Loading...
HomeMy WebLinkAboutHealth & Human Services 09-09-05 c. ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Clarence Malick, Chairman St. Croix County Board FROM: Tom Dorsey (Fred Johnson, 246 -8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 09/09/05 TIME: 8:00 a.m. ( NOTE TIME CHANGE LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: 10/14/05 (tentative: 09/22/05) ACTION ON PREVIOUS MINUTES: 08/12/05 ANNOUNCEMENTS: APPOINTMENTS: UNFINISHED BUSINESS: 1. Public Health 140 Review NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Personnel Issues 4. Nursing Home private room pay increase 5. Velocity Contract 6. Strategic Planning 7. Presentation of 2006 Health and Human Services and Nursing Home Budgets ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: Fred Johnson DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA /NOTICE * *ADDITIONS /CHANGES /CORRECTIONS l � �t a ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 09, 2005 The St. Croix County Health and Human Services Board met on September 09, 2005 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Tom Dowd Dr. Michael Kretz Linda Luckey Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Tom Caflisch, excused STAFF PRESENT: Fred.Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Carolyn Krieger, Nursing Home Administrator Kathy Dunlap, Family and Children's Coordinator Pat Haeny, Family and Children's Supervisor Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Barbara Nelson, Public Health Supervisor - Health Officer Ron Lockwood, Long Term Support Coordinator Ron Eichstaedt, St. Croix Industries Director Mary Squyer, Economic Support Supervisor Norma Vrieze, Birth to Three Director Malva Berg, Secretary OTHERS PRESENT: Chair Dorsey called the meeting to order at 8:00 AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Friday, October 21, 2005 at 8:30 AM. Dorsey will review vouchers when .they are completed. AGENDA Motion A motion was introduced by Wentz, seconded by Burri, 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 08/12/05 Health and Human Services Board meeting be approved with the following changes: .-page 2, second paragraph, eliminate sentence 2 so the paragraph will read as follows: Based on the 2004 Medicaid cost report, the overall cost per resident per day is $221. Krieger said there are currently 17 private pay residents. She said four facilities have been compared for nursing home staff hours per resident day. -page 2, paragraph 7, change the wording in sentence one from easier to more fair. ��i x.10 -IZ c St. Croix County.Health and Human Services Board Page 2 September 09, 2005 -page 2, paragraph 8, reference to the Wipfli report regarding The Changing Realities of the Senior Services Industry by John Keefe should be included in the minutes. Larry Lester sent copies of this report to Board members. -page 7, 2006 Budget Highlights, in the motion change Corp Council's to Corp. Counsel`s. -page 7, regarding storm damage, fully identify reference to "Kristen" so anyone reading the minutes will be able to identify. ANNOUNCEMENTS The Nursing Home, Public Health, Long Term Support, and Economic Support have been contacted by the Department of Health and Family Services regarding possibly assisting evacuees of Hurricane Katrina in Wisconsin. Kretz requested the Board members be notified by e -mail of the assistance requested. So far, Public Health has been service based regarding immunization and the Nursing Home has been inquiries regarding empty beds. Johnson said the final approval to hook up the generator has been verbally approved by the State Engineer, Romaine Anderson. Johnson announced the doors itemized in capital outlay will probably not be acted on but he will not be sure until inspected by the State Engineer in two to three weeks. PUBLIC HEALTH 140 REVIEW Public Health has been a Level II health department. Evidence has been submitted to move to a Level III. There were no deficiencies identified per the returned addendum and letter. Nelson said Larry Gilbertson and Jim Zanto, part of the review team, confirmed there is no question in their mind that Public Health is functioning as a Level III but the letter indicates a Level II. There is no financial impact for 2006 but could be for future years. A call has been placed to Gilbertson and Nelson plans to contest the Level II designation. Level III requires a health officer to have one of three educational preparations. Nelson stated she has 12 graduate credits, 16 is required; however, she cited WI Statute 251.06 (lm) that addresses an exemption under 46.23. Fred Johnson's credentials were provided during the review process. The Board applauded Public Health for the results of the review. Kretz questioned if the staff received recognition from the Board for the results of the review. Johnson will follow through on this with Dorsey. CONSIDERATION OF CLAIMS Health and Human Services Board member Dorsey reviewed