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HomeMy WebLinkAboutHealth & Human Services 01-19-11 Schrank will review vouchers. Revised: 01/13/2011 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: January 19, 2011 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 - 12/15/10 DATE OF NEXT MEETING — 02/16/11 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. Follow up on Business Plan for St. Croix Health Center 4. Work plan for Health Center K -tag 67 violation 5. Report for Fire Marshall inspection on Health Center 6. Follow up on Economic and Employment Impact Report for St. Croix Health Center 7. Nursing Home Administrator's Report 8. Personnel Issues a. New employees /vacancies 9. Economic Support — Federal poverty limits 10. Medical Assistance Transportation Broker 11. Report on the Changes in Family Care meeting 12. Multi- Systemic Treatment Training 13. "Reproductive Health Training 14. Public Health Preparedness Consortium 15. Wisconsin Child and Family Services review report 16. Department of Children and Families Emergency Rule- foster Care DCF 56 17. Wisconsin Health Information Technology Extension Center proposal. 18. 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. 1/13/2011 8:55 AM ** 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. 1/13/2011 8:55 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD January 19, 2011 The St. Croix County Health and Human Services Board met on January 19, 2011 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Leon Berenschot Roger Larson Linda Luckey Richard Marzolf (excused to arrive late at 9:03) Dr. Lisa Ramsay Alfred Schrank Daryl Standafer (for quorum) MEMBERS ABSENT: Deb Rasmussen, excused Frederick Horne, excused Esther Wentz, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Frank Robinson, Nursing Home Administrator Tonya Kusmirek, Financial Manager Steve Kirt, Behavioral Health Clinical Services Supervisor Tammy Wilson, HIS Supervisor Ronda Brown - Anderson, Economic Support Supervisor Malva Sirek, Clerical Supervisor OTHERS PRESENT: Kim Dupre, Information Systems Analyst Sharon Norton - Bauman, County Board Member Dave Simons, SEH Art Tobin, Building Services Director Ashley Halladay, New Richmond News Charlie Carlson Norm Matzek Dean Winquist 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, February 16, 2011 at 8:30 AM. Berenschot will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Luckey, seconded by Schrank, and St. Croix County Health and Human Services Board Page 2 January 19, 2011 unanimously adopted: That the minutes of the 12/15/10 Health and Human Services Board meeting be approved with changes noted. FINANCIAL REPORTS The following financial report for Health and Human Services through December, 2010 was distributed. Kusmirek explained the books are still open through the end of February. She reported CARS monies are still being booked. Kusmirek will be going to the State next week to work on CARS reports. The audit for Health and Human Services (HHS) will take place in June. Health & Human Services - Fund 225 December 2040 as orian 10, 2011 Annual December Budget % of Revenue by Service Budget Actuals Balance Budget Administration $ 187,070 $ 534,960 $ 347,890 286.0% ACDA Services 768,662 550,871 217,791 71.7% Mental Health 3,702,935 2,928,045 774,890 79.1% Family & Children's 3,188,401 2,384,201 804,200 74.8% Public Health 2,035,541 1,830,499 205,142 89.9% Economic Support 1,020,270 846,932 173,338 83.0% General Relief 3,000 1,125 1,875 37.5% Coordinated Services /SED 2,802,917 2,148,078 654,839 76.6% Carryover Funds 1,049,211 1,049,211 - 100.0% Service Revenue $ 14,758,147 $ 12,273,922 $ 2,484,185 83.2% Annual December Budget % of Expenditure by Service Budget Actuals Balance Bud et Administration $ 1,236,281 $ 1,164,099 $ 72,182 94.2% Alcohol-Druq Abuse 768,662 731,033 37,629 95.1% Mental Health 3,702,935 3,142,761 560,174 84.9% Family & Children's 3,188,401 2,388,350 800,051 74.9% Public Health 2,035,641 1,905,993 129,648 93.6% Economic Support 1,020,270 1,129,794 109,524 110.7% General Relief 3,000 - 3,000 0.0% Coordinated Service /SED 2,802,917 2,461,153 341,764 87.8% Service Expenditures $ 14,758,147 $ 12,923,183 $ 1,834,924 87.6% Revenues Over (Under) Expenditures $ 649,261 Expected Percent of Budget 144.096 The following financial report for St. Croix Industries through December, 2010 was distributed. Kusmirek explained that additional revenues and expenditures are expected before the year end close figures are completed. St. Croix County Health and Human Services Board Page 3 January 19, 2011 St. Croix Industries - Fund 625 December 2040 as of Jan 10, 2011 Annual December Bud et % of Revenues Budget Actuals Balance Budget WS Oper2tions $ 1,375,209 $ 1,398,226 $ 23,017 101.7% WS Production 306,513 344,232 37,719 112.3% WS Helpinq Hands 86,500 132,199 45,699 152.8% VAS PopNendinq 6,300 13,731 7,431 218.0% WS Ram 3,350 7,317 3,967 218.4% VAS Vocational Placement 341,488 346,279 4,791 101.4% WS Comm Based Day Proq 197,730 