HomeMy WebLinkAboutHealth & Human Services 07-21-10 Berenschot will review vouchers.
NOTICE OF MEETING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
DATE AND TIME: July 21, 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 - 06/16/10
DATE OF NEXT MEETING — 08/18/10 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 (NH) and Health and Human Services
(HHS)
b. HHS aged receivable report
3. HHS and NH Audit Reports
4. Health and Human Services Strategic Plans
4. 2011 Budget planning
5. Nursing Home Administrator's Report
6. Personnel Issues
a. New employees /vacancies
b. 2011 positions request
c. Closed session pursuant to Wisconsin Statutes § 19.85(1)(f) to consider financial,
medical, social or personal histories of an employee that, if discussed in public, would be
likely to have a substantial adverse effect upon the reputation of the employee referred to
in such histories. Reconvene in open session.
7. 2009 Annual Report
8. Family Care audit and implementation update
9. Review ADRC survey
10. Ad Hoc Facility Planning Update
11. Employee Survey Results
12. WIMCR Report
13. HIPAA/HITECH Compliance Planning
14. Update on new smoke free air law
15. New tobacco product watch
16. Child Welfare Public Disclosure Updated Reporting Requirements
17. Juvenile Justice Evidence Based Training and Implementation Funding Request
18. Possible agenda items for next meeting
Items for County Board approval must be submitted to the County Clerk's
office by Wednesday morning preceding a County Board meeting.
7/2/2010 1:01 PM
o
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
IC I
Items for County Board approval must be submitted to the County Clerk's
office by Wednesday morning preceding a County Board meeting.
7/2/2010 1:01 PM
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
July 21, 2010
The St. Croix County Health and Human Services Board met on July 21, 2010 at the St. Croix
County Health and Human Services/Health Center complex.
MEMBERS PRESENT: Roger Larson, Vice Chair
Leon Berenschot
Frederick Horne
Linda Luckey
Richard Marzolf
Deb Rasmussen
Alfred Schrank (arrived at 9:35)
MEMBERS ABSENT: Dr. Lisa Ramsay, excused
Esther Wentz, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Frank Robinson, Nursing Home Administrator
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
Darlene Krenz, Accounts Payable/Payroll Supervisor
Kathy Dunlap, Family and Children's Coordinator
Geralyn Karl, Health Educator
Wendy Kramer, Public Health Officer/Public Health Coordinator
Kim Dupre, Information Systems Analyst
Malva Sirek, Secretary
OTHERS PRESENT: Tammy Funk, Human Resource Administrator
Michelle Pietrick, Finance Director
Steve Tracey, Auditor, Tracey and Thole CPA
Trenton Fast, CPA, Larson/Allen
Lauren Kvam, Student
Tiana Ferrick, Student
Vice Chair Larson 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, August 18, 2010 at 8:30 AM. Rasmussen will review vouchers.
St. Croix County Health and Human Services Board
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July 21, 2010
AGENDA Motion A motion was introduced by Berenschot, seconded by Rasmussen, and
unanimously adopted: That the agenda be approved.
MINUTES Motion A motion was introduced by Berenschot, seconded by Rasmussen, and
unanimously adopted: That the minutes of the 06/16/10 Health and Human Services Board
meeting and Open Hearing be approved as distributed.
REVIEW ADRC SURVEY Beckman reported the Aging and Disability Resource Center (ADRC)
will be two years old in August. Lorie Jensen, a student intern from Stout, performed a satisfaction
survey for ADRC consumers. 195 consumers were surveyed either by phone interview or by mail.
Consumers surveyed used a variety of services through ADRC. 189 of the 198 consumers surveyed
claimed the assistance they received was useful and thorough and 100% of those surveyed claimed
they would contact the ADRC for future assistance. Survey results did indicate that it would be
more convenient to have Economic Support staff closer to the ADRC. This has been discussed as a
possibility, but at this time there is no space available at the ADRC office. Beckman reported the
County is upgrading their web page and the new site is scheduled to be up and running by
September 0. Beckman said it is part of the State contract to do a satisfaction survey.
HHS AND NH AUDIT REPORTS Trenton Fast, LarsonAllen, reported the audit follows SAS 114
regulations as required. The audit is performed on a risk -based audit approach. The Nursing Home
received an unqualified opinion, which is the highest ranking that can be given for an audit. Fast
reported there were no new significant changes in the Nursing Home in 2009. He said everyone
within the organization was great to work with and no problems were encountered. He noted the
Nursing Home experienced a change in payor mix in 2009 with more Medicare and private pay
residents. He said Medicare residents typically have short term therapy stays. Medicare pays more
than Medicaid and this is a way to increase Nursing Home revenue. Johnson commented there was
a redistribution of rooms made in 2009 to create more private rooms. This impacted census figures
as more Medicare consumers were attracted to the facility as there were more private rooms
available.
