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Esther Wentz will review vouchers.
NOTICE OF MEETING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
September 12, 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 - 08/29/07
DATE OF NEXT MEETING — 10/19/07 at 8:30 a.m.
OLD AND NEW BUSINESS
1. Consideration of Claims and Vouchers
2. Financial Report
3. Write off recommendations for Accounts Receivable
4. Health and Human Services Governing Body By -laws Review
5. Nursing Home Report (8:30am Wade Swanson, Business Development Analyst, from Health
Dimensions will be introduced to the board as he is here for a site visit). **
6. Nursing Home Subcommittee Report
7. Personnel Issues New Position request (Public Health)
8. Long Term Support-Long Term Care Reform resolution
9. Agency rate setting
10. Presentation of the 2008 Budget request
11. Review of WCA 2007 conference resolutions recommendation to the Administration
Committee.
ADJOURN
(Items may be taken in different order)
** Additions /Changes /Corrections
Items for County Board approval must be submitted to the County Clerk's office
by Wednesday morning preceding a County Board meeting.
9/11/2007 7:53 AM
Health and Human Services Board - September 12, 2007 Page 1 of 7
St. Croix County * Wisconsin
AGENDA - HEALTH AND HUMAN SERVICES BOARD
I
ST CROIX COUNTY
NOTICE OF COMMITTEE MEETING
Esther Wentz will review vouchers.
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County Mau September 12, 2007 at 8.30
(Board Room, St. Croix County DHHS Building, New Richmond "q)
CALL TO ORDER
ROLL CALL
REVIEW OF AGENDA
CONSENT AGENDA
APPROVAL OF MINUTES OF PREVIOUS MEETING - 08/29/07
DATE OF NEXT MEETING — 10/19 /07 at 8:3o a.m.
OLD AND NEW BUSINESS
1. Consideration of Claims and Vouchers
2. Financial Report
3. Write off recommendations for Accounts Receivable
4. Health and Human Services Governing Body By -laws Review
5. Nursing Home Report (8:3oam Wade Swanson, Business Development Analyst, from Health Dimensions will be
introduced to the board as he is here for a site visit).**
6. Nursing Home Subcommittee Report
7. Personnel Issues New Position request (Public Health)
8. Long Term Support-Long Term Care Reform resolution
9. Agency rate setting
io. Presentation of the 2oo8 Budget request
ii. Review of WCA 2007 conference resolutions recommendation to the Administration Committee. **
ADJOURN
(Items may be taken in different order)
** Additions /Change /Corrections
MINUTES
HEALTH AND HUMAN SERVICES BOARD
SEPTEMBER i2, 2007
The St. Croix County Health and Human Services Board met on September 12, 2007 at the St. Croix County Health
and Human Services /Health Center complex.
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Health and Human Services Board - September 12, 2007 Page 2 of 7
MEMBERS PRESENT: Esther Wentz, Chair
Gordon Awsumb
Leon Berenschot
Lois Burri
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Tom Caflisch
Dr. Glenn Hoberg
Deb Rasmussen
MEMBERS ABSENT: Linda Luckey, excused
Ron Troyer, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
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Jennifer Pempek, Financial Manager
Bill Van Offeren, Nursing Home Administrator
Ron Lockwood, Long Term Support Coordinator
Ron Kiesler, Behavioral Health Coordinator
Norma Vrieze, Early Intervention Director
Mary Squyer, Economic Support Supervisor
Kathy Dunlap, Family and Children's Coordinator
Pat Haeny, Family and Children's Supervisor
Ron Eichstaedt, Director, St. Croix Industries
Kathy Huston, CSP Coordinator
Charlotte Sortedahl, Public Health Coordinator - Health Officer
Malva Sirek, Secretary
OTHERS PRESENT: Clarence Malick, County Board Chair
Chuck Whiting, Administrative Coordinator
Michelle Pietrick, Finance Director
Wade Swanson, Health Dimensions
Loyla Waskul
Lona Thompson
Norm Matzek
Chair Wentz called the meeting to order at 8:3o AM noting the meeting was properly and legally publicized.
NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, October 17,
2007 at 8:3o AM. Burri will review vouchers.
AGENDA Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously adopted:
That the agenda be approved as circulated, noting the next meeting will be October 17, 2007.
MINUTES Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That
the minutes of the o8/29/07 Health and Human Services Board meeting be approved as distributed.
ANNOUNCEMENT Wade Swanson, Business Development Analyst, Health Dimensions, was present and
introduced to the Board. He will be performing a site tour of the nursing home. Health Dimensions is a long term
care management facility.
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Health and Human Services Board - September 12, 2007 Page 3 of 7
Johnson indicated invitations to the annual foster care banquet to be held on ii /o8 /07 are in the Board packets. He
mentioned this is a great opportunity to recognize foster parents.
CONSIDERATION OF CLAIMS Health and Human Services Board member Wentz reviewed the vouchers.
Motion A motion was introduced by Wentz, seconded by Caflisch, and unanimously adopted: That the following
vouchers be approved and be made a part of the supplemental minute book:
Human Services vouchers io7o8i through 107o84, dated August 23, 2007 in the amount of $22,556.00.
Human Services voucher 107o85, dated August 23, 2007 in the amount of $11.38.
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Human Services voucher 107567, dated August 23, 2007 in the amount of $1,300.00.
Human Services vouchers 107776 through 107777, dated September o6, 2007 in the amount of $4,312.00.
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Human Services vouchers 1o8291 through 1o8330, dated September 10, 2007 in the amount of $5
Human Services and Nursing Home vouchers 106589 through 1o6722, dated August 16, 2007 in the amount of
$
Human Services and Nursing Home vouchers 106723 through 1o674o, dated August 16, 2007 in the amount of
$ 11 ,9 2 7.75•
Human Services, Nursing Home, Farm and Government Center vouchers 107o86 through 107203, dated August 23,
2007 in the amount of $149,830.19•
Human Services and Nursing Home vouchers 107569 through 107666, dated August 30, 2007 in the amount of
$43
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Human Services and Nursing Home vouchers 1o7778 through 107869, dated September o6, 2007 in the amount of
$97,209.81.
Human Services and Nursing Home voucher 1o8331, dated September 10, 2007 in the amount of $7,79o.82.
Human Services and Nursing Home vouchers 1o8332 through 1o8462, dated September 10, 2007 in the amount of
$16o,963.74•
Human Services and Nursing Home vouchers 1o8463 through 1o8629, dated September 10, 2007 in the amount of
$245,138.11.
Nursing Home vouchers 1o8630 through 1o8646, dated September 10, 2007 in the amount of $23,840.83•
Human Services, Workshop, Public Health, vouchers 437 through 466, dated July 24, 2007 in the amount of
$378,237.98•
Human Services, Workshop, Public Health, Social Services vouchers 467 through 497, dated August 07, 2007 in the
amount of $383,459.95•
Human Services and Nursing Home vouchers 348 through 353, dated July 18, 2007 in the amount of $11,093.76.
Human Services and Nursing Home vouchers 385 through 393, dated July 25, 2007 in the amount of $144,070.00.
Human Services and Nursing Home vouchers 354 through 384, dated July 26, 2007 in the amount of $173,77
Workshop vouchers 85 through 9o, dated July 24, 2007 in the amount of $11,986.98.
Workshop vouchers 91 through 96, dated August 07, 2007 in the amount of $13,151.71.
FINANCIAL REPORT The following financial report for Nursing Home through July, 2007 was distributed. The
report is figured on a census of 61. Medicaid revenue for 2007 is lower than 2oo6 figures. Private pay revenue for
2007 has been higher than 2oo6. The census of the nursing home has been lower in the last few months. Census in
the nursing home today is 62.
