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HomeMy WebLinkAboutHealth & Human Services 08-30-04 Revised 08/23/04 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: 08/30/04 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: 09/10/04 ACTION ON PREVIOUS MINUTES: 08/13/04 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Presentation and Action on 2005 Budget for Health and Human Services and Nursing Home a. Capital Outlay Plan Updates b. Nursing Home Emergency Generator Replacement Needs 2. Discussion of Resolutions the Wisconsin Counties Association will consider regarding the following subjects: • #16- Supporting the State of Wisconsin to protect the health of the public • #17- Support for Federal legislation to change the Medicare formula to stop inequities in payments among states 3. Request to create position of Advanced Practice Nurse Practitioner for 2005 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 HEALTH AND HUMAN SERVICES BOARD . The St. Croix County Health and Human Services Board met on August 30, 2004 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Dr. Michael Kretz Tom Caflisch Linda Luckey Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Stan Krueger, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Fred Johnson, Family and Children's Supervisor Kathy Dunlap, Family and Children's Supervisor Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Mary Squyer, Economic Support Supervisor Ron Lockwood, Long Term Support Coordinator Barbara Nelson, Public Health Supervisor - Health Officer Kathy Leisch, Secretary OTHERS PRESENT: None Chair Dorsey called the meeting to order at 8:3o AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for September 10, 2004 at 8:3o 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 Wentz, seconded by Rasmussen, and unanimously adopted: That the minutes of the 07/09/04 Health and Human Services Board meeting be approved with the following addition to page 2, second paragraph of Family & Children's Program Report, third sentence, addition of the word "more" in the sentence: "He said there has been an increased need and "more" placements in foster care than there has been in a long time." PRESENTATION AND ACTION ON 200s BUDGET FOR HEALTH AND HUMAN SERVICES Borup stated they have been struggling to complete the budget with computer providing some unstable numbers — salaries and fringes. Borup stated Public Health's full budget is not included but the Mission Statement and review for all program areas is included. County cost for 2005 will be up, in part due to Mental Health /AODA increases, Juvenile Alternate Care (foster care, group home care, institutional care), mandated caseload increase in Long Term Support, per the discussion with the Board on o8 /13 /04. Borup stated that for the most part our operational budgets are complete. Borup reviewed the Department analysis with the Board. Borup stated an increase in total expenses of $3,678,690. He said the major items contributing to this increase are Long Term Support, Mental Health and Family & Children's. Borup stated Economic Support has lower salaried staff coming in and a couple of staff at entry -level salary positions, keeping Economic Support's increase minimal. The County levy for 2004 has an increase of 17.9 %. Borup stated the major factors impacting the levy are Juvenile Alternate Care, Mental Health /AODA Inpatient /Contracts and Long Term Support (Mandated CIP -1B Community Placements). Borup summarized the Salary & Fringe increases. Borup stated the Farm Surplus is $38,424 and is not included in any program and can be applied to reduce the County levy if the Board chooses to do so. COORDINATED FAMILY SERVICES (CFS) This is a new initiative that has been developed as a joint effort by Mental Health and Family and Children's Services. This interdepartmental effort addresses item 13 of the County Board strategic planning priorities, as this is a shared service within Health and Human Services. CFS is an approach to respond to children and families with multiple and persistent needs, including chemical abuse, juvenile delinquency, mental health, and child protective services, in their homes (or least restrictive setting) through a comprehensive, coordinated, interagency system of care. This service delivery system will be targeted specifically to those children and youth that are at high risk of placement as a preventive measure or for those youth in placement to set up a system of support to expedite reunification. The development of this initiative also fits well with County Board strategic planning priorities number 1, dealing with fiscal issues. First, no county levy money is allocated to this budget request, but rather grants and other earmarked state funding. Additionally, this initiative has been implemented in other counties and has effectively lowered alternate care placement budgets. With the recent increases in placement expenses that both Mental Health and Family and Children's have experienced, we are targeting program development for the high -risk youth we serve without