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HomeMy WebLinkAboutHealth and Human Services 05-15-06 r s. BURRI WILL REVIEW VOUCHERS AT 8:00 AM. REVISED NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD May 15, 2006 at 8:30 AM (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 04/17/06 DATE OF NEXT MEETING — 06113106 4:30 FPM OLD AND NEW BUSINESS 1. Review General Relief Policy 2. Economic Support — new worker training 3. Consideration of Claims and Vouchers 4. Financial Report 5. Nursing Home Report 6. Personnel Issues a. Fill Public Health Coordinator/Health Officer position b. New position requests 7. Long Term Support-Long Term Care Reform 8. Barn/Farm Lease 9. Capital Outlay planning for 2007 10. Closed session per Wisconsin Statute 19.85 (1) (e)- management of the nursing home. 11. Reconvene into open session per Wisconsin Statute 19.85 (2) — return to open session. 12. Strategic Planning 13. Springsted liaison workgroup ** ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 5/8/2006 11:55 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD May 15, 2006 The St. Croix County Health and Human Services Board met on May 15, 2006 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Tom Dorsey Lois Burri Tom Caflisch Tom Dowd Dr. Michael Kretz Linda Luckey Deb Rasmussen Esther Wentz MEMBERS ABSENT: Ralph Swenson STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor 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: Leon Berenschot Ron Troyer Chair Dorsey 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 Tuesday, June 13, 2006 at 4:30 PM followed by the Open Budget Hearing Meeting at 6:00 PM in the Nursing Home social room. Wentz will review June 'F vouchers. AGENDA Motion A motion was introduced by Wentz, seconded by Kretz, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Kretz, seconded by Wentz, and unanimously adopted: That the minutes of the 04/17/06 Health and Human Services Board meeting be approved with the following additional explanations: ... Pempek reminded Board members Nursing Home IGT funds have been received for six months due to the State's policy and only two months of expenses are recorded... ...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 in part because children's advocacy groups were not interested in children being part of a managed care model. 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. REVIEW GENERAL RELIEF POLICY Squyer informed the Board that the State has pulled their plan for non - emergency transportation to be administered by the St. Croix County Health and Human Services Board Page 2 May 15, 2006 private sector and left the program with the County. The private sector determined there wasn't enough money in the program, thus the program will continue to be administered by the County, which gives the county more control over clients being able to access doctor appointments, but does increase workload for the Economic Support Supervisor. General Relief is a non - mandated program. It is a program of last resort. Squyer said the County needs to spend money to get money from the State and the County has spent very little money in the last few years so hasn't received reimbursement from the State for General Relief. She said $15,000 has been allocated to the General Relief budget the last few years. She said the monies are used for anything that may be life threatening such as medication, etc. She said burials may be an issue in the future as funeral homes are asking the financial status of a client before they will do a pick up. It was the consensus to continue budgeting General Relief as part of the regular budget process for 2007. ECONOMIC SUPPORT - NEW WORKER TRAINING There is an opening in Economic Support due to a resignation. New workers in Economic Support need three months of training and the training is in Milwaukee. The cost of the training, mileage, food, wages, accommodations, etc. is over $9,000. Squyer said a person has been hired from Work Force Connections for this position and has received half of the required training. Squyer has requested of the State and has been allowed to do the balance of the training in -house and requested the Board to give permission to contract with the employee who resigned to perform the training in -house for 6 -8 