HomeMy WebLinkAboutHealth & Human Services 02-16-11 Berenschot will review vouchers.
Revised: 02/09/11
NOTICE OF MEETING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
DATE AND TIME: February 16, 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 - 01/19/11
DATE OF NEXT MEETING — 03/16/11 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. Nursing Home Administrator's Report
4. Personnel Issues
a. New employees /vacancies
5. Update on Financial department changes
6. Follow up on Business Plan for St. Croix Health Center
7. Public Health Preparedness Consortium
8. Wisconsin Child and Family Services review report
9. Department of Children and Families Emergency Rule- foster Care DCF 56
10. Telephone and network planning between New Richmond and Hudson
11. "Public Health Accreditation Grant
12. "Prenatal Care Coordination
13. * *Well Child Screening
14. Possible agenda items for next meeting
NOTE: A quorum of the St. Croix County Board of Supervisors (County Board) may be present
at this meeting. Therefore, this notice also serves as notice of a meeting of the County Board for
the purpose of obtaining information relating to subjects listed above for use at future County
Board meetings.
ADJOURN
(Items may be taken in different order)
** Additions /Changes /Corrections
Items for County Board approval must be submitted to the County Clerk's office
by Wednesday morning preceding a County Board meeting.
2/9/2011 8:27 AM
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
February 16, 2011
The St. Croix County Health and Human Services Board met on February 16, 2011 at the St.
Croix County Health and Human Services/Health Center complex.
MEMBERS PRESENT: Leon Berenschot
Frederick Horne
Roger Larson
Linda Luckey
Richard Marzolf
Dr. Lisa Ramsay
Alfred Schrank
MEMBERS ABSENT: Deb Rasmussen, excused
Esther Wentz, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Frank Robinson, Nursing Home Administrator
Tonya Kusmirek, Financial Manager
Wendy Kramer, Public Health Officer/Public Health Coordinator
Kathy Dunlap, Family and Children's Coordinator
Kathy Fredrickson, Public Health RN
Sharon Reyzer, Public Health Supervisor
Malva Sirek, Clerical Supervisor
OTHERS PRESENT: Tammy Funk, Human Resource Coordinator
Daryl Standafer, County Board Chair
Sharon Norton - Bauman, County Board Member
Art Tobin, Building Services Director
Casey Swetlik, Communications/Emergency Management Director
Tom Boron, Information Technology Director
Katie Korbel
Norm Matzek
Jeff Holmquist, New Richmond News
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
Friday, February 25, at 8:30 AM. The following meeting is scheduled for Wednesday, March
16, 2011 at 8:30 AM.
AGENDA Motion A motion was introduced by Berenschot, seconded by Schrank, and
unanimously adopted: That the agenda be approved as distributed.
St. Croix County Health and Human Services Board
Page 2
February 16, 2011
MINUTES Motion A motion was introduced by Schrank, seconded by Marzolf, and
unanimously adopted: That the minutes of the 01/19/11 Health and Human Services Board
meetings be approved with modifications noted by Marzolf.
CONSIDERATION OF CLAIMS All check registers for January for funds 205, 225, 230, 600
and 625 were reviewed by Health and Human Services (HHS) Board member Berenschot. All
questions were answered satisfactorily.
Motion A motion was introduced by Berenschot, seconded by Horne, and unanimously
adopted: To approve the January vouchers.
FINANCIAL REPORTS The following financial report for Health and Human Services through
December, 2010 was distributed. Kusmirek reminded members that the reports for December are
fluid and more year end expenses and revenue will come in. Kusmirek noted the next phase for
financial reporting will be to move to accrual accounting as the January report has very little
revenue reported. Kusmirek noted part of the 2010 payroll needs to move back to 2010 from 2011
and that should be done soon. HSRS and CARS reporting needs to be submitted by 03/31/2011 for
final report.
