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HomeMy WebLinkAboutHealth & Human Services 07-18-07 Leon Berenschot will review vouchers. NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 18, 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 - 06/20/07 DATE OF NEXT MEETING — 08/15/07 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report a. Collections activities (8:30 AM) 3. Nursing Home/Health and Human Services Audit Report (9:00 AM) 4. Nursing Home Report 5. Health and Human Services Facility Planning (10:00 AM) 6. Personnel Issues -New Position Requests 7. Long Term Support-Long Term Care Reform/ADRC 8. HHS Departments Priorities for 2008 and budget planning for 2008 9. Mobile Crisis utilization update 10. Health and Human Services Governing Body By -laws Review 11. Capital Outlay — St. Croix Industries 12. Strategic Planning Survey 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. 7/9/2007 7:49 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 18, 2007 The St. Croix County Health and Human Services Board met on July 18, 2007 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Gordon Awsumb Lois Burri Tom Caflisch Ron Troyer MEMBERS ABSENT: Leon Berenschot Dr. Glenn Hoberg Linda Luckey Deb Rasmussen, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Bill Van Offeren, Nursing Home Administrator Kathy Dunlap, Family and Children's Coordinator Ron Kiesler, Behavioral Health Coordinator Steve Kirt, Behavioral Health Clinical Services Supervisor Kathy Huston, CSP Coordinator Cathy Drury, Accredited Medical Records Practitioner Fay Strenke, Accounts Receivable Supervisor Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor Wendy Kramer, Public Health Supervisor Charlotte Sortedahl, Public Health Coordinator - Health Officer Ron Eichstaedt, Director, St. Croix Industries Geralyn Karl, PH- Health Educator Malva Sirek, Secretary OTHERS PRESENT: Kjersti Duncan, Director, Department on Aging Steve Tracey, LarsonAllen, LLP Bob Brown, Ayres and Associates Art Tobin, Facilities Manager Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. ANNOUNCEMENTS Johnson announced that Dr. Mike Kretz sent a short e-mail on July 2, 2007 which indicated his intent to resign from the Health and Human Services Board. Action by the full County Board approved the appointment of Dr. Glenn Hoberg as the physician representative on the committee. Johnson will be in contact with Dr. Hoberg to welcome him to the committee. It was the consensus of the Board Dr. Kretz was a good Board member who contributed to Health and Human Services. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, August 15, 2007 at 8:30 AM. Berenschot will review August vouchers. A second August meeting will be held on August 29 at 8:30 AM. AGENDA Motion A motion was introduced by Burri, seconded by Troyer, and unanimously adopted: That the agenda be approved as circulated. St. Croix County Health and Human Services Board Page 2 July 18, 2007 MINUTES Motion A motion was introduced by Burri, seconded by Awsumb, and unanimously adopted: That the minutes of the 06/20/07 Health and Human Services Board meeting and 06/20/07 Open Hearing be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services Board member Wentz reviewed the vouchers. Motion A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 103226 through 103231, dated June 21, 2007 in the amount of $44,418.00. Human Services vouchers 103232 through 103233, dated June 21, 2007 in the amount of $860.00. Human Services vouchers 103763 through 103799, dated July 05, 2007 in the amount of $56,749.60. Human Services and Nursing Home vouchers 103388 through 103479, dated June 28, 2007 in the amount of $339,671.45. Human Services and Nursing Home vouchers 103657 through 103756, dated July 05, 2007 in the amount of $134,105.23. Human Services and Nursing Home vouchers 104154 through 104289, dated July 12, 2007 in the amount of $219,090.57. Human Services, Nursing Home, and Farm vouchers 103091 through 103225, dated June 21, 2007 in the amount of $296,863.56. Human Services, Nursing Home, and Government Center vouchers 104290 through 104430, dated July 12, 2007 in the amount of $97,707.21. Human Services and Nursing Home vouchers 101992 through 102136, dated June 07, 2007 in the amount of $320,984.83. Nursing Home vouchers 104431 through 104463, dated July 12, 2007 in the amount of $27,101.52. Human Services, Workshop, Public Health, vouchers 376 through 405, dated June 26, 2007 in the amount of $378,260.43. Human Services, Workshop, Public Health, Social Services vouchers 406 through 436, dated July 10, 2007 in the amount of $384,183.18. Human Services and Nursing Home vouchers 284 through 315, dated June 28, 2007 in the amount of $146,214.61. Human Services and Nursing Home vouchers 316 through 347, dated July 12, 2007 in the amount of $151,263.10. Workshop vouchers 73 through 78 dated June 28 2007 in the amount f g o $10,928.03. Workshop vouchers 79 through 84, dated July 10, 2007 in the amount of $11,310.03. St. Croix County Health and Human Services Board Page 3 July 18, 2007 FINANCIAL REPORT Pempek distributed the following financial report for Health and Human Services through May, 2007. Pempek reminded the Board that after August the State does paper take backs for