weeks at a much lower price, which is estimated at $3,000. Motion A motion was introduced by Caflisch, seconded by Rasmussen, and unanimously adopted: That the Board approves contracting with Heather Gensen to provide in -house new worker training for Economic Support for six to eight weeks. CONSIDERATION OF CLAIMS Health and Human Services Board member Burri reviewed the vouchers. Motion A motion was introduced by Burri, seconded by Wentz, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 73769 through 73775, dated April 20, 2006 in the amount of $36,902.44. Human Services vouchers 74871 through 75060, dated May 12, 2006 in the amount of $148,707.22. Human Services vouchers 75061 through 760 +5, dated May 12, 2006 in the amount of $44,358.03. Human Services vouchers 74667 through 74841, dated May 12, 2006 in the amount of $125,639.60. Human Services and Nursing Home vouchers 73391 through 73466, dated April 20, 2006 in the amount of $88,508.11. Human Services and Nursing Home vouchers 73467 through 73501, dated April 20, 2006 in the amount of $20,993.26. St. Croix County Health and Human Services Board Page 3 May 15, 2006 Human Services and Nursing Home vouchers 73929 through 74058, dated April 27, 2006 in the amount of $355,534.88. Human Services and Nursing Home vouchers 74068 through 74155, dated May 04, 2006 in the amount of $171,852.11. Nursing Home vouchers 74842 through 74870, dated May 12, 2006 in the amount of $60,792.28. Human Services, Workshop, Public Health, Social Services vouchers 228 through 257, dated April 18, 2006 in the amount of $355,340.20. Human Services, Workshop, Public Health, Social Services vouchers 258 through 289, dated May 02, 2006 in the amount of $353,370.99. Human Services and Nursing Home vouchers 235 through 265, dated April 20, 2006 in the amount of $161,398.55. Human Services and Nursing Home vouchers 266 through 296, dated May 02, 2006 in the amount of $173,036.60. Workshop vouchers 43 through 48, dated April 18, 2006 in the amount of $11,783.28. Workshop vouchers 49 through 54, dated May 02, 2006 in the amount of $12,296.72. FINANCIAL REPORT The following financial reports through March, 2006 were distributed to the Board. The average census through March is 68.3 and the budget is based on 66. Last week census was down to 65 but is up to 68 today with several admissions pending. Pempek indicated $190,000 for worker's comp. would be paid in May. Staff does receive training on lifting and inservice training is offered to reduce worker's comp. losses. She also indicated the salary increases are not included in the report but were budgeted for 2%. She said the consultants and Nursing Home Administrator will be paid in April. PPD (per patient day) will change the report format and department managers will receive inservice training on PPD. It is hoped a powerpoint presentation on PPD will be available to present at next month's meeting. Administration can control hours and some operational costs, but it does not control wages and benefits, which is the majority of the Nursing Home budget. Wentz said efforts will be made to possibly reduce wages and benefits across the county in the future. The Nursing Home union has filed for mediation. Non -union staff in the Nursing Home received no increase. Luckey explained binding arbitration. An arbitrator can only chose between the county or union offer and not look at the private sector. The arbitrator always looks at the ability to pay. Kretz said there is a need to act in a fiscally responsible way to control costs with salaries and fringes and is concerned that as a Board member they have no impact on wages. Van Offeren reminded the Board that July 1 a new reimbursement formula will be used through MDS for all categories excluding private pay. The Nursing Home private pay population is 8% at the current time. Only Registered Nurses can determine the MDS but nurses have to have a clear picture of assessments for MDS. This will need to be done every month on an ongoing basis. Reimbursement will be dependent on acuity level. Van Offeren indicated he would rather levels be figured high and have to give monies back than to have the levels too low. St. Croix County Health and Human Services Board Page 4 May 15, 2006 ST CROIX HEALTH CENTER OPERATIONS REPORT ,IAN - MAR 