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HomeMy WebLinkAboutHealth & Human Services 07-09-04 i 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 (John Borup, 246 -8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 07/09/04 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: 08/13/04 (07/22/04 TENTATIVE) ACTION ON PREVIOUS MINUTES: 06/11/04 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Request to develop electronic receipting per request of Tracy and Thole 4. Program Reports a. Public Health b. Long Term Support cost containment plans C. Nursing Home S. Mental Health /AODA Inpatient cost containment strategies 6. Review of Department fund balance 7. 2003 Wisconsin Act 318 - Impact on Community Aids Program Funding 8. 2005 budget planning 9. Personnel Issues 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 CLERIC NEWS MEDIA /NOTICE s ' ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 09, 2004 The St. Croix County Health and Human Services Board met on July 09, 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 Linda Luckey Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Stan Krueger, 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 Barbara Nelson, Public Health Supervisor- Health Officer Becky Ruka, Accounts Receivable Supervisor Mary Squyer, Economic Support Supervisor Kim Dupre, Computer Services Malva Berg, Secretary OTHERS PRESENT: Michelle Pietrick, Finance Director Buck Malick, County Board Chair 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 August 13, 2004 at 8:30 AM. Swenson will review vouchers at the July meeting. AGENDA Motion A motion was introduced by Wentz, seconded by Swenson, 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 06/11/04 Health and Human Services Board meeting be approved as circulated. CONSIDERATION OF CLAIMS The following reports were distributed to the Board: June fixed asset report, June cash report and May financial reports. Ziegler said the land rent has not been received from Schottler. There is no County revenue in the General Relief program as the program is not mandated. Funds are given based on the previous year's expenses. It was suggested that intake to the program be closed until the end of the year with emergencies being shared with the Board chair due to depleted funds. Kretz indicated if the County wants to keep the program, the program should be funded. If the program is not funded, it should be closed. Health and Human Services Board member, Burri, reviewed the vouchers; the following voucher was pulled for discussion: ' St. Croix County Health and Human Services Board Page 2 July 09, 2004 HUMAN SERVICES: 25006: Special Children's Center, $78.00. Brain injury purchased services. The Special Children's Center provides various therapists who work with clients in Early Intervention, Autism and Waiver Program. Motion A motion was introduced by Burri, seconded by Wentz, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 24559 through 24565, dated June 17, 2004 in the amount of $34,869.10. Human Services vouchers 24905 through 25066, dated June 17, 2004 in the amount of $167,186.33. Human Services vouchers 25214 through 25263 dated June 24, 2004 in the amount of $270,850.57. Human Services vouchers 25402 through 25502, dated July 01, 2004 in the amount of $72,556.63. Human Services voucher 26209, dated July 08, 2004 in the amount of $661.00. Human Services vouchers 25864 through 26013, dated July 08, 2004 in the amount of $133,593.88. Human Services vouchers 26014 through 26208, dated July 08, 2004 in the amount of $79,915.15. Human Services vouchers 26210 through 26234, dated July 08, 2004 in the amount of $44,779.12. Nursing Home vouchers 24566 through 24585, dated June 17, 2004 in the amount of $49,564.82. Nursing Home vouchers 25393 through 25401, dated July 01, 2004 in the amount of $6,311.02. Nursing Home vouchers 25510 through 25562, dated July 08, 2004 in the amount of $44,779.12. Human Services, Workshop, Public Health, Social Services vouchers 343 through 372, dated June 15, 2004 in the amount of $345,431.24. Human Services, Workshop, Public Health, Social Services vouchers 373 through 402, dated July 01, 2004 in the amount of $350,053.42. Human Services and Nursing Home