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HomeMy WebLinkAboutHealth & Human Services 04-20-11 Rasmussen will review vouchers. Revised 04/12/2011 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: April 20, 2011 at 8:30 LOCATION.• (Board Room, St Croix County DHHS Building, 1445 N. Fourth Street, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 04/08/11 DATE OF NEXT MEETING – 05/18/11 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report c. Accounts Receivable write off recommendations d. Finance Director's report on monthly calendar cut off dates for expenses and revenues e. Review of revenue account consolidation f * *Fiscal transition planning 3. Nursing Home Administrator's Report 4. "Review of Committee of the Whole discussion on business plan for St. Croix Health Center 5. Personnel Issues a. New employees /vacancies b. * *Behavioral Health restructuring outreach and assessment services. 6. Health Center water heater replacement 7. Head Start lease ending—St. Croix Industries -Day Services move 8. Community Health Partnership rates for St. Croix Industries 9. 2011 State Health Rankings 10. Family and Children's caseworker contact report 11. State Budget Updates 12. * * Court Services for Parental Conflict Mediation 13. Possible agenda items for next meeting NOTE: A quorum of the St. Croix County Board of Supervisors (County Board) may be present at this meeting. Therefore, this notice also serves as notice of a meeting of the County Board for the purpose of obtaining information relating to subjects listed above for use at future County Board meetings. 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. 4/14/2011 6:15 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 20, 2011 The St. Croix County Health and Human Services Board met on April 20, 2011 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Frederick Horne Roger Larson Linda Luckey Richard Marzolf Deb Rasmussen Alfred Schrank MEMBERS ABSENT: Dr. Lisa Ramsay, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Frank Robinson, Nursing Home Administrator Wendy Kramer, Public Health Officer/Public Health Coordinator Kathy Dunlap, Family and Children's Coordinator Paul Wick, Behavioral Health Therapist Clark Schroeder, St. Croix Industries Director Kathy Huston, Adult Community Support Services Coordinator Malva Sirek, Clerical Supervisor OTHERS PRESENT: Michelle Pietrick, Finance Director Tammy Funk, Human Resource Coordinator Art Tobin, Building Services Director Kim Dupre, Information Systems Analyst Shaela Liebfried Norm Matzek Shirley Matzek Jeff Holmquist, New Richmond News Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, May 18, 2011 at 8:30 AM. Marzolf will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the agenda be approved as distributed. St. Croix County Health and Human Services Board Page 2 April 20, 2011 MINUTES Motion A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the minutes of the 04/08/11 Health and Human Services Board meetings be approved as distributed CONSIDERATION OF CLAIMS All check registers for March for funds 205, 225, 230, 600 and 625 were reviewed by Health and Human Services (HHS) Board member Rasmussen. All questions were answered satisfactorily. Motion A motion was introduced by Rasmussen, seconded by Schrank, and unanimously adopted: To approve the March vouchers. COURT SERVICES FOR PARENTAL CONFLICT MEDIATION A meeting took place with the four Judges, Fred Johnson, Ron Kiesler and Paul Wick regarding parental conflict mediation services which the agency has provided for the courts. This is a non - mandated service that is not covered by insurance, Medical Assistance or sliding fee. This meeting was an attempt to develop a policy to maximize the use of staff time and cover agency expenses. An assessment will be developed to determine who is appropriate for services. The assessment would be covered under insurance, Medical Assistance and sliding fee. When the assessment is completed, a report with the results will be prepared for the courts. If the client(s) are determined appropriate for services, parental conflict mediation can be provided by our agency, but clients can choose other options for this service as well. There are a lot of ancillary items associated with mediation such as letters, contact with guardian ad litem, and testifying in court. Cost for this would be covered by the upfront fee. The proposed cost schedule for mediation is as follows: • $500 upfront charge for ancillary services. This would need to be paid at the time of scheduling the appointment, is non - refundable, would be shared by the two parties and would cover case management, phone