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HomeMy WebLinkAboutHealth & Human Services 06-11-04 ESTHER WENTZ WILL REVIEW VOUCHERS AT 8:00 AM REVISED: 06/09/04 ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Clarence Malick, Chairman St. Croix County Board FROM: Tom Dorsey (John Borup, 246 -8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 06/11/04 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: 07/09/04 (06/24/04 TENTATIVE) ACTION ON PREVIOUS MINUTES: 05/27/04 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Health and Human Services Governing Body By -laws update NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Discussion of Sale of Tobacco to Minors - District Attorney Eric Johnson 4. Program Reports a. Mental Health /AODA Emergency Detention Report- Sheriff Dennis Hillstead b. Long Term Support C. Family & Children's /Termination of Parental Rights Legal Services d. Nursing Home 5. Collection Policy Update 6. Personnel Issues 7. Capital Outlay Plan 8. Red Cross request to designate St. Croix Industries for emergency /mass care facility. ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: John M. Borup DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA /NOTICE ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD June 11, 2004 The St. Croix County Health and Human Services Board met on June 11, 2004 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Thomas Caflisch Dr. Michael Kretz Stan Krueger Linda Luckey Deb Rasmussen Esther Wentz MEMBERS ABSENT: Ralph Swenson, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Judy Ziegler, Accounting Supervisor Carolyn L. Krieger, Nursing Home Administrator Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Ron Lockwood, Long Term Support Supervisor Geralyn Karl, Health Educator Barbara Nelson, Public Health Supervisor- Health Officer Deb Lindemann, PHN Fred Johnson, Family and Children's Supervisor Kathy Dunlap, Family and Children's Supervisor Becky Ruka, Accounts Receivable Supervisor Malva Berg, Secretary OTHERS PRESENT: Greg Timmerman, Corporation Counsel Eric Johnson, District Attorney Dennis Hillstead, Sheriff 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 July 9, 2004 at 8:30 AM. Burri will review vouchers at the July meeting. AGENDA Motion A motion was introduced by Wentz, seconded by Krueger, 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 05/27/04 Health and Human Services Board meeting and Open Budget Hearing be approved as circulated. ANNOUNCEMENTS The Family Support Birth to Three Advisory Committee is made up of family of consumers and family members and is required by statute. Chair Dorsey reappointed Wentz and Deb Willink to the committee for a two -year period. CONSIDERATION OF CLAIMS The following reports were distributed to the Board: May unemployment report, May fixed asset report, May cash report and April financial reports St. Croix County Health and Human Services Board Page 2 June 11, 2004 Health and Human Services Board member, Wentz, reviewed the vouchers; the following vouchers were pulled for discussion: NURSING HOME: 24041: Ayres and Associates, $1,250.71. Construction work in process. Partial payment on remodeling contract. Motion A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 22841 through 22935, dated May 20, 2004 in the amount of $212,503.13. Human Services vouchers 22936 through 22937, dated May 20, 2004 in the amount of $11,309.10. Human Services vouchers 22959 through 23079, dated May 27, 2004 in the amount of $283,105.53. Human Services vouchers 23207 through 23211, dated May 27, 2004 in the amount of $14,463.68. Human Services vouchers 23218 through 23281, dated June 03, 2004 in the amount of $130,433.22. Human Services vouchers 23885 through 24039, dated June 11, 2004 in the amount of $113,242.63. Human Services vouchers 24120 through 24206, dated June 11, 2004 in the amount of $174,628.03. Human Services vouchers 24207 through 24322, dated June 11, 2004 in the amount of $66,598.91. Human Services vouchers 24097 through 24119, dated June 11, 2004 in the amount of $43,998.71. Nursing Home vouchers 22829 through 22840, dated May 20, 2004 in the amount of $6,950.89. Nursing Home vouchers 22946 through 22958, dated May 27, 2004 in the amount of $8,111.82. Nursing Home vouchers 24040 through 24096, dated June 11, 2004 in the amount of $47,791.61. Human Services, Workshop, Public Health, Social Services vouchers 282 through 311, dated May 18, 2004 in the amount of $347,691.81. Human Services, Workshop, Public