HomeMy WebLinkAboutHealth & Human Services 08-18-10 Deb Rasmussen will review vouchers.
Revised 08/13/10
NOTICE OF MEETING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
DATE AND TIME. August 18, 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 - 07/21/10
DATE OF NEXT MEETING — 09/15/10 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. Nursing Home Administrator's Report
4. Personnel Issues
a. New employees /vacancies
5. Health and Human Services Strategic Plans
6. Family Care audit and implementation update
7. Employee Survey Results
8. HIPAA/HITECH Compliance Planning
9. Child Welfare Public Disclosure Updated Reporting Requirements
10. 4% Rate Increase for Nursing Home Private Pay **
11. 2011 Budget Presentation
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
12. 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)
Items for County Board approval must be submitted to the County Clerk's
office by Wednesday morning preceding a County Board meeting.
8/13/2010 10:33 AM
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
August 18, 2010
The St. Croix County Health and Human Services Board met on August 18, 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
Deb Rasmussen
Alfred Schrank
MEMBERS ABSENT: Dr. Lisa Ramsay, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Frank Robinson, Nursing Home Administrator
Tonya Kusmirek, Financial Manager
Brad Beckman, ADRC Coordinator
Ron Kiesler, Behavioral Health Coordinator
Ronda Brown - Anderson, Economic Support Supervisor
Clark Schroeder, St. Croix Industries Director
Fay Strenke, Accounts Receivable Supervisor
Tammy Wilson, HIS Supervisor
Kathy Dunlap, Family and Children's Coordinator
Norma Vrieze, Birth to 3 Coordinator
Kim Dupre, Information Systems Analyst
Malva Sirek, Secretary
OTHERS PRESENT: Chuck Whiting, Administrative Coordinator
Michelle Pietrick, Finance Director
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, September 15, 2010 at 8:30 AM. Schrank will review vouchers.
AGENDA Motion A motion was introduced by Larson, seconded by Schrank, and
unanimously adopted: That the agenda be approved as distributed.
MINUTES Motion A motion was introduced by Larson, seconded by Schrank, and
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August 18, 2010
unanimously adopted: That the minutes of the 07/21/10 Health and Human Services Board
meeting be approved with changes requested by Marzolf.
CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member
Rasmussen reviewed the vouchers.
Motion A motion was introduced by Rasmussen, seconded by Berenschot, and unanimously
adopted: That the following vouchers be approved and be made a part of the supplemental
minute book:
Department of Aging and ADRC vouchers 177939 through 177942, dated July 13, 2010 in the
amount of $736.19.
Human Services, Nursing Home, St. Croix Industries and Government Center vouchers 177943
through 178051, dated July 13, 2010 in the amount of $169,079.24.
Human Services voucher 178202, dated July 26 and 28, 2010 in the amount of $280.52.
Department of Aging and ADRC vouchers 178226 through 178237, dated July 26 and 28, 2010
in the amount of $2,447.26.
Human Services, Nursing Home, Government Center, and St. Croix Industries, vouchers 178238
through 178332, dated June 26 and 28, 2010 in the amount of $68,857.68.
Department of Aging and ADRC vouchers 178458 through 178498, dated August 04, 2010 in
the amount of $6,272.59.
Human Services, Nursing Home, ADRC, and Government Center, vouchers 178499 through
178571, dated August 04, 2010, in the amount of $100,054.12.
Nursing Home and St. Croix Industries vouchers 178572 through 178594, dated August 04,
2010, in the amount of $20,808.18.
Human Services vouchers 178834 through 178874, dated August 05, 2010, in the amount of
$37,996.83.
Human Services, Department of Aging and ADRC vouchers 179233 through 179281, dated
August 11, 2010 in the amount of $9,401.05.
Human Services, Nursing Home, St. Croix Industries, Government Center, Department on
Aging, and ADRC vouchers 179282 through 179384, dated August 11, 2010 in the amount of
$72,956.55.
Nursing Home vouchers 179385 through 179399, dated August 11, 2010, in the amount of
$6,787.37.
