational Placement $341,488.00 $179,013.59 $162,474.41 52.4%
WS Comm Based Day Prog $197,730.00 $86,035.62 $111,694.38 43.5%
EXPENDITURES $2,317,090.00 $1,229,646.47 $1,087,443.53 53.1%
Total S 130,591.74
The following financial report for the Nursing Home through July, 2010 was distributed. A total of
$501,170 in IGT funds has been received by the Nursing Home for 2010. The 2010 budgeted
amount for IGT funds was $469,000. The `All Other Sources' line item will need to be adjusted as
Medicaid and Medicare dollars have been allocated incorrectly into this line. Medicare is the best
pay source for the Nursing Home. Johnson indicates adjustments were made in Medicare revenue
for 2011 as Medicare census has not been what was anticipated. An additional $100,000 in revenue
has been included as a dividend payment from liability insurance as a result of the county's
performance.
St. Croix County Health and Human Services Board
Page 6
September 15, 2010
St. Croix Health Center
Judy 2010
Budget Actual Difference PercentagE
Census 0
Operating Revenue:
Medicare $2,223,908.00 $706,742.44 $1,517,165.56 31.78%
Medicaid $2,043,172.00 $1,211,733.92 $831,438.08 69.31%
Private Pay $975,919.00 $718,819.88 $257,D99.12 73.66%
Revenue - IGTISupplemental Funds $469,000.00 $501,170.00 - $32,170.00 106.86%
All Other Sources $27,616.00 $358,009.71 - $330,391.71 1296.29%
Total operating Revenue $5.739.617.00 $3 1 .496,475.95 $2,243,141.05 60.92%
Operating Expenses
Daily Patient Services $3,827,182.32 $2,263,755.36 $1,563,426.96 59.15%
Special Services $287,498.00 $166,263.58 $121,234.42 57.63%
General Services $1,239,492.00 $672,242.16 $567,249.84 54.24%
Administrative Services $610,305.00 $360,106.07 $250,198.93 59.00%
Unassigned:
Depreciation (% Based) $0.00
Others: $528,063.00 $216,363.59 $311,699.41 40.97%
Utilities $208,461.00 $29,902.91
Workers Comp, Computer Tech $264,602.00 $110,927.68
Insurance $55,000.00 $75,533.00
Total operating Expenses $6,492,540.32 $3.678,730.76 $2,813,809.56 56.66%
Net From Operations ($182,254.81)
(Cost of doing business prior to
applying levy & outstanding rev)
County Revenues
Co Allocations (% Based) $616,131.32 $359,408.00 $256,723.32 58.33%
Nursing Home Carry Over $136,792.00 $79,795.33 $56,996.67 58.33%
Total outstanding $752,923.32 $439,203.33 $313.719.99
Net from all Sources $256,948.52
AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts
Receivable report for Health and Human Services through July was reviewed. Strenke reported
Accounts Receivable unit is now fully staffed. As the staff are trained the workload is getting
caught up. Strenke indicated the Medicaid balance changed due to when the payments are received.
She said the recovery on doubtful accounts is seen more in April and May due to tax intercept.
NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census
for July was 67, with 9 Medicare, 38 Medicaid, 17 private pay, 2 insurance and 1 Family Care
residents. The Medicare average daily rate paid is $460.00 compared to the budgeted amount of
St. Croix County Health and Human Services Board
Page 7
September 15, 2010
$426.00. Medicare has been down; however, other areas are up but do not pay the same rates as
Medicare.
A meeting was held with Sundance to discuss the possibility of expanding outpatient therapy.
Sundance is very interested and wants to move forward with the discussion.
A contract with LarsonAllen is in process to work on some financial Performa's for the Nursing
Home regarding reimbursement on the cost report for renovation or building a new building plus
the impact of expanding the outpatient therapy department. It is anticipated information will be
ready to present to the Board by the end of October.
Robinson acknowledged and thanked staff who contributed above and beyond the call of duty
during the absence of Connie Sarauer, Nursing Home Director of Nursing: Joyce Jurisch, RN,
MDS Coordinator; Eva Krueger, RN, Charge Nurse; and Lisa Leahy, Director of Social
Services.
Robinson reported the resident/family Nursing Home picnic was held on August 26 and was a
huge success. Over 300 people were served and over $4,000 was raised on the silent auction
which benefits the resident fund. Wentz said the picnic was great and appreciates the efforts of
the staff to make the picnic a success.
4% RATE INCREASE FOR NURSING HOME PRIVATE PAY Robinson is requesting the
Nursing Home private pay rate be increased 4% from the current $178.25 to the proposed
$185.38 /day. He said this increase keeps the private pay rate in line with other facilities and is
lower than many other facilities. He based the 4% increase on the amount Medicaid rates increased.
