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HomeMy WebLinkAboutHealth & Human Services 08-08-03 ESTHER WENTZ WILL REVIEW VOUCHERS AT 8:00 AM 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: 08/08/03 TIME: 8:30 a.m. LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: 08/28/03 OR 09/12/03 ACTION ON PREVIOUS MINUTES: 07/11/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Springsted Personnel Study Update NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. 2004 Budget Update 4. Program Reports a. Long Term Support b. Accounts Receivable c. Nursing Home d. Public Health 5. Resolution to Participate in Mutual Aid Agreement for Emergency Public Health Preparedness 6. Personnel Issues ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: John M. Borup DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA/NOTICE ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 8, 2003 The St. Croix County Health and Human Services Board met on August 8, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Chris Bethke Lois Burri Dr. Michael Kretz Mary Louise Olson Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Mary Louise Olson, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Barbara Nelson, Public Health Supervisor-Health Officer Laurie Diaby-Gassama, Agent Sharon Reyzer, PHN Ron Lockwood, Long Term Support Coordinator Becky Ruka, Accounts Receivable Supervisor Malva Berg, Secretary OTHERS PRESENT: None Chair Dorsey called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEETING: The next Health and Human Services Board meeting is scheduled for Thursday, August 28 at 8:30 AM. The following meeting will be held on Friday, September 12 at 8:30 AM. AGENDA: Motion: A motion was introduced by Berenschot, seconded by Bethke, and unanimously adopted: That the agenda be approved as circulated. Dr. Kretz commented that the minutes did not include tobacco survey statistics he presented. He will forward data to include in the minutes. MINUTES: Motion: A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the minutes of the 07/11/03 Health and Human Services Board meeting be approved. Borup said the county is struggling with some electronic issues for the budget preparation but will try to get the completed budget to Board members for review by August 26tH ANNOUNCEMENTS: Borup said the grant portion for the Federal terrorism money to enhance the safety of the building has been submitted to Jack Colvard. St. Croix County Health and Human Services Board Page 2 August 8, 2003 SPRINGSTED PERSONNEL STUDY UPDATE: Written copies of the study were distributed to Board members on July 11. Board approval is needed before the report is submitted to Chuck Whiting. Dr. Kretz questioned if mental Health/AODA has given any consideration for the coverage of tobacco cessation in their services and felt the County should act to provide this service. Borup said we are mandated under Wisconsin Statute 51.42 to provide services to people who are mentally ill and chemically dependent and present behavioral and safety issues for themselves and the county but tobacco cessation is not mandated under Wisconsin Statutes. Dr. Kretz said there should be interdepartmental cooperation and departments should not be put in "silos" per the mission statements. Borup said each department has its own responsibilities but units cooperate with interagency issues. He said each unit has a mission statement defined by State Statutes. Wentz said the Springsted study had narrow margins defined which didn't leave a lot of room to elaborate on cooperation. Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the Board approves the Springsted documents and recommends the documents be forwarded to Chuck Whiting so the process may move on. CONSIDERATION OF CLAIMS: The following reports were distributed to the Board: July cash report, June unemployment report, and July fixed asset report. Ziegler said there were three payrolls in July. Health and Human Services Board member, Wentz, reviewed the following vouchers: HUMAN SERVICES: 1861: Westwind Supper Club, $102.62, Restitution. This was a court-ordered collection from a juvenile for damages to the supper club. Once the money has been collected per court order, it is sent to the victim. Nursing Home: 10928: Ayres and Associates, Inc. $2,439.28, administrative expense. This is the first payment for fees for remodeling parts of the nursing home. Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 657 through 751, dated July 17, 2003 in the amount of $163,139.70. Human Services vouchers 839 through 899, dated July 24, 2003 in the amount of $264,786.06. Human Services vouchers 991 through 1030, dated July 31, 2003 in the amount of $32,169.35. Human Services vouchers 1362 through 1551, dated August 8, 2003 in the amount of $178,255.46. Human Services vouchers 1627 through 1875, dated August 8, 2003 in the amount of $131,734.46. St. Croix County Health and Human Services Board Page 3 August 8, 2003 Nursing Home vouchers 647 through 656, dated July 17, 2003 in the amount of $5,169.37. Nursing Home vouchers 837 through 838, dated July 24, 2003 in the amount of $737.81. Nursing Home vouchers 988 through 990, dated July 31, 2003 in the amount of $13,163.12. Nursing Home vouchers 1552 through 1626, dated August 08, 2003 in the amount of $86,903.79. Human Services and Nursing Home vouchers 385 through 394, dated July 08, 2003 in the amount of $5,702.95. Human Services, Workshop, Public Health, Social Services vouchers 375 through 403, dated July 11, 2003 in the amount of $325,638.28. Human Services and Nursing Home vouchers 385 through 414, dated July 15, 2003 in the amount of $194,030.63. Human Services, Workshop, Public Health, Social Services vouchers 404 through 422, dated July 25, 2003 in the amount of $279,245.90. Human Services and Nursing Home vouchers 415 through 432, dated July 29, 2003 in the amount of $158,544.83. FINANCIAL REPORTS: The following financial reports through June were distributed to the Board. Nursing Home census will be at 77 by the end of the day. There are currently no Medicare residents in the nursing home. The only pay sources for current nursing home residents are Medicaid and private pay. Medicare rates pay 3:1 over Medicaid rates. St. Croix County Health and Human Services Board Page 4 August 8, 2003 ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/03 THROUGH 06/30/03 NURSING HOME First. Ouarter gecond Ouarter Cash Balance 06/30/03 $481,269.48 $802,693.44 Add: Accounts Receivable, 06/30/03 $483,281.50 $414,006.71 Accounts Payable-06/30/03 ($204,004.29) ($382,430.92) Net Current Items, 06/30/03 $760,546.69 $834,269.23 2003 Revenue Recorded through 06/30/03 $1,539,011.74 $3,121,737.53 Includes Allocations of Anticipated Revenues 2003 Expenses Recorded through 06/30/03 $1,567,988.39 $3,185,855.02 Includes Allocations of Expected Expenses Excess Revenues over Expenses ($28,976.65) ($64,117.49) St. Croix County Health and Human Services Board Page 5 August 8, 2003 HEALTH AND HUMAN SERVICES - 2003 SUMMARY Total OF REVENUES Jan.-June. Budget Balance % Administration 469,177.98 763,412.00 294,234.02 61.5% AODA Services 236,384.22 440,846.00 204,461.78 53.6% Long Term Support 6,126,190.70 12,731,125.00 6,604,934.30 48.1% Mental Health 1,109,187.83 2,381,245.00 1,272,057.17 46.6% Family & Children's 1,426,254.37 2,648,969.00 1,222,714.63 53.8% Economic Support 615,862.77 1,025,999.00 410,136.23 60.0% General Relief 1,642.60 18,663.00 17,020.40 8.8% REVENUES HUMAN SERVICES PROGRAMS 9 984,700-47 0 010 59.00 10 Q29 5 8. 3 49_97. Public Health 691.164.46 I J47 443 00 656 278.54 TOTAL REVENUES HEALTH AND HUMAN SERVICES 10 675-BA4 93 27 7 702.00 10 681 8 7 07 50__0% SUMMARY Total OF EXPENDITURES Jan.-June. Budget Balance % Administration 378,705.90 763,412.00 384,706.10 49.6% Alcohol-Drug Abuse 223,244.09 440,846.00 217,601.91 50.6% Long Term Support 6,503,184.37 * 12,731,125.00 6,227,940.63 51.1% Mental Health 1,249,731.24 2,381,245.00 1,131,513.76 52.5% Family & Children's 1,269,130.17 * 2,648,969.00 1,379,838.83 47.9% Economic Support 569,016.83 1,025,999.00 456,982.17 55.5% General Relief 3,748.36 18,663.00 14,914.64 20.1% Accrued Payroll 0.00 0.00 0.00 0.0% EXPENDITURES HUMAN SERVICES PROGRAMS 10,196,760.96 20,010,259.00 9,813,498.04 51.0% Public Health 65 558 1.347.443.00 694.207.42 48_51 TOTAL EXPENDITURES HEALTH AND HUMAN SERVICES 10.849.996.54 21 3c;7 702-00 10 507 709.46 5Q_g% To be on budget, percentage should be 50.0% St. Croix County Health and Human Services Board Page 6 August 8, 2003 ST CROIX HEALTH CENTER OPERATIONS REPORT JANUARY THROUGH JUNE 2003 JAN-JUNE BUDGET ACTUAL DIFFERENCE % CENSUS 8$ 85 3 3.41% OPERATING REVENUE: MEDICARE $ 1,254,708.00 $ 433,453.85 $ 821,254.15 " 34.56% MEDICAID $ 2,929,061.00 $ 1,431,805.33 $ 1,497,255.67: 48.88% PRIVATE PAY $ 1,025,316.00 $ 383,585.97 $ 641,730.03 37.41'% ALL OTHER SOURCES $ 1,117.00 $ 19,955.82 $ (18,838.82) 1786.56% TOTAL OPERATING REVENUE $ 5,210,202.00 $ 2,268,800.97 $ 2,941,401.03 43.55% OPERATING EXPENSES: DAILY PATIENT SERVICES $ 4,252,427.00 $ 1,936,414.98 $ 2,316,012.02 45.54% SPECIAL SERVICES $ 300,748.00 $ 146,314.55 $ 154,433.45 