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August 18, 2010
Human Services, Nursing Home, Government Center and St. Croix Industries, vouchers 179400
through 179485, dated August 11, 2010 in the amount of $49,256.33.
Human Services voucher 179486, dated August 11, 2010, in the amount of $686.18.
FINANCIAL REPORT The following financial reports for Health and Human Services through
June, 2010 were distributed. Johnson explained a large one -time payment to the State was made out
of the ADRC expense line due to participation in Long Term Care Reform. Johnson further
explained a staff person was added in Economic Support and purchased services for Medical
Assistance burials is over budget. The State will reimburse for the burials so these monies will be
sum sufficient unless the State runs out of money for this fund.
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August 18, 2010
HEALTH AND HUMAN SERVICES - 2010
SUMMARY Total
OF REVENUES Budget June 30, 2010 Balance %
Administration $187,070.00 ($100,040.41) $287,110.41 -53.5%
AODA Services $768,662.00 $334,714.05 $433,947.95 43.5%
Long Term Support $0.00 $752.13 ($752.13) #DIV /0!
Mental Health $3,702,935.00 $1,369,826.17 $2,333,108.83 37.0%
Family & Children's $3,188,401.00 $1,372,027.15 $1,816,373.85 43.0%
Public Health $2,035,641.00 $1,224,181.02 $811,459.98 60.1%
Economic Support $1,020,270.00 $434,008.93 $586,261.07 42.5%
General Relief $3,000.00 $750.00 $2,250.00 25.0%
Coordinated Services /SED $2,802,917.00 $1,204,666.78 $1,598,250.22 43.0%
ARDC $2,457,878.00 $1,154,301.00 $1,303,577.00 47.0%
Department on Aging $924,053.00 $709,046.40 $215,006.60 76.7%
Carryover Funds $1,049,211.00 $524,605.50 $524,605.50 50.0%
REVENUES HUMAN
SERVICES PROGRAMS $18,140,038.00 $8,228,838.72 $9,911,199.28 45.4%
SUMMARY Total
OF EXPENDITURES Budget June 30, 2010 Balance %
Administration $1,236,281.00 $586,069.30 $650,211.70 47.4%
Alcohol -Drug Abuse $768,662.00 $380,842.71 $387,819.29 49.5%
Long Term Support $0.00 $0.00 $0.00 #DIV/0!
Mental Health $3,702,935.00 $1,599,700.24 $2,103,234.76 43.2%
Family & Children's $3,188,401.00 $1,310,007.52 $1,878,393.48 41.1%
Public Health $2,035,641.00 $1,017,800.82 $1,017,840.18 50.0%
Economic Support $1,020,270.00 $598,828.14 $421,441.86 58.7%
General Relief $3,000.00 $0.00 $3,000.00 0.0%
Coordinated Service /SED $2,802,917.00 $1,200,454.66 $1,602,462.34 42.8%
ARDC $2,457,878.00 $2,063,636.84 $394,241.16 84.0%
Department on Aging $924,053.00 $347,541.34 $576,511.66 37.6%
EXPENDITURES HUMAN
SERVICES PROGRAMS $18140,038.00 $9,104,881.57 $9,035,156.43 50.2%
Total ! (876.042.85)
The following financial reports for St. Croix Industries through June, 2010 were distributed. St.
Croix Industries is seeing swings in the financial statement due to billing and the timing of
payments received. Schroeder explained the workshop production expenses are doing well but
receivables can be variable by as much as $250,000 due to when the billing goes out and when
monies are received. Schroeder explained that vehicles are expensed out in the year of purchase and
depreciation is not a separate fund.
