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HomeMy WebLinkAboutHealth & Human Services 08-15-07 Leon Berenschot will review vouchers. NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 1 S, 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 - 07/18/07 DATE OF NEXT MEETING — 08/29/07 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Election of Officers 3. Financial Report 4. Peer to Peer Version 5 Echo software and user conference ** 5. Accounts Receivable independent review by WIPFLI (9:00 A.M.) 6. Nursing Home Report 7. Health and Human Services recommendation to County Board on Nursing Home options (10:00) 8. Consideration of Financial Assistants position description ** 9. Personnel Issues -New Position Requests 10. Aging and Disability Resource Center position request 11. Long Term Support-Long Term Care Reform 12. Health and Human Services Governing Body By -laws Review 13. 2008 Budget planning 14. Resolution regarding application for contract for aging and disability resource center ** 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. 8/13/2007 10:15 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 15, 2007 The St. Croix County Health and Human Services Board met on August 15, 2007 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Gordon Awsumb Leon Berenschot Lois Burri Dr. Glenn Hoberg Deb Rasmussen Ron Troyer MEMBERS ABSENT: Tom Caflisch, excused Linda Luckey, excused STAFF PRESENT: Fred Johnson Health a th and Human Services Director Bill Van Offeren, Nursing Home Administrator Fay Strenke, Accounts Receivable Supervisor Ron Lockwood, Long Term Support Coordinator Ron Kiesler, Behavioral Health Coordinator Norma Vrieze, Early Intervention Director Kim Dupre, Information Technology Darlene Krenz, Financial Assistant Lead Worker Malva Sirek, Secretary OTHERS PRESENT: Bill Cranmer, County Board Supervisor Julie Speer, County Board Supervisor Clarence Malick, County Board Chair Chuck Whiting, Administrative Coordinator Michelle Pietrick, Finance Director Greg Timmerman, Corporation Counsel Larry Lester, WIPFLI Peggy Van Zanten, WIPFLI Michael Yankunas, WIPFLI Loyla Waskul, Nursing Home CNA Brenda Wickenhauser, Nursing Home CNA Stan Barr Laverna Chickadal Norm Matzek Joyce and Dean Winquist Lorna Stob 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, August 29, 2007 at 8:30 AM. The following meeting will be moved to September 12, 2007 at 8:30 AM. ANNOUNCEMENTS Johnson introduced Dr. Glenn Hoberg as the newly appointed citizen member to the Health and Human Services Board. AGENDA Motion A motion was introduced by Rasmussen, seconded by Troyer, and unanimously adopted: That the agenda be approved as circulated. St. Croix County Health and Human Services Board Page 2 August 15, 2007 MINUTES Motion A motion was introduced by Burri, seconded by Awsumb, and unanimously adopted: That the minutes of the 07/18/07 Health and Human Services Board meeting be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services Board member Berenschot reviewed the vouchers. Motion A motion was introduced by Berenschot, seconded by Troyer, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 105296 through 105300, dated July 26, 2007 in the amount of $24,651.00. Human Services vouchers 105301 through 105302, dated July 26, 2007 in the amount of $925.03. Human Services voucher 105629, dated August 02, 2007 in the amount of $7,500.00. Human Services vouchers 105814 through 105851, dated August 09, 2007 in the amount of $56,747.85. Human Services and Nursing Home 104837, dated July 19, 2007 in the amount of $7,054.71. Human Services and Nursing Home vouchers 104838 through 104976, dated July 19, 2007 in the amount of $326,545.59. Human Services and Nursing Home vouchers 104977 through 104976, dated July 19, 2007 in the amount of $11,624.02. Human Services and Nursing Home vouchers 105525 through 105628, dated August 02, 2007 in the amount of $106,292.59. Human Services and Nursing Home vouchers 106388 through 106556, dated August 09, 2007 in the amount of $323,626.73. Human Services, Nursing Home, and Farm vouchers 105374 through 105490, dated July 26, 2007 in the amount of $419,536.90. Human Services, Nursing Home, and Government Center vouchers 106196 through 106346, dated August 09, 2007 in the amount of $104,369.60. Nursing Home vouchers 106347 