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HomeMy WebLinkAboutHealth & Human Services 10-17-07 Lois Burn will review vouchers. NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD October 17, 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 - 09/12/07 DATE OF NEXT MEETING — 11/14/07 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Health and Human Services Governing Body By -laws Review 3. Financial Report a. Report on Medicaid/Medicare private collection agency on past accounts b. Enterprise software needs assessment 4. Nursing Home Report a. County Board Chair referral for DHHS action on recommendation to stop admissions in the Nursing Home b. County Board Chair referral for DHHS action on recommendation to `cap' any subsidy to vendors for the future operation of the Nursing Home 5. Nursing Home Subcommittee Report 6. Long Term Support-Long Term Care Reform/ADRC 7. Communicable disease update 8. Review of Public Health priorities 9. Review of Nursing Home and DHHS budget request after Finance meeting 10. Personnel Issues 11. Boonie's Bait request to use pond to raise minnows 12. Consideration to strengthen County's existing St. Croix County smoke -free policy 13. Comprehensive Community Service workgroup and authorization to apply for anticipated start up funding. 14. Economic Support program report on birth certificate and identity verification requirements 15. Review of Agency policy for resource allocation for locally matched Children's Long Term Support waivers 16. Review of pilot project opportunity for children's waivers and authorization to apply 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. i 9/26/2007 12:43 PM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD October 17, 2007 The St. Croix County Health and Human Services Board met on October 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 Dr. Glenn Hoberg Linda Luckey Ron Troyer MEMBERS ABSENT: Deb Rasmussen, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Bill Van Offeren, Nursing Home Administrator Mary Squyer, Economic Support Supervisor Kathy Dunlap, Family and Children's Coordinator Kathy Huston, CSP Coordinator Charlotte Sortedahl, Public Health Coordinator- Health Officer Ed Thurman, Environmental Health Specialist Malva Sirek, Secretary OTHERS PRESENT: Clarence Malick, County Board Chair Chuck Whiting, Administrative Coordinator Tammy Funk, Human Resource Administrator Kjersti Olson, Director Department on Aging Chuck Struemke, County Board member Kim Dupre Loyla Waskul Thor Backus Marcus Burns, Student Jessica McCarthy, Student Amanda Leonard, Student Amber Desoto, Student Walter Anderson Shay Telander, New Richmond News 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, November 14, 2007 at 8:30 AM. Wentz will review vouchers. AGENDA Motion A motion was introduced by Caflisch, seconded by Dr. Hoberg, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the minutes of the 09/12/07 Health and Human Services Board meeting be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services Board member Burri reviewed the vouchers. St. Croix County Health and Human Services Board Page 2 October 17, 2007 Motion A motion was introduced by Burri, seconded by Caflisch, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services voucher 108647, dated September 13, 2007 in the amount of $1,340.00. Human Services vouchers 109158 through 109160, dated September 20, 2007 in the amount of $20,615.00. Human Services vouchers 110252 through 110291, dated October 04, 2007 in the amount of $52,914.35. Human Services vouchers 110957 through 110959, dated October 11, 2007 in the amount of $20,615.00. Human Services and Nursing Home vouchers 108648 through 108714, dated September 13, 2007 in the amount of $54,707.11. Human Services and Nursing Home vouchers 109024 through 109157, dated September 20, 2007 in the amount of $263,585.95. Human Services, Nursing Home, and Farm vouchers 109161 through 109202, dated September 20, 2007 in the amount of $40,463.43. Human Services and Nursing Home vouchers 109510 through 109601, dated September 27, 2007 in the amount of $312,758.50. Human Services and Nursing Home vouchers 109814 through 109932, dated October 04, 2007 in the amount of $308,880.68. Human Services, Nursing Home, and Government Center vouchers 110762 through 110923, dated October 11, 2007 in the amount of $142,427.50. Human Services