Fast reported the time between when services are provided and when we are paid for those services
is 32 days for 2009. He said the average is 43.5 and it is very good to have this number as low as it
is.
Fast indicated there is no management letter for the Nursing Home audit as there were no issues to
bring to the Board's attention regarding operational issues.
Johnson reported the Health and Human Services (HHS) IS) audit will be included as part of the overall
county audit report. This will save some auditing expense, but the committee will not receive a
separate bound audit report specific to HHS.
Steve Tracey distributed a draft of the HHS report. In the future unreserved fund balances may go
into the general fund with the general fund being available if HHS has a bad year financially. This
St. Croix County Health and Human Services Board
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July 21, 2010
is a shift in the concept of prior years to apply unreserved fund balances as carryover funds. HHS
does not keep a fund balance. The General Fund is available if HHS experiences a bad year
financially. Tracey reported $1,049,211 in carryover funds was applied to the 2010 HHS budget.
Tracey reported the carryover balance for 2009 was $1,425,566.
Johnson reported that part of the reason for the fund balance was the last of the Long Term Support
staff and consumers transitioned to ADRC and CUP (Community Health Partners) in 2009. This
transition happened more quickly than anticipated and expenses were reduced. Also, in 2009 there
was a significant amount of PHER (Public Health Emergency Response) dollars (approximately
$183,000) received for Public Health for H1N1. This funding was used to address the pandemic and
consequently other local funding was not utilized. There was also a $273,000 budget amendment
for children's waivers in 2009 which replaced the need for some of the local match money for
providing services to children with disabilities.
Tracey indicated staff is exploring restructuring accounts to help with reporting and consolidating
accounts for outside reporting. Adjusting accounts would help the financial statement and audit
statement work better together. Johnson also commented that this work will be done in conjunction
with the auditors to assure that the restructuring meets reporting needs at the State and to assure that
monthly financial statements accurately represent our fiscal status.
In 2010, the Nursing Home cost reporting will be done by Larson/Allen versus Wipfli as it has been
in the past.
CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member
Berenschot reviewed the vouchers.
Motion A motion was introduced by Berenschot, seconded by Marzolf, 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 175709 through 175742, dated June 16, 2010 in the
amount of $2,369.43.
Human Services, Nursing Home, St. Croix Industries and ADRC vouchers 175743 through
175840, dated June 16, 2010 in the amount of $183,986.01.
Human Services, Nursing Home, Government Center, and St. Croix Industries, vouchers 175976
through 176029, dated June 23, 2010 in the amount of $60,658.61.
Department of Aging and ADRC vouchers 176030 through 176042, dated June 23, 2010 in the
amount of $3,871.73.
Human Services, Nursing Home, and St. Croix Industries, vouchers 176249 through 176312,
dated June 30, 2010, in the amount of $24,090.47.
St. Croix County Health and Human Services Board
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July 21, 2010
Department of Aging and ADRC vouchers 176537 through 176572, dated July 08, 2010 in the
amount of $13,924.11.
Nursing Home vouchers 176573 through 176588, dated July 08, 2010, in the amount of
$14,817.09.
Human Services, Nursing Home, St. Croix Industries, Government Center, Department on
Aging, and ADRC vouchers 176589 through 176662, dated July 08, 2010 in the amount of
$134,193.95.
Human Services vouchers 177268 through 177312, dated July 09, 2010, in the amount of
$38,928.50.
Human Services vouchers 177313 through 177315, dated July 09, 2010, in the amount of
$1,047.01.
Human Services voucher 177316, dated July 09, 2010, in the amount of $430.00.
Human Services voucher 177316, dated July 09, 2010, in the amount of $1,155.85.
Department of Aging and ADRC vouchers 177320 through 177422, dated July 14, 2010 in the
amount of $15,661.32.
Human Services, Nursing Home, and St. Croix Industries, vouchers 177423 through 177542,
dated July 14, 2010 in the amount of $70,536.93.
Nursing Home vouchers 177543 through 177557, dated July 14, 2010, in the amount of
$3,631.95.
Human Services vouchers 177558 through 177561, dated July 14, 2010, in the amount of
$15,113.50.