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Health and Human Services Board - September 12, 2007 Page 4 of 7
St. Croix Health Center
Ally 2007
Budget Actual nifil —ace P. — ^mgr
Census 63 61 7
01 —ming Revenue:
Madn are Sb tU S3Ml,1 �.5tl Sod" ":831.4: 4134%
Medica-d 12.466;31087 S1.2n 61,232.68317 50.02:-
Pnvale Pay EE99IX7 97 5517,9]3 27 118t 904 21 7400%
All Cthnr S--- $217,171 45 $119.n w- 29 139 085 16 59 41%
Total Opetadng Revenue ,. 14 224.321,55 _. _ 12.278.760.57 ,11,945,568.98, 53.94
upeiatilrg L.P.I..e
Oady Patient sq.,Ces 13.% 61 11,812,025.42 11,74555519 97.93'~
Special Semces 1274p2476 1147,74909 1126,27567 5392"u
Ganarm San•cev
$1,172794 OS W999793 1553.19612 5196%
AdIn Istraure So.-, 4 93 5357,749 43 {235 778.50 W,21i k
Unassigned
Oepre nation (% Oased) 10 00
011— 120600720 V53.9%72 113239540 5371%
ll ,l.b 5 937,579.22
WI Ueis Comp, Computer Tech 14,922.25
Ic:uwa q 101,1%25
1.141 upetnang txpenses 15- 883:929.55 13A80,728.59 12,803.200:16 52.361.
Nel From Operations (1801.958 .421
I -o:t ci doing 5u..— Pin, to
aoplyrng leay 8. uulstaudny rev)
Ornstanding Rownuos
Gatslandmg Q^ale APF-I nw 114 000 a3 1'0 00 114 000 CC 000%
% of Otrktandn9 IG' W. s377,C1A 00 SU 00 1377,000.CU U,UU%
Cc Allocallons(% Based) 41;r68 OO 7 5740_ 552358110 53.3)%
Total 0rrutan4it9 11.659,600.00 5740.019.00 1919.581A0
NN born all £:.u:ces - 161.949.02
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119-, nulslending 13T Rev mc"d to 2MG .a audiors
The following financial report for Health and Human Services through July, 2007 was distributed. The Board was
reminded that all CARS advances have been received through July. After July the State starts reconciling numbers so
revenues may start decreasing. General Relief figures are actual expenses of the program, no salaries or fringes are
included for General Relief. The free clinic in River Falls has been coordinating services with Public Health and
Economic Support. Purchased services for Behavioral Health are over budgeted amounts for the year.
HEALTH AND HUMAN SERVICES - 2007
SUMMARY Total
OF REVENUES Budget July 31, 2007 Balance %
Administration 1,080,74983 1,509.426.15 (428,676.32) 1397:
AODAServices 765,59992 425.095.12 340,50480 555/.
Long Term Support 18196.35185 12,358.17510 5,838,176.75 679%
Mental Health 2.879.503 70 1,640.528,69 1,238.975 01 57 0%
Family &CMlldren's 3,132.97840 1, 961.644.87 1,171.333.53 626%
Public HOSlth 1.617.17553 1088.811.78 S28.36383 673%
EconomrcSupport 1.112.508.60 749.205.00 363.30360 673%
GenmalRelrel 15,000.00 8.75000 6.25000 583%
CoordmatedSer eces/SED 900.06600_ 514.08613 _ 385.92987 ^ 571%
REVENUES HUMAN
SERVICES PROGRAMS 28. 699 933 83 20.255.72216 9.444211 07 682%
SUMMARY Total
OF LXPENUTI URES Budget July 31.2007 Balance
Adminlstratlan 1,080.095.03 585.231.74 494,064.09 542
Alcohol -Drug Abuse 765,599.92 381,003.74 384,596.18 498:
Long Term Support 18,196.351.85 1 D008,509.11 9 8,107,843.66 55 4%
Mental Health 2,879.503.70 1,810,175.54 1,069,328.16 629%
Family& Children's 3,132,978.40 1,669.926.04 1,463,052.36 533%
Public Health 1,617,837,53 927.82612 690,010.81 573 %a
Econom;c Support 1,112,50860 587.11525 525.393.35 528%
General Relret 15,00000 1.79279 13.247 21 11 7%
Coordinated Service /SED 900,066 44 342.244 30 557,822.14 38 O%
EXPENDITURES HUMAN
SERVICES PROGRAMS 29.699.94227 16.393.78431 13.306.15796 552%
Exr oss Rov ovor Expanses _ f 3.861.936.45
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WRITE OFF RECOMMENDATIONS FOR ACCOUN'T'S RECEIVABLE An aged receivable report for 2002 through
2005 was distributed to the Board. Figures reported between Wipfli and St. Croix County are different due to ongoing
business. The Board was reminded that if claims are not submitted in a timely fashion, payment will not be made.
