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HomeMy WebLinkAboutHealth & Human Services 01-17-07 Leon Berenschot will review vouchers. REVISED 01/16/07 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD January 17, 2007 at 8:30 AM (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 12/18/06 DATE OF NEXT MEETING — 02/21/07 8:30 AM OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report 3. Barn - Contingency Fund Request 4. Nursing Home Report 5. Health and Human Services Facility Planning 6. Surgeon General's Report Action 7. Economic Support Program Review 8. Personnel Issues a. Limited Term Employment- Medical Records and Long Term Support** 9. Long Term Support-Long Term Care Reform/ADRC 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. 1/16/2007 12:36 PM c ' ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD January 17, 2007 The St. Croix County Health and Human Services Board met on January 17, 2007 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Gordon Awsumb Leon Berenschot Lois Burri Tom Caflisch Linda Luckey Ronald Troyer MEMBERS ABSENT: Dr. Michael Kretz, excused Deb Rasmussen, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Bill Van Offeren, Nursing Home Administrator Ron Lockwood, Long Term Support Coordinator Steve Kirt, Behavioral Health Clinical Services Supervisor Ron Kiesler, Behavioral Health Coordinator Kathy Huston, CSP Coordinator Mary Squyer, Economic Support Supervisor Ron Eichstaedt, Director, St. Croix Industries Colleen Hammer, Rehab Coordinator, St. Croix Industries Deb Willink, Long Term Support Social Worker Cia Westphal, Long Term Support Social Worker Wendy Kramer, Public Health Supervisor Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Kjersti Duncan, Director, Department on Aging Dan Reis, Pierce County Board Judith Frye, Dept. of Health and Family Services Diane Waller, Dept. of Health and Family Services Paul Cook, CMO Holly Hakes, Aurora Don Andresem, Aurora Keith Gregerson, Long Term Support Committee Chair Sumner Seidenkranz Kathy Shafer, Long Term Support Reggie Bicha, Pierce County Sue Gilbertson, Pierce County Long Term Support Lorraine Jacobs, St. Croix Co. Long Term Support 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, February 21, 2007 at 8:30 AM. Wentz will review February vouchers. AGENDA Motion A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the agenda be approved as circulated. St. Croix County Health and Human Services Board Page 2 January 17, 2007 MINUTES Motion A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the minutes of the 12/18/06 Health and Human Services Board meeting approved as circulated. LONG TERM SUPPORT -LONG TERM CARE REFORM /ADRC Judith Frye, Associate Administrator for Long -Term Support, Division of Disability and Elder Services, was present to give information and history regarding Long Term Care Reform. She reported 25 years ago Wisconsin was one of the first states to provide care and support in the community. Ten years ago concerns arose regarding existing programs because of substantial waiting lists so a redesign for the long term care systems was proposed. Governor Thompson came out with a model named Family Care. Family Care goals included choice access, quality, cost and effectiveness. Family Care has been piloted in five counties in an attempt to eliminate waiting lists. Family Care offers more access to people who need support and services. Family Care looks at all options for meeting clients' needs. It is consumer focused with individualized care plans that utilize an interdisciplinary team of care managers, which includes a nurse and social worker. Under current long term care reform planning, a RFP will be issued when requested to expand the Family Care type benefit to other portions of the State. This would create an entitlement program similar to counties where this benefit currently exists. Community Health Partnership is the private agency that has been working with a local consortium of counties, including St. Croix, to be the care management organization that would handle all services for eligible consumers. In other regions, counties are looking to form family care