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HomeMy WebLinkAboutHealth & Human Services 05-16-07 Lois Burri will review vouchers. Revised 05/02/07 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD May 16, 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 - 04/18/07 DATE OF NEXT MEETING — 06/20/07 OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report 3. Accounts Receivable independent review 4. Nursing Home Report 5. Health and Human Services Facility Planning (9:00 AM) 6. Personnel Issues 7. Long Term Support-Long Term Care Reform/ADRC 8. Disposition Lease of Barn 9. Resolution In Support Of Governor Doyle's 100% Smoke Free Worksite Proposal 10. Presentation of the 2006 Annual Report (9:30 AM) 11. Communicable Disease Update ** 12. Employment/Placement Specialist Services (11:00 AM) ** 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. 5/2/2007 2:44 PM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD May 16, 2007 The St. Croix County Health and Human Services Board met on May 16, 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. Michael Kretz Linda Luckey Deb Rasmussen Ron Troyer MEMBERS ABSENT: none STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Bill Van Offeren, Nursing Home Administrator Ron Lockwood, Long Term Support Coordinator Kathy Dunlap, Family and Children's Coordinator Ron Eichstaedt, St. Croix Industries Director Steve Kirt, Behavioral Health Clinical Services Supervisor Charlotte Sortedahl, Public Health Coordinator - Health Officer Laurie Diaby - Gassama, Public Health Sanitarian Mary Squyer, Economic Support Supervisor Ron Kiesler, Behavioral Health Coordinator Kathy Huston, CSP Coordinator Pat Haeny, Family and Children's Supervisor Norma Vrieze, Early Intervention Director Cathy Drury, Health Information Management Supervisor Wendy Kramer, Public Health Supervisor David Best, Service Technician Malva Berg, Secretary OTHERS PRESENT: Bob Brown, Ayres and Associates Donnette Steinberger, Augsburg Nursing Student 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, June 20, 2007 at 4:00 PM. The Open Budget Hearing will start at 6:00 PM. Wentz will review June 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 Kretz, seconded by Burri, and unanimously adopted: That the minutes of the 04/18/07 Health and Human Services Board meeting be approved with the following modifications: Page 2, 2 nd paragraph, add punctuation to the following: "...bars and restaurants only, countywide, not just unincorporated areas, and not to restrict smoking on public grounds and in vehicles." St. Croix County Health and Human Services Board Page 2 May 16, 2007 Page 2, 3 rd paragraph, " Wentz appeint_d Dr. Kretz volunteered to work with Greg Timmerman to create an ordinance." Page 2, 8 th paragraph, "...accountable be for planning implementation. Board members were invited to be a part of the Oversight Committee." Johnson indicated a decision was made in closed session at the December 18, 2006 Health and Human Services meeting that was not documented in open session. Johnson consulted with Timmerman regarding this issue. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the Board approves amending the minutes of the December 18, 2006 minutes by adding the following: A decision was made in closed session with unanimous support of the Board to have an independent review of accounts receivable completed with WIPFLI or another entity that has a specialty or certification in auditing for fraud. CONSIDERATION OF CLAIMS Health and Human Services Board member Burri reviewed the vouchers. Motion A motion was introduced by Burri, seconded by Rasmussen, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 99382 through 99387, dated April 26, 2007 in the amount of $44,243.00. Human Services vouchers 97179 through 97306, dated May 22, 2007 in the amount of $57,859.62. Human Services and Nursing Home vouchers 100062 through 100095, dated April 19, 2007 in the amount of $162,121.56. Human Services and Nursing Home vouchers 99044 through 99085, dated April 19, 2007 in the amount of $11,732.06. Human Services and Nursing Home vouchers 99589 through 99797, dated May 03, 2007 in the amount of $197,513.39. Human Services and Nursing Home vouchers 100611 through 100760, dated May 10, 2007 in the amount of $133,337.40. Human Services, Nursing Home, and Government Center vouchers 100458 through 100591, dated May 10, 2007 in the amount of $97,101.91. Human Services, Nursing Home, and Farm vouchers 99294 through 99381, dated April 26, 2007 in the amount