calls, etc. • $200 /hour fee which is split by the two parties. • $100 no -show fee in addition to the $200 /hour Parental Conflict Mediation fee • If there are three no- shows, the mediation would be cancelled, terminated and closed. Johnson said all services for Health and Human Services are being evaluated for mandated, essential and optional. Mediation falls outside the mandated portion but is part of the service delivery model that has assisted the courts with these cases. Johnson will get this information to the courts and if there are any concerns, the policy can be brought back for review. Motion A motion was introduced by Horne, seconded by Larson, and unanimously adopted: That the Board approves moving forward with the policy as outlined covering Parental Conflict Mediation. NURSING HOME ADMINISTRATORS REPORT Robinson said the average monthly census for March was 63, with 6 Medicare, 39 Medicaid, 15 private pay, 1 Family Care and 1 insurance resident. The Medicare average daily rate paid was $534.32 for March compared to the budgeted amount of $485.00. Robinson said it has been a year since the annual survey, which is done every nine to fifteen months. Staff are anticipating the annual survey anytime. St. Croix County Health and Human Services Board Page 3 April 20, 2011 Robinson reported the soup and salad bar has been a huge success with revenue exceeding expenses even with the initial start up costs. He expressed appreciation for the support of employees from the Nursing Home and Health and Human Services. REVIEW OF COMMITTEE OF THE WHOLE DISCUSSION ON BUSINESS PLAN FOR ST. CROIX HEALTH CENTER Johnson reported the Committee of the Whole met on April 14 He indicated he did not come out of the meeting with a definitive direction or plan for the St. Croix Health Center. Horne indicated it is up to the Health and Human Services (HHS) Board to come up with a plan and what route to take to get the Nursing Home off the levy and move forward. A 50 -bed nursing home and 48 -bed assisted living with some discussion with the union regarding concessions would get to a plan that would get the Nursing Home off the levy. The current Nursing Home building is not viable to get off the levy. The union would need to take a 16% reduction due to the inefficiencies of the current structure. Discussion was based on the 2013 projections. Luckey suggested first bringing down the levy before building a new building. If a new facility with assisted living were built, then the current Nursing Home building could house Health and Human Services. Rasmussen recommended looking at the market and other facilities going up in the area. Robinson reported if Act 10 goes into effect, it would mean a 5.8% reduction in expenses. There would be a $500,000 one time savings if the facility went to a one- level, 50 -bed facility, and the Nursing Home would receive a higher Medicaid reimbursement with a 50 -bed facility. An assisted living works right away as it is anticipated an assisted living would fill right away. If the assisted living is attached to a nursing home, then costs for dietary, maintenance, etc. can be shared. The target population for the assisted living would be for the lower end at approximately $2,500 per month range versus $6,000 per month range. Luckey questioned if a one year contract with the union would be negotiated so that they would have a target on them with each new contract. Horne said some concessions from the employees are needed to stay in business. Robinson said there are different regulations for assisted living facilities and nursing homes. If both were built, Robinson would manage both buildings. An assisted living is more successful with a nursing home attached. Robinson reminded the Board that the K -tag issue for the Nursing Home is still out there. Tobin indicated it may be possible to allocate bond monies for the K -tag issue to a new building versus putting $250,000 in the current Nursing Home. RESOLUTION REGARDING HEALTH CENTER BUSINESS PLAN The Board reviewed the resolution and discussed this as the first step with the potential for an additional resolution regarding the recommended business plan at the May meeting. Shaela Liebfried, Nursing Home Union President, was asked for an opinion if the Nursing Home union staff would be on board with the resolution. Liebfried recommended including non -union staff in the concessions, not just union staff. Motion A motion was introduced by Berenschot, seconded by Marzolf, and unanimously adopted: That the Board approves the following resolution: St. Croix County Health and Human Services Board Page 4 April 20, 2011 RESOLUTION REGARDING