Human Services, Nursing Home, Government Center and St. Croix Industries, vouchers 177562
through 177679, dated July 14, 2010 in the amount of $49,539.11.
FINANCIAL REPORT The following fmancial reports for Health and Human Services through
April and May, 2010 were distributed. In May there was a shift in ADRC expenses due to $1.5
million paid to the State due to participation in Long Term Care Reform. To be on budget for May,
the percentage should be 41.6 %. Revenues are lower in Behavioral Health due to more indigent
clients with self -pay clients having less ability to pay and a turnover of staff in Accounts Receivable
(billings are late).
St. Croix County Health and Human Services Board
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July 21, 2010
HEALTH AND HUMAN SERVICES - 2010
SUMMARY Total
OF REVENUES Budget April 30, 2010 Balance %
Administration $187,070.00 ($63,125.14) $250,195.14 -33.7%
AODA Services $768,662.00 $191,512.28 $577,149.72 24.9%
Long Term Support $0.00 $682.13 ($682.13) 0.0%
Mental Health $3,702,935.00 $807,316.00 $2,895,619.00 21.8%
Family & Children's $3,188,401.00 $867,002.39 $2,321,398.61 27.2%
Public Health $2,035,641.00 $682,768.13 $1,352,872.87 33.5%
Economic Support $1,020,270.00 $186,620.59 $833,649.41 18.3%
General Relief $3,000.00 $500.00 $2,500.00 16.7%
Coordinated Senrices/SED $2,802,917.00 $725,091.79 $2,077,825.21 25.9%
ARDC $2,457,878.00 070,417.67 $1.687,460.33 31.3%
Department on Aging $924,053.00 $388,340.47 $535,712.53 42.0%
Carryover Funds $1,049,211.00 $349,737.00 $699,474.00 33.3°x,
REVENUES HUMAN
SERVICES PROGRAMS $18,140,038.00. $4,906,863.31 $13,233,174.69 27.0%
SUMMARY Total
OF EXPENDITURES Budget April 30, 2010 Balance %
Administration $1,236,281.00 $402,335.27 $833,945.73 32.5%
Alcohol -Drug Abuse $768,662.00 $253,540.14 $515,121.86 33.0%
Long Term Support $0.00 $0.00 $0.00 0.0%
Mental Health $3,702,935.00 $998,484.66 $2,704,450.34 27.0%
Family BChildren "s $3,188,401.00 $839,594.49 $2,348,806.51 26.3%
Public Health $2,035,641.00 $689,053.17 $1,346,587.83 33.8%
Economic Support $1,020270.00 $381,986.39 $638,283.61 37.4%
General Relief $3,000.00 $0.00 $3,000.00 0.0%
Coordinated Service/SED $2,802,917.00 $710,071.16 $2,092,845.84 25.3%
ARDC $2,457,878.00 $280,595.43 $2,177,282.57 11.4%
Department on Aging $924,053.00 $227,154.15 $696,898.85 24.6%
EXPENDITURES HUMAN
SERVICES PROGRAMS $18,140,038.00 $4,782,814.86 $13,357,223.14 26.4%
Total S 124.048.45
St. Croix County Health and Human Services Board
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July 21, 2010
HEALTH AND HUMAN SERVICES - 2010
SUMMARY Total
OF REVENUES Budget May 31, 2010 Balance %
Administration $187,070.00 ($77,461.90) $264,531.90 -41.4%
AODA Services $768,662.00 $266,415.29 $502,246.71 34.7%
Long Term Support $0.00 $717.13 ($717.13) 0.0%
Mental Health $3,702,935.00 $1,166,327.17 $2,536,607.83 31.5%
Family & Children's $3,188,401.00 $1,203,524.77 $1,984,876.23 37.7%
Public Health $2,035,641.00 $911,015.13 $1,124,625.87 44.8%
Economic Support $1,020,270.00 $309168.01 $711,101.99 30.3%
General Relief $3,000.00 $625.00 $2,375.00 20.8%
Coordinated Services/SED $2,802,917.00 $1,044,557.04 $1,758,359.96 37.3%
ARDC $2,457,878.00 $985,370.83 $1,472,507.17 40.1%
Department on Aging $924,053.00 $481,892.52 $442,160.48 52.1%
Carryover Funds $1,049,211.00 $437,171.25 $612,039.75 41.7%
REVENUES HUMAN
SERVICES PROGRAMS $18,140,038.00 $6,729,322.24 $11,410,715.76 37.1/_
SUMMARY Total
OF EXPENDITURES Budget May 31, 2010 Balance %
Administration $1,236,281.00 $490,978.22 $745,302.78 39.7%
Alcohol -Drug Abuse $768,662.00 $308,364.65 $460,297.35 40.1%
Long Term Support $0.00 $0.00 $0.00 0.0%
Mental Health $3,702,935.00 $1.312,865.96 $2,390,069.04 35.5%
Family & Children's $3,188,401.00 $1,078,947.41 $2,109,453.59 33.8%
