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HomeMy WebLinkAboutHealth & Human Services 05-22-03 X 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: 05/22/03 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: 06/13/03 ACTION ON PREVIOUS MINUTES: 05/09/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Capital Outlay Plan Update 2. Nursing Home Downsizing Plans NEW BUSINESS: 1. Program Reports a. Public Health b. Long Term Support c. Economic Support 2. Health Insurance Portability and Accountability Act (HIPAA) Policy 3. Personnel Issues 4. Budget update 5. Action on Nursing Home Roof Repair bids 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 May 22, 2003 The St. Croix County Health and Human Services Board met on May 22, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Lois Burri Dr. Michael Kretz Mary Louise Olson Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Chris Bethke STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Ron Lockwood, Long Term Support Coordinator Mary Squyer, Economic Support Supervisor Barbara Nelson, Public Health Supervisor-Health Officer Becky Ruka, Accounts Receivable Supervisor Kathy Leisch, 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 Friday, June 13, 2003 at 8:30 AM. Olson will review vouchers at 8:00 AM. The following meeting is scheduled for Thursday, June 26 at 5:30 PM. The open budget hearing will follow at 6:30 PM at St. Croix Industries in the small production area. AGENDA: Motion: A motion was introduced by Berenschot, seconded by Olson, and unanimously adopted: That the agenda be approved as circulated. MINUTES: Motion: A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the minutes of the 05/09/03 Health and Human Services Board meeting be approved as distributed. CAPITAL OUTLAY PLAN UPDATE: Borup stated there was only one change in the capital outlay plan at this time. Borup stated they are working on having the ability to keep two vehicles at the Courthouse so the employees who live in that area would be able to pick the vehicles up there. Borup stated this would reduce the 2004 request for three vehicles down to two vehicles, which would reduce the trade cost to a $20,000 figure. Borup stated he would be forwarding this to Chuck Whiting. Kretz asked what kind of mileage is put on these vehicles each year and Borup stated there is approximately 20,000 miles each year. Borup stated this update excludes St. Croix Industries, Building Services and the Nursing Home. Borup stated the budget includes HIPAA compliant shelving and carpet. Swenson asked if the software upgrade was St. Croix County Health and Human Services Board Page 2 May 22, 2003 automatic. Borup stated the computer software is automatically upgraded every three or four years to keep up with technology. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: That the Board approves the change in the capital outlay plan and submit the plan to Chuck Whiting. NURSING HOME DOWNSIZING PLANS: Robole, Facilities Director, has submitted a request to an architectural firm for services to remodel the Nursing Home per action at the last Health and Human Services Board meeting. Dorsey asked whether the architectural firm has established that they will be able to remove the walls. Krieger stated the architectural firm needs to tell us exactly what needs to be done so we can cost it out with the contractor. Krieger stated that it is very important to get our costs as accurately as possible for next year. Borup stated Robole would have more specific news on this at the June meeting. Krieger stated the Wipfli report indicated the number of administrative nurses as "overstaffed." Since that time one 88% administrative nurse position was not filled. Krieger stated there might have been an error in the amount of time allotted for the activity director. Krieger is getting clarification on this. Most of the positions require full time positions. Krieger stated we can be penalized by the State and Federal government if a position is not required to be full time and we choose to make it something less we can be cited as not having sufficient staff to provide adequate care. Krieger said she has met with staff several times to talk with how they will be downsized according to the census. Krieger said the community has been concerned as to whether or not there will be a big lay off. Krieger stated staffing for census in the 80's would enable census to remain in the 80's until September 1. Census will be decreased after September 1 through staff attrition. Census today is 86 with one admission pending. They are short-term admissions. PUBLIC HEALTH: Nelson invited Board members to attend the Western Wisconsin WALHDAB Association meeting on Wednesday, May 28. This is an educational opportunity for Board members that is offered two times per year with different topics/agendas. Nelson stated she is statutorily required to keep the Board apprised of communicable disease updates. Nelson said Wisconsin currently has nine suspect cases, one probable case and no laboratory confirmed cases of SARS. St. Croix County does not have any probable or suspect cases at this time. Nelson said the State will be conducting surveillance again this year on the West Nile Virus (WNV) starting May lgt and Public Health will participate as a collection site for birds. The surveillance will be conducted until three positive birds are collected in the county. Nelson said mosquito surveillance relating to WNV and LaCrosse encephalitis would also continue through contract with Dave Geske as in the past. The Environmental Health Specialist has been working with the county recycling staff to provide information/education with notices about, and at, the tire St. Croix County Health and Human Services Board Page 3 May 22, 2003 collection on June 7th. The problems tires create in regards to mosquito breeding were discussed. Kretz asked whether there is a preparedness plan on Bioterrorism and if we are a part of that. Nelson provided several colored maps and said St. Croix County is a part of Consortium Two and is part of the Hospital Consortium