HomeMy WebLinkAboutHealth & Human Services 08-17-11NOTICE OF MEETING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
August 17, 2011— 8:30 A.M.
Board Room, St. Croix County DHHS Building
1445 N. 4ch Street, New Richmond Wisconsin
CALL TO ORDER
ROLL CALL
APPROVAL OF MINUTES OF PREVIOUS MEETING: 07/20/2011
ANNOUNCEMENTS & CORRESPONDENCE
1. Financial Report for Nursing Home and Health and Human Services
2. Nursing Home Administrator's report
3. St. Croix Health Center Federal Environmental Survey
4. 2011 Departmental Operational Goals —Youth Community Support Services (YCSS)
5. Economic Support Fraud Consortium Report
6. Resolution — Income Maintenance Administration
7. Community Options Funding
DATE OF NEXT MEETING: 09/21/11 at 8:30 A.M.
ADJOURN
REVIEWED AND APPROVED BY: Committee Chair and County Administrator
DATE APPROVED: 08/08/11
(Items may be taken in different order)
* * Additions /Changes /Corrections
A quorum of the St. Croix County Board of Supervisors (County Board) may he present at this meeting. Therefore, this
notice also serves as notice of'a meeting of'the County Boardfor the purpose of'ohtaining information relaxing to subjects
listed above for use at future County Board Meetings.
8/8/2011
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
August 17, 2011
The St. Croix County Health and Human Services Board met on August 17, 2011 at the St. Croix
County Health and Human Services/Health Center complex.
MEMBERS PRESENT: Esther Wentz, Chair
Leon Berenschot
Roger Larson
Richard Marzolf
Deb Rasmussen
Alfred Schrank
MEMBERS ABSENT: Frederick Horne
Linda Luckey
Dr. Lisa Ramsay, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Frank Robinson, Nursing Home Administrator
Kathy Dunlap, Family and Children's Administrator
Ron Kiesler, Behavior Health Administrator
Ronda Brown - Anderson, Economic Support Supervisor
Malva Sirek, Clerical Supervisor
OTHERS PRESENT: Pat Thompson, County Administrator
Art Tobin, Building Services Director
Kim Dupre, Information Systems Analyst
Jeff Holmquist, New Richmond News
Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally
publicized.
NEXT MEETING The next Health and Human Services Board meeting is scheduled for
Wednesday, September 21, 2011 at 8:30 AM.
MINUTES Motion A motion was introduced by Larson, seconded by Berenschot, and
unanimously adopted: That the minutes of the 07/20/11 Health and Human Services Board
meeting be approved as distributed.
NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census
for July was 60, with 6 Medicare, 37 Medicaid, 1 Family Care and 14 private pay residents. The
Medicare average daily rate paid was $579.92 for July compared to the budgeted amount of
$485.00. Acuity rates continue to be higher than budgeted. The average census improved to 60
in July and there have been more referrals from the hospital.
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August 17, 2011
Robinson reminded Board members that the annual family picnic will be Thursday, August 18,
2011, starting at 4:30 PM. Over 90 baskets have been donated for the silent auction. Money
raised from the silent auction will be used for the residents for outings and other activity events.
Board members are invited to be guests at the picnic.
ST. CROIX HEALTH CENTER FEDERAL ENVIRONMENTAL SURVEY Robinson reported
a Federal surveyor from the Chicago Regional Office of CMS came to the facility unannounced to
perform a compliance survey on the life safety code. This survey is to review how the State of
Wisconsin is surveying on their life safety code inspection. This is the first time the current Nursing
Home building has been visited by CMS. The Federal surveyor issued 21 citations in addition to
the three citation previously issued by the State. The citations are building code issues; a few
examples are some of the sidewalks settled more than 3/8 ", sidewalk lighting on one of the
emergency exits, fire caulking in smoke barrier walls, among others. Building Services have been
on top of these items and are working with SEH Engineering to help determine how to respond and
fix these deficiencies. No cost estimates are available at this time to fix these deficiencies. Tobin
indicated there were no HVAC, plumbing or electrical issues cited. The plan of correction is due
August 19, 2011.
2011 DEPARTMENTAL OPERATIONAL GOALS —YOUTH COMMUNITY SUPPORT
SERVICES (YCSS Johnson reminded Board members that a different Department will be
highlighted each month to help guide the Board with policy decisions. Dunlap and Kiesler first
discussed Multi- Systemic Therapy (MST) Services and distributed a brochure describing the
services. MST is a program that provides intensive services mostly in the home for youth at high
risk of placement out of the home. The program is community based and family focused.