Public Health $2,035,641.00 $849,736.66 $1,185,904.34 41.7%
Economic Support $1,020,270.00 $496,406.80 $523,863.20 48.7%
General Relief $3,000.00 $0.00 $3,000.00 0.0%
Coordinated Service/5ED $2,802,917.00 $929,814.07 $1,873,102.93 33_.2%
ARDC $2,457,878.00 $1,990,195.29 $467,682.71 81.0%
Department on Aging $924,053.00 $267,564.40 $636,488.60 31.1
EXPENDITURES HUMAN
SERVICES PROGRAMS $18,140,038.00 $7,744,873.46 $10,395,164.54 42.7%
Total S (1,015.551.22)
The following financial reports for St. Croix Industries through April and May, 2010 were
distributed. St. Croix Industries is stable for revenue as revenue is billed each month. There may be
some inconsistency in receivables with the timing of when bills are paid, etc. Schroeder reported
the population for Day Services clients has decreased recently but anticipates more clients will be
put in the Day Service program in the future.
St. Croix County Health and Human Services Board
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July 21, 2010
St. Croix Industries - 2010
SUMMARY Total
OF REVENUES Budget April 30,201 D Balance %
WS Operations $1,375,209.00 $513,568.79 $861,640.21 37.3%
WS Production $306,513.00 $151,062.84 $155,450.16 49.3%
WS Helping Hands $86,500.00 $34,349.23 $52,150.77 39.7%
WS Pop/Vending $6,300.00 $4,003.83 $2,296.17 63.6%
WS Ran, $3,350.00 $2,515.79 $834.21 75.1%
WS Vocational Placement $341,488.00 $134,455.75 $207,032.25 39.4%
WS Comm Based Day Prog $197,730.00 $37,905.95 $159.824.05 19.2%
REVENUES $2,317,090.00 $877,862.18 $1,439,227.82 37.9%
SUMMARY Total
OF EXPENDITURES Budget April 30, 2010 Balance %
WS Operations $1,375,209.00 $381,844.83 $993,364.17 27.8%
WS Production $306,513.00 $121,527.05 $184,985.95 39.6%
WS Helping Hands $86,500.00 $25,413.38 $61,086.62 29.4%
WS Pop/Vending $6,300.00 $2,006.12 $4,293.88 31.8%
WS Ram $3,350.00 $406.89 $2,943.11 12.1%
WS Vocational Placement $341,488.00 $104,149.35 $237,338.65 30.5%
WS Comm Based Day Prog $197,730.00 $50,455.03 $147,274.97 25.5%
EXPENDITURES $2,317,090.00 $685,802.65 $1,631,287.35 29.6%
Total 192,059.53
St. Croix County Health and Human Services Board
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July 21, 2010
St. Croix Industries - 2010
SUMMARY Total
OF REVENUES Budget May 31, 2010 Balance %
WS Operations $1,375,209.00 $567,914.52 $807,294.48 41.3%
WS Production $306,513.00 $161,968.42 $144,544.58 52.8%
WS Helping Hands $86,500.00 $42,211.86 $44,288.14 48.8%
WS Pop/Vending $6,300.00 $4.654.39 $1,645.61 73.9%
WS Ram $3,350.00 $3,013.09 $336.91 89.9'°/
WS Vocational Placement $341,488.00 $144,924.03 $196,563.97 42.4%
WS Comm Based Day Prog $197,730.00 $43,437.29 $154,292.71 22.0%
REVENUES $2,317,090.00 $968,123.60 $1,348,966.40 41.8%
SUMMARY Total
OF EXPENDITURES Budget May 31, 2010 Balance %
WS Operations $1,375,209.00 $518,659.39 $856,549.61 37.7%
WS Production $306,513.00 $152,815.46 $151697.54 49.9%
WS Helping Hands $86,500.00 $31,198.91 $55,301.09 36.1
WS Pop/Vending $6,300.00 $2,409.73 $3,890.27 38.2%
WS Ram $3,350.00 $721.89 $2,628.11 21.5
WS Vocational Placement $341,488.00 $128,023.12 $213,464.88 37.5%
WS Comm Based Day Prog $197,730.00 $62,007.34 $135,722.66 31.4%
EXPENDITURES $2,317,090.00 $895,835.84 $1,421,254.16 38.7%
Total S 72,287.76
The following financial reports for the Nursing Home through April and May, 2010 were
distributed. Nursing Home revenues are on track. Medicare census is lower than projected but
private pay census is higher. IGT funds of $375,750 were received, which is less than the $469,000
budgeted. The line item All Other Sources includes Medicare/MA revenue and will need to be
reallocated. Workman's compensation had a large payment that impacts funds available. Worker's
comp payment was based on expenses from two years ago.
