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HomeMy WebLinkAboutHealth and Human Services 09-13-06 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 13, 2006 at 8:30 AM (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL APPROVAL OF MINUTES OF PREVIOUS MEETING - 08/21/06 DATE OF NEXT MEETING — 10/16/06 8:30 AM OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report 3. Barn lease update 4. Goose hunting on County farm land 5. Program reports a. Nursing Home Report b. Surgeon General's Report Action c. Preparedness pandemic table top report 6. Personnel Issues 7. Long Term Support-Long Term Care Reform 8. Health and Human Services Governing Body By -laws Review 9. Presentation of the 2007 Budget request 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. 8/30/2006 7:54 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 13, 2006 The St. Croix County Health and Human Services Board met on September 13, 2006 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 Ronald Troyer MEMBERS ABSENT: None STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Ron Kiesler, Mental Health /AODA Coordinator Kathy Dunlap, Family and Children's Coordinator Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor Norma Vrieze, Early Intervention Coordinator Ron Eichstaedt, St. Croix Industries Supervisor Charlotte Sortedahl, Public Health Coordinator - Health Officer Wendy Kramer, Public Health Supervisor Pat Haeny, Family and Children's Supervisor Bill Van Offeren, Nursing Home Administrator Kim Dupre, IT Malva Berg, Secretary OTHERS PRESENT: Buck Malick, County Board Chair Chuck Whiting, Administrative Coordinator Craig Thompson, Legislative Director, Wisconsin Counties Association 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 Monday, October 16, 2006 at 11:30 AM. Burri will review October vouchers. ANNOUNCEMENTS Johnson announced the Public Health WALHDAB group is planning a Board of Health training for October 18, 2006 from 10:00 AM to 2:00 PM. The training is aimed at all Board members, not just new Board members. More information regarding location will be forwarded when received. MINUTES AND AGENDA Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously adopted: That the agenda for 09/13/06 and the minutes of the 08/21/06 Health and Human Services Board meeting be approved as circulated. CONSIDERATION OF CLAIMS Health and Human Services Board member Kretz reviewed the vouchers. St. Croix County Health and Human Services Board Page 2 September 13, 2006 Motion A motion was introduced by Kretz, seconded by Burri, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services voucher 81631, dated August 17, 2006 in the amount of $1,023.84. Human Services vouchers 81739 through 81743, dated August 17, 2006 in the amount of $19,260.76. Human Services voucher 82125, dated August 24, 2006 in the amount of $2,012.50. Human Services voucher 82126, dated August 24, 2006 in the amount of $60.00. Human Services vouchers 83171 through 83200, dated September 07, 2006 in the amount of $58,486.92. Human Services and Nursing Home vouchers 81632 through 81738, dated August 17, 2006 in the amount of $68,766.34. Human Services and Nursing Home vouchers 81744 through 81775, dated August 17, 2006 in the amount of $11,365.85. Human Services and Nursing Home vouchers 82027 through 82124, dated August 24, 2006 in the amount of $380,647.40. Human Services and Nursing Home vouchers 82249 through 82346, dated August 31, 2006 in the amount of $84,671.27. Human Services and Nursing Home vouchers 83052 through 83170, dated September 07, 2006 in the amount of $298,426.13. Human Services and Nursing Home vouchers 83360 through 83497, dated September 12, 2006 in the amount of $104,296.78. Human Services and Nursing Home vouchers 83201 through 83359, dated September 12, 2006 in the amount of $85,839.77. Nursing Home vouchers 83498 through 83533, dated September 12, 2006 in the amount of $39,393.33. Human Services, Workshop, Public Health, Social Services vouchers 497 through 526, dated August 22, 2006 in the amount of $345,957.03. Human Services, Workshop, Public Health, Social Services vouchers 497 through 528, dated September 05, 2006 in the amount of $348,271.95. Human Services and Nursing Home vouchers 520 through 551, dated August 24, 2006 in the amount of $163,802.17. Human Services and Nursing Home vouchers 