48.65%' GENERAL SERVICES $ 1,279,983.00 $ 587,017.65 $ 692,965.35 , 45.86% ADMINISTRATIVE SERVICES $ 507,779.00 $ 238,206.31 $ 269,572.69 46.91% UNASSIGNED: DEPRECIATION(%BASED) $ - $ 93,084.00 $ (93,084.00); OTHERS $ 367,926.00 $ 184,817.53 $ 183,108.47 60.23% TOTAL OPERATING EXEPNSES $ 6,708,863.00 $ 3,185,855.02 $ 3,523,007.98 47.49% NET FROM OPERATIONS $ (917,054.05) NON-OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 14,808.00 $ 7,404.00 $ 7,404.00 60.00% ITG FUNDS (%oBASED) $ 798,386.00 $ 406,998.00 $ 391,388.00 50.98% CO ALLOCATION (%BASED) $ 685,467.00 $ 342,732.00 $ 342,735.00 50.00% TOTAL NON-OPERATING ITEMS $ 1,498,661.00 $ 757,134.00 $ 741,527.00 50.52% MA BED REDUCTION EST FUNDS $ 95,802.56 NET FROM ALL SOURCES $ $ (64,117.49) PERCENTAGE SHOULD BE 50.00 FUND BALANCE 01/01103 AUDITED $ 1,684,566.10 PRIOR OPERATIONS $ (64,1,17.49) CASH REPLENISHMENT(%$250,000) $ 125,000.00 FUND BALANCE END OF PERIOD $ 1,745,448.61 2004 BUDGET UPDATE: Borup said there are some concerns with electronic issues in preparing the 2004 budget. Board action will be requested on the budget at the August 28th meeting. Borup anticipates delivery of the budget to Board members by August 26. Borup reported the Federal share of MA is being increased by 2% but this is one-time money. This will make 2003-2004 budget process a bit better. Medicaid does not take cover all county costs for services provided. This results in increased costs for services. LONG TERM SUPPORT: Lockwood reported there has been a major change in the children's waiver, which serves autistic children. This change will allow for St. Croix County Health and Human Services Board Page 7 August 8, 2003 case management of about ten more children. The waiver allows for three years of intensive care then moves on to monitoring care. It will limit the amount of time spent for care to the monies we get. After three years if there is no substantial benefit, or the situation will not improve, the program will be eliminated. The program has been in force for approximately ten years in Wisconsin and allows for the reinforcement of treatment for autistic children. Lockwood reported this is the first time a waiver has served children that are emotionally disturbed and there has been some Federal participation in treatment. Northern Center will close in July of 2005. Lockwood reported we have one more year to develop community services for seven clients placed there. Lockwood reported Long Term Support is purchasing nursing consultation services from Public Health to add a nursing perspective to case management in Long Term Support care. A description of the Resource Allocation Decision Method (RAD) was distributed to the Board. A children's waiver pilot program set up by the State will need to be applied for. The pilot would amount to an additional $49/day per child. ACCOUNTS RECEIVABLE: Ruka reported there are quite a few regulations that need to be followed for billing. Ruka reviewed the sliding fee scale. If a client is on the sliding fee scale, they are billed $25/month no matter how many visits they have or how many people are in the family. The scale is set up by the State of Wisconsin and the county is required to follow the scale. Ruka explained there is a $25 no-show fee if appointments are not kept. If a client has three no-shows in a six-month period, the client needs to meet with Mental Health/AODA administrative staff to see if the client is committed to services. If a client runs out of insurance benefits, their fees go to the sliding fee scale based on income. A lot of private practice clinics will not take clients who do not have insurance or clients who have exhausted insurance benefits. If a client is under Social Security Disability, we may not forcibly make the client pay what insurance doesn't cover and we cannot collect the deductible from Medicare. Clients who use out of network insurance benefits do not qualify for the sliding fee scale. Assessment fees for an OWI need to be paid before the assessment is given. The client's bill for services needs to be paid before they can get their license back. The Department has a policy that if a client has over $50 past due, the account will be sent to a collection agency. The agency the Department uses is a local agency in Hudson, Wisconsin. Swenson questioned how much is written off each year. Ruka will report back on this. Ruka indicated they are finding more inability by clients to pay for services and longer paying time than in the past. She said court-ordered evaluations are required to be paid for before the