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HomeMy WebLinkAboutHealth & Human Services 08-13-04 ' r RALPH SWENSON WILL REVIEW VOUCHERS AT 8:00 AM REVISED - 08/05/04 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: 08/13/04 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: 08/26/04 ACTION ON PREVIOUS MINUTES: 07/09/04 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Program Reports a. Family & Children's b. Long Term Support cost containment plans C. Nursing Home 4. Mental Health /AODA Inpatient cost containment strategies 5. Personnel Issues 6. 2005 Budget Planning 7. Nursing Home Emergency Generator Replacement Needs 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 August 13, 2004 The St. Croix County Health and Human Services Board met on August 13, 2004 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Dr. Michael Kretz Stan Krueger Linda Luckey Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Tom Caflisch, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Judy Ziegler, Accounting Supervisor Carolyn L. Krieger, Nursing Home Administrator Fred Johnson, Family and Children's Supervisor Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Ron Lockwood, Long Term Support Coordinator Malva Berg, Secretary OTHERS PRESENT: Ralph Robole, Facilities Manager 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 30, 2004 at 8:30 AM. Krueger and Dr. Kretz will review vouchers at the September 10, 2004 meeting. Swenson suggested more time for Board members to review vouchers. It was agreed vouchers will be reviewed at 7:45 AM. AGENDA Motion A motion was introduced by Wentz, seconded by Kretz, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Wentz, seconded by Kretz, and unanimously adopted: That the minutes of the 07/09/04 Health and Human Services Board meeting be approved. ANNOUNCEMENTS Dorsey said the Nursing Home picnic was well attended. He said it was very nice and staff should be commended for a job well done. Dr. Kretz recommended sending a letter to staff thanking them for their efforts. NURSING HOME EMERGENCY GENERATOR REPLACEMENT NEEDS The current Nursing Home generator has been in operation since 1982. Staff approached the Board in 1999 regarding purchasing a different generator and the issue was pushed back to 2007 in the capital outlay plan. On August 2 the Nursing Home experienced a 2+ hour power outage that lead to a discussion with maintenance regarding the positive and negative aspects of the power outage and the present generator. The age and size of the generator has revealed that obtaining parts may be an issue. The present generator provides emergency lighting and elevator but leaves dietary inoperable and the power outage limited the medication pass. The medication pass will be enabled with the purchase of St. Croix County Health and Human Services Board Page 2 August 13, 2004 battery backups, but the increased acuity of residents over the past 4 -5 years presents other issues. Resident rooms do not have electricity during generator use, so oxygen equipment, electric beds, or any other electrical device will not work. Right now the oxygen tanks are plugged into outlets in the hallway with extension cords. The acuity of care of the residents continues to escalate with an increase in intensive skilled care residents and use of more oxygen concentrators. The amount for replacement generator currently is $50,000, which was based on an estimate received in 1999. Robole feels $60,000 would be a more accurate estimate for 2005 but has not received any current prices from vendors. The Board recommended investigating the ability to connect to the City of New Richmond utilities before moving up on the capital outlay plan. Krueger suggested checking on used generators, i.e. from hospitals. Dr. Kretz felt we may be facing liability issues also. Swenson questioned whether this issue should wait until 2005 and if approved for 2005, when will it be addressed in 2005. He recommended adding this item to the August 30 agenda. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the Board approves moving the Nursing Home generator to 2005 in the capital outlay plan after learning the results of the possibility of connecting to the City of New Richmond utilities. MENTAL HEALTH /AODA INPATIENT COST CONTAINMENT STRATEGIES Kiesler distributed outlines of five different grids regarding the cost of purchased services. The grid for July projects loss figures of - $22,963. Kiesler said revenues haven't varied much. The majority of the clients hospitalized don't have insurance. The Sheriff has been more open to consider options other than hospitalization. The proposed diversionary program did not work, as we were unable to recruit an APNP. The BQA notified us that we are unable to hire a family