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HomeMy WebLinkAboutHealth & Human Services 11-14-03 e CHRIS BETHKE 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: 11/14/03 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: 12/12/03 ACTION ON PREVIOUS MINUTES: 10/10/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Nursing Home Admission/Discharge Policy NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. 2004 Budget Update 4. Program Reports: a. Mental Health/AODA b. Nursing Home C. Public Health 5. Public Health Agent Program Licensing Fees 6. Action on Department Plans to Participate in the "Children's Waivers and Intensive Autism Services" 7. Approval to Purchase Commercial Laundry Dryers for Nursing Home 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 P ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD November 14, 2003 The St. Croix County Health and Human Services Board met on November 14, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Chris Bethke Lois Burri Mary Louise Olson Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Leon Berenschot, excused Dr. Michael Kretz, 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, Sanitarian Ed Thurman, Environmental Health Specialist Ron Lockwood, Long Term Support Ron Kiesler, Mental Health/AODA Coordinator Steve Kirt, Mental Health/AODA Clinical Services Supervisor Becky Ruka, Accounts Receivable Supervisor Malva Berg, Secretary OTHERS PRESENT: Brianne Prinsen, Social Worker Intern 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, December 12 at 8:30 AM. Wentz will review vouchers in December. Dr. Kretz is excused from the meetings for the next several months. AGENDA: Motion: A motion was introduced by Bethke, seconded by Wentz, 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 10/10/03 Health and Human Services Board meeting be approved. ANNOUNCEMENT: Borup announced that Colleen Hammer's home exploded. Her husband Kent Haugen was injured but is recovering. A donation account has been set up at the First National Bank for the Kent/Colleen Benefit Fund. APPOINTMENTS: Lynn Harstad resigned from the Family Support Committee. The Committee would like Dave and Cindy Hadlich appointed to replace the open position. St. Croix County Health and Human Services Board Page 2 November 14, 2003 Motion: A motion was introduced by Wentz, seconded by Swenson, and unanimously adopted: That the Board accepts the resignation of Lynn Harstad and approves the appointment of Dave and Cindy Hadlich to the Family Support Committee to replace her. NURSING HOME ADMISSION/DISCHARGE POLICY: Krieger reported to have the admission policy reviewed by an attorney would cost approximately $1,000. Krieger distributed the open admissions policy statement from 1990. It was the consensus of the Board to delete the last sentence of the statement and replaced with: The St. Croix Health Center will decide whether a resident is appropriate for placement depending upon the nursing care needs. Krieger said she didn't feel the need to spend money on a legal opinion as the policy is very generic. Swenson said there should be a legal opinion on the policy or have no policy at all. It was the consensus of the Board to have Greg Timmerman review the policy for legal advice in an effort to contain costs. Krieger said the facility has to weigh the financial obligations of the facility and still meet expectations of the admissions. CONSIDERATION OF CLAIMS: The following reports were distributed to the Board: October cash report, September unemployment report, and October fixed asset report. Health and Human Services Board member, Burri, reviewed the following vouchers: HUMAN SERVICES: 6934: The Deerfield, $6,422.09, Long Term Support purchased services. Monthly costs for a CIP I Waiver client. 7267: Rise Habilitation Services, $1,903.23, day services for two CIP IB clients. 7251: Miller & Miller, $1,105.00, Family and Children's purchased services. Legal fees to assist children in foster care to be eligible for adoption into permanent homes. 