HEALTH CENTER BUSINESS PLAN Resolution No. St. Croix County, Wisconsin WHEREAS, the Health and Human Services Board is the established standing committee for the St. Croix County Health Center; and WHEREAS, the Health and Human Services Board has reviewed strategic plans and business plans for the future operation of the St. Croix County Health Center; and WHEREAS, the Health and Human Services Board reviewed updated business plan information at the April 8, 2011 meeting; and WHEREAS, the most recent business plan evaluated multiple scenarios for the future operation of the St. Croix County Health Center; and WHEREAS, all scenarios required County tax levy beyond the year 2015; and WHEREAS, LarsonAllen Accounting Firm has identified that average wage and fringe benefits paid at the St. Croix County Health Center are higher than other comparable governmental facilities. NOW, THEREFORE BE IT RESOLVED that the St. Croix County Board of Supervisors directs the Administration Committee to pursue negotiations pertaining to wages and fringe benefits with the Health Center employees' bargaining unit to enable the continued operation of the Health Center without County levy. Johnson will contact LarsonAllen to initiate an examined forecast. Effective May, 2011, all resolutions must include fiscal impact, Human Resource impact and legal impact. Larson requested a pro forma for a new building with 72 -bed Nursing Home and assisted living concept. HEALTH CENTER WATER HEATER REPLACEMENT Tobin reported there is an issue with the water heater in the Nursing Home. The water heater is no longer made, is no longer available and there is no retrofit to fix it. He has been working with engineers, who were on -site last week. This is original equipment and cost will be approximately $35,000 to $37,000. Tobin is investigating a hydronic system, energy efficiencies and going green as much as possible. He reported some asbestos abatement will be required, which will be done by a company out of Eau Claire. There is also some asbestos abatement work also to be completed at St. Croix Industries. The cost estimated for both is about $3,700. The asbestos removal company will test air quality before, during and after the removal. Tobin indicated the new water heater can be repurposed if a new nursing home and assisted living are built. He also indicated new sections can be added to the water heater according to demand for hot water. St. Croix County Health and Human Services Board Page 5 April 20, 2011 HEAD START LEASE ENDING —ST. CROIX INDUSTRIES -DAY SERVICES MOVE Johnson reported the Head Start lease ends June 30, 2011. Head Start will be moving to the old New Richmond Middle School building and it is planned that St. Croix Industries Day Services will move to the old Head Start area. Tobin is investigating removal of the Day Services building. Luckey questioned if there would be room for Day Services in the Nursing Home if Health and Human Services moved into the Nursing Home. Tobin indicated there are 63,000 square feet in the Nursing Home and 27,000 square feet of used space in the current HHS building so there would be room. Schroeder highlighted that there should be a buffer zone between Day Services clients and office space due to noise level. FAMILY AND CHILDRENS CASEWORKER CONTACT REPORT Dunlap reported Family and Children's are mandated to have face -to -face contact with every child in alternate care every month. St. Croix County Family and Children's has met this mandate at 100% in the last year. She reported St. Croix County has one placement in Milwaukee, one in Irma and one in Waupaca. She indicated the county can ask others to contact the alternate placement two months out of three in a quarter. Dunlap reported Child Protection assessments are supposed to be completed and approved by the supervisor within 60 days of first contact. St. Croix County is the only county in the Western Region that is 100% on all reports turned in and signed and 100% face -to -face contact. Dunlap said staff have done a great job in accomplishing mandates. Johnson indicated good, well trained staff has helped keep our placement rates low and resulted in positive outcomes noted. Dunlap said the Family and Children's staff do a tremendous job. ACCOUNTS RECEIVABLE WRITE OFF RECOMMENDATIONS Johnson's authority limit for writing off accounts is $10,000. Family and Children's has a child in out -of -home care. Child Support due for this placement is $22,000 with additional interest due of $22,500. The parent has been deemed disabled and received a settlement. Child Support is asking to settle for $22,000 and waiving the interest. Johnson recommended the settlement be accepted. Motion A motion was introduced by Marzolf, seconded by Schrank, and adopted with Berenschot voting no: That the Board accepts the settlement offered by Child Support for principle only of $22,000 and writing off $22,500 interest. The Board recessed from 9:50 -10:00 AM. Horne left the meeting. 