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HomeMy WebLinkAboutHealth & Human Services 11-18-09 4 ' 4 e a - Marzolf will review vouchers. Revised: 11/13/09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: November 18, 2009 at 8:30 LOCATION.• (Board Room, St. Croix County DHHS Building, 1445 N. Fourth Street, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING -10/21/09 DATE OF NEXT MEETING -12/16/09 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report 3. Federal Poverty Levels information 4. Nursing Home Administrator's Report 5. 2010 Routine Meeting Dates 6. Personnel Issues a. New employees/vacancies 7. H IN 1 update 8. Nursing Home diversification of revenue - construction of 20-unit assisting living 9. Update regarding Spring Valley Health Care Campus project 10. Review of Ad Hoc Facility Committee planning 11. Implementation of tobacco-free County grounds policy 12. Pre-vocational Services Resolution for St. Croix Industries 13. Review Health and Human Services, St. Croix Industries, and Nursing Home's 2010 budget 14. Resolution amending the 2010 Health and Human Services Youth Community Support Services budget* 15. Possible agenda items for next meeting ADJOURN (Items may be taken in different order) Additions/Changes/Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 11/13/2009 10:50 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD November 18, 2009 The St. Croix County Health and Human Services Board met on November 18, 2009 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Linda Luckey Richard Marzolf Gerald Peterson Dr. Lisa Ramsay Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Huma,Services;Director Jennifer Pempek, Financial Manager Frank Robinson, Nursing Home Administrator Kathy Dunlap, Family and Children's Coordinator Wendy Kramer, Public Health Officer/Public Health Coordinator F'seii Geralyn Karl, HeaA. Educator Kim Dupre, Information Systems Analyst Malva Sirek, Secretary x OTHERS PRESENT: Roger Rebholz, County Board Chair Tammy Funk, Human Resource,„Administrator Melanie Schorr, Intern Jeff'olmquist, New Richmond News Loyla Was}-,al Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally publiciz(~cl. .r NEXT MEETING. .".The next Health 'and Human Services Board meeting is scheduled for Wedne diyA December 16,'2009 at 8:30 AM. Berenschot will review vouchers. AGENDA: Moti6n:5 A notion was introduced by Berenschot, seconded by Larson, and unanimously'"adopted: That the agenda be approved with moving agenda item #10 above agenda item #8. MINUTES: Motion: A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the minutes of the 10/21/09 Health and Human Services Board meeting be approved as distributed. CONSIDERATION OF CLAIMS: Health and Human Services (HHS) Board member Wentz reviewed the vouchers. Motion: A motion was introduced by Marzolf, seconded by Larson, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 160254 through 160255, dated October 2116, 2009 in the amount of $12,930.00. St. Croix County Health and Human Services Board Page 2 November 18, 2009 Human Services voucher 161133, dated November 04, 2009 in the amount of $430.00. Human Services vouchers 161134 through 161176, dated November 04, 2009 in the amount of $55,964.11. Department on Aging vouchers 160256 through 160265, dated October 21, 2009 in the amount of $4,404.91. Human Services, Nursing Home, St. Croix Industries, and Government Center vouchers 160266 through 160408, dated October 21, 2009 _in the amount of $102,214.80. Human Services, ADRC and Department on Aging voucher 160551 through 160564, dated October 28, 2009 in the amount of $2,524,14, Human Services, Nursing Home, and St. Croix Industties~°?Vrouche'rs 160565 through 160676, dated October 28, 2009 in the amount of $9<; 613. 