revenues from the CARS report. HEALTH AND HUMAN SERVICES - 2007 SUMMARY Total OF REVENUES Budget May 31, 2007 Balance % Administration 1,080,749.83 1,248,257.44 (167,507.61) 115.5% AODA Services 765,599.92 278,130.36 487,469.56 36.3% Lang Term Support 18,196,351.85 8,650,272.54 9,546,079.31 47.5% Mental Health 2,879,503.70 1,184,057.94 1,695,445.76 41.1% Family & Children's 3,132,978.40 1,481,437.48 1,651,540.92 47.3% Public Health 1,617,175.53 752,416.73 864,758.80 46.5% Economic Support 1,112,508.60 560,046.45 552,462.15 50.3/0 General Relief 15,000.00 6,250.00 8,750.00 41.7% Coordinated Services /ED 900,066.00 420,415.57 479,650.43 46.7% REVENUES HUMAN SERVICES PROGRAMS 29,699,933.83 14,581,284.51 15,118,649.32 49.1% SUMMARY Total OF EXPENDITURES Budget May 31, 2007 Balance % Administration 1,080,095.83 419,560.31 660,535.52 38.8% Alcohol -Drug Abuse 765,599.92 267,819.88 497,780.04 35.0% Long Term Support 18,196,351.85 6,896,706.26 11,299,645.59 37.9% Mental Health 2,879,503.70 1,338,357.44 1,541,146.26 46.5% Family & Children's 3,132,978.40 1,168,684.44 1,964,293.96 37.3% Public Health 1,617,637.53 681,089.54 936,747.99 42.1% Economic Support 1,112,508.60 422,762.50 689,746.10 38.0% General Relief 15,000.00 1,313.66 13,686.34 8.8% Coordinated Service /SED 900,066.44 255,354.48 644,711.96 28.4% EXPENDITURES HUMAN SERVICES PROGRAMS 29,699,942.27 11,451,648.51 18,248,293.76 38.6% Excess Rev over Expenses ! 3.129.636.00 WIMCR payments are substantial but the state will take back from the County allocation. Awsumb questioned spending monies to take high -need children off the waiting lists or making plans to reduce the numbers on the waiting list in the future. This will be an agenda item for the August meeting. Pempek distributed the following financial report for the Nursing Home through May, 2007. The average census was 61 for May. Pempek indicated the private pay population was up. The arbitration ruling was received. Retro pay for the Nursing Home staff will be reflected on the July report. It is anticipated this cost will be approximately $22,281 for union staff only. Also included in the July report will be PTO payout for Nursing Home staff. Awsumb and Troyer requested line item detail for Administration budget and expenses. St. Croix County Health and Human Services Board Page 4 July 18, 2007 St. Croix Health Center May 2007 Budget Actual Difference Percentage Census 68 61 7 Operating Revenue: Medicare $840,960.00 $283,098.96 $557,861.04 33.66% Medicaid $2,466,310.60 $889,242.27 $1,577,068.33 36.06% Private Pay $699,887.50 $375,938.27 $323,949.23 53.71% All Other Sources $217,171.45 $65,079.92 $132,091.53 39.18% Total Operating Revenue $4,224,329.55 $1,633.359.42 $2,590,970.13 38.67% Operating Expenses Daily Patient Services $3,557,580.61 $1,224,013.01 $2,333,567.60 34.41% Special Services $274,024.76 $104,804.72 $169,220.04 38.25% General Services $1,172,794.05 $420,475.00 $752,319.05 35.65% Administrative Services $593,527.93 $241,024.66 $352,503.27 40.61% Unassigned: Depreciation (% Based) $0.00 Others: $286,002.20 $136,387.97 $149,614.23 47.69% Utilities $50,771.72 Workers Camp, Computer Tech $4,451.00 Insurance $61,165.25 Total Operating Expenses $5,883,929.55 $2,126,705.36 $3,757,224.19 36.14% Net From Operations ($493,345.94) (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 $528,585.00 $740,015.00 41.67% Total Outstanding $1.659,600.00 $528,585.00 $1,131.015.00 Net from all Sources $35,239.06 $196,000 Outstanding IGT Rev moved to 2006 via auditors COLLECTIONS ACTIVITIES Discussions have taken place with Katy Kapaun from Child Support regarding efforts that can be made to possibly lower Health and Human Services accounts receivables balances. It was determined Child Support will be able to do mail returns for Accounts Receivable at this time but will not be able to do other collection activities. Strenke indicated Medicare and Medicaid billings are going out monthly. She also reported there is a two -week turnaround versus six month turnaround for billing. Strenke indicated the NPI # was changed by the Federal Government and work is being done to change with the insurance companies. She reported guaranteed money billings are going out on time and follow up is being provided on claims. The Board thanked Strenke and Pempek for their efforts. St. Croix County Health and Human Services Board Page 5 July 18, 2007 NURSING HOME /HEALTH AND HUMAN SERVICES AUDIT REPORT Steve Tracey distributed draft reports of the audits. He said the reports will be formally bound by month's end. The Health and Human Services change in balance at year end is predicted at $951,513. The Nursing Home change in balance at year end is predicted at $250,496 after County levy application of $1.3 million for an actual resulting loss of $1,059,000 for the Nursing Home. Tracey said electricity, heat, etc. are allocated based on square footage as there is not a separate meter for the Nursing Home. Health and Human Services is a special revenue fund of the County. Tracey said assets over $5,000 are depreciated. Unreserved funds of $898,371 from 2005 were applied and carried over to the 2007 budget. It was decided Health and Human Services and Nursing Home would not have a separate fund or reserve balance for unanticipated