St. Croix County Health and Human Services Board
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July 21, 2010
St. Croix Health Center
April 2010
Budget Actual difference Rercentagc
Census 0
Operating Revenue:
Medicare $2,223,908.00 $411,614.68 $1,812,293.32 16.51%
Medicaid $2,043,172.D0 $695,363.42 $1,347,808.58 34.03%
Private Pay $975,919.00 $411,797.70 $564,121.30 42.20%
Revenue - IGT /Supplemental Funds $469,000.00 $375,750.00 $93,250.00 80.12%
All Other Sources $27,618.00 $119,191.34 - $91,573.34 431.57%
Total Operating Revenue $5,739,617.00 $2,013,717.14 $3.725,899.85 35.08%
Operating Expenses
Daily Patient Services $3,827,182.32 51,288,342.21 $2,538,840.11 33.66%
Special Services $287,498.00 $94,973.42 $192,524.58 33.03%
General Services $1,239,492.00 $399,852.05 $639,639.95 32.26%
Administrative Services $610,305.00 $208,603.46 $401,701.54 34.18%
Unassigned:
Depreciation (% Based) $0.00
Others: $528,063.00 $45,243.17 $462,819.83 8.57%
Utilities $208,461.00 $23,601.67
Workers Comp, Computer Tech $264,602.00 $1,108.50
Insurance $55,000.00 $20,533.00
Total Operating Expenses $6,492,540.32 $2.037,01431 $4.455.526.01 31.37%
Net From Operations ($23,297.17)
(Cost of doing business prior to
applying levy & outstanding rev)
County Revenues
Co Allocations (% Based) $616,131.32 $205,376.00 $410,755.32 33.33%
Nursing Home Carry Over $136,792.00 $45,597.33 $91,194.67 33.33%
Total Outstanding $752,923.32 $250,973.33 $501,949.99
Net from all Sources $227.676.16
St. Croix County Health and Human Services Board
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July 21, 2010
St. Croix Health Center
May 20'10
Budget Actual Difference PercentagF
Census 0
Operating Revenue:
Medicare $2,223,906.00 $467,508.78 $1,736,399.22 21.92%
Medicaid $2,043,172.00 $876,447.22 $1,166,724.78 42.90%
Private Pay $975,919.00 $519,964.31 $455,954.69 53.28%
Revenue - IGTfSupplemental Funds $469,000.00 $375,750.00 $93,250.00 60.12%
All Other Sources $27,616.00 $171,005.70 - $143,387.70 619.18%
Total Operating Revenue $5,739,517.00 $2.430,676.01 $3,308,940.99 42.35%
Operating Expenses
Daily Patient Services $3,827,182.32 $1,618,488.17 $2,208,694.15 42.29%
Special Services $267,498.00 $119,736.36 $167,761.62 41.65%
General Services $1,239,492.00 $491,362.76 $748,109.24 39.64%
Administrative Services $610,305.00 $264,101.2 $346,203.75 43.27%
Unassigned:
Depreciation (% Based) $0.00
Others: $528,063.00 $209,426.10 $318,636.90 39.66%
Utilities $208,461.00 $23,601.67
Workers Comp, Computer Tech $264,602.00 $110,291.43
Insurance $55,000.00 $75,533.00
Total Operating Expenses $6,492,540.32 $2.703.134.66 $3,789.405.66 41.63%
Net From Operations ($272,458,65)
(Cost of doing business prior to
applying levy & outstanding rev)
County Revenues
Co Allocations (% Based) $616,131.32 $256,720.00 $359,411.32 41.67%
Nursing Home Carry Over $136,792.00 $56,996.67 $79,795.33 41.67%
Total Outstanding $752.923.32 $313.716.67 $439,206.65
Net from all Sources $41,258,02
AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts
Receivable report for Health and Human Services through May was reviewed. Strenke reported
three of the five staff in the unit are new, which has impacted the timeliness of billing and is
reflected in the figures given. Interviews have begun for two full time Accounts Receivable staff.