106,511 91,219 53.9% Total Revenue 2,317,090 2,348,496 $ (31,4061 101.4% Annual December Budget % of Expenditures Budget Actuals Balance Bud et WS Operations $ 1,375,209 $ 1,141,545 $ 233,654 83.0% WS Production 306,513 355,846 49,333 116.1% WS Helpinq Hands 86,500 92,212 5,712 1 106.6% WS PopNendinq 6,300 6,690 390 106.2% WS Ram 3,350 3,330 20 99.4% VAS Vocational Placement 341,488 298,378 43,110 87.4% VAS Comm Based D2y Proq 197,730 137,125 60,605 69.3% Total Expenditures $ 2 $ 2,035,126 $ 281,964 1 87.8% Revenues Over fUndei) Expenditures $ 313,370 Expected Percent of Budg 100.0% The following financial report for the Nursing Home through December, 2010 was distributed. Kusmirek explained the books are still open until the end of February and there is more revenue due to come in. She also explained there was a prepayment of IGT funds of approximately $458,500 for the second half of 2010 and first half of 2011. Approximately $215,000 of these funds will be cn reflected on the 2011 report. The Nursing Home audit is scheduled for the week of March 7 St. Croix County Health and Human Services Board Page 4 January 19, 2011 St. Croix Health Center - Fund 600 December 2010 as orian 10. 2011 Operating Revenue: Budget Actuals Difference % of Budget Medicare $ 2,223,908 $ 1,295,971 $ 926,937 58.3% Medicaid 2,043,172 1,855,492 186,580 90.9% Private PaV 975,919 1,331,966 356,047 136.5% Revenue - GUSLipplemental Funds 469,000 742,420 273,420 158.3% Out Patient Thera - 18,627 18,627 0.0% All Other Sources 18,458 10,746 7,712 58.2 Total Operating Revenue $ 5,730,457 $ 5,257,221 S 473,236 91.7% Operating Expenses Dail Patient Services $ 3,827,182 $ 3,728,636 $ 98,546 97.4% Special Services 287,498 264,496 23,002 92.0% General Services 1,239,492 1,134,471 105,021 91.5% Administrative Services 610,305 575,399 34,906 94.3% Sub Total S 5,964,477 S 5,703,002 S 261,476 95.6% Other Expenses: De reciation %Based Others: Utilities $ 208,461 $ 109,504 $ 98,957 52.5% Workers Comp, Computer Tech & Capital 264,602 117,731 146,871 44.5°1° Insurance 55,000 74,119 19,119 134.8% Other Expenses Sub Total $ 528,063 $ 301,355 $ 226,708 57.1% Total Operating Expenses $ 6,492,540 $ 6,004,356 $ 488,184 92.5% Revenues Over Under Ex endltures from Operations $ (747,135) County Revenues Insurance Dividend - unexpected revenue not result of Operations $ 9,160 $ 100,858 $ (91,698) 1101.1% Co Allocations - Le %Based 616,131 616,131 100.0% Nursinq Home Carry Over 136,792 136,792 100.0% Total Outstanding $ 762,083 1 $ 853,781 $ (g1 112.03% Revenues Over(Undef) Expenditures Including County Contributions $ 106,646 Expected Percent of Budget 100.0% - We have received a prepayment or iGT in the amount or $458,500 $241,250 for 2010 $217,150 for 2011 Johnson reported the auditors are expected on site February 2 and 3, 2011 to work with staff on organization of the annual budget to simplify the chart of accounts and match with State reporting. AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through December was briefly reviewed. Kusmirek said the receivable figures will change at year end with more funds coming in. Staff are looking at some of the longer term accounts and possibly writing off some of the accounts with input from Pietrick plus possibly turn some accounts over to collections. This will allow more staff time to focus on receivables and get billing in more quickly. When accounts are sent to collections, only a small percentage is collected and the collection agency only gets paid a small percentage if they collect. Johnson indicated the Crisis Emergency Services application was approved. A workgroup is in place to determine how to bill for emergency services and how to expand the services. St. Croix County Health and Human Services Board Page 5 January 19, 2011 CONSIDERATION OF CLAIMS All check registers for December for funds 205, 225, 230, 600 and 625 were reviewed by Health and Human Services (HHS) Board member Schrank. All questions were answered satisfactorily. Motion A motion was introduced by Schrank, seconded by Berenschot, and unanimously adopted: That the December vouchers be approved. FOLLOW UP ON BUSINESS PLAN FOR ST. CROIX HEALTH CENTER Other Wisconsin counties have been surveyed regarding the use of county levy to support their operations. A common theme for those facilities that did not require county levy to support their operations was that they had other services, such as assisted living or apartments, and costs for the nursing home could be shifted. Specific discussions with all Counties that responded to this survey were not completed as part of our follow up, but conversations with Dunn and Lacrosse County did occur. St. Croix County staff summarized the meeting with Dunn County. Dunn County currently has a county levy of approximately $750,000. They have completed a significant amount of work with the plan to build a new nursing home. The plan includes a greenhouse concept (smaller housing units) with a budget of approximately $22.5 million. This project