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August 18, 2010
St. Croix Industries - 2010
SUMMARY Total
OF REVENUES Budget June 30, 2010 Balance %
WS Operations $1,375,209.00 $780,142.71 $595,066.29 56.7%
WS Production $306,513.00 $170,677.82 $135,835.18 55.7%
WS Helping Hands $86,500.00 $49,582.85 $36,917.15 57.3%
WS Pop/Vending $6,300.00 $5,470.40 $829.60 86.8%
WS Ram $3,350.00 $3,602.12 ($252.12) 107.5%
WS Vocational Placement $341,488.00 $197,603.57 $143,884.43 57.9%
WS Comm Based Day Prog $197,730.00 $61,869.05 $135,860.95 31.3%
REVENUES $2,317,090.00 $1,268,948.52 $1,048,141.48 54.8%
SUMMARY Total
OF EXPENDITURES Budget June 30, 2010 Balance %
WS Operations $1,375,209.00 $612,167.29 $763,041.71 44.5%
WS Production $306,513.00 $186,095.39 $120,417.61 60.7%
WS Helping Hands $86,500.00 $38,604.87 $47,895.13 44.6%
WS Pop/Vending $6,300.00 $3,198.84 $3,101.16 50.8%
WS Ram $3,350.00 $1,065.95 $2,284.05 31.8%
WS Vocational Placement $341,488.00 $150,929.09 $190,558.91 44.2%
WS Comm Based Day Prog $197,730.00 $74,001.37 $123,728.63 37.4%
EXPENDITURES $2,317,090.00 $1,066,062.80 $1,251,027.20 46.0%
Total S 202,885.72
The following financial reports for the Nursing Home through June, 2010 were distributed. Johnson
explained there were some coding issues with Medicare and Medicare revenue and these funds are
showing up under all other sources. This will be fixed in the near future.
Robinson explained the Medicare census is lower than the budgeted figure. There was a census of
six Medicare residents in June and the budget was built on a census of ten. However, the Medicare
census today is ten. Adjustments have been made to the 2011 budget because of these numbers.
IGT funds of $375,750 were received; however, the budget anticipated IGT funds of $469,000 for
2010. All other expenditures are on target. Robinson reminded members there was a large worker's
compensation expense applied last month. Johnson noted the financial situation in the Nursing
Home now is still showing a positive balance, in part due to the IGT payment, but it is trending
towards possibly ending the year in the negative given the low Medicare census.
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August 18, 2010
St. Croix Health Center
June 2010
Budget Actual Difference PercentagE
Census 0
Operating Revenue:
Medicare $2,223,908.00 $575,964.12 $1,647,943.88 25.90%
Medicaid $2,043,172.00 $1,043,696.82 $999,475.18 51.08%
Private Pay $975,919.00 $623,941.42 $351,977.58 63.93%
Revenue - IGT /Supplemental Funds $469,000.00 $375,750.00 $93,250.00 80.12%
All Other Sources $27,618.00 $208,915.70 - $181,297.70 756.45%
Total Operating Revenue $5,739.617.00 $2,828,268.06 $2.911,348.94 49.284b
Operating Expenses
Daily Patient Services $3,827,182.32 $1,929,499.67 $1,897,682.65 50.42%
Special Services $287,498.00 $142,337.00 $145,161.00 49.61%
General Services $1,239,492.00 $583,049.58 $656,442.42 47.04%
Administrative Services $610,305.00 $313,320.64 $296,984.36 51.34%
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 $6,492.510.32 $3,184,570.48 $3.307,969.84 49.05%
Net From Operations ($356.302.42)
(Cost of doing business prior to
applying levy & outstanding rev)
County Revenues
Co Allocations (% Based) $616,131.32 $308,064.00 $308,067.32 50.00%
Nursing Home Carry Over $136,792.00 $68,396.00 $68,396.00 50.00%
Total outstanding $752,923.32 $376,160.00 $376,463.32
Net fiom all Sources $20,157.58
AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts
Receivable report for Health and Human Services through June was reviewed. Strenke explained
permanent staff have been hired to replace the temporary staff and will be starting August 19 and
30, 2010. She explained insurance is down and Medicaid is down also due to some claims needing
to be resubmitted. Doubtful accounts monies are down due to less tax intercept monies. Tax
intercept monies are mostly received in March and April.
NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census
for June was 65, with 6 Medicare, 38 Medicaid, 19 private pay, 1 insurance and 2 Family Care
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residents. The Medicare average daily rate paid is $473.05 compared to the budgeted amount of
$426.00. The census has been down but is in an upward trend again.