practice APNP for mental health clinical services. Another option may be to try to recruit nationally or work with schools but most attending the APNP program have already been promised a job through an employer. Hiring an APNP is critical to diversion costs. Kiesler said a new position request for an APNP was not made in June so an APNP position has not been approved for the 2005 budget. New position requests are brought to the Personnel Committee once a year in May or June. Borup said the hardest part will be to find a person to fill the position. There is an option to wait a year and bring the position request to the Board next year. Motion A motion was introduced by Kretz, seconded by Rasmussen and unanimously adopted: That the Board approves a new position be created for an APNP for 2005. Motion A motion was introduced by Krueger, seconded by Luckey and adopted with Kretz voting no, That the above motion be amended to delay vote on the motion until the August 30 meeting. FAMILY AND CHILDREN'S PROGRAM REPORT Johnson said a Coordinated Family Services (CFS) position was approved as a new position in 2005 at no County cost. The Department is aggressively pursuing the CFS program to assist with families that are in multiple services and at high risk of out of home placement. Johnson reported expenses are over budget so far this year. He said there has been an increased need and placements in foster care than there has been in a long time. Staff are pursuing the SED waiver more aggressively. The budgeted amount for alternate care for 2004 is $906,000 and Johnson said he projects to use $1,000,000 for alternate care for the 2005 budget. Swenson suggested using the most probable figure for the budget to report at the St. Croix County Health and Human Services Board Page 3 August 13, 2004 September 10 meeting. Johnson said as the population growth continues, dealing with difficulties will continue to grow. The Board recessed from 10:35 to 10:40 AM. CONSIDERATION OF CLAIMS The following reports were distributed to the Board: July fixed asset report, July cash report, June and July unemployment report and June financial reports. Health and Human Services Board member, Swenson, reviewed the vouchers; the following voucher was pulled for discussion: HUMAN SERVICES: 26668: Blaiser, Jessica, $183.00, employee travel. Ms. Blaiser is a social worker in the Mental Health Community Support Program and this check is for reimbursement for mileage on her personal car for home visits and some client transportation. 26685: Geske, Dave, $727.95, Public Health Contracted Services, Public Health contracts with Dave to provide ongoing surveillance of mosquito population in St. Croix County. He and his staff trap mosquitoes to determine the kinds that are here and what diseases they may carry and discuss removing mosquito breeding areas (old tires, open cans, tubs etc. of water) with county residents' help to decrease the mosquito population. 28856: Northwest Counseling and Guidance Clinic, $2,598.50. MA transportation. The clinic provides transportation for children in foster care to and from their clinic at a cost of $.50 /mile. The foster care program is part of the Family and Children's Program and MA transportation is part of Economic Support. When we bill transportation for those children with MA cards through Economic Support, we are reimbursed 100% by the State. If we left the transportation cost under the Family and Children's Program, it would be all County appropriation. 29004: , $1,536.94, MA transportation. This client is a Vietnam vet who suffers from exposure to Agent Orange. He has to make almost daily visits to the VA Hospital. We are reimbursed 100% of the expenses from the State. Motion A motion was introduced by Swenson, 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 26654 through 26764, dated July 15, 2004 in the amount of $42,266.90. Human Services vouchers 2661 through 26763, dated July 15, 2004 in the amount of $148,401.31. Human Services voucher 26944, dated July 15, 2004 in the amount of $4,617.51. Human Services vouchers 26967 through 27060, dated July 22, 2004 in the amount of $318,390.71. Human Services and Nursing Home vouchers 27375 through 27477, dated July 28, 2004 in the amount of $294,330.38. St. Croix County Health and Human Services Board Page 4 August 13, 2004 Human Services and Nursing Home vouchers 27672 through 27741, dated August 04, 2004 in the amount of $243,150.13. Human Services vouchers 28596 through 28618, dated August 13, 2004 in the amount of $43,171.35. Human Services vouchers 28804 through 29010, dated August 13, 2004 in the amount of $230,898.08. Human Services vouchers 28619 through 28803, dated August 13, 2004 in the amount of $86,988.70. Nursing Home vouchers 26627 through 