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HomeMy WebLinkAboutHealth & Human Services 09-21-11NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 21, 2011– 8:30 A.M. Board Room, St. Croix County DHHS Building 1445 N. 4ch Street, New Richmond Wisconsin L CALL TO ORDER II. ROLL CALL III. APPROVAL OF MINUTES OF PREVIOUS MEETING: 08/17/2011 IV. BUSINESS ITEMS 1. Financial Report for Nursing Home and Health and Human Services 2. Nursing Home Administrator's Report 3. 2011 Departmental Operational Goals— Economic Support 4. 2012 Budget Update 5. Nursing Home Audit Report- LarsonAllen 6. Federal Survey —Plan of Correction Funding Resolution 7. 2012 Meeting Schedule V. ANNOUNCEMENTS & CORRESPONDENCE VI. ADJOURN DATE OF NEXT MEETING: 10/19/11 at 8:30 A.M. REVIEWED AND APPROVED BY: Committee Chair and County Administrator DATE APPROVED: 09/07/2011 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. 9/12/2011 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 21, 2011 The St. Croix County Health and Human Services Board met on September 21, 2011 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Roger Larson Linda Luckey Richard Marzolf Dr. Lisa Ramsay Deb Rasmussen Alfred Schrank MEMBERS ABSENT: Frederick Horne STAFF PRESENT: Fred Johnson, Health and Human Services Director Cindy Anderson, Nursing Home Administrator Ronda Brown - Anderson, Economic Support Supervisor Malva Sirek, Clerical Supervisor OTHERS PRESENT: Pat Thompson, County Administrator Sharon Norton - Bauman County Board Member Trenton Fast, CPA, LarsonAllen Art Tobin, Building Services Director Kim Dupre, Information Systems Analyst Shaila Liebfried Pam Benson William Scholz, Intern Norm Matzek 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, October 19, 2011 at 8:30 AM. MINUTES Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted: That the minutes of the 08/17/11 Health and Human Services Board meeting be approved as distributed. Johnson introduced William Scholz, UW -RF Intern, and Cindy Anderson, Nursing Home Administrator, hired through Pathways. NURSING HOME AUDIT REPORT- LARSONALLEN Fast reviewed the 2010 audit results for the St. Croix Health Center. Fast reported as auditors there are 14 required communication items to present to the Board. Fast gave an unqualified opinion for St. Croix Health Center for St. Croix County Health and Human Services Board Page 2 September 21, 2011 2010, which is the highest level. Fast indicated St. Croix Health Center has a larger group of employees, which is better for checks and balances and no issues were found. He compared figures in St. Croix Health Center audit with other government facilities. He indicated overall nursing home occupancy is dropping with more transition to assisted living, etc. and less nursing home beds in the industry. He reported 2010 had higher health insurance costs, higher worker compensation claims, and higher retirement costs. There were more private pay days in the Nursing Home in 2010 and a 9% increase in expenses. He said the Nursing Home has no debt and accounts receivables have a 30 -day turn around, which is very good. The current industry standard recommendation is 90 to 120 days cash on hand to operate and St. Croix Health Center has 44 days cash on hand, which is not a lot of reserve. The 2012 budget will reflect an 11% decrease in Medicare reimbursement. With health care reform, it is not definite what Medicaid payments will be. 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 August, 2011 was distributed. Johnson reported from July to August, revenue is up 4.9% and expenditures are up 6.7 %. He indicated there was an additional expense of $4,000 for Westcap that will be transferred to Health and Human Services in 2012 and it has now been added on this report which would account for the difference in revenue and expense totals. 2071 Annual August Aduals Budget % of Revenues BLKkjot AckzWs To Date RaLmme RLKW Heakh & Hinman SenAces S 15,971,121 S 629,553 S 9,001,412 S 6,969,709 56.4% St Croix tdustries Z418 186 1 761 733 68.5% Aging 943 89 744 19B 79.0% ADRC Z274 66 Z140 20$ 134 94.1% N�rsi ng Home 6 418 663 3443 3 056 262 53.0% TOW Progarn Revenue S 28.10G AN S 1,3,2,26 $ 16,986,337 $ 11,120,556 60af% EjWenses Heakh & Hinman Services S 15,975,121 S 1,149,230 S 8,758,587 S 7,216,534 54.8% St Croix tdustries 2,418,182 164,663 1,445,059 973,123 59.8% Aging 943,362 64,616 575,145 368,217 61.0% ADRC 2,274,599 67_507 1,917,801 356,798 84.3% Nirsing Home 6,499,631 455,211 3,983,025 2,516,606 61.3% TOW Progam Expenrihses S 23.110 AN S 1996,= S 16,679,617 S 11,431 70 59 -3% R"U"LAUS ONW(MAd") EVOMMUCS i 505.0 s 