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HomeMy WebLinkAboutHealth & Human Services 08-29-07 4.T NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 29, 2007 at 8:30 (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 - 08/15/07 DATE OF NEXT MEETING —09/12/07 at 8:30 a.m. OLD AND NEW BUSINESS 1. Nursing Home Subcommittee Report 2. Health and Human Services Facility Planning 3. Consideration of Financial Assistants position description 4. Personnel Issues -New Position Requests 5. Long Term Support-Long Term Care Reform/ADRC 6. Health and Human Services Governing Body By -laws Review 7. 2008 Budget Planning 8. Application of Health and Human Services and Nursing Home 2006 Audit Surpluses 9. Write off recommendations for Accounts Receivable 10. Accounts Receivable policies /procedures in response to WIPFLI report 11. LTS waiting lists - Children and Adults 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. 8/16/2007 8:26 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 29, 2007 The St. Croix County Health and Human Services Board met on August 29, 2007 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Gordon Awsumb Leon Berenschot Lois Burri Thomas Caflisch Dr. Glenn Hoberg Deb Rasmussen Ron Troyer MEMBERS ABSENT: Linda Luckey, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Bill Van Offeren, Nursing Home Administrator Fay Strenke, Accounts Receivable Supervisor Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor Kathy Dunlap, Family and Children's Coordinator Pat Haeny, Family. and Children's Supervisor Steve Kirt, Behavioral Health Clinical Services Supervisor Ron Kiesler, Behavioral Health Coordinator Ron Eichstaedt, Director, St. Croix Industries Kathy Huston, CSP Coordinator Norma Vrieze, Early Intervention Director Charlotte Sortedahl, Public Health Coordinator - Health Officer Malva Sirek, Secretary OTHERS PRESENT: Clarence Malick, County Board Chair Art Tobin, Facilities Manager Bob Brown, Ayres and Associates 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, September 12, 2007 at 8:30 AM. Wentz will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the minutes of the 08/15/07 Health and Human Services Board meeting be approved as distributed. NURSING HOME SUBCOMMITTEE REPORT A telephone conference was conducted to organize the committee and a second telephone conference occurred on August 27 with Health Dimensions, who manage the Sheboygan nursing home. A lot of information was shared. The committee felt there are still options out there for the nursing home. Financial info was sent to Health Dimensions along with a market analysis and other pertinent information. The union is still intact in the Sheboygan home. The Medicaid ratio in most of the Health Dimension homes is higher than St. Croix County's ratio. The New Richmond City Administrator St. Croix County Health and Human Services Board Page 2 August 29, 2007 was also at the conference with Health Dimensions. Other vendors are also being sought and further information will be available to the Board on September 12 CONSIDERATION OF FINANCIAL ASSISTANTS POSITION DESCRIPTION: Updated job description for the financial assistant positions has been submitted for consideration. There are at least two different job descriptions for financial assistants in the County. One description was approved by the Finance Committee and requires an Associates Degree. The second description requires a high school diploma currently. The descriptions are pointed different due in part to the different education requirements. Johnson requested an independent evaluation or review be done on the financial assistant positions to determine the correct educational requirement and job description for this classification of employee. Motion A motion was introduced by Burri, seconded by Rasmussen and unanimously adopted: That the Board approves bringing the financial assistants job descriptions forth in the budget process and have a study to have the financial assistants job descriptions properly graded by human resources and /or outside consultants. HEALTH AND HUMAN SERVICES FACILITY PLANNING Bob Brown from Ayres and Associates presented the concept plans to Finance in August. Three separate options were formed with the plans: 1) An addition attached to the Government Center with new courts on second floor. 2) An addition attached to the Government Center with courts moved to the first floor of the Government Center. 3) A standalone facility for Health and Human Services and a smaller addition to the Government Center for the courts. Brown displayed the concept plans for the Board. The plans were created based on information provided. It is anticipated there will be a 10% increase in staff over ten years. The plans were developed for 174 employees. Awsumb asked what departments could be grouped together and what services may be located at other locations. Awsumb questioned if the figures for construction were for an energy star building so the structure is built for the long term. For the second option, the judges may be resistant to court rooms on the first floor plus remodeling would need to be done to other departments, which is disruptive to business. For the third option, a stand -alone facility for Health and Human Services is proposed at one story with no stairs and no elevators and a partial basement. More expense and work would be involved if there are two separate building projects compared to one project. Johnson recommended a building committee to study issues and determine if we are actually going to move forward with planning. Awsumb said most Federal government space is leased. Awsumb suggested creating a RFP. Malick said rent is a cost that falls within levy limits, but building bonds may be outside levy limits that are currently in place. There may be options for building leases within the county which should be studied before going forward with a recommendation. It was suggested an internal survey be conducted to include location, co- locations and potential lease options. Malick