vouchers 362 through 393, dated June 15, 2004 in the amount of $176,553.39. Human Services and Nursing Home vouchers 394 through 424, dated July 01, 2004 in the amount of $176,118.08. FINANCIAL REPORTS The following financial reports through May were distributed to the Board. Ziegler said IGT monies for the Nursing Home come in on a fiscal year basis and we operate on a calendar year basis. Medicare placements were less than budgeted for. New Nursing Home rates due to downsizing should be received in September. Borup said collections are behind St. Croix County Health and Human Services Board Page 3 July 09, 2004 due to HIPAA issues and software issues delayed billing. Ruka said insurance electronic submissions are now being sent on paper to the insurance companies until the software is up. Ruka said we are seeing a decrease in clients with insurance and there are more restrictions on insurance payments, which results in less money for the County. ST. CROIS COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/04 THROUGH 05/31/04 NURSING HOME May. 2004 Cash Balance 05/31/04 $1,307,947.72 Add: Accounts Receivable 05/31/04 $363,509.61 Account Payable 05/31/04 ($136,928.00) Net Current Items 05/31/04 $1,534,529.33 2004 Revenue Recorded through 05/31/04 $2,315,818.09 Includes Allocations of Anticipated Revenues . 2004 Expenses Recorded through 05/31/04 $2,346,048.37 Includes Allocations of Expected Expenses Excess Revenues over Expenses ($30,230.28) St. Croix County Health and Human Services Board Page 4 July 09, 2004 HEALTH AND HUMAN SERVICES 2004 SUMMARY Total OF REVENUES Jan.- May Budget Balance % Administration 377,809.29 873,534.97 495,725.68 43.3% AODA Services 229,181.95 469,152.15 239,970.20 48.9% Long Term Support 6,387,079.93 14,616,574.52 8,229,494.59 43.7% Mental Health 1,013,434.92 2,745,667.40 1,732,232.48 36.9% Family & Children's 1,125,643.80 2,844,524.50 1,718,880.70 39.6% Public Health 630,943.93 1,420,079.06 789,135.13 44.4% Economic Support 435,822.35 957,504.85 521,682.50 45.5% General Relief 6,163.05 19,212.68 13,049.63 32.1% REVENUES HUMAN SERVICES PROGRAMS 10.206.079 22 23.946 250.13 13 740 170.91 42 6% SUMMARY Total OF EXPENDITURES Jan.- May Budget Balance % Administration 370,603.39 873,534.97 502,931.58 42.4% Alcohol -Drug Abuse 182,941.33 469,152.15 286,210.82 39.0% Long Term Support 6,248,451.98 * 14,616,574.52 8,368,122.54 42.7% Mental Health 987,363.80 2,745,667.40 1,758,303.60 36.0% Family & Children's 1,153,010.22 * 2,844,524.50 1,691,514.28 40.5% Public Health 535,688.51 1,420,079.06 884,390.55 37.7% Economic Support 374,163.66 957,504.85 583,341.19 39.1% General Relief 8,668.46 19,212.68 10,544.22 45.1% EXPENDITURES HUMAN SERVICES PROGRAMS 9,860,891.35 23,946,250.13 14,085,358.78 41.2% Excess Rev over Expenses 345.187.87 To be on budget, percentage should be 41.66. St. Croix County Health and Human Services Board Page 5 July 09, 2004 ST CROIX HEALTH CENTER OPERATIONS REPORT JANUARY THROUGH MAY JAN -MAY 2004 BUDGET ACTUAL DIFFERENCE % CENSUS 70.6 71 -0.5 99.3% OPERATING REVENUE: MEDICARE $ 1,226 ,972.00 $ 340 ,394.72 $ 886 ,577.28 27.7% MEDICAID $ 2,136,804.00 $ 1,096,841.49 $ 1,038,962.61 61.4% PRIVATE PAY $ 1,074 ,462.00 :$ 278 ,126.11 $ 796 ,335.89 25.9% ALL OTHER SOURCES $ 6,706.00 $ 16,020.77 $ (11,314.77) 268.7% TOTAL OPERATING REVENUE $ 4,443,944.00 $ 1,733,383.09 $ 2,710,560.91 39.0% OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,607,389.85 $ 1,408,732.21 $ 2,198,657.64 39.1% SPECIAL SERVICES $ 267,452.94 $ 108,641.96 $ 168,810.99 40.6% GENERAL SERVICES $ 1,173,975.87 $ 434,328.42 $ 739,647.45 37.0% ADMINISTRATIVE SERVICES $ 501,036.96 $ 204,011.17 $ 297,025.79 40.7% UNASSIGNED: DEPRECIATION( %BASED) $ 178,000.00 $ 74,165.00 $ 103,836.00 41.7% OTHERS $ 302,423.05 " $ 116,169.62 $ 186,253.43 38.4% TOTAL OPERATING EXPENSES $ 6,030,278.67 $ 2,346,048.37 $ 3,684,230.30 38.9% NET FROM OPERATIONS $ (612,665.28) NON - OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 17,650.00 $ 7,355.00 $ 10,296.00 41.7% IGT FUNDS ( %BASED) $ 664,705.00 $ 236,295.00 $ 329,410.00 41.7% CO ALLOCATIONS( %BASED) $ 815,480.00 $ 339,785.00 $ 475,696.00 41.7% TOTAL NON - OPERATING ITEMS $ 1,397,835.00 $ 582,436.00 $ 815,400.00 41.7% NET FROM ALL SOURCES $ (30,230.28) JUNE HEALTH INS INCLUDED $ 53,388.79 NET FOR MAY $ 23,158.51 PERCENTAGE SHOULD BE 41.66 i FUND BALANCE 01/01/04 $ 1,911,092.35 OPERATIONS $ 23,158.51 FUND BALANCE END OF PERIOD $ 1,934,250.86 1 % OF UNION WAGES IS $ 8,379.74 REQUEST TO DEVELOP ELECTRONIC RECEIPTING PER REQUEST OF TRACY AND THOLE At the 2003 audit exit, Tracey and Thole requested we do electronic receipting in the same system as the courthouse. An upgrade in the IDI software is needed to generate separate receipts for the Health and Human Services. This cost will be shared with the Highway Department. Customization of the financial software will avoid duplication of receipting to make it more efficient with less handwritten receipts. ' St. Croix County Health and Human Services Board Page 6 July 09, 2004 Motion A motion was introduced by Kretz, seconded by Wentz, and unanimously adopted: That the Board approves establishing electronic receipting for Health and Human Services. REVIEW OF DEPARTMENT FUND BALANCE Per the 2003 audit report, the Department ended the year with a deficit of ($33,998). The 2004 budget included a "prior year" carryover of $200,000. We will not be able to cover all of the $200,000. This deficit is primarily due to costs that are out of our control, e.g. out -of -home expenses, inpatient emergency detention costs, etc. The Board is being made aware of the situation with the fund balance. This issue may need to be brought to Finance in the late third or early fourth quarter of this year. Swenson recommended waiting until late September, early October to go to Finance. This item will be placed on the September agenda. 2005 BUDGET PLANNING Staff received instructions in June but are still waiting for information on salaries and fringes. The union contracts are three -year contracts so information for union staff is in place. More instructions will be available soon. Finance approved the financial sheet used last year. Pietrick said Ziegler did well last year with the spreadsheet and requested a summary sheet with a financial summary along with approval by the parent committee. Kretz questioned the advantage /risk of having a zero fund balance. Without a fund balance, there is no cushion to fall back on for unanticipated circumstances, i.e. increased inpatient admissions, etc. PUBLIC HEALTH PROGRAM REPORT Nelson thanked Caflisch and Kretz for attending the WALHDAB meeting /training on June 16. Caflisch and Kretz reported on the presentations they attended. Nelson gave a powerpoint presentation including a brief overview of the local 2003 Community Health Needs Assessment, which is mandated by Statute; an update on the local health improvement plan of which monthly meetings are held to identify strategies and plan for community education and involvement; and shared highlights of the statewide mapping project that links local priorities to Healthiest Wisconsin 2010. The top three items locally and statewide are tobacco use, drugs and drug abuse, and obesity /lack of physical activity. The Healthiest Wisconsin 2010 plan has been used as a model nationwide. Nelson said by statute, Wisconsin has to develop a health plan every ten years. Public Health receives no State monies, all funding comes from grants, consolidated contracts, fee for service, donations and county levy. WIC cases have continually increased. During 2003, we were funded for a caseload of 733 and currently 749 but constantly exceed that number. We are not allowed to have a waiting list with WIC, thus we are required to add clinic appointments to accommodate the growing need. This impacts our budget. We received notification this morning that our caseload will be increased by 65 participants. Nelson reported on communicable disease issues. There have been increases in reported cases of Pertussis in Western Region; St. Croix Co has only had one thus far this year. Surveillance continues for West Nile Virus (WNV). Public Health is collecting and sending in birds for testing. So far this year there have been no human, bird or horse cases of WNV in St. Croix Co. Nelson announced the Quarterly Legislative Event will be held at 9:00 AM on 07/19/04 at Health and Human Services The Board recessed from 10:10 to 10:20 AM. St. Croix County Health