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HomeMy WebLinkAboutHealth & Human Services 02-21-07 e Esther Wentz will review vouchers. Revised: 02/14/07 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 21, 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 - 01/17/07 DATE OF NEXT MEETING — 03/21/07 8:30 AM OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report 3. Economic Support Program Review 4. Continuous Quality Improvement Report- Family and Children's 5. Nursing Home Report 6. Closed session pursuant to Wisconsin Statutes sec. 19.85 (1)(e) to review nursing home proposal(s). ** 7. Reconvene to open session pursuant to Wisconsin Statutes sec. 19.85 (2). ** 8. Health and Human Services Facility Planning 9. Personnel Issues — CSP Clinical Social Worker 10. Long Term Support-Long Term Care Reform /ADRC Resolution 11. Resolution on the designation of elder adult -at -risk and adult at risk agencies 12. Public Health Report a. Governor Doyle launches statewide anti - smoking initiative b. Update on Public Health role with Fentanyl 13. Discussion on issuing a RFP to dismantle and remove the barn from the county property ** ICI. Closed session per Wisconsin Statutes 19.85 (1) (c) for Director's review 15. Reconvene in open session per Wisconsin Statutes 19.85 (2), return to open session. ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 2/14/2007 12:11 PM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 21, 2007 The St. Croix County Health and Human Services Board met on February 21, 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 Deb Rasmussen Ronald Troyer MEMBERS ABSENT: Dr. Michael Kretz, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Kathy Dunlap, Family and Children's Coordinator Pat Haeny, Family and Children's Supervisor Ron Lockwood, Long Term Support Coordinator Ron Kiesler, Behavioral Health Coordinator Mary Squyer, Economic Support Supervisor Bill Van Offeren, Nursing Home Administrator Kathy Huston, CSP Coordinator Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Mary Boots 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, March 21, 2007 at 8:30 AM. Berenschot will review March 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 Caflisch, seconded by Troyer, and unanimously adopted: That the minutes of the 01/17/07 Health and Human Services Board meeting approved as circulated. 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 92898 through 92905, dated January 18, 2007 in the amount of $40,617.08. Human Services vouchers 92906 through 92907, dated January 18, 2007 in the amount of $1,063.51. St. Croix County Health and Human Services Board Page 2 February 21, 2007 Human Services voucher 93581, dated February 05, 2007 in the amount of $1,357.83. Human Services vouchers 94241 through 94273, dated February 08, 2007 in the amount of $57,949.50. Human Services voucher 94274, dated February 08, 2007 in the amount of $360.00. Human Services and Nursing Home vouchers 92776 through 92897, dated January 18, 2007 in the amount of $370,076.92. Human Services and Nursing Home vouchers 92749 through 92763, dated January 18, 2007 in the amount of $3,073.07. Human Services and Nursing Home vouchers 92951 through 93111, dated January 25, 2007 in the amount of $92,762.51. 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 Farm vouchers 92912 through 92950, dated January 25, 2007 in the amount of $280,006.56. Human Services and Nursing Home vouchers 93350 through 93375, dated February 01, 2007 in the amount of $39,588.28. Human Services and Nursing Home vouchers 93376 through 93432, dated February 01, 2007 in the amount of $38,576.60. Human Services and Nursing Home vouchers 94100 through 94130, dated February 08, 2007 in the amount of $44,316.00. Human Services and Nursing Home vouchers 93613 through 93647, dated February 08, 2007 in the amount of $17,224.76. Human Services and Nursing Home vouchers 93648 through 93793, dated February 08, 2007 in the amount of $228,356.64. Human Services and Nursing Home vouchers 94131 through 94273, dated February 08, 2007 in the amount of $57,949.50. Human Services, Workshop, Public Health, Social Services vouchers 42 through 72, dated January 23, 2007 in the amount of $365,366.26. Human Services, Workshop, Public Health, Social Services vouchers 73 through 104, dated February 06, 2007 in the amount of $376,697.70. Human Services and Nursing Home vouchers 33 through 42, dated January 16, 2007 in the amount of $20,974.19. Human Services and Nursing Home vouchers 43 through 74, dated January 25, 2007 in the amount of $160,981.21. Human Services and Nursing Home vouchers 75 through 106, dated February 08, 2007 in the amount of $150,939.95. Workshop vouchers 7 through 12, dated January 23, 2007 in the amount of $12,689.29. St. Croix County Health and Human Services