Dunlap reported approximately 80% of the work is done with the parents. The program was
licensed in St. Croix County in December of 2010 and is the first licensed MST entity in
Wisconsin. The actual program started February 14, 2011. The process is highly data driven and
there are a lot of checks and balances in place to ensure model fidelity. The program is an
approximate 20 -week process and currently there are 11 active cases. Referrals can be initiated
from Child Protection, Youth Community Support Program, Juvenile Treatment, therapists, etc.
The cost per case for a 20 -week course is approximately $5,000, whereas an out -of -home service
can be as much as $9,000 /month for residential placements. The program currently has a waiting
list that continues to grow. The hope is to increase the number of therapists so that we can serve
families without lengthy periods of time on the waitlist. This program was generated from
discussion at Youth/ Juvenile Treatment Court
An assessment of the ECHO system from WHITEC has been done. Staff are looking at
alternatives for EHR (Electronic Medical Records) and hope to have a recommendation ready by
the end of September for a system that will meet the agency's needs. This was pulled from the
2011 budget but the plan is to include in the 2012 budget.
A work group was established in May, 2011 to establish an implementation plan for third -party
billing for Children's Long Term Support (CLTS) waivers. The billing is going from eight codes
to 40 codes for billing for services. There are approximately 150 vendors involved. Bills will go
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August 17, 2011
directly to the State from the vendors for payment, not through Health and Human Services.
Vendor training needed to be done to be paid by third -party administration. The plan is to go
live by November 1, 2011. There is still a fair amount of additional work to be done at the
County level.
Reassessment of workload has also been completed. There are currently two staff openings in
the program. The State rules for Children's waiver change often and there is a huge learning
curve for this program. Continued assessment of workflow will likely continue, particularly the
third party administration. The results of the Carlson Study also impacted this group of staff.
ECONOMIC SUPPORT FRAUD CONSORTIUM REPORT DHS (Department of Health
Services) restored some fraud investigation funding as of January 2011. St. Croix County opted to
join a consortia for fraud prevention and investigation for CY2011. Per January -June statistics, St.
Croix County exceeded all other county scores for a cost - benefit ratio of $25 in benefits saved for
every $1 spent on administration of the program. Economic Support staff complete the front -end
fraud investigation and refer potential fraud cases for investigations. A 15% incentive of benefits
recovered can be recouped for fraud and client -error collections. St. Croix County's participation in
a fraud consortium demonstrates their ability to successfully participate in a consortia model
delivery system.
RESOLUTION — INCOME MAINTENANCE ADMINISTRATION The original State biennial
budget recommended to centralize Income Maintenance Administration, which could have
eliminated or reduced a local presence. There was an alternate proposal from Wisconsin County
Human Services Association ( WCHSA) and Wisconsin Counties Association to work with the local
partners to form regional consortia, and the language that passed in the biennial budget is very
similar to this proposal. The result is that there will be no more than ten consortia in the State. In
the consortia, St. Croix County will be required to contribute revenue to support Income
Maintenance Administration designated at the 2009 level or $271,503 for a two year obligation. St.
Croix County has participated in preliminary consortia planning and it is recommended that St.
Croix County become a part of a consortium to have an impact on the quality and timeliness of
services provided to St. Croix County residents. It is undetermined who will be the fiscal and lead
agent for the ten - county consortia. Johnson said St. Croix County has good, quality Economic
Support staff and supervisor. Brown Anderson said it is important to recognize Economic Support
works closely with many other departments to provide support and wrap around services to mutual
clients, therefore, service delivery will impact HHS as a whole. Thompson indicated St Croix
County's participation in Income Maintenance consortia planning efforts support the County's
strategic planning efforts to provide services to its most vulnerable citizens.
Johnson and Brown Anderson plan to attend a WCHSA meeting on August 22 to obtain additional
information.
Motion A motion was introduced by Larson, seconded by Schrank, and unanimously adopted:
That the Board approves the following resolution:
St. Croix County Health and Human Services Board
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August 17, 2011
RESOLUTION AUTHORIZING PARTICIPATION IN INCOME
MAINTENANCE ADMINISTRATION CONSORTIUM
Resolution No.
St. Croix County, Wisconsin
WHEREAS, under current law, Wisconsin Statutes § 49.78, the State Department of
Health Services ( "DHS ") has delegated certain duties and responsibilities related to the
administration of the Income Maintenance program to counties; and
WHEREAS, under current law, Wisconsin Statutes §§ 46.031 and 49.78, require St.