through 106387, dated August 09, 2007 in the amount of $32,012.80. Human Services, Workshop, Public Health, vouchers 437 through 466, dated July 24, 2007 in the amount of $376,005.45. Human Services, Workshop, Public Health, Social Services vouchers 467 through 497, dated August 07, 2007 in the amount of $382,001.56. Human Services and Nursing Home vouchers 348 through 353, dated July 18, 2007 in the amount of $46,893.81. Human Services and Nursing Home vouchers 385 through 393, dated July 25, 2007 in the amount of $8,402.84. St. Croix County Health and Human Services Board Page 3 August 15, 2007 Human Services and Nursing Home vouchers 354 through 384, dated July 26, 2007 in the amount of $205,060.64. Human Services and Nursing Home vouchers 394 through 425, dated August 09, 2007 in the amount of $143,302.52. Workshop vouchers 85 through 90, dated July 24, 2007 in the amount of $12,604.61. Workshop vouchers 91 through 96, dated August 07, 2007 in the amount of $13,288.92. ELECTION OF HEALTH AND HUMAN SERVICES BOARD OFFICERS Wentz announced the election of officers would take place. Wentz asked for nominations for the position of Chair. Burri nominated Wentz for the Chair position. Burri requested to close nominations for Chair. Wentz requested a vote and a unanimous vote was cast for Wentz to be Chair. Wentz asked for nominations for the position of Vice Chair. Troyer nominated Dr. Hoberg for the position of Vice Chair. Troyer requested to close nominations for Vice Chair. Wentz requested a vote and a unanimous vote was cast for Dr. Hoberg to be Vice Chair. Wentz asked for nominations for the position of Secretary. Wentz nominated Rasmussen for the position of Secretary. Wentz requested to close nominations for Secretary. Wentz requested a vote and a unanimous vote was cast for Rasmussen to be Secretary. FINANCIAL REPORT The following financial report for Nursing Home through June, 2007 was distributed. Johnson noted staffing fluctuated due to lower census. Census in the Nursing Home today is 67. There were 13 private pay residents in the Nursing Home in June. St. Croix County Health and Human Services Board Page 4 August 15, 2007 St. Croix Health Center June 2007 Budget Actual Difference Percentage Census 68 61 7 Operating Revenue: Medicare $840,960.00 $340,653.16 $500,306.84 40.51% Medicaid $2,466,310.60 $1,060,617.11 $1,405,693.49 43.00% Private Pay $699,887.50 $441,548.27 $258,339.23 63.09% All Other Sources $217,171.45 $101,924.61 $115,246.84 46.93% Total Operating Revenue $4,224,329.55 $1,944,743.15 $2,279,586.40 46.04% Operating Expenses Daily Patient Services $3,557,580.61 $1,395,420.98 $2,162,159.63 39.22% Special Services $274,024.76 $118,360.67 $155,664.09 43.19% General Services $1,172,794.05 $478,333.96 $694,460.09 40.79% Administrative Services $593,527.93 $313,535.31 $279,992.62 52.83% Unassigned: Depreciation (% Based) $0.00 Others: $286,002.20 $145,055.71 $140,946.49 50.72% Utilities $58,968.21 Workers Comp, Computer Tech $4,922.25 Insurance $61,165.25 Total Operating Expenses $5,883,929.55 $2,45 0,706.63 $3,433,222.92 41.65% Net From Operations ($505,963.4$) (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 $634,302.00 $634,298.00 50.00% Total Outstanding $1.659,600.00 $634,302.00 $1,025,298.00 Net from all Sources $128.338.52 $196,000 Outstanding IGT Rev moved to 2006 via auditors The following financial report for Health and Human Services through June, 2007 was distributed. Bound booklets of the audit report were made available for Board members. Johnson said placements in the Behavioral Health area have increased. No changes have been implemented to make sure the audit finding regarding material weakness will be changed for 2007. Pietrick plans to move to full accrual and accomplish this for the 2007 audit. St. Croix County Health and Human Services Board Page 5 August 15, 2007 HEALTH AND HUMAN SERVICES - 2007 SUMMARY Total OF REVENUES Budget June 30, 2007 Balance % Administration 1,080,749.83 1,472,566.93 (391,817.10) 136.3% AODA Services 765,599.92 377,915.13 387,684.79 49.4% Long Term Support 18,196,351.85 11,717,555.34 6,478,796.51 64,4% Mental Health 2,879,503.70 1,433,819.38 1,445,684.32 49.8% Family & Children's 3,132,978.40 1,765,930.49 1,367,047.91 56.4% Public Health 1,617,175.53 949,651.97 667,523.56 58.7% Economic Support 