the use of county funds. This also effectively addresses County Board priority number 4, deal with mandates. This service will be available to those clients we are currently mandated to serve; service provision will be provided based on a different model as described above. Key funding issues: 1NNo county funds included in this budget request. ■Competitive grant funding opportunity of $87,955 through OJA (Office of Justice 'Assistance) will be submitted on October 2004. ,,Hospital diversion grant anticipated through Mental Health Services. The State changed the focus of the grant to those counties attempting to start up Coordinated Family Service projects, but did not change the name of the grant. S E T itle IV -E program incentive money (expansion) anticipated through Family and — Children's Services. 1 ■Family Preservation money previously allocated to a Glenwood City Project 'reallocated to this initiative. Johnson stated this is an excellent opportunity to start a new program without allocating County funds. Caflisch asked what would happen next year. Johnson stated we would evaluate if we are successful with meeting our program goals and report to the Board throughout next year. Johnson stated the OJA grant is a 3 -year cycle. ECONOMIC SUPPORT UNIT Squyer stated that despite the continued caseload growth of l000 cases since 2003, Economic Support has not increased staff. Economic Support revenue may exceed what we have budgeted. There is a reasonable chance we will receive an additional $35,808, however due to the uncertainty we have not entered it into the budget. There is a good possibility we will be able to hire someone who has been trained in November to replace the retiring staff member. This will save us $6,00o for New Worker Training. Because we have spent no dollars on General Relief Medical so far in 2004, we will probably get no State money. $15,000 County Allocation has been budgeted for General Relief for 2005. We continue to pay a higher percentage of salary and fringe benefits for the Director and 3 Bookkeepers to maximize the Federal Pass Thru. Due to the fact we are getting the same revenue as 2004 and salary and fringe benefits have increased by 3 %, we are requesting a County Allocation of $182,911. Borup stated Economic Support budget is down $14,220 in terms of overall expense. Borup stated Economic Support has lower salaried staff coming in and a couple of staff at entry -level salary positions. Squyer stated the General Relief dollars is included in the budget but can be taken out if needed. Borup stated that the General Relief program is not a mandated service. Squyer stated that at the time there has been no General Relief medical dollars spent. FAMILY AND CHILDREN'S /SED WAIVER SERVICES: Overall Budget Request Summary: 2005 Budget Request (Family and Children's) $ 3,077,774 i 2005 Budget Request (SED Waiver) $ 216.000 $ 3, Total 2004 Budget Adjusted (Family and Children's) $ 2.841386 $ 450,388 Increase The SED (Severely Emotionally Disturbed) Waiver is a new purchased service line item for the department. This money identified in the SED Waiver budget ($88,56o County Levy) would previously have been allocated to purchase service line items for foster care and treatment foster care in the Family and Children's Services budget. Money was moved to this new purchased service line item to maximize federal match ($127,440) for youth that we are already mandated to serve. As reported to the board, access to the waiver budget will be limited only to those SED youth that are already eligible for mandated placement services, thus this program has the possibility of reducing/ stabilizing costs to the county in the future, so long as the demand for mandated services remains similar. Conservative numbers were used in the SED Waiver budget request as it is very new and the State regulations are yet to be clearly defined. This programmatic change is consistent with County Board strategic planning priority numbers 1 and 4, dealing with fiscal issues and mandates, as this creates an alternative funding source other than county levy for mandated services. Alternate Care Purchased Service Summary: 2005 Budget Request (Family and Children's) $1,111,000 2005 Budget Request (SED Waiver) $ 216.000 ($88,56o County Levy) $1,327,000 Total 2004 Budget Adjusted (Family and Children's) $ go6.000 $ 421,000 Increase This specific program area is the largest area of growth within the Family and Children's /SED Waiver budget request. Complex social issues, increased population, along with other variables has increased the demand for mandated alternate care services. Family and Children's services has over the past 8 to 9 years maintained a lower average number of youth in care when compared to like size counties across the state. In addition, more recent average numbers of days in alternate care for St. Croix County youth has been lower as indicated below: ■From 2003 to 1999 Average number of days in alternate care 8,705 ;;From 1998 to 1994 Average number of days in alternate care 13,837 However, this budget request reflects