552 through 583, dated September 07, 2006 in the amount of $154,373.80. Workshop vouchers 97 through 102, dated August 22, 2006 in the amount of $9,799.80. Workshop vouchers 103 through 108, dated September 05, 2006 in the amount of $10,658.79. St. Croix County Health and Human Services Board Page 3 September 13, 2006 FINANCIAL REPORT Pempek distributed the following Health and Human Services financial report for January through July. Pempek indicated there are two outstanding journal entries for SED so a change in SED figures will be noted next month. The CARS system has reached six month mark and will start taking monies back to balance the CARS accounts. Monies have been recently received from WIMCR and are not part of this report. HEALTH AND HUMAN SERVICES - 2006 SUMMARY Total OF REVENUES Budget Jan -July Balance % Administration 925,134.00 969,218.25 (44,084.25) 104.8% AODA Services 649,146.01 377,206.92 271,939.09 58.1% Long Term Support 17,542,262.00 10,121,978.90 7,420,283.10 57.7% Mental Health 2,909,086.00 1,884,153.14 1,024,932.86 64.8% Family & Children's 3,120,265.00 2,268,059.08 852,205.92 72.7% SED 216,000.00 269,372.26 (53,372.26) 124.7% Public Health 1,537,680.00 925,861.80 611,818.20 60.2% Economic Support 1,010,360.00 630,075.70 380,284.30 62.4% General Relief 15,000.00 8,787.00 6,213.00 58.6% Coordinated Services 260,403.00 103,587.32 156,815.68 39.8% REVENUES HUMAN SERVICES PROGRAMS 28,185,336.01 17,558,300.37 10.627,035.64 62.3% SUMMARY Total OF EXPENDITURES Budget Jan - July Balance % Administration 925,134.00 522,289.62 402,844.38 56.5% Alcohol -Drug Abuse 649,146.01 354,716.11 294,429.90 54.6% Long Term Support 17,542,262.00 9,506,668.62 8,035,593.38 54.2% Mental Health 2,909,086.00 1,639,309.00 1,269,777.00 56.4% Family & Children's 3,120,265.00 1,908,093.59 1,212,171.41 61.2% SED 216.000.00 35,392.00 180,608.00 16.4% Public Health 1,537,680.00 827,028.33 710,651.67 53.8% Economic Support 1,010,360.00 566,638.55 443,721.45 561% General Relief 15,000.00 3,061.16 11,938.84 20.4% Coordinated Services 260,403.00 87,638.32 172,764.68 33.7% EXPENDITURES HUMAN SERVICES PROGRAMS 28,185,336.01 15,450,835.30 12,734,500.71 54.8% Excess Rev over Expenses $ 2.107.465.07 Percentage of Budget: 58.31 "'WIMCR revenues recorded $ 2,107,465.07 Revenues above include state advances Jan -Aug 06 $ 2,107,465.07 Pempek distributed the following Nursing Home report for January through July. IGT monies of $188,070 have been received. Nursing Home salary increases are not reflected on the report. Prior to applying the levy and outstanding revenue, the July balance is $(927,761.36), after applying IGT and County levy, the balance is $21,873.64. r St. Croix County Health and Human Services Board Page 4 September 13, 2006 ST CROIX HEALTH CENTER OPERATIONS REPORT Jan - July 2006 Jan - July 2006 BUDGET ACTUAL DIFFERENCE % PPD ,CENSUS 66 67 1 OPERATING REVENUE: MEDICARE $ 629,623.05 $ 617,720.33 $ 11,902.72 98% 5.52 MEDICAID $ 2,609,616.07 $ 1,149,368.48 $ 1,460,247.59 44% 48.32 PRIVATE PAY` $ „ 547,475.00 $ 627,362.41 $ (19,887.41) 115% 12.39 RATE APPEALS - ACTUAL $ 14,824.00 $ - $ 14,824.00 0% ALL OTHER SOURCES"*" $ 220,453.00: $ 147,921.58 $ 72,531.42 67% 1.01 TRANSFER FROM CONTINGENCY $ - $ - $ - 0 ;TOTAL OPERATING REVENUE $ 4 $ 2,542,372.$0 $ 1,479,618.32 63% 67.27 OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,363,410.47 $ 1,813,749.00 $ 1,549,661.47 54% 20.16 SPECIAL SERVICES $ 274,458.35 $ 135,576.53 $ 138,881.82 49% 2.10 GENERAL SERVICES $ 1,169,758.41 $ 587,342.23 $ 582,416.18 50% 13.10 ADMINISTRATIVE SERVICES $ 527,734.19 $ 283,356.92 $ 244,377.27 54% 3.40 UNASSIGNED: $ - 0,00 DEPRECIATION( %BASED) $ - $ - $ - 0,00 OTHERS (INS -WC- CAPITAL -UTIL) $ 373,372.00 $ 325,054.74 $ 48,317.26 87% 3.27 Utilities $ 74,473.14 Workers Comp, Computer Tech $ 194,039.60 Insurance $ 56,542.00 $ 325,054.74 TOTAL OPERATING EXPENSES $ 5,708,733.42 $ 3,170,134.16 $ 2,238,599.26 61% 31.95 NET FROM OPERATIONS (927,761.36) -6.61 (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) EXTRAORDINARY REVENUES OUTSTANDING RATE APPEAL REV $ 14,824.00 $ - $ 14,824.00 0% % OF OUTSTANDING IGT REV $ 377,000.00 $ 188,070.00 $ 188,930.00 50% CO ALLOCATIONS( %BASED) $ 1,309,742.30 $ 761,565.00 $ 548,177.30 58% TOTAL OUTSTANDING $ 1,701,566.30. $ 949,635.00 $ 751,931.30 NET FROM ALL SOURCES _..._. $ 21,873.61 PERCENTAGE