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HomeMy WebLinkAboutHealth & Human Services 06-13-03 MARY LOUISE OLSON WILL REVIEW VOUCHERS AT 8:00 AM REVISED 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: 06/13/03 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: 06/26/03 at 5:30 PM ACTION ON PREVIOUS MINUTES: 05/22/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Nursing Home Downsizing 2. Capital Outlay Plan Update NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Program Reports a. St. Croix Industries b. Mental Health/AODA c. Nursing Home 4. Personnel Issues a. Action on new position requests for 2004 1. Mental Health Therapist 2. Public Health Registered Nurse increase from 80% to 100% 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 June 13, 2003 The St. Croix County Health and Human Services Board met on June 13, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Chris Bethke Lois Burri Dr. Michael Kretz Mary Louise Olson Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Leon Berenschot, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Ron Kiesler, AODA/Mental Health Coordinator Steve Kirt, Mental Health/AODA Clinical Services Supervisor Ron Lockwood, Long Term Support Coordinator Ron Eichstaedt, St. Croix Industries Supervisor Barbara Nelson, Public Health Supervisor-Health Officer 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, June 26, 2003 at 5:30 PM. The following meeting is scheduled for Friday, July 11 at 8:30 AM. AGENDA: Motion: A motion was introduced by Swenson, seconded by Bethke, and unanimously adopted: That the agenda be approved as circulated. MINUTES: Motion: A motion was introduced by Bethke, seconded by Wentz, and unanimously adopted: That the minutes of the 05/22/03 Health and Human Services Board meeting be approved as distributed. ANNOUNCEMENTS: Borup announced that the paperwork for the termination of W-2 has been completed and staff will meet with State personnel next week. The State has requested the county to stay in the program until the end of October. Borup said with the unit being down three staff members there is a staffing shortage and we only have a legal commitment to run the program until mid-September. Dr. Kretz announced that he is a representative for the local consortium (Western Region Partnership for Public Health Preparedness) to attend the NALBOH (National Association of Local Boards of Health July 10 through 19th in Baltimore. St. Croix County Health and Human Services Board Page 2 June 13, 2003 NURSING HOME DOWNSIZING: Nursing Home staff have met regarding the building space in the Nursing Home and how to utilize to best meet the needs of the residents and staff and for division of duties for each floor. It is difficult for staff to cover all the paperwork requirements while still taking care of residents. Robole has contacted Ayres and Associates, architects, regarding remodeling in the Nursing Home. It is hoped that more accurate figures for remodeling will be available by the end of June. The current Nursing Home census is 83. Downsizing will be an ongoing process. Krieger said cabling for the electronic software should be completed next week and this should speed up the med passes and lessen med errors. There will be ongoing staff training with the goal to have paperless medical records. Krieger said ongoing labor/management meetings have been held to work on moral and labor issues. Krieger said she has received word that the high labor region may be reinstated and that bed tax for licensed beds may be reduced from $116 to $75. Krieger recommended a salary freeze for nursing home staff. Borup questioned if the Nursing Home could afford salary increases. Krieger estimated the IGT funds for 2004 will be approximately $500,000. In 2003, approximately $942,000 in IGT funds was received. It was the consensus of the Board that when preparing the Nursing Home 2004 budget to use the most probable case, not the best case or worse case. CAPITAL OUTLAY PLAN UPDATE: Borup said the plan needs to be updated to