3os.r�o P---"t ofBuVef 1 1 66_x% NURSING HOME ADMINISTRATOR'S REPORT Johnson said the average monthly census for August was 57, with 6 Medicare, 36 Medicaid, 1 Family Care and 14 private pay residents. The Medicare average daily rate paid was $574.52 for August compared to the budgeted amount of $485.00. Johnson reported the family picnic held last month had over 300 family members served and the silent basket auction raised over $3,600 that will be placed in the resident donation account to be used for resident entertainment, bingo prizes, etc. Anderson gave a brief work history of her career. She indicated she is very pleased to work in a 5 -Star facility. She reported she previously worked with Robinson and has been with Pathways for four years. St. Croix County Health and Human Services Board Page 3 September 21, 2011 The Centers for Medicare and Medicaid Services (CMS) completed a Federal look behind survey at St. Croix Health Center on July 26, 2011, which resulted in 21 citations. A plan of corrections was submitted to CMS on September 13, but was not accepted. After consultation with Building Services and Short, Elliot and Henderson (SEH) another plan of correction was submitted to CMS on September 20, 2011 and a response has not yet been received on that submission. The plan of correction needs to be approved by September 27 or CMS will stop payment to St. Croix Health Center for Medicare and Medicaid for new admissions. 2011 DEPARTMENTAL OPERATIONAL GOALS— ECONOMIC SUPPORT: Johnson reminded Board members that a different Department will be highlighted each month to help guide the Board with policy decisions. Brown Anderson reported many new strategies have been implemented to improve customer service; however reports to measure progress have not been updated by the State at this time. The goal is to get 75% of all new applications processed within 30 days. Targeted case reviews are difficult to complete when workload is too heavy as the focus is on benefits out the door first. Targeted case reviews have been done on approximately a third of the required monthly amount and the plan is to increase the number completed incrementally each month. Customer service surveys are available year round in the Economic Support lobby and duplicates are submitted to the state quarterly. The Economic Support unit participated in a management review in August which resulted in minimal corrective action and was a positive review. It was an opportunity for staff to get positive feedback on teamwork and work done. A meeting regarding forming a 10- county Economic Support/Income Maintenance consortia has been attended weekly by Brown Anderson and Johnson. St. Croix County Economic Support is currently close to the mark for staffing based on caseloads, which is currently one of the primary focuses. Wisconsin County Association (WCA) will provide a template agreement between the 10 counties forming the consortia. Eau Claire County will be the fiscal agency for the consortia. Operational goals will change according to the contract and performance standards and these details are still being worked out. In November enrollment center cases will be transitioned to the consortia counties, which was not part of the plan when consortia planning started. Staff are anxious regarding anticipated case load size with the ongoing goal of accurate and timely benefits to eligible individuals. Staff are working on fraud and front -end investigation and are actively pursuing benefit recovery. There is a 15% incentive on client -error and fraud collections. Staff are also actively pursuing third party liability (TPL) settlements as there is also a 15% incentive on settlement amounts. Thompson complimented Brown Anderson on work done. The County is well represented at the State level when Brown Anderson speaks and the County is fortunate to have her representing St. Croix County. Brown Anderson indicated many internal trainings have taken place in Economic Support. She said teamwork is critical in a task -driven system. In addition, Economic Support work is crucial in protecting at -risk populations and meeting clients' basic needs. The Board recessed from 9:35 – 9:40 AM. Dr. Ramsay left the meeting. St. Croix County Health and Human Services Board Page 4 September 21, 2011 2012 BUDGET UPDATE A summary document of the 2012 Budget was distributed to the Board. Thompson indicated there were no major changes in the proposed Aging budget. There will be some use of the trust fund to balance the Aging budget to pay for capital needs. There will be a reduction in State payments and revenue in ADRC. The 2012 