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HomeMy WebLinkAboutHealth & Human Services 03-14-03 x ESTHER WENTZ WILL REVIEW VOUCHERS AT 8:00 AM ST. CROIX COUNTY REVISED 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: 03/14/03 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: 04/11/03 ACTION ON PREVIOUS MINUTES: 02/13/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Approval of Juvenile Foster Care manual NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Personnel Issues a. Mental Health staffing needs 4. Program Reports a. Public Health b. Nursing Home c. Department Medical Records space needs 5. Planning for 2004 Budget 6. Discussion of Nursing Home Census 7. Closed session per Wisconsin Statute 19.85 (1) (c) for Director's annual review 8. Reconvene into open session per Wisconsin Statute 19.85(2) 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 x ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD March 14, 2003 The St. Croix County Health and Human Services Board met on March 14, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Lois Burri Fern Johnson-Schmidt Mary Louise Olson Ralph Swenson Esther Wentz MEMBERS ABSENT: Chris Bethke, excused James Craig, 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 Fred Johnson, Family and Children's Supervisor Cathy Drury, Medical Records Supervisor Becky Ruka, Accounts Receivable Supervisor Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator 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, March 27th at 8:30 AM. The following meeting will be Friday, April 11th at 8:30 AM. AGENDA: Motion: A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the agenda be approved as circulated. MINUTES: Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the minutes of the 02/13/03 Health and Human Services Board meeting be approved as distributed. ANNOUNCEMENTS: John Shaw will be speaking on client advocacy at the old courthouse on 03/31/03 at 6:30 and will be giving the advocate's perception of the Governor's proposal. APPROVAL OF JUVENILE FOSTER CARE HANDBOOK: The foster care manual has been updated on driving while in care and foster care liability and has been reviewed with Corp Counsel and Risk Management. Swenson questioned several areas of the handbook for clarification/consistency in wording. Johnson will make necessary changes. St. Croix County Health and Human Services Board Page 2 March 14, 2003 Motion: A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the Board approves the Foster Care Manual to include corrections/clarifications as indicated by Board members. Johnson reported no errors were found in the foster care audit of the files. The unit has been given a tool to do a self-review through the end of April. Due to staff resignation at Children's Service Society (end of April 2003), the contract the Department has with Children's Service Society will most likely be modified. At this time various options are being considered, which include terminating the contract and modifying responsibilities within the department. CONSIDERATION OF CLAIMS: The following reports were distributed to the Board: February cash report and February unemployment report. Health and Human Services Board member, Wentz, reviewed the following vouchers: NURSING HOME: 2582: Jess, Marilyn, $304.50, Pharmacy Consultant. The Nursing Home contracts with a registered pharmacist to review prescription medicines for possible problems if medicines don't interact properly. 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 17912 through 17980, dated February 20, 2003 in the amount of $199,607.58. Human Services vouchers 17983 through 18060, dated February 27, 2003 in the amount of $295,156.23. Human Services vouchers 18061 through 18062, dated February 28, 2003 in the amount of $1,010.00. Human Services vouchers 18063 through 18114, dated March 06, 2003 in the amount of $49,865.97. Human Services vouchers 18115 through 18245, dated March 14, 2003 in the amount of $270,071.52. Human Services vouchers 18246 through 18384, dated March 14, 2003 in the amount of $151,927.31. Nursing Home vouchers 2555 through 2563, dated February 20, 2003 in the amount of $29,503.42. Nursing Home vouchers 2564 through 2566, dated February 27, 2003 in the amount of $5,116.65. Nursing Home vouchers 2567 through 2603, dated March 14, 2003 in the amount of $43,625.45. St. Croix County Health and Human Services Board Page 3 March 14, 2003 Human Services and Nursing Home vouchers 49 through 78, dated February 11, 2003 in the amount of $193,197.00. Human Services, Workshop, Public Health, Social Services vouchers 50 through 79, dated February 06, 2003 in the amount of $325,185.43. Human Services, Workshop, Public Health, Social Services vouchers 80 through 108, dated February 25, 2003 in the amount of $322,544.37. Human Services and Nursing Home vouchers 79 through 108, dated February 25, 2003 in the amount of $182,990.87. FINANCIAL REPORTS: The following unaudited financial reports through December were distributed to the Board. Swenson said the social worker decertification issue was tabled at Finance Committee on 03/13 due to the contingency fund balance being low. ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/02 THROUGH 12/31/02-(Unaudited) NURSING HOME 12/31/02 Cash Balance 12/31/02 $98,656.45 Add: Accounts Receivable, 12/31/02 Private Pay $52,477.70 Medicare $177,577.12 Medicaid $319,170.64 General $0.00 Accounts Payable-12/31/02 ($384,611.85) Net Current Items, 12/31/02 $263,270.06 2002 Revenue Recorded through 12/31/02 $6,994,283.77 Includes Allocations of Anticipated Revenues 2002 Expenses Recorded through 12/31/02 $6,512,594.98 Includes Allocations of Expected Expenses Excess Revenues over Expenses $481,688.79 St. Croix County Health and Human Services Board Page 4 March 14, 2003 HEALTH AND HUMAN SERVICES - 2002 SUMMARY Total OF REVENUES Jan.-Dec. Budget Balance Administration 801,706.77 786,486.00 (15,220.77) 101 AODA Services 412,079.00 434,703.00 22,624.00 94 Long Term Support 11,861,030.45 12,358,744.00 497,713.55 96 Mental Health 2,378,340.42 2,297,343.00 (80,997.42) 103 Family & Children's 2,454,513.13 2,519,843.00 65,329.87 97 Economic Support 1,101,275.14 1,095,090.00 (6,185.14) 100 General Relief 26,255.96 13,494.00 (12,761.96) 194 REVENUES HUMAN SERVICES PROGRAMS 19,035,200.87 19,505,703.00 470,502.13 97 Public Health 1,304,409.08 1,256,677.00 (47,732.08) 103 TOTAL REVENUES HEALTH AND HUMAN SERVICES 20,339,609.95 20,762,380.00 422,770.05 98 SUMMARY Total OF EXPENDITURES Jan.-Dec. Budget Balance Administration 733,324.59 786,486.00 53,161.41 93 Alcohol-Drug Abuse 394,809.17 434,703.00 39,893.83 90 Long Term Support 12,080,849.17- 12,358,744.00 277,894.83 97 Mental Health 2,350,294.56 2,297,343.00 (52,951.56) 102 Family & Children's 2,573,347.68- 2,519,843.00 (53,504.68) 102 Economic Support 1,021,725.63 1,095,090.00 73,364.37 93 General Relief 20,589.00 13,494.00 (7,095.00) 152 Accrued Payroll 0.00 0.00 0.00 0 EXPENDITURES HUMAN SERVICES PROGRAMS 19,174,939.80 19,505,703.00 330,763.20 98 I Public Health 1,188,497.04 1,256,677.00 68,179.96 94 I TOTAL EXPENDITURES HEALTH AND HUMAN SERVICES 20,363,436.84 20,762,380.00 398,943.16 98 I I To be on budget, percentage should be 100.00%. I I St. Croix County Health and Human Services Board Page 5 March 14, 2003 ST CROIX HEALTH CENTER OPERATIONS REPORT JAN THROUGH DECEMBER 2002 JAN-DEC BUDGET ACTUAL DIFFERENCE % CENSUS 93 88.5 4.5 95.16 OPERATING REVENUE: MEDICARE $ 1,254,400.00 $ 1,065,962.30 $ 188,43710 $ 84.98 MEDICAID $ 2,488,864.00 $ 2,798,295.49 $ (309,431.49) $ 112.43 PRIVATE PAY $ 1,185,142.00 $ 864,890.15 $ 320,251.85 $ 72.98 ALL OTHER SOURCES $ 66,253.00 $ 24.895.83 $ 41,357.17 37.58 TOTAL OPERATING REVENUE $ 4,994,659.00 $ 4,754,043.77 $ 240,615.23 $ 95.18 OPERATING EXPENSES: DAILY PATIENT SERVICES $ 4,299,224.00 $ 4,020,780.44 $ 278,443.56 $ 93.52 SPECIAL SERVICES $ 294,040.00 $ 279,964.28 $ 14,075.72 $ 95.21 GENERAL SERVICES $ 1,237,243.00 $ 1,146,187.76 $ 91,055.24 $ 92.64 ADMINISTRATIVE SERVICES $ 524,607.00 $ 544,204.36 $ (19,597.36) $ 104.74 UNASSIGNED: DEPRECIATION (%BASED) $ - $ 186,172.64 $ (186,172.64) $ - OTHERS $ 340.510.00 $ 335.285.50 $ 5,224.50 98.47 TOTAL OPERATING EXPENSES $ 6,695,624.00 $ 6,512,594.98 $ 183,029.02 $ 97.27 NET FROM OPERATIONS $ (1,700,965.00) $(1,758,551.21) $ 57,586.21 $ 103.39 NON-OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 18,000.00 $ 14,804.00 $ 3,196.00 $ 82.00 ITG FUNDS (%BASED) $ 700,000.00 $ 942,471.00 $ (242,471.00) $ 135.00 CO ALLOCATION (%BASED) $ 982,965.00 $ 1,282.965.00 $ (300,000.00) 131.00 TOTAL NON-OPERATING ITEMS $ 1,700,965.00 $ 2,240,240.00 $ (539,275.00) $ 132.00 NET FROM ALL SOURCES - $ 481.688.79 PERCENT SHOULD BE 100.00% FUND BALANCE 01/01/02 AUDITED $ 1,506,067.69 PRIOR OPERATIONS $ 481,688.79 CASH REPLENISHMENT (%$250,000) $ 250,000.00 FUND BALANCE END OF PERIOD $ 2,237,756.48 MENTAL HEALTH STAFFING NEEDS: Kiesler reported caseload demands for Mental Health continue to increase significantly (see "distinct client count by month", below) and asked the Board's input for planning for 2004. The continued demand for increasing Mental Health Services is bringing up the need for an additional psychotherapist. The length of our