evaluation is done. Psychological evaluations are in the range of $200 to $300 each and are either done on a sliding scale or through insurance. She requested the Board to consider requesting the payment up front for the evaluations. Wentz questioned the danger to the public if the evaluation isn't done in a timely manner because of inability to pay. Another possible area to generate St. Croix County Health and Human Services Board Page 8 August 8, 2003 revenue is for custodial counseling, ex-spousal counseling, etc. She said some private practices require a retainer for therapist consultation with lawyers/judges and asked the Board to consider implementing this practice. Ruka said attorneys request letters of therapists/counselors. She questioned the ability to charge for these letters. It was the consensus of the Board that this would be a billable service. Ruka said credit card/debit card payment option is being investigated. The Department is considering requiring deductible/co-payment payments at each visit at time of service. Borup said these are administrative decisions and will pursue them. The Board recessed from 9:45 to 9:55. NURSING HOME: The Nursing Home census will be 77 by the end of the day. Krieger reported the Medicaid population is stable. She said the Medicare population has made a significant difference in Medicare dollars as budgeted for 2003. She said the expenses budgeted are under budget but we are not able to control revenues. Due to electronic issues, the salaries and fringes anticipated for 2004 are not available so the 2004 budget process is not moving forward until those figures are available. The Nursing Home has stopped taking admissions so the census will be down to 72 residents by the end of the year. She questioned the Board if out-of- county residents should be discharged so the Nursing Home could accept Medicare admissions to improve Medicare revenue. She said there are currently four out-of-county residents in the Nursing Home. Krieger said these are all long-term residents. Other county facilities have discharged their out-of-county residents. Dorsey said this is a dead issue until the Board can look at the issue. Krieger said the Nursing Home receives three-to- one revenue for Medicare versus Medicaid residents. Dr. Kretz requested discharging out-of-county residents from the nursing home be on the next agenda. Krieger said the Nursing Home has been required to allow all residents who have always smoked to be able to smoke in the facility. She said with the discharges, the facility will probably be smoke-free by the end of the year. Positions that have been eliminated in the Nursing Home have been eliminated by position, not by the person in that position. Seniority is not recognized when RN positions are eliminated since RNs are non-union, but some consideration has been made concerning longevity. PUBLIC HEALTH: Public Health received a plaque from the Wisconsin Women's Foundation in recognition of serving as a pilot with First Breath, a program to help pregnant women stop smoking. Quit rate in the group was 43.8% with a comparison rate of 17.1% without the group. There were 15 agencies involved at the beginning and now there are 81 agencies involved in the program. Quit line cards were distributed to Board members. Rasmussen and Dr. Kretz requested a copy of the study for the First Breath Program. AGENT STATUS PROGRAM: The agent program completed its first year of operation in April. The "official" agent authority began on July 1, 2002 with the program year ending on June 30, 2003. Diaby-Gassama reported there St. Croix County Health and Human Services Board Page 9 August 8, 2003 are 313 licensed facilities in St. Croix County and 100% of the facilities received an annual inspection. A policy and procedure manual was established for the program, a computer data based was developed for the program, county inspection forms and handouts were developed, inspection reports, announcements were reformatted for publishing in local newspapers and newsletters were established. Application, forms, educational materials and newsletters are currently available on the county web site. Dr. Kretz asked if it was possible to work with restaurants regarding heart healthy meals and portion sizes. It is difficult to isolate the financial cost of the program due to start up costs, license renewal times, etc. but it is estimated the program is $5,700 in the black for the first year. Diaby-Gassama will recommend an increase in fees to the Board. Some counties have established an annual percent increase. The