Health, Social Services vouchers 312 through 342, dated June 01, 2004 in the amount of $345,992.91. Human Services and Nursing Home vouchers 298 through 329, dated May 18, 2004 in the amount of $169,245.36. St. Croix County Health and Human Services Board Page 3 June 11, 2004 Human Services and Nursing Home vouchers 330 through 361, dated June 03, 2004 in the amount of $174,194.96. The following financial reports for April were distributed to the Board. Ziegler said the contract settlement for the union contract has impacted balances. The Medicaid /Medicare /Private Pay mix for the Nursing Home was planned but did not meet expectations. The Medicaid percentage was up and Medicare percentage was down. The Nursing Home budgeted 3% for the union contract and employees received 4 %. Borup emphasized the difficulty in predicting these revenues with downsizing. Ziegler said the financial reports reflect some revision in the numbers for the reports per Swenson's request to reflect accruing of the figures to get a more accurate picture of balances. Krueger asked for a breakout of the 1% difference in settling the contract compared to what was budgeted. ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/04 THROUGH 04/30/04 NURSING HOME Ist Ouarter, Anril 2004 Cash Balance 04/30/04 $1,716,874.19 $1,459,897.89 Add: Accounts Receivable 04/30/04 $269,019.58 $348,147.86 Account Payable 04/30/04 ($346,459.08) ($304,528.39) Net Current Items 04/30/04 $1,639,434.69 $1,503,517.36 2004 Revenue Recorded through 04/30/04 $1,413,407.99 $1,850,990.83 Includes Allocations of Anticipated Revenues 2004 Expenses Recorded through 04/30/04 $1,401,909.74 $1,875,666.49 Includes Allocations of Expected Expenses Excess Revenues over Expenses $11,498.25 ($24,675.66) St. Croix County Health and Human Services Board Page 4 June 11, 2004 HEALTH AND HUMAN SERVICES 2004 SUMMARY Total OF REVENUES Jan.- April Budget Balance % Administration 296,164.33 873,534.97 577,370.64 33.9% AODA Services 173,580.19 469,152.15 295,571.96 37.0% Long Term Support 5,362,102.96 14,616,574.52 9,254,471.56 36.7% Mental Health 841,104.57 2,745,667.40 1,904,562.83 30.6% Family & Children's 914,142.00 2,844,524.50 1,930,382.50 32.1% Public Health 511,464.05 1,420,079.06 908,615.01 36.0% Economic Support 329,890.77 957,504.85 627,614.08 34.5% General Relief 4,263.24 19,212.68 14,949.44 22.2% REVENUES HUMAN SERVICES PROGRAMS S 4,32.712.11 24.946 2gn 1 JS S13 538 0 2 35_2% SUMMARY Total OF EXPENDITURES Jan.- April Budget Balance % Administration 301,266.28 873,534.97 572,268.69 34.5% Alcohol -Drug Abuse 155,608.33 469,152.15 313,543.82 33.2% Long Term Support 5,123,308.15 * 14,616,574.52 9,493,266.37 35.1% Mental Health 842,294.92 2,745,667.40 1,903,372.48 30.7% Family & Children's 945,536.80 * 2,844,524.50 1,898,987.70 33.2% Public Health 453,606.17 1,420,079.06 966,472.89 31.9% Economic Support 307,693.18 957,504.85 649,811.67 32.1% General Relief 8,327.84 19,212.68 10,884.84 43.3% EXPENDITURES HUMAN SERVICES PROGRAMS 8,137,641.67 23,946,250.13 15,808,608.46 34.0% Excess Rev over Expenses 295.070.44 To be on budget, percentage should be 33.33. St. Croix County Health and Human Services Board Page 5 June 11, 2004 ST CROIX HEALTH CENTER OPERATIONS REPORT JANUARY THROUGH APRIL JAN -APRIL 2004 BUDGET ACTUAL DIFFERENCE % CENSUS 70.5 70.5 0 100 OPERATING REVENUE: MEDICARE $ 1,226,972.00 $ 276,377.86 $ 950,594.14 22.5 % MEDICAID $ 2,135,804.00 $ 874,421.77 $ 1,261,382.23 40.9% PRIVATE PAY $ 1,074,462.00 $ 217,857.38 $ 856,604.62 20.3% ALL OTHER SOURCES $ 6,706.00 $ 16,618.47 $ (10,112.47) 250.8% TOTAL OPERATING REVENUE $ 4,443,944.00 $ 1,385,475.48 $ 3,058,468.52 31.2% OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,607,389.85 $ 1,131,414.02 $ 2,475,975.83 31.4% SPECIAL SERVICES $ 267,452.94 $ 86,710.03 $ 180,742.91 32.4% GENERAL SERVICES $ 1,173,975.87 $ 346,717.92 $ 827,257.95 29.5% ADMINISTRATIVE SERVICES $ 501,036.96 $ 157,022.49 $ 344,014.47 31.3% UNASSIGNED: DEPRECIATION( %BASED) $ 178,000.00. $ 59,332.00 $ 118,668.00 33.3% OTHERS $ 302 ,423.05 $ 94 ,470.03 $ 207 ,953.02 31.2% TOTAL OPERATING EXPENSES $ 6,030,278.67 $ 1,875,666.49 $ 4,154,612.18 31.1% NET FROM OPERATIONS $ (490,191.01) NON - OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 17,650.00 $ 5,884.00 $ 11,766.00 33.3% IGT FUNDS ( %BASED) $ 564,705. 