2011 STATE HEALTH RANKINGS Kramer reviewed Wisconsin 2011 County Health Rankings. St Croix County ranks #2 in health outcomes and #9 in health factors. It is important to look at the details in the County Health Rankings. St. Croix County Community Health Improvement Process (CHIP) Steering Committee meets to assess needs and resources. Priorities addressed are tobacco use and exposure, overweight, obesity and lack of physical activity, access to primary and preventive health services, adequate and appropriate nutrition, and alcohol and other substance use and addiction. The Committee is working to find programs and policies that produce changes in health factors, which then impact health St. Croix County Health and Human Services Board Page 6 April 20, 2011 outcomes. The committee and Task Force Champions are meeting to review present objectives and actions plans and will begin the implementation phase this month. CHIP is working for improved health outcomes and health factors which are linked to the County Health Rankings. PERSONNEL ISSUES NEW EMPLOYEES/VACANCIES Johnson reported Norma Vrieze is retiring as Birth to 3 Director July 5, 2011. He is investigating filling the position as a service coordinator position with the Health Officer taking on program reporting and fiscal reporting moving to Finance. He reported billing may be paid by a third party administrator in the future. There has been discussion regarding Birth to 3 becoming a waiver program, but that is on hold now. Johnson indicated he hopes to have more information by mid -May to make a final decision on whether to fill the position as a service coordinator or to fill on a manager level. Johnson said the position needs to be filled. Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted: That the Board approves filling the Birth to 3 Director position as it is currently with the possibility to fill as a service coordinator if possible. Johnson also reported Jan Ray, Reproductive Health APNP, has announced her retirement in October, 2011. He will be looking at alternatives on how to provide this service. COMMUNITY HEALTH PARTNERSHIP RATES FOR ST. CROIX INDUSTRIES Schroeder reported St. Croix Industries anticipates an approximate reduction of $225,000 or more in revenue from Community Health Partnership (CHP). CUP is in severe financial crisis and the State has indicated they will no longer backfill their losses effective 06/30/2011. Reimbursement rates for the work center, community employment and day services have all been reduced. Schroeder indicated IRIS will remain the same and seems to be a fairly stable revenue stream. Schroeder is working with Heather Wolske to get authorizations and contracts established. Johnson reported Aurora has issued 21 discharge notices to clients. He reported before Family Care the daily rate was $159 /day and now it is $94 /day. There is only so much a provider can do to cut before they can no longer provide the service. Long term placements may be disrupted due to rate adjustments. There may be implications to Behavioral Health also in addition to impacting vocational outcomes. Schroeder indicated that an RFP has been issued for community based pre - vocation services. St. Croix Industries is reviewing the RFP to see if money can be made before a proposal would be submitted. This will be an ongoing agenda item. St. Croix County Health and Human Services Board Page 7 April 20, 2011 FINANCIAL REPORTS The following financial report for Health and Human Services through March, 2011 was distributed. Johnson reported the levy has been allocated in whole. He indicated there will be monthly CARS reports and monthly reconciliation on waivers when the position is refilled, but this has not been completed at this time. Health & Human Services - Fund 225 March 2011 Annual March Budget % of Revenue by Service Budget Actuals Balance Budget Administration $ 5,624,1 19 $ 5,125,803 $ 498,316 91.1% ACDA Services 696,880 147,387 549,493 21.1% Mental Health 2,561,597 177,181 2,384,416 6.9% Family & Children's 1,501,668 58,293 1,443,375 3.9% Public Health 1,127,707 69,839 1,057,868 6.2% Economic Support 814,943 90,171 724,772 11.1% General Relief - - - 0.0% Coordinated ServiceslSE❑ 3,644,207 49,538 3,594,669 1.4% Service Revenue $ 15,971,121 $ 5,718,212 $ 10,252,909 35.8% Annual March Budget % of Expenditure by Service Budget Actuals Balance Budget Administration $ 1,337,034 $ 262,181 $ 1,074,853 19.6% Alcohol-Druq Abuse 797,658 153,616 644,042 19.3% Mental Health 3,516,766 605,757 2,911,009 17.2% Family & Children's 3,039,817 525,314 2,514,503 17.3% Public Health 2,112,632 418,387 1,694,245 19.8% Economic Support 1,187,786 246,949 940,837 20.8% General Relief 1,500 500 1,000 33.3% Coordinated ServicelSE❑ 3,977,928 496,879 3,481,049 12.5% Service Expenditures $ 15,971,121 $ 2,709,584 $ 13,261,537 17.0% Revenues Over fUnder) Expenditures $ 3,008,628 1 — —+ Expected Percent of Bud et 25.0% St. Croix County Health and Human Services Board Page 8 April 20, 2011 The following financial report for St. Croix Industries through March, 2011 was distributed. Projected revenues and accounts in billing will be shown on the report in the future. Schroeder reported there was $508,000 on the receivable report as of March 31, 2011. St. Croix Industries - Fund 625 March 2071 Annual March Budget % of Revenues Budget Actuals Balance Budget WS Operations $ 1,496,000 $ 240,260 $ 1,255,740 16.1% WS Production 321,482 1 1 1,507 209,975 34.7% WS Helpinq Hands 116,700 41,034 75,656 35.2% WS PopNendinq 10,500 2,633 7,367 25.1% WS Vocational Placement 362,500 59,395 303,105 16.4% WS Comm Based Day Prog 108,000 14,982 93,018 13.9% Total Revenue $ 2,415,182 $ 469,811 $ 1,945,371 19.5% Annual March Budget % of Expenditures Budget Actuals Balance Budget WS Operations $ 1,407,854 $ 247,772 $ 1,160,082 17.6% WS Production 324,778 98,799 225,979 30.4% WS Helpinq Hands 86,250 23,773 62,477 27.6% WS Popf\/endinq 10,500 802 9,698 7.6% WS Vocational Placement 421,630 69,027 352,603 16.4% WS Comm Based Day Proq 167,170 29,755 137,415 17.8% Total Expenditures $ 2,418,182 $ 469,927 $ 1,948,255 19.4% Revenues Over (Under) Expenditures $ 1 16 Exp ected Percent of Budg 25.0% St. Croix County Health and Human Services Board Page 9 April 20, 2011 The following financial report for the Nursing Home through March, 2011 was distributed. The Nursing Home very seldom has write offs. The Nursing Home has a history of what is billed is what we get. No workefs compensation is reported on the following report and it is not sure when that will be completed due to staffing changes. St. Croix Health Center - Fund 600 March 2011 Operating Revenue: Budget Actuals Difference of Budget Medicare $ 1,546,150 $ 561 $ 1,645,589 0.0% Medicaid 2,178,532 - 2,178,532 0.0% Private Pay 1,548,651 1,548,651 0.0% Revenue - GT/Supplernental Funds 463,416 217,150 246,266 46.9% Out Patient Therapy 20,000 20,000 0.0% All Other Sources 18,500 1,498 17,002 8.1% Cafe Revenue 2,118 2,118 0.0% Total Operating Revenue $ 5,875,249 $ 221,327 $ 5,653,922 3.8% Operating Expenses Dail Patient Services $ 3,887,323 $ 799,943 $ 3,087,380 20.6% Special Services 277,387 59,346 218,041 214% General Services 1,259,760 238,265 1,021,495 18.9% Administrative Services 590,335 114,241 576,094 16.5% Cafe Expenses $0.00 1,256 1,256 0.0% Sub Total $ 6,114,805 $ 1,213,050 $ 4,901,755 19.8% Unassigned: De reciation % Based Others: Utilities $ 169,751 $ 26,273 $ 143,488 15.5% Workers Comp, Computer Tech 160,065 1,417 158,648 0.9% Insurance 55,000 19,465 35,535 354% Unassigned Sub Total $ 364,826 $ 47,155 $ 337,671 12.3% Total Operating Expenses 1 $ 6,499,631 $ 1,260,205 $ 5,239,426 19.4% Revenues Over Under Expenditures) from Operations $ ( 1,038,678) County Revenues Insurance ❑ividend - unexpected revenue not result of Operations $ 9,000 $ - $ 9,000 0.0% Co Allocations - Le % Based 369,019 359,019 $ 100.0% Nursinq Home Carry Over 246,363 246,363 - 100.0% Total Outstanding $ 624,382 $ 615,382 $ 9,000 98.56% Revenues Over (Under) Expenditures Including County Contributions $ ( 423,496] Expected Percent of Budget 25.0% FINANCE DIRECTORS REPORT ON MONTHLY CALENDAR CUT OFF DATES FOR EXPENSES AND REVENUES A calendar of cut off dates for revenue and expense posting was distributed. This calendar formalizes what has been standard practice. This schedule will assist with monthly financial reporting being consistent. The calendar will be updated. AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through February was briefly reviewed. Write offs are now being done when accounts are sent to collections rather than all being done at year end. REVIEW OF REVENUE ACCOUNT CONSOLIDATION Accounts are being retitled and consolidated. Pietrick is reviewing the current account structure and will change the structure and St. Croix County Health and Human Services Board Page 10 April 20, 2011 break downs to charge for services. This change in account numbers will be made to ensure coding is in the correct