add two servers for 2004 at a cost of $7,500 and $5,000 and one server for 2005 at a cost of $5,000. Motion: A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the Board approves adding two servers for 2004 at a cost of $7,500 and $5,000 and one server for 2005 at a cost of $5,000 to the capital outlay plan and to forward the updated plan to Chuck Whiting. CONSIDERATION OF CLAIMS: The following reports were distributed to the Board: May cash report, April unemployment report, and May fixed asset report. Health and Human Services Board member, Olson, reviewed the following vouchers: HUMAN SERVICES: 19428: Autism Society of Minnesota, $600.00, LTS client expense. Cost to send an autistic child to camp. Cost is covered by the CIP IB waiver program. 19507: Northwest Passage, LTD, $14,838.00. Cost for two juveniles for 30 days each and one for 15 days in a CCI-Child Care Institution. Motion: A motion was introduced by Olson, seconded by Wentz, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 19336 through 19427, dated May 15, 2003 in the amount of $362,840.06. St. Croix County Health and Human Services Board Page 3 June 13, 2003 Human Services vouchers 19428 through 19480, dated May 22, 2003 in the amount of $98,091.13. Human Services vouchers 19481 through 19524, dated May 29, 2003 in the amount of $292,438.01. Human Services vouchers 19525 through 19577, dated June 05, 2003 in the amount of $109,064.16. Human Services vouchers 19580 through 19731, dated June 13, 2003 in the amount of $294,558.68. Human Services vouchers 19732 through 19960, dated June 13, 2003 in the amount of $136,960.51. Nursing Home vouchers 2741 through 2757, dated May 15, 2003 in the amount of $28,272.04. Nursing Home vouchers 2758 through 2760, dated May 22, 2003 in the amount of $732.76. Nursing Home vouchers 2761 through 2763, dated May 29, 2003 in the amount of $118.00. Nursing Home vouchers 2764 through 2767, dated June 05, 2003 in the amount of $235.28. Nursing Home vouchers 2768 through 2862, dated June 13, 2003 in the amount of $55,834.14. Human Services, Workshop, Public Health, Social Services vouchers 257 through 286, dated May 15, 2003 in the amount of $329,667.73. Human Services and Nursing Home vouchers 261 through 291, dated May 20, 2003 in the amount of $186,473.59. Human Services and Nursing Home vouchers 199 through 229, dated April 22, 2003 in the amount of $185,600.58. Human Services, Workshop, Public Health, Social Services vouchers 286 through 315, dated June 03, 2003 in the amount of $330,347.59. Human Services and Nursing Home vouchers 292 through 322, dated June 03, 2003 in the amount of $190,981.90. FINANCIAL REPORTS: The following financial reports through April were distributed to the Board. Ziegler said the State has agreed to pay at the number of days we had in the Nursing Home in March for the rest of the year while we downsize, so we will get more MA dollars at the end of the year. The County hopes to close the books earlier in 2004. Borup reminded the Board that 2003 is by design a tighter budget year. He pointed out the Department's expenditures and revenues. Revenues are a bit slow but are picking up. Some key revenues such as M.A. Deficit Reduction St. Croix County Health and Human Services Board Page 4 June 13, 2003 will not be received until late in the year. Mental Health inpatient costs are high. Borup also noted that the social workers that are non-union are receiving salaries higher than we budgeted; these expenditures are reflected in this report. ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/03 THROUGH 04/30/03 NURSING HOME 4/30/2003 Cash Balance 04/30/03 $712,996.66 Add: Accounts Receivable, 04/30/03 Private Pay $40,333.37 Medicare $167,900.78 Medicaid $214,348.37 General $0.00 Accounts Payable-04/30/03 ($322,258.75) Net Current Items, 04/30/03 $813,320.43 2003 Revenue Recorded through 04/30/03 $3,479,800.22 Includes Allocations of Anticipated Revenues 2003 Expenses Recorded through 04/30/03 $3,253,289.67 Includes Allocations of Expected Expenses Net Revenues over Expenses $226,510.55 St. Croix County Health and Human Services Board Page 5 June 13, 2003 HEALTH AND HUMAN SERVICES - 2003 SUMMARY Total OF REVENUES Jan.