St. Croix County Health and Human Services Board
Page 3
February 16, 2011
Health & Human Services - Fund 225
December 2070 as of Fe6rua 8, 207 7
Annual December Budget % of
Revenue by Service Budget Actuals Balance Budget
Administration $ 4,562,746 $ 4,260,192 $ 302,554 93.4%
AODA Services 768,662 505,922 152,740 78.8%
Mental Health 2,566,089 2,255,164 310,925 87.9%
Family & Children's 1,635,999 1,238,154 397,845 75.7%
Public Health 1,042,872 1,113,130 70,258 106.7%
Economic Support 748,945 1 1,508,410 759,465 201.4%
General Relief 3,000 - 1 3,000 0.0%
Coordinated ServiceslSED 2,380,583 2,571,067 190,484 108.0%
Car over Funds 1,049,211 1,049,211 - 100.0%
Service Revenue $ 14,758,107 $ 14,601,251 $ 156,856 98.9%
Annual December Budget % of
Expenditure by Service Budget Actuals Balance Budget
Administration $ 1,236,281 $ 1,209,163 $ 27,118 97.8%
Alcohol-Druq Abuse 768,662 758,422 10,240 98.7%
Mental Health 3,702,935 3,319,509 383,426 89.6%
Family & Children's 3,188,401 2,513,288 675,113 78.8%
Public Health 2,035,641 1,997,257 38,384 98.1%
Economic Support 1,020,270 1,178,450 158,180 115.5%
General Relief 3,000 500 2,500 16.7%
Coordinated Semce /SED 2,802,917 2,955,156 152,239 105.8%
Service Expenditures $ 14,758,107 $ 13,941,745 $ 816,362 94.5%
Revenues Over (Under) Expenditures $ 659,506
Expected Percent of Budget 100.096
2040 Figures are fluid during the Year End Closing Process
The following financial report for St. Croix Industries through December, 2010 was distributed.
Again, Kusmirek indicated that the reports for December are fluid as more year end expenses and
revenue will come in. Kusmirek again noted part of the 2010 payroll needs to move back to 2010
from 2011 and that should be done soon.
St. Croix County Health and Human Services Board
Page 4
February 16, 2011
S t. Croix Industries - Fund 625
December 2040 as of February 8, 2044
Annual December Budget % of
Revenues Budget Actuals Balance Budget
S Op erations 1,375,209 1,464,226 89,017 106.5%
S Production 306,513 353,739 47,226 115.4%
S Helpinq Hands 86,500 144,841 58,341 167.4%
S Popf\/endinq 6,300 13,731 7,431 218.0%
S Ram 3,350 7,317 3,967 218.4%
S Vocational Placement 341,488 361,613 20,125 105.9%
S Comm Based Day Proq 197,730 109,475 88,255 55.4%
Total Revenue $ 2,317,090 1 $ 2,454,942 $ 1 37,852 1 05,996
Annual December Budget % of
Expenditures Budget Actuals Balance Budget
S Op erations $ 1,375,209 $ 1,183,584 $ 191,625 86.1
S Production 306,513 386,808 80,295 126.2%
S Helpinq Hands 86,500 94,948 8,448 109.8%
S PopNendinq 6,300 7,130 830 113.2%
S Ram 3,350 3,758 408 112.2%
S Vocational Placement 341,488 309,959 31,529 90.8%
S Comm Based Day Prog 197,730 141,548 56,182 71.6%
Total Expenditures 2,317,090 2,127,734 $ 189,356 91.8%
Revenues 0ver([Under) Expenditures $ 327,208
Expected Pefeent of Budget 100.0%
2040 Figures are fluid during the Year End Obsing Process
The following financial report for the Nursing Home through December, 2010 was distributed.
Kusmirek noted payroll changes for the Nursing Home from 2011 to 2010 are reflected in the
following report. The Medicare area is slightly lower than budgeted; however, private pay numbers
are higher than budgeted. IGT funds have been broken down between 2010 and 2011 according to
the report received from the State. Utilities are now monitored by a separate meter to more
accurately reflect usage.