increased demand for these services which is funded by an increase in county levy ($293,56o) and federal waiver funds ($127,440) mandates and public safety. County Levy Summary: 2005 Budget Request (Family and Children's) $1,708,421 2005 Budget Request (SED Waiver) $ 88,560 $1,796,981 Total County Levy 2004 Budget Adjusted (Family and Children's) $ 1,45,18. $ 343,796 Total increase Other Key Item Summary: Salaries and Fringe (up) $36,623 No Prior year carry over (down) $37,500 Other operations (down) $ 3,210 Youth Aids Grant (down) $ 9,335 Collections revenues budget (down) $22,500 TPR Grant (up) $ 5,000 LONG TERM SUPPORT St. Croix Industries (Accounts 501 -515 and 534) is anticipating a significant increase in its operating costs in 2005. Other costs will also be associated with the replacement of three transportation vehicles. Coupled with these cost increases is an anticipated greater demand for its services. There will be a greater demand for Work Services and Vocational Placement if the economy continues to decline. Traditionally as the economy suffers and the job market tightens disabled individuals have a tougher time getting and keeping employment. It is being anticipated that in 2005 waiting lists will continue. St. Croix Industries will not be able to serve individuals as soon as they are referred. Also more severely physically and cognitively disabled individuals will be referred for services. St. Croix Industries' resources will be stretched to its limits. The Birth to Three program (Account 519) anticipates a 20 percent increase in enrollment from August of 2003. No increase is expected in our State allocation, which accounts for approximately 41% of our projected revenues. Birth to Three services is mandated and waiting lists are not allowed. Therefore, counties in Wisconsin are bearing a large part of the costs of providing services. The budget reflects slightly higher provider contract costs to accommodate increased enrollment. One County staff member will be providing more case management services, which will affect both expenses and revenues slightly. Our focus for 2005 is managing growth effectively and economically. The new Children's DD Waiver program (Account 516) will serve the needs of children with autism. It is anticipated that ten children will receive the intensive benefit valued at $93 per day and ten children will receive the on -going benefit valued at $28 per day. Total expenses of $473,000 will be covered by State and Federal resources. The other MA Waiver programs (Accounts 517, 5 5 528, 532) show dramatic growth in costs due to the closing of Northern Center, the new ICFMR Restructuring Initiative, greater service needs for current program participants and the anticipated costs for three new protective placements. Lockwood stated the CIP 1A program is targeted to people coming out of Northern Center and he doesn't expect a significant increase in County dollars. He stated there may be somewhat of a reduction. MENTAL HEALTH/AODA The demand for psychiatric hospital admissions, while remaining high, has decreased during the first 8 months of 2004. The number of admissions is down 17% from the last year and 8% lower than 2 years ago. However, the rate is still up 63% from over the last 5 years. The vast majority of psychiatric hospitalizations continue to be due to emergency detentions (93%). In addition, the average length of stay has increased by 50% due to the severity of illness. Historically, 75% of all emergency detentions are for individuals that are not open to our mental health services at the time of the detention. As a result of this growing demand the Health and Human Services Committee directed us to increase our budget for contracted services by $33 or 33.4 %• Because of the history over the last 5 years in St. Croix County (as well as nationally), we are trying to develop a diversion program in an attempt to deal with this fiscal issue and lessen expenditures for inpatient care. While this is something that is consistent with goals #1, #4, and #12 of the County Board, as developed in the 2004 strategic planning meeting, we have encountered obstacles in setting up the diversion program involving State certification of an Advanced Practice Nurse Practitioner and the salary demands of those with that certification. We are continuing to work with Health and Human Services Committee in an effort to develop strategies to overcome these obstacles. As a part of that process we have developed monthly reports for the Board (goals #2 and #11) that show the current expenditures, as well as, projected liability for services in our contracted facilities. We have also become regular participants in the St. Croix County Law Enforcement Chiefs meetings in an effort to collaborate and strategize with them on methods to contain the costs incurred by various departments and local government agencies involved in Emergency Detentions (goals #2 and #13). Because of the wage and fringe increases of $116,671 for Mental Health /AODA staff and contracted services expenditure increases of $331,544 (totaling