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HomeMy WebLinkAboutHealth & Human Services 12-09-05 LOIS BURRI WILL REVIEW VOUCHERS AT 8:00 AM. 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: 12/09/05 TIME: 8:30 a.m. LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: ACTION ON PREVIOUS MINUTES: 11/18/05 ANNOUNCEMENTS: APPOINTMENTS: UNFINISHED BUSINESS: 1. Nursing Home Operational Assessment NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Program reports a. Nursing Home Report b. Long Term Support Report c. Mental Health Report d. Public Health 4. Personnel Issues 5. 2006 DHHS meeting schedule 6. Fleet vehicles 7. Donation accounts 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 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD December 09, 2005 The St. Croix County Health and Human Services Board met on December 09, 2005 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Tom Caflisch Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Tom Dowd, excused Dr. Michael Kretz, excused Linda Luckey, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Operations Manager Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Barbara Nelson, Public Health Supervisor - Health Officer Geralyn Karl, St. Croix County Health Educator Carolyn Krieger, Nursing Home Administrator Kristie Tellijohn, Director of Nursing -NH Malva Berg, Secretary OTHERS PRESENT: Clarence Malick, County Board Chair Lois Worbes, Nursing Home Staff 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 Friday, January 13, 2006 at 8:00 AM. Esther Wentz will review vouchers at 7 :30 AM. 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 Swenson, seconded by Wentz, and unanimously adopted: That the minutes of the 11/18/05 Health and Human Services Board meeting be approved as circulated. ANNOUNCEMENTS Johnson announced St. Croix County received $64,713, which was the amount requested, plus consideration for future evaluation as a promising practice for the Coordinated Family Service (CFS) project from the Governor's Juvenile Justice Commission. Johnson indicated an advisory board is required for CFS and recommendations for appointments to the board will be brought forth in the future. Johnson presented a letter from Craig Thompson, Legislative Director for Wisconsin Counties Association (WCA), regarding DHFS request for information (RFI) for entities to respond to regarding providing long term care in new ways and integrating acute and primary care with transitional long term care services. WCA's broad position is for the state to take over responsibility St. Croix County Health and Human Services Board Page 2 December 09, 2005 for all of human services but Thompson outlined reasons encouraging counties to continue to participate in efforts to respond to the Department's RFI. Another letter from Thompson was distributed regarding action on Assembly Bill 802 - Funding for County Nursing Homes. Basically the bill supports approximately $2.1 million in IGT monies for county nursing homes compared to possibly sharing the amount with all nursing homes in Wisconsin. 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 voucher 62774 dated November 23 2005 in the amount of $2,761.60. Human Services vouchers 62775 through 62782, dated November 23, 2005 in the amount of $67,700.59. Human Services vouchers 63525 through 63691, dated December 09, 2005 in the amount of $88,174.67. Human Services vouchers 63717 through 63746, dated December 09, 2005 in the amount of $48,709.22. Human Services vouchers 63747 through 63913, dated December 09, 2005 in the amount of $221,486.12. Human Services and Nursing Home vouchers 62212 through 62288, dated November 17, 2005 in the amount of $284,989.62. Human Services and Nursing Home vouchers 62289 through 62326, dated November 17, 2005 in the amount of $9,437.52 Human Services and Nursing Home vouchers 62327 through 62329, dated November 17, 2005 in the amount of $649.30. Human Services and Nursing Home vouchers 62684 through 62773, dated November 23, 2005 in the amount of $298,939.67. Human Services and Nursing Home vouchers 62799 through 62910, dated December O1, 2005 in the amount of $158,601.35. Nursing Home vouchers 63692 through 63716, dated December 09, 2005 in the amount of $10,330.46. Human Services, Workshop, Public Health, Social Services vouchers 664 through 693, dated November 15, 2005 in the amount of $340,480.59. Human Services, Workshop, Public Health, Social Services vouchers 694 through 725, dated December 01, 2005 in the amount of $349,780.12. Human Services and Nursing Home vouchers 728 through 759, dated November 17, 2005 in the amount of $172,225.79. Human Services and Nursing