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HomeMy WebLinkAboutHealth & Human Services 09-24-10 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: September 24, 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 - 09/15/10 DATE OF NEXT MEETING — 10/20/10 at 8:30 a.m. OLD AND NEW BUSINESS 1. Health and Human Services Board Members 2011 Budget Priorities 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 2. 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. 9/17/2010 7:57 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 24, 2010 The St. Croix County Health and Human Services Board met on September 24, 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, arrived at 9:15 MEMBERS ABSENT: Dr. Lisa Ramsay STAFF PRESENT: Fred Johnson, Health and Human Services Director Frank Robinson, Nursing Home Administrator Tim Markgraf, YCSS Lead Social Worker Brad Beckman, ADRC Director Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Sharon Norton - Bauman, County Board Member Art Tobin, Building Services Director Diane Peterson, Economic Support Worker 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. AGENDA Motion A motion was introduced by Marzolf, seconded by Berenschot, and unanimously adopted: That the agenda be approved as distributed. Johnson reviewed the recent message from Chuck Whiting and the Administration Committee regarding the 2011 proposed budget. The Administration Committee appears committed to no increase in the levy, has applied $1.2 million of fund balance to reduce the gap to approximately an $800,000 shortfall at this point. There apparently is consideration of a reduction in the work week to 37.5 hours to address the $800,000 gap. The Committee also voted to go to the County Board with a resolution to implement a soft hiring freeze, which would require any hiring to take place only after approval by the parent committee, Administration Committee and the County Board. Also, the St. Croix County Health and Human Services Board Page 2 September 24, 2010 Administration voted to have all expenditures of $750 or more between now and the end of the year approved by the parent committee chair. Johnson reported emergency inpatient hospitalizations and food orders for the Health Center are just a few items that are over the $750 amount. After review, it appears the purpose of the directive is not client driven but applies to operational purchases that could be postponed given the current budget situation. Johnson expressed concern with going to 37.5 hour work week and feels a better long term solution would be to establish priorities from the County Board and then set programming to coincide with those priorities. This could result in a targeted program reduction dependent upon available funding and would likely include staffing reductions. Service levels would be adjusted according to priorities, rather than an across the board reduction. Johnson is looking for Board priorities to be set for Health and Human Services as well. Johnson reported meeting with staff and managers to receive ideas for tax levy cost savings. Marzolf distributed a sheet of cost saving ideas that he received for Board review. In Fund 230, the ADRC has increased Medical Assistance Admin money by approximately an additional $40,000. This calculation increased after further consultation with state fiscal staff. He said expected employment agreement salaries have been reduced for additional benefit specialist and adult protection services. The net reduction between revenue enhancement and reductions is approximately $132,000 in reduced levy expense. In Fund 205, Johnson reported reallocating a higher percentage of three staff positions from Aging to the ADRC. This will save approximately $10,000 and the reallocation has been reviewed by state fiscal staff. There was no reduction in the nutrition program at this time; however, a program analysis will be done to investigate if we can save monies by putting a plan in place to consolidate cooking at one or two sites versus the current model. Johnson said monies from a trust account can only be used for 2011 wage adjustment for the nutrition site staff. This was recently approved by the Administration Committee as these staff were previously not on the county wage grid. Human Resources estimated a $98,000 increase in salary expense and this would be expected to increase the Aging levy request for 2012. Fund 225 encompasses several Health and Human Services departments. Johnson said administration took out software requests and $316,000 for Medical Records EHR. He said consulting expenses, staff development and contractual services were reduced. Also, all new vehicles were also removed from the budget request. The total adjustment equals approximately $347,000. Johnson said Economic Support has to scan all records into electronic case files. He is looking at the possibility of moving that scanning duty to Medical Records and then charging a portion of that position to Economic Support, which is expected to bring in additional Federal funding (approximately $5,000). Youth Community Support Services (YCSS) moved Multi- systemic Therapy (MST) from salary to contract and reduced the cost by approximately $7,000. MST is expected to be a purchase of service contract and is not budgeted as positions. This service will reinforce one of the primary focal points of the YCSS unit which is to reduce the risk of alternate care and keep hospitalizations St. Croix County Health and Human Services Board Page.3 ' September 24, 2010 down. Focus on this unit will also be to increase billable time and revenue projections were increased. These adjustments are expected to decrease levy expenses by approximately $147,000. Approximately $41,000 in state revenue was added to the budget for Behavioral Health and expenses were further decreased by approximately $21,000. Family and Children's made additional contract adjustments and will not purchase computers, which totals an additional $58,000 in levy reductions. Economic Support enhanced revenue by $12,000 for collections on medical assistance overpayments. They are also working with the Sheriff s Department looking to increase work related to fraud and benefit recovery across all the programs they administer. Additional capital outlay expenses for St. Croix Industries were eliminated to address increased health insurance costs. The St. Croix Industries 2009 fund balance of approximately $500,000 is part