suggested exploring having a court in New Richmond. Johnson will discuss with Corporation Counsel, court staff and Health and Human Service staff. It was questioned what other counties utilize for lease space and to duplicate what the state does for leased space. It was suggested sending an e -mail to other counties through the regional office and possibly have Dana Baker investigate leased space in other counties. St. Croix County Health and Human Services Board Page 3 August 29, 2007 The Nursing Home is not a flexible building for remodeling for a different purpose due to how the structure was built. The Board recessed from 10:00 to 10:07 AM. Johnson said the lead worker is still a financial assistant and that description will be forwarded with the other financial assistant description. PERSONNEL ISSUES -NEW POSITION REQUESTS The following new position requests were brought forward: Administration • Medical Records Technician -No staff have been added to this unit since 1977. Due to continued County growth and the increased demand for Behavioral Health and AODA services for the last decade, the number of staff providing those services has increased, which in turn has dramatically increased the workload in Medical Records. The position was also requested and approved by this Board in 2007. Johnson said two staff simply cannot keep up to the workload in this unit.'Support staff have not been added as other positions were added in the various units. Awsumb questioned the impact Long Term Care Reform will have and questioned if temporary help could fill the void and not create a permanent position if Long Term Care Reform changes staffing needs. Johnson will include the cost of temporary help in,.the budget. • Financial Assistant - Temporary help is currently being utilized but there simply is not enoughh staff to complete the work. The majority of the work is related to Behavioral Health and little change will be noted with the shift from Long Term Support to Long Term Care Reform. • Clerk Typist -This position is requested to keep up with the daily demands of the Accounts Receivable Unit and scheduling all appointments for Behavioral Health. Dragon.Naturally Speaking software may be introduced in 2008 to help with transcription backlog. • Accounts Payable Supervisor (New) -This would be a reclassification due to workload increases and current duties. No additional staff would be added and if approved, there would not be a lead worker position. Motion 'A motion was introduced by Awsumb, seconded by Berenschot, and unanimously adopted: That the Board approves the Financial Assistant and Clerk Typist positions for administration and approves the reclassification for the Accounts Payable Supervisor. Behavioral Health • Chemical Dependency Counselor- This is currently a full -time contracted position. The position is funded by a stable meth grant and it supports a DOC grant. If the position is not filled, the $108,000 in grant monies are at risk along with $15,000 in revenue generated through billing the position brings in; or if the funding would stop, the position would go away. Johnson recommended that Human Resources track and do an annual review of sunset positions and eliminate if the grant monies go away. Awsumb questioned contracting the position out to the private sector. Kirt indicated he is not aware of an agency willing to contract and it was a struggle to fill the position with a qualified candidate. This position generates revenue above and beyond the grant monies. St. Croix County Health and Human Services Board Page 4 August 29, 2007 Motion A motion was introduced by Berenschot, seconded by Burri, and adopted with Troyer and Awsumb voting no: That the Board approves the Chemical Dependency Counselor position request. Birth to Three • Speech Therapist .6 FTE -This position will be contracted for 2008. Economic Support • Economic Support Specialist- According to a cost model developed by the State, St. Croix County's projected need for eligibility workers is 8.73 FTE; current staffing is 7.5 FTE. Economic Support is out of compliance which creates the potential for corrective action and fines. It is anticipated the workload in Economic Support will increase with Long Term Care Reform and Economic Support is the only entity for determining financial eligibility for ADRC clients. Johnson reported LaCrosse County went from 400 clients to 1800 clients due to implementation of Family Care. Motion A motion was introduced by Awsumb, seconded by Troyer and unanimously adopted: That the Board approves the Economic Support Specialist position. Public Health • Public Health Nurse -This position has been requested for the past four years. Public Health is a population -based service and faces increasing demands due to growth. The ADRC will contract. for 50% Public Health Nurse position to provide services to the ADRC. The other 50% of the position will be county levy dollars and billing. It was questioned if other counties are contracting Public Health Nurse positions. Awsumb requested the position request be postponed to the next meeting so contracting may be explored. St. Croix Industries • Day Services Activity Aide- Increase from 75% to 100% position. Increase is needed to provide necessary supervision for serving more individuals in the program. Motion A motion was introduced by Burri, seconded by Rasmussen, and unanimously adopted: That the Board approves increasing the Day Services Activity Aide position from 75% to lon position. • Job Coach /Community Trainer - Position was approved as an LTE position in May when the Behavioral Health and St. Croix Industries community employment programs merged. Eichstaedt said there are currently ten on the St. Croix Industries placement program wait list and six on the CSP wait list. Position failed with no motion. Huston noted CSP clients' quality of life improves when they are working as symptoms decrease. • Job Coach Coordinator (New) -This request will be delayed to give the program more time to develop the program. 