4f)?. Department on Aging and ADRC vouchers 160 4 through 160865.,E dated November 4, 2009, in the amount of $4,175.76 Human Services, Nursing Home, St.. Croix Industries, Government Center, Department on Aging, and ADRC vouchers 166II66 through 160954, dated November 04, 2009 in the amount of $76,416.34. Human Services, Department on:Aging and ADRC, vouchers 161918 through 162016, dated November 11, 2009 in the, amount of $29,0,25.36. Human Services, Nursi c~ Home, St. Croix Industries, and Government Center, vouchers 162017 throb 162106, dated November 11, 2009 in the amount of $88,156.37. A Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 16182,1 through 16191.7, .;dated November 11, 2009 in the amount of $65,018.93..: H. f„ Nursing R6iive'".. ouch,'grs X162103 through 162155, dated November 11, 2009 in the amount $7g 1y. Human.Services,Tforkshdp, Public Health, Social Services vouchers 529 through 556, dated Septemb"6r'A,17, 2009 in the amount of $390,689.67. Human Services and Nursing Home vouchers 495 through 519, dated September 17, 2009 in the alftount of $137,606.19. Workshop vouchers 110 through 115, dated September 17, 2009 in the amount of $14,940.60. Human Services, Workshop, Public Health, Social Services vouchers 557 through 586, dated October 01, 2009 in the amount of $392,599.80. Human Services and Nursing Home vouchers 520 through 546, dated October 01, 2009 in the amount of $162,790.43. St. Croix County Health and Human Services Board Page 3 November 18, 2009 Workshop vouchers 116 through 121, dated October 01, 2009 in the amount of $13,059.77. Human Services, Workshop, Public Health, Social Services vouchers 587 through 615, dated October 15, 2009 in the amount of $395,844.30. Human Services and Nursing Home vouchers 547 through 571, dated October 15, 2009 in the amount of $153,033.77. Workshop vouchers 122 through 127, dated October 15, 2009 in the amount of $9,154.06. FINANCIAL REPORT: The following financial report for Health and Human Services through September, 2009 was distributed. Pempek noted the state has not taken back an overpayment for Long Term Support funds, .;,tch is estimated to be approximately $1.2 million. =:n F; St. Croix County Health and Human Services Board Page 4 November 18, 2009 i HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget September 30, 2009 Balance % Administration (282,648.48) (566,829.30) 284,180.82 200.5% AODA Services 755,622.52 550,078.23 205,744.29 72.8% Long Term Support 2,631.098.96 31848,834.22 (1,217,735.26) 146.3% Mental Health 3,445,706.61 2,475,489.83 970,216.78 71.8% Family & Children's 2,908,13 35 .69 .2,234,927.95 673,907.74 76.B* Public Health 1,976,028.13 1,661,999.91 314,028.22 84.1% .Economic Support 1,140,696.47 741,906.67 398,789.80 65.0% General Relief 0.00 0.00 0.00 0. Coordinated Services{SED- 2,835,374.19 1,821,602.98 1,013,771.21 64.2%- ARDC 632,000.00 423,615.00 208,385.00 67.0% Department on Aging 846.623.00 683,323.00 163,300.00 80.7°/ Carryover Funds 1,312,360.00 984,270.00 328,090.00 75.0°/ REVENUES HUMAN SERVICES PROGRAMS 18,201,897.09 14,859,218.49 3,342,678.60 81.6% SUMMARY Total .OF EXPENDITURES Budget September 30, 2009 Balance % Administration 1,029,711.52 757,822.00 271,889.52. 73.6% Alcohol-Drug Abuse 755,822.52 528,056.44 227,766.08 69.9°, Long Term Support 2,631,098.96 2,071,036.67 560,062.29 78.7% Mental Health 3,445,706.61 2,590,341.22 855,365.39 75.2% Family& Children's 2,908,835.69 2,109,527.98 799,307.71 72.5% Public Health 1,976,028.13 1,386,499.02 589,529.11 70.2% Economic Support 1,140.696.47 867,622.10 273,074.37 76.1% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service/SED 2,835,374.19 1,736,894.99 1,098,479.20 61.3% ARDC 632,000.00 384,107.88 247,892.12 60.8% o Department on Aging 846,623.00 526,133.70 320,469.30 62.1 EXPENDITURES HUMAN SERVICES PROGRAMS 18,201,897.09 12,958,071.59 51243,825.50 71.2% Total S 1.901.146.90 The following financial report for St. Croix Industries through September was distributed.,, St. Croix County Health and Human Services Board Page 5 November 18, 2009 St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget September 30, 2009 Balance % WS Operations 1,342,664.56 1,044,259.91 298,404.65 77.8% WS Production 422,286.84 217,744.22 204,542.62 51.6% WS Helping Hands 71,726.26 77,639.71 (5,913.45) 108.2% WS Pop/Vending 7,250.00 7,697.30 (447.30) 106.2% WS Ram 77,44100 26,309.91 51,133.09 34.0% WS Vocational Placement 371,831.60 253,696.49 118,135.11 68.2% WS Comm Based Day Prog 183,214.95 120,952.01 62,262.94 66.0% REVENUES 2,476,417.21 1,748,299.55 728,117.66 70.6% SUMMARY Total OF