includes geothermal heating and cooling, which is funded separately at approximately $1.7 million above the $22.5 million. Geothermal heating and cooling would require approximately $180,000 per year of county levy; however, this would also present the potential to heat and cool other buildings of the County. Geothermal heating and cooling estimated pay back for Dunn County is approximately 42 years; however, they have done no test drilling, no conductivity tests, no application to DNR and estimates are on paper only. Payback for geothermal heating/ cooling for St. Croix County was estimated at 72 years. Dunn County is proposing a package for employees for three years that involves wage freeze, no insurance adjustment and profit sharing. The existing Dunn County facility would likely be used for office space if a new nursing home is built. Dunn County hopes to tap into revenue enhancements and currently qualifies for USDA financing. This project was started 2.5 years ago and there appear to be a lot of variables before the project can be finalized and move forward. Dunn County has no contingency plan if this project doesn't move forward to completion. They also have a plenum issue throughout the entire nursing home, similar to what St. Croix Health Center has in the basement only. HHS staff also spoke with the Hillview Nursing Home Administrator from LaCrosse County. This building has 199 beds and has experienced approximately 95% occupancy. The staff in this facility has their own separate union. The facility is a well maintained approximately 30 year old building that has no debt service. Their payer source is similar to St. Croix Health Center's payer source mix other than Hillview has more residents funded through the Care Management Organization. The facility also has a 59 -unit apartment complex that is a profit center for them. They are also building a 30 -unit assisted living complex. Projections for the operation of all three facilities require no county levy. The administrator also discussed the Lakeview facility in LaCrosse County. The residents in this facility require a higher level of care due to behavioral issues. Lakeview formed a commission with other counties which allowed Lakeview to get around the issue of Medical Assistance supplementation when billing other counties for the higher cost of care for placement at St. Croix County Health and Human Services Board Page 6 January 19, 2011 Lakeview. They have a continuum of care that focuses on behavioral issues, but are reported to require county levy to continue to fund operations. Discussion on business planning included estimated cost savings if the St. Croix Health Center was at the median cost of other governmental homes. Estimated savings is approximately $1.12 million. The facility is not overstaffed for operating on two floors as was again reviewed by the auditors as part of the business planning work that they completed. The acuity level of care between other facilities in the area and St. Croix Health Center are also very similar. There was dialog on the Nursing Home business plan at the Committee of the Whole with no direction given after the meeting. Standafer indicated that the intent of the meeting was to have dialogue and not set a direction on the future of the facility. Johnson questioned if an alternative for the Health and Human Services Board is to bring this issue back to the Committee of the Whole to have discussion about the future plans, which Standafer indicated that would be an option. Dupre read from documentation from the 2000 Nursing Home financial statements indicating the Nursing Home paid for the Nursing Home building in 1982, with interest, and there was nothing in the assumptions of the business plan to include the proceeds from the sale of the Nursing Home building. Marzolf asserted the Board owes it to the constituents to give Robinson the chance to do what he can for the facility. Robinson said the $286,000 increase in insurance costs alone for 2011 is not sustainable. Robinson reported the levy today is less than the $1.3 million it was in 2005. He indicated the Nursing Home is at the end of the line in reductions that can be made. None of the plans in the business plan from LarsonAllen show an ability to get off the levy. Robinson said the things that can be controlled for the Nursing Home have been controlled. Revenue has been enhanced as well as can be done. The Nursing Home census has been impacted due to the press coverage and the public perception of the longevity of the Nursing Home being in question. Robinson said the Nursing Home census is down to 59 today; however, most of the surrounding nursing homes have also reported a lower census. Robinson indicated the issue of bed tax was addressed at a recent meeting with legislators in that Federal matching dollars were used to fund other Medical Assistance programs and the nursing homes are not getting the full amount promised. It was consensus of the Board to table this issue for the February