He reported most facilities contacted anticipate a private pay increase for 2011. The rates
distributed in the survey of surrounding area facilities are for 2010. He said some residents price
shop before choosing a facility but the factors that impact the decision to enter a facility are location
and services. The Nursing Home offers therapies seven days a week. Standafer questioned the
actual cost of care. The care cost is dependent on the resident and their needs. The average care cost
per day was previously calculated to be approximately $229. This will be updated for the next
meeting. Increasing the private pay rates will allow the Nursing Home to stay competitive and still
maximize the revenue stream. The 2011 proposed budget for the Nursing Home includes $46,000
due to the proposed private pay rate increase. Robinson indicated private pay residents need a 30-
day notice of the rate increase.
Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously
adopted: That the Board approves increasing Nursing Home private pay rates 4% from $178.25 to
$185.38 /day effective November 1, 2010.
AD HOC FACILITY PLANNING REPORT Johnson provided information regarding where HHS
clients reside that access HHS services. Johnson will provide copies to Board members. The
Nursing Home business plan is in process now and is anticipated to be ready to present by early
November. Johnson will be meeting with the four St. Croix County judges in October to address
alternatives to lost productivity for staff when they are traveling to work with the courts.
St. Croix County Health and Human Services Board
Page 8
September 15, 2010
FINANCIAL ANALYSIS AND MARKET STUDY FOR ST. CROIX HEALTH CENTER
PLANNING Johnson said Corporation Counsel has reviewed and returned the contract for
performing a financial analysis and market study for St. Croix Health Center to LarsonAllen. The
cost for the study is approximately $15,000 with 50% of that total coming from 2010 funds and the
other 50% from 2011 funds.
PERSONNEL ISSUES NEW EMPLOYEESNACANCIES Johnson distributed a vacancy report
for September. Johnson reported Leah Mergens moved to the YCSS Program Aide position
September 7, 2010.
Johnson expressed concern regarding potential vacancies and will be cautious about filling positions
if there will be layoffs the first of the year. This will impact current and new staff. Whiting
recommended reviewing vacant positions with Johnson who will review with the Administration
Committee if there are plans to fill vacancies before the end of the year.
NATIONAL REHABILITATION ASSOCIATION CONFERENCE IN NEW ORLEANS
LOUISIANA Skramstad is requesting permission to attend the National Rehabilitation Association
Conference in New Orleans, Louisiana as a way to stay abreast of Federal and other states' plans so
St. Croix Industries can be positioned for the future. Skramstad reported she will also attend a
National Board meeting and Great Plains Region Board meeting at this conference. Administration
supports attendance at the conference. Having direct input on prevocational and vocational
definitions and future programming at this conference will impact St. Croix Industries funding
changes. The Pathways grant, which is a Medicaid Infrastructure Grant, ends at the end of 2011 and
the changes being proposed through this grant will have an impact on St. Croix Industries and
consumers in St. Croix County whom receive employment and pre - employment services. There are
currently just under 200 workers at St. Croix Industries, with 95 clients in Work Services, 10 -15 in
the Day Services Program, and over 80 clients in Community Employment. The cost of the
conference is approximately $329 for roundtrip airfare, $285 to attend the conference, including
board meetings, plus $129 /night hotel.
Motion A motion was introduced by Schrank, seconded by Berenschot, and unanimously adopted:
That the Board approves Sonya Skramstad attending the National Rehabilitation Association
Conference in New Orleans, Louisiana.
St. Croix Industries has money in the budget to cover this cost. Standafer questioned if any of this
information could be obtained without attending the conference. Skramstad indicated we have not
been able to access detail of the information in the past. She said the powerpoint is also not available
without attending the conference.
VOLUNTARY ACCREDITATION OF STATE AND LOCAL HEALTH DEPARTMENT
Public Health is planning on pursuing voluntary accreditation by the Health Department. Dr.
Ramsay is also involved in this self - assessment process. National accreditation would benefit
Public Health in the following ways:
St. Croix County Health and Human Services Board
Page 9
September 15, 2010
• Creditability
• Recognition of high performing health departments
• Framework for effective planning
• Culture of quality and performance improvement
• Access to resources for improvement
• Public health services aimed at improving health outcomes
The ultimate goal of an accreditation program is to improve the public's health through improved
quality and performance of public health departments.
The Healthiest Wisconsin 2020 Health Plan was offered to Board members. The plan is also
available on -line.
Kramer reported Public Health has received 300 doses of the flu vaccine.