SHOULD BE 58.31% Potential Salary Increases: $16,856 - $50,567 annual Projection PRESENTATION OF THE 2007 BUDGET REQUEST Craig Thompson from Wisconsin Counties Association (WCA) was present to give information regarding mandates and funding issues for Human Services. A list of mandate services is being St. Croix County Health and Human Services Board Page 5 September 13, 2006 developed by WCA and was not available for this meeting but Thompson highlighted several examples. Chapter 51.42 statute states the county board of supervisors has the primary responsibility to the well- being, treatment and care of the mentally ill, developmentally disabled, alcoholic and other drug dependent citizens residing within its county and for ensuring that those individuals in need of such emergency services found within its county receive immediate emergency services. This primary responsibility is limited to the programs, services and resources that the county board of supervisors is reasonably able to provide within the limits of available state and federal funds and of county funds required to be appropriated to match state funds. Community aids are received from the state and have been stagnate for the last 20 years without any increases for inflation. The county match to community aids is required at 9.89 %. Any monies over the 9.89% are considered county overmatch monies. However, even with the limitation on available funding, the county must assure the well being, care and treatment and thus many counties have put in overmatch funding to assure the broad mandate in 51.42 is met. There are no set guidelines for client to staff ratio and this is left up to the individual counties. Thompson indicated the list of mandates and non or discretionary services should be ready in about two weeks. Under the Youth Aids formula, counties are given a set amount of money to pay for services in the community and to pay for correctional placements. This gives counties incentive to keep juveniles out of placement. However, if there are too many placements, there is less money left for prevention/ intervention. Youth aids cannot have a waiting list. Similar to community aids, youth aids funding from the state has remained stagnate and counties have put in more overmatch dollars to meet the needs in the community. A property tax rate limit has been implemented to further impact monies Human Services receives. The state is responsible for setting criteria for eligible services and needs to be responsible for part of funding instead of allocating one chunk of money. The Board thanked Thompson for his information. Thompson indicated WCA could be accessed at http://lfww.wicounties.org. The Board recessed from 9:41 to 9:48 AM. Johnson said Thompson was invited to give his presentation to explain to the Board why Health and Human Services continues to ask for County levy each year. Johnson indicated there were a lot of problems with salary and fringe information on the county software program for Public Health and Nursing Home which resulted in problems preparing the budget. There may be more modifications needed due to software issues. Each unit gave a brief presentation on highlights for their area of the budget. Long Term Support: Birth to Three is mandated under HFS 90 for children under the age of three with delayed development. The program has been in effect for 30 years. Approximately 110 clients have a service plan in a given year with approximately 73 clients participating at this time. Clients screened, monitored or referred to other providers are not included in this count. The program is not allowed to have a waiting list. The census continues to grow as the county continues to increase in population. A service plan is required in place for clients within 45 days from referral to the program. There is a parental cost share component to the program that is means tested and follows state formula. The County is the payer of last resort. Lockwood said the Children's Waiver - Autism Program is new and growing. It is under the home and community based waiver program. He indicated there are currently 22 clients served in this program. Clients receive $100 /day for three years and then receive $28 to $30 /day to receive services in the St. Croix County Health and Human Services Board Page 6 September 13, 2006 community. There