Marketing for the Nursing Home continues. Robinson anticipates the new County website will
be operational by the first part of September, which will include Nursing Home information.
Advertisements have been aired on WIXK along with staff being interviewed on the radio.
There have been more calls to the Nursing Home since this was started. Updates on how
residents are doing in therapy are being sent to referring physicians and referring departments.
Robinson said the MDS (Minimum Data Set) conversion is on track to occur October 1, 2010.
This will change charting and tracking for MDS and this is how the facility gets paid. Staff will
be trained in August and the Nursing Home will be ready for the change by October 1St
Training for the kiosks was originally set for May; however, the software was not ready from
ECS until the second week of August. The training for the kiosks happened last week; however,
the kiosks have been operational since April.
Robinson also reported the numerous tasks that have been accomplished with the help of IT. A
new server and a virtual server were installed in the Nursing Home. The Nursing Home now has
wireless capabilities thanks to the efforts put forth by IT. The wireless capabilities allow nurses
to take laptops into the rooms and charting can take place at bedside and at the medication carts.
A portable phone can be taken with each nurse on the floor so they can get calls wherever they
are on the floor. Also, residents have a wireless phone so they can have total privacy in their
room for phone calls. A computer with Skype capabilities has been set up for the residents so
they can talk to family and see them in other states or locations. Robinson said Medicare rates
have increased about $100 /day due to the improvements listed above. Robinson said the Nursing
Home is moving in the right direction.
Robinson reported the Nursing Home is updating their electronic records the end of August with
Medistat. Medistat will allow the staff to put in doctors' orders and diagnosis codes that will
allow us to bill easier. This is a program update from ECS. The second week of August we will
implement our touch screen capabilities in our EMR (Electronic Medical Record). This allows
staff to chart using a touch screen to pictures, which will make it easier and faster to do charting
and allow us to capture more revenue. Johnson noted that the discussion on kiosk utilization and
IT updates was completed as there may have been an impression that there were delays and lost
revenue due to the Nursing Home. Johnson highlighted that the County Board approved the
purchase of the electronic charting system in September of 2009 and they were functional in
April of 2010. Other IT enhancements were completed prior to April of 2010, which Robinson
highlighted, and this did allow for partial implementation of electronic charting and now the final
step will be completed.
The annual resident/family picnic for the Nursing Home is scheduled for August 26. There is
also a basket auction and raffle to support Nursing Home activity programs.
PERSONNEL ISSUES NEW EMPLOYEESNACANCIES Johnson distributed a vacancy report
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for August. Two financial assistants have been hired for the Accounts Receivable unit.
Johnson introduced Tonya Kusmirek as the new Financial Manager.
HEALTH AND HUMAN SERVICES STRATEGIC PLANS Johnson reported Nursing Home
and Health and Human Services strategic plan goal charts were distributed at the July meeting.
Plans have been done by each department and those results will be shared with the Board for an
overview of operational plans for 2010 at upcoming meetings.
FAMILY CARE AUDIT AND IMPLEMENTATION UPDATE Schroeder invited Board
members to attend the annual St. Croix Industries picnic which will be held August 20 from noon to
3:00 PM at the Settlement by Somerset.
He also invited Board members to attend a fund raiser on September 19 from 4:00 to 8:00 PM at
Willow River Inn/Carbone's in Burkhart. The money from this fund raiser will be used for St.
Croix Industries summer picnic, holiday party/dance and for client outings.
St. Croix Industries is a member of Rehab for Wisconsin Group (RFW). Debate continues at the
State level regarding Family Care, IRIS, etc. St. Croix County is not in the Family Care business
and Community Health Partnership administers these services locally. St. Croix County is still
funding the system as has been previously reviewed with the Board.
Under the new system, there are some very happy parents who under the old system may have had
to wait 10 years to get services from long term support. However, with the new system, there have
also been some concerns raised. Some issues are: reductions in service hours after transition from
county administered waiver programs, inconsistencies and deficiencies in notices of action,
concerns with application of functional screens by MCOs, insufficiency of mental health services,
problems with coordination between MCOs and county protective services, and MA eligibility
gaps. The Ombudsman program is an organization funded by the State to hear appeals of consumers
and their guardians for some of the issues that may be similar to those noted above. At St. Croix
Industries, staff has noticed consumers being moved from 2 -3 bed homes to 6 -8 bed homes due to
residential rate changes.