EXPENDITURES Budget September 30, 2009 Balance % WS Operations 1,342,664.56 958.657.57 384,006.99 71.4% WS Production 422,286.84 223,085.44 199,201.40 52.8% WS Helping Hands 71,726.26 49,232.63 22,493.63 68.6% S Pop/Vending 7,250.00 4,613.04 2,636.96 63.6% WS Ram 77,443.00 19,622.74 57,820.26 25.3% WS Vocational Placement 371,831.60 237,646.64 134,184.96 63.9% WS Comm Based Day Prog 183,214.95 133,086.67 50,128.28 72.6% EXPENDITURES 2,476,417.21 11625.944.73 850,472.48 65.7% Total 122.354.82 The following financial. report for the Nursing Home through September, 2009 was distributed. Projected Medicare residents have been well over the budgeted figures as the Medicare census:,--,"amproves. The 2009 budget was built on an average of 6 Medicare residents. September had an average of 7 Medicare residents 4_,.",Octob"er had an average of 9 Medicare residents and so far in November, the 'average Medicare resident census is 11-12 and this is before the rehab rooms were officially opened and without advertising. The rehab unit is now open and ready fos "admissions. i St. Croix County Health and Human Services Board Page 6 November 18, 2009 St. Croix Health Center September 2009 Budget Actual Difference Percentage Census Operating Revenue: Medicare $903,252.00 $840,669.79 $62,582.21 93.07% Medicaid $2,481,432.00 $1.748,591.87 $732,840.13 70.47% Private Pay $760,413.00 $641,695.98 $118,717.02 84.39% Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGT/Supplemental Funds $350,000.00 $348,738.00 $1,262.00 99.64% All Other Sources $216,041.00 $172,221.22 $43,819.78 79.72% Total Operating Revenue $4,723,138.00 $3,751,916.86 $971,221.14 79.44% Operating Expenses Daily Patient Services $3,397,317.36 $2,477,810.90 $919,506.46 72.93% Special Services $284,262.00 $194,507.74 $89,754.26 68.43%. General Services $1,148,672.04 $805,066.28 $343,605.76 70.D9% Administrative Services $628,277.68 $519,852_.04 $108,425.64 82.74% Unassigned: Depreciation Based) $0.00 Others: $402,923.00 $216,657.75 $186,265.25 53.77% Utilities $202,080.00' $92,712.33 Workers Comp, Computer Tech $133,400.00 $33,288.42 Insurance $67,443.00 $90,657.00 Total Operating Expenses $5,861,452.08 $4,213,894.71 $1,647.557.37 71.89% Net From Operations ($461,977.85) (Cost of doing business prior to applying levy & outstanding rev) „ County Revenues Cc Allocations Based) $947,314.08 $710,485.56 $236,828.52 75.00% Nursing Home Carry Over $191,000.00 $143,250.00 $47,750.00 75.00% Total Outstanding $1,138,314.48 $853,735.56 $284,57852 Net from all Sources $391,757.71 /{XW,y AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through September was reviewed. Staff continue to clean up records, pulling records and sending clients to collections. The ECHO work group has made the system more user friendly and has more report options. Claims are getting submitted electronically and we have received the first electronic payment. At the end of the month, Open Minds will have an on-site visit to the facility to perform a maximization desk review in an attempt to enhance Medicaid revenues. It is anticipated the findings will be available in mid-December. The cost of the review is approximately $10,000; however, history of similar St. Croix County Health and Human Services Board Page 7 November 18, 2009 reviews shows an increase of 5-10% in revenue. Additionally, the review will assist if a future Medicaid audit were to occur and will also address workflow process, which can address increased efficiencies. FEDERAL POVERTY LEVELS INFORMATION: Pempek distributed information regarding Federal Poverty Levels which were discussed at the October meeting. NURSING HOME ADMINISTRATOR'S REPORT: Robinson said the average monthly census for September was 64, with 6 Medicare, 41 Medicaid, 16,:private pay and 1 Family Care resident; for October average monthly census, was 65, with 9 Medicare, 39 Medicaid, 16 private pay and 1 Family Care resident: He said the rehab construction is completed and most rooms are occupied. The, Nursing Home license has been changed to reflect the private room number change. The Nursing Home went from 18 private rooms to 34 private rooms. There have been approximately 25 resident room changes to accoz odate the shift t€ ' the rehab unit. Robinson noted the Medicare census is,//`ahead of the census goal for 2009, which is a positive for the Nursing Home." Medicare reimbursement is approximately $426/resident/day compared to a-;', rate of approximately $178/resident/day for Private Pay reimbursement. Robinson said staff has shifted from getting back to discharge planners within a°,,day to getting back to them within 30 minutes. Staff .,?