expenditures. By moving surplus funds forward, the levy request is lowered for existing operations, which could create a significant increase in levy request should Health and Human Services and /or Nursing Home not end with similar surplus funds in the future. Funds left over from 2006 of $951,514 would be carried over to 2008 budget, which was discussed last year with the Board. Tracey reported accounts receivables are not recognized as income until collected. There were increased revenues in 2006 from Family and Children's waivers. Placements were down and several placements were moved from high cost to lower cost placements. In addition, insurance also covered some placements for Family and Children's. Tracey reported $504,480 was the net amount of WIMCR monies received before the take back of BCA dollars. A management letter indicated with new accounting standards the audit firm noted certain deficiencies in internal control that they considered to be significant deficiencies and other deficiencies that they consider to be material weaknesses. Tracey noted this comment will also show up in the County audit due to completeness of financial records. It is difficult to get final numbers due to final adjustments and reconciliations late in the year. Awsumb questioned what needed to be modified to take that statement out of the management letter. Tracey indicated it is difficult to remove the statement and the statement cannot be removed for 2006. Awsumb questioned modifying letter to state controls put in place so 2007 audit meets benchmarks. Tracey will work with Pempek on this issue and an update will be provided at a future meeting. The Board recessed from 10:12 to 10:16 AM. HEALTH AND HUMAN SERVICES FACILITY PLANNING Bob Brown from Ayres Associates presented two concept plans, one for a stand -alone building and one for a building attached to the current Government Center. The free - standing building has 55,114 square feet with assigned Health and Human Services area on the first and second floor. This concept plan also includes a full basement with a large portion of the basement area labeled "unassigned." It is based on 128 full time and 24 part time employees, which was the ten year projection. The attached building plan (attached to the Government Center) has approximately 58,494 square feet allocated for Health and Human Services on the first and second floor. This concept plan also includes a full basement with a large portion of the basement area labeled "unassigned." The other portion of this concept plan would house two new courtrooms and a new family court area. Future expansion is not identified on the plans. The square footage is estimated at 360 square feet per employee and Awsumb asked that this get closer to 250 square foot per employee, which is an industry standard. Brown will also meet with the Finance Committee in August. Brown will review concept plans with staff and an additional presentation to Health and Human Services would likely be scheduled for September. St. Croix County Health and Human Services Board Page 6 July 18, 2007 PERSONNEL ISSUES -NEW POSITION REQUESTS Thirteen new position requests were brought forward. Caflisch requested the positions be classified as to the positions that are most needed. Positions requested are as follows: Administration • Medical Records Technician -No staff have been added to this unit since 1977. Due to continued County growth and the increased demand for Behavioral Health and AODA services for the last decade, the number of staff providing those services has increased, which in turn has dramatically increased the workload in Medical Records. The position was also requested and approved by this Board in 2007. • Financial Assistant • Clerk Typists (2) -These three positions are requested to keep up with the daily demands of the Accounts Receivable Unit and scheduling all appointments for Behavioral Health. There are currently two temporary staff assisting with duties. The clerk typist positions will also assist with the transcription backlog in Behavioral Health. Awsumb recommended voice recognition software for Behavioral Health and other departments along with electronic files. • Accounts Payable Supervisor (New) -This would be a reclassification due to workload increases and current duties. Current Wipfli study indicates to Administration the position should be comparable to the Accounts Receivable Supervisor. Behavioral Health • Chemical Dependency Counselor -This is currently a contracted position. The union has not grieved this contract. The position is funded by a stable meth grant. If the position is not filled, the grant monies go away along with $15,000 in revenue generated through billing the position brings in; or if the funding would stop, the position would go away. Coordinated Family Services • Program Aid- The request is to serve more children on the waiting list. Costs for the program would include no County levy dollars and would be funded by Comprehensive Community Services Medicaid - Federal Share, Children's Waiver - Federal Share and Targeted Case Management Medicaid - Federal Share monies. Birth to Three • Speech Therapist .6 FTE -This service has been contracted since the 1990 however the contract agencies are not