26653, dated July 15, 2004 in the amount of $19,421.94. Nursing Home vouchers 26947 through 26956, dated July 22, 2004 in the amount of $9,557.38. Human Services, Workshop, Public Health, Social Services vouchers 403 through 434, dated July 15, 2004 in the amount of $348,726.66. Human Services, Workshop, Public Health, Social Services vouchers 433 through 453, dated July 27, 2004 in the amount of $303,631.43. Human Services, Workshop, Public Health, Social Services vouchers 455 through 486, dated August 10, 2004 in the amount of $349,052.60. Human Services and Nursing Home vouchers 425 through 458, dated July 13, 2004 in the amount of $178,126.77. Human Services and Nursing Home vouchers 469 through 490, dated July 27, 2004 in the amount of $154,637.04. Human Services and Nursing Home vouchers 491 through 523, dated August 10, 2004 in the amount of $178,681.93. Human Services and Nursing Home vouchers 459 through 468, dated July 19, 2004 in the amount of $6,177.64. FINANCIAL REPORTS The State fiscal year runs from 07/01 through 06/30. More IGT monies were received than was budgeted. The Board questioned if the IGT figure was adjusted in the report. Krieger reported that a special cost report will need to be done due to the downsizing of the Nursing Home. A Medicaid adjustment occurred 07/01/04. On October 1" Medicare will increase 2 %. Krieger said there may be minimal changes in scheduling when the new dining rooms are utilized but there will be no significant salary changes or staff cuts. She said the majority of staffing cuts happened in the last year during the downsizing. She said supply use is down and costs are down due to lower census. The remodeling did not impact the staffing levels. The following financial reports through June were distributed to the Board. St. Croix County Health and Human Services Board Page 5 August 13, 2004 ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/04 THROUGH 06/30/04 NURSING HOME 1st Ouarter 2nd Ouarter Cash Balance 06/30/04 $1,716,874.19 $1,274,683.33 Add: Accounts Receivable 06/30/04 $269,019.58 $358,460.96 Account Payable 06/30/04 ($346,459.08) ($424,074.38) Net Current Items 06/30/04 $1,639,434.69 $1,209,069.91 2004 Revenue Recorded through 06/30/04 $1,413,407.99 $2,764,853.97 Includes Allocations of Anticipated Revenues 2004 Expenses Recorded through 06/30/04 $1,401,909.74 $2,850,091.41 Includes Allocations of Expected Expenses Excess Revenues over Expenses $11,498.25 ($85,237.44) St. Croix County Health and Human Services Board Page 6 August 13, 2004 HEALTH AND HUMAN SERVICES 2004 SUMMARY Total OF REVENUES Jan.- June Budget Balance % Administration 442,329.64 873,534.97 431,205.33 50.6% AODA Services 297,987.28 469,152.15 171,164.87 63.5% Long Term Support 7,702,378.02 14,616,574.52 6,914,196.50 52.7% Mental Health 1,352,514.23 2,745,667.40 1,393,153.17 49.3% Family & Children's 1,380,317.99 2,844,524.50 1,464,206.51 48.5% Public Health 769,909.12 1,420,079.06 650,169.94 54.2% Economic Support 496,813.47 957,504.85 460,691.38 51.9% General Relief 34.86 19,212.68 19,177.82 0.2% REVENUES HUMAN SERVICES PROGRAMS 12. 442.284.61 4 46 0 1 11.503.965.52 52.0% SUMMARY Total OF EXPENDITURES Jan.- June Budget Balance % Administration 455,361.98 873,534.97 418,172.99 52.1% Alcohol -Drug Abuse 233,141.60 469,152.15 236,010.55 49.7% Long Term Support 7,470,698.23 * 14,616,574.52 7,145,876.29 51.1% Mental Health 1,268,918.52 2,745,667.40 1,476,748.88 46.2% Family & Children's 1,445,997.33 * 2,844,524.50 1,398,527.17 50.8% Public Health 682,349.79 1,420,079.06 737,729.27 48.1% Economic Support 477,382.55 957,504.85 480,122.30 49.9% General Relief 9,248.91 19,212.68 9,963.77 48.1% EXPENDITURES HUMAN SERVICES PROGRAMS 12,043,098.91 23,946,250.13 11,903,151.22 50.3% Excess Rev over Expenses 399.185.70 To be on budget, percentage should be 50.00. St. Croix County Health and Human Services Board Page 7 August 13, 2004 ST CROIX HEALTH CENTER OPERATIONS REPORT JANUARY THROUGH JUNE JAN -JUNE 2004 BUDGET ACTUAL DIFFERENCE % CENSUS 70.5 71 -0.5 100.7% OPERATING REVENUE: MEDICARE $ 1,226,972.00 $ 397,390.09 $ 829,581.91 32.4% MEDICAID $ 2,135,804.00 $ 1,627,388.99 $ 508,415.01 76.2% PRIVATE PAY $ 1,074,462.00 $ 21,925.57 $ 1,052,536.43 2.0% ALL OTHER SOURCES $ 6,706.00 $ 19,227.32 $ (12,521.32) 286.7 TOTAL OPERATING REVENUE $ 4,443,944.00 $ 2,065,931.97 $ 2,378,012.03 46.5% OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,607,389.85 $ 1,712,819.54 $ 1,894,570.31 47.6% SPECIAL SERVICES $ 267,452.94 $ 130,290.26 $ 137,162.68 48.7% GENERAL SERVICES $ 1,173,975.87 $ 528,238.09 $ 645,737.76 45.0% ADMINISTRATIVE SERVICES $ 501,036.96 $ 248,108.38 $ 252,928.58 49.5% UNASSIGNED: DEPRECIATION( %BASED) $ 178,000.00 $ 88,998.00: $ 89,002.00 50.0% OTHERS $ 302,423.05 $ 141,637.14 $ 160,785.91 46.8 