8524: Claudia Early, $18.75, Spanish interpreter. Health and Human Services are incurring costs for interpreters as more clients are coming without the ability to speak English. Nursing Home: 7287: Centuria commercial Laundry, $2,316.36, final laundry bill for approximately two weeks. All laundry is currently being done at the facility by staff. Motion: A motion was introduced by Burri, 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 6919 through 7032, dated October 16, 2003 in the amount of $158,811.97. Human Services vouchers 7206 through 7286, dated October 23, 2003 in the amount of $164,403.80. Human Services vouchers 7452 through 7507, dated October 30, 2003 in the amount of $206,576.94. St. Croix County Health and Human Services Board Page 3 November 14, 2003 Human Services vouchers 7514 through 7573, dated November 06, 2003 in the amount of $160,369.80. Human Services voucher 417, dated November 06, 2003 in the amount of $23,479.09. Human Services voucher 8456, dated November 11, 2003 in the amount of $1,600.00. Human Services vouchers 8470 through 8654, dated November 14, 2003 in the amount of $248,088.84. Human Services vouchers 8752 through 8943, dated November 14, 2003 in the amount of $64,370.09. Nursing Home vouchers 7033 through 7051, dated October 16, 2003 in the amount of $12,713.42. Nursing Home vouchers 7206 through 7286, dated October 23, 2003 in the amount of $3,075.58. Nursing Home vouchers 7444 through 7451, dated October 30, 2003 in the amount of $2,290.98. Nursing Home vouchers 7510 through 7513, dated November 06, 2003 in the amount of $3,210.57. Nursing Home vouchers 8655 through 8751, dated November 14, 2003 in the amount of $54,776.57. Human Services, Workshop, Public Health, Social Services vouchers 566 through 593, dated October 20, 2003 in the amount of $333,306.20. Human Services and Nursing Home vouchers 583 through 612, dated October 21, 2003 in the amount of $165,632.12. Human Services, Workshop, Public Health, Social Services vouchers 594 through 622, dated October 30, 2003 in the amount of $336,551.79. Human Services and Nursing Home vouchers 613 through 642, dated November 04, 2003 in the amount of $169,435.19. FINANCIAL REPORTS: The following financial reports through September were distributed. Only a portion of the position cuts is reflected in the Nursing Home financial report. IGT monies for the Nursing Home are expected any day. It is anticipated the Nursing Home should break even by the end of the year with the receipt of IGT funds. Borup pointed out there has been an increase in inpatient use for Mental Health Services. Family and Children's has had a better year in terms of out-of-home placements. Borup said there has been nothing significant in changes in the State of Wisconsin for the 2004 budget. t r St. Croix County Health and Human Services Board Page 4 November 14, 2003 ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/03 THROUGH 09/30/03 NURSING HOME 9/30/2003 Cash Balance 09/30/03 $26B,011.45 Add: Accounts Receivable, 09/30/03 Accounts Receivable $550,071.67 Accounts Payable-09/30/03 ($240,863.53) Net Current Items, 09/30/03 ($577,219.59) 2003 Revenue Recorded through 09/30/03 Includes Allocations of Anticipated Revenues 2003 Expenses Recorded through 09/30/03 Includes Allocations of Expected Expenses Net Revenues over Expenses I St. Croix County Health and Human Services Board Page 5 November 14, 2003 HEALTH AND HUMAN SERVICES - 2003 SUMMARY Total OF REVENUES Jan.-September. Budget Balance % Administration 666,OB4.78 763.412.00 97,327.22 87.3% AODA Services 342,476.48 440,846.00 98,369.52 77.7% Long Term Support 9.350,141.44 12,731.125.00 3,380.983.56 73.4% Mental Health 1,571,360.64 2,381,245.00 809,884.36 66.0% Family & Children's 2.017,544.73 2,648,969.00 631,424.27 76.2% Economic Support 899,816.36 1,025,999.00 126,182.64 B7.7% General Relief 7,900.60 18,663.00 10,762.40 42.3% REVENUES HUMAN SERVICES PROGRAMS 14.855-325-03 70 010 259.00 5 154 933 97 74-2 Public Health 1-065 562-62 1 347-443-00 281-880-3B 79.1 TOTAL REVENUES HEALTH AND HUMAN SERVICES 15.920-6B7-65 ,71 357.702-. 9 436-814-35 74.5% SUMMARY Total OF EXPENDITURES Jan.