an increase of $407,303 over the 2004 budget), the 2005 Mental Health /AODA budget is requiring additional county levy of $469,756 over last year. Kiesler stated that increases in Mental Health is due to out of home costs or institutional costs. Kiesler stated the salary and fringe benefits increase of $116,671 did not look right to him when compared to the LTS and Family & Children's salary & fringe benefit increases but he had not had time to really understand how that had jumped so significantly. Kiesler stated they decreased revenue by $52,00o and the difficulty in projecting that has been that they have not received revenue consistently throughout the year. He stated that Ruka had just gotten money to flow from the Echo and HIPPA program. Kiesler stated that revenue flow has started to come in with the billing going out and checks have been returned. Kiesler stated Ruka was unable to give them a tracking of how much money had came in during the fourth quarter of last year versus the first six months of this year. Kiesler stated Ruka would need a month to get those figures to them. Swenson asked whether the revenue figure was a most probable figure. Kiesler stated this would be the most probable figure based on the limited information that they have. Swenson asked whether this figure covers both revenue and expenses? Kiesler stated yes. Kirt stated expenses tilt towards worst -case scenario, if our experience in 2003 is taken out of the statistical model (which were presented at the August 13th Health & Human Services Board meeting. At that meeting Krueger wanted 2003 left in the model for projecting 2005 expenses). PUBLIC HEALTH The most recent Public Health Profiles documents that St. Croix County Public Health is below State and regional per capita funding and staffing. St. Croix County funding is at $17.54 /capita with $9.55 from local levy while the State average is at $21.86 /capita with $11.28 from local levy, and Western Region average is $27.87 /capita with $12.09 from local levy. Local health department staffing per 1o,000 population is: St. Croix Co. W Region State Administrative 0.1 o.6 0.5 Professional staff 1.6 2.7 2.3 Technical /Paraprofessional 0.3 0.7 0.4 Support Staff 1.0 1.6 o.8 Communicable Disease — Mandated Service: Immunization Program — client donations have steadily decreased every year ('03 - $14,374; '02 - $16,012; '01- $17,252; '00 - $23,o63). This reflects the state of the economy. Vaccine and supply costs continue to increase. Communicable disease surveillance, prevention and control has increased and impacted most recently by SARS, monkeypox, tuberculosis, Pertussis (whooping cough), E. coli cases. Environmental Health— Mandated service: Continued increase in human health hazard cases with more requiring issuance of orders and ongoing follow -up Maternal Child Health programs— Mandated Service: WIC (Women, Infants, and Children) Supplemental Nutrition program through Dept. of Ag has experienced funding reductions and local caseload exceeds the funded caseload levels. We cannot create a waiting list and certain populations have priority service timelines. Interpreter /Translation costs are >$goo for the first six months of 2004 and are expected to increase annually. Reduction in revenues: Maternal Child Health (MCH) funds cut by 5% (equates to over $3,000 in Reproductive Health program) WI Well Woman Program (WWWP) cuts by 1o% ,Can Control & Prevention grant moved to State Chronic Disease and Cancer Control section with loss of local funding -- >$io,000 in 2003; reduced to >$5,000 in 2004; o in 2005 Deficit Reduction reduced by $7,000 -8,00o compared to previous years Preparedness (bioterrorism - generated funding) requirements continue although the State has had a reduction in funding which also translates to a reduction locally. The intent of the consortium is to keep the funding level to local health departments stable this year despite the overall cut. Positive issues: Our Agent Program continues to operate successfully requiring no County levy support. Collections in Reproductive Health have increased significantly in 2004 and anticipated to continue in 2005 due to the Reproductive Health waiver. We are no able to recoup for services rendered on clients eligible for the waiver who, in the past, were on a sliding fee scale and may or may not have been regular payers. Certification as a Dispensary for TB Clinical Services program will allow us to recoup for services provided to persons with TB disease or infection who are uninsured or underinsured. Nelson stated some of the mandated services are communicable disease and grant funding is down. The collections from clients from immunizations continue to go down every year. These are services that Public Health is required to do. WIC program recently got a funding caseload increase to that program should run even. Nelson stated they are unable to create a waiting list for the WIC program so when the caseload gets higher than the funding provided they still have to serve the clients. Borup stated there are no new personnel in terms of County