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HomeMy WebLinkAboutHealth and Human Services 04-17-06 .L NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 17, 2006 at 1:00 PM (Board Room, St Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL APPROVAL OF MINUTES OF PREVIOUS MEETING - 03/20/06 DATE OF NEXT MEETING — 05115106 8:30 AM (Tentative) OLD AND NEW BUSINESS 1. DHHS Strategic Planning 2. Consideration of Claims and Vouchers 3. Financial Report including update on year -end closeout 4. Nursing Home Report/implementation of operational assessment 5. Long Term Support -Long Term Care Reform 6. Public Health Level III Designation 7. Public Health Resolution regarding vaccine supply, distribution and access. 8. Targeted Case Management - potential 9. Personnel Issues 10. Closed session per Wisconsin Statute 19.85 (1) (c) for Director's review. 11. Reconvene into open session per Wisconsin Statute 19.85 (2). Return to open session. 12. Barn Lease 13.2006 DHHS meeting schedule 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. 4/5/2006 11:16 AM l ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 17, 2006 The St. Croix County Health and Human Services Board met on April 17, 2006 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Tom Caflisch Tom Dowd Dr. Michael Kretz Linda Luckey Deb Rasmussen Esther Wentz MEMBERS ABSENT: Ralph Swenson, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Operations Manager Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Barbara Nelson, Public Health Supervisor- Health Officer Bill Van Offeren, Nursing Home Administrator Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Kjersti Duncan, Department on Aging Director Tim Ringhand, Division of Public Health Paul Cook, Community Health Partnership (CHP) Chair Dorsey called.the meeting to order at 1:00 PM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Monday, May 15, 2006 at 8:30 AM. Burri will review vouchers MINUTES Motion A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the minutes of the 03/17/06 Health and Human Services Board meeting be approved as circulated. LONG TERM SUPPORT -LONG TERM CARE REFORM Long Term Care Reform was discussed at the Legislative Event held this morning. Planning is moving forward toward the implementation of Community Health Partnership's model for a nine county /three private provider consortium, including St. Croix County. The project would include managed and coordinated care for people St. Croix County serves and would serve all adults on the waiting lists as no waiting lists are allowed. Children are not included in managed care and are not part of this project at this time. When Family Care was implemented all waiver services funding was put under one umbrella and the county was not required to contribute to the programs when implemented. The project has not been able to expand beyond the pilots because of costs so now the plan may include financing from the counties. Lockwood indicated 750 of Medical Assistance dollars are spent on people with long term care needs. This project may later include Medicare to make it a comprehensive package as there may possibly be savings on the Medicare side and those funds could be used to support the project locally. The frail elderly /physically disabled will probably be enrolled in the project St. Croix County Health and Human Services Board Page 2 April 17, 2006 first; however, definite plans on implementation have not been set. Pierce and St. Croix Counties are planned to pilot implementation in this region as early as October of 2006, but issues such as enrollment, benefit package, consumer choice all need to be decided. Paul Cook of Community Health Partnership (CHP) reported they have been active for the last nine years and there are three others in the southern part of the state. The Community Health Partnership program offers a benefit package that includes acute and primary care, along with long term care needs, and has operated this program in Chippewa, Dunn and Eau Claire counties for the past nine years as previously indicated. CHP is planned to be the managed care organization in this nine county region and is working closely with the counties and the state to expand their care delivery model in this region. The partnership project allows some flexibility with spending and plans are tailored to individual consumers and focused on the consumer. Savings come more from prevention rather than denying services. Resource centers will be set up to allow a central access system. Extra financing will be available to coordinate services for implementing a Aging and Disability Resource