St. Croix County Health and Human Services Board
Page 5
February 16, 2011
St. Croix Health Center - Fund 600
December 2010 as of February 8, 2011 % of
Operating Revenue Budget Actuals Difference Budget
Medicare $ 2,223,908 $ 1,416,640 $ 807,268 63.7%
Medicaid 2,043,172 2,056,053 12,881 100.6%
Private Pay 975,919 1,401,256 425,337 143.6%
Revenue - GT/Supplernental Funds 469,000 742,420 273,420 158.3%
Out Patient Thera - 15,039 15,039 0.0%
All Other Sources 18,458 10,740 55 7,717 582%
Total Operating Revenue $ 5,730,457 $ 5,642,149 $ 88,308 98.5%
Operating Expenses
Daily Patient Services $ 3,827,182 $ 3,944,245 $ 117,064 103.1%
Special Services 287,498 278,371 9,127 96.8%
General Services 1,239,492 1,198,465 41,027 96.7%
Administrative Services 510,305 598,034 12,271 98.0%
Sub Total $ 5,964,477 $ 6,019,116 $ [54,638] 100.9%
Other
Utilities $ 208,461 $ 126,546 $ 81,915 60.7%
Workers Comp, Computer Tech 264,602 117,731 146,871 44.5%
Insurance 55,000 74,119 19,119 134.8%
Unassigned Sub Total $ 528,063 $ 316,397 $ 209,666 60.3%
Total Operating Expenses $ 6,492,540 $ 6,337,512 $ 155,028 97.6%
Revenues Darer f Under Ex enditures from Operations $ ( 695,364)
County Revenues
Insurance ❑ividend -unexpected revenue not result of Operations $ 9,160 $ 100,853 $ (91,693) 1101.0%
Co Allocations - Le % Based 616,131 616,131 1000%
Nursinq Home Carry Over 136,792 136,792 100.0
Total Outstanding $ 762,083 $ 853,776 $ (91,693)1 112.03%
Revenues Over (Under) Expenditures Including County Contributions $ 156,413
Expected Percent of Budget 100.096
- We have received a prepayment of 1GT in the amount of $458,500
$241,250 for 2010
$217,150 for 2011
2010 Figures are fluid during the Year End Closing Process
AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts
Receivable report for Health and Human Services through January, 2011 was briefly reviewed.
Kusmirek indicated after year end books are closed, more focus will be placed on accounts greater
than 90 days out. The industry average indicates anything over 90 days is difficult to collect. When
accounts are moved to collections, those accounts are moved off the books. If there are collections
on those accounts, those amounts are reflected in doubtful accounts.
UPDATE ON FINANCIAL DEPARTMENT CHANGES Johnson reported each department in
Health and Human Services (HHS) has met with Kusmirek and the auditors in an attempt to
consolidate revenue streams. Reports from other counties are being investigated also. The next step
will be to look at expense line items which have previously been discussed with the Board.
New Richmond staff is doing some groundwork to develop procedures regarding financial
activities. Written procedures will give consistency in reporting, cash handling, voucher system
(New Richmond staff handles vouchers differently than Hudson staff), etc. This lack of written
St. Croix County Health and Human Services Board
Page 6
February 16, 2011
procedures has led to frustration but a process has been set to develop and write these processes to
address this concern. Financial staff is being cross - trained for redundancy and back up.
WISCONSIN CHILD AND FAMILY SERVICES REVIEW REPORT Dunlap reported in 2010
the Federal Child and Family Services Review process began. This review of Family and
Children's was first done in Wisconsin in 2003. She reported Wisconsin failed this Federal review
as did all the other States. This second review focused on Milwaukee, LaCrosse and
Sauk/Columbia County in 2010 and again the State did not pass the review. Some of the identified
challenges have to do with timely response to maltreatment, addressing permanency goals for
children consistently across the State, accessibility to service array, child well -being outcomes and
ongoing training. Examples related to impact of this Program Improvement Plan were discussed. St.
Croix County has very few (18) in out -of -home care with three of those in court- ordered Kinship
care, so permanency outcomes may be less of a concern locally. Impact of the Program
Improvement Plan will continue to be addressed at the local level.
DEPARTMENT OF CHILDREN AND FAMILIES EMERGENCY RULE- FOSTER CARE DCF
56: In the Family and Children's Service Review of Wisconsin's child welfare system this past
year, the Federal Administration for Children and Families found that Wisconsin is not operating in
substantial conformity with a number of provisions. The Department has submitted a program
improvement plan that commits the Department to complete implementation of levels of care
system and child assessment tool throughout the first quarter of 2011. Discussion included review of
levels of care implementation at the local level and training requirements for foster parents and staff.
PRENATAL CARE COORDINATION (PCC) Fredrickson has been PCC Coordinator for over a
year. PCC is provided for pregnant women, newly pregnant women through WIC or reproductive
health. Fredrickson highlighted areas covered by PCC such as tobacco use /exposure, alcohol use,
breastfeeding, perinatal depression, safe infant sleep practices, family planning supplies and
services, medical pre -natal care and involved fathers. Education needs are investigated and pre-
natal classes are encouraged.