2006 Jan -March 2006 BUDGET ACTUAL DIFFERENCE _a CENSUS 66 Avg 68.33 Curr: 71 OPERATING REVENUE: MEDICARE $ 629,623.05 $ 260,358.57 $ 369,264.48 41% `MEDICAID $ 2,609,616.07. $ 541,640.79 $ 2,067,975.28 21% :PRIVATE PAY '' $ 547,475.00 $ 201,029.04 $ 346,445.96 37% RATE APPEALS - ACTUAL $ 14,824.00 $ - $ 14,824.00 0% �IGT FUNDS - $ 377,000.00 $ - $ 377,000.00 PALL OTHER SOURCES*** $ 220,453.00 $ 52,877.57 $ 167,575.43 24% -TRANSFER FROM CONTINGENCY $ - $ $ - TOTAL OPERATING REVENUE $ 4,398,991.12 $ 1.055,905.97 $ 3,343,085.15 24% OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,363,410.47 $ 813,591.60 $ 2,549,818.87 24% SPECIAL SERVICES $ 274,458.35 $ 65,441.16 $ 209,017.19 2470 -GENERAL SERVICES $ 1,169,758.41 $ 258,294.81 $ 911,463.60 22% =ADMINISTRATIVE SERVICES $ 527,734.19 $ 112,621.83 $ 415,112.36 21% ,UNASSIGNED: $ - ,DEPRECIATION( %BASED) $ $ - $ - ,OTHERS: (INS -WC- CAPITAL -UTIL) $ 373,372.00 $ 97,159.53 $ 276,212.47 26% TOTAL OPERATING EXPENSES $ 5,708,733.42 $ 1.347,1013.93 $ 4,361,624.49 24% NET FROM OPERATIONS $ - $ (291,202.96) (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 $ 377,000.00 ; $ - $ 377,000.00 0% , CO ALLOCATIONS( %BASED) $ 1,309,742.30 $ 326,385.00 $ 983,357.30 25% -TOTAL OUTSTANDING $ 1,701,56630 $ 326,385.00 $ 1,375,181.30 NET FROM ALL SOURCES $ 35,182.04 PERCENTAGE SHOULD BE 23.44 Outstanding billings: $32,006 Potential Salary Increases: $16,856 - '$50,567 annual projection Workers Comp payment of 190.000. will be paid in May. Pempek indicated the auditors will be in this week to audit the 2005 books. The auditors will attend the July meeting to present the audit report. At the St. Croix County Health and Human Services Board Page 5 May 15, 2006 last audit report Auditor Tracey recommended 30 to 90 days of working capital on hand; however, the Board previously felt the general fund is considered a reserve and voted to move unrestricted cash balance from the Nursing Home. Pempek explained working with an unrestricted fund balance versus an unrestricted cash balance. HEALTH AND HUMAN SERVICES - 2006 SUMMARY Total OF REVENUES Budget Jan - March Balance % Administration 925.134.00 806,201.69 118,932.31 87.1% AODA Services 649,146.01 172,173.75 476,972.26 26.5% Long Term Support 17,542,262.00 5,967,380.19 11,554,881.81 34.1% Mental Health 2,909,086.00 1,106,265.19 1,802,820.81 38.0% Family & Children's 3,120,265.00 1,232,932.88 1,887,332.12 39.5% SED 216,000.00 186,586.48 29,413.52 66.4% Public Health 1,537,680.00 366,356.76 1,171,323.24 23.8% Economic Support 1,010,360.00 358,921.03 651,438.97 35.5% General Relief 15,000.00 3,750.00 11,250.00 25.0% Coordinated Services 260,403.00 78,869.36 181,533.64 30.3% REVENUES HUMAN SERVICES PROGRAMS 28.185,336.01 10.299.437.33 17.885.898.68 36.5% SUMMARY Total OF EXPENDITURES Budget Jan - March Balance % Administration 925,134.00 257,093.79 668,040.21 27.8% Alcohol -Drug Abuse 649,146.01 155.272.13 493,873.88 23.9% Long Term Support 17,542,262.00 4,177,614.18 13,364,647.62 23.8% Mental Health 2,909,086.00 713,469.15 2,195,616.85 24.5% Family & Children's 3,120,265.00 737,227.00 2,383,038.00 23.6% SED 216,000.00 42,813.00 173,187.00 19.0% Public Health 1,537,680.00 378,893.81 1,158,786.19 24.6% Economic Support 1,010,360.00 265,460.18 744,899.62 26.3% General Relief 15,000.00 1,415.25 13,584.75 9.4% Coordinated Services 260,403.00 27,55930 232,843.70 10.6% EXPENDITURES HUMAN SERVICES PROGRAMS 28,185,336.01 6,756,817.79 21,428,518.22 24.0% Excess Rev over Expenses ;li 3=542.619.54 Percentage of Budget 2499 "WIMCR revenues recorded $ 3,542,619.54 Revenues above include state advances Jan - May 06 $ 3,542,619.54 FILL PUBLIC HEALTH COORDINATOR/ HEALTH OFFICER POSITION Johnson said open department head positions must go through the Administration Committee before being filled. The Committee determined this position did not need St. Croix County Health and Human Services Board Page 6 May 15, 2006 Administration Committee approval to fill. Johnson asked if any Board members wanted to be part of the interview process. Wentz, Berenschot and Rasmussen volunteered to be part of the interview process. Motion A motion was introduced by Caflisch, seconded by Burri, and unanimously adopted: That the Board approves proceeding to fill the Health Officer /Public Health Coordinator