One. Nelson said St. Croix County Public Health consortium is aligned with the Twin Cities trauma centers. Nelson said a lot of her time is being spent on consortium activities. An Incident Command training will be held in June that she and some other staff will attend. This is a military style of command and will be the system used in the case of an emergency situation. There will also be a Risk Communication Workshop held in June. Nelson said they are working locally on terrorism planning. She said Wendy Kramer and she attended a two and a half day terrorism planning training as part of a team that involved fire, emergency management, EMS, and Law Enforcement. This team continues to meet and work on local preparedness. Nelson said that each year Public Health does several different surveys and one of the surveys is on funding. Nelson stated St. Croix County is not a high spending county in terms of public health per capita and spends only $8.46 per capita from the tax levy on each resident. St. Croix County is the second lowest county in the 19 county western region. Nelson said there is currently 3.6 public health staff per 10,000 population, which is also the second lowest county in the western region. Kretz asked what the burden of tobacco is with our public health department. Kretz said corporate tobacco spends about $186 million dollars annually in our State. Kretz said tobacco is the number one killer with about 20% of the mortality in the nation. Kretz said this is an investment and for St. Croix County to not invest in this would be a missed opportunity. Nelson referred Board members to two handouts: one on the burden of tobacco in St. Croix County, the other the burden of diabetes. Nelson said the City of River Falls recently voted unanimously to draft a smoke-free dining ordinance and to present it at the next council meeting in June for its first reading. Nelson distributed a fact sheet from a local group "Breathe Easy River Falls." She spoke with a member from that group and was asked to share the fact sheet information with the Board. Nelson stated there will assuredly be an impact from the tobacco industry on the community, especially to restaurants and bars, and "Breathe Easy River Falls" will continue to counter propaganda on the tobacco industry. The Tobacco Free Coalition continues its education role in the community. Olson asked if the next burden would be on obesity in regards to restaurants. She said that some fast food restaurants are being sued because of the amount of fat in their food. Nelson said obesity is not far from becoming a pandemic issue in our nation. The Board recessed from 10:10 to 10:20. LONG TERM SUPPORT: Lockwood stated there are currently seven severely disabled adults in Northern Center. They are in the age range of late 40's to early 50's and cannot be moved to a nursing home setting. Lockwood said some families are filing a petition to stop the State from moving these clients from the Northern Center. They will need a structured living arrangement for their safety and for everyone's safety and will need intense supervision. Lockwood stated the waiver rate is $325.00 a day plus the Medicaid card. • St. Croix County Health and Human Services Board Page 4 May 22, 2003 Costs should not exceed the amount until the fifth or sixth year after placement. Lockwood stated the State of Wisconsin recently awarded $52,420 to St. Croix County HHSD from the Community Links Workforce and Community Capacity Building fund for 2003. The money will be used to significantly increase the medical expertise available to the waiver care management program. The Long Term Support Unit will purchase bachelor's level registered nursing services from Public Health. Current long-term care planning activities are conducted almost exclusively by social workers and consequently are inadequate to accommodate persons with more severe and complex health care needs. Lockwood said the nursing staff would assist with health care assessments, conduct medication reviews, complete health care forms, provide medical consultation and provide care management for persons with complex medical needs. The St. Croix County Aging Department will use $13,000 from this award to support the Caregiver Support Program and the Social-Model Day-Away Club. Lockwood said Counties in our region are collaborating to deal with the dramatic downsizing of Northern Center and 2004 budget constraints. The counties involved are: Barron, Chippewa, Clark, Dunn, Eau Claire, Pierce, St. Croix and Trempealeau. Given the increasingly specialized behavioral and medical needs of the client population and the need to create economies of scale, it is necessary to develop shared living arrangements with other counties. Long Term Support managers in the region realize the need for more information regarding how the various residential care providers might develop multi-county arrangements. Lockwood stated issues being explored are: • Individual rates vs. average rates, • Empty bed costs, • Optimal geographic locations, etc. ECONOMIC SUPPORT: Squyer continued discussion from the last meeting. • Food Stamp Issues: Squyer stated a recent article in the St. Paul paper was critical of County administration of food stamps in Wisconsin. It is not a problem in St. Croix County. Wisconsin's error rate for Food Stamps is indeed high; however, most of the problems stem from Milwaukee County. The Food Stamp Application is 19 pages long and very complex for both the client and the worker. Squyer said errors are found through (QC) quality control at the State level. The State is allowed to go into the client's home while the County worker does not leave the office. Squyer said the errors range from the client not reporting a new job, new shelter or utility expenses, assets over the limit or a miscalculation error by the worker. Squyer said the program is working well with only a $37.00 error noted in the latest QC. No matter what the reason for the error, whether it is a client or worker error, the County is responsible for the error. It is the policy of most counties to ask all persons