Board questioned if the new fee schedule could be implemented for new businesses. This will be investigated. Effective August 1, one Public Health car is being located at the Government Center to improve access for the Agent program. It is anticipated there will be cost savings in travel expenditures with this change. COMMUNITY HEALTH NEEDS ASSESSMENT: The first meeting of the Steering Committee was held on July 24 with three additional meetings planned prior to year end. By the September meeting a public survey will have been developed. A final report and recommendations on the survey will be presented to the Board at the December meeting. Nelson distributed a sheet listing State Public Health Plan Web Pages. BLUE CROSS/BLUE SHIELD FUNDS: The Medical College of WI and the UW Medical School are recipients of nearly 600 million dollars that are a result of the Blue Cross Blue Shield's conversion from a non-profit, tax-exempt organization to a for-profit company. The state insurance commissioner ordered that the company stock be "paid back" to the citizens of the state because while BC/BS was tax-exempt, they built their now, for-profit company off the backs of taxpayers. The Wisconsin United for Health Foundation wants to hear comments on the plans developed by the UW Medical School and the Medical College of WI. The funds from the settlement are not yet available and are not expected to be available for sometime. The stock must be sold yet and once the stock is sold it needs to begin to earn interest before funds will be available for service and other programs. The funds are to be used to help bring improvements in public health. This is a great opportunity for voices for public health/Public Health to be heard. It was questioned if a letter should be written by the Board to possibly get monies from the State from the BC/BS funds. Nelson said the State does not provide base funding to provide core public health functions but grant monies are available. Staff were instructed to explore the possibility to expand monies for public health in St. Croix County. Additional information will be brought to the Board as it is made available. RESOLUTION TO PARTICIPATE IN MUTUAL AID AGREEMENT FOR EMERGENCY PUBLIC HEALTH PREPAREDNESS: This resolution is a mutual aid agreement with eight other counties. The resolution has been accepted by Corp Counsel. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: That the Board approves participating in the Mutual Aid St. Croix County Health and Human Services Board Page 10 August 8, 2003 Agreement for Emergency Public Health Preparedness and to forward the following resolution for approval by the full County Board. RESOLUTION TO PARTICIPATE IN MUTUAL AID AGREEMENT FOR EMERGENCY PUBLIC HEALTH PREPAREDNESS RESOLUTION WHEREAS, Public Health Emergencies may require resources above and beyond the capabilities of the St. Croix County Health and Human Services Department and other allied agencies in St. Croix County, and WHEREAS, the St. Croix County Health and Human Services Department participates in a nine county consortium including Barron County Health and Human Services Department, Chippewa County Department of Public Health, Dunn County Health Department, Eau Claire City-County Health Department, Pierce County Health Department, Pepin County Health Department, Rusk County Department of Health and Human Services, and Polk County Department of Health, whose sole purpose is to address public health preparedness issues, and WHEREAS, mutual aid agreement will facilitate mutual assistance between members of the nine county consortium in the event of bioterriorism, other infectious disease outbreaks and public health threats and emergencies, and WHEREAS, Wisconsin Statute 66.0301 requires that county boards approval mutual aid agreements. NOW, THEREFORE, be it resolved that the St. Croix County Health and Human Services Board does hereby agree to participate in a mutual aid agreement, attached hereto and incorporated herein with the above mentioned counties for purposes of response to public health emergencies. Dated this 8th day of August, 2003. Offered by: St. Croix County Health and Human Services Board. Nelson distributed a copy of the June/July issue of The Nations Health Newsletter, which recognized St. Croix County Public Health activities for Public Health Is Everywhere activities. Dorsey asked if there were any other issues to bring before the Board. Motion: A motion was introduced by Bethke, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 11:20 AM Chair: Attest: (Secretary)