Dane County is resisting joining Family Care. They were scheduled to start 01/01/2011. The State
has asked Rock County to delay joining Family Care until 01 /01/2012.
Schroeder reported as a whole, MCOs lost $17,841,581 in 2009 even with an additional
$19,166,371 in DHS funding over and above the capitation payments in a risk - sharing arrangement.
There has been pressure on the Joint Legislative Audit Committee to have an audit of Family Care
due to the feeling there is not enough money for Family Care solvency. This was voted on in late
July and would be completed by next spring.
Last fall the State announced plans to limit prevocational services for St. Croix Industries clients.
This issue will be coming back with new regulations taking effect 09/01/2010. It is felt these new
regulations will remove persons with disabilities from earning a wage to sitting in a day program
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because they cannot or are not interested in working in an integrated job in the community. We may
see a shift in how services are provided if this is implemented. Staff ratio for workshop services is
approximately 1:10 or 1:12, whereas staff ratio for Day Services is approximately 1:4 due to the
higher acuity level. Schroeder anticipates there will be changes in funding and St. Croix Industries
may have to rely on fund balances the program generated from the previous year. As more
information becomes available regarding this presumed transition away from prevocational
services, further reports to the Board will be provided.
EMPLOYEE SURVEY RESULTS The employee survey results for HHS and NH were reviewed.
A good score was received overall but there is still opportunity for improvement.
HIPAA/HITECH COMPLIANCE PLANNING Health and Human Services is working with
Corporation Counsel and Risk Management to address HIPAA/HITECH for the covered entities in
the County. A risk analysis is an anticipated need regarding the exchange of protected health
information. The County will be moving forward with this after more detail on the State plans is
discussed at upcoming regional meetings. More updates will follow when available.
The Board recessed from 9:45 — 9:50 AM.
CHILD WELFARE PUBLIC DISCLOSURE UPDATED REPORTING REQUIREMENTS Act
78 recently was put into effect. It outlines how and what information is shared with the public
following a case of child's death, serious injury or suspected maltreatment and any case in which a
child in out -of -home care placement is suspected to have committed suicide. The determinations
must be made by a physician. Dunlap reported this impacts all counties.
4% RATE INCREASE FOR NURSING HOME PRIVATE PAY Robinson reported 4% private
pay rate increase would amount to an increase of $7.12 per day and increase revenue in the 2011
budget by $46,778. Robinson indicated that this rate increase would still be competitive with
neighboring facilities. Robinson based the 4% on the 4% increase received in Medicaid rates as of
July 1, 2010. The private pay rate currently is $178 and the rate would increase to $185.12 per day.
There is an additional $15 /day private room differential applied to all private rooms. Robinson said
a 30 -day notice has to go out to all private pay clients before the increase can go into effect. Horne
requested more detailed information and a comparison of rates with area facilities. Johnson
informed the Board the 4% increase in private pay is already figured into the 2011 budget request
for the Nursing Home and, dependent upon board action, may require an update before the budget is
finalized. Johnson will add this to the agenda for the next meeting.
2011 BUDGET PRESENTATION Summary documents for the budget were distributed to the
Board. Detailed information will be provided as requested. The Administration Committee meets
the first part of September and the committee of the whole meets on September 14 t h. The next
Health and Human Services Board meeting is scheduled for September 15 so more detail on the
overall county budget can be review at that meeting. The budgets will be reviewed in September
and October, so there is still time for review and adjustment after today's meeting. The County
Board will take action on the budget the end of October.
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ADRC and Aging funds are separate from HHS as a demonstration of what is happening to the
Aging Program. St. Croix Industries is a special revenue fund and is also separate from HHS. The
Nursing Home is an enterprise fund and separate from HHS. Johnson said prior year funds will be
applied to the County general fund and not treated as carryover funds.