Billing for Medicaid needs to be done within 32 months, Medicare billing needs to be done within 18 months and
most insurance needs to be billed within six months of service provided. All past Medicaid /Medicare billing has been
resubmitted and all were denied for payment because they were too old. Awsumb requested Pempek to find a private
firm to bill for Medicaid /Medicare past bills. Pempek stated she doubted Health and Human Services could find a
collection agency who would accept our old Medicaid /Medicare due to the age and that the collection agency would
not be able to collect their standard percentage.
Everything has been billed on time since February 2007 and past due accounts have been rebilled back to October
2oo6. Pempek was directed to contact a Medicaid /Medicare billing company. Medicaid /Medicare billing companies
will only accept accounts that are active. A policy regarding collections will be set up in the future. Only self -pay
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Health and Human Services Board - September 12, 2007 Page 5 of 7
accounts can be turned over to collection agencies.
Motion A motion was introduced by Berenschot, seconded by Burri, That the Board approves write offs of
Medicare /Medicaid payments not received or billed prior to October, 2005 but still refer if staff can find someone to
follow up on write off /adjustment accounts.
Burri withdrew the second on the above motion, Berenschot withdrew the above motion.
Motion A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the Board
approves applying reasonable reimbursement to all records on the system and to write off all Medicaid /Medicare
accounts prior to October 2005 in the amount of approximately $327,486 after applying all allowable adjustments of
approximately $48o,000.
Pempek and Johnson will attend the next Finance Committee meeting.
Rasmussen reported new guidelines for tamper -proof prescriptions, which are scheduled to go into effect 10/01/07,
may affect future reimbursement and affect the nursing home populations.
NURSING HOME REPORT Van Offeren clarified that Wade Swanson is in business development for Health
Dimensions and is not an operational person.
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The current Nursing Home census is 62 with three possible admissions this week. Pool staff have been utilized in the
nursing home over the last few months. The situation of the nursing home is causing distress to the nursing home
employees and it is difficult to recruit employees.
AGENCY RATE SETTING Nursing Home: Van Offeren distributed a survey of private pay rates for other nursing
homes in the area. He recommended a 5% increase for private pay rates for St. Croix Health Center. The last rate
increase for St. Croix Health Center was November 1, 2005.
Motion A motion was introduced by Awsulnb, seconded by Caflisch, and unanimously adopted: That the Board .
approves a 5% increase in Nursing Home private pay rates as of November 1, 2007 to be as follows:
ISN: 194.25
SNF: 173.25
ICF: 168.00
Van Offeren distributed a press release regarding Department of Health and Family Services, Secretary Hayden,
recommending a 15% reduction in essential Medicaid long term care program funding.
The Board recessed from 9:50 to 9 :55 AM.
NURSING HOME SUBCOMMITTEE REPORT Johnson reported Brian Purtell has been contacting possible vendors
regarding the Nursing Home. The City of New Richmond has participated in telephone conferences with vendors to
discuss options along with subcommittee members of Rasmussen, Awsumb and Wentz. Johnson envisions an update
to the County Board at the September 18t meeting. A tentative County Board meeting to discuss goal setting review
may occur on October 16 Malick question if any Nursing Home union staff have been involved in the discussions.