Center (ADRC) . This is not a privatization of the system so the county still has oversight on decisions made. Economic Support, Public Health and Department on Aging will also be involved in the project as ADRC's must be in place prior to the implementation of managed care services as noted above. At this time, the funding levels for ADRC's is uncertain, but we have asked the state for clarification on amounts and how counties are to access this funding. There are some concerns regarding implementation outlined in a draft letter distributed to the Board members. Johnson indicated this letter has now been sent to the State. Johnson informed the Board Long Term Care Reform would be a routine agenda item at future meetings as more information becomes available regarding county risks, levy issues, etc. We will continue to participate in planning, but cannot make final decisions regarding Long Term Care Reform in St. Croix County until the issues outlined in the noted letter are answered. This information will then be brought to the Board. CONSIDERATION OF CLAIMS Health and Human Services Board member Wentz reviewed the vouchers. Motion A motion was introduced by Wentz, 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 71501 through 71505, dated March 23, 2006 in the amount of $39,969.48. Human Services vouchers 71506 through 70507, dated March 23, 2006 in the amount of $319.17. Human Services vouchers 72929 through 72961, dated April 14, 2006 in the amount of $39,029.29. Human Services vouchers 72962 through 73128, dated April 14, 2006 in the amount of $270,759.39. Human Services vouchers 72745 through 72928, dated April 14, 2006 in the amount of $165,573.13. St. Croix County Health and Human Services Board Page 3 April 17, 2006 Human Services and Nursing Home vouchers 71056 through 71113, dated March 15, 2006 in the amount of $43,390.66. Human Services and Nursing Home vouchers 71114 through 71136, dated March 15, 2006 in the amount of $12,789.29. Human Services and Nursing Home vouchers 71396 through 71500, dated March 23, 2006 in the amount of $303,576.78. Human Services and Nursing Home vouchers 71725 through 71833, dated March 30, 2006 in the amount of $392,565.76. Human Services and Nursing Home vouchers 71963 through 72059, dated April 06, 2006 in the amount of $382,520.48. Nursing Home vouchers 73129 through 73160, dated April 14, 2006 in the amount of $37,638.60. Human Services, Workshop, Public Health, Social Services vouchers 166 through 195, dated March 21, 2006 in the amount of $364,731.71. Human Services, Workshop, Public Health, Social Services vouchers 196 through 227, dated April 04, 2006 in the amount of $363,407.81. Human Services and Nursing Home vouchers 173 through 203, dated March 23, 2006 in the amount of $161,803.59. Human Services and Nursing Home vouchers 204 through 234, dated April 05, 2006 in the amount of $166,054.99. Workshop vouchers 31 through 36, dated March 21, 2006 in the amount of $13,208.51. Workshop vouchers 37 through 42, dated April 04, 2006 in the amount of $9,934.21. FINANCIAL REPORT INCLUDING UPDATE ON YEAR -END CLOSEOUT Pempek indicated reports distributed are unaudited and expects the auditors to be in the building later this week. More adjustments are expected in Long Term Support. No one qualified for ICF -MR relocation this year for Long Term Support. Monies are not awarded for this program unless monies are spent. The diversion program is showing results in the Mental Health area although it is difficult to predict crises in all units. Dr. Kretz said cost savings are working and showing up in financial reports. Pempek reminded Board members Nursing Home IGT funds have been received for six months and only two months of expenses are recorded. In Health and Human Services four months of revenue have been advanced and the WIMCR dollars were moved to 2006 budget and again only two months of expenses are recorded. The following reports through February were distributed: St. Croix County Health and Human Services Board Page 4 April 17, 2006 ST CROIX HEALTH CENTER OPERATIONS REPORT JAN - FEB 2006 JAW - FEB 2006 BUDGET ACTUAL DIFFERENCE % ? CENSUS _..... 66' _. 72 .. ..... 6:. 109 % .... .... ._...... .__...__ .... .... _ ......._._ ..... . .OPERATING REVENUE: MEDICARE $ 629,623.05 ' $ 178,369.27 $ 451,253.78 28% 1 MEDICAID $ 2,609,616.07: _ _... . __ _.......__..._..._._- __.._- - -- 353,814.06 $_2,255,802.01 14% PRIVATE PAY 547,475.00 $ 120,731.56 $ 426,743.44 ; 22% RATE APPEALS - ACTUAL $ _ 14,824.00. $ ... _.. 14 ,824.00 D °f° IGT FUNDS - ACTUAL _.. $ 377,000.00 188,000.00 ` 50 %` =. ALL OTHER SOURCES' ; $ 220,453.00 $._.._.38,486.91 ; $ 181,966.09 17% TRANSFER FROM CONTINGENCY ;TOTAL OPERATING REVENUE _._..._..