FUND 225: HEALTH AND HUMAN SERVICES Johnson said there was no transfer of farm
revenue to HHS as the farm revenue now goes to the general fund. Johnson noted there will be a
decrease in Headstart funds as Headstart's square footage decreased by half and their lease will end
in June, 2011. Johnson also noted the WIMCR payment included in the budget is an average of the
payments for the last three years.
The budget was built with a 15% increase in health insurance costs and 0% increase on salaries.
Johnson highlighted the two positions for transcription included in the budget. Staff investigated
costs associated with contracting for this service as requested. Costs would be approximately the
same to contract for these services versus keeping in house; however, the service does quality
checks and audit checks on the transcription. In addition, the department would only pay for the
services provided as this documentation methodology moves forward. Wilson reported after
implementation of Electronic Health Records (EHR), the New Richmond Clinic was able to
downsize their transcription services. Wilson also found that the trend towards transcription is
moving to contracting with a company to provide the service. The request for two Medical Record
transcriptionists is recommended to be removed from the budget and staff will pursue a purchase of
service contract to fill this need. Luckey intended for the positions to be filled with a temporary
contract position not with an agency service. Johnson said the information is protected health
information and feels more comfortable working with a reputable business. Discussion was raised
regarding current union grievances related to current use of agency temporary staff and transcription
has typically been completed by union staff. Johnson noted that the recommendation to contract for
this service stands and if the grievance process moves forward and alternate plans need to be made,
adjustments can be made at that time.
Johnson said liability costs of $75,000 were put under administration versus distributing to other
departments. He also noted phone costs were configured on 12 months for 2011 versus nine months
in the 2010 budget. He noted there has been a higher demand for interpreter services so a contract
for interpreter services was included. Capital outlay was increased due to need for EHR from
$71,000 in 2010 to $410,000 in 2011. Luckey requested detail for capital outlay.
Discussion was held on the ECHO system. The ECHO system currently does not have an audit
feature at this time, but an update to the system will be available. The agency went with ECHO due
to the low cost; however, we have paid for that low cost in staff time. Consultant dollars were
budgeted to help make a decision that could range from staying with ECHO to purchasing new
software. This could be very similar to the process the county used to identify needs related to
enterprise software. A new system will take 12 to 18 months to implement and the Federal
Government has set 2014 as the deadline for implementation of an electronic health record.
Discussion also included moving this software purchase to be part of the overall county enterprise
software request for proposals and removing it from capital outlay. Marzolf questioned the
possibility of partnering with other counties to meet our needs. There is no statewide system.
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The AODA department collections were decreased by approximately $11,000 based on history.
There has been less ability by clients to pay and thus more sliding fee scale. The IDP emergency
fund of $26,000 was not budgeted to 2011. A one -time stimulus of $30,560 was received in 2010
and will not be available for 2011.
Several items impacted the Behavioral Health budget, but this overall budget has been reduced.
There have been fewer hospital admissions due to the Diversion Program. The COP (Community
Options Program) was previously in the Long Term Support Department and was rolled into
Behavioral Health.
The law changed on 06/30/09 so that Behavioral Health has to evaluate clients before they are
admitted to an inpatient locked unit. The contract with Northwest Connections was increased to
handle the increased call volume with mobile diversion. This has increased the demand on
Behavioral Health Services. Three positions have been increased from 35 hours /week to 40 hours
per week due to increased need for emergency services case management. Inpatient hospitalizations
have been decreased.
Youth Community Support Services (YCSS) has contracted for two additional social workers to
take care of cases from the CLTS waitlist for children that have immediate health and safety needs.
There are currently 80+ clients on the list. A levy of $30,954 increase is included in the YCSS
budget. This department will continue to focus on increasing state /federal financial participation,
which assists other departments in reducing purchase of services that previously relied solely on
county levy.
After further investigation the multi- systemic program was is recommended to be changed to
contract with three therapists versus hiring two county employees. This is the model that
Washington County Minnesota has implemented and we believe it is something that can be
replicated here. This intervention will be targeted to those youth and their families where there is a
high risk of placement or where there is need to work intensely with families as youth are returned
home.
The Board recessed from 11:25 — 11:35 AM.