/,?.is reviewing brocl res for the Nursing Home. Other items being explored &t~ getting a sign on the highway for the facility and putting listings in the yellow pages. Robinson reported that the staff have bought into the change and~.continue to provide input. However, some residents that have been admitted "have higher acuity needs so he has increased staffing levels accordingly. Robinson reported he is pleased with the work done by Building Services to getsthe rehab unit going. Robinson meets with David Best from .Building Services weekly and communications have improved greatly. REVIEW OF AD HOC"-- FACILITY COMMITTEE PLANNING: Johnson distributed information shared at the County Board meet-a.n€'regarding results of the Long Range Facility Planning Study`; Phase I. ,The.,'>facility condition index (FCI) is an industry accepted method for""comparison of building condition. This will need to be addressed- for thefacilites in New Richmond to assist in making final decisidhs about 'next steps"'for building use. Phase I of the study should be completed'=by the first part of December. If approved, Phase II of the study woubegin,`;,which recommends focus on the New Richmond campus first. NURSING HOME DIVERSIFICATION OF REVENUE - CONSTRUCTION OF 20-UNIT ASSISTED LIVING: On(; f'khe 2010 operational targets is to have one (or more) new product fully assessed, implemented and profitable, which has been accomplished with the implementation of the rehab unit (implementation currently underway). A second target is to add one (or more) additional products that would be researched and staged for implementation. Facility planning and diversification of revenue need to run hand-in-hand to assure the building fits with the needs and services. Robinson is researching programming and outside pay sources to make the facility profitable. It needs to be determined what the potential is for the building and it would be premature to do anything until the facility planning study is completed. St. Croix County Health and Human Services Board Page 8 November 18, 2009 Robinson said the configuration of the Nursing Home has changed with the implementation of the rehab unit, so meetings with staff have also been implemented. Robinson reported staff continues to move forward to meet the needs of the Nursing Home residents. Peterson expressed concern regarding possibly moving too slow on issues. It was the consensus that Nursing Home diversification of revenue-construction of assisted living will remain on future agenda to keep the issue in front of the Health and Human Services Board and County Board. Dr. Ramsay suggested training staff to go into the homes of clients who want to stay in their homes. Medicare does not reimburse for home health services. Robinson is investigating the possibility of restarting home health services. UPDATE REGARDING SPRING VALLEY HEALTH CARE CAMPUS PROJECT: Kevin Larson, Spring Valley Health Care Campus, was not available to°meet prior to today's meeting. Frank Robinson and Fred Johnson will attempt to meet'' with Kevin Larson and tour his facility and provide an update at the December meeting. 