districts and be the care management entity. The state would contract with the managed care organization and provide reimbursement per enrollee based upon a capitated rate, which is actuarially sound. When the RFP is issued, it is an open competitive process. When questioned regarding cost being a variable for consideration in scoring the RFP, Frye responded that under State law, only quality can be considered, not cost. Frye will forward that statutory reference. While the process is competitive, there are not a lot of CMO's that have experience managing long term support services, so responses could be limited. There are several factors that will still need to be addressed as the county considers implementation. Choice for service is a major factor with only one CMO. There would likely be choices of service providers the CMO has contracts with, but the utilization of one CMO will require Federal approval. Choice for service may be the fee for service alternative which Frye indicated would not include current waiver programs. Additionally, the funding for long term care reform at this point is planned to include a county contribution. Wisconsin Counties Association proposes the contribution to be bought down to 22% of the Basic County Allocation (BCA). For St. Croix County, this would mean a buy down of the current contribution over a five year period. The Board recessed from 10:15 to 10:25 AM. ADRC (Aging and Disability Resource Center) will be important to all Wisconsin residents as a resource center. 70% of eligible people are not seeking public support, have their own resources and need help to make wise choices. An ADRC is needed before starting Family Care model. State and Federal government fully fund ADRCs, there are no county dollars, but clarification of this funding mechanism is needed as well as discussions on what fully staffed ADRC encompass. Some pilot counties received a small allocation for increased Economic Support needs but the monies were not sufficient, which continues to be a county concern. 4 -St. Croix County Health and Human Services Board Page 3 January 17, 2007 Long Term Care Reform can affect many other areas of Human Services. Staff reductions were questioned. No fiscal analysis has been done until variables are decided regarding implementation of Long Term Care after the Governor's budget is issued. The county obligation could be anywhere from $2.5 million to $300,000. Projected growth and inflation rate needs to also be considered in the analysis. The Board thanked Frye for her presentation. Contact will be made with Chuck Wilhelm regarding a financial analysis for Long Term Care. The Governor's budget should be issued by mid - February. Awsumb requested a copy of the state law and information regarding the scoring system for the RFP. The analysis should be ready to bring back to the Health and Human Services Board possibly by mid - February or March. Whiting indicated it is better to participate at the early stages rather than waiting. Discussed protesting the way the RFP is structured at Legislative Event on January 22 and writing a letter to the Governor. Johnson will draft a letter to address the concerns regarding RFP process as awards will be made with no consideration in regards to cost. The Board recessed from 11:00 to 11:05 AM. HEALTH AND HUMAN SERVICES FACILITY PLANNING Bob Brown from Ayres and Associates estimated the cost for costs and space study to be between $20,000 to $28,000. The estimate to do only a space needs study for Health and Human Services is $12,000 to $18,000. It was the consensus of the Board a conceptual plan is not needed for Health and Human Services at this time. Finance Committee decided to complete a space study for the Government Center at this time. The estimated cost for that study is approximately $10,000. Brown estimated both studies without a conceptual plan would be approximately $20,000. Issues to be reviewed will be active /inactive storage, staff sharing office space, long term what the county will need for land, Health and Human Services space at the Government Center, etc. Motion A motion was introduced by Caflisch, seconded by Awsumb, and