Board Page 3 February 21, 2007 vouchers 13 through 18 dated February Workshop g Y 06, 2007 in the amount of $10,849.90. FINANCIAL REPORT Pempek distributed the following Nursing Home financial report for January through December. She reminded members closeouts will occur over the next few weeks as there are late billings and late revenues. The Medicare and private pay payer source mix is up. General services costs are down due to a decrease in maintenance staff in the Nursing Home. Pathways staff continue to be utilized and is reflected in administrative services. The average census for the year is 61.5; the budget was prepared at a census of 66. I St. Croix County Health and Human Services Board Page 4 February 21, 2007 ST CROIX HEALTH CENTER OPERATIONS REPORT January - December 2006 Jan -Dec 2006 BUDGET ACTUAL DIFFERENCE _o CENSUS 66 61 -5 OPERATING; REVENUE:_ MEDICARE $ 629,623.05 $ 1,020.167.01 $ (390,543.96) 162% MEDICAID $ 2,609,616.07 $ 1,821,324.79 $ 788,291.28 70% PRIVATE PAY $ 547,475.00 $ 1,156,258.14 $ (610,783.14) 212% ALL OTHER SOURCES*** $ 220 ,453.00 $ 268 ,091.66 $ (47 ,636.68) 122% TRANSFER FROM CONTINGENCY $ - $ - $ - TOTAL OPERATING; REVENUE $ 4,007,167.12 $ 4,267,841.62 $ (260,674.50) 107% OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,363,410.47 $ 3,239,387.56 $ 124,022.91 96% SPECIAL SERVICES $ 274,458.35 $ 241,355.09 $ 33,103.26 86% GENERAL SERVICES $ 1,169,758.41 $ 1,029,786.48 $ 139,971.93 88% ADMINISTRATIVE SERVICES $ 527,734.19 $ 691,106.64 $ (163,372.45) 131% UNASSIGNED: DEPRECIATION( %BASED) $ - $ - $ - $ 373 ,372.00 $ 373 ,372.00 0% Utilities $ 122,166.91 Workers Comp, Computer Tech $ 196,285.97 Insurance $ 63,069.83 OTHER EXP: $ 381,522.71 TOTAL OPERATING EXPENSES $ 5,708,733.42 $ 5,583,158.48 $ 125,574.94 98% NET FROM OPERATIONS $ - $ (1,315,316.86) (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) EXTRAORDINARY REVENUES RATE APPEAL REV $ 14,824.00 $ 14,624.00 $ - 100% % OF OUTSTANDING IGT REV $ 377,000.00 $ 384,070.00 $ (7,070.00) 102% CO ALLOCATIONS( %BASED) $ 1,309,742.30 ' $ 1,305,640.00 $ 4,202.30 100% TOTAL OUTSTANDING $ 1,701,566.30 $ 1,704,434.00 $ (2,867.70) NET FROM ALL SOURCES $ 389,117.14 PERCENTAGE SHOULD BE 100.00% Pempek distributed the following Health and Human Services financial report for January through December. The closeout for Health and Human Services will be done by March 30 with the exception of Long Term Support. Pempek reported some shifting in SED and Long Term Support revenues and expenditures will occur. General Relief was budgeted at $15,000 for 2006 and only $1,002 was spent. Johnson said financial reports are reviewed monthly with managers from each unit to make sure revenue sources and expenditures are correct. I St. Croix County Health and Human Services Board Page 5 February 21, 2007 HEALTH AND HUMAN SERVICES - 2006 SUMMARY Total OF REVENUES Budget January - Dec Balance % Administration 925.134.00 1,166,850.30 (241.716.30) 126.1 AODA Services 649,146.01 668,329.99 (19,183.98) 103.0% Long Term Support 17,542,262.00 17,041,032.40 501,229.60 97.1% Mental Health 2,909,086.00 2,839,557.45 69,528.55 97.6% Family & Children's 3,120,265.00 3,164,649.54 (44,384.54) 101.4% SED 21'6.000.00 380,172.64 (164.172.64) 176.0% Public Health 1,537,680.00 1,479,780.01 57,899.99 96.2% Economic Support 1,010,360.00 903,644.20 106,715.80 89.4% General Relief 15,000.00 15,000.00 Coordinated Services 260,403.00 185,802.85 74,600.15 71.4% REVENUES HUMAN SERVICES PROGRAMS 28,185,336.01 27,844,819.38 340.516.63 98.8% SUMMARY Total OF EXPENDITURES Budget January - Dec Balance % Administration 925,134.00 986,484.28 (61,35028) 106.6% Alcohol -Drug Abuse 649,146.01 732,051.68 (82,905.67) 112.8% Long Term Support 17,542,262.00 17,389,724.33 152,537.67 99.1% Mental Health 2,909,086.00 2,959,534.42 (50,448.42) 101.7% Family & Children's 3,120,265.00 2,778,304.99 341,960.01 89.0% SED 216000.00 239.104.66 (23104.66) 110.7% Public Health 1,537,680.00 1,508,858.87 28,821.13 98.1 % Economic Support 1,010,360.00 1,001835.59 6,524.41 99.4% General Relief 15,000.00 1,002.37 13,997.63 6.7% Coordinated Services 260,403.00 204,314.30 56,088.70 78.5% EXPENDITURES HUMAN SERVICES PROGRAMS 28,185,336.01 27,803,215.49 382,120.52 98.6% Excess Rev over Expenses # 41.603.89 Percentage of Budget: 100 '° ' WIMCR revenues recorded $ 41,603.89 ECONOMIC SUPPORT PROGRAM REVIEW Squyer distributed a chart indicating programs that will apply to elderly for Long Term Care and other programs that will be covered under family Medical Assistance which will be included in BadgerCare Plus. BadgerCare Plus will consolidate multiple categories of Medicaid to one. The application is a two page application, which can be completed on -line. Income will have to be verified for applications, which is time consuming. There is a strong possibility