2008 BUDGET PLANNING Johnson said no budget document is available today but anticipates it will be completed by week end with copies going to Board members midweek next week. Each unit highlighted some anticipated changes in unit budgets which will be detailed when the budget document is issued. Johnson indicated additional money was added to administration's budget to address a variety of items, including but not limited to national training, consultant fees, long range planning, grant writing, fund development temporary St. Croix County Health and Human Services Board Page 5 August 29, 2007 staffing, preparedness and supplies, etc. He said $112,000 was budgeted for capital outlay but with building plans, items for capital outlay will be reviewed closely before being done. AODA (Alcohol /Other Drug Abuse) is anticipating a drop of $16,000 in county levy dollars due to IDP supplemental funding. CFS (Coordinated Family Services) has expanded by two Long Term Support staff moved into the unit. An increase of $183,214 in county levy is anticipated. SED (Severely Emotionally Disturbed) monies will be utilized to serve more kids in out of home placements. This reduces the amount of monies spent by Family and Children's for placements, which is all county levy money. Staff are cautious as to the placements for SED waiver as the county is responsible for all costs for clients on this program until they are 22 or no longer waiver eligible. The Board was reminded that children are not part of Long Term Care Reform and efforts are underway to assess clients on. the children's waiver waiting list. Monies for Behavioral Health are being reallocated due to more individuals not being eligible for IMD funding and the current increase in contract expenses will be reflected in purchased services. Birth to Three staff will do more intake and case management. The current budget will also include an increase in contract cost for 2008 (speech services). The Birth to 3 Director is also working on the ADRC and some expenses for this position could be shifted to the ADRC budget if county approves. From 25 to 30 SCI (St. Croix Industries) clients may be eligible for Home and Community Based waiver monies: Currently the county is funding all services for these clients at St. Croix Industries. Efforts will be made to apply for waiver monies for these clients, which would be 58% federal monies with 42%- county match. Production, helping hands and wayside monies will be less due to the economy and competition.. with China. There are less bulk mailings being done due to postal changes. Case management responsibilities will continue under Long Term Support. A cost shift was made for the children's waiver to CFS. Mandated reporting for elderly at risk will require an increase in staff time. An increase in MA personal care program is needed due to state funding not adequately covering costs. The state has reduced options for individuals and this has applied more pressure to local county budget. Efforts have been ongoing to curb out -of -home care costs but they are slightly increasing in 2007 in the Family and Children's Unit. Out of home placements in St. Croix County are lower than in surrounding counties. Correction costs will increase 30% in 2008. There are currently two clients in Lincoln Hills Juvenile Correctional Facility. Overall, Family and Children's budget reflects a decrease of $44,000 in county dollars. Awsumb commended staff on exceptional work to decrease the Family and Children's budget by 10% from 2006 to 2007. Family and Children's continues to utilize the YES Program and Positive Alternatives. Haeny reported 17 year olds may come back into the juvenile justice system due to a trend in the country, which will impact the unit's budget. Public Health consolidated multiple budget accounts down to six, which will be easier for reporting purposes and require less journal entries. It is anticipated revenues will remain stable or slightly increased. St. Croix County Health and Human Services Board Page 6 August 29, 2007 Economic Support's budget includes an increase of $17,000 in county dollars over 2007 plus $27,500 for a new position. To capture Federal Pass Thru Dollars, $41,700 of Administration salaries is included in the Economic Support budget. A projection for the Nursing Home was created by Larry Lester. A regular operational budget will be created for the Nursing Home for 2008 and will be brought to the Board on September 12 Awsumb requested year to year comparisons of budgets and budgeted figures to actual figures for a five year history trend. Board members were reminded that costs fluctuate due to changes and shifts in programs. Troyer left the meeting at 11:30. The updated capital outlay plan was distributed to the Board. The figures will be reflected in the budget detail and copies will be forwarded to Chuck Whiting. APPLICATION OF HEALTH AND HUMAN SERVICES AND NURSING HOME 2006 AUDIT SURPLUSES The following funds have been identified from the 2.006 audits: $533,231 for Nursing Home unrestricted funds and $951,514 for Health and Human Services unrestricted funds. Pempek reminded the Board that nothing has been done to increase Nursing Home assets in the past three to five years. Assets have been depreciated but nothing has been added back and encouraged the Board to look at building up assets. This affects reimbursement rates:_in addition to making the balance sheet look worse. It was the consensus to. not do anything until a final analysis of the Nursing Home is complete. Johnson will apply the Health and Human Services unrestricted funds as it was previously determined the County should have one contingency fund and contingency funds not be held by individual departments. Retaining some of the surplus funds in anticipation of Long Term Care Reform was discussed as transition costs may increase expenses for the short term. LONG TERM SUPPORT - LONG TERM CARE REFORM /ADRC West Central Wisconsin Care Management Collaborative (WCC) has requested a resolution to be a