Other area providers take fewer or no clients with Medicaid, Medicare or sliding fee. When
Behavioral Health parity went into effect, many insurance companies dropped mental health and
alcohol/drug service benefits so clients then to go on a sliding fee.
The Board recessed from 10:00 — 10:15 AM.
St. Croix County Health and Human Services Board
Page 11
July 21, 2010
UPDATE ON NEW SMOKE FREE AIR LAW Geralyn Karl thanked the Board for their support
for the smoke -free air law, which went into effect 07/05/2010. Wisconsin is the 27 state to
implement a smoke -free air law. She said there are no formal complaints regarding the smoke -free
air law filed in St. Croix County at this time. Schrank requested a copy of the law. Karl circulated a
packet regarding the smoke -free law that was sent to businesses from the state. This was followed
by a personal note sent to the business from the local Public Health Department.
NEW TOBACCO PRODUCT WATCH Karl introduced Lauren Kvam and Tiana Ferrick who
are WI Wins Youth Investigators and part of FACT (Fighting Against Cooperative Tobacco).
They circulated tobacco products and sweet or candy products, noting the similarities between
the products (size, shape, font and color). This information will also be shared around the county
and the region.
NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census
for April was 67, with 6 Medicare, 40 Medicaid, 18 private pay, 1 insurance and 2 Family Care
residents. The Medicare rate paid is $497.04 compared to the budgeted amount of $426.00.
Robinson reported a new sign has been installed on Highway 64 directing traffic to St. Croix
Health and Rehab Center. He said advertising has begun to be aired on WICK with interviews
with staff and commercials. Updates on rehab residents are being sent to referring agencies and
doctors. The facility has noted an increase in Medicare census since this was started. Updates
on therapy residents are also being placed in the New Richmond News. Robinson and his staff
are working with Tom Boron and his committee on being part of the new county website.
Robinson reported a rehab reunion was held for residents who were discharged home after
successfully completing therapy treatment. A team of employees manned the beer tent and pop
stand during New Richmond Fun Fest Days as a way to be part of the community and to
advertise the facility. All employees had matching blue shirts which said: We are here to serve,
St. Croix Health and Rehab. A banner that read: St. Croix Health and Rehab was also posted.
Training is occurring now for the new MDS (Minimum Data Set) system conversion schedule to
occur by October 1, 2010. MDS is how the Nursing Home gets paid for resident care.
Robinson reported electronic medical records will also be updated the end of July and August.
Medistat will be implemented the end of July, which will allow us to put in doctors' orders and
diagnosis codes that will enable us to bill easier. Robinson anticipates the touch screen
capabilities will be implemented the first week of August. This will allow staff to chart by
touching the screen pictures, which will make it easier and faster to complete charting.
Five Nursing Home staff will attend the annual ECS conference at the Wisconsin Dells this
week.
Berenschot suggested Robinson investigate having a booth representing the Nursing Home at the
St. Croix County Fair.
EMPLOYEE SURVEY RESULTS The employee survey results for HHS and NH will be
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reviewed at the August meeting. The Nursing Home completed the employee survey and found
results to be similar to the results of the HHS employee survey.
AD HOC FACILITY PLANNING UPDATE Johnson, Larson and Horne attended the Ad Hoc
Facility Planning meeting on July 7, 2010. At that meeting, it was determined to keep the Nursing
Home as is. The Nursing Home facility condition index is good. It was suggested for the Nursing
Home to expand niche markets for the Nursing Home and potentially do some upgrades to the
Nursing Home. Staff will be receiving information from LarsonAllen regarding the possibilities for
reimbursement for any upgrades or new building projects and this information will be needed to
assist in making final decisions regarding the facility.
It was determined by the study that the HHS building is obsolete. After discussion at the Ad Hoc
meeting, it was the consensus to build a stand -alone new HHS building in New Richmond. There
were several factors considered when making the decision to build in New Richmond, one of which
is that many of the Behavioral Health clients are located near this facility. Another factor taken into
consideration is that a stand -alone building would offer greater energy efficiencies opportunities
rather than adding onto the current Government Center building. It was determined satellite offices
are likely needed no matter where a building is built as the HHS department serves the entire
county. If this plan proceeds, more satellite offices space will be needed in Hudson due to Family
and Children's working closely with the court system. Also, Behavioral Health does work regularly
with Corporation Counsel due to Emergency Detentions and as mentioned earlier in the meeting, if
the ADRC stays located in Hudson, consideration of relocating Economic Support staff would also
need to be considered. SEH will look at the current utilization of space in Hudson in the next step of
the study.