is no county match in this program. The Intermediate Care Facilities for the Mentally Retarded Relocation Program has been reduced due to lower than anticipated participation. Many of the clients in this program have expired or have been re- designated as not needing active treatment, therefore monies were not used last year. The Nursing Home Relocation Program is a new program and helps persons in nursing homes to relocate back into the community. This is the first budget year for this program. Approximately $427,000 State /Federal funds have been allocated to this program with no county monies. The balance of the programs are on hold as they require a 40% county match and monies are not available. Lockwood reported Long Term Support operate under a budget in 2007 that is similar to previous years. Long Term Care Reform implementation is possible in 2007. St. Croix Industries: Wentz complimented Eichstaedt on the resident picnic held for St. Croix Industries workers. Eichstaedt indicated St. Croix Industries production, Helping Hands and RAM (Rest Area Maintenance) are self- sufficient programs requiring no county appropriations. He said production revenue is dependent on the economy and vendors who provide the work. Also a factor is DVR funding, which is difficult to predict. He said there have been private pay participants in the program the last few years along with five school districts and other counties. Under capital outlay a new transportation vehicle purchase is included. In 2007 it is planned to pay off four transportation vehicles in addition to purchasing one new vehicle. Also included under capital outlay is replacing the parking lot in front of the St. Croix Industries building, replacing carpeting and a rapid roll inside door. Eichstaedt reported space rental costs also increased. It was questioned why there are no rent charges at the Government Center and rent is charged in Human Services. Whiting indicated if rent can be charged back to the department, it is. Eichstaedt said waiting lists will continue for St. Croix Industries more due to limits of the physical structure rather than finances. He reported 85 were served under the workshop program, 27 -30 in the day program, and 37 in the placement program with about 165 /year total clients served. Of these numbers 47 were county- funded individuals with some county dollars used for almost all persons served. St. Croix Industries is mandated under the Health and Human Services mandate but St. Croix County is not mandated to operate the services that are provided by St. Croix Industries. Kretz questioned the wage increases in the budget requests, especially the nursing home, with the levy freeze. Whiting indicated there are other sources of revenue other than the levy. He said the county has some flexibility for non - represented employees but little with union employees. GOOSE HUNTING ON COUNTY FARM LAND Kyle Kulow, Dr. Mike Reiter, and David Larson with the St. Croix County Sportsman's Alliance presented a proposal agreement to coordinate hunting on the County farm land. This proposal was accepted unanimously by the Finance Committee. Geese have been interfering with the New Richmond airport and this is an effort for population management. The scope of the proposal was expanded from goose hunting to other hunting as there have also been issues with deer populations in the area. This agreement would take maintenance staff out of the management role for hunting. The Alliance would also work with the person who rents the farm land. Corp. Counsel has reviewed the agreement. A map of the hunting area will be online St. Croix County Health and Human Services Board Page 7 September 13, 2006 and is included with the agreement. DNR recommendations will be followed regarding using steel shot versus lead shot, etc. As long as no fee is charged, there will be no liability risk to the county. Motion A motion was introduced by Caflisch, seconded by Berenschot, and unanimously adopted: That the Board approve the proposal of the Sportsman Alliance to hunt on County land. The Board recessed from 11:30 to 11:35 AM. PRESENTATION OF THE 2007 BUDGET REQUEST (continued) Economic Support: Economic Support programs are sum - sufficient programs. One new position for an Economic Support Specialist is requested to enroll persons going through Adult Disabled