and Nursing Home vouchers 110602 through 110761, dated October 11, 2007 in the amount of $115,575.11. Nursing Home vouchers 110924 through 110956, dated October 11, 2007 in the amount of $52,891.40. Human Services, Workshop, Public Health, vouchers 559 through 588, dated July 24, 2007 in the amount of $380,253.58. Human Services, Workshop, Public Health, Social Services vouchers 589 through 619, dated August 07, 2007 in the amount of $383,887.33. Human Services and Nursing Home vouchers 495 through 525, dated July 18, 2007 in the amount of $158,807.43. Human Services and Nursing Home vouchers 526 through 556, dated July 25, 2007 in the amount of $153,688.59. Workshop vouchers 109 through 114, dated July 24, 2007 in the amount of $12,058.78. Workshop vouchers 115 through 120, dated August 07, 2007 in the amount of $13,021.61. St. Croix County Health and Human Services Board Page 3 October 17, 2007 FINANCIAL REPORT The following financial report for Nursing Home through August, 2007 was distributed. Johnson reported a census of 63. Percentages should be at 64% and is at 62.49% due to lower census. The census today is 66. Johnson reported there are more private pay residents in the payor mix. Staff numbers have fluctuated according to resident census. Johnson indicated charges for pool staff, the Director of Nursing and Administrator position are charged to the Administration line of the report. Paperwork has been completed to apply for IGT monies, but the money has not been received. St. Croix Health Center August 2007 Budget Actual Difference PercentagE Census 6663 63 5 Operating Revenue: Medicare $840,960.00 $486,572.49 $354,387.51 57.86% Medicaid $2,466,310.60 $1,407,905.61 $1,058,404.99 57.09% Private Pay $699,887.50 $601,518.27 $98,369.23 65.94% All Other Sources $217,171.45 $143,697.49 $73,473.96 66,17% Total Operating Revenue $4,224,329.55 $2,639,693.86 $1,584,635.69 62.49°,1;, Operating Expenses Daily Patient Services $3,557,580.61 $2,103,218.13 $1,454,362.46 59.12% Special Services $274,024.76 $176,721.76 $97,303.00 64.49% General Services $1,172,794.05 $703,639.16 $469,154.89 60.00% Administrative Services $593,527.93 $446,291.16 $147,236.77 75.19% Unassigned: Depreciation (% Based) $0.00 Others: $286,002.20 $162,107.53 $123,894.67 56.68% Utilities $75,770.53 Workers Comp, Computer Tech $5,171.75 Insurance $81,165.25 Total Operating Expenses $5,883,929.55 $3,591,977.74 $2,291,951.81 61.05% Net Front Operations ($952,283.88) (Cost of doing business prior to applying levy & outstanding rev) Outstanding Revenues Outstanding Rate Appeal rev $14,000.00 $0.00 $14,000.00 0.00% % of Outstanding IGT Rev $377,000.00 $0.00 $377,000.00 0.00% Co Allocations (% Based) $1,268,600.00 $845,736.00 $422,864.00 66.67°% Total Outstanding $1,659,600.00 $845,736.00 $813,864.00 Net from all Sources _$106,547.88 The following financial report for Health and Human Services through August, 2007 was distributed. Johnson reported purchased services are over budget in Behavioral Health. He also reminded the Board that WIMCR dollars were placed in Administration so revenues are higher than budgeted. Johnson reported the auditors will be in house to perform a single audit next week. • St. Croix County Health and Human Services Board Page 4 October 17, 2007 HEALTH AND HUMAN SERVICES - 2007 SUMMARY Total OF REVENUES Budget August 31, 2007 Balance % Administration 1,080,749.83 1,538,969.45 (458,219.62) 142.4% AODA Services 765,599.92 498,268.66 267,331.26 65.1% Long Term Support 18,196,351.85 14,757,916.74 3,438,435.11 81.1% Mental Health 2,879,503.70 1,871,730.37 1,007,773.33 65.0% Family & Children's 3,132,978.40 2,185,406.76 947,571.64 69.8% Public Health 1,617,175.53 1,248,088.85 369,086.68 77.2% Economic Support 1,112,508.60 853,081.71 259,426.89 76.7% General Relief 15,000.00 10,000.00 5,000.00 66.7% Coordinated Services /SED 900,066.00 563,796.01 336,269.99 62.6% REVENUES HUMAN SERVICES PROGRAMS 29,699,933.83 23,527,258.55 6,172,675.28 79.2% SUMMARY Total OF EXPENDITURES Budget August 31, 2007 Balance % Administration 1,080,095.83 701,186.95 378,908.88 64.9% Alcohol -Drug Abuse 765,599.92 438,687.54 326,912.38 57.3% Long Term Support 18,196,351.85 11,693,387.66 6,502,964.19 64.3% Mental Health 2,879,503.70 2,081,760.93 797,742.77 72.3% Family & Children's 3,132,978.40 1,923,412.32 1,209,566.08 61.4% Public Health 1,617,837.53 1,069,202.91 548,634.62 