-September. Budget Balance % Administration 546,216.48 763,412.00 217,195.52 71.5% Alcohol-Drug Abuse 337,230.56 440,646.00 103,615.42 76.5% Long Term Support 10,035,359.32 * 12,731.125.00 2.695,765.68 78.6% Mental Health 1,961,577.84 2,381,245.00 419,667.16 82.4% Family & Children's 1,924,301.28 * 2,646,969.00 724,667.72 72.6% Economic Support 827,112.83 1,025,999.00 198,686.17 80.6% General Relief 7.046.06 18,663.00 11,616.94 37.8% EXPENDITURES HUMAN SERVICES PROGRAMS 15,638,844.39 20,010,259.00 4,371,414.61 78.2%. Public Health 998-306.86 1 347.443.00 349-1_36 14 74.1% TOTAL EXPENDITURES HEALTH AND HUMAN SERVICES 16-637-151.25 21-357,702 on 4 72n 550 75 77-9i To be on budget, percentage should be 75.0% St. Croix County Health and Human Services Board Page 6 November 14, 2003 NURSING HOME OPERATIONS REPORT JAN-AUGUST SEPTEMBER 'TOTAL OPERATING REVENUES 3,166,681.20 3,520,044.80 'OPERATING EXPENSES: DAILY PATIENT SERVICES 2,723,732.55 3,059,944.51 SPECIAL SERVICES 185,382.79 208,748.43 GENERAL SERVICES 759,994.21 855,156.63 ADMINISTRATIVE SERVICES 355,595.14 390,812.32 UNASSIGNED: DEPRECIATION BASED) 134,000.00 150,750.00 OTHER 221,311.88 249,465.08 TOTAL OPERATING EXPENSES 4,380,016.57 4,914,876.97 NET FROM OPERATIONS 1,213,335.3 1,394,832.1 NON-OPERATING ITEMS: REVENUE FROM RATE APPEALS 12,000.00 13,500.00 WAGE PASSTHROUGH REVENUE - - INTERGOVERNMENTAL TRANSFER G BASED 628,312.00 706,851.00 CO. ALLOCATION BASED on OPS. LEVY OF $1,282,965) 855,312.00 962,226.00 TOTAL NON-OPERATING ITEMS 1,495,624.00 1,682,577.00 EXCESS of REVENUES OVER EXPENSES 282,288.63 287,74453 JNTERFUND TRANSFERS: - 'TRANSFERS FROM OTHER FUNDS - TOTAL INTERFUND TRANSFERS - TOTAL OPERATING, NON-OPERATING & TRANSFERS 'FUND BALANCE 2002 AUDITED NUMBER 1,506,067.69 1,506,067.69 PERIOD OPERATIONS 282,288.63 287,744.83 'CASH REPLENISHMENT BASED on $250,000 for YEAR) 166,666.64 187,500.00 ;FUND BALANCE, END of PERIOD 1,955,022.96 1,981,312.52 :The facility notes that several positions were cut in March in order to decrease ,expenses by $99,702 for the last ten months of 2002. ACTUAL IGT AWARD FOR 2001-2002 IS $942,471. MENTAL HEALTH/AODA PSYCHIATRIC INPATIENT DIVERSION PROGRAM: Staff have continued to explore the options and feasibility of creating a mental health inpatient diversion program. This program would include: psychiatric care, residential care, and mobile crisis services. The hopeful outcome of the St. Croix County Health and Human Services Board Page 7 November 14, 2003 program would be to control the escalating number of psychiatric inpatient admissions and in turn the escalating drain on the County levy. The five months of research (namely, discussions State staff and staff from other Counties throughout the State) has helped our staff to reach the following conclusions: • The development of a diversion program is feasible at this time in St. Croix County. Furthermore, the development of a diversion program is in the best clinical interest of St. Croix County residents and in the best financial interest of St. Croix County taxpayers. • The development of a diversion program will require an evolution in the way in which we are organized in Mental Health Services and the way in which we conduct services. Namely, if this is to be cost effective it would require a restructuring of our psychiatric services, Community Based Residential Facility (CBRF) services, and emergency services delivery system. • From a logistics and practicality perspective, it would be necessary for St. Croix County to independently develop the diversion program. We would always have the option to sell beds to neighboring Counties if/when it made sense financially. • The evolution of a mental health psychiatric inpatient diversion program will take months, possibly a year or two, from the time it is approved until the time it is complete. Kiesler presented the Board with an outline of proposed phases to implement this program including: • Phase 1: Psychiatric Services: Reevaluate and restructure psychiatric nursing services and reevaluate and restructure psychiatric physician services. • Phase 2: Residential Services: Reevaluate and restructure crisis mental health residential services; reevaluate and restructure long term mental health residential services; and evaluate and develop mental health diversion facility. • Phase 3: Emergency Services: Reevaluate and restructure mental health and alcohol/drug abuse emergency services. Various Board members asked for specifics on how our psychiatric services might be restructured. Kiesler presented various options on how both psychiatry and psychiatric nursing might be restructured to meet the needs of a future diversion program and immediately improve revenues. Kiesler emphasized the sensitivity of this report as it may require restructuring of positions within the Department. The Board was