dollars. Caflisch asked about the extra cost of changing from a LTE employee to a full -time employee with benefits. Borup stated there would be no savings to the County if they would cut the full -time position because the position is grandfathered in with a sunset clause. CAPITAL OUTLAY PLAN UPDATES: Borup stated while a part of the 2005 budget, we have broken these items out with minor changes noted from previous action taken earlier this summer. Health and Human Services Administration: 1MContinue to budget for 18 PC's with costs increased $95 /unit and two units in front — office covered by 40% cost share with Nursing Home and 60% Health and Human Services. INTwo automobiles net trade cost - increase trade cost from $21,000 to $25,000 with 'Department keeping two trade -ins' longer (have less value), and uncertainty of inflation's impact on cost of 2005 vehicles. Nursing Home: 1 ■Minor change with PC adjustment noted above. Borup recommended not cutting any of this budget numbers and presenting the budget as presented. Motion A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the Board approves the Health & Human Services budget totals as presented and to forward to Finance Committee. 2005 2005 2005 2004 LEVY PERCENT TOTAL PROGRAM COUNTY COUNTY INCREASE OF EXPENSE REVENUE LEVY LEVY (DECREASE) CHANGE TOTAL HEALTH & HUMAN SERVICES $27,614959 $20,998,33 $6,616,627 $5,611,264 $1,005,363 $ CAPITAL OUTLAY REQUEST $ 212,865 TOTAL 2005 COUNTY APPROPRIATIONS $6,829.492 The Board recessed from 10:05 to 10:15 AM. PRESENTATION AND ACTION ON 200 BUDGET FOR NURSING HOME Krieger discussed the following highlights of 2005 Nursing Home Budget: County Levy for Operations: $1,008.721 County Levy for Capital: $ 218,512 Total Levy Request $1,227, Major Factors Impacting Levy IGT $ - 114,705 Worker's Comp. Cost $ - 62,875 (cost reduced) Medicare $ - 412,682 The nursing home revenues consist of operating revenues consisting of Medicare, Medicaid, and Private Pay, and non - operating revenues of Intergovernmental Transfer funds, rate appeals revenue, County levy, and other smaller amounts of revenue. Revenues are dependent upon Federal and State funding, as well as case mix. Medicaid Rate setting (60% federal 40% state) for the 2005 year actually occurs with the State fiscal year of 7 -1 -04 to 7 -1 -05. Medicare rate setting occurs with the Federal fiscal year of 10 -1 -04 to 10 -1 -05. The State of Wisconsin typically does not finalize the Medicaid rate until late in the year. This year the nursing home was required to submit an extra cost report from 1 -1- 04 to 6 -30 -04 due to the downsizing. The rate prediction made by WAHSA shows St. Croix County's rate going down due to an adjustment in the labor region factor of the Medicaid formula. Until the cost report is analyzed by the local auditor, the Medicaid rate is uncertain, and Medicaid revenues are an estimate. Medicare revenues are dependent upon a nursing home assessment that rates the level of care in one of 44 categories. A resident can move in and out of the 44 categories during the stay, which changes the rate of the per diem. Medicare Part A also requires the nursing home to pay for all expenses during the stay, so revenues can be offset by expenses that are unpredicted. The 2005 Revenue budget is based on an average census of 70. The 2004 budget was based on an average census of 70.5, but history has shown that the average is slightly (below 70.5 for the first half of 2004. Admissions are dependent upon empty beds and downsizing to 72 beds has limited the number and pay source admitted. Residents who are admitted who are unable to go back home transition to Medicaid. Consequently, the Medicare revenue has decreased due to inability to admit because of full census, and at the same time Medicaid revenue has increased due to longer stays and noncoverage by Medicare for their stay. The State of Wisconsin does not cover the total cost of Medicaid. The Intergovernmental Transfer Fund (IGT) is administered by the State, but is funded by the Federal government based on losses incurred by the State and is a matching program. The program is designed to fund County homes completely for losses incurred, but the State over the years has used IGT to fund other Medicaid programs, thus creating cost shifting back to the County The Federal government is gradually decreasing the amount of matching funds to the State of Wisconsin, so the projected amount for 2005 is decreased from 2004. The IGT funding follows the State's fiscal year. The nursing home cares for many of the Counties protectively placed residents, and cost of care is a St. Croix County responsibility. If the St. Croix Health Center did not care for these residents, the Human Services department would bear the expense of caring for difficult and expensive County citizens. Expenses: Although the nursing home has creased expenses with efficiency within the facility, the overall decrease includes increases in wages. The budget for 2004 included a 3% increase, but the actual increase was 4 1 /2%, so the 3% increase for 2005 is a cumulative