applying for any type of assistance if they would like to apply for Food Stamps however we can't force them to apply. Squyer said the elderly population are still uncomfortable coming into what they think is the Welfare Department, even though the Food Stamp Program is a Federally funded Nutrition Program. Food stamps require a face-to-face interview, unlike Medical Assistance, where the client may mail in the application or do a telephone interview. Squyer said that there is still a stigma attached to getting food stamps. Not as much as before when we used coupons but people still have to separate non-edible foods from edible and pay separately. Squyer said that • St. Croix County Health and Human Services Board Page 5 May 22, 2003 people in line at the grocery stores notice and know they are using food stamps. Squyer said that when applying for food stamps, income will be self-declared. There is an income limit but no asset limit. Swenson questioned why there is not an asset limit and suggested that people should send letters or call your representatives to recommend asset limits be set for food stamps. Squyer said the State is working on a new application for food stamps that will be much simpler for the client and the worker. They are also enhancing the CARES computer system to calculate income, which will prevent errors. There is no longer an asset limit for food stamps. With the simplification of the food stamp program the error rate should decrease. Squyer said the State will start to run ads on TV for food stamps as well as outreach educating the public about the program. • Income Maintenance Workload Reduction (Projected): Squyer stated the State will be reducing the (IM) Maintenance Allocation for the year 2003 to 2004 by 15% and a reduction of about 22% in the base funding from workload at the County level. The CARES computer system will be enhanced to do much more work for the worker. Simplification of the Food Stamp Program will free up more time for the worker to handle more cases. Squyer said these would be located in Dane County, Milwaukee County and LaCrosse County. Customers will need to call the centers to report changes in their case. This again will free up time for the workers. Squyer said the State expects County workers will be able to handle a caseload of 400 cases with these changes. Squyer said we should know more by the middle to end of 2004. Squyer stated that IM caseloads are increasing rapidly: January 2002 - 1660 cases January 2003 - 1967 cases February - 1966 cases March - 2065 cases April - 2241 cases May - 2395 cases Squyer contributed this to unemployment and the bad economy. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA): Borup stated that throughout the years in his job he would get phone calls from family members or the public about clients. HIPAA strengthens client confidentiality. Department staff are in a position where they cannot respond to health related questions. Ruka stated there are four components to HIPAA. The administrative simplification deals with electronic submissions and receiving claims electronically. Ruka said the security component has not been finalized yet but the privacy notice component is effective as of April. The privacy notices have been mailed to ongoing clients to sign and mail back to us. New clients will be asked to sign the privacy notice as they come into our office. Ruka said the Birth to Three program was exempt but as of three weeks ago they will need to become HIPAA compliant. Ruka said we are a hybrid entity and a hybrid entity is a single legal entity with one tax ID number. Ruka stated some departments are covered and some are not covered but because the County provides health insurance we are required to be HIPAA compliant. Our health plan is self-funded. We are also the provider of health care services in many areas in this building and the waiver programs in Long Term Support are considered a health plan. We will now have to accept claims from • St. Croix County Health and Human Services Board Page 6 May 22, 2003 medical providers electronically and not by paper. Ruka said we will be working with our computer software vendor and the State to get it set up to submit and receive claims electronically. Ruka provided board members with a summary of the SCC HIPAA policies. PERSONNEL ISSUES: Teren Steele, AODA Counselor, has accepted a position at Midelfort Clinic in Eau Claire. Her last day will be May 23. Borup stated we are recruiting for her replacement. Borup stated Economic Support is down three positions and is hoping to be within budget for 2004. BUDGET UPDATE: Borup stated Rod Paulson would not be back to do the department budget until June 16. State Long Term Support revenues are still pending. Swenson asked whether we should be changing auditors. Borup stated Rod had surgery and it may be delayed because of that. Borup said they would like this to be done in a timelier manner if possible. ACTION ON NURSING HOME ROOF REPAIR BIDS: Borup stated Krieger and he have gone over the materials for the Nursing Home roof repair bids. Borup and Krieger are recommending bidder number three, which is North Central. Borup said they have been a good vendor and have done good work for us in the past. North Central had previously applied foam to the 1974 building and the first application to the Nursing Home. Borup stated the low bidder, Creekside Roofing, did not meet all the bid specifications and that Robole had found a Federal tax lien on Creekside Roofing. Borup stated that Corp. Counsel said it was very legitimate to share this information with the Board. Borup said Corp. Counsel is comfortable with recommending North Central because of their reputation and the quality of service we have gotten from them in the past. Motion: A motion was introduced by Swenson, seconded by Olson, and unanimously adopted: That the Board accepts the bid of $60,000 for North Central to replace the Nursing Home roof. Dorsey asked if there were any other issues to bring before the Board. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 11:20 AM Chair: Attest: (Secretary)