unanimously adopted: That the Board approves proceeding with the space study for Health and Human Services in the amount of approximately $10,000. This is not a budgeted item. It was the consensus of the Board to review in September where the cost of the study should come from, Health and Human Services or request from the contingency fund. Whiting requested one contract from Brown of Ayres and Associates covering both Health and Human Services and the Government Center. A copy will also be sent to Johnson. CONSIDERATION OF CLAIMS Health and Human Services Board member Berenschot reviewed the vouchers. Motion A motion was introduced by Berenschot, seconded by Troyer, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 90410 through 90415, dated December 15, 2006 in the amount of $39,074.40. Human Services vouchers 91511 through 91543, dated January 11, 2007 in the amount of $53,381.92. Human Services vouchers 91544 through 91545, dated January 11, 2007 in the amount of $1,720.00. St. Croix County Health and Human Services Board , Page 4 January 17, 2007 Human Services vouchers 91546 through 91548, dated January 11, 2007 in the amount of $1,362.34. Human Services and Nursing Home vouchers 90429 through 90519, dated December 21, 2006 in the amount of $154,427.03. Human Services, Nursing Home, and Farm vouchers 90520 through 90567, dated December 21, 2006 in the amount of $33,826.18. Human Services and Nursing Home vouchers 90783 through 90895, dated December 27, 2006 in the amount of $725,788.22. Human Services and Nursing Home vouchers 91005 through 91012, dated January 04, 2007 in the amount of $2,912.64. Human Services, Nursing Home, and Government Center vouchers 91013 through 91111, dated January 04, 2007 in the amount of $175,275.12. Human Services and Nursing Home vouchers 91127 through 91272, dated January 04, 2007 in the amount of $114,999.16. Human Services and Nursing Home vouchers 91887 through 91901, dated January 11, 2007 in the amount of $8,892.62. Human Services and Nursing Home vouchers 92902 through 92109, dated January 11, 2007 in the amount of $203,813.99. Nursing Home vouchers 91112 through 91126, dated January 04, 2007 in the amount of $2,903.34. Nursing Home vouchers 92110 through 92148, dated January 11, 2007 in the amount of $32,323.21. Human Services, Workshop, Public Health, Social Services vouchers 793 through 824, dated December 26, 2006 in the amount of $364,266.52. Human Services, Workshop, Public Health, Social Services vouchers 1 through 32, dated January 09, 2007 in the amount of $361,849.32. Human Services and Nursing Home vouchers 726 through 755, dated December 28, 2006 in the amount of $151,760.63. Human Services and Nursing Home vouchers 1 through 32, dated January 11, 2007 in the amount of $165,150.14. Workshop vouchers 79 through 84, dated December 26, 2006 in the amount of $8,894.61. Workshop vouchers 1 through 6, dated January 09, 2007 in the amount of $11,437.13. FINANCIAL REPORT Pempek distributed the following Health and Human Services financial report for January through November. Pempek said the 2005 audit was completed when the auditors were here in November. WIMCR monies were moved forward to make 2005 whole. The monies expected from WIMCR for December are not anticipated to be received before March, 2007. -St. Croix County Health and Human Services Board Page 5 January 17, 2007 HEALTH AND HUMAN SERVICES - 2006 SUMMARY Total OF REVENUES Budget Jan - November Balance % Administration 925,134.00 1,127,253.21 (202,119.21) 121.8% AODA Services 649,146.01 624,261.34 24,884.67 96.2% Long Term Support 17,542,262.00 16,463,603.50 1,078,658.50 93.9% Mental Health 2,909,086.00 2,710,616.36 198,469.64 93.2% Family & Children's 3,120,265.00 3,019,998.30 100,266.70 96.8% SED 216,000.00 372,792.64 (156,792.64) 172.6% Public Health 1,537,680.00 1,397,169.34 140,510.66 90.9`'/ Economic Support 1,010,360.00 879,079.92 131,280.08 87.0% General Relief 15,000.00 13,787.00 4 Coordinated Services 260,403.00 169,682.75 90,720.25 65.2% REVENUES HUMAN SERVICES PROGRAMS 28,185.336.D1 26,778.244.36 1,405,878.65 95.0% SUMMARY Total OF EXPENDITURES Budget Jan - November Balance % Administration 