of the $1.2 million used to apply to the overall county budget deficit. The Nursing Home made additional reductions of items that will not be purchased. Equipment was reduced an extra $31,000 so no dressers or beds will be purchased and building services reduced overall gas costs by approximately $38,000. Johnson reported Trenton Fast from LarsonAllen is creating a business plan for the Nursing Home that will include options of a new building/ renovating the current building and creating a niche market for the Nursing Home. Johnson said Robinson met with Sun Dance Therapies regarding expanding therapy services. The Medicare census for the 2011 Nursing Home budget request was built on a census of 9.5. Current average Medicare census for the past year is lower than 9.5, so adding to this anticipated census is not recommended at this time, but may be changed after the business plan is available. Robinson reported $177,000 per year is raised for adding one bed for Medicare. Capital purchases are still in the budget for Building Services to upgrade lighting, toilets, ceiling tile replacement, interior wall/door repair, etc. These areas were noticed during the recent Nursing Home survey. Tobin said we are looking at more efficient lighting and reduced water usage. He said there is about a 4.5 year payback on these items if replaced. Johnson said the above items for all funds amount to an approximate reduction of $660,000 in the tax levy request. At this point, this does not include lay off or reduced work week for staff that report within this organizational structure. The points of discussion today were reductions in the levy request of approximately $360,000, which is in addition to the $300,000 in reductions made after the Administration Committee concluded their three day budget meetings at the beginning of September. Johnson expressed concern that this is a short-term fix with postponing the purchase of computers, capital assets, etc. and if more reductions are required, staff and program reductions would be the next step It was the consensus of the Board to accept budget adjustments as presented. 1 St. Croix County Health and Human Services Board Page 4 September 24, 2010 Johnson highlighted that Long Term Care Reform will incrementally reduce from $2.7 million to $376,000 over five years, so while there is a current budget shortfall and anticipated revenues from the State are not expected to increase, this does offer some local relief over the next several budget cycles. This proposed budget will need to be managed to assure that revenue and expenses are on target and if needed, adjustments can be made during 2011. Johnson will be working with the finance department to include fiscal projections in the financial reports in the future. Rasmussen encouraged working with insurance company to reduce health insurance costs. Employees should contribute more towards insurance costs. Whiting reported there were a couple of large insurance claims and the county does not have a fund balance left to apply to insurance costs. Diane Peterson said she is part of the insurance committee as a union representative that works with Chuck Whiting and administrative staff in an effort to try to draw down insurance costs. Johnson will work with Whiting regarding adding administrative staff from Health and Human Services to the insurance committee. Whiting reported the committee is currently looking at adding a tier system for pharmaceuticals. Whiting reported the county is self - insured and St. Croix County has a lower cost of care compared to most counties in the state; however, insurance costs continue going up faster than wage cost. He said health care reform will impact insurance costs. Norton -Bauman questioned the 30% reduction in County levy in 2010 and another 20% for 2011 that would lead to the Nursing Home being off the County levy by 2015. Johnson said projections for year end will be presented on the Nursing Home at the October HHS Board meeting. Discussion on the ADRC, St. Croix Industries and Register of Deeds do not draw on the County levy but the rest of the County departments do. Wentz said the County has an obligation to follow the outcome of the advisory referendum to continue operating the Nursing Home. Every jurisdiction in the County voted to continue operating the Nursing Home even if it requires County levy. Discussion on private pay subsidy for nursing home residents. Luckey questioned how we can have the least impact on the levy. If private pay rates were raised so they are self - sustaining, it would jeopardize the revenue coming in and make the Nursing Home less competitive. If the private pay rates were higher, the situation could be worse. Robinson said the Nursing Home needs a feeder system. The Nursing Home has to restructure how it is doing business. He said the long range plan is to be off the County levy by 2015 but there is not a percentage amount every year. Also, 10% of revenue is slated to come from a new market niche. He gave the example of Christian Community Home campus set up. He said clients are aging in place on their campus, which is what is needed to be successful in the nursing home business. Johnson said if we are going to be in a budget crunch for a while, we need to look at priorities, how we are meeting mandates and to what level are we meeting mandates. He is looking for more direction from the County Board on priorities. Johnson offered an option to earmark more Public Health time to help establish a more formal health and wellness program for employees in an effort to lower insurance costs. r St. Croix County Health and Human Services Board Page„ 5 September 24, 2010 Some additional cost saving ideas included: • Incentive for early retirement. • No consultant services. • Voluntary reductions in staff time. • Incentives to not take health insurance. • Increased productive time of staff to do more billing. • Reduce staff development. • Reduction of mileage reimbursement. • No PTO payout at end of year. Things being done to get the budget approved do not solve the long range operational problems. Whiting said we may need to be ready to make changes during the year. All operations are different and there is not one single answer that can fit every department. When discussing reduced work hours, the Jail, Highway, Sheriff and Nursing Home are 24/7 operations. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 10:18 AM Chair: Attest: (Secretary)