Home vouchers 760 through 792, dated December 01, 2005 in the amount of $173,020.19. St. Croix County Health and Human Services Board Page 3 December 09, 2005 Workshop vouchers 67 through 72, dated November 15, 2005 in the amount of $13,291.38. Workshop vouchers 73 through 78, dated December 01, 2005 in the amount of $12,364.80. MENTAL HEALTH REPORT Staff have continued to work to develop mobile crisis services. The outcome of mobile crisis is to divert clients from costly inpatient services to less costly residential or outpatient care and thus reduce inpatient placements. Dr. Ron Diamond, MD from the state is schedule to present a training to law enforcement /dispatchers on January 20, 2006. Don Gillen will also be asked to be part of this training to address liability questions. Law enforcement will be paid $60 /person to attend. The funds to make this a paid training come from a Western Region Hospital Diversion Grant. A contract with Northwest Counseling Services is being developed to provide mobile crisis staff. A cooperative effort with SCC law enforcement agencies and emergency communication is being coordinated to work with the mobile crisis response. The success /failure of this mobile crisis effort will hinge largely on law enforcement acceptance, particularly those working 4:00 PM to midnight. Kiesler reported Rusk and Washburn counties have experienced a 50o reduction in emergency detentions because of officer participation since implementing mobile crisis services. Barron, on the other hand, where law enforcement has not accepted their mobile crisis system, the number of ED's has actually gone up since 1/1/05. It is anticipated services will be activated in February, 2006. PERSONNEL ISSUES The vacant AODA position has been filled by Linda Cooper, with a start date of 01/03/06. Another interview with jail personnel will be scheduled for a potential candidate for the jail AODA position. It has been a very difficult process to fill these positions. Pierce County has had an open AODA position for six to eight months and Polk County has open AODA positions for approximately a year and a half. Money was a factor in the difficulty of filling the positions. It was the consensus of the Board that this issue be brought to Personnel Committee in the future. A report on MH /AODA contract status was distributed to the Board. A bill from October, 2004 was received this month. There will be a clause in new contracts stating vendors have 90 days after the first of the year for billing or a deadline of March 31st. Staff predict contracts may be in the black at year end. PUBLIC HEALTH Karl reviewed the After Action Report of the September BIO -EX 05 preparedness exercise. This exercise took place in the nine counties of the Western Region Partnership for Public Health Preparedness (WRPPHP) Consortium and involved local and state emergency personnel. She outlined how the exercise developed and findings from the exercise.. St. Croix County will be involved in more exercises in the future. Incident command training is recommended for Health and Human Services staff. Karl recommended families develop a family packet so families are prepared to cope with disaster and crisis in their own families. Nelson reported on the recent meetings of CRI (Cities Readiness Initiative), with the Twin Cities Metro members and federal partners, and distributed a map containing locations of mass dispensing sites as a part of this preparedness plan. The goal of CRI is to create plans to receive, distribute and dispense oral antibiotics to the entire Twin Cities Metro including St. Croix and Pierce counties population within 48 hours of the need being determined. This is being based on an aerosolized anthrax event. The USPS is St. Croix County Health and Human Services Board Page 4 December 09, 2005 being utilized for household delivery and it is anticipated delivery of prophylaxis meds would be made via mail carriers within 10 hours of leaving the postal service facility. The federal agreement requires each postal carrier must have a security person accompany them. It is estimated this would involve over 1650 personnel. This plan is still in the development stage with many unknowns. There will be training and exercises to follow. Nelson said a satellite phone has been provided for each of the nine counties in the consortium as a result of available grant funds. This has been provided to Emergency Communications and will be installed at the Government Center EOC. Other features are being pursued. Malick requested Nelson provide a powerpoint presentation to the Board and County Board in January regarding IPS (Interim Pharmaceutical Stockpile) and