the vouchers. Motion A motion was introduced by Dorsey, 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 57309 through 57491, dated September 09, 2005 in the amount of $116,504.35. Human Services vouchers 57537 through 57571, dated September 09, 2005 in the amount of $103,005.55. Human Services vouchers 56930 through 57074, dated September 09, 2005 in the ,amount of $211,848.25. Human Services and Nursing Home vouchers 55850 through 55919, dated August 18, 2005 in the amount of $245,881.44. St. Croix County Health and Human Services Board Page 3 September 09, 2005 Human Services and Nursing Home vouchers 56230 through 56345, dated August 25, 2005 in the amount of $486,004.57. Human Services and Nursing Home vouchers 56510 through 56566, dated September '01, 2005 in the amount of $51,346.57. Nursing Home vouchers 57492 through 57536, dated September 09, 2005 in the amount of $18,288.82. Human Services, Workshop, Public Health, Social Services vouchers 478 through 507, dated August 23, 2005 in the amount of $343,836.66. Human Services, Workshop, Public Health, Social Services vouchers 508 through 539, dated September 06, 2005 in the amount of $347,992.29. Human Services and Nursing Home vouchers 534 through 565, dated August 25, 2005 in the amount of $186,597.84. Human Services and Nursing Home vouchers 565 through 597, dated September 08, 2005 in the amount of $176,328.08. Workshop vouchers 31 through 36, dated August 17, 2005 in the amount of $9,742.30. Workshop vouchers 37 through 42, dated September 06, 2005 in the amount of $9,617.67. FINANCIAL REPORTS Due to budget preparation, the financial reports will be delayed until next month. PERSONNEL ISSUES Holly Bjerke has been hired to fill the full time Family and Children's Ongoing Child Protection Social Worker position. Interviews have taken place for the half time payroll position and an offer is pending. NURSING HOME PRIVATE ROOM RATE INCREASE A survey was distributed indicating the private room charge from seven facilities, two county homes and five not - for- profit homes. The charge ranged from $6 to $24 /day. Krieger questioned which is more valuable to the consumer, a larger room with shared bath or a smaller room with a private bath. Private room rate is currently an additional $12 per day and Johnson would like to see the rate stay consistent between the two types of private rooms and recommended a $3 /day increase. Krieger said St. Croix Health Center is one of the few facilities in the area that charge room tax to the resident ($2.50 /day). Motion A motion was introduced by Kretz, seconded by Rasmussen, That the Board approves increasing the private room rates by $5.00 per day. Motion did not pass. Motion A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the Board approves increasing the private room rates by $3.00 /day effective November 1, 2005. A 30 -day notice is required to notify guardians /families /residents of the increase. - VELOCITY CONTRACT The Velocity contract runs until 09/30/05. The rate will remain consistent through the next year with an escalator clause after that. A contract has not been received but is anticipated it will go out nine years. The contract will. be reviewed with Corp. Counsel when it is received. I .. St. Croix County Health and Human Services Board Page 4 September 09, 2005 The Board recessed from 8:45 to 8:55 AM. PRESENTATION OF 2006 HEALTH AND HUMAN SERVICES AND NURSING HOME BUDGETS: Johnson announced he appreciates all the staff time and patience that went into developing the budget and would prefer that all managers sit in on the whole budget presentation. He said revenues listed in the budget are projections of anticipated revenue. A summary sheet of the budget was given to Board members. Farm: Farm revenues include barn rent, land rent, house rent and utility costs paid by renters. The balance of the farm account goes into the general fund. Kretz questioned why the farm is under the Health and Human Services Board. Administration: A decision was made to allocate all WIMCR revenues to one budget (Administration) due to the difficulty in predicting revenues and tracking how the revenues are to be applied. This results in a net decrease in 'county levy request for Administration but Mental Health and Long Term Support will require increases in county levy in part due to this reallocation. The increases in Administration budget are costs related to operational costs, strategic planning, inservice coordinator time, background checks and interpreter services. Wages and fringe are down due to new staff. Staff numbers have not increased since 2000 but the population has increased. Monies from office supplies will shift to computer, chairs, and other equipment to more accurately portray what monies are being spent on. Inservice coordinator time will be utilized for orientation of new staff and inservice development. The maintenance budget does not include salary and fringes, just