of $402,597.86. Nursing Home vouchers 100592 through 100610, dated May 10, 2007 in the amount of $7,439.96. Human Services, Workshop, Public Health, Social Services vouchers 230 through 260, dated April 17, 2007 in the amount of $366,971.52. Human Services, Workshop, Public Health, Social Services vouchers 261 through 293, dated May 01, 2007 in the amount of $370,306.46. St. Croix County Health and Human Services Board Page 3 May 16, 2007 Human Services and Nursing Home vouchers 234 through 265, dated April 19, 2007 in the amount of $149,310.29. Human Services and Nursing Home vouchers 266 through 297, dated May 03, 2007 in the amount of $150,222.86. Workshop vouchers 43 through 48, dated April 17, 2007 in the amount of $13,934.68. Workshop vouchers 49 through 54, dated May 01, 2007 in the amount of $12,286.39. FINANCIAL REPORT Pempek distributed the following financial report for the Nursing Home through March, 2007. The average census for March was 66. St. Croix Health Center March 2007 Budget Actual Difference % Census 70 66 4 Operating Revenue: Medicare $840,960.00 $202,997.69 $637,962.31 24.14 °I° Medicaid $2,466,310.60 $516,235.46 $1,950,075.14 20.93% Private Pay $699,887.50 $229,305.00 $470,582.50 32.76% All Other Sources $217,171.45 $51,128.74 $166,042.71 23.54% Total Operating Revenue $4,224,329.55 $999,666.89 $3,224,662.06 23.66°• Operating Expenses Daily Patient Services $3,557,580.61 $752,469.69 $2,805,110.92 21.15% Special Services $274,024.76 $63,968.71 $210,056.05 23.34° General Services $1,172,794.05 $244,046.49 $928,747.56 20.81% Administrative Services $593,527.93 $130,689.20 $462,838.73 22.02% Unassigned: Depreciation (% Based) $0.00 Others: $286,002.20 $61,661.63 $224,340.57 21.56% Utilities $34,642.63 Workers Comp, Computer Tech $4,088.75 Insurance $22,930.25 Total Operating Expenses $5.883,929.55 $1,252,835.72 $4,631,093.83 21.29°, Net From Operations ($253,168.83) (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 $317,151.00 $951,449.00 25.00% Total Outstanding $1,659,600.00 $317,151.00 $1,342,449.00 Net from all Sources $63.982.17 St. Croix County Health and Human Services Board Page 4 May 16, 2007 Pempek distributed the following financial report for Health and Human Services through March, 2007. Pempek reported there was a large increase in Administration due to WIMCR dollars received at the end of March in the amount of $1,108,120.36. Accounts Receivable accounts are currently under audit. Billings are current. Awsumb requested an accounts receivable aging report be prepared for the next Board meeting. At the last meeting it was reported the total 2007 budget numbers do not zero out due to an adjustment made primarily due to health insurance as reported by Finance Director, Michelle Pietrick. A review was performed by Pempek and her staff which revealed that monies were moved primarily due to borrowing for capital outlay expenses and did not find changes due to health insurance. This information will be forwarded to the Finance Director and this will also be discussed further at the next Finance Committee meeting. HEALTH AND HUMAN SERVICES - 2007 SUMMARY Total OF REVENUES Budget March 31, 2007 Balance % Administration 1,080,749.83 1,191,700.61 (1101950.78) 110.3% AODA Services 765,599.92 163,980.38 601,619.54 21.4% Long Term Support 18,196,351.85 4,776,277.04 13,420,074.81 26.2% Mental Health 2,879,503.70 596,536.03 2,282,967.67 20.7% Family & Children's 3,132,978.40 786,465.28 2,346,513.12 25.1% Public Health 1,617,175.53 449,603.21 1,167,572.32 27.8% Economic Support 1,112,508.60 386,555.51 725,953.09 34.7% General Relief 15,000.00 3,750.00 11,250.00 25.0% Coordinated Services /ED 900,066.00 335,951.91 564,114.09 37.3% REVENUES HUMAN SERVICES PROGRAMS 29,699,933.83 8,690,819.97 21,009,113.86 29.3% SUMMARY Total OF EXPENDITURES Budget March 31, 2007 Balance % Administration 1,080,095.83 228,330.94 851,764.89 21.1% Alcohol -Drug Abuse 765,599.92 140,472.96 625,126.96 18.3% Long Term Support 18,196,351.85 4,058,427.21 14,137,924.64 22.3% Mental Health 2,879,503.70 847,426.05 2,032,077.65 29.4% Family & Children's 3,132,978.40 689,866.43 2,443,111.97 22.0% Public Health 1,617,837.53 400,454.61 1,217,382.92 24.8% Economic Support 1,112,508.60 242,550.01 869,958.59 21.8% General Relief 15,000.00 1,508.56 13,491.44 10.1% Coordinated Service/SED 900,066.44 103,962.04 796,104.40 11.6% EXPENDITURES HUMAN SERVICES PROGRAMS 29,699,942.27 6,712,998.81 22,986,943.46 22.6% Excess Rev over Expenses S 1.977,821.16 In the capital outlay plan $110,000 was