SNS (Strategic National Stockpile). Nelson reported on communicable diseases. She said there have been four confirmed cases of Pertussis in the fourth quarter and 30 suspect cases that required follow -up. She identified the other reportable cases all of which were isolated cases. Of significance were two cases of Neisseria meningitis and one suspect of E coli 0157:H7. Nelson suggested that the consortium epidemiologist provide a report to the Board in February or March to give the Board a summary of disease in St. Croix County. Nelson distributed copies of the 2005 and beyond St. Croix County Community Health Needs Assessment brochure. She encouraged Board members to review the brochure for findings and recommendations and highlighted direct impact objectives and indirect impact objectives of the improvement plan. Nelson reported Dr. Rasmussen in Glenwood City began the seal -a -smile campaign and continues with this program in that school. Dr. Mike participated with St. Croix Central schools. Through Public Health, 145 children have received 215 varnish applications as a part of the dental varnish program. Public Health staff continue to attempt to work with dentists in St. Croix County to expand dental care for low- income families or family with no dental insurance. Public Health continues to promote private well water testing in cooperation with Planning /Zoning and Land and Water Conservation. Nelson serves on the Meth Advisory Committee along with Steve Kirt, Esther Wentz, who chairs it, and Tom Caflisch. The goal is to raise awareness of meth use and production and to educate the community about the risks and affects of methamphetamines use. Nelson reported tobacco checks in the county are going well. There is also a smoke -free home campaign going on in the county. Question was raised regarding vendor selling cigarettes to underage children, and members were encouraged to call Geralyn if there is a concern this might be happening. The next Legislative event is scheduled for 01/23/06 in the DHHS Board room from 9 -11 am. Members were encouraged to contact Nelson with agenda items. The Board recessed from 9:40 to 9:50 AM. LONG TERM SUPPORT REPORT Long Term Support continues to move forward with planning process for Long Term Care Reform. The Department is responding to an RFP to implement a multi - county approach to LTC Reform in partnership with the Community Health Partnership, Inc. and the Management Group, Inc. If the RFP is awarded, the counties will receive $250,000 over the next two years to St. Croix County Health and Human Services Board Page 5 December 09, 2005 develop a managed care approach to long term care services. If we are able to implement LTC, it could possibly eliminate waiting lists. A Community Links application has been applied for which would be used to create a network developer position that would be responsible for improving the mix of services available to persons with long term cares needs and ensure the services purchased are cost effective. Also, Long Term Support proposes to implement a new Waiver Manual Alternative that allows counties to provide partially funded slots that can be limited by the county to a fixed per diem as long as health and safety needs are met. County- funded respite care recipients would be converted to partially funded waiver slots with the county dollars used as local match, thus the respite program could be expanded to serve more clients. 2006 MEETING SCHEDULE Discussed possible change of dates for Board meetings as the second Friday of the month conflicts with Fiscal Managers Meeting in Eau Claire and the third Friday conflicts with Directors Meetings in Eau Claire, which need to be attended by Johnson and Pempek. The meeting dates /times were set through April and will be revisited after the elections. FINANCIAL REPORTS Financial reports through October were distributed. It is projected the Nursing Home will close the year in the black with County levy. Pempek indicate Nursing Home Rate Appeals was less than budgeted. IGT monies are anticipated sometime in December but were budgeted for 2006. 