925,134.00 910,613.24 14,520.76 98.4% Alcohol -Drug Abuse 649,146.01 656,409.06 (7,263.05) 101.1 Long Term Support 17,542,262.00 15,804,313.26 1,737,948.74 90.1% Mental Health 2,909,086.00 2,693,790.15 215,295.85 92.6% Family & Children's 3,120,265.00 2,527,872.93 592,392.07 81.0% SED 216,000.00 219,705.66 (3,705.66) 101.7% Public Health 1,537,680.00 1,397,436.73 140,24127 90.9% Economic Support 1,010,360.00 927,652.96 82,707.04 91.8% General Relief 15,000.00 989.50 14,010.50 &6`:'a Coordinated Services 260,403.00 173,804.22 86,598.78 66.7% EXPENDITURES HUMAN SERVICES PROGRAMS 28,185,336.01 25,312,587.71 2,872,748.30 89.8% Excess Rev over Expenses S 1.465.656.65 Percentage of Budget: 91.63 `WIMCR revenues recorded An IRS audit regarding supportive home care and respite care has been going on through the Government Center. Information has been provided as requested. Pempek distributed the following Nursing Home report for January through November. Pempek indicated there has been a shift of payment sources for Nursing Home residents. She reported the PTO payout will be on December's report. The update on Kronos has not taken place. Approximately $1,200 of the $14,000 has been spent thus far. Approximately $173,000 is reflected in Administrative Services for Pathways services through the first week of November. St. Croix County Health and Human Services Board , Page 6 January 17, 2007 ST C:ROIX HEALTH CENTER OPERATIONS REPORT Jan - Nov 2006 Jan - Nov 2006 BUDGET ACTUAL DIFFERENCE N CENSUS 66 61 -5 OPERATING REVENUE: MEDICARE $ 629,623.05 $ 959,128.79 $ (329,505.74) 152 % MEDICAID $ 2,609,616.07 $ 1,788,009.69 $ 821,606.38 69% PRIVATE PAY ' ` $ 547 ,475.00 $ 947 ,463.75 $ C399,988.75) 173% ALL OTHER SOURCES' $ 220,453.00 $ 243,417.36 $ (22,964.36) 110% TRANSFER, FROM CONTINGENCY $ - $ - $ - TOTAL OPERATING REVENUE $ 4,007,167.12 $ 3,938,019.59 $ 69,147.53 98% OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,363,410.47 $ 3,011,486.44 $ 351,924.03 990 SPECIAL SERVICES $ 274,458.35 $ 223,696.77 $ 50,761.58 82% GENERAL SERVICES $ 1,169,758.41 $ 953,469.21 $ 216,289.20 82% ADMINISTRATIVE SERVICES $ 527,734.19 $ 639,024.79 $ (111 290.60) 121% UNASSIGNED: DEPP,ECIATION( %BASED) $ - $ - $ - $ 373 ,372.00 $ 373 ,372.00 0% Utilities $ 110,769.10 Workers Comp, Computer Tech $ 194,415.98 Insurance $ 63,069.83 OTHER EXP: $ 368,254.91 TOTAL OPERATING EXPENSES $ 5,708,733.42 $ 5,195,932.12 $ 512,801.30 91% NET FROM OPERATIONS $ - $1;1.257.912.53} (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) EXTRAORDINARY REVENUES RATE APPEAL REV $ 14,824.00 $ 14,824.00 $ - 100% % OF OUTSTANDING IGT REV $ 377,000.00 $ 188,070.00 $ 188,930.00 50'3% CO ALLOCATIONS(%BASED) $ 1,309,742.30 $ 1,196,745.00 $ 112,997.30 91% TOTAL OUTSTANDING $ 1,701,566.30 $ 1,399,639.00 $ 301,927.30 NET FROM ALL SOURCES $ 141,726.17 PERCENTAGE SHOULD BE 91.66% Potential Salary Increases: $16.856 - $50,567 annual projection "IGT Award 2nd lralf in tfre anyt of $196,000 12.-"06 $7070 over b(Iflt Total IGT Award $384070 Arrtfcfpated Clef)redatlon for 2006 $117,548 'St. Croix County Health and Human Services Board Page 7 January 17, 2007 Accounts receivable work has been getting back on track for billings. The ECHO software update has been applied and payments are showing up on billing statements. It is hoped to have a "clean" system by February. Protocol for accounts receivable has been reviewed with Wipfli and they had no additional suggestions. If there is no activity or payment on an account for six years, the account needs to be removed from the system. There may be some write offs for accounts receivable that will be reviewed with the Board at future meetings. BARN - CONTINGENCY FUND REQUEST The cost to pump the manure pit was $4,510. This amount was deducted from the second land rent payment made by John Schottler. When the pit was emptied it was noted the pit is in need of reinforcement before being utilized again. Johnson reported after discussion with maintenance and possibility of utilizing the barn as an animal shelter, straw was not placed on the barn floor as requested. It was the consensus of the Board to document this transaction and bring