actual costs. It is anticipated fuel costs will increase 45 to 70% and that increase is not factored into the budget as presented. Current budget figures include a 25% increase. "Mental Health /AODA: Salary and fringes are included for a new AODA position in the jail as movement towards a drug court continues. Also increased office equipment, educational materials and supplies are needed for this new position. Based on utilization, it is anticipated contracts will increase 77 %. Meth is part of the cause for increased utilization. There is no cheap fix for meth. The fix is to get the problem contained and diminished. Treatment for meth is a long term process. Development of drug court is another effort that could have a positive impact on the purchase of service contracts. Judge Vlack has agreed to continue in the development of a Drug Court. There have been an increased number of voluntary clients, mostly due to newspaper articles on meth. The fact that there has been a significant reduction in the number of meth labs has not reduced the costs to the county because the demand is still there and they are now looking to the super -labs in Mexico and the Southwest for their product. Computer equipment is no longer part of capital outlay but is now in program costs. The Board questioned if Michelle Pietrick has been made aware of this shift. Kiesler reported that in the 2006 budget Mental Health will need $75,324 more and AODA will need $96,358 more in County levy than in 2005. However, Kiesler also reported that $190,901 in WIMCR revenues were shifted from the MH /AODA budget to Administration budget in the 2006 budget (for ease of reporting and recording), hence MH /AODA would net a County levy reduction of $19,219 for 2006 if the WIMCR dollars had not been shifted. Contract costs are down approximately $30,000 'due to moving some cost to AODA and based upon six month utilization. This also includes Mental Health f i r • St. Croix County Health and Human Services Board Page 5 September 09, 2005 mobilization /diversion program. Mental Health is developing a hybrid diversion program, contracting for just the mobile worker and providing the other aspects (e.g. telephone coverage, supervision, etc.) with our own resources at an additional cost of about $30,000. It was found to be cost prohibitive to purchase mobile emergency services from another vendor. It would have cost •$120,000 to $150,000 to purchase the entire package. There are two emergency systems in place now -one for Family and Children's and one for AODA /Mental Health. Johnson is not in favor of merging the two emergency services without ,studying further. Coordinated Family Services: Providing services through this process is not mandated but we are primarily serving clients that we would be mandated to serve in Family and Children's and /or CSP. The Office of Justice Assistance grant allowed St. Croix County to implement this model of service provision with no county levy in 2005. In 2006, the county levy match requirement begins to show up as step down provision in grant funding begin. Performance criteria for the grant(s) are directed towards lessening the demand for hospitalization and out -of -home placements (at least in the past). As grant funding lessens and county levy requirement for funding increases, review of this process of service provision will be completed with the Board. Also, staff costs from CSP .and Family and Children's have been shifted to the budget to increase service delivery and more accurately reflect how staff time has been spent. (20% CSP social worker, 100% Family and Children's social worker, 5% CSP supervisor, and 5% of Family and Children's social worker). This has also helped to maximize use of grant funding and reduce the county levy request in Family and Children's and CSP. It is anticipated this program will lessen out of home placements. The program is kept separate in order to try to capture Federal dollars. Family and Children's: Expenses in wages and fringes have been reduced due to transferring one social worker position plus 5% of social worker supervisor position to Coordinated Family Services program. Payment by insurance companies for some residential placements should result in increased revenues. Billing in the SED program resulted in approximately $10,000 increase due to this program being staffed in 2006. A new program, Drug Endangered Children Program, has been initiated with new protocol and staff are not sure what the outcome will be for this program. It is anticipated that correction placement costs will increase 18%. Long Term Support: Long Term Support is requesting a significant increase in County levy due to less State aid to Long Term Support operations and WIMCR monies that were put into the Administration budget. It is anticipated COP - W/CIP II supplemental funds from the State will not be available (approximately $160,000). These were year -end monies and it is