Nursing Home budget reflects application of $203,000 surplus funds and will need to have approximately $130,000 in tax levy to balance the budget due to the recent announcement of 11% reduction in Medicare payments. The Nursing Home budget was built on a census of 63. St. Croix Industries' budget was built with projected lower revenue and application of approximately $39,000 in surplus. The Health and Human Services budget was built with an anticipated decrease in revenue for YCSS in 2012. Purchase of service contracts were decreased and one FTE position that is currently vacant was eliminated. This budget will be presented to Administration on October 3 2011 and to the full County Board in November of 2011. Johnson asked Anderson when she started to prioritize the Nursing Home Plan of Correction and then review the 2012 budget to see if there are further adjustments that can be made to eliminate the need for levy for operations. It is not definite what cuts will be made with Medicaid and budgets may need to be adjusted when that information is received. All capital expenses have been removed from the operating budget and a County capital fund will be established for capital requests. St. Croix County Health and Human Services Board Page 5 September 21, 2011 2012 - Heakh & Hunan SeMCe Furls 2011 Bmftd 2012 Binge[ So6mitled 2012 Admishatw Hwayd Chage Fm Submew Famd 205 - - ODAalmNdiom 199,996 207,429 211,726 4,297 Odw and adw 34,658 11,100 11,100 0 Pmgraffn iK=M 193,550 205,700 199,700 ,000 Mae and Federal Oats 296,388 213,284 224,861 11 577 Lew 218,830 276,682 206,865 ,81 Trial Re WKM & 943.362 9U1.195 854.252 59, F-d 941,362 869,966 854,252 15,7U1 2,0110 0 0 0 Trial Expmses 943,362 869,956 854,252 15,7U1 Famd 230 -ADRC MatelFedUal Oats 735 ,000 795,547 795,547 0 Lew 1,539,599 1,387,716 1,307,716 0 ToW RMeFKNM & LeVy 2,274,999 2,183,263 2,183,263 0 Fwd 230 -ADRC 2,274,299 2,181,002 2,181,002 0 300 17.261 2.261 15, 000 Trial EVmses 2,274,999 2,198,263 2,183,263 15,000 F=d 600 - MwOWHome R- 463,416 434,000 434,000 0 Medcam ParnOdt& 1,646,150 1,587,350 1,437,000 150,350 Meffirad ParnEWS 2,176,532 2,210,960 2.210.9601 0 Poude Pay RwNm 1,570,651 1,236,760 1,236,760 0 hfisDeLweo Rmeu 27,500 78,500 78,500 0 Lew 363,019 0 130,109 130,109 246,363 202,893 202,893 0 Total ReYe Km. Levy & Stffpkis 6,499,631 5,750,463 5,730,222 ,241 F=d 600 - I - Home 6,426,979 5,723,221 5,711222 11999 sAwae mai�,sm. 7.635 19.000 19.000 0 CapkW EN 63,817 8,242 0 Trial EVmses 6,498,431 5,750,463 5,730,222 ,241 Famd 625 - SC Cmoc dies RmwKws 2,418,182 2,191,750 2,191,750 0 0 39,720 39,720 0 Trial Rm mes & Swpkis Wpbed 2,418,182 2,231,470 2,231,470 0 F=d 625 St Cmoc dies 2,313,582 2,228,170 2,228,170 0 sAwae mai�,sm. 8,600 3,300 3,300 0 104,450 0 0 0 Trial EWmses 2,426,632 2,231,470 2,231,470 0 F=d 225 - WaMt, & Hmm Services gym: Add - aboo 517,150 527,500 527,500 0 AODIA 682,800 722,351 723,178 821 Medal Heakh 2,736,731 2,760,076 2,728,543 1, Frm mic 8U4,943 779,715 779,715 0 F & Chftem 1512,668 1.343.058 1343,058 0 YCSS 3,513,125 2,519,554 2,540,842 21,288 Pubic Heakh 1,127,707 1,058,884 1,058,884 0 Trial N=4M RmwKm 10,905,204 9,711,138 9,701,7U1 ,424 Fud 225 Levy 5,106,963 4,894,521 4,768,970 125,551 Trial Reines & Levy - Fud 225 16,012,173 U1,605,659 U4,470,684 134,97 F=d 225 - MS Add -aboo 1,418,626 1,581,378 1,524,947 56, AODA 793,388 752,764 752,764 0 Medal Heakh 3,490536 3,458,098 3,440,023 18,07 Ecmmuc SWpmt 1,170,901 1,051,218 1,051,218 0 Famly & ChMens 3,028,771 2,909,571 2,890,896 18,67 YCSS 3,963,406 2,899,100 2,858,800 ,300 Pubic Heakh 3,977,090 1,953,536 1,952,036 1,5110 Trial Expmses 17,828,718 U1,605,659 U4,470,684 134,97 St. Croix County Health and Human Services Board Page 6 September 21, 2011 FEDERAL SURVEY —PLAN OF CORRECTION FUNDING RESOLUTION Johnson has reviewed the resolution with Timmerman. Tobin indicated the findings listed in Category 1 will be done by September 23, 2011. Everything cited needs to be completed within a year of the exit interview. When completed, the inspection will be passed back to the State inspector to complete, not the CMS inspector. As mentioned previously, after consultation with Building Services and Short, Elliot and Henderson (SEH) another plan of correction was submitted to CMS on September 20, 2011 and a response has not yet been received on that submission. The plan of correction needs to be approved by September 27 or CMS will stop payment to St. Croix Health Center for Medicare and Medicaid for new admissions. Motion A motion was introduced by Shrank, seconded by Berenschot, and unanimously adopted: That the Board approves the following resolution: RESOLUTION APPROVING HEALTH CENTER PLAN OF CORRECTION Resolution No. St. Croix County, Wisconsin WHEREAS, the State of Wisconsin completed a State life safety code survey on June, 27, 2011; and WHEREAS, the St. Croix Health Center received three citations as a result of the State life safety code survey and completed corrective action on two of the citations; and WHEREAS, the St. Croix Health Center planned to request a continued waiver on the third citation, the K067 citation, which was issued because the corridor in the basement is being used as an air plenum; and WHEREAS, on July 26, 2011, the Centers for Medicare and Medicaid Services (CMS) completed a Federal look behind survey at the St. Croix County Health Center to determine if the State of Wisconsin is appropriately surveying facilities; and WHEREAS, the St. Croix County Health Center received 21 citations as a result of the Federal look behind survey; and WHEREAS, St. Croix County has engaged Short, Elliot, Hendrickson, Inc. (SEH) to assist in developing a plan of correction for the Federal look behind citations; and WHEREAS, the initial plan of correction submitted on August 19, 2011 was denied by CMS; and WHEREAS, an amended plan of correction was resubmitted on September 13, 2011 after direct consultation with a CMS representative to clarify requirements to obtain an approved plan of correction; and St. Croix County Health and Human Services Board Page 7 September 21, 2011 WHEREAS, the amended plan of correction must be approved by CMS by September 27, 2011 or a mandatory three -month denial of payment for new Medicaid and Medicare resident admissions will be imposed; and WHEREAS, 14 of the 21 Federal look behind citations will be corrected by September 26, 2011 as part of the amended plan of correction at an estimated cost of $40,600 to $47,250 (see attached); and WHEREAS, the amended plan of correction includes a temporary waiver(s) request for additional time to complete corrective action to accommodate public bidding requirements, determine a funding source, and receive authorizations beyond September 27, 2011 for 6 of the 21 Federal look behind citations; and WHEREAS, estimated cost for the temporary waiver items is $135,800 to $181,550 (see attached); and WHEREAS, the amended plan of correction to CMS includes a request for an annual waiver for the K067 citation; and WHEREAS, the estimated cost for correction of the K067 citation is $200,000 to $225,000, but as long as a waiver is approved annually, this correction will not have to be made (see attached); and WHEREAS, upcoming future expenses that have been identified by the Building Services Department and SEH to meet code updates that will need to be addressed by 2013 have an estimated cost of $80,000 to $105,000 (see attached); and WHEREAS, additional future expenses have been identified by the Building Services Department and SEH for repairs to walls and for drainage problems at an estimated cost of $50,000 to $100,000 (see attached); and WHEREAS, the St. Croix Health Center does not have funding available for the repairs required to complete any corrective action; and WHEREAS, reallocation of current bond proceeds has been determined to be the preferred alternative to finance costs of repairs identified in this resolution, not including the K067 citation ($200,000 to $225,000) upcoming future expenses ($80,000 to $105,000) and additional future expenses ($50,000 to $100,000) ; and WHEREAS, the Health and Human Services Board recommends that the Administration Committee reallocate current available bond proceeds to cover the cost of repairs (the County Board previously authorized the Administration Committee to reallocate bond proceeds). THEREFORE, BE IT RESOLVED that the St. Croix County Board of Supervisors directs the Administration Committee to reallocate current bond proceeds in the amount of up to $228,800 which is the highest estimated price range to pay for the costs in the plan of correction, not including the K067 citation, upcoming future expenses and additional future expenses. St. Croix County Health and Human Services Board Page 8 September 21, 2011 2012 MEETING SCHEDULE Johnson reported the Council on Aging and Disabilities opted to follow the County Board meeting schedule for 2012 and not hold a meeting in the months of February and July unless there is an item that would require committee action and then a meeting could be scheduled. It was the consensus of the Board to continue to have monthly Health and Human Services Board meetings for 2012. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 10:32 AM Chair: Attest: (Secretary)