designated for a phone system for Health and Human Services. The Board questioned obtaining a new phone system now when a new building may be built in the future. Johnson will meet with Pat Daniels from Elert and Associates, telephone consultants, to discuss this issue. The current telephone system has no technical support and concern was expressed regarding keeping the system operational during the upcoming severe St. Croix County Health and Human Services Board Page 5 May 16, 2007 weather season. It was also approved to borrow $15,000 for the parking lot at St. Croix Industries. Building Services will begin work on the project. HEALTH AND HUMAN SERVICES FACILITY PLANNING UPDATE Bob Brown, from Ayres and Associates, distributed the space needs study for Health and Human Services. The study distributed does not cover the Government Center. The current building is 62,000 square feet; a replacement building is projected at 47,000 square feet. Square footage would vary if the building was stand alone or connected with the Government Center due to efficiencies that could be shared, i.e. IT, building services, storage, etc. Brown reported the government standards are 1.4% assignable square footage to include circulation, corridors, bathrooms, etc. Awsumb indicated the industry standards are 1.15 %, which would decrease the size of the building. Brown indicated the schematic design will validate the necessary square footage. Johnson prepared a cost benefit analysis to compare operating a new facility versus the current building. He noted there are several big ticket items for capital outlay expenditures in the next few years, including fire alarm panel for $80,000, chiller for $83,000, generator for $90,000, upgrade to digital pneumatic control design for $45,000 (all numbers are estimates). Utility costs for the current building are $2.67 /square foot compared to the projected $1.50 /square foot for a new building. Another area of savings if a new building is constructed is transportation for staff. Considered in this figure were building services staff that travel between facilities and Human Services staff for court - related travel only. Comparisons were also made with Eau Claire County as Ayres and Associates completed a space needs study there in 2002. A review of the staffing levels and actual square footage allocated for comparable departments (between St. Croix and Eau Claire) came very close to 250 square feet per person, which was the projected space need Supervisor Awsumb identified as an industry standard. It is unclear if the comparison included conference rooms. Another consideration for future growth and needs is that Eau Claire County experienced a 1.7% population growth compared to St. Croix County experiencing a 26.7% population grown (2000 to 2006 estimate). Board members discussed the location of a new building and costs to do something with the current building. The next step in this process would be to create a concept plan. Motion A motion was introduced by Kretz, seconded by Caflisch, and unanimously adopted: That the Health and Human Services Board supports a proposal to Finance Committee to create two concept plans for Health and Human Services for a stand alone facility and a facility connected to the Government Center to meet the facility needs for Health and Human Services. Awsumb reiterated he would like the plan to reflect a 15% efficiency, not 40 %. PRESENTATION OF THE 2006 ANNUAL REPORT Van Offeren reported there has been a general decline in long term care utilization in nursing homes by the elderly. In 2005 there were 401 nursing homes in Wisconsin, in 2006 that number declined to 377. It is a rapidly changing market with home care increasing again, lower utilization of nursing homes and nursing homes with more private rooms. There were 72 admissions and 79 discharges from the nursing home in 2006. Family and Children's Services are mandated. Chapter 48 and 938 are the primary governing statutes under which the Family and Children's Unit St. Croix County Health and Human Services Board Page 6 May 16, 2007 operates. Dunlap reported fewer alternate care days in 2006 from 2005; however, there have been two placements in treatment foster care who have to be in placement all year. Haeny reported a drop in offenses referred to Juvenile Intake. One noticeable area of decline was a reduction in the number of bomb scare reports/ incidents. Coordinated Family Services (CFS) continued to expand in 2006 with the administration of the Severely Emotionally