1,112,508.60 719,758.87 392,749.73 64.7% General Relief 15,000.00 7,500.00 7,500.00 50.0% Coordinated Services /ED 900,066.00 483,521.46 416,544.54 53.7% REVENUES HUMAN SERVICES PROGRAMS 29,699,933.83 18,928,219.57 10,771,714.26 63.7°% SUMMARY Total OF EXPENDITURES Budget June 30, 2007 Balance % Administration 1,080,095.83 487,302.27 592,793.56 45.1% Alcohol -Drug Abuse 765,599.92 310,664.67 454,935.25 40.6% Long Term Support 18,196,351.85 8,454,386.30 9,741,965.55 46.5% Mental Health 2,879,503.70 1,559,550.51 1,319,953.19 54.2% Family & Children's 3,132,978.40 1,354,568.47 1,778,409.93 43.2% Public Health 1,617,837.53 766,474.66 851,362.87 47.4% Economic Support 1,112,508.60 481,073.82 631,434.78 43.2% General Relief 15,000.00 1,449.82 13,550.18 9.7% Coordinated Service /SED 900,066.44 304,896.95 595,169.49 33.9% EXPENDITURES HUMAN SERVICES PROGRAMS 29,699,942.27 13,720,367.47 15,979,574.80 46.2% Excess Rev over Expenses S 5.207.552.10 PEER TO PEER VERSION 5 ECHO SOFTWARE AND USER CONFERENCE Positive progress is being made in Accounts Receivable after updates were made to the ECHO software; however, there are general and specific concerns with some parts of the ECHO software. A peer -to -peer ECHO software conference is being held September 9 through 12 in Portsmouth, New Hampshire. Administration is recommending sending three staff to this conference to cover various areas of ECHO software including administration, technical and clinical to determine if Accounts Receivable can get ECHO to work appropriately to meet the County's needs or if another system should be sought. The cost to attend the conference is approximately $1,500 per person. Attendees to the conference are customers throughout the industries who use the software and are able to share what ECHO can and cannot do. Dupre reported ECHO has a large presence on both coasts but has very little representation in the Midwest. Johnson said this conference is not budgeted but there is no local training. Motion A motion was introduced by Awsumb, seconded by Troyer and unanimously approved: That the Board approves sending three Health and Human Services staff to the Peer -to -Peer Version 5 ECHO Software and User Conference in New Hampshire September 9 through 12. ACCOUNTS RECEIVABLE INDEPENDENT REVIEW BY WIPFLI A draft report for the independent review was distributed and collected at the end of the presentation. A final report will be provided at a later date. Peggy Van Zanten St. Croix County Health and Human Services Board Page 6 August 15, 2007 and Michael Yankunas from WIPFLI contracted with Greg Timmerman so the review would be done independent of Health and Human Services. van Zanten did the field work for the review and commented on the excellent assistance she received from staff, who were both timely and knowledgeable. Timmerman agreed to the procedure. A fraud examination is different than a financial examination. WIPFLI was brought in to assess accounts receivable. Opportunities were found that accounts receivable could be manipulated but no conclusive evidence was found that this was done. Several areas of weakness in internal controls were found. Before 2004 there were no unique passwords in the system so actions done were not traceable. This has been remedied. There was no previous ability to create accounts receivable aging reports. Updates to the software addressed this issue. It was found that updates were not done in a timely fashion or not done at all. There was a lack of recordkeeping for account write offs or adjustments, which need to be tracked and reviewed on a regular basis. Many files were found to be inactive and not sent to collection agency. There was an absence of standard procedure for making adjustments to customer balances. A significant improvement was made from the 12/2006 upgrade for the subsidiary ledger and aging report. Information was not available in real time prior to the 12/2006 upgrade and this information is needed to reconcile. It was discovered when accounts were sent to collections, they were not written off ECHO but still reflected in the ECHO system. Those records need to be cleared off ECHO. This is not a one time issue but a process needs to be in place to keep the process cleaned up. Self pay collectible balance numbers may be inflated due to full