HHS meeting and have a recommendation or resolution to take appropriate action ready for the March County Board or Committee of the Whole meeting. The Board recessed from 10:02 — 10:12 AM. WORK PLAN FOR HEALTH CENTER K -TAG 67 VIOLATION The facility is asking for an extension on the K -tag situation. SEH architects and engineers are on board with the situation. Air flow readings will be taken in January and then the State will be contacted regarding extending the time table beyond 06/10/2011. If an extension is not granted, the work that is being completed now will allow completion of the project within June 2011 deadline. St. Croix County Health and Human Services Board Page 7 January 19, 2011 Tobin said this issue has gone to the Administration Committee and money has been transferred to complete the project. REPORT FOR FIRE MARSHALL INSPECTION ON HEALTH CENTER During a recent routine inspection by the Fire Marshall it was discovered that doors in the basement were not closing properly. Maintenance suspects that there are water drainage problems in the wall of the Nursing Home. A temporary repair has been made and approved by the Fire Marshall until spring when Building Services staff will investigate further to try to determine the source of the water getting in the wall. Repair plans and estimated costs will be reviewed at a later time. Tobin also reported there are ice dam problems in the HHS building. FOLLOW UP ON ECONOMIC AND EMPLOYMENT IMPACT REPORT FOR ST. CROIX HEALTH CENTER Johnson gave the Economic Impact report from NorthStar Economics to Bill Rubin, Executive Director of Economic Development, who endorsed the report as being acceptable. NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census for November was 61, with 7 Medicare, 37 Medicaid, 16 private pay, and 1 insurance resident. The Medicare average daily rate paid is $533.530 compared to the budgeted amount of $426.00. Robinson said charting at the kiosks is more accurately reflecting care being given and resulting in higher reimbursement for the acuity of care. Robinson believes the press the Nursing Home has been receiving has resulted in the census being down. Robinson reported that WTTC has moved all clinicals for RNs and CNAs to St. Croix Health Center. There are currently 14 CNA students and 7 -8 RN students in clinicals. The reason WITC gave for moving all clinicals to St. Croix Health Center is because of the quality of care they see at our facility. Robinson explained bedhold charges for residents who go to the hospital, etc. are only able to be charged when census is above 94 %. Census today is at 86 %. Robinson complimented Tobin and Building Services staff on doing an excellent job on snow removal. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson distributed a vacancy report for January, which included the following positions: St. Croix Health Center: • 90% RN Evening Supervisor • 45% Food Service Worker • 40% CNA position St. Croix County Health and Human Services Board Page 8 January 19, 2011 Economic Support: • Economic Support Specialist St. Croix Industries: • Job Developer Robinson explained staffing is adjusted according to the census in the Nursing Home. If these positions are not approved, they will need to be covered by on -call staff, other part-time staff, overtime or pool staff. An Economic Support Specialist position was added in May of 2010. Training time for the Economic Support Specialist positions is lengthy. The position that began in May was able to reach a full caseload last week, having received cases intermittently since August 2010. Another Economic Support Specialist submitted her resignation to be effective today. The caseload numbers for Economic Support have increased significantly over the last few years. The county would lose federal match funding of 50% if the position was not filled. Johnson reported issues with site to site communications. He reported delays between switching screens in Economic Support, which is significant for a unit that is completely electronic. He reported skips on voicemail messages, which have also now shown up in phone conversations. Technical support is needed and the connection between Hudson and New Richmond needs to improve. This issue was reviewed with the Administration Committee and the Ad Hoc Facility Planning Committee and longer range solutions are being reviewed at next month's meeting. The Job Developer position for St. Croix Industries was previously approved and filled. However, that person resigned from the position. The trend for St. Croix Industries is towards more integrated employment. St. Croix Industries is a revenue source for the County. Motion A motion was introduced by Berenschot, seconded by Marzolf, and unanimously adopted: That the Board approves moving all positions forward to the Administration Committee. ECONOMIC SUPPORT — FEDERAL POVERTY LIMITS The income limits for eligibility for Food Share have not changed since April of 2009. Limits are based on Federal