WELL CHILD SCREENING One outcome of Public Health's strategic planning was to provide
more reporting to the Board. Well Child Screening is a Medicaid or sliding fee for service physical
exam provided by a registered nurse that includes vision, hearing, development screenings, lab
work, health and nutrition counseling. The services for this program have been cut from two to one
day per month because the number of clients has decreased due to minute clinics being available in
the community. This program sees foster care children for their required physical for placement.
PUBLIC HEALTH ACCREDITATION GRANT Public Health has taken steps to move towards
voluntary accreditation. A grant opportunity is now available that could support staff efforts if the
grant is awarded. The accreditation program is aimed at improving the public's health through
improved quality and performance of public health departments. Approximately $300,000 of
funding has been released through the Public Health Accreditation Board through a cooperative
agreement with the Centers for Disease Control and Prevention. St. Croix County Public Health
applied for $12,000 to begin working towards establishing a Quality Improvement Plan, begin
implementation of a Quality Improvement Plan, and identification of appropriate Performance
St. Croix County Health and Human Services Board
Page 7
February 16, 2011
Management systems and tools that will work best for our department and how to implement. These
monies were not included as part of the 2011 budget process.
Motion A motion was introduced by Marzolf, seconded by Schrank and unanimously adopted:
That the Board approves Public Health to proceed with the Public Health Accreditation Grant.
Kramer indicated this grant will cover some expenses of the process, but not all; however, the
grant will offset costs of something Public Health would do anyway.
The Board recessed from 10:00 — 10:08 AM.
TELEPHONE AND NETWORK PLANNING BETWEEN NEW RICHMOND AND HUDSON
Boron explained there is a 10 meg microwave link for phone and data between Hudson and New
Richmond. There have been some phone drops with the phone system with this link. Boron is
looking to Frontier for an internet solution to this problem and to use the microwave as a fall back
plan. The phone /internet bundle would be slightly higher than what we are currently paying for this
service. The Frontier bundle may or may not fix the problems noted; however, this would help with
speed with the internet feeds, which would help with Economic Support applications. Swetlik
indicated that another option would be to investigate the problem through Five Star if the phone
problem is not solved. Five Star is a Mitel expert out of LaCrosse/Eau Claire. There is consultant
money in the IT budget to cover Five Star's investigation. This backup plan is being implemented
as fiber between New Richmond and Hudson is no longer a viable alternative. This is not a long
term solution to the telephone and network link between New Richmond and Hudson, but should
improve service. Longer range solutions will be reviewed as part of the facility planning committee
work.
PUBLIC HEALTH PREPAREDNESS CONSORTIUM Health and Human Services staff has met
with Emergency Communications to begin discussion on how the two departments could
collaborate to complete preparedness work. When the next funding cycle ends on 08/09/2011, the
county will have the option to decide where preparedness monies will be spent. Until that time,
there is no flexibility with preparedness funding as currently some monies come to the County and
some go to the preparedness consortium. Kramer said a lot of counties still want to be a part of the
consortium; however, LaCrosse, Monroe and Dunn County will not be a part of the consortium.
The consortium has provided good leadership and has prepared most of the planning that is
currently in place. Emergency Management and Public Health could be able to compliment each
other and form a merger. Emergency Management is going before the County Board on 03/01/2011
to request a .5 position. It is possible if that position is approved, duties could be added to the
position but the position would not be able to meet all preparedness needs. This will be considered
as part of the 2012 budget process.
PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson indicated there were no
vacancies to report for January. He said all positions approved at the January meeting were
approved at the Administration Committee and have now been forwarded to the County Board.
Johnson said four new contract employees have been hired. Teresa Largaespsada and Kelly McNiff
have gone to training for MST program and are developing a caseload. Nancy Wiedmeyer and
St. Croix County Health and Human Services Board
Page 8
February 16, 2011
Michelle Lloyd have begun as YCSS Social Workers. Sara Sedahl is scheduled to begin
02/28/2011 to fill the AODA Counselor position.
NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census
for December was 60, with 6 Medicare, 37 Medicaid, 15 private pay, and 2 Family Care
residents. Robinson noted census is down overall but January Medicare census has improved at
9. The Medicare average daily rate paid is $533.53 compared to the budgeted amount of
$426.00. Staff are managing the updates made to MDS in October, 2010 well.
Robinson reported the Nursing Home had a very successful holiday party for the residents and
their families with over 300 family members attending.