Horne left the meeting at 11:25.
FUND 625: ST. CROIX INDUSTRIES It is anticipated there will be more revenue from the IRIS
Program and more DVR revenue as more clients move to IRIS. Schroeder anticipates utilization of
more on -call help. Schroeder noted less operational costs as the vans are new. Building
improvements may be made dependent on the decision of the Ad Hoc Committee. Schroeder noted
landscape needs around the St. Croix Industries building to keep water away from the building. He
said there is no county levy requested for 2010 or 2011.
FUND 225: HEALTH AND HUMAN SERVICES (continued) Dunlap noted an increase in
Family and Children's collection/billings. Some child care funds have shifted back to Economic
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Support. The CLTS waiver decreased to coincide with the decrease in anticipated contract
expenses. Personnel costs increased due to contracted services being moved to an employment
agreement versus being in operational costs plus anticipated increase in health insurance costs.
Vrieze noted an increase in billing fees for Reproductive Health which resulted in a significant
increase in revenue. The WIC caseload also increased, which resulted in increased revenue. Vrieze
reported Birth to 3 waiver revenue is expected to increase and Birth to 3 also received AARA
stimulus funding through July 31, 2011. Birth to 3 cannot have a waiting list as clients need to be
enrolled within 45 days of referral.
Public Health lost tobacco control funding as a result of a statewide reorganization and development
of multijurisdictional coalitions. Public Health Emergency Response (PHER) monies were received
in 2010; however, it is anticipated there will be none in 2011. Capital outlay items for Public Health
include purchasing chairs for the agency's conference room.
Economic Support allocations are predicted to be similar to 2010. Brown Anderson reported 67% of
child care administration allocation was moved back to Economic Support, and they will be
assuming the child care eligibility contract in 2011 bringing in an additional estimated $38,000 in
program revenue. The funeral and burial program cost is up. MA transportation is down due to the
state managed transportation program anticipated to be implemented in April 2011. Capital outlay
includes copier /printer /scanner purchase and computer replacement for Economic Support.
FUND 230: ADRC A Benefit Specialist position is being requested due to increased case load.
The ADRC was more than 100% on time and attendance so Federal monies will be maximized to
apply to the Benefit Specialist position. Another position is requested for Adult Protection due to
increased referrals of Adult Protection cases and protective placement reviews. Johnson reminded
the Board that Long Term Support staff was downsized when the move was made to ADRC. Now
more staff is needed due to increased referrals. County levy dollars will be needed for the Adult
Protection position. Johnson said the ADRC and Aging budget proposals will go before the St.
Croix County Council on Aging and Disabilities. No capital outlay funds are included in the ADRC
budget.
FUND 205: AGING Beckman noted the Caregiver Support Grant has to be used for services. He
also noted the grants from State and Federal are a bit less this year. One position in Aging was filled
with union personnel so there was an increase in wage. No capital outlay funds are included.
FUND 600: ST. CROIX HEALTH CENTER The Medicare census for the budget was lowered to
reflect the current Nursing Home Medicare census. The budget includes a 4% increase in private
pay rates. Robinson said the IGT amount was based on recommendation of WASHA calculations.
He also included a small revenue increase for outpatient therapy revenues. Robinson noted shift
differential was decreased to reflect actual costs. Capital outlay costs reflect the Ad Hoc Facility
Planning recommendations and life safety repairs due the K -tag violation issued during the survey
process. The capital outlay amount is a place holder as the county will likely bond for this project.
Pietrick will provide the Board members with capital outlay detail for each unit. Staff will work
St. Croix County Health and Human Services Board
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August 18, 2010
with the auditor to create a business plan for the Nursing Home.
Discussion was held on possible 5% and 10% cuts in the budget.
Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously
adopted: That the Board approves to move the proposed budget forward in the process.
POSSIBLE AGENDA ITEMS FOR NEXT MEETING
• 4% Rate Increase for Nursing Home Private Pay
Wentz asked if there were any other issues to bring before the Board.
Wentz adjourned the meeting.
Time: 1:00 PM
Chair:
Attest:
(Secretary)