66.1 Economic Support 1,112,508.60 685,657.45 426,851.15 61.6% General Relief 15,000.00 2,490.70 12,509.30 16.6% Coordinated Service /SED 900,066.44 395,767.59 504,298.85 44,0% EXPENDITURES HUMAN SERVICES PROGRAMS 29,699,942.27 18,991,554.05 10,708,388.22 63.9% Excess Rev over Expenses S 4.535,704.50 REPORT ON MEDICAID /MEDICARE PRIVATE COLLECTION AGENCY ON PAST ACCOUNTS Five agencies were contacted; responses were received from three agencies. No agency would accept Medicaid /Medicare accounts more than 12 to 18 months old for collection activities. ENTERPRISE SOFTWARE NEEDS ASSESSMENT Health and Human Services staff have not participated due to lack of time with budget preparation being a priority. This was discussed with Chuck Whiting and Health and Human Services staff will participate as the process moves forward. Staff will be attending a meeting on 10/29/07 regarding Sage. Johnson indicated a review of utilization of our current system and process must be completed as part of the needs assessment process. Whiting reported a needs assessment was done a few years ago and the assessment needs to be updated to address the needs of all departments and define the roles of staff. He indicated multiple software is currently being utilized to create financial reports. Reports are not currently integrated and there is no standard approach to reporting. The Sage system is approximately ten years old. Some Human Resource components have been added to the Sage system. NURSING HOME REPORT van Offeren pointed out a bed availability report for beds available in nursing homes and hospitals in the County was located in the Board packets. • St. Croix County Health and Human Services Board Page 5 October 17, 2007 Van Offeren reported the pass- through refrigerator in the kitchen is in need of repair. He requested approval for that repair. Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That the Board approves repair to the pass through refrigerator for $845.66 plus shipping, Freon and miscellaneous parts. Van Offeren reported with the large amount of rain recently, the windows in the Nursing Home are leaking. Johnson reviewed the concern with maintenance and was informed that after the rain stopped, building service staff sealed the window but apparently these windows have been problematic for some time. In the winter, snow will come in because the weather stripping is worn out. The windows need to be replaced. Johnson reported funds are in the capital outlay budget to begin window replacement, but these have been cut /postponed in previous budgets. Van Offeren reported some electrical parts of the elevator in the Nursing Home are in need of repair and there has been some difficulty with the elevator door. Tobin is aware of the issue and has reported to Finance Committee. An update will be provided to the Board when available. Van Offeren distributed a memo outlining information on the Spring Valley Health Care Center and Baldwin Care Center. Spring Valley Health Care Center is in the process of completing an application for Federal Tax Credit Program, Section 402, for low income housing. They are not aware of any grant monies available for nursing home construction. A question was posed as to why the Baldwin Care Center is financially viable and St. Croix Health Center is not. Baldwin Care Center's fringes and wages are $118.22 versus St. Croix Health Center's fringes and wages being $178.24. St. Croix Health Center's wages and benefits are 50% greater than Baldwin Care Center. Resolutions passed by LaCrosse County and Ozaukee County regarding supporting a change for returning Federal funds from certified public expenditures of county nursing homes were distributed to Board members. Johnson suggested a letter could be sent to the Governor requesting money paid in by the nursing home come back to the nursing home and not go to other entities. Suggestions were also made to send letters to legislators to support this resolution. Caflisch indicated this resolution would help but not solve the financial issues of the nursing home. Motion A motion was introduced by Burri, seconded by Berenschot, and unanimously adopted: That the Board supports sending a letter to legislators and the Governor to support the resolution supporting a change for returning Federal funds from certified public expenditures of county nursing homes with calculations