current waiting St. Croix County Health and Human Services Board Page 6 March 14, 2003 list is taking away our ability to attract private insurance clients. without private insurance clients, we will experience a significant loss of revenue. Along with losing more private insurance clients, hospitalizations have increased due to clients not being able to access timely outpatient services. Mental Health Outpatient - Distinct Client Count By Month 270 250 a 230 d w ♦ ♦ Kept Appts 0 210 • ♦ -Linear (Kept Appts) d ♦ s • Z • 190 170 150 • N N N N N N N N N ~ ~ 9 9 9 9 9 9 4J 14 -9 ® 76 lC Z 9 S., 2 1 9 (3 1 r7 d + 7m Jan-7M.,- Mayljouintoui'- L0.1g] Sep-Oct- Nov-11 Jan Feb- Mar Apr- May Jun- Jul- Aug Se Oct- Nov Dec Jan Feb01 01 01 0101 01 02 02 02 02 02 02 02 02 02 02 02 02 03 03 ♦KeptAppts 165 157 169 169 168 165 153 166 172 197 175 173 193 185 189 206 202 191 197 213 203 218 220 205 243 255 Month Kiesler distributed a chart projecting potential lost revenue through less insured clients. POTENTIAL LOST REVENUE THROUGH LOST MHO MAJINSURED CLIENTS 10% Drop 20% Drop 30% Drop MA HMO Hours Per Year 179.9 369.4 539.1 Reimbersment Per Hour $56.00 $55.00 $55.00 MA HMO Lost Revenue $9,895 $19,767 $29,651 Private Insurance Hours Per Year 291 582 873 Average Reimersment Per Hour $84.00 $84.00 $84.00 Private Insurance Lost Revenue $24,444 $48,888 $73,332 Total Lost Revenue Per Year $34,339 $68,656 $102,983 Note: MA HMO rate effective 71112002 - 7/112003. He also distributed chart (below) showing that since 1985 the MH/AODA unit has been able to generate enough revenue to offset increased expenses, hence the amount of required County levy/Basic County Allocation (State funds) St. Croix County Health and Human Services Board Page 7 March 14, 2003 required to balance the budget has remained relatively constant over the last 17 years. Kiesler expressed concern that non-action by the board would jeopardize this balance. MHIAODA Annual Expense vs. Annual Revenue vs. Annual BCA & County Levy $3,000,000 $2,500,000 $2,000,000 ■ ■ ♦ Revenue r ■ ■ r r ♦ + ■ Expense ■ c $1,500'000 r BCA/County Levy + ♦ ♦ ♦ ♦ ♦ -Linear (Expense) ♦ $1,000,000 -Linear (Revenue) r -Linear (BCAlCounty AL Levy) IL r $500,000 r r r r • $0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year Borup stated that St. Croix County is funded by BCA as the lowest per capita rate in the State. With the population growth in St. Croix County we continue to fall further behind. Borup said the issue needs to be settled by May for the 2004 budget process. New position requests need to be brought to the Personnel Committee in May. Administration will proceed with this process. Also, there is a space issue if another position is approved as there are no empty offices. Borup stated Kiesler will work on this. NURSING HOME: Krieger said 3.3 FTES have been cut due to the lower census in the Nursing Home. She said the State budget as proposed will have a significant negative impact without some planning for the rest of 2003 and all of 2004. She said the IGT money will be reduced from $77.1 million to $37.1 million starting in 2003. A 3.3% MA increase will be funded by a bed tax. That will cost the St. Croix Health Center about $38,000. It will go up from $32 on occupied beds to $116 on licensed beds effective July 1, 2003. The high labor region enhancement will be eliminated and will cost the St. Croix Health Center $11-$12/day effective July 1, 2003. The MA rate will continue to move towards a price-based formula that will hurt most county homes. The new IGT St. Croix County Health and Human Services Board Page 8 March 14, 2003 program to generate $547 million is intended to increase community and home services like COP and CIP, not nursing homes. The Medicaid Trust Fund can be used for relocation if DHFS determines that costs for services for the nursing home resident in the community are below the limit, the County department must offer a CIP II slot to eligible elderly or physically disabled nursing home resident or a CIP IB slot to the eligible nursing home resident with developmental disabilities. Residents in the Nursing Home who have MA receive $45/month for personal items and that will amount will drop to $30/month. She said a 6% surcharge will be assessed on fines from the State surveyors and this surcharge will be used to fund a position to collect forfeiture fines. The fines collected will go into the schools, not health care. Berenschot said there will be a Joint Finance Meeting on 04/03/03 in River Falls and felt the Health and Human Services Board should be represented. It was the consensus of the Board that