very unlikely we will get State supplemental aid any longer. Long Term Support is still spending the $160,000 for 2005 but it is possible these monies may not be received in 2005 and this amount is not being budgeted in 2006. A decline in Federal aid is anticipated. The match effective 10/01/05 will change to 58% Federal /42% County versus the previous 60/40 which will amount to approximately $123,000 less Federal funds. There is also a review of the administrative charging procedures in Long Term Support. It is anticipated that this review will be completed and reported to the Finance Committee on September 29 to potentially revise the County levy request in Long Term Support. Long Term Support is in a critical situation with - approximately 180 on the waiting list with disabilities and there are a large number coming out of the school system that need support but resources are not available to support services. Lockwood indicated he is not comfortable as a 1 St. Croix County Health and Human Services Board Page 6 September 09, 2005 manager asking for more monies to address the waiting list when so much has been requested already. Additionally, $200,000 is built into the budget to support supplemental costs for seven clients, some of which require 24 -hour care. There are difficult decisions to make regarding clients served that have significant needs and needing to contain costs. The budget does not address any waiting list needs. The waiting list is crisis driven. It has been eight years since anyone from the waiting list has been served. Kretz indicated if there was no intention for action on the waiting list, then that should be relayed to the clients on the waiting list. The issue has been brought up at the annual budget meetings and if the issue is not going to be addressed the meetings should be canceled. Luckey said she cannot support to the taxpayers raising the budget $200,000 to support seven people. Public Health: The majority of Public Health revenue is grant money. There is an increase in expenses in wages and fringe benefits due to moving a half -time Public Health Nurse to full time and as a result of step increases. Economic Support: The Fraud Program may be discontinued November 1. 'Eliminating training and travel reduced expenses in Economic Support. Squyer is investigating working with MA transportation to generate additional revenue. She will be working with law enforcement to designate as specialized transportation vehicles when clients are emergency detained (ED'd). Law enforcement will need to complete a form to receive $1.05 /mile for transportation with Economic Support receiving an additional $.05 /mile. General Relief is not mandated but included in the budget. It was the consensus of the Board to keep General Relief as it is the last resort for people. Dr. Kretz expressed concern about keeping this program, yet we have not taken one person off the waiting list in Long Term Support. Nursing Home: There will be no increase from the State for Medicaid on 07/01/05. There will be no increase in Medicare in 2006 with the addition of nine RUGS levels. IGT funds will be decreasing in 2006. The most conservative approach was used based on actuals when preparing the budget. Krieger said there were less Medicare days in July and August and less private pay residents, which lowered the average for the year. Kretz questioned if it was possible to go to employees to request them to give back any potential increase they may receive. Wentz said there is a no -win situation with four different unions. Strategic planning amount of $15,000 is included in the budget. It was the consensus of the Board that Nursing Home be given top priority in strategic planning. Krieger said four RNs have been replaced with four LPNs, lowering costs for salaries /fringes in nursing. The Board questioned the on -call budget for the Nursing Home. Krieger will investigate further and make changes. Motion A motion was introduced by Swenson, seconded by Wentz, and passed with Luckey voting no: That the Board approves the budget process to go forward subject to agreed upon changes in the Nursing Home and changes that are needed in Health and Human Services and the Health and Human Services chair will sign and bring to Finance on 09/28/05. Kretz would like a final vote on the budget if further adjustments are needed and would like another meeting. Luckey echoed that opinion. Johnson will call a meeting on 09/26 or 09/27 if needed. Minimally, all adjustments will be reviewed with the Board at the October meeting. Kretz said the budget shows a monumental effort of staff and appreciates their efforts. St. Croix County Health and Human Services Board . Page 7 September 09, 2005 Dorsey asked if there were any other issues to bring before the Board. Motion A motion was introduced by Wentz, seconded by Kretz, and unanimously adopted: That the meeting be adjourned. Time: 12:50 PM Chair: Attest: (Secretary)