added into the resolution specific to St. Croix County. Johnson will create a resolution specific to St. Croix County and request that this be added to the 11/06/07 County Board agenda. NURSING HOME SUBCOMMITTEE REPORT The Nursing Home Subcommittee met on October 10, 2007. An update was given on a proposal from Health Dimensions for a management agreement. They would not be interested in County land but have identified other land in the area and would need a subsidy to build and operate a new facility. Presbyterian Homes is interested in acquisition of nursing home beds only to allow a continuum of care at their facility. There is a potential for Christian Community Homes to come back to the table regarding the nursing home. Discussion has been held with the City of New Richmond but no specifics have been offered. A letter has been sent to the City of New Richmond in an attempt to get a clear sense of what the City may propose. Caflisch indicated • St. Croix County Health and Human Services Board Page 6 October 17, 2007 with the current levy limit on municipalities, the City is financially limited and could offer possible bonding or land. Awsumb indicated there is an interest in a public /private partnership. Another meeting is scheduled for October 24, 2007. The committee will request of the County Board or Health and Human Services Board permission to enter into closed session to negotiate regarding proposals received for the nursing home. COUNTY BOARD CHAIR REFERRAL FOR DHHS ACTION ON RECOMMENDATION TO STOP ADMISSIONS IN THE NURSING HOME and COUNTY BOARD CHAIR REFERRAL FOR DHHS ACTION ON RECOMMENDATION TO `CAP' ANY SUBSIDY TO VENDORS FOR THE FUTURE OPERATION OF THE NURSING HOME Chuck Struemke presented two draft resolutions regarding the above mentioned topics. It was felt these resolutions were premature in the current process and would interfere with negotiations. The County Board has not removed the Health and Human Services Board from jurisdiction of the Nursing Home Subcommittee. Motion A motion was introduced by Burri, seconded by Troyer, and unanimously adopted: That the Board approves removing the, following from the agenda: County Board Chair referral for DHHS action" on recommendation to stop admissions in the Nursing Home and County Board Chair referral for DHHS action on recommendation to `cap' any subsidy to vendors for the future operation of the Nursing Home and table indefinitely any discussion until the RFP Nursing Home Subcommittee reports back to the Health and Human Services Board. Luckey questioned how a figure could be set ahead of time due to offsetting factors in negotiations. There will be a cost to close or a cost to keep open. Awsumb reminded the Board there has been an increase in private pay residents in the last year, which is a positive and will help in privatization and will make the facility more attractive to private organizations. It is also encouraging that a vendor that has previously worked with the union is part of the process. The Board recessed from 9:32 to 9:40 AM. Caflisch stated the reasons for going into closed session are specifically outlined in the State statute. The subcommittee cannot go into closed session until either Health and Human Services Board or County Board approval is given. The County Board wanted a much more fine -tuned definition of why a closed session is requested. Malick said parts of the subcommittee meetings could be closed session and it may not be necessary for the entire meeting to be in closed session. A recommendation needs to be received from the RFP Committee to the County Board or Health and Human Services to request a closed session. Brian Purtell will inform the committee when the point has been reached in negotiations that a closed session needs to be requested. Caflisch requested to authorize a closed session for the committee today rather than have the committee's hands tied. Wentz said the committee is not to a point that a viable offer is on the table. Malick indicated negotiations are done via vendor to lawyer, not to the committee as the committee will not be doing the negotiating. HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW Johnson suggested minor changes to the By -Laws. He recommended including the Coordinated Family Services Unit, which has changed its name to Youth Community Support Services, to Article 1, Name section. Also, under