-April. Budget Balance % Administration 285,744.59 763,412.00 477,667.41 37.4% AODA Services 143,676.07 440,846.00 297,169.93 32.6% Long Term Support 4,149,551.63 12,731,125.00 8,581,573.37 32.6% Mental Health 669,345.29 2,381,245.00 1,711,899.71 28.1% Family & Children's 897,199.91 2,648,969.00 1,751,769.09 33.9% Economic Support 288,625.99 1,025,999.00 737,373.01 28.1% General Relief 1,221.11 18,663.00 17,441.89 6.5% REVENUES HUMAN SERVICES PROGRAMS 6 4 64 9 2n.o1a S nn 13 574 894A1 32 Public Health 420 994 1 1.347 443-nn 926.488 09 31,2% TOTAL REVENUES HEALTH AND HUMAN SERVICES 6.856.319 50 21.3_ 57 702 nn 14.501 38 50 32.1% SUMMARY Total OF EXPENDITURES Jan.-April. Budget Balance % Administration 216,388,79 763,412.00 547,023.21 28.3% Alcohol-Drug Abuse 134,255.67 440,846.00 306,590.33 30.5% Long Term Support 4,106,772.97 * 12,731,125.00 8,624,352.03 32.3% Mental Health 774,708.67 2,381,245.00 1,606,536.33 32.51 Family & Children's 740,478.61 * 2,648,969.00 1,908,490.39 28.0% Economic Support 331,861.52 1,025,999.00 694,137.48 32.3% General Relief 2,369.64 18,663.00 16,293.36 12.7% Accrued Payroll 428,072.89 0.00 (428,072.89) 0.0% EXPENDITURES HUMAN SERVICES PROGRAMS 6,734,908.76 20,010,259.00 13,275,350.24 33.7% Public Health 387.764 04 1.347.443 00 959 678.96 28.8% TOTAL EXPENDITURES HEALTH AND HUMAN SERVICES 7-122 672.8n 1 357 70 00 4 3S 099.20 33.3% To be on budget, percentage should be 33.33% • St. Croix County Health and Human Services Board Page 6 • June 13, 2003 ST CROIX HEALTH CENTER OPERATIONS REPORT JAN THROUGH MARCH 2003 JAN-MARCH BUDGET ACTUAL DIFFERENCE % CENSUS 88 86 2 2.27% OPERATING REVENUE: MEDICARE $ 1,254,708.00 $ 360,301.38 $ 894,406.62 28.72% MEDICAID $ 2,929,061.00 $ 967,350.87 $ 1,961,710.13 33.03%. PRIVATE PAY $ 1,025,316.00 $ 236,564.46 $ 788,751.54 23.07% ALL OTHER SOURCES $ 1,117.00 $ 19,576.37 $ (18,459.37) 1752.58% TOTAL OPERATING REVENUE $ 5,210,202.00 $ 1,583,793.08 $ 3,626,408.92 30.40% OPERATING EXPENSES: DAILY PATIENT SERVICES $ 4,252,427.00 $ 1,312,575.75 $ 2,939,851.25 30.87% SPECIAL SERVICES $ 300,748.00 $ 98,406.04 $ 202,341.96 , 32.72% GENERAL SERVICES $ 1,279,983.00 $ 393,422.53 $ 886,560.47 30.74% ADMINISSTRATIVE SERVICES $ 507,779.00 $ 156,251.63 $ 351,527.37 30.77% UNASSIGNED: DEPRECIATION(%BASED) $ - $ 62,056.00 $ (62,056.00), #DIVAD! OTHERS $ 367,926.00 $ 120,925.68 $ 247,000.32 32.87% TOTAL OPERATING EXEPNSES $ 6,708,863.00 $ 2,143,637.63 $ 4,565,225.37 31.95% NET FROM OPERATIONS $ (559,844.55) NON-OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 14,808.00 $ 4,936.00 $ 9,872.00 33.33% ITG FUNDS (%BASED) $ 798,386.00 $ 271,332.00 $ 527,054.00 33.99% CO ALLOCATION (%BASED) $ 685,467.00 $ 228,488.00 $ 456,979.00 33.33% TOTAL NON-OPERATING ITEMS $ 1,498,661.00 $ 504,756.00 $ 993,905.00 33.68% NET FROM ALL SOURCES $ - $ (55,088.55) 33.33 FUND BALANCE 01!01/03 AUDITED $ 1,684,566.10 PRIOR OPERATIONS $ (55,088.55) CASH REPLENISHMENT(%$250,000) $ 83,325.00 FUND BALANCE END OF PERIOD $ 1,712,802.55 ST. CROIX INDUSTRIES PROGRAM REPORT: Eichstaedt said a monthly report is issued to summarize what has gone on in the program and this report is shared with staff and department heads. He said St. Croix Industries has three areas: work services for clients who are not able to work in the community and may need rehab services; day services which is structured and unstructured activities for developmentally disabled clients, and community employment which prepares and places clients into community jobs for competitive and supportive employment. He said St. Croix Industries served 85 clients in May and there are six clients on the waiting list for work services. • St. Croix County Health and Human Services Board Page 7 June 13, 2003 A fifth transport driver was added so routes could be shortened. Wheelchair individuals are picked up last in the AM and dropped off first in the PM to allow them a shorter time