once the system is cleaned up, BadgerCare will go to the state for eligibility. The State has a new report to rate the timeliness of processing applications. A fine of $250 per case may be imposed for each case not processed on time. The State expects 95% of costs to be processed timely, and St. Croix County is at 81 %. No county in the state is at 95% now. Squyer reported caseloads in Economic Support have increased from 1,300 with 16 staff to now 3,200 cases with 12 staff. Downsizing of staff occurred due to eliminating W -2 as a county - administered program. Squyer outlined several audits occurring on cases. I i St. Croix County Health and Human Services Board Page 6 February 21, 2007 Squyer reported MA transportation is larger. A per diem rate is paid for clients who are on Medicaid to provide transportation to get to medical appointments. The program went from $15,000 to $25,000 per month. The program is being computerized and we will be required to use procedure codes for all mileage to be paid. This new program will double the time it took to process billing forms in the past. Advertisements have been placed for the vacant worker position. Some of the new worker training will occur in Oshkosh. An additional requirement for M.A. recipients is citizenship and identity requirements, which is time consuming. The state made a one -time payment of $13,147 to the county for proving citizenship and identity. Of 1,936 applications 46 in St. Croix County were denied or terminated benefits due to citizenship. Dunlap reported if a child was placed in out -of -home care in the past the child automatically qualified for medical assistance. Now proof of identity and citizenship will be required. It is possible some children in out of home care will now have no insurance coverage. Dunlap will follow up with Risk Management on insurance options should a youth enter care and are not a citizen. Squyer updated the status of General Relief. In 2007 monies have been approved for diabetic supplies for one client. General Relief monies were approved for a client with a life threatening condition. Services are being paid at the MA rate. There is a good chance all funds designated for General Relief, $15,000, will be depleted early in 2007. Squyer reminded the Board General Relief is not a mandated program. It was the consensus of the Board to continue the program as is. A certificate was received from James Jones recognizing the agency for being below 6% error rate for the Food Share Program. CONTINUOUS QUALITY IMPROVEMENT REPORT - FAMILY AND CHILDREN'S The executive summary was received in January, eleven months after the on -site review, which took place in February 2006. The state is mandated to conduct this review which checks for child safety, best practice, well being and permanency. It looks to outcomes for children and families served, strengths of local practice and the opportunities for improving system performance. St. Croix County scored the highest of counties (February, 2006) surveyed on strengths. St. Croix County's strength is reflected in stable, skilled knowledgeable staff who work well together. Concerns were raised regarding legal representation. Meetings are held at least quarterly with the judges and every other month with law enforcement. Dunlap indicated distance between Health and Human Services and the Government Center is one issue; however, it is also important for Family and Children's staff to be able to communicate with Mental Health and Alcohol /Drug Abuse on a regular basis. There are a minimum of 50 cases brought to the courts each month. The summary results indicate St. Croix County has a strong and solid case practice model to build upon. Another survey is expected in the future. The Board recessed from 9:48 to 9:55 AM. PERSONNEL ISSUES - CSP CLINICAL SOCIAL WORKER Kiesler and Huston requested to convert a CSP Social Worker (Bachelor Level, Grade 7) position to a CSP Clinical Social Worker (Master Level, Grade 8) position due to a clinical need for the program. The CSP Clinical Social Worker position would be able to directly provide the psychotherapy that is now subcontracted through the Mental Health Outpatient Clinic. This plan would conform with State surveyor St. Croix County Health and Human Services Board Page 7 February 21, 2007 recommendations to have a self- contained unit. There are currently 16 -18 individuals receiving services as subcontracted. This shift would enhance continuity of care. Kiesler reported this shift would cost more but would also generate more funds (approximately two to one ratio, revenue to expense). Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That the Board approves converting a CSP Social Worker (Bachelor Level, Grade 7) position to a CSP Clinical Social Worker (Master Level, Grade 8) position and forwarding to the Finance Committee for review. This item will be added to the March 8th Finance agenda. NURSING HOME REPORT The Nursing Home census is 63. Staffing through Pathways continues. Johnson reported Fay Strenke has accepted the Health and Human Services Accounts Receivable Supervisor position. HEALTH AND HUMAN SERVICES FACILITY PLANNING Johnson reported Bob Brown from Ayres and Associates has met with administrative staff. A space survey has been sent out to administrative staff. Information is pending from maintenance staff. A concept plan was not included as part of the study and Johnson indicated the study outcome /needs will vary depending on if the building was a stand alone building or an attached building and may require a concept plan. Johnson also provided review information from a 1985 master space plan provided by Ralph Robole. It is anticipated the study may be completed in March or April. LONG TERM SUPPORT -LONG TERM CARE REFORM /ADRC Board members received summary notes on Long Term Care Redesign meeting held on February 2, 2007. Five counties, including Chippewa, Dunn, Eau Claire, Pierce and St. Croix, are included in the consortium. The state is not interested in setting up individual counties as a CMO, thus the reason for forming the consortium. Dunn and Chippewa County have already passed a resolution requesting the State issue a RFP for a Care Management Organization to provide redesigned Long Term Care services. Pierce County will have a second reading this month on a similar resolution. Johnson said this is a two -step process; first, a resolution to request the State to issue an RFP and then when one county's contribution is determined, to issue a second resolution. This two -step resolution process was discussed specifically in the 02/02/07 meeting with the State and State representatives agreed that this would be their expectations. This allows the county the opportunity to opt out should concerns arise around fiscal input. St. Croix County has three options: 1) Do nothing, continue as is and potentially spend some of the surplus to meet needs of clients on the waiting lists; 2) Create own managed care organization; or 3) Join care management organization. A copy of the statute as reported by Judith Frye regarding evaluating proposals primarily as to the quality of care that is proposed to be provided was given to Board members. Board members are questioning why the process can't also be competitively bid on price. The Board questioned who was on the waiting lists and what services they are waiting for. This information will be provided for the Board. A survey is sent out every six months questioning clients if they wish /need to remain on the waiting list. Currently, clients on the waiting list are served only if there is a crisis. Lockwood explained partial slot funding has been created. Previously all health and safety needs had to be met to remove a client from the waiting list. Partial slot fund waivers are being tried with St. Croix Industries clients. Approximately 15 slots opened up when partial slot funding was implemented. Staff are concerned of a `woodwork' effect if there is movement on the waiting lists. Lockwood reminded Board members the State of Wisconsin has frozen St. Croix_County Health and Human Services Board Page 8 February 21, 2007 contributions for the basic programs for 12 years. The county is responsible for 40% match to provide services. Lockwood reported a survey is going out to consumers of St. Croix County; results will be tabulated by UW- Stout. No assurances have been received on buy -down from the state, which would be part of the negotiation should the RFP be released for this consortium. A fiscal analysis regarding Long Term Care Redesign may be available in March or April. Johnson reported the Council on Aging supported the proposed resolution and the Long Term Support Committee passed a resolution to support the resolution for reform. RESOLUTION ON THE DESIGNATION OF ELDER ADULT -AT -RISK AND ADULT AT RISK AGENCIES The resolution has been reviewed by assistant Corp. Counsel. The resolution is a result of changes in the law regarding self - neglect or neglect of the elderly. The system has been changed to strengthen the reporting system for vulnerable adults in addition to elders. In the old statutes, reporting was voluntary, now reporting is mandatory for professionals. Stronger criteria for response to complaints have been implemented. Reporting must now occur within 72 hours; however, this does not remove law enforcement responsibilities. Motion A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the Board approves the following resolution: RESOLUTION ON THE DESIGNATION OF ELDER ADULT -AT -RISK AND ADULT -AT -RISK AGENCIES Resolution No. St. Croix County, Wisconsin