amounts being billed rather than split or recorded as reasonable and customary charges. Insurance is billed at full rate but insurance pays on a contractual basis. The difference is written off when the payment is received. Thus, write offs need to happen on a regular basis. Yankunas said he cannot definitively define if fraud occurred. Government accounting is moving to full accrual versus cash basis. St. Croix County is on a cash basis and should be able to move to full accrual once processes are cleaned up. Improvements will make things easier for the auditors also. Important controls need to be in place for segregation of duties. Yankunas identified if need, opportunity and ability circumstances come together, the county is vulnerable to fraud. Yankunas said there have been no regular write offs and accounts on the system date back to 2002. He was not able to find where the system was manipulated for misappropriation of funds and nothing has come forward due to a change in staffing. Yankunas said write offs need to happen on a regular basis, not just yearly but presented on a monthly basis for information only. Yankunas outlined a recommended authority limit for Board consideration for write off determinations. Billings occur in different departments and Yankunas recommended establishing monitoring controls if the billings are left in different departments rather than centralized. Monitoring of reports sent to collections is important. Crystal reports need to be retained for historical record and this is now being done. It was found that more statements were turned off (to not generate a statement) in ECHO than clients sent to collections. A policy should be established to require a password change on a regular basis (i.e. every 90 days) and parameters should be set for appropriate passwords. A policy should be developed for normal accounts receivable write off adjustments and it needs to be a part of the budget process. This should be a management decision in conjunction with the Board. A policy should be developed to delegate authority to send accounts to collections and authority should be delegated to more than one person and the information should be brought to the Board for action. Upgrades need to be done on a timely basis with input on decisions from IT and others. Again, upgrades cannot be left to one person or taken off the table and not done. It was • St. Croix County Health and Human Services Board Page 7 August 15, 2007 recommended to work with Timmerman to establish an employee misconduct and dishonesty policy. It was recommended setting up a tip line and /or a confidential reporting method. Johnson said internal controls need to be in place and policies /procedures need to be developed. This item will be an agenda item for the next meeting. Timmerman said County resources are best utilized in resolving issues instead of outside resources. Timmerman will give written authorization to WIPFLI to release the final results of the review to the Board. WIPFLI will supply bound copies for the Board. The Board recessed from 10:49 to 10:52 AM. NURSING HOME REPORT The current Nursing Home census is 67. Van Offeren reported the Nursing Home non -union back pay amounted to approximately $10,105 and the union back pay amounted to approximately $43,265, not including impact on fringe benefits. Van Offeren reported there is a new Federal F -tag, F -323, which replaces F -324, and was effective 08/01/07. Van Offeren described the definition if the facility is aware of any situations in the facility, they need to be fixed immediately. HEALTH AND HUMAN SERVICES RECOMMENDATION TO COUNTY BOARD ON NURSING HOME OPTIONS Past options included: St. Croix County continue to operate Nursing Home, downsize to 50 beds, relocate the current residents and close the current Nursing Home, contact organizations who attended informational meetings regarding initial CCH negotiated offer, Christian Community Home's negotiated offer, other options. Larry Lester prepared a five -year financial forecast regarding the nursing home. He used 2006 as a base year as it was a more stable year. Several assumptions were outlined for the Board with many variables to consider. For example, if some county homes go out of business the $37.1 million in IGT fund allocation may go up for St. Croix County