fund. At this point, input from the program side, in consultation with the auditors on revenue streams, is complete and adjustments in the accounting structure will need to be completed by finance. State, Federal, etc. monies will be identified more efficiently in future reports to auditors. FISCAL TRANSITION PLANNING Kusmirel's last day is April 22 and efforts are moving forward to fill this position. Johnson reported there is work being done with current financial staff and some additional cross training will be done to backfill the workload. Kusmirek may come back on a contracted basis. The position was approved by the Administration Committee as an Assistant Finance Director. The position will be presented to the County Board on May 3 As indicated previously, the chart of accounts is being studied to either consolidate or expand to match with reporting from the state. This needs to be completed by the end June, 2011 so staff can work with the new account structure for 2012. Fiscal staff will focus on things that will get the agency set for the 2012 budget while still working on what still needs to be done for 2011. BEHAVIORAL HEALTH RESTRUCTURING OUTREACH AND ASSESSMENT SERVICES There is one vacancy in Adult Community Support Services (ACSS), which was an employment agreement, and the request is being made to fill this position. A request is also being made to move a Social Worker providing ACSS team model of treatment to a Clinical Social Worker that supports the program by performing clinical assessment necessary to admit chronically mentally ill persons into the Community Support Program (CSP). Huston presented a model to restructure Adult Community Support Services. With the move to mobile crisis /diversion there has been an increased need for follow up and long -term services to keep clients in the community and out of the hospital. Currently approximately one -third of the outreach contacts are converted to CSP admissions. Only a Master's Degree Social Worker can admit clients to CSP, where clients would best be served. There was previously a Clinical Social Worker in the organizational chart. The employee filling the employee agreement would take over the caseload of the employee filling the Clinical Social Worker position. The move is anticipated to be budget neutral as both positions are revenue generating. Diversion needs more social work staff to do outreach, to ensure seamless transition from outreach to clinical assessment and program admission. A job description will be presented to Charlie Carlson in May. Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously adopted: That Board approves sending to Administration Committee and then to County Board to approve filling the employee agreement social worker position up to forty hours a week and moving a current Level 7 Social Worker providing ACSS team model of treatment to a Level 8 Clinical Social Worker that supports the program by performing clinical assessment necessary to admit chronically mentally ill persons into the Community Support Program (CSP). STATE BUDGET UPDATES Johnson distributed information from Wisconsin Counties Association (WCA) regarding Family Care, Income Maintenance Centralization, Juvenile Corrections, and Child Support. He also distributed St. Croix County budget summary which estimates some of the budget impact implications due to changes. Johnson indicated there are still St. Croix County Health and Human Services Board Page 11 April 20, 2011 $500,000,000 in Medicaid cuts but it has not been specified where these cuts will occur but could impact the Nursing Home, Behavioral Health, etc. Johnson highlighted some areas where the County could be impacted by these changes. If there is no retroactive eligibility, costs in some circumstances could fall back on the County. Clients who are protectively placed and cannot get Medical Assistance coverage will fall back on the County. If a cap is put on Family Care and clients cannot be put on a wait list due to health and safety issues, some costs are expected to fall back on the County. With consolidation of juvenile corrections to Lincoln Hills, per diem will increase along with an expected reduction in allocation. POSSIBLE AGENDA ITEMS FOR NEXT MEETING • Community Health Partnership rates for St. Croix Industries Wentz asked if there were any other issues to bring before the Board. Johnson reiterated that the Nursing Home had County levy of $1.3 million in 2005 which was reduced to approximately $600,000 in 2011. He said staff in the Nursing Home has done a lot of good work to reduce the levy. Wentz adjourned the meeting. Time: 12:37 PM Chair: Attest: (Secretary)