Robinson reported the Nursing Home is beginning a soup and salad bar for staff today.
Robinson noted no major adjustments in the private pay census because of the increased rate. He
noted the Nursing Home census is traditionally down over the holidays.
A request has been submitted to extend the k -tag waiver past June. The plenum is the only
outstanding issue left on the k -tag. It is anticipated the State surveyors will conduct their survey
in March or April.
FOLLOW UP ON BUSINESS PLAN FOR ST. CROIX HEALTH CENTER Johnson said a
question was raised at the last meeting regarding the sale proceeds if the Nursing Home was sold.
Johnson said after consulting with Greg Timmerman, Corporation Counsel, it was determined the
proceeds are not required to go to the Nursing Home as the Nursing Home is a County asset.
Johnson reviewed some of the issues Governor Walker is exploring. The proposal includes
employee share of WRS (Wisconsin Retirement System) be paid by the employee, versus the
State /County. He is also proposing employees contribute up to approximately 12% of the health
insurance premium. Johnson said that preliminary estimates for health insurance premium and
WRS contribution adjustments could impact the five funds for the Health and Human Services
budgets by approximately $700,000. Approximately $187,000 of that would be a decrease in the
Nursing Home budgeted expense if the measure is passed.
Marzolf proposed increasing the deductible on health insurance in an attempt to decrease health
insurance premiums. Funk indicated the health insurance committee has been meeting on this
subject. Under Walker's proposal, health insurance premiums would not be negotiable. It was
indicated the County has been unable to negotiate the Nursing Home union separately from other
unions in the County.
Horne questioned if a collaborative effort could be made to keep the Nursing Home open to be a
success. What happens with the Nursing Home will have an impact on the City of New Richmond.
Marzolf said it is critical to carry out decisions made in the strategic planning sessions and move in
the right direction. Larson said there has been a lot of discussion but no plan to move forward to the
County Board. He proposed a separate meeting to move forward with the Nursing Home. He
St. Croix County Health and Human Services Board
Page 9
February 16, 2011
would like another meeting held before the end of February to discuss the Nursing Home.
Standafer said the State of Wisconsin is broke. He said the County will be receiving significantly
less money from the State due to massive and severe cuts in funding sources and questioned the
consequences of the cuts.
Marzolf recommended inviting Colleen Bates, Eau Claire County Board Vice Chair, to a future
meeting. Marzolf felt she could possibly provide some insight into possible consequences of closing
the Nursing Home that St. Croix County cannot foresee. Standafer suggested that Greg Moore, Eau
Claire County Board Chair, be invited to attend as he may have a differing viewpoint that should
also be discussed.
It was questioned how many protectively placed residents were in the Nursing Home. Robinson
indicated he is not sure of the count but that everyone is treated equally despite their placement
status. Johnson reported there are 32 protectively placed persons in St. Croix County skilled care
facilities, with six being placed at the Nursing Home. Discussion was held about the care needs of
these residents and that they are not paid for by St. Croix County, specifically the behavioral health
unit. St. Croix County does not pay for protectively placed residents at other facilities as they are
mostly covered by Medical Assistance.
Norton - Bauman said to maintain and utilize the building the way it is will not do anything to reduce
the cost of operation. Horne said the Nursing Home needs a long term plan and to engage the
workers, the union, and the County Board.
Motion A motion was introduced by Berenschot, seconded by Horne, and unanimously adopted:
That the Health and Human Services Board will hold another meeting on February 25, 2011 at 8:30
AM in New Richmond.
Motion A motion was introduced by Marzolf, seconded by Horne, That those members who
receive per diem for meeting attendance will relinquish their per diem for that meeting.
Roll call vote:
Esther Wentz- absent
Leon Berenschot -no
Frederick Horne -no
Roger Larson -no
Linda Luckey -no
Richard Marzolf -yes
Dr. Lisa Ramsay -no
Deb Rasmussen- absent
Alfred Schrank -no
One yes, six no, two absent, motion failed.
Standafer indicated waiving per diem should be voluntary, not mandatory. It is an individual decision to not
claim per diem if you do not want to claim.
St. Croix County Health and Human Services Board
Page 10
February 16, 2011
POSSIBLE AGENDA ITEMS FOR NEXT MEETING
• Follow up 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: 11:25 AM
Chair:
Attest:
(Secretary)