Article V, #8, he recommended adding "Health" to County Human Services Department to make the final change County Health and Human Services Department. Johnson also questioned if clarification was needed for Article V, Section B, ##6. Approve fiscal transfers. After discussion, it was the consensus of the Board that no further clarification was needed due to reports being approved by Finance. • St. Croix County Health and Human Services Board Page 7 October 17, 2007 Motion A motion was introduced by Troyer, seconded by Dr. Hoberg, and unanimously adopted: That the By -laws be approved with changes listed above. LONG TERM SUPPORT -LONG TERM CARE REFORM /ADRC There is now a State model of fiscal transfer; however, there is no budget from the legislature. Johnson anticipates having a formal financial implication to St. Croix County soon so a final decision may be made regarding Long Term Care reform. Community Health Partners (CHP) was awarded a letter of intent from the State for St. Croix County. CHP is offering two benefit packages, the traditional family care package or the CHP partnership package; so technically, consumers will have two choices within one entity. A letter was sent to Secretary Hayden regarding St. Croix County not being considered in the WCC award. No response has been received. The State is working on a self- directed support waiver; however, there has not been a lot of detail available nor is it clear haw it will be managed. It is anticipated the current county contribution of $2.6 million will be bought down to $376,000 over a five year period. There will be an impact on current staff. Awsumb cautioned carefully looking at the impact on staff. St. Croix County's transition to Long Term Care would impact 2008 budget to some extent. It is anticipated Chippewa County, Dunn County and Pierce County will transition first and St. Croix County will follow in approximately August, 2008. The most important projections will be five years out; however, those figures are not available at this time due to inadequate information available. Awsumb questioned the numbers on the waiting lists and what clients are on the waiting list for so a clear understanding of the problem can be determined. Guidelines have changes for waiver funded services due to implementation of partial slot funding. Johnson reported when LaCrosse County went to the Family Care model, caseloads approximately increased from 400 to 1600 and Portage County increased from 300 to 900 when Family Care was piloted. With this information, it is anticipated there will also be growth in caseloads in St. Croix County. Luckey encouraged that services to clients be audited to ensure that services offered are only essential services. Health and Human Services and Department on Aging need to work together on the development of ADRC, which will be the gateway into the Long Term Care system. ADRC emphasis will be on asset preservation. Olson reported an Ad Hoc meeting was held on ADRC to discuss governance structure models. REVIEW OF NURSING HOME AND DHHS BUDGET REQUEST AFTER FINANCE MEETING Johnson reported salaries were adjusted from 2.5 to 2% and health insurance amounts were decreased approximately $270,000 for Health and Human Services and approximately $130,000 for Nursing Home. He also reported a van was removed from St. Croix Industries budget in the amount of $55,000. Johnson reported summary sheets will be forwarded to the Board when completed. REVIEW OF PUBLIC HEALTH PRIORITIES Sortedahl reported Public Health's mission and vision statements and values were updated in 2007 to more accurately reflect what Public Health does. She reported a state health plan is required every ten years. For the community, a local community needs assessment should be done every five years. Awsumb questioned if the county is putting its resources in the right place for disaster planning. Awsumb questioned priorities identified as preparedness is not included in that list and feels preparedness is a priority. St. Croix County Health and Human Services Board Page 8 October 17, 2007 Caflisch left the meeting at 11:10 am. Sortedahl reported St. Croix County Public Health is a Level 3 health department and certain programs are needed to remain a Level 3. Awsumb questioned why Pierce County offers dental services and not St. Croix County. Sortedahl reported access to dental care