asked for direction on how to proceed. While this agenda item was not an action item, the Board expressed a strong interest in developing the option of an Advanced Practice Nurse Practitioner position versus pursuing a full-time staff psychiatrist position. Kiesler said we need to continue to evolve to meet the market needs (namely, a system which supports short term/crisis intervention and stabilization rather than long term residential care) in order to continue to provide cost effective services. It was the consensus of the Board to list this item as an action item on December's agenda. The Board recessed from 9:50 to 10:00 AM. St. Croix County Health and Human Services Board Page 8 November 14, 2003 ACTION ON DEPARTMENT PLANS TO PARTICIPATE IN THE "CHILDREN'S WAIVERS AND INTENSIVE AUTISM SERVICES": The Long Term Support Planning Committee recommends St. Croix County agree to administer the proposed Children's Waivers. The Waivers will target children with physical, sensory and developmental disabilities as well as children with severe emotional disturbance (SED). These new Home and Community-based MA Waivers will provide a fully funded intensive treatment service for ten children with autism. All other services require a 40% county match. Because of budget constraints the limited county resources will be targeted to SED children currently supported entirely with county funds. Initially Treatment Foster Care and Residential Care will not be allowable service settings. The State will seek to amend the waivers to include foster care services. Our involvement in this program will result in a savings of County expense. The State is requesting the County to administer this program not to exceed $96/day. If costs exceed this amount, then there will be less clients in the program. Lockwood said ten children have already been identified for this program and one has been identified as being on a maintenance program at $36/day. The State sets the rates. Borup said there is no duplication of efforts for this program. St. Croix County has placement cost responsibilities. A number of different entities are responsible for the same child and there is a need for coordination of services. Board approval is requested for participation. Motion: A motion was introduced by Wentz, seconded by Swenson, and unanimously adopted: That the Board approves St. Croix County's participation in the Children's Waivers and Intensive Autism Services. APPROVAL TO PURCHASE COMMERCIAL LAUNDRY DRYERS FOR NURSING HOME: Krieger said laundry changes have been implemented on a trial basis to try to improve efficiency. Krieger is requesting approval to purchase two commercial dryers for a total cost of $7,300 to allow the Nursing Home to transition away from Centuria Laundry and reduce operating costs. Krieger said staff would be able to do the commercial laundry without new equipment but it would take longer. New dryers would make the workload less and allow staff to keep up with the laundry. Motion: A motion was introduced by Burri, seconded by Bethke, and unanimously adopted: That the Board approves the purchase of two commercial dryers for a cost of $7,300. Krieger said the Nursing Home census is 72 today. Krieger said the survey has been completed by the architect. The contract has been run by Greg Timmerman with changes and recommendations made. A schedule has been made as follows: complete bidding in mid-December, award bidding in mid-January, start the project in early February with completion of the project in three to four months. Wentz suggested forming a building subcommittee to work with the contractor on retrofitting. Chair Dorsey to consider appointments. PUBLIC HEALTH AGENT PROGRAM LICENSING FEE: The Public Health Agent's Program is proposing the following fee changes for 2004: 1. It is proposed the required reimbursement to the State be added to the current local fee. The current agent contract reimbursement rate is ten percent of the State's license fee. St. Croix County Health and Human Services Board Page 9 November 14, 2003 2. A 3% annual increase in license fees would be implemented in the following year's license schedule. 