Johnson reported he, Tammy Funk and Chuck Whiting visited Hennepin County where they use the
ROWE (Results Only Work Environment) approach. Johnson is attempting to contact the company
that set up this system for Hennepin County Human Services. From the discussion, Hennepin
County phased this process in, but is transitioning all of their Human Service Staff. While ROWE
does not automatically assume that staff will work remotely (telecommute), it does open up that
possibility and therefore could impact the size and design of any building project. Hennepin County
has yet to address downsizing facility needs, but from feedback we received, it appears they are
going to address this issue in the near future.
PERSONNEL ISSUES NEW EMPLOYEESNACANCIES Johnson distributed a vacancy report
for July for HHS. Johnson reported second interviews for the Financial Assistant positions are
scheduled for July 22, 2010. The Administration Committee approved the reclassification of a
Clerk/Typist position to a Program Aide position and that posting will be posted this week. Tami
Billeter turned down the Financial Manager position as she decided to stay with Pierce County.
Human Resources is attempting to contact another candidate regarding the vacancy.
2011 POSITION REQUESTS The following positions were requested:
• Two (2) full -time permanent Multi- Systemic Therapists: These two therapists would
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July 21, 2010
provide the required components to implement Multi- Systemic Therapy (MST) which is an
evidenced -based practice to serve high risk juveniles and children diagnosed with mental
health issues.
Multi- systemic therapy is intensive and pulls systems together for families. Kiesler reported
Washington County has been utilizing this system for approximately three to five years.
With current programming, these high -risk juveniles and children are seen approximately
one to two times per month. With MST, the youth and families are seen three to four times a
week in their home. It is expected that no new county monies are attached to these positions.
Monies would come from State and Federal dollars plus monies from other contracts that
the department currently has in place. Approximately 24 clients could be served per year;
however, the alternate care placement cost to serve these youth can be very expensive
dependent upon need. This has been a proven system for Washington County and they have
funded the MST staff through reduced alternate care expenses. Services for this program can
be billed through Medicaid and we would pursue that funding. With the implementation of
Juvenile Treatment Court process, the current outpatient therapies are not intensive enough
to bring about the desired changes. Judge Vlack supports the 2011 Office of Justice
Assistance second year grant application of over $43,000 being allocated towards the
implementation of MST for Juvenile Justice Court juveniles. Kiesler said this approach
would require a major re -work on how services are provided and there are major costs for
start up that are anticipated to be covered by the grant. If MST is not implemented, we
would be recommending that funding be restored to alternate care budgets. The decision at
this point is how to utilize our resources to help families stay together safely and reduce or
maintain our current expenditures in out of home placements, which is low as has been
reviewed previously.
• Two (2) full -time Medical Records Transcriptionists: There is no centralized system for
transcription. Transcription is currently done unit by unit. Currently a lot of what is being
done is being handwritten. We are required to be on electronic health records (EHR) by
2014 or suffer losing Medicaid and Medicare rates. Currently services are being provided
and billed and we are behind on documentation. This is required to support billed services.
Steve Kirt is currently performing a study of support staff. Luckey questioned if contracting
for these services would be an option. Johnson indicated that this was not reviewed at this
time, but could be explored and will be brought back to the board at the next meeting.
• Increase two (2) current Behavioral Health Emergency Services Social Workers from 35
hours per week to 40 hours per week: The law changed June 30, 2009 requiring law
enforcement to receive approval from Behavioral Health prior to transporting a client to an
approved facility for emergency detention. Previous to this date, law enforcement utilized
mobile crisis between 30 to 60% of the time. Since the new law, compliance has been at
100 %. Since the new law, Emergency Detention hospitalizations (when averaged) dropped
28 %; however, mobile crisis contacts have increased from an averaged 119 a year to an
averaged 318 a year. This represents a 267% increase in the number of mobile crisis
contacts that staff must track, monitor and case manage.
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July 21, 2010
• Increase current Behavioral Health ACSS Social Worker from 35 hours per week to 40
hours per week: This position will serve as back up to the ACSS Coordinator and provide
clinical supervision required by statute and maintains a caseload of Coordinate Service
Teams.