Disturbed (SED) Waiver. This waiver offsets county levy spending by approximately $291,612 for mandated services in 2006. Expansion of this waiver for eligible youth is anticipated with two Long Term Support social workers transitioning into the CFS unit. This change will allow staff to more efficiently manage wait lists and hopefully reduce the numbers on the wait lists. The CFS unit was created as a separate unit to recoup Federal monies that otherwise would have been county dollars. Sortedahl reported Public Health responsibilities and powers are addressed in Wisconsin Statutes, Chapters 250 -255. She reviewed service areas in Public Health that cover prevention, protection and health promotion. Huston reported there were 123 clients in the Community Support Program (CSP) in 2006. There were no client deaths by suicide in 2006. Huston further reported a Coordinated Service Team (CST) is being developed in 2007 for adults under CSP. Kiesler reported the Mental Health /Alcohol /Other Drug Abuse Unit changed the unit name to Behavioral Health. Kiesler reported any hospital in the State can take inpatient psychiatric clients if they are licensed facility but there is limited bed availability for inpatient psychiatric clients. Mobile crisis has been in operation since January, 2006 and was recently certified by the state which means the agency can now bill for MA clients who receive services. When mobile crisis began, 62% of the time law enforcement personnel utilized mobile crisis. Staff are exploring options to reach out to officers for support for mobile crisis. In 2006, 58 people were diverted from inpatient psychiatric hospitalization. A jail program and Drug Court were also established in 2006 mainly due to the increase in meth clients. Lockwood reported with the expansion of assisted living facilities, clients have more options than nursing home care. Lockwood reported no additional monies have been allocated for the CIP 2 /COP W waiver program for the last 12 -15 years. Lockwood reported staff continue to prepare for the transition to Long Term Care Reform. Vrieze reported 125 children were enrolled in the Birth to Three Program for 2006. Eichstaedt reported the waiting list for community employment increased to six this year, other programs remained stable. Squyer outlined the programs included in Economic Support. All programs are mandated under WI State chapter 49, except for General Relief. Entitlement benefits decreased from 2005, possibly due to less stem cell transplants in 2006 than in 2005. Pempek reviewed year end financial summaries for Health and Human Services and Nursing Home. The amounts included in the annual report are not audited. The Board recessed from 10:50 to 10:55 AM. COMMUNICABLE DISEASE UPDATE Diaby - Gassama gave a report on Norovirus. She presented a scenario of steps involved when there is a report of Norovirus. She offers a `Potluck Food Safety Course' to any St. Croix County residents. Kretz questioned if the rules could be changed around potlucks to require event coordinators to view or participate in the `Potluck Food Safety Course.' Johnson will follow up on this request with Lieske Giese, Eau St. Croix County Health and Human Services Board a Page 7 May 16, 2007 Claire /Western Regional Office, during her visit to Public Health on 05/18/07. Diaby - Gassama will also send an article to the media to advertise availability of this course to the public. EMPLOYMENT /PLACEMENT SPECIALIST SERVICES The Department is looking at alternative models for delivery of employment placement services that are provided through St. Croix Industries and our Community Support Program (CSP). Administration is requesting to consolidate the two services for the balance of the year on a pilot basis and possibly avoid duplication of services. There are currently 11 clients on the Community Employment wait list. A LTE position would be created to possibly share the resources to fill employment needs for both Mental Health /CSP clients and St. Croix Industries clients. Skramstad would do the job development /job placement with follow up provided by job coach. This consolidation may also benefit the wait list for St. Croix Industries, which also has a wait list. Motion A motion was introduced by Troyer, seconded by Berenschot and unanimously adopted: That the Board approves an LTE entry job coach as a pilot program. It was the consensus of the Board that staff report back to the Board as part of the budget process. ACCOUNTS RECEIVABLE INDEPENDENT REVIEW WIPFLI