ECHO CONFERENCE Administration is requesting to send three staff to the ECHO conference in
New Hampshire in October. Several decisions need to be made regarding implementation of our
Electronic Health Record (EHR) including the possibility of purchasing new software; however,
ECHO is the system we currently have and participation in this conference will assist in making
long range decisions. Johnson supports attendance at this conference; however, the ECHO
conference attendance has been pulled from the 2011 budget proposal. New information will be
gathered at this conference and presented to the consultant when making long range decisions.
Something has to be put in place by 2014 for EHR or we will begin to lose Medicaid/Medicare
dollars.
Motion A motion was introduced by Home, seconded by Berenschot, and unanimously adopted:
That the Board approves sending three (3) staff to the ECHO conference in New Hampshire.
The Board recessed from 10:04 —10:13 AM.
OBESITY PREVENTION WORK BY ST. CROIX COUNTY YOUTH NUTRITION AND
ACTIVITY COALITION Teresa Kvam is a Nutritionist who works with the WIC Program/Public
Health. She has been working with the New Richmond School District, tracking BMI (body mass
index) to determine a pattern in overweight and obese children. Tracy Klingler, a UND student and
Public Health Intern, graphed this information for evaluation. The data has been collected for years
on Skyward, a computer system that the schools use for tracking grades, in addition to heights,
weights and BMI's. This computer program was upgraded last year and now automatically
converts the BMI number for children to percentiles. The St. Croix County Youth Nutrition and
Activity Coalition recently received an $8,000 grant, which is an obesity prevention grant.
Wisconsin Nutrition and Physical Activity Program received grant funds to assist in implementing
policy, systems or environmental change strategy that will reduce the burden of obesity, physical
inactivity and poor nutrition in the state. Obesity in youth is a top concern and came out as a
concern from the 2004 Community Needs Assessment.
St. Croix County Health and Human Services Board
Page 10
September 15, 2010
Public Health is actively involved in wellness at the schools. Johnson has offered for Public Health
to also be involved with the County for a wellness program for employees due to health insurance
costs. Public Health is ready to work with Human Resources to assist in the development of
employee wellness programming.
MULTI- SYSTEMIC PLANNING CONTRACT FUNDING REQUEST A request is being made
to transfer $8,000 in funds earmarked for State Mental Health Institute Program to cover anticipated
contract costs to begin program development work on multi- systemic therapy (MST) in 2010,
which is planned for implementation in 2011. MST will target children that are at significant risk
for out -of -home placement. MST is a clinical process that targets re- structuring the family in a
manner that decreases re- arrest rates and out -of home placements. Kiesler reported this service
works in conjunction with wrap around services, which have also been successful in reducing out -
of -home placements in St. Croix County. He said MST is an evidenced -based program developed
over 25 years ago at the Medical University of South Carolina. The clinical process targets the
entire family, not just the individual child.
The average amount of time clients are in MST is 20 weeks. The services MST offers are available
to that family 24 hour /day, 7 days /week. MST Therapists are not paid by the hour, they are paid by
a specific amount per case and met with weekly to determine their performance /success with each
case they are assigned.
Motion A motion was introduced by Berenschot, seconded by Marzolf, and unanimously adopted:
That the Board approves transferring $8,000 from State Mental Health Institute Program to cover
anticipated contract costs to begin work on multi - systemic therapy.
The balance of the year will be used to set up the MST program and train for the program. It is
anticipated there will be some final outcomes approximately a year from now and the Board will be
kept updated on progress made.
2011 BUDGET REQUEST: There is a shortfall in the 2011 budget request that does not apply fund
balance or include new county levy dollars. Johnson asked the Board for priorities for budget
adjustments. Johnson said not all areas are dollar for dollar cuts due to federal match, etc. It was the
consensus of the Board that Johnson should communicate what the consequences of potential cuts
will be. Johnson indicated all funds in all county departments should have an equitable reduction.
Norton -Bauman said the Administration is looking for guidance from the departments for possible
reductions. It is better to have the priorities come from the parent committee versus the
Administration Committee or County Board.
The Health and Human Services Board will hold a meeting on Friday, September 24, 2010 at 8:30
AM to discuss budget priorities for 2011.
Marzolf suggested cutting the Board per diem as a model for the rest of the County. Any ideas for
cuts and priorities should be channeled in writing to Johnson and Wentz.
POSSIBLE AGENDA ITEMS FOR NEXT MEETING
St. Croix County Health and Human Services Board
Page 11
September 15, 2010
• Updates on MST.
Wentz asked if there were any other issues to bring before the Board.
I
Wentz adjourned the meeting.
Time: 11:37 AM
Chair:
Attest:
(Secretary)