position. It was recommended to utilize the Regional Office to advertise for the position and be part of the interview committee. Human Resources will advertise to recruit for this position. The Board requested Nelson be part of the interview process. Nelson agreed to sit in on the process to be a resource but not be a voting participant. PERSONNEL ISSUES Johnson listed new position requests for the 2007 budget process. Public Health request to increase 50% PHN position to 100% position. This position was approved in the 2006 budget and then pulled from the budget. New position requested in AODA. New position requested in Medical Records. Medical Records has operated with two staff since 1977. With HIPAA changes and more clients, more staff time is needed. Possibly two new positions will be requested for Economic Support. Economic Support caseloads are over 525 plus Public Health and Economic Support will play a role in Long Term Care Reform Aging and Disability Resource Centers (ADRC). New positions will be reviewed by Finance in August. This is a preliminary list and more detail will be provided at future meetings. Johnson informed the Board Public Health is moving ahead with plans to cover the workload increase due to Kathy Fredrickson's leave of absence. Nelson distributed a brochure on the Food Resource Directory and informed the Board that Public Health is a member of the Food Resource Collaborative. She also distributed a handout on mumps /mumps vaccines and said there are no reported cases in St. Croix County as yet. The Board recessed from 10:10 to 10 :20 AM. LONG TERM SUPPORT -LONG TERM CARE REFORM Lockwood reported there have not been any significant developments since the last Board meeting. The collaborative has invited Community Health Partnership (CHP) to expand to Pierce /St. Croix County from October 2006 to April 2007. CHP currently receives a capitation from the State to provide a managed care program in Eau Claire, Chippewa, and Dunn Counties for approximately 825 clients. This managed care program is planned to expand into St. Croix and Pierce County and will serve the elderly and younger physically disabled but may phase in the developmental disability population where most of the local match monies go and this part has not been resolved. One possible scenario will be to reduce community aids to finance managed care. St. Croix County would benefit if this were to happen as St. Croix has been funded lowest per capita in the state and match monies will not be required. Monies will be given directly to CHP. CHP does not have the staff now and will likely have to buy services from Long Term Support until fully staffed but it is not clear what will happen after that. This process will cause a significant impact on staff and there will be changes in departments where one scenario could be Long Term Support staff working more on benefit specialist counseling, functional assessments, screening and enrollment and the case management organization provides direct services. DHHS and the Council on Aging staff are working on developing the ADRC's (Aging and Disability Resource Center) which is how the County would provide many of these services in this w St. Croix County Health and Human Services Board Page 7 May 15, 2006 scenario. There are concerns, questions, and uncertainties regarding exactly how Long Term Support, Nursing Home and St. Croix Industries will be impacted by the reform effort. We continue in planning efforts but are awaiting a response from the State regarding local contribution. Letters that have been previously submitted by counties have not received a response to date. Johnson will be at a WCHSA (Wisconsin County Human Services Association) meeting later this week and it is anticipated that Secretary Nelson will discuss County contribution with enough detail that the counties in the LTC Reform Consortium can start to address impact. BARN /FARM LEASE The barn lease expires 05/31/06. Van Dyk has indicated he will not renew the lease. Johnson explained there has been some discrepancy between the County and Van Dyk on items to remain /be removed from the barn and Johnson is negotiating with Van Dyk on these items. Dana Baker is working on separate RFB's for the farm buildings, the farm land or both the farm land