2006 contracts are being developed and will contain wording stating vendors have 90 days after the first of the year for billing or a deadline of March 31" to submit billing. Pietrick and Pempek will work with the auditors to develop a policy regarding cut off dates for billing and payments and will bring to the Board. St, Croix County Health and Human Services Board Page 6 December 09, 2005 ST CROIX HEALTH CENTER OPERATIONS REPORT Est Yearend based on 10M."05 actuats ,IAN - OCT 2005 BUDGET ACTUAL DIFFERENCE % CENSUS 70 70 0 0 OPERATING REVENUE: MEDICARE $ 743,498.00 $ 620,443.28 $ 123,054.72 ° 0.8344922 MEDICAID $ 2,642,397.00 $ 2,185,446.15 $ 456,950.85 0.8270696 PRIVATE PAY " $ 817,926.00 $ 607,692.55 $ 210,233.45 0.7429676 RATE APPEALS - ACTUAL $ 17 ,652.00 $ 14 ,824.00 $ 2,828.00 0.8397915 IGT FUNDS - ACTUAL $ 450,000.00 $ 476,007.00 $ (26,007.00) 1.0577933 ALL OTHER SOURCES*? $ 9,464.00 35,258.09 $ (25,774.09) 3.7176392 ,TRANSFER FROM CONTINGENCY $ - $ 8,600.00 $ (8,600.00) TOTAL OPERATING REVENUE " $ 4,680,957.00 $ 3,948,271.07 $ 732,685.93 0.6434752 OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,411,487.50 $ 2,818,709.83 $ 592,777.67 0.8262407 SPECIAL SERVICES $ 1 266,510.42 $ 207,737.91 $ 58,772.51 0.7794739 GENERAL SERVICES _ _ $ 1,111,184.21 $ 783 ,648.01 $ 327 ,536.20 0.7052368 .ADMINISTRATIVE SERVICES $ 539,734.15 $ 516,203.25 $ 23,530.90:0.9564028 UNASSIGNED: DEPRECIATION( %BASED) $ - $ _ $ - OTHERS: (INS -WC- CAPITAL -UTIL) $ 255,835.00 $ 283,270.15 $ (27,435.15) 1.1072377 TOTAL OPERATING EXPENSE'S $ 5584,751.28 $ 4.609,569.15 $ 975,182.13 0.8253849 NET FROM OPERATIONS . $ $ �G1,298.01I� (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) OUTSTANDING REVENUES OUTSTANDING RATE APPEAL REV $ 2,828.00 % OF OUTSTANDING IGT REV $ - $ _ $ - 0 CO A" OCATIONS(%BASED) $ 1 ,017,504.00 $ 847,920.00 $ 169,584.00 0.8333333 TOTAL OUTSTANDING :$ 1,020,332.00 $ 847,920.00 $ 172,412.00 NET FROM ALL SOURCES _......._ $ 186,621.92 PERCENTAGE SHOULD BE 83.33% St. Croix County Health and Human Services Board Page 7 December 09, 2005 HEALTH AND HUMAN SERVICES - 2005 SUMMARY Total Average if OF REVENUES Budget Jan - October Balance % Administration 1,020,399.92 1,251,163.14 (230,763.22) 122.6% AODA Services 473,948.78 424,119.15 49,829.63 89.5% Long Term Support 17,299,811.93 14,902,887.21 2,396,924.72 86.1% Mental Health 3,006,239.35 2,127,126.67 879,112.68 70.8% Family& Children's 3,059,580.00 2,772,663.39 286,916.61 90.6% Public Health 1,471,999.17 1,274,961.38 197,037.79 86.6% Economic Support 927,622.06 841,656.88 85,965.18 90.7% General Relief 14,832.45 14,768.00 64.45 99.6% Coordinated Services /ED 380,509.80 380,509.80 0.00 100.0% REVENUES HUMAN SERVICES PROGRAMS 27.654.943.46 23.989.855.62 3,665.087.84 86.7% SUMMARY Total OF EXPENDITURES Budget Jan.- October Balance % Administration 1,020,399.92 785,996.88 234,403.04 77.0% Alcohol -Drug Abuse 473,948.78 436,917.09 37,031.69 92.2% Long Term Support 17,299,811.93 14,712,119.29 2,587,692.64 85.0% Mental Health 3,006,239.35 2,137,895.65 868,343.70 71.1% Family & Children's 3,059,580.00 2,564,560.30 495,019.70 83.8% Public Health 1,471,999.17 1,217,882.97 254,116.20 82.7% Economic Support 927,622.06 826,594.96 101,027.10 89.1% General Relief 14,832.45 1,084.82 13,747.63 7.3% Coordinated Service /SED 380,509.80 37,899.42 342,610.38 10.0% EXPENDITURES HUMAN SERVICES PROGRAMS 27,654,943.46 22,720,951.38 4,933,992.08 82.2% Excess Rev over Expenses S 1.268,904.24 Percentage of Budget: 83.33 NURSING HOME OPERATIONAL ASSESSMENT The 2005 Nursing Home budget was developed based on a census of 70.5. Census today is 67 with two possible admissions and one pending. Since the Operational Assessment presentation, staff has focused on implementation of unit restructuring and staffing recommendations for a 72 -bed facility. There have been all staff meetings, department head reviews, an additional session with the consultants, and clarification of the financial summaries. Staff generated questions to the consultants on the assessment. As a result, the powerpoint presentation scheduled for 12/13/05 for the County Board will be updated. Discussions will begin to develop a behavioral unit with Mental Health and Long Term Support. The objective will be to work together to develop a niche in St. Croix County which may include developmentally disabled as well as chronic mentally ill adults. Active treatment involves a lot of staff time and paperwork. Clinical information will be automated. Several reports regarding discharge instructions, discharge medication list, infection control, 24 -hour report information are near completion. There are more automated reports planned and Y St. Croix County Health and Human Services Board Page 8 December 09, 2005 this will be an ongoing process. Weekend coverage for housekeeping/ laundry begins December 18, 2005. Without adding a .4 FTE for every full time position to cover seven days a week, staff will need to work with one less on some days, which means there will be some gaps in coverage. The facility will be monitored to determine what duties will need to be changed to accommodate the resident areas. The greatest change will be nursing restructuring and managing staff to census. The most important