and Associates staff, Peggy Van Zanten, has started the independent review. A letter of agreement has been drafted to contract with Corporation Counsel to keep the review independent. Corporation Counsel will identify when more information is available. NURSING HOME REPORT Johnson reported the Nursing Home census is 61. The State survey took place May 7 through 9. The facility received a deficiency - free survey. Staff are to be commended for their excellent work. It was recommended to recognize staff for their excellent survey at the Open Hearing. An article was placed in the New Richmond News regarding the survey results. PERSONNEL ISSUES Johnson announced Carrie Doehrmann has been hired to fill the vacant Accounts Receivable position. Charlotte Skoviera from Economic Support has announced her retirement effective June 15, 2007. Her position will be posted. Johnson said two social workers from the Long Term Support Unit, who have a caseload of children, will be moving to the Coordinated Family Services (CFS) Unit in the next few months. A more detail report of planning and implementation of this change will be discussed at a future meeting. LONG TERM SUPPORT -LONG TERM CARE REFORM /ADRC No response has been received from Secretary Hayden or local representatives regarding the letter sent to them. A similar model to the proposed St. Croix County model has been created in Chippewa County. St. Croix County staff are meeting on June 4th with Chippewa County to look at their model. Staff continue to request the fiscal analysis tool from the state and to date has not been received. Board members are invited to a Long -Term Care Expansion presentation presented by Jim Hoegemeier, Executive Director of The ARC Wisconsin Disability Association on Long Term Care Reform on June 11, 2007 at 5:30 PM at the Cashman Conference Center at WITC -New Richmond. Care management organizations, staff and consumers are also invited. DISPOSITION LEASE OF BARN Johnson reported the pheasant pen area has been St. Croix County Health and Human Services Board Page 8 May 16, 2007 cleaned up by maintenance and Pre - Release inmates. A motion was made at Finance to issue an RFP to get any salvage value from the equipment, silos, and buildings on the county farm property. Johnson will work with Building Services and Procurement to get the RFP issued. RESOLUTION IN SUPPORT OF GOVERNOR DOYLE'S 100% SMOKE FREE WORKSITE PROPOSAL The Board was provided a copy of Senate Bill 150 for review. Kretz said it is the duty of the Board to protect people who are involuntarily exposed to smoke (second -hand smoke) . Several areas of concern were questioned by members, some of which include: unclear cross reference on fines, why private vehicles are listed, and penalties on business owners. It was the consensus of the Board that they support a comprehensive law in Wisconsin regarding smoking restrictions; however, were concerned with some of the language in Bill 150. Johnson offered to forward a letter with a list of questions to Senator Risser's office. Motion A motion was made by Kretz, seconded by Berenschot, That the Board approves Senate Bill 150, also known as Breathe Free Wisconsin Act. Motion A motion was made by Awsumb, seconded by Wentz, That the Board approves an amendment to the above motion to support a uniform Wisconsin statute change to ban smoking including all indoor places but to exclude private passenger vehicles, outdoor areas except as currently defined in statute, and any private residence and that fines or penalties should not be increased. Roll call vote on above amendment only: Esther Wentz - yes Gordon Awsumb - yes Leon Berenschot - no Lois Burri - yes Tom Caflisch - yes Dr. Michael Kretz - no Linda Luckey - yes Deb Rasmussen - no Ronald Troyer - -no Five yes, four no, motion passed. Roll call vote on the motion regarding Senate Bill 150 as amended: Esther Wentz - yes Gordon Awsumb - yes Leon Berenschot - no Lois Burri - yes Tom Caflisch - yes Dr. Michael Kretz - no Linda Luckey - yes Deb Rasmussen - no Ronald Troyer - -no Five yes, four no, motion passed. The Board directed Johnson to send a letter as quickly as possible to state legislators on the above amendment. Wentz asked if there were any other issues to bring before the Board. St. Croix County Health and Human Services Board Page 9 May 16, 2007 Berenschot announced a 16 -unit assisted living facility is being built in Glenwood City in September or October, 2007. Wentz adjourned the meeting. Time: 12:30 PM Chair: Attest: (Secretary)