00 $ 188,236.00 $ 376,469.00 33.3% CO ALLOCATIONS( %BASED) $ 815,480.00 $ 271,395.35 $ 544,084.65 33.3% TOTAL NON - OPERATING ITEMS $ 1,397,835.00 $ 465,515.35 $ 932,319.65 33.3% NET FROM ALL SOURCES $ (24,675.66) PERCENTAGE SHOULD BE 33.33 FUND BALANCE 01/01/04 $ 1,911,092.35 OPERATIONS $ (24,675.66) FUND BALANCE END OF PERIOD $ 1,886,416.69 HEALTH AND HUMAN SERVICES GOVERNING BODY BYLAWS Timmerman briefly outlined some of the changes made in the Bylaws. They now reflect that Board of Supervisors must approve appointments made by the County Board Chair, which was not included in the Bylaws previously. Motion A motion was introduced by Kretz, seconded by Krueger and unanimously adopted: That the Health and Human Services Board approved adding to the Governing Body Bylaws that appointments made to the Health and Human Services Board by the County Board Chair be approved by the full County Board of Supervisors. Motion A motion was introduced by Kretz, seconded by Burri and unanimously adopted: That the Health and Human Services Board organize after the first meeting following confirmation of appointments to the Health and Human Services Board by the full County Board. St. Croix County Health and Human Services Board Page 6 June 11, 2004 Motion A motion was introduced by Krueger, seconded by Wentz, and unanimously adopted: That the Board approves removing the wording regarding limits on spending for fuel oil, supplies, and food for the Director and that the Director is not limited in purchasing supplies. Motion A motion was introduced by Krueger, seconded by Kretz, and unanimously adopted: That the Board approves the revision to Section B, number two, that the Director may call the Board Chair for authorization to make purchases over $2,000 for necessary equipment repair. Motion A motion was introduced by Burri, seconded by Wentz, and unanimously adopted: That the Board approves the total document for the Governing Body Bylaws as amended. DISCUSSION OF SALE OF TOBACCO TO MINORS The law prohibiting the sale of cigarettes to minors under the age of 18 is 134.66. Counties and local municipalities can adopt the ordinance and several municipalities are in the process of doing that now, but we do not have a county ordinance. Compliance checks are done by the Pierce /St. Croix Tobacco Free Coalition with the cooperation of law enforcement. Law enforcement determine if the law was broken in order to issue a citation. The law is in place but resources are at issue. There are priority issues for available manpower to enforce the law /issue citations. Hillstead mentioned the current meth epidemic in the County. A County ordinance would be helpful to keep consistency. If a County ordinance was in place, a call could be made to law enforcement to issue the citation, which would have less paperwork and make it easier on County law enforcement. Passing of a County ordinance would have to go through Public Protection. Another benefit of having a County ordinance is the penalty dollars would go to the County rather than the State. This law is tied to a Federal Amendment that if the County is not at least 80% compliant on tobacco checks, the County stands to lose a considerable amount of money for AODA and other county dollars. Motion A motion was introduced by Wentz, seconded by Krueger, and unanimously adopted: That the Health and Human Services Board recommends that Corporation Counsel work with Public Protection to draft a County ordinance to prevent the sale of tobacco to minors and the ordinance then be presented to the full County Board. FAMILY AND CHILREN'S /TERMINATION OF PARENTAL RIGHTS LEGAL SERVICES Currently Federal Funds (Title IV -E) are being used to purchase legal services through Miller and Miller for termination of parental rights (TPR). There are current discussions with the District Attorney's office to shift the use of these funds to increase legal time available to cover child welfare cases (including TPR cases) to the District Attorney's office. TPR legal services are specialized and intensive and the legal services have been contracted with Miller and Miller the last few years. Their contract is in place through the end of 2004. TPR is time intensive and continuity is important. Johnson said in November, 2003 the Governor's office cut the staff in the District Attorney's office from five to 3.7 staff. He has had to prioritize cases and explore alternate areas of funding. Staff are continuing to investigate this concept and will report back to the Board with details at a later date. MENTAL HEALTH /AODA EMERGENCY DETENTION REPORT Emergency Detentions have gone from 146 to 340 /year Countywide in the last four years for the Sheriff's department