and buildings. The barn will be offered for rent 07/01/06. Johnson will continue to update the Board on the farm status. NURSING HOME REPORT Van Offeren said the current census is 68 with two admissions pending. He said there were four deaths and two discharges home last week, which impacted the census. STATE SURVEY: I Van Offeren explained citations /deficiency process for the survey. The Nursing Home received three deficiencies in the D category, which are a concern, but not serious. Three cites were also received but the actual paperwork regarding these has not been received as yet. The consultants issued the final nursing home survey report. It was determined at this time with the current census it is not feasible to implement a behavior unit due to need for training of three to six months to implement /train, change of decor, etc. Staff will receive initial education regarding a behavior unit but no defined behavioral program will be implemented in the near future. Van Offeren indicated staff needs more training on MDS. Effective April 1 a unit -based schedule was implemented. A complete adjustment to the schedule should be completed by June. Van Offeren said 3.65 hours /ppd is on the schedule that has just been issued. He said the study is being implemented via controlling the scheduling. He said offices have been moved. He informed the Board that maintenance services are well over the benchmark in the nursing home and will be addressed. The survey has forced administration to look at issues in all departments, including maintenance. Johnson will be meeting with Robole to discuss the maintenance budget. Activity programs are changing for the new type of residents who are here for a short time. CLOSED SESSION PER WISCONSIN STATUTE 19.85 (1) (E)- MANAGEMENT OF THE NURSING HOME Motion A motion was introduced by Wentz, seconded by Caflisch, that Board enter into closed session per Wisconsin Statute 19.85 (1) (E) to discuss the management of the Nursing Home. Roll call vote: Thomas Dorsey -yes Lois Burri -yes St. Croix County Health and Human Services Board Page 8 May 15, 2006 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 11:25 AM. Johnson, Pempek, Van Offeren, Troyer, and Berenschot were invited to stay for the closed session. RECONVENE INTO OPEN SESSION PER WISCONSIN STATUTE 19.85 (2) - RETURN TO OPEN SESSION Motion A motion was introduced by Caflisch, seconded by Wentz, that 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 Eight yes, one absent, motion passed. The Board reconvened in open session. Time: 11:47 AM. STRATEGIC PLANNING The planning committee consists of Wentz, Kretz, Johnson and Kirt. The initial meeting was held on May 9, 2006. A summary of the meeting was distributed to the Board. The strategic plan is being developed as a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it, with a focus on the future. A strategic planning survey was distributed to each Board member to complete by May 25 or earlier. It is planned the final report for the strategic plan will be distributed to the full Health and Human Services Board at the July 17 meeting. SPRINGSTED LIAISON WORKGROUP The workgroup has met with Carolyn Holmsten from Springsted to review job descriptions. Another meeting is scheduled for 05/19 to begin the pointing of positions. Johnson will continue to update the Board as to the status of the workgroup. CAPITAL OUTLAY PLANNING FOR 2007 Preliminary planning for 2007 has begun. A detailed capital outlay plan will be presented at the next Board meeting and this will include as much detail as possible related to the long term cost for the Nursing Home as requested in the County goal setting document. It is, however, difficult to separate out costs solely for Nursing Home as many of these capital improvements items serve both the Nursing Home as well as DHHS. St. Croix County Health and Human Services Board Page 9 May 15, 2006 Dorsey asked if there were any other issues to bring before the Board. Wentz announced this is Dorsey's last meeting and expressed the Board's appreciation for his time and effort for being chair of this Board. Dorsey expressed his thanks for working with staff and wishes that the Board keep the Nursing Home operating. Dorsey adjourned the meeting. Time: 12:15 PM Chair: Attest: (Secretary)