keeping up to needed services, which raises concern about serving children in a timely fashion. This would also allow for the Birth to 3 Director to spend administrative time in the ADRC. Economic Support • Economic Support Specialist- According to a cost model developed by the State, St. Croix County's projected need for eligibility workers is 8.73 FTE; current staffing is 7.5 FTE. Economic Support is out of compliance which creates the potential for corrective action and fines. Public Health • Public Health Nurse -This position has been requested for the past three years. Public Health is a population -based service and faces increasing demands due to growth. In 2006, an estimated 80,015 people lived in St. Croix County. St. Croix County has grown 23.5% during 2000 -2006, making it the fastest growing Wisconsin county. In 2004, St. Croix St. Croix County Health and Human Services Board Page 7 July 18, 2007 County had .9 public health nurses per 10,000 people, which was lower than the western region average of 1.2/10,000 and the state average of 1.0 /10,000. Currently, there are .57 public health nurses per 10,000 people in St. Croix County. Other service needs that are not being met were reviewed with the position request. St. Croix Industries • Job Coach Coordinator (New) -This position would assist the Job Placement Specialist in maintaining and expanding the Community Employment Program. When we reorganized to combine St. Croix Industries (SCI) and Community Support Program Placement (CSP), SCI assumed the job development and placement responsibilities for referred CSP clients. • Day Services Activity Aide - Increase from 75% to 100% position. Increase is needed to provide necessary supervision for serving more individuals in the program. • Job Coach /Community Trainer - Position was approved as an LTE position in May when the Behavioral Health and St. Croix Industries community employment programs merged. Johnson indicated it is difficult to prioritize the need for the above positions. Decisions on the positions will need to be made by August. HEALTH AND HUMAN SERVICES DEPARTMENTS PRIORITIES FOR 2008 AND BUDGET PLANNING FOR 2008 St. Croix County's population continues to grow and Health and Human Services is doing more work with less staff. Health and Human Services units outlined priorities for their units, which were forwarded to the Health and Human Services Board members. MOBILE CRISIS UTILIZATION UPDATE From 01/01/07 to 06/30/07 there were 46 opportunities to utilize mobile crisis. Of those opportunities, mobile crisis was involved 23 times with 21 clients being diverted (or not hospitalized) and only two clients were hospitalized. From 01/01/06 to 06/30/06 there were 60 opportunities to utilize mobile crisis. Of those opportunities, mobile crisis was involved 36 times. A huge savings is realized by the County for clients that do not need to be hospitalized. Wentz will contact the chair of Public Protection for this issue to be on the agenda of their next meeting. Wentz, Johnson, Kirt and Kiesler will attend that meeting. LONG TERM SUPPORT -LONG TERM CARE REFORM /ADRC Duncan and Vrieze distributed a proposed organizational chart for St. Croix County's ADRC (Aging and Disability Resource Center) along with the ADRC process flowchart. Department on Aging has been identified as the lead agency for the center. Application was written to West Central Consortium asking that they consider St. Croix County as a region in the state they would serve when responding to the State RFP and the indication is that this will happen. STRATEGIC PLANNING SURVEY Behavioral Health has been working with Pete Kling regarding Behavioral Health's Strategic Plan. It has become apparent that to move forward with planning an external scan is necessary. This scan would cover client, local stakeholder, and regional /state stakeholder surveys for the department. Public Health has accomplished this through a community needs assessment. The survey would be conducted through the Survey Research Center out of UWRF. It is proposed the survey be completed for the entire agency, not just Behavioral Health, and is proposed to cost under $10,000. Motion A motion was introduced by Burri, seconded by Caflisch and unanimously adopted: That the Board approves allowing the Department to go ahead with the II St. Croix County Health and Human Services Board Page 8 July 18, 2007 survey. HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW This item will be postponed until the August meeting. CAPITAL OUTLAY - ST. CROIX INDUSTRIES A rapid roll door for $12,000 for St. Croix Industries was included in the 2007 capital outlay plan. The door will not be needed. Flooring was approved for St. Croix Industries for 2008 and 2009. Staff received an estimate to replace flooring at St. Croix Industries and is requesting permission to repurpose the $12,000 from the rapid roll door and instead replace flooring in 2007. Motion A motion was introduced by Troyer, seconded by Burri, and unanimously adopted: That the Board approves repurposing $12,000 from the St. Croix Industries capital outlay plan for up to $12,000 for carpeting and tile for St. Croix Industries. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 12:20 PM Chair: Attest: (Secretary)