only. Hillstead said when a call comes into dispatch four items flag an immediate response: if the person has an inability to care for self, if the r e. St. Croix County Health and Human Services Board Page 7 June 11, 2004 individual will cause harm to another person, a welfare check, or if the person will cause harm to self (suicidal). Law enforcement will error on the side of caution. Kiesler said the meth problem is affecting the number of emotionally disturbed clients. Kirt added that chemically induced psychosis is hard to determine if it is from a delusional disorder or from drugs. He said there are a lot of new, young people entering the system. Transportation costs have increased and put further strain on law enforcement. Kiesler distributed the revised flow chart for a client entering services. He said the diversion concept brought to the Board is not working out because of lack of APNP availability. Alternate options are being explored to implement and will report back to the Board next month. The contracted services expense sheet for mental health and AODA services was distributed. Kiesler said Emergency detentions increased in May but the total for the year is down from last year at this time. He stated it appears more of the admissions have insurance compared to last year. The primary concern, as it affects the 2004 budget, is the client who is committed to St. Croix County and initially placed at Winnebago Mental Health Institute. We have recently coordinated his transfer to Trempealeau County IMD were the bed rate is one -third the cost of Winnebago. We are monitoring this situation closely, and plan to continue monthly updates on our contract costs. The Board recessed from 10:30 to 10:35 AM. The new MA Home and Community Based Waiver Programs For Children started January 1, 2004. Currently 17 children with autism are being served under the DD Children's Waiver with the state providing the local match. Staff are unable to implement the Physically Disabled Children's Waiver as there is no county money to match the federal monies. The Severely Emotionally Disturbed (SED) waiver in the Family and Children's Unit allows capture of partial Federal funding (60 %) for care of SED juveniles up to age 18. Long Term Support administers and interfaces with the State regarding these SED Waiver services while the case management and foster care purchasing is provided by the Family and Children Services Unit and /or the Community Support Program. The county is able to control the application process and keep it restrictive. Service is limited to those individuals for whom the county already provides foster care or treatment foster care. New MA Waiver guidelines allow the county to set limits /guidelines for services for the developmental disability population. Lockwood said no one has moved off the DD Waiver waiting list for four and a half years. LTS staff is considering controlling the DD Waiver costs for people currently on the program or possible reduction in services to try to serve clients on the waiting list without changing the outcomes for current clients. The persons on the program must continue to have their health and safety needs met. Lockwood is concerned about uncertain State revenues and is working with staff to balance cost containment with revenues. These efforts to control costs may result in service reduction to current clients and may help move people off the waiting list. Service cuts may bring complaints from client or families but would not result in any harm to clients. Lockwood and Borup met with the Long Term Support planning committee to discuss budget issues and possible service cuts. Borup's expectations of staff are to keep a balanced budget. NURSING HOME The census today is 70. Krieger said year -to -date there have been 53 referrals with 22 admissions. The remodeling is going well with anticipated completion by mid -July. The company is currently waiting for HVAC materials. Contact has been made with the State inspector. Wentz said this is a wonderful construction company; they are very conscientious. The project had $262,000 authorized and we are currently under budget at $210,000. St. Croix County Health and Human Services Board Page 8 June 11, 2004 COLLECTION POLICY UPDATE Revisions in the collections policies are being requested to try to capture monies we haven't been getting but could. Ruka outlined proposed policy updates. Motion A motion was introduced by Caflisch, seconded by Krueger, and unanimously adopted: That the Board approves the collection policy updates as follows: COMMUNITY SUPPORT PROGRAM (CSP) - Community Support Program services for clients with no insurance will be liable for services or clients private insurance will be liable for deductibles, coinsurances, co- payments. In both cases the client responsibility will not exceed $1,000 per calendar year. CSP CLIENTS COVERED BY BADGERCARE - BadgerCare (Managed Care Medicaid) does not cover CSP services. However, WWMA has terminated their contract with HMO MA so clients covered under HMO MA will be under standard MA services. while most clients fall within the WWMA zip codes those that do not will be asked to apply for an exemption. If the client does not wish to apply for the exemption, the Department will offer to cover the costs of their co- payments. Should they still not wish to apply for the exemption they will be treated as clients with no insurance. COURT ORDERED ANGER MANAGEMENT EVALUATIONS - Wisconsin Administrative Code allows for court ordered evaluations to be billed at full cost of care with any subsequent care (on -going therapy) being subject to the maximum monthly payment schedule. Currently these evaluations are subject to the maximum monthly payment schedule. Clients in need of court ordered AODA evaluation services are required to pay the cost of the service before the evaluation is completed with any on -going treatment being billed either to the client's insurance with the client responsible for the balance or the uninsured clients are placed on the maximum monthly payment schedule. INTOXICATED DRIVERS PROGRAM (IDP) - Wisconsin Statue 46.03(18f) allows clients to make up to four payments for their assessment. When clients are allowed to make payments on their assessment they run the risk of becoming non - compliant with the Department of Transportation. SCCDHHS has no control over this process. If the client takes more than two months to pay their assessment cost typically they are placed in non - compliance by the DOT. Clients need to pay within two months or risk being placed in non - compliance by the Department of Transportation. Changes need to be made to the no -show policy for IDP assessments to be comparable to the Court Ordered AODA assessments. Clarification needs to be made to the refund policy for both the IDP assessment and Court Ordered AODA assessment so as to better define when a refund is given and when it isn't. RETAINERS FOR CUSTODY /EXSPOUSAL THERAPY SERVICES - Therapists providing these services spend significant amounts of time in reporting to collateral sources both verbally and in writing. This fee would help to offset the costs associated with these services. LETTERS TO ATTORNEYS - This is generally a one -time request. Attorneys will ask for updates on the client's progress or recommendations regarding the client's situation. A fee to charge to the client or attorney (depending on the situation) for these services will be implemented. TAX INTERCEPTS - This is being researched further in conjunction with Corporation Counsel to determine if this is a means by which outstanding balances may be collected. St. Croix County Health and Human Services Board Page 9 June 11, 2004 CAPITAL OUTLAY PLAN Borup said tubs for the Nursing Home have been added to the 2006 budget. Also carpeting has been added to the 2005 building services capital outlay plan for Human Services and the Nursing Home. Motion A motion was introduced by Kretz, seconded by Caflisch, and unanimously adopted: That the Board approves the Nursing Home Capital Outlay Plan and the addition of carpet in the amount $6,500 for Human Services and $1,000 for the Nursing Home for the Building Services Capital Outlay Plan for 2005. RED CROSS REQUEST TO DESIGNATE ST. CROIX INDUSTRIES FOR EMERGENCY /MASS CARE FACILITY The American Red Cross has requested to designate St. Croix Industries as an emergency /mass care facility. Motion A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the Board approves the American Red Cross request to designate St. Croix Industries as an emergency /mass care facility. Dorsey asked if there were any other issues to bring before the Board. Kretz gave a brief presentation on the Governor's effort for Kid's First and requested feedback from Board members on this effort. Krueger asked to be excused from the next meeting. Motion A motion was introduced by Wentz, seconded by Dorsey, and unanimously adopted: that the meeting be adjourned. Time: 11:40 AM Chair: Attest: (Secretary)