2010 ROUTINE MEETING DATES: After discussion regarding dates of County Board and other meetings, this item will be postponed to theDecember meeting. RESOLUTION AMENDING THE 2010 HEALTH,/AND HUMAN SERVICES YOUTH COMMUNITY SUPPORT SERVICES BUDGET: The Office of Justic*_ Assistance (OJA) offered an opportunity for a $100,000 grant with the potential, of funding for two additional years based on performance. There is a county r6atch requirement of $11,111, which is anticipated will be funded trough money g~ne.rated through billing. Juvenile Treatment Court will offer an alternative, I process for families and their children involved in J 'nil Court where the current services model does not make lasting change arrd.the.,youth are at high risk for recidivism and/or out of home placement. Upon rece,ipL of the money, a full-time staff will need to be hired to work with' the prTime will be needed to get staff trained in billing requirements to maintain the sustainability of the program. Additionally, time, will be spelt; ."implementing this new process with assigned cases. The f686 0f,treatmeiht court will be on the children, but will also work to actively., enga`ge the parents in routine court and team meetings. Judge Vlack is very dedicated 'to this program and is determined to make it work similar to ~awhat has beeH,?,.dohe with the"adult Drug Court program. It is believed that after three, years, t1kp p? xam will be self-sustaining with no need for additional county monies, due. to 8111ing for services and avoiding out of home placements. It is anticipated the County match amount of $11,111 will be gained through case management billing for each year. The position will start by 01/01/2010. Suggestions".,,were"`made to retool the resolution. The Board recessed from 10:00 - 10:20 AM. PRE-VOCATIONAL SERVICES RESOLUTION FOR ST. CROIX INDUSTRIES: At this point, it appears a resolution supporting pre-vocational services that involve work in a sheltered workshop for an unlimited period of time as a choice for consumers may not be necessary due to an outcry from consumers. The State may have a push towards more integrated employment for sheltered workshop clients in the next five years. Johnson will work with Wentz on an appropriate response based upon feedback from meetings that are occurring this week. . St. Croix County Health and Human Services Board Page 9 November 18, 2009 RESOLUTION AMENDING THE 2010 HEALTH AND HUMAN SERVICES YOUTH COMMUNITY SUPPORT SERVICES BUDGET (continued): Motion: A motion was introduced by Marzolf, seconded by Rasmussen, and unanimously adopted, that the Board approves the following resolution: RESOLUTION AMENDING 2010 HEALTH AND HUMAN SERVICES BUDGET St. Croix County, Wisconsin WHEREAS, the St. Croix County Department of Health and Human Services and the St. Croix County Circuit Court have collaborated on a grant application to the Office of Justice Assistance (OJA'"td request funding for Juvenile Treatment Court; and WHEREAS, the problem statement in the grant application identified 37 of the 140 juvenile delinquency or juvenile in need,of protection or services court orders have been open before the courtt'-for more than one year; and WHEREAS, those working with juveniles in St. Croix County recognized that for these families, the system of ho4 orders are initiated, managed, and reviewed was not sufficient to make lasting` hanges;~ and WHEREAS, the cost of purchased services for these cases was estimated at $500,000 (not including social corker, police, attorney, or court time); and'' - WHEREAS, a committee was f&ied in January 2009 to develop a Juvenile Treatment Court Program that was bayed on the drug court model and coordinated service teams;, and WHEREAS, the mission of the Juvenile Treatment is to use intensive court supervision,,.. evideribe based practices and coordinated service teaming to assess needs and. implement services to assist families reduce alcohol and drug abuse, delinquent behaviors, truancy and uncontrollable behavior to improve.the lives of juveniles, families and the community; and WHEREAS,\ the Department of Health and Human Services received notice on November 10't', 2009 that the Federal award from the Office of Justice Assistance wasr,$100,000 with a local match requirement of $11,111 for the first year, which will be obtained through case management billing; and % WHEREAS:--this Office of Justice Assistance Grant is a three (3) year grant with a local match requirement for subsequent years; and WHEREAS, the Department of Health and Human Services has developed planning to fund a new social work position with no County levy; and WHEREAS, this new position will administer this program and will track outcomes of the Juvenile Treatment Court as part of the