3. The license categories would change concurrently with the State. Swenson asked if the program would breakeven with the proposed increases and Diaby-Gassama said yes. Motion: A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the Board adopts the above listed fee changes for 2004. ABANDONED WELL INVENTORY: Thurman distributed maps showing locations of potential well abandonment locations and well and manure storage abandonments. He said participation in properly abandoning these wells is completely voluntary. He said Land and Water Conservation cost shared to close wells with 80% State funded and 20% County funded and the property owner would incur no cost. It was the consensus of the Board to invite Bob Heise to attend the next meeting to report as to the cost of abandoned wells. INSPECTION OF ST. CROIX COUNTY BEACHES AND RECREATION FACILITIES: Inspection began this year and continued on a biweekly basis from June 3 through September 8. No beaches were closed or required to post an advisory during the 2003 water recreation season due to water testing results. COMMUNICABLE DISEASE UPDATE/STATUS OF TB: Nelson reported that there have been five influenza cases in Wisconsin, but none in the western region. Nelson reported of three undocumented individuals tested for TB, two tested negative and one positive. She said skin testing is not a requirement to enter the U.S. She said infection is not treated in developing countries, only active disease, if even that. In the past month Public Health has seen seven individuals with positive skin tests (Mantoux) for tuberculosis. A positive test indicates the person has been exposed to active disease at some point in their life. Further tests need to be conducted in order to determine if the individual has infection (latent disease) or active TB disease. This involves at minimum a physician exam and chest x-ray. In some cases, blood work is also recommended. Medications are available, at no cost, through the WI TB Program, Division of Public Health. Ongoing monitoring, contact investigation, education, etc are responsibility of the local health department (LHD). This involves significant staff time. Ch. 252 and Administrative Rule (HFS 145) address the responsibility to "promptly take all measures necessary to prevent, suppress and control communicable disease". Along with this responsibility comes financial costs beyond the staff costs. At present, Public Health has been able to secure the additional services with local clinics for MA reimbursement rates for those individuals who are uninsured. Of the seven, three for sure are not eligible for MA. In addition, there are three individuals who were tested and are awaiting results. None of these three are insured nor are eligible for MA. Of the ten total, five are Hispanic and only one speaks broken English thus interpreter services are required as well. St. Croix County Health and Human Services Board Page 10 November 14, 2003 Public Health is not obligated to know the citizenship status of individuals, only to provide the services. This information is shared with the Board "to keep the appropriate governing body fully informed" (per Ch. 252.03). A request has been submitted to the State for Public Health to become certified as a Dispensary for TB Clinical Services. This will provide cost coverage for services to uninsured/underinsured, non-MA eligible individuals with TB infection or disease. The process will take a matter of months to accomplish. Dorsey asked if there were any other issues to bring before the Board. Recently the Department has been seeing NSF checks on a more frequent basis than in the past. Michelle Pietrick will be drafting a countywide policy to address NSF checks. The policy will include information as to how the fee is to be arrived at but keep it general enough so that it does not have to be rewritten each time the bank charge changes. Swenson applauded staff for investigating this policy and questioned if $10 is a large enough administrative charge. Borup will investigate further. Bethke said the Master Gardeners would like to increase the size of the garden. They have plans to prune the apple trees in the orchard in March. Bethke requested that one month of the farm rent be given to the Master Gardeners to install an eight-foot fence around the garden to try to less deer damage. Borup will get an estimate for an eight-foot fence. Motion: A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: that the meeting be adjourned. Time: 11:25 AM Chair: Attest: (Secretary)