for Medical Assistance clients /low income clients is an issue in St. Croix County. Pierce County has a dentist volunteer to provide this service, St. Croix County does not. Awsumb questioned the amount of growth in demand for client services in Public Health. There has been a 20% increase in WIC services. Public Health accounts have been combined to simplify the budgetary process; however this makes it difficult to single out costs for each program. Sortedahl gave details on all services provided through Public Health. The Board recessed from 11:50 to 11:57 AM. COMMUNICABLE DISEASE UPDATE Public Health Health Officer is required to report to the Board on a periodic basis. Sortedahl gave a review on all services provided through Public Health, including communicable disease. PERSONNEL ISSUES Johnson reported Star Hansen resigned from Economic Support effective 10/10/07. In addition, there is one staff from Economic Support on family leave. Duties for this unit cannot be outsourced due to training needs and no training is currently available. The posting for the vacant position has gone up and a former employee has agreed to return as a temporary position at 30 hours /week. BOONIE'S BAIT REQUEST TO USE POND TO RAISE MINNOWS It was the consensus of the Board to have Johnson negotiate this request. Johnson indicated he will implement a charge for use of the pond. REVIEW OF PUBLIC HEALTH PRIORITIES "(continued) Awsumb requested the Board consider adopting a policy on informed consent for clients receiving vaccines, federal legislation regarding consent, and that the Board discuss implications of the HPV vaccine at a future meeting. Sortedahl distributed a sample vaccine information sheet (VIS) that are distributed according to federal guidelines. Also, she distributed MMWR quick guide distributed by the CDC which recommends immunization schedules to be followed for persons aged 0 -18 years. COMPREHENSIVE COMMUNITY SERVICE WORKGROUP AND AUTHORIZATION TO APPLY FOR ANTICIPATED START UP FUNDING The application for start up funds needs to be submitted by 11/02/07. A comprehensive community service (CCS) workgroup has been formed to develop the request for start -up funding with a maximum grant of $40,000. CCS allows more people to access needed services. The CCS certification would allow us to receive federal monies for which we will need county match dollars. Approximately $240,000 to $260,000 is anticipated to be available to be redirected as county match funds to draw down the federal amount from the Long Term Support budget. This would provide intervention to families we serve anyway to possibly keep clients out of long term placement. Motion A motion was introduced by Berenschot, seconded by Troyer, and unanimously adopted: That the Board approves applying for the Comprehensive Community Service certification grant. REVIEW OF AGENCY POLICY FOR RESOURCE ALLOCATION FOR LOCALLY MATCHED CHILDREN'S LONG TERM SUPPORT WAIVERS Dunlap reported this policy was presented to families on 10/03/07 and was well received. The policy addresses services will + • St. Croix County Health and Human Services Board Page 9 October 17, 2007 be provided based on the health and safety needs of the client. Families may be connected with services versus being provided monies for services. Dunlap reported of the 120 clients on the wait list, 67 have been addressed. 46 have been assessed and 21 have been removed from the list due to relocation, requesting to be removed from the list, etc. Dunlap reported the state has requested a copy of St. Croix County's information to potentially use with other counties. CONSIDERATION TO STRENGTHEN COUNTY'S EXISTING ST. CROIX COUNTY SMOKE -FREE POLICY This item will be delayed to the November meeting. ECONOMIC SUPPORT PROGRAM REPORT ON BIRTH CERTIFICATE AND IDENTITY VERIFICATION REQUIREMENTS This item will be delayed to the November meeting. REVIEW OF PILOT PROJECT OPPORTUNITY FOR CHILDREN'S WAIVERS AND AUTHORIZATION TO APPLY It is anticipated the State will be looking to fund pilot projects for children's waivers. This information is being provided to the Board as St. Croix County may apply to participate in the pilot program. Wentz asked if there were any other issues to bring before the Board. Future meeting dates will be discussed at the November- meeting. Wentz adjourned the meeting. Time: 12:25 PM Chair: Attest: (Secretary)