WHEREAS, in 2007 the St. Croix County Board of Supervisors did designate the Department of Health and Human Services as the agency to develop and implement the elder abuse reporting system for St. Croix County; and WHEREAS, 2005 Wisconsin Act 388, enacted May 10, 2006, requires each county board to designate an agency in the county as the elder adult -at -risk agency to serve the population of elder adults- at -risk for the purposes of s.46.90 Wis. Stats.; and WHEREAS, 2005 Wisconsin Act 388, enacted May 10, 2006, also requires each county board to designate an agency in the county as the adult -at -risk agency to serve the population of adults -at -risk for the purposes of s.55.043 Wis. Stats.; and I WHEREAS, the elder- adult -at -risk agency and the adult -at -risk agency shall have the following duties with regard to their respective populations: 1. Develop a policy for notifying other investigative agencies, including law enforcement officials in appropriate cases; 2. Establish an abuse reporting system to carry out the purposes of s.46.90 Wis. Stats. and s.55.043 Wis. Stats.; 3. Enter into a memorandum of understanding regarding the operation of the system with the county department under s.46.215 or 46.22 and with any private or public agency, including a county department under s.51.42 or 51.437, within the county that is participating in the reporting system. The memorandum of understanding shall, at a minimum, identify the agencies that are 5t. Croix County Health and Human Services Board Page 9 February 21, 2007 responsible for the investigation of reports of abuse, financial exploitation, neglect, or self - neglect of elder - adults -at -risk and adults at risk, as well as for the provision of specific direct services. 4. Receive reports of abuse, financial exploitation, neglect, or self - neglect of elder - adults -at -risk and adults at risk. 5. Publicize the existence of the reporting system in the county and provide a publicized telephone number that can be used by persons wishing to report suspected cases of abuse, financial exploitation, neglect, or self - neglect. Also, provide a telephone number that can be used to make reports after the agency's regular business hours. NOW, THEREFORE, BE IT RESOLVED by the St. Croix County Board of Supervisors that they do hereby designate the Department of Health and Human Services as St. Croix County's "Elder Adult -at -Risk Agency" pursuant to Chapter 46 of the Wisconsin Statutes, and the Department of Health and Human Services as St. Croix County's "Adult -at -Risk Agency" pursuant to Chapter 55 of the Wisconsin Statutes. BE IT FURTHER RESOLVED that the duties of these agencies are as described above. BE IT FURTHER RESOLVED that this designation shall be effective March 1, 2007. Johnson said discussion will occur with Long Term Support staff regarding impact this change will have on workload and coordination will occur with Behavioral Health and Family and Children's staff regarding providing 24 -hour coverage for reporting. RFP TO DISMANTLE AND REMOVE THE BARN FROM THE COUNTY PROPERTY Caflisch expressed concern to maintain non -used buildings. Johnson reported Don Johnson, who is leasing the county farm land starting in 2007, may be interested in the farm buildings. It was the consensus of the Board to delay further discussion until a decision is made on the Nursing Home RFP. RESOLUTION IN SUPPORT OF STATEWIDE ANTI - SMOKING INITIATIVE AND INCREASE IN CIGARETTE TAX Further discussion on the ordinance will take place with Corp. Counsel, Johnson and Kretz. This item will be delayed until a future meeting. Caflisch requested an agenda item be added next month addressing phone conferencing with members not present at meetings. CLOSED SESSION PER WISCONSIN STATUTES 19.85 (1) (C) FOR DIRECTOR'S REVIEW AND CLOSED SESSION PURSUANT TO WISCONSIN STATUTES SEC. 19.85 (1)(E) TO REVIEW NURSING HOME PROPOSAL(S) Motion A motion was introduced by Caflisch, seconded by Berenschot, that the Board enter closed session pursuant to Wisconsin Statutes sec. 19.85(1) (c) and (e) to review Nursing Home proposal(s) and for Director's review. Roll call vote: Esther Wentz -yes Gordon Awsumb -yes Leon Berenschot -yes Lois Burri -yes Tom Caflisch -yes Ct. Croix County Health and Human Services Board Page 10 February 21, 2007 Dr. Kretz- absent Linda Luckey -yes Deb Rasmussen -yes Ronald Troyer -yes Eight yes, one absent, motion passed. The Board entered closed session at 11:25 AM. RECONVENE IN OPEN SESSION PER WISCONSIN STATUTES 19.85 (2), RETURN TO OPEN SESSION Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That the Board reconvene into open session per Wisconsin Statute 19.85 (2). The Board reconvened in open session at 12:17 PM. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 12:18 PM Chair: Attest: (Secretary)