first step for decentralization of nursing will involve training of nurses. The facility will move to a "point of service care delivery system." Scheduling nurses to become part of the service care delivery system will eliminate the need to schedule a doctor's nurse, MDS nurse, and a care planning nurse. Medicare changes will need to be addressed with the start of Medicare Part D. Good training is critical for revenue for coding the MDS. Most critical decisions regarding coding are done during the day shift. This will be implemented after staff are trained. The second step involves scheduling nursing staff at 950 of the average daily census as compared to consultant recommend 90 %. Each payroll period, the units of the Nursing Home will be reviewed for salary /fringe and the amount budgeted and spent to document implementation. Staffing will be based on a core staffing pattern of 95% or 68 residents. As census increases or decreases from 68, four nursing hours will be added or subtracted for each resident. The average resident census will be reviewed quarterly. The adjustment in estimated cost savings (moving from 90% to 95 %) was not available at the time of the Board meeting. During the discussion with the consultants on December 6 they thought the adjustment may be minimal but the fiscal analysis would need to be done by Wipfli financial staff. When this information is available, it will be forwarded to DHHS Board members. If the financial impact is significantly different, staff may need to adjust more quickly to implement a 90% average daily census core staffing. The last step for nursing will involve training CNAs to perform all rehab during their regular duties to eliminate the rehab aide. The unit assistant and ward clerk duties will also be analyzed to increase efficiency. All the changes listed above have a goal completion date of no later than April 1, 2006. The savings projected in the assessment did not account for monies needed for training or purchasing training videos. The recommendations in the study cannot be fully implemented by January 1, 2006, so the County cannot realize the whole amount of the savings indicated in the assessment. A Quality Assurance meeting was held with the doctors; as a result they will be presenting a petition to retain the doctor's nurse position. Personnel will be asked to take over hiring in the Nursing Home for interviewing and checking references, etc. The new resident meal plan is scheduled to be implemented in March and may impact Dietary staffing. It was the suggestion of the Board to try the changes outlined above for at least six months after implemented before doing anything more. Caflisch indicated the consultants indicated the Nursing Home will be back to the same point financially in two years as it is now. The Board questioned why St. Croix County Health and Human Services Board Page 9 December 09, 2005 changes weren't implemented after the last study. The assessment is on a tight timeframe. Members considered delaying the presentation to the County Board for a month. Malick recommended not delaying the presentation but members are able to table the assessment after the presentation. Malick said no one wants to delay savings that can be realized in the Nursing Home. Motion A motion was introduced by Caflisch, seconded by Rasmussen, and unanimously adopted: That the Board approves initiating phase one of the assessment to be done by 04/01/06 or sooner. Four months later the numbers will be evaluated and a decision made by August 30, 2006 as to the next phase and phase two will be brought to the full Board at a regularly scheduled meeting. FLEET VEHICLES The department has generally brought forward a recommendation to sell fleet vehicles about this time of year. Given the amounts the vehicles have previously sold for, it is recommended at this point not to sell the vehicles and move the purchase of new vehicles to later in 2006. Dorsey asked if there were any other issues to bring before the Board. Swenson announced the Finance Committee discussed cropland and barn leases. Finance is responsible for land, buildings and bonds. Requests for bids will be issued by Finance rather than the Health and Human Services Board for the farm land. The farm land contract expires in December 2006. The renewal leases will not exceed three years. Swenson left the meeting at 11:50 AM. DONATION ACCOUNTS A list of donation accounts was distributed to Board members. Johnson highlighted changes in accounts added and closed. Motion A motion was introduced by Wentz, seconded by Rasmussen, and unanimously adopted: That the meeting be adjourned. Time: 12:02 PM Chair: Attest: (Secretary)