as there will be fewer nursing homes to draw from the pot of money. It is predicted Medicare rates will be increased 3% in October, 2007 due to inflation. It was assumed the County would receive a maximum per bed of $75,900 for capital reimbursement as it would likely not meet all the criteria needed to receive $125,000 per bed. Lester reminded the Board that Wisconsin has a moratorium on the number of nursing home beds in Wisconsin and according to a market study, there is a surplus of beds currently. However, it is anticipated there will be an increase in service needs in 2016 due to baby boomers needing nursing home services. Wentz indicated that no department in the county generates enough money to support their own department other than Register of Deeds. At one time, the jail supported itself, but that too has changed as the jail is filled with St. Croix County residents. Wentz also said that the Nursing Home and Farm operations returned money to the County in previous years. Whiting said there was a 3% increase in new construction evaluation in St. Croix County. He said St. Croix County is 70 in the state in equalized value. Dean Winquist gave a presentation and distributed information regarding a facility recently built and sold in North Branch, Minnesota. He encouraged the Board to explore other options than closure. Awsumb said a new facility is • St. Croix County Health and Human Services Board Page 8 August 15, 2007 viable if operated by a private sector company. There is a need to focus on what is viable for the county. It may require a public /private partnership. Awsumb recommended a working group comprised of Board members and staff to explore possibilities so a recommendation can be made to the County Board. This needs to be done in a timely manner due to limited time before budgets are due. Motion A motion was introduced by Awsumb, seconded by Rasmussen, and adopted with Troyer and Dr. Hoberg voting no; That the Board appoint a subcommittee to work with staff and interested parties over the next four weeks to identify and come to preliminary proposal to form a public /private partnership to operate a nursing home and assisted living facility and incorporate the plan into budget for 2008. Wentz said input from families of residents is important. Malick said resource people can be utilized but do not need to be on the committee. Troyer argued this task cannot be completed in four weeks. The status of the Nursing Home and budgeting are two separate issues. The following were appointed to the subcommittee: Awsumb, Larry Lester, Rasmussen, Johnson, Van Offeren. The Board recessed from 12:20 to 12:27 PM. RESOLUTION REGARDING APPLICATION FOR CONTRACT FOR AGING AND DISABILITY RESOURCE CENTER The intention to operate an ADRC needs to be submitted by October, 2007, with operation to begin approximately February, 2008. Johnson requested appointment of an Ad Hoc Committee that included Board members to address governance issues as well as organizational structure. The County Board will have to address the governance structure brought forward and Malick indicated his preference not to appoint Board members. Motion A motion was introduced by Troyer, seconded by Rasmussen, and unanimously adopted: That the Board approve the following resolution and forward to the full County Board. RESOLUTION AUTHORIZING APPLICATION TO OPERATE AN AGING AND DISABILITY RESOURCE CENTER AND APPOINTMENT OF AD HOC PLANNING COMMITTEE Resolution No. St. Croix County, Wisconsin WHEREAS, the St. Croix County Board of Supervisors adopted Resolution No. 8(2007) regarding long -term care redesign in St. Croix County on April 17, 2007; and WHEREAS, Resolution No. 8(2007) states that St. Croix County will establish an aging and disability resource center (ADRC) that: (1) is a trusted source of information about prevention strategies, community resources, and long -term options for the elderly or persons who have a disability; (2) serves persons whether or not they have resources to purchase their own services or need help doing so; (3) serves as a single entry point to publicly- funded long term care (LTC) programs; and (4) would have a role in ensuring that consumers' needs are met by managed care organizations. The mission of an ADRC is to empower and support seniors, persons who have a