Croix County to enter into a contract with DHS for the provision of Income Maintenance
program administration services; and
WHEREAS, as part of the Governor's budget proposal for the 2011 -13 biennium, 2011
Assembly Bill 40, the Governor proposed that, starting in calendar year 2012, responsibility for
administration of the Income Maintenance program be transferred from counties to DHS; and
WHEREAS, counties across Wisconsin registered objections to the Governor's proposal
and offered an alternative whereby counties would work cooperatively in creating regional
consortia, which would be responsible for Income Maintenance program administration services,
and
WHEREAS, the counties offered the Legislature an alternative to the Governor's
complete DHS takeover of Income Maintenance program administration, which proposal
allowed, among other things, for the creation of consortia over the course of the 2011 -13
biennium and a gradual phase -in of consortia -based contracts to replace the individual county
contracts for Income Maintenance program administration; and
WHEREAS, the Legislature's Joint Committee on Finance accepted the counties'
alternative proposal, in part, and rejected the complete DHS takeover of Income Maintenance
program administration services; and
WHEREAS, 2011 Wisconsin Act 32 (Act 32), the Biennial Budget Bill, modifies current
law related to the authorization for DHS to enter into contracts with individual counties in
relation to Income Maintenance program administration services and instead authorizes the
formation of county -based regional consortia and further authorizes the consortia to enter into a
contract with DHS related to the provision of the services; and
WHEREAS, Act 32 specifically provides that "...each county with a population of less
than 750,000 shall participate in a multi- county consortium that is approved by the department. .
." and further that ". [b]y October 31, 2011, the department shall approve multi- county
consortia...;" and
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August 17, 2011
WHEREAS, Act 32 further provides that "[t]he department may not approve more than
10 multi- county consortia...;" and
WHEREAS, Act 32 further provides that "[i]f a county with a population of less than
750,000 does not participate in a multi- county consortium or the department (DHS) determines
that a multi- county consortium does not satisfy the department's performance requirements, the
department shall assume responsibility for administering income maintenance programs in that
county or in the geographical area of the multicounty consortium...;" and
WHEREAS, Act 32 further provides that, without regard to whether a county chooses to
allow DHS to take over Income Maintenance program administration services or join a
consortium that will provide the services, St. Croix County is required to maintain a tax levy
contribution to the system at an amount not less than the amount contributed in 2009; and
WHEREAS, as a result of Act 32, St. Croix County is faced with a choice of either fully
relinquishing all responsibility for Income Maintenance program administration services to DHS
or joining a multi- county consortium consistent with the requirements established in Act 32; and
WHEREAS, St. Croix County believes it to be in the best interests of the citizens and
employees of St. Croix County to join a multi- county consortium related to the provision of
Income Maintenance program administration services consistent with the requirements
established in Act 32; and
WHEREAS, joining a multi- county consortium for purposes of the provision of Income
Maintenance program administration services will require that St. Croix County enter into a
contract or series of contracts with other counties that make up the consortium; and
WHEREAS, the contracts with other counties will establish, among other things, the
following: (1) financial responsibility for the consortium; (2) financial accountability among
consortium members; (3) individual county responsibilities related to the provision of services;
(4) methods for service level accountability among consortium members; and (5) overall
responsibility for the contract that will be entered into by the among the multi- county consortium
and DHS; and
WHEREAS, the intent of this Resolution is to authorize the County Administrator to
enter into any and all contracts and execute other documents necessary to create, form, authorize
and /or operate the multi - county consortium of which St. Croix County will be a member; and
THEREFORE, be it resolved by the Saint Croix County Board of Supervisors that:
1. St. Croix County hereby declares its intent to join a multi- county consortium consistent
with the requirements set forth in Act 32.
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August 17, 2011
2. St. Croix County hereby authorizes the County Administrator or his designee to enter into
any and all contracts or other documents necessary to create, form, authorize and /or
operate the multi- county consortium of which St. Croix County will be a member.
3. St. Croix County hereby authorizes its County Administrator or his designee to take any
and all actions necessary to effectuate the intent of this resolution.
The Board recessed from 9:50 — 9:57 AM.
COMMUNITY OPTIONS (COP) FUNDING COP waiver funding was previously part of Long
Term Support Services. When service delivery was reformed some of the COP funding shifted to
Care Management Organization (CMO); however, Health and Human Services was able to retain a
portion of the funding for children's waivers and adults with dual diagnosis wavier, which is
approximately $400,000. The State requires the governing board review how this money is spent
quarterly. This review was previously done by the Long Term Support Committee but will now be
done by the Health and Human Services Board on a quarterly basis.
Johnson recommended all waiver monies be earmarked for adults. He reported an additional
$270,000 was received for children's waivers to expand the number of children receiving services.
He reported some children have aged out of the system and have been transferred to the CMO.
Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted:
That the Board approves all COP waiver monies be used for adults.
Johnson will update the COP plan with the state.
FINANCIAL REPORT FOR NURSING HOME AND HEALTH AND HUMAN SERVICES
The following financial report for Health and Human Services, Nursing Home, St. Croix Industries,
Aging and ADRC through July, 2011 was distributed. This format is consistent with the format used
by all standing committees. Johnson noted all levy dollars have been applied. He also indicated the
state payment for ADRC has been made in full.
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