and Human Services Board Page 7 July 09, 2004 MENTAL HEALTH /AODA INPATIENT COST CONTAINMENT STRATEGIES: Kiesler reported a client was moved from Winnebago to Trempealeau which costs about one -third of the cost to stay at Winnebago. He said we are currently in a better financial position in 2004 than we at this time in 2003. Staff, at the board's direction, have been investigating the APNP issue and have contacted the University of Minnesota regarding retraining for an APNP. There are 2500 APNP in the state but only 89 certified to practice for adult mental health in Wisconsin. The majority of the 89 are located in the eastern side of the state. All 89 were contacted but no response was received back. Staff are looking to possibly retrain current nurse to be APNP. More information will be provided to the Board at next month's meeting. The Board directed for Mental Health to go with the APNP route rather than a full -time Psychiatrist as the APNP route was the most economical to pursue. County Board Chair Malick suggested Kiesler attempt to get the list of Minnesota Licensed APNPs, and strongly encouraged the Health and Human Service Board members to consider re- reviewing the current wage grid for this position if we are unable to recruit an APNP at its current level. The APNP wage grid is currently set at Haye Level 9. Borup said Kiesler and Kirt have done a remarkable job over the years in cost containment. Borup said it was staff's responsibility to give information to the Board regarding cost containment strategies however there are circumstances beyond staff control such inpatient hospitalizations, nor are staff able to change the need for services in the community. Kiesler stated that he thought it was staff's responsibility to bring to the board cost containment strategies for their consideration. LONG TERM SUPPORT COST CONTAINMENT PLANS Borup said State revenues are generating questions regarding reliability of getting revenues for the County. Aging of clients into adulthood is also raising costs. There was a move towards normalization in the 70 80's and 90 which is more expensive. They are looking at restructuring community programs into four, five and six bed units, not one and two bed units. This item will be on the agenda for the August meeting. NURSING HOME The Nursing Home is full at 72 and admissions are being turned away. Krieger reported in June there were 17 referrals with four admissions; 13 were declined due to no bed availability. For the year, we have received 90 referrals with 26 admissions and 64 declined. The remodeling project is going well. It was recommended that the final check be held until the issue regarding the linoleum is cleared. The roof unit is not installed. When it is installed, the State Inspector will be brought in to inspect and approve moving into the remodeled area. It is anticipated the area will be ready to occupy by August 1. Borup offered a tour of the Nursing Home after the meeting. Most staff efficiencies /adjustments have already been put in place but administration will continue to monitor as new dining area is used. 2003 WISCONSIN ACT 318 - IMPACT ON COMMUNITY AIDS PROGRAM FUNDING It appears this act is intended to help the State Budget. As we understand it, the State will reduce community aid dollars to counties. Counties will need to capture more MA to make up the loss. More work will be created for counties and there will be increased uncertainty around projected revenues. Staff will continue to keep the Board posted as training is scheduled for July 15. St. Croix County Health and Human Services Board Page 8 July 09, 2004 PERSONNEL MATTERS Borup mentioned that there are grievances going on in both the Nursing Home and Human Services and has been in contact with Dorsey regarding these issues. APPOINTMENTS Dorsey appointed Betsy May to the Birth to Three Advisory Board. Dorsey asked if there were any other issues to bring before the Board. Luckey requested the language of the memo the Board members sign to approve the vouchers be adjusted. Ziegler will contact Rod Paulson before making this change. Motion A motion was introduced by Caflisch, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 11:15 AM Chair: Attest: (Secretary) I