__...._.__..._ $ 4, 398,991.12.' .$...,.__.881,= iQ1.11 3,518,589.32 OPERATING EXPENSES: _ DAILY PATIENT SRVICES $ 3,363,410.47 $ 525.361.B5 w $ 2,838,048.62 16%! SPECIAL SERVICES _. _. _ _$._.... 274,458.35 $ 44,643.19 $ _ 229,815.16: 16W GENERAL SERVICES $ 1,169,758.41 $ 171,46B.55 $ 996.289.86 ; 15 °J° ADMINISTRATIVE SERVICES $ 527,734.19 , $ 83,933.01 „$ 443,801.18 16 % UNASSIGNED: $ - DEPRECIATION( %BASED ) :OTHERS: (INS -WC- CAPITAL -UTIL) : 373,372.00 $ 88,169.34 ` $ 285,202.66 24%! TOTAL OPERATING EXPENSES $ 5,708,733.42 ' $ 913,575.94 $ 4,795,157.48: 16% :NET FROM OPERATIONS $ - $ (33,171.14} (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) OUTSTANDING REVENUES OUTSTANDING RATE APPEAL REV ' $ 14,824,00 $ - $ 14,824.00: 0%! '% OF OUTSTANDING IGT REV ' $ 188,000.00 $ - $ 186,000.00: OW ... - .... . ..... .. 'CO ALLOCATIONS( %BASED) $ 1 ,309 $ 218,290.40 $ 1,091,451.90 17% -TOTAL OUTSTANDING $ 1,512,566.30 $ 218.290.40! $ 1 ,294,275.90 : F NET FROM ALL SOURCES $ 185,116.26 _....._ . _ ........_..... - -. .._.. _ _ . _...... _ o _...... _.__ ....... _. _ ... _ ..... ...... .... .. -- _.._ ......._ _.... _. _ _ ... a 1 :PERCENTAGE SHOULD BE 16.66: .................... ._.._........... _.. 3 Outstanding billings: $32,006 ' Potential Salary Increases: ................_... _ _....._..__...._... ........... .. 316,856 - $50,567 annual projection St. Croix County Health and Human Services Board Page 5 April 17, 2006 HEALTH AND HUMAN SERVICES - 2006 SUMMARY Total OF REVENUES Budget Jan - Feb Balance % Administration 925,134.00 766,252.06 158,881.94 82.8% AODA Services 584,307.00 93,914.00 490,393.00 16.1% Long Term Support 17,542,262.00 4,366,094.12 13,174,167.88 24.9% Mental Health 2,909,086.00 647,912.30 2,261,173.70 22.3% Family & Children's 3,120,265.00 711,592.76 2,40B,672.24 22.8% SED 216,000.00 148,874.00 67,126.00 68.9% Public Health 1,537,680.00 204,249.78 1,333,430.22 13.3% Economic Support 1,010,360.00 230,B38.47 779,521.53 22.0% General Relief 15,000.00 2,50D.00 12,500.00 16.7% Coordinated Services 260,403.00 72,424.70. 187,978.30 27.8% REVENUES HUMAN SERVICES PROGRAMS 28,120,497.00 7,246.652.19 20,873.844.81 25.8% SUMMARY Total OF EXPENDITURES Budget January Balance % Administration 925,134.00 152,735.05 772,398.15 16.5% Alcohol -Drug Abuse 584,307.00 92.885.72 491,421.28 15.9% Long Term Support 17,542,262.00 2,422,682.16 15,119,579.84 13.8% Mental Health 2,909.086.00 467,954.71 2,441,131.29 16.1% Family & Children's 3,120,265.00 492,70B.83 2,627,556.17 15.8% SED 216,000.00 0.00 216,000.00 0.0% Public Health 1,537,680.00 248,554.62 1,289,125.38 16.2% Economic Support 1,010,360.00 171,925.47 838,434.53 17.0% General Relief 15,000.00 900.67 14,099.33 6.0% Coordinated Service /SED 260,403.00 13,879.43 246,523.57 5.3% EXPENDITURES HUMAN SERVICES PROGRAMS 28,120,497.00 4,064,227.46 24,056,269.54 14.5°. Excess Rev over Expenses ! 3.182.424.73 Percentage of Budget: 16.66 IMCR revenues recorded $ 3,182,424.73 Revenues above include state advances Jan -April 06 $ 3,182,424.73 PUBLIC HEALTH LEVEL III DESIGNATION A plaque containing a certificate of Level III designation, the highest designation, for Public Health was presented to the Board. This designation is in force for up to five years. The increased designation also means additional monies for the county. A thorough review was performed using statutes. Public Health utilizes many grants to provide a full level of public health services to the community and also provides environmental health services. Tim Ringhand, Division of Public Health, indicated St. Croix County has an excellent team of staff and the certificate is the result of the department and agency effort.. Board members requested Nelson to report on the certificate at the County Board meeting. St. Croix County Health and Human Services Board Page 6 April 17, 2006 PUBLIC HEALTH RESOLUTION REGARDING VACCINE SUPPLY, DISTRIBUTION AND ACCESS: In the last few years, problems have developed regarding the availability and distribution of the flu vaccine. In 2004 -2005 season there were manufacturer problems. This is an issue that needs to be addressed now in preparation of a possible pandemic. Policy makers need to hear about issues with vaccine supply, distribution and access. This is more of a coordination than money issue. The resolution was reviewed with Corp. Counsel -and will be placed on the 05/16/06 County Board agenda. Motion A motion was introduced by Caflisch, seconded by Kretz, and unanimously adopted: That the Board approves the following resolution: RESOLUTION REQUESTING IMPROVEMENT OF SUPPLY AND DISTRIBUTION OF AND ACCESS TO INFLUENZA VACCINE TO LOCAL HEALTH CARE PROVIDERS RESOLUTION NO. St. Croix County, Wisconsin WHEREAS, influenza vaccine is a highly effective tool in preventing influenza - related morbidity and mortality, especially in high -risk category individuals; and WHEREAS, annually nationwide: 5 -20% of the population is afflicted with influenza; more than 20,000 people are hospitalized due to complications; and more than 36,000 people die due to influenza and /or complications; and WHEREAS, supply and distribution of influenza vaccine is hampered by a variety of factors, creating instability in supply and inequities in access to the vaccine; and WHEREAS, as a result of the supply and distribution problems, local health departments and private medical provider's are being criticized for their inability to deliver vaccine to the public during a "regular" flu season; and WHEREAS, it is critical that the supply and distribution of influenza vaccine be stabilized before our nation and the world is faced with its next influenza pandemic; and WHEREAS, local and state preparedness efforts are ongoing in an attempt to enhance emergency response capacity and require stability of supplies of critical pharmaceuticals; and WHEREAS, United States Department of Health and Human Services (DHSS) Secretary Michael Leavitt is promoting preparedness for a potential pandemic of influenza at a governor's summit in each state but without a plan for assuring adequate supply and equitable distribution of influenza vaccine and other vital pharmaceuticals; and WHEREAS the St. Croix County u t Health and Human Services y e es Board recommends communicating to Wisconsin Department of Health and Family Services Secretary Helene Nelson, Governor Jim Doyle, U.S. Senators Russ Feingold and Herb Kohl, U.S. Representative Ron Kind, and President George W. Bush the urgency of correcting these ongoing problems and assuring a reliable supply and distribution system for our state and our nation of essential influenza vaccine. St. Croix County Health and Human Services Board Page 7 April 17, 2006 WHEREAS, the St. Croix County Health and Human Services Board also recommends encouraging support from the Wisconsin Hospitals Association, Wisconsin Public Health Association, Wisconsin Association of Local Health Departments and Boards, Wisconsin Counties Association, Pierce -St. Croix Medical Society, American Academy of Family Physicians, and Association for Professionals in Infection Control (APIC). THEREFORE, be it resolved by the St. Croix County Board of Supervisors that it supports the Health and Human Services Board recommendation and that a copy of this resolution be forwarded to those named above. Offered by the Health and Human Services Board on May 16, 2006. PERSONNEL ISSUES Johnson announced there is a vacant position in Economic Support and another vacant position in Accounts Receivable. Nelson announced her plans to retire effective 06/30/06. The Board extended congratulations on her decision, their appreciation for working with her, and wished her well. Tim Ringhand reminded the Board the Regional Office is available to help with recruitment and orientation for the position. CLOSED SESSION PER WISCONSIN STATUTE 19.85 (1) (C) FOR DIRECTOR'S REVIEW: Motion A motion was introduced by Wentz, seconded by Burri, that the Board enter closed session per Wisconsin Statute 19.85 (1) (c) to perform the Director's review: Roll call vote: Thomas Dorsey -yes Lois Burri -yes Tom Caflisch -yes Tom Dowd -yes Dr. Kretz -yes Linda Luckey -yes Deb Rasmussen -yes Ralph Swenson- absent Esther Wentz -yes Eight yes, one absent, motion passed. The Board entered closed session at 2:20 PM. RECONVENE INTO OPEN SESSION PER WISCONSIN STATUTE 19.85 (2). RETURN TO OPEN SESSION Motion A motion was introduced by Caflisch, seconded by Rasmussen, that the Board reconvene in open session per Wisconsin Statute 19.85 (2): Roll call vote: Thomas Dorsey -yes Lois Burri -yes Tom Caflisch -yes Tom Dowd -yes Dr. Kretz -yes Linda Luckey -yes Deb Rasmussen -yes Ralph Swenson - absent Esther Wentz -yes St. Croix County Health and Human Services Board Page 8 April 17, 2006 Eight yes, one absent, motion passed. The Board reconvened in open session at 2:48 PM. TARGETED CASE MANAGEMENT- POTENTIAL REDUCTIONS AND AGENCY IMPACT A memo from Susan Reinardy, Deputy Secretary, Department of Health and Family Services, and information regarding targeted case management services was distributed to Board members. As a result of the Federal Deficit Reduction Action of 2005, Medicaid (MA) Targeted