on the route. Eichstaedt said getting service for the busses is a problem. The Board questioned the possibility of contracting transportation services. Rasmussen suggested contacting school districts as many school districts have a bus technician and may have available resources to use. The Board recessed from 9:50 to 10:00. A group photo was taken of the Board members. MENTAL HEALTH/ AODA: Inpatient expenditures for acute psychiatric hospitalizations have dramatically increased since 2000. The increase is exceeding the population growth and continues to increase. In 1999 the average was one emergency detention every two days and now the average is one emergency detention every day. To date this year there have been 161 emergency detentions and of that number 155 were either emergency detention or prior commitment, which we have little or no control over since law enforcement makes that decision; only six were voluntary admissions. Of the 161 admissions, only 112 had insurance or MA, which means that St. Croix County pays for approximately one-third of the admissions. These costs are contracted and due to the lack of hospital beds, we have no control over the inpatient costs. Staff are investigating moving from a Level 2 emergency services certification to a Level 3 to try to contain costs. A diversionary facility such as a group home or crisis home is needed to move to Level 3. Also needed is a doctor that will work with the situation immediately. There may be a need to look at a full time psychiatrist rather than contract for services to meet our needs and also bill for services. For a Level 2 assessment is done over the phone and the sheriff's department takes the client to a facility to assess and lessen liability. For a Level 3 the assessment is done face-to-face by an emergency services worker working along with the sheriff's department. Dr. Kretz said keeping clients in the community may have a better outcome than going to inpatient hospitalization but money should not drive the situation. An offer has been made for the open AODA Counselor position. Staff are currently working with the union to address years of service compensation for the position. There is a four to six week waiting list for Mental Health Services. There is very limited choice in St. Croix County for MA clients other than Health and Human Services. Administration requests a new permanent full time Mental Health Therapist position for 2004 to cover service needs. Motion: A motion was introduced by Dr. Kretz, seconded by Burri, and unanimously adopted: That the Board approves establishing a new full time permanent Mental Health Therapist position for 2004 and that the request be forwarded on to the Personnel Committee. It was the consensus of the Board to bring back information on changing from a Level 2 facility to Level 3 facility and to inform the Board what other counties are doing for services also. PUBLIC HEALTH RN INCREASE FROM 80% TO 100%: Public Health currently has an 80% position. The request is to increase this position to 100% with additional funds being billed to Long Term Support for nursing consultation services. The additional funds are only good for one year with possible • St. Croix County Health and Human Services Board Page 8 June 13, 2003 carryover for next year; however, there may be ongoing funding depending on the Governor's budget. This position would provide an initial consultation role and once trained into the waiver mechanics, would provide medical services to clients. Motion: A motion was introduced by Dr. Kretz, seconded by Bethke and adopted with Swenson voting no, That the Board approves increasing the Public Health RN permanent position from 80% to 100% with a sunset clause if funding ends. Nelson distributed the Public Health newsletter highlighting information on agent status. News developed by Laurie Diaby-Gassama, RS for the Agent Program. It is being sent out annually with license renewals. 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: 11:05 AM Chair: Attest: (Secretary)