back as a request to the contingency fund later in the year along with a year -end for the department if necessary. Caflisch requested a RFP to dismantle and remove the barn from the county property be a future agenda item. NURSING HOME REPORT An additional informational meeting regarding the RFP was held on January 3, 2007. Another meeting was scheduled with an individual on January 10, 2007, but this vendor cancelled. VanOfferen reported seven entities attended the two meetings and six have expressed an interested in pursuing the RFP. All RFPs are due on February 15, 2007. A meeting regarding the RFP process is scheduled for February 8, 2007 at 1:00 PM. Johnson said there will have to be an election of officers as this is a new subcommittee. There will possibly be a closed session regarding the scoring of the RFPs. Another follow up meeting is scheduled for February 21, 2007 at 1:00 PM. Van Offeren reported the memorandum of understanding side letter has been signed by the union and administration. A memo was received from the State regarding the Norwalk virus. Van Offeren reported the Norwalk virus went through the nursing home and was handled correctly. A fine of $5,300 for the April 26 2006 incident was received on December 12. If the fine was paid in ten days, the fine was reduced to $3,500 so a check was sent. A notice has not been received regarding the July 31 incident. Discussion was held regarding possibly filing an appeal regarding the July 31 incident and get attorney recommendation. It was the consensus of the Board to do what is needed to talk to the attorney of record regarding an appeal. Van Offeren reviewed a letter received from Reinhart regarding new implications and consequences for falls in long term care facilities. Van Offeren reported a Fall Committee has been formed in the Nursing Home and meets three times a week. He said chair and bed alarms have been purchased in addition to hip savers. He said families get informed consent regarding protection for the residents from falls but some families refuse the additional aids. Falls are also reviewed by the Quality Assurance Committee. Van Offeren reported the current Nursing Home census is 63. He also reported there are 313 assisted living beds in St. Croix County; occupancy of those beds was not available. SURGEON GENERAL'S REPORT ACTION A meeting was held on December 21 regarding a e St. Croix County Health and Human Services Board Page 8 January 17, 2007 draft ordinance. Nick Andriacchi from Smoke -Free Wisconsin also attended the meeting. A draft ordinance has been forwarded to Corporation Counsel to review questions related to the county authority. A follow up meeting is scheduled for January 24, 2007. Nothing has been issued from the state regarding a statewide smoking ban. Corporation Counsel will review and send back to the subcommittee who will bring back to the Health and Human Services Board. PERSONNEL ISSUES Michelle Leccia has been hired as a full time social worker in Family and Children's. Paula Brandt resigned in Economic Support and recruitment is ongoing to replace this position. Recruitment is ongoing to fill the open position in Accounts Receivable. There was a brief discussion on the appropriate pay level of this position but this will be reviewed as part of full Springsted implementation and will consider accounts payable supervisor position as a comparable. Johnson requested a limited term employee for Medical Records and Long Term Support. Funding would come from an employee who is currently on LOA. This position would sunset when the employee returns from LOA. Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That the Board approves hiring a LTE Medical Record Assistant with the position to sunset when the permanent employee returns from LOA. ECONOMIC SUPPORT PROGRAM REVIEW This agenda item was postponed to the February meeting. Wentz asked if there were any other issues to bring before the Board. Malick received a letter questioning why Fentanyl deaths in St. Croix County were being investigated by the Medical Examiner rather than Public Health. Wentz adjourned the meeting. Time: 12:50 PM Chair: Attest: (Secretary)