The current union contract runs through December 2007. Opening negotiations for 2008 have occurred.
PERSONNEL ISSUES -NEW POSITION REQUESTS (PUBLIC HEALTH) Sortedahl polled several contract nursing
agencies regarding possibly contracting for a Public Health Nurse. Results of that survey were distributed to Board
members. The agencies contacted do not generally provide nurses for Public Health as Public Health is a specialty
practice. The additional Public Health Nurse position is not included in the budget. It is proposed the nurse position
would be funded half by Public Health and half by the ADRC. St. Croix County has the lowest nurse -to- population
ratio of any county in Wisconsin according to available data. An additional nurse would be able to provide services
that are billable and allow the unit the most flexibility compared to adding other staff positions. Information
regarding rates for jail nursing services was not available as nursing services are included in part of a global contract.
Discussion regarding this position will resume when the budget is discussed.
LONG TERM SUPPORT -LONG TERM CARE REFORM RESOLUTION The RFP award was announced and
Community Health Partnership (CHP) was notified of intent to award a contract for St. Croix County, along with four
other counties that have been involved in planning in our local consortia. St. Croix County, along with Pierce and Eau
Claire Counties, were not named in the intent to award a contract for the West Central Consortium (WCC). Staff
worked to bring in another care management organization (CMO) to offer consumer choice between CMO's and after
a brief conversation with State staff, Judith Frye, it appears the "placeholder" status that WCC identified for St. Croix
County was insufficient to be considered as part of that service area. WCC had requested St. Croix County proceed
with a resolution to the full County Board that identified two key points, which were a public CMO as a choice for
consumers and that St. Croix County would delay enrollment if necessary to assure equal choice from the onset.
Johnson is not recommending a resolution at this time, but favors another letter to Secretary Hayden that expresses
disappointment in the intent to award notice and the opportunity for reconsideration. Johnson will work with Chair
Wentz on a letter.
AGENCY RATE SETTING Behavioral Health: The last rate adjustment for Behavioral Health took place in 2004.
Rates are established off the cost report which is submitted to the state. These cost reports have remained relatively,
stable since 2004. The cost reports take into account staffing costs and all allowable associated overhead and indirect
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costs from Health and Human Services and government center. Kiesler said while these are our billed rates Medicaid,
Medicare, and private insurance pay less than the billed rates. Note there is an error on the rate chart (see below).
$325 for IDP services equates to 2.5 hours of AODA Counselors time, not 2 hours as listed below. All other
information is accurate.
Motion A motion was introduced by Caflisch, seconded by Awsumb, and unanimously adopted: That the Board
approves the new hourly rates as proposed effective 10/01/07.
PRESENTATION OF THE 2oo8 BUDGET REQUEST Johnson said there is an increased levy request for 2008 Of
$355,818.87. He reminded the Board WIMCR dollars were previously under several departments and those monies
were moved to Administration to better track changes. In 2004 the Nursing Home had a surplus that helped out
Health and Human Services. Johnson said there is an increase due to new position approvals in Accounts Receivable
and contracted help approved in Medical Records. Johnson said $18o,000 of 2oo6 prior year carryover was applied
to CSP services and the balance was used in Administration
In July, 2007 two Long Term Support Social Work positions were moved to the CFS unit and this is reflected in the
2oo8 budget. $15,000 was applied to the children's waivers to reduce children's wait list for services.
With St. Croix Industries (SCI), Federal dollars will be leveraged for persons that would have previously been served
with County dollars. From 25 to 30 persons previously served by County dollars are being moved to waiver programs
to recoup 58% of cost by Federal dollars to pay for St. Croix Industries related services for these clients. These clients
would also then be served by a managed care organization in the first six months versus waiting two years. This
results in a net decrease in SCI levy request, but an increase will be noted in Long Term Support.