Case Management reimbursement services will be cut after 01/01/2006. The impact of this cut is uncertain at this time and three possible outcomes were outlined for the Board with varying amounts of possible fiscal impact. Targeted case management will continue as budgeted and information will be brought to the Board as it is available. Wentz left the meeting at 3:00 PM. DHHS STRATEGIC PLANNING A RFP request was submitted to six vendors. With the tight timeline and a $15,000 budget, five of the six vendors pulled out of the process. One RFP was submitted. Staff interviewed with Cathy Lins who has a strong background in research, training and strategic planning, and is located near Madison. She indicated no issues with working in this area. A positive point is her strong .connections in Madison. A steering committee will be set up with staff Steve Kirt and Fred Johnson, one or two HHS Board members and potentially one County Board member. Approximately four steering committee meetings will be held, starting in April and ending around the end of June. Some items explored will be major issues, resource issues, funding issues and grant writings. The results will be used as a template for Board meetings and be part of the 2007 budgeting process. Dr. Kretz volunteered to be on the committee. It was reported Wentz indicated an interested in being on the committee. It was the consensus other appointment(s) should be made by the Board chair at the 04/24/06 County Board meeting. Dowd left the meeting at 3:20 PM. NURSING HOME REPORT/ IMPLEMENTATION OF OPERATIONAL ASSESSMENT The final visit by the consultants will be 04/18/06. The operational plan will be in effect by tomorrow. There will be some more reduction of hours to get to 3.65 hours /patient day. Administration is looking at making sure the operation is measured by per patient day cost. Van Offeren explained the State has benchmarks in each department and reimbursement is based on those benchmarks. Training sessions will be set up for staff to learn how to utilize PPD (Per Patient Day) to more efficiently operate the Nursing Home and these measures will ensure changes the consultants made will stay in effect after they leave. Van Offeren announced staff moves to first floor will be completed by May 8. Census today is 71 with one admission anticipated this week. A waiting list has been started. Van Offeren indicated more uses for the Kronos system will be explored and possibly implemented to more efficiently use the system. Van Offeren requested approval to purchase IPC to cover walls in the two dining rooms as the wallboard is dented and marked up from wheelchairs, carts, etc. The IPC will prevent further damage to the walls and require less maintenance time. He indicated there were monies budgeted for computers that could be line transferred to purchase the wall coverings. Motion A motion was introduced by Caflisch, seconded by Burri, and unanimously adopted: That the Board approves transferring monies from the St. Croix County Health and Human Services Board Page 9 April 17, 2006 Nursing Home computer budget to purchase the IPC wall coverings. Johnson indicated it has been a somewhat stressful time in the nursing home with changes that have been made, but employees have worked well with the consultants and their work is appreciated. Johnson stated he also appreciated the work done by the consultants as change is difficult. A new reimbursement formula will go into effect 07/01/06 but details are not available yet. On 04/03/06 St. Croix Health Center received an award of excellence for therapies offered. Lisa Leahy also gave a presentation at Holy Family Hospital. BARN AND FARM LAND LEASE The barn lease will expire at the end of May, 2006. Van Dyk has indicated he will not renew the lease. The farm land lease will expire at the end of December 2006. This was discussed with the Finance Committee and a possible three -year land lease will be explored. Dana Baker is working with RFBs (Request for Bids) for both leases. 2006 DHHS MEETING SCHEDULE A tentative meeting schedule for the balance of 2006 was distributed. It was the consensus of members to use this schedule for the balance of 2006. Meetings will be held at 8:30 AM the third Monday of the month. Dorsey asked if there were any other issues to bring before the Board. New County Board member orientation was held on 04/14/06 from 8:30 to noon. Johnson indicated there were a lot of questions and expressed a lot of appreciation to staff for efforts put forth. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the meeting be adjourned. Time: 3:45 PM Chair: Attest: (Secretary)