Resource Center (ADRC) if Long Term Care Reform is implemented. If LTCR is not implemented the position will not be filled. General Relief is not mandated. The program is only for client benefits and is budgeted at $15,000, which would be County levy monies if utilized. Wentz recommended continuation of the General Relief Program as it is a source of last resort for St. Croix County residents. Alcohol /Drug Abuse, Mental Health, Community Support Program, Coordinated Family Services: Kiesler outlined staff reallocations that took place in 2006. Also two new positions were created due to the drug court grant and AODA jail program. Mental Health contracted services to the jail will be brought back in- house and assistance will be given to the jail to contract for these services independently. The psychiatric inpatient diversion program will be expanded two additional hours seven days /week due to needs identified from input from law enforcement. This has been a successful program. Kiesler reported 65% of law enforcement utilize the mobile crisis program; however 35% are not using the service. He indicated there are dramatic cost savings in utilizing this program and indicated a need to work together with law enforcement to use mobile crisis. A joint meeting with Health and Human Services Board and Public Protection will be explored. It was recommended educating emergency room nurses on the mobile crisis information to help the program's success. Kiesler indicated there are approximately 20 -30 clients on the CSP waiting list and 5 -6 on the CFS waiting list. The waiting list for AODA /MH is counted by weeks to get into services and clients could wait up to six weeks. In the AODA /MH wait list scenario, typically insured clients will seek services elsewhere. Another staff would need to be hired to eliminate the waiting list at the cost of approximately $50,000; however, this is not recommended at this time due no office space being available. Family and Children's: Coordinated Family Services (CFS) program is separated from Family and Children's to allow for case management billing. Expansion of CFS into the schools will continue. Dunlap indicated expansion of the SED (Severely Emotionally Disturbed) waiver will continue to transfer county allocations from Family and Children's purchased service budget to draw down federal dollars for clients that would previously be fully county funded. SED waiver requires 42% county input in order to receive Federal pass- through costs of 58 %. Dunlap reported approximately 2,000 families are served in Family and Children's in a year's time. Public Health: Public Health mandates can be located in Wisconsin Statutes Chapters 250 -255. St. Croix County Public Health is a Level 3 which requires provision of a minimum of 14 services. A significant number of programs were consolidated in the Public Health budget. Preparedness monies were cut but the responsibilities were not dropped. A half -time Public Health Nurse (PHN) St. Croix County Health and Human Services Board Page 8 September 13, 2006 position is requested to move to full time in the 2007 budget. Public Health is population- based. From the 2002 PH Profiles, St. Croix County was at 1.6 professional staff (PHN, RD, NP) 110,000 population while the Western Region averaged 2.7/10,000 and the State average was 2.3/10,000. St. Croix County is the fastest growing county in Wisconsin. Other issues that have impacted staffing are communicable disease (CD) surveillance /investigations, increased number of births, and preparedness efforts /requirements. Administration: Administration is requesting addition of a full -time Medical Records Technician. Also notable in capital outlay is $110,000 designated for a new telephone system as recommended by Elert and Association's study as the current system no longer has technical support. Also included is $73,000 for worker's comp. Johnson recommends applying carryover WIMCR monies of $264,000 to the 2007 budget. Nursing Home: The Nursing Home budget is based on a census of 66 residents. The proposed County levy figure in the 2007 budget is $1,240,948. Johnson indicated the Nursing Home budget for maintenance was cut by one staff and that position was not added to Health and Human Services. Board members indicated the nursing home is competing with the private sector. Troyer