Early Intervention Program (EIP) is finding more insurance denials for therapies. More monies are allocated for
contracted therapies.
There is a 2.5% increase in residential care costs and expansion of services to St. Croix Industries clients. The Long
Term Support budget for 2oo8 no longer contains services for children, as these programs were moved to
Coordinated Family Services (CFS), along with two staff. The Long Term Support budget was put together with no
plan for changes in Long Term Care Reform. While staff have spent considerable time working toward reform, the
budget was built as if it will not occur due to the fact that several steps still need to be completed in order for reform
to occur in St. Croix County.
We are mandated to serve developmental disabled population but there is not a similar mandate for serving the
elderly. However, if elderly are in a nursing home, they qualify for nursing home relocation monies. St. Croix County
has reached a cap for collecting administrative dollars and this is a concern for the future.
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Family and Children's purchased services decreased due to a shift to waivers (CFS). With the SED waiver, the waiver
goes with the client for services until the client is 21. The county is responsible for any client on the SED waiver until
they are 21 so staff are cautious placing clients on this waiver.
Economic Support experienced an increase in budget due to adding a new position.
Public Health combined several programs to consolidate the chart of accounts numbers and for ease of accounting.
The state has no requirement to report accounts in detail. Awsumb questioned priorities in Public Health. Wentz
said the Board depends on staff to lead and recommend priorities. Wentz suggested discussing Public Health
priorities at another meeting. Awsumb would like priorities reviewed by the Board. A community health needs
assessment was done that prioritized community needs. Another Public Health RN is needed as Public Health
services are population based and St. Croix County currently has .57 Public Health Nurses /1o,000 population, which
is the lowest in the state plus St. Croix County's population continues to grow. The nurse position would be funded
half by County levy and half by ADRC. A nurse position is needed to meet the needs of elderly and adult population
of the ADRC.
Motion A motion was introduced by Berenschot, seconded by Rasmussen, and adopted with Caflisch and Awsumb
voting no, That the Board approves a Public Health Nurse position for 2oo8.
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Awsumb indicated Health and Human Services should live within the County budget of 2.475% increase in allocation
for the budget.
Motion A motion was introduced by Awsumb, seconded by Caflisch, and unanimously adopted: That the Board
approves limiting the increase in County levy to 2.475% in total for Health and Human Services and various units in
the department's budgets be adjusted to reflect this.
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Health and Human Services Board - September 12, 2007 Page 7 of 7
Johnson said he will not look to cut positions. Discussion was held of application of carryover funds plus possible I
increase in health insurance.
The Board recessed from 12:22 to 12:27 PM.
Awsumb suggested looking at a budget for the Nursing Home for a quarter only. Awsumb suggested delaying a vote
on the Nursing Home budget for a month.
Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That the Board
approves moving the Nursing Home budget forward to Finance Committee with surpluses applied.
The Farm budget was distributed to the Board. No monies were budgeted to rent out the buildings for 2008.
The ADRC budget was distributed to the Board. New revenues of $632,000 would be received dependent on the
ADRC transition. Staff would move from Aging and Health and Human Services as Long Term Care is implemented.
Health and Human Services Accounts Receivable would do billing for MA pass thru.
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Motion A motion was introduced by Caflisch, seconded by Rasmussen, and unanimously adopted: That the Board
approves moving the Farm and ADRC budgets forward to the Finance Committee.
REVIEW OF WCA 2007 CONFERENCE RESOLUTIONS RECOMMENDATION TO THE ADMINISTRATION
COMMITTEE It was the consensus of the Board Wentz will indicate to the Administration Committee the
resolutions the Health and Human Services Board supports and the Administration Committee will forward to j
Malick.
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HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW This item will be postponed until the
October meeting.
Wentz asked if there were any other issues to bring before the Board.
Wentz adjourned the meeting.
Time: 1:0o PM
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