effect with the 2004 4 1 /2% increase that was budgeted at only 3%. Major expense reductions include the laundry- contracted expenses of $51,960 elimination due to laundry services adjusting scheduling to provide a complete laundry service. Worker compensation expense decreased from $143,118 to $80,243, a saving of $62,875. Salary and fringes have been reduced due to the downsizing and elimination of staff. County Goal Setting: Operation goal of nursing home clinical software upgrade was ,comp etl ed 11 -03. The electronic medication administration is completed with a laptop i operating on a wireless system. Review of mandated nursing home services: Nursing home services are not mandated. However, the nursing home is mandated to comply with the Federal and State regulations that include HFS,132, HFS 129, Federal OBRA, OHSA, ADA EEOC, Medicare and Medicaid regulations, as well as local County and city regulations. The nursing home care for court ordered protective placement of residents. Care of those unique individuals is mandated by the State for St. Croix County and would appear as an expense in the Human Services budget. Krieger suggested the Nursing Home Union wage increases be reviewed since Nursing Home is an enterprise and revenues do not cover her expenses. Krieger stated that Dunn County has based its wage increases in years past on the Medicaid increase. Luckey asked if there are any rules that govern relationships with unions that dictate d how wage increases are based. Swenson suggested that Board members lobby colleagues on the personnel committee. Borup agreed to pursue and discuss options with joint finance and personnel committees. Swenson brought up issue of using the extra remodeling fund to pay for new generator, installing speakers in the dining room and installing nurse call lights and discussion ensued. Motion A motion was introduced by Wentz, seconded by Swenson, and unanimously adopted: That the Board approves to apply $800.0o from the Nursing Home remodeling fund to install speakers in new dining rooms and install nurse call lights. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the Board approves to request funds for Nursing Home generator from the 2004 County contingency funds from Finance Committee. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the Board approves the Nursing Home budget totals as presented and forward to Finance Committee. DISCUSSION OF RESOLUTIONS THE WICSONSIN COUNTIES ASSOCIATION WILL CONSIDER REGARDING THE FOLLOWING SUBJECTS: 11 #16— Supporting the State of Wisconsin to protect the health of the public: This resolution opposes the "outsourcing" of responsibilities and Federal funding under consideration by State DHFS. Administration supports continuing existing Public Health capacity. 11 #17— Support for Federal legislation to change the Medicare formula to stop - inequities in payments among states: Like many other Federal programs, Wisconsin is a "donor" state —we give more than we get back. Administration supports resolution. Discussion ensued regarding resolution #16 and resolution #17. Borup stated that administration supports both resolutions. Motion A motion was introduced by Swenson, seconded by Luckey, and unanimously adopted: That the Board supports both resolutions and approves sending a letter of support to the County Board chair to be communicated to the Wisconsin Counties Association (WCA) The Board further suggests that resolution #16 be further clarified and strengthened. REQUEST TO CREATE POSITION OF ADVANCED PRACTICE NURSE PRACTITIONER FOR 200..5: Borup stated that per the Board's motion on August 13th, request to create APNP position postponed to August 30th meeting. Kiesler updated numbers on cost impact of APNP, diversion facility savings, and emergency services revenues. Phase 1: Psychiatric Services Reevaluate and restructure psychiatric nursing services. Propose maintaining current MH /AODA Nurse Clinician position, full -time. Propose creating an Advanced Practice Nurse Prescriber position, full -time. Propose reducing current psychiatrist contract from 3 days /week to 1 day /week. Phase 2: Emergency Services Reevaluate and restructure mental health and alcohol /drug abuse emergency services. Propose restructuring MH /AODA Emergency Services from Charter 34, sub.2 (Telephone response only) to Chapter 34, sub-3 (Telephone and on -site response during designated hours). Phase 3: Residential Services Reevaluate and restructure crisis mental health residential services (i.e. ATLAS House). Propose restructuring ATLAS House from 8 crisis beds to 4 crisis and 4 diversion beds. Propose developing a Mental Health satellite office at the ' reconfigured ATLAS House. Motion A motion was introduced by Kretz, seconded by Burri, and adopted with Swenson voting no, That the Board approves to forward the proposal to personnel and then to the full Board for approval. Dorsey asked if there were any other issues to bring before the Board. Motion A motion was introduced by Wentz, seconded by Rasmussen, and unanimously adopted: that the meeting be adjourned.