reported there are nine nursing homes in St. Croix County with 474 beds. Awsumb said the nursing home is not a mandated service and the costs are an unacceptable burden to St. Croix County taxpayers. It was also indicated that changes have been made in the nursing home operation and need a chance to work. Staff have done what the Board charged Administration to do as a result of the operational assessment, operation a 72 -bed nursing home, implemented staffing cuts, implemented PPD (per patient day), etc. Van Offeren reported on Friday the State accepted the submitted plan of correction for the recent incident and survey. Now the surveyors will come in and check to make sure we are doing what is in the plan of care. van Offeren reported three nurses have been separated from employment. The Board recessed from 2:45 to 2:50 PM. Johnson reviewed the powerpoint presentation prepared to give the County Board on 09/20/06. IGT funds have been declining but appear to be stabilized at this point. Board members requested information be included on how much has been spent to subsidize the nursing home and any fund transfers that have been made. Also, suggested including a slide used for the Nursing Home in previous years. Johnson consulted with Timmerman to see if a request for proposal could be discussed and action taken as it was listed on the agenda as nursing home report. Timmerman implied the discussion was covered under Nursing Home Reports. Motion A motion was introduced by Awsumb, seconded by Kretz: Recognizing the County has no mandate to operate a nursing home and that all residents will be fully served at other facilities as provided by other funding sources, the County Health and Human Services Board recommends a request be forwarded to the County Board for proposal to solicit private and non - profit nursing home and assisted living businesses to operate a facility at the county -owned building. The RFP shall be open to purchase or lease options and respondents are encouraged to propose a facility which accommodates both uses. The Health and Human Services Board shall create a subcommittee to write the RFP with the input of staff and consultants and all others they deem appropriate. The RFP shall be issued by October 15 2006 or as soon as practical thereafter and responses shall be done within 45 days thereafter. St. Croix County Health and Human Services Board Page 9 September 13, 2006 Roll call vote: Esther Wentz -no Gordon Awsumb -yes Leon Berenschot -no Lois Burri -no Tom Caflisch -yes Dr. Kretz -yes Linda Luckey -yes Deb Rasmussen -yes Ronald Troyer -yes Six yes, three no, motion passed. Motion A motion was introduced by Troyer, seconded by Caflisch, and unanimously adopted: That the Board approves the Health and Human Services 2007 proposed budget to forward to Finance, applying $264,000 carryover WIMCR for a total county levy of $431,739, which includes General Relief. Motion A motion was introduced by Rasmussen, seconded by Burri and unanimously adopted: That a roll call vote be held on the Nursing Home budget. Motion A motion was introduced by Rasmussen, seconded by Berenschot: That the Board accepts the 2007 Proposed Nursing Home budget. Esther Wentz -yes Gordon Awsumb -no Leon Berenschot -yes Lois Burri -yes Tom Caflisch -no Dr. Kretz -no Linda Luckey -no Deb Rasmussen -yes Ronald Troyer -no Four yes, five no, motion failed. Wentz wanted to be on record as voting yes. SURGEON GENERAL'S REPORT ACTION This item was tabled until the next meeting. BARN LEASE UPDATE The current lease has been continued until October. The cost to have the manure pit drained is approximately $4,600. Berenschot requested that pipes be drained and straw be spread on the floor to preserve the water lines. LONG TERM SUPPORT -LONG TERM CARE REFORM Johnson requested a member of Health and Human Services Board participate in the October 2 nd and October 17 meetings on Long Term Care Reform implementation. Malick volunteered Wentz to attend these meetings. Wentz asked if there were any other issues to bring before the Board. Wentz thanked Johnson for his work on the Nursing Home issue. Kretz thanked staff, especially Johnson and Pempek, for their work on the budget. St. Croix County Health and Human Services Board ` Page 10 September 13, 2006 Wentz adjourned the meeting. Time: 3:55 PM Chair: Attest: (Secretary)