TOTAL OPERATING EXPENSES $ 6,030,278.67 $ 2,850,091.41 $ 3,180,187.26 47.3% NET FROM OPERATIONS $ (784,159.44) NON - OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 17,650.00 $ 8,826.00 $ 8,824.00 50.0% IGT FUNDS ( %BASED) $ 564,705.00 $ 262,354.00 _ $ 282,351.00 50.0% CO ALLOCATIONS( %BASED) $ 815,480.00 $ 407,742.00 $ 407,738.00 50.0 TOTAL NON- OPERATING ITEMS $ 1,397,835.00 $ 698,922.00 $ 698,913.00 50.0% NET FROM ALL SOURCES $ (85,237.44) PERCENTAGE SHOULD BE 50 FUND BALANCE 01101/04 $ 1,911,092.35 OPERATIONS $ (85,237.44) FUND BALANCE END OF PERIOD $ 1,825,854.91 1 % OF UNION WAGES FRINGES IS $ 12,082.28 LONG TERM SUPPORT COST CONTAINMENT PLANS Lockwood reported a class action lawsuit was filed against the State to stretch the timeline of closing Northern Wisconsin Center in Chippewa Falls to 2005. The State budgeted money to extend the closure if placements are not found. Seven St. Croix County residents were approved for community placement by the State review team. Two have been placed in community placement but options are limited. Three other placements are in the planning and the guardians are involved in decisions. It is hoped that five will be placed by the end of the year. Of St. Croix County Health and Human Services Board Page 8 August 13, 2004 the remaining two, one is very medically needy and the other one has a guardian who is adamant regarding placement. Lockwood reported that two clients from Central Center have been approved for community placement. He said the guardians for these two clients are opposed to alternate placement and the issue may go to court. Penalties for not placing clients in alternate placement may be incurred. Also, State law allows the transfer of care of Nursing Home MR or DD active treatment level of care to the community. Lockwood reported there are three clients in St. Croix Health Center and three in other nursing homes in the County. As of 01/01/05 there are 11 residents meeting this criterion that will be the County's responsibility for cost of care. The State is supposed to give allocation for these residents' care until they are able to be placed in the community. If our utilization increases, the County will have to pay 40% of the increase in the cost of care. It is another way the State is shifting authority/ responsibility from the State to County government. He said the CMI population is the next target once the DD /MR shift is done. Lockwood reported it has been six years since anyone new has been served off the waiting list. Currently there are many one, two and three living arrangements and these numbers will have to be increased to three, four and five in care settings. It is easier to staff larger numbers in care settings. This is the best alternative with the limited State resources/ funding. Staff are working closely with case managers to implement cost cutting approaches that do not jeopardize the health and safety of persons being served as required by the Federal Home and Community -Based MA Waiver Manual. The Board complimented Lockwood on his initiative for cost containment. NURSING HOME The Nursing Home received a $500 grant from St. Croix Electric Co -op. to fund resident community activities. Krieger reported the census is 71 today. In July 17 referrals were received and declined due to a full census. Krieger updated the Board on the remodeling project. The contractor is working on flooring and the painter should be completed by the end of next week and hopefully the area will be ready to occupy soon. Krieger reported the bath chair /lift /with scale needs repairs in the amount of $4,500 due to the seat being cracked and metal fatigue in the legs. A new chair is approximately $6,500 and comes with a five -year warranty. This is a piece of equipment that is needed on a daily basis. The issue just came up yesterday so there was not time to add to the agenda for action. It was the consensus of the Board to purchase the new bath chair. PERSONNEL MATTERS Amy Bestland, Family and Children's Social Worker has resigned. Matt Zabel moved into the vacant position and staff are recruiting to fill Zabel's position in Family and Children's. Shirley Johnson has tendered her retirement resignation as of the end of November. It is hoped that someone within the area with experience will be able to be recruited and if not, training for new workers starts in October. Will attempt to recruit in -house and then recruit from the outside. 'St. Croix County Health and Human Services Board Page 9 August 13, 2004 Dorsey asked if there were any other issues to bring before the Board. Board discussed agenda items for the August 30 meeting. Motion A motion was introduced by Rasmussen, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 11:55 AM Chair: Attest: (Secretary)