grant. THEREFORE, be it resolved that the St. Croix Board of Supervisors authorizes an amendment to the 2010 Health and Human Services budget for St. Croix County Health and Human Services Board Page 10 November 18, 2009 receipt of the Office of Justice Assistance grant and local match totaling the amount of $111,111. FURTHER, be it resolved that the St. Croix County Board of Supervisors authorizes an amendment to the 2010 Health and Human Services budget for Juvenile Treatment Court and the new social worker position to administer the program. PERSONNEL ISSUES: Johnson said there are no vacancies and no new hires. He reported the CARES call center for the State of Wisconsin will be closed 11/09/09 through 12/04/09 for Economic Support calls. The'`call center will be focusing on the backlog of BadgerCare Core Plus applications;y The,. State has extended an offer to any available Economic Support workers tom.„work*'hours to help with this backlog. These staff and the county would be reimbursed for actual expenses up to $68/hour. This was reviewed with Human Reso Ices and staff can provide assistance on Saturdays during AV designated, time frame. Robinson reported interviews have been conducted 'for the 'Director of Nursing position and have been narrowed to two candidates. There will be some overlap of services between Connie Sarauer and the new hire. REVIEW HEALTH AND HUMAN SERVICES, SD CROIX\INDUSTRIES, AND NURSING HOME'S 2010 BUDGET: Johnson distributed the ''`,budget summary powerpoint which was distributed at the County Board-'1eeting.'". He said~HOealth and Human Services had an additional $100,000 reduction, which "Will put more risk in the area of Behavioral Health mobile crisis and divers iono,,and ADRC guardianship. Johnson will clarify the process .to • track nendments,.~ade to the 2009 and 2010 budgets as modifications have been made."'Pay issues5for non-represented employees are planned to be discussed in December':' , Johnson questione'dwhat Board members would like for the adjusted budget information, if they w8 ld like the entire budget or just the summary sheets. It was the consensus d the ..embers that the summary sheets would be sufficient. `these ldocument,, will be distributed when the current 2010 budget amendments have been4,finalized. ~ Pr. ry H H1N1,,UPDATIE: Kramer `reported the supply of H1N1 vaccine in St. Croix County continues t&,, be limited'. She said there are different types of vaccine which carry t4 fferAt approvals for ages and/or medical conditions. Public Health has been,,;shariAg their supply of vaccine with local providers that need it. Public Health has not received enough vaccine to hold mass vaccination clinics. She said therecMs been a slight decline in reported cases of H1N1 statewide. Kramer reported Public Health opened its Emergency Operations Center on October 5th and continues to meet weekly. Kramer reported on the satellite phone used as back up communication for Public Health. The phone is not always dependable; however, it is a recommended redundant communication. It is the fourth method of redundant communication. The cost is $25/month for the phone, which is the best we can get for what we pay. Johnson will follow up with Casey Swetlik and possibly terminate the service. St. Croix County Health and Human Services Board Page 11 November 18, 2009 IMPLEMENTATION OF TOBACCO-FREE COUNTY GROUNDS POLICY: The policy will be presented and promoted to staff. Staff will be provided education on the policy. Karl presented a timeline regarding the implementation of the tobacco- free grounds policy. Cessation presentations will be presented to interested staff. The message regarding St. Croix grounds being tobacco-free will be advertised to the public. By the end of the year, signs will be posted to indicate St. Croix County grounds are tobacco-free and to mark boundaries for County property. Karl will meet with Human Resources on an as-needed basis throughout the process. POSSIBLE AGENDA ITEMS FOR NEXT MEETING: No items were brought----to the Board. Wentz asked if there were any other issues to bring before the Board.'- Wentz adjourned the meeting. y Time: 11:15 AM Chair: 'Attest: - (Secretary) II