provider for managed care for St. Croix County. Eau Claire, Pierce and St. Croix have the option to join eight other counties already in the coalition to have WCC as another provider choice for Long Term Care. WCC requires shared resources for a multi - county ADRC if the decision by St. Croix County is made to be a part of WCC. The resolution must support the addition of a public provider choice for their citizens and defer enrollment and program options until such time as the desired dual Family Care Options (WCC) and Community Health Partnership (CHP) can be offered concurrently to enable and assure real consumer choice. There has been no announcement of award for the State RFP at this time. Lockwood indicated the shared risk is not as clear with WCC. The budget bill currently before the Governor removes County liability for Family Care Districts if there are losses in the county where family care is operating. WCC would likely require one representative from each county to serve on the governing board. Long Term Care is scheduled to implement with CHP on 04/01/08 and WCC is concerned with CHP starting first so there may be a two to three month delay in the start date to July, 2008. This postponed rollout date may occur anyway due to delays in the State announcement regarding RFP awards. The start up costs with WCC may need to be negotiated, but at this time these costs are not known. Johnson said 2008 budgets will be built as if nothing will change and a fiscal analysis will be done on the impact of Long Term Care Reform. The WCC MCO will employ governmental employees but the employees will not be St. Croix County employees; however, they would likely be union employees with access to St. Croix County Health and Human Services Board Page 7 August 29, 2007 Wisconsin retirement. The pay scales will be developed based on all the counties in the consortium, which are mostly rural counties so the scale could be lower than St. Croix County, but it is not known at this time. Lockwood reminded the Board a final resolution will be needed when a decision is made as to which direction to go with Long Term Care Reform related to financial contribution, but a resolution supporting the addition of provider choice and deferring enrollment program options will be brought to the September 12 Health and Human Services Board meeting. Lockwood indicated the risk section of document provided at the Board meeting comparing the Private MCO and the Public MCO indicates under the private MCO there is no risk to the county for managed care. All the risk is born by the private MCO. However, under the public MCO if the organization is created under the proposed family care district statutes, the `obligations and debts of the family care district are not the obligations or debts of the county that created the family care district.' If the establishing counties choose to form under an intergovernmental agreement or other legal agreement, the county could bear liability for the debts or obligations of the public MCO, but that is not being considered as an alternative now. WRITE OFF RECOMMENDATIONS FOR ACCOUNTS RECEIVABLE The final report from WIPFLI was made available to Board members. Page 8 of the report indicates the recommended write offs. Internal policies and internal Controls are also recommended in the report and policies and procedures in addition to internal controls will be brought forward at future meetings. Awsumb requested a year by year breakdown by pay source back to 2002. Aging,reports on receivables can now be created for system write offs. Malick recommended routine monthly reports on write offs to the Board so the Board may look at trends. LTS WAITING LISTS - CHILDREN AND ADULTS Staff had a phone conference with Vince Morrow of the Regional Office and Diana Adamski, the State employee specializing in Children's Waivers, to clarify St. Croix County's role with waivers. Kiesler reported that waivers are the funding source of last resort and is not an entitlement at,any level. St. Croix County uses waivers to fill gaps related to meeting health and safety needs. Beth Anez has been contracted to go through the waiting list and is using an assessment tool developed by staff to assess needs of the clients on the list. There are 36 points on the assessment tool. There are currently 115 cases on the waiting list. All cases on the list are eligible for waiver funding as all have had a functional screen completed. Assessments are being done in chronological order. It is hoped the needs assessment will be completed within the next couple of months. Staff will evaluate the health and safety of each client to provide services in the most cost effective manner. Policies and procedures will need to be developed and brought to the Board for review and approval. Rasmussen encouraged that the project results be published and made available to other counties in the state. It was the consensus of the Board to continue assessing clients on the waiting list and the Board supports serving clients based on health and safety and in the most cost effective manner. Coordinated Family Services • Program Aid- The program aid would assume some duties currently being performed by social workers that do not require a professional degree. This in turn would allow social workers to add clients to their caseloads, hence reducing the waiting list. Costs for the program would include no County levy dollars and would be funded by Comprehensive Community Services Medicaid - Federal Share, Children's Waiver - Federal Share and Targeted Case Management Medicaid - Federal Share monies. St. Croix County Health and Human Services Board Page 8 August 29, 2007 Motion A motion was introduced by Burri, seconded by Rasmussen, and unanimously adopted: That the Board approves a Coordinated Family Services Program Aid position. HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW This item will be postponed until the August meeting. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 1:02 PM Chair: Attest: (Secretary)