disability and their families by providing useful information and finding help that persons seek through in person visits to the resource center, telephone inquiries or visits to the consumer's home; and St. Croix County Health and Human Services Board Page 9 August 15, 2007 WHEREAS, it is intended that an application to operate an ADRC will be submitted to the state in October, 2007; and WHEREAS, Wis. Stats. §46.283 (1) requires a county board of supervisors to authorize an application to operate an ADRC; and WHEREAS, it is intended that operation of an ADRC would commence by February, 2008, two months prior to the implementation of any managed care organization; and WHEREAS, the state expects ADRC applicants to coordinate with managed care expansion planning, work collaboratively with local public agencies serving the elderly and persons who have a disability, and to involve consumers and other stakeholders from the community at large, linking mental health and substance use representatives, in the development of the ADRC; and WHEREAS, the Wisconsin Department of Health and Family Services has proposed funding in the next biennial state budget for ADRCs in many counties, with an allocation for St. Croix County of approximately $632,000. THEREFORE, be it resolved that the St. Croix County Board of Supervisors authorizes the Department on Aging to submit an application for an ADRC which will serve the elderly and persons who have a disability. FURTHER, be it resolved that the County Board Chair will appoint an ad hoc ADRC planning committee that will develop and recommend to the Board of Supervisors a plan for organizing and governing the ADRC. AGING AND DISABILITY RESOURCE CENTER POSITION REQUEST The Wisconsin Department of Health and Family Services has proposed funding in the next biennial state budget for ADRCs in many counties, with an allocation for St. Croix County of approximately $632,000. Johnson said 30% of Duncan's time and 25 of Vrieze's time would be allocated to the ADRC administrative team. A request was made for new positions for the ADRC, which would be funded by the $632,000. Long Term Support will be downsized with some positions with the plan to shift some staff to the ADRC. The budget for the ADRC would be a separate budget with no county dollars planned for 2008. Motion A motion was introduced by Berenschot, seconded by Troyer, and unanimously adopted: That the Board approves the following new positions for the ADRC for 2008: 1- Disability Benefit Specialist 2- Long Term Care Options Counselors 1- Information and Assistance Specialist 1- Elderly Benefit Specialist .5- Public Health Nurse HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW This item will be postponed until the August meeting. 2008 BUDGET PLANNING Johnson said there are three additions to the capital outlay plan for 2008. This will be updated and brought back as part of the budget process. It is anticipated preliminary budget projections will be available at the August 29 meeting. Application of prior year carryover dollars will be discussed at the August 29 meeting. Work has begun on consolidating waiting lists for children. An individual has been contracted to assess the health and safety needs of clients on the wait list and if they are St. Croix County Health and Human Services Board Page 10 August 15, 2007 still in need of services. LONG TERM SUPPORT -LONG TERM CARE REFORM Long Term Support budget will be built as if Long Term Care will not happen; however, a fiscal analysis will be done. April 1, 2008 is the most optimistic date to begin Long Term Care. Lockwood anticipates it may be late fall or the end of the before Long Term Care will begin. CONSIDERATION OF FINANCIAL ASSISTANTS POSITION DESCRIPTION This item will be postponed until the August meeting. PERSONNEL ISSUES -NEW POSITION REQUESTS This item will be postponed until the August meeting. Wentz asked if there were any other issues to bring before the Board. Wentz complimented the Nursing Home staff on the family picnic. Approximately $1,792 was raised for the resident fund account. Wentz said the St. Croix Industries picnic was a success and congratulated staff on a job well done. She said 160 clients are service in St. Croix Industries. Wentz adjourned the meeting. Time: 1:10 PM Chair: Attest: (Secretary)