Poverty Levels. The caseload and recipient numbers for Food Share have more than doubled since 2006. MEDICAL ASSISTANCE TRANSPORTATION BROKER The State had a plan to centralize and manage the Medical Assistance Transportation program. The date has been delayed until July 1, 2011 and now Economic Support will have to continue to provide the service. This is a busy program and will place an extra burden on Economic Support staff for work that was planned to be done by a centralize contract provider by April 1 st REPORT ON THE CHANGES IN FAMILY CARE MEETING Approximately 25 consumers attended the 12/15/2010 meeting. Thomas Cook reviewed client rights and responsibilities at the meeting. Johnson distributed a State memo that provides some clarification regarding authorization for prevocational services. There appears to be less focus on time limits for pre - vocational services and a statement that this service is a viable alternative for consumers as long as integrated St. Croix County Health and Human Services Board Page 9 January 19, 2011 employment is explored and considered. MULTI- SYSTEMIC TREATMENT (MST) TRAINING The MST program is being developed in an attempt to avoid placement for clients outside of the home. This will be the first certified MST program in Wisconsin. Training was budgeted from part of the OJA (Office of Justice Assistance) grant. Three staff will be going to one -week training in South Carolina, which is the next step in developing the MST program. Standafer questioned the possibility of sending one staff versus three and then train the trainer. This is not part of the MST contract. The MST program is being implemented in an attempt to avoid residential placement and to send staff to this training will cost approximately half of the cost of one month of residential placement for one client. Motion A motion was introduced by Marzolf, seconded by Schrank, and unanimously adopted: That the Board approves attendance of three staff attending one -week MST training in South Carolina. REPRODUCTIVE HEALTH TRAINING A staff from Reproductive Health received a grant to attend contraceptive technical training in Boston in April, 2011. The grant will cover all costs except for wage and fringe costs. Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted: That the Board approves attendance of two staff to attend contraceptive technical training in Boston. PUBLIC HEALTH PREPAREDNESS CONSORTIUM Previously 25% of preparedness funding went to the Western Regional Partnership to support the consortium. Now all monies go to the Counties. The County has the choice to keep all the monies and manage preparedness without the partnership or to make a portion of the monies available to the partnership. Administration is recommending continuing to utilize the partnership and to pay the County's portion to the partnership. Staff will meet with Emergency Communications to begin to explore how funding could be utilized locally to support more collaboration between County departments to complete preparedness work. WISCONSIN CHILD AND FAMILY SERVICES REVIEW REPORT This item will be tabled until February as staff that were scheduled to give the report are performing interviews today. DEPARTMENT OF CHILDREN AND FAMILIES EMERGENCY RULE — FOSTER CARE DCF 56): This item will be tabled until February as staff that were scheduled to give the report are performing interviews today. WISCONSIN HEALTH INFORMATION TECHNOLOGY EXTENSION CENTER ( WHITEC) PROPOSAL WHITEC is a subsidiary of Medistar and is a health care based organization for meaningful use of electronic health records. Kirt reported there are two staff in the building who qualify for funding under WHITEC to get Physicians and Advanced Practice Nurse Prescribers to meaningful use. Fully instituted certified electronic health records need to be in place before payments start, but each position could bring up to $63,750 to the agency. WHITEC will analyze the county's needs and look at ECHO, along with other EHR systems to make recommendations. St. Croix County Health and Human Services Board Page 10 January 19, 2011 WHITEC will also work with Public Health records. Electronic health records (EHR) need to be in place by 2015 and WHITEC will help us move to meaningful use of EHR. The cost through WHITEC would be $16,633, which is less than the $34,000 we budgeted for EHR consultation in 2011. Kirt explained that ECHO would only do part of the change for about the same amount of money. Corporation Counsel has reviewed the contract with WHITEC. It was the consensus of the committee to move forward with WHITEC. POSSIBLE AGENDA ITEMS FOR NEXT MEETING • Public Health Preparedness Consortium • Wisconsin Child and Family Services review report • Department of Children and Families Emergency Rule- foster Care DCF 56 • Recommendations on Business Plan for St. Croix Health Center Larson asked if there were any other issues to bring before the Board. Larson adjourned the meeting. Time: 11:29 AM Chair: Attest: (Secretary)