• Increase current YCSS Social Worker from 35 hours per week to 40 hours per week: There
are currently 80 children on the wait list for YCSS services and this continues to grow as
referrals are received on a weekly basis. Some referrals have immediate health and safety
needs.
• One full time ADRC Benefit Specialist: This position was reviewed and approved by the
ADRC Board who has independent authority under ADRC.
• One full time ADRC Adult Protection Social Worker: This position was reviewed and
approved by the ADRC Board who has independent authority under ADRC.
• Increase current ADRC Preventative/Nutrition Program Coordinator from 19 to 24 hours
per week: This position was reviewed and approved by the ADRC Board who has
independent authority under ADRC.
Board members requested a cost comparison for contracting for the Medical Records
transcriptionist positions versus hiring as a St. Croix County employee.
Motion A motion was introduced by Horne, seconded by Berenschot, and unanimously adopted:
That the Board approves all above positions to be included in the budget but reserving the right to
review the Medical Records transcriptionist positions estimated contract costs at the August
meeting.
Horne left the meeting at 11:50 AM.
JUVENILE JUSTICE EVIDENCE BASED TRAINING AND IMPLEMENTATION FUNDING
REQUEST Dunlap requested to transfer $7,500 from a purchased service line item that is
earmarked for alternate care placements to cover funding for training to implement Juvenile Justice
evidence -based practice. Johnson highlighted that this request for funding transfer is the result of
work that was identified in the Family and Children's 2010 operational plan to implement evidence
based work and approval by the Board would support the work done by staff in this department.
Motion A motion was introduced by Schrank, seconded by Rasmussen, and unanimously
adopted: That the Board approves transfer of $7,500 from a purchased service line item that is
earmarked for alternate care placements to cover funding for training and implementation of
Juvenile Justice evidence -based practices.
2011 BUDGET PLANNING Johnson updated the Board on the timeline for the 2011 budget.
He questioned members on preference for a detailed budget or summary budget with detail
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available.
Motion A motion was introduced by Schrank, seconded by Berenschot, and unanimously
adopted: That the Board approves receiving summary sheets for the 2011 budget with detail of
the 2011 budget being available.
Johnson said the 2011 budget will be sent out to Board members before the August 18 HHS Board
meeting. The 2011 budget will go to the Administration Committee and County Board in
September.
Johnson reported the Family Resource Center gave a presentation at the Open Hearing and has
submitted an initial request of $20,000. Services from the Resource Center have been provided to
Public Health, Birth to 3 clients and Family and Children's. Luckey questioned how HHS can
afford to fund private agencies. Berenschot requested more information on the Family Resource
Center regarding financial reports and annual reports.
2009 ANNUAL REPORT The 2009 Annual Report was distributed to members. Johnson said
financial reports are not available at this time and audited financial reports will be forwarded to
Board members at a later date.
POSSIBLE AGENDA ITEMS FOR NEXT MEETING The following items were postponed to the
August meeting:
• Health and Human Services Strategic Plans
• Family Care audit and implementation update
• Employee Survey Results
• WIMCR Report
• HIPAAMITECH Compliance Planning
• Child Welfare Public Disclosure Updated Reporting Requirements
CLOSED SESSION
A motion was introduced by Berenschot, seconded by Schrank; That the Board enter closed session
pursuant to Wisconsin Statutes § 19.85(1)(f) to consider financial, medical, social or personal
histories of an employee that, if discussed in public, would be likely to have a substantial adverse
effect upon the reputation of the employee referred to in such histories.
Roll call vote:
Esther Wentz- absent
Leon Berenschot -yes
Frederick Horne - absent
Roger Larson -yes
Linda Luckey -yes
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July 21, 2010
Richard Marzolf -yes
Dr. Lisa Ramsay- absent
Deb Rasmussen -yes
Alfred Schrank -yes
Six yes, three absent, motion passed.
The Board entered into closed session at 12:07 PM
Tammy Funk, Frank Robinson, and Fred Johnson participated in the closed session.
Motion A motion was introduced by Berenschot, seconded by Marzolf, and unanimously adopted
that the Board reconvene in open session. Time: 12:13 PM
Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted
that the Board approves granting the employee in question eight (8) weeks of unpaid leave.
Larson asked if there were any other issues to bring before the Board.
Larson adjourned the meeting.
Time: 12:16
Chair:
Attest:
(Secretary)