Borup should attend if possible. Whiting said there are lots of issues with the budget with different priorities. The Board recessed from 10:00 to 10:10. DISCUSSION OF NURSING HOME CENSUS: The Wipfli report will be given to the full County Board on 03/18/03. With low census and the Nursing Home facing revenue cuts as discussed previously, the Nursing Home is at significant fiscal risk. Given current circumstances, administration is recommending a reduction to 72-76 licensed beds. Krieger said now is the opportune time to downsize as there may be incentives to downsize. If downsizing is approved by the Health and Human Services Board, the issue would then go to the full County Board and then a request would be made to the State. This process would need to be completed by June 30th to avoid the licensed bed tax and capture incentives for downsizing. Administration is also interested in pursuing possible alternative uses for the Nursing Home space that would be vacated if a number of beds were downsized. This area would be separate from the Nursing Home so there would be no exposure or threat to Nursing Home residents. One possibility suggested was a Mental Health CBRF, which has potential to generate revenues and reduce costs, thus redirecting monies to the County rather than outside the County. Also, it may be possible to offer more private rooms in the nursing home and more dining areas if licensed beds were downsized. This item will be added to the agenda for 03/27/03 as an action item. A resolution will be drafted regarding downsizing the Nursing Home. If the resolution passes, it will be brought to the full County Board at the 04/15 meeting. Krieger was instructed to clarify monies/incentives available to the Nursing Home for downsizing. It was the consensus of the Board to operate the Nursing Home as usual for now. PLANNING FOR 2004 BUDGET: Borup highlighted a few areas of the Governor's budget proposal. Community Aids will be cut .22%, which amounts to about $3,797 cut. Youth Aids was unchanged but hoped for some increase to offset rise in alternative care costs with the state raising correctional costs 11%. The proposed closure of Northern Center will place seven county residents in the community with a reimbursement of $325/day plus MA card. There are several issues with Economic Support, they are as follows: ■ The state proposed to take 75% of the Medical Assistance ONLY cases from the county level and move them to the state level beginning January 1, 2004. The St. Croix County Health and Human Services Board Page 9 March 14, 2003 move should be completed by the end of 2004. Depending on how long this move would take, the county would probably see a lay off of three staff in Economic Support. ■ The second proposal is to take the Food Stamp and Child Support cases from the county level and move them to the state level beginning January 1, 2005. Also along with these programs the state will be able to take the rest of the Medical Assistance cases in 2005. This change will be completed by the end of 2005. These changes would leave the counties with W-2 only, which we would not be able to afford to run. With this in mind, by the end of 2005 we could no longer have an Economic Support Unit. Advocacy Groups are starting to gather to dispute this drastic change. The issues being looked at are fraud and the ability of Economic Support customers to apply for complex programs by mail and/or telephone. The two major groups being looked at are the elderly and disabled. St. Croix County was the only County in the Western Region where W-2 performed at a level to meet criteria for right of first refusal. DEPARTMENT OF MEDICAL RECORDS SPACE NEEDS: With HIPAA compliance demands, there is a need to centralize medical records. Administration is looking at spaces available in the building to accomplish centralization, which would benefit the Department in many ways. It was the consensus of the Board this move is necessary. Borup will work with Robole for mechanics of the move. Benefits of the move include: ➢ Current location is inadequate. ➢ Efficiency to be gained in accessibility of information and records. ➢ Efficiency in the control and maintenance of records. ➢ Customer service-all questions/concerns related to client information would be directed to one department. ➢ Consistency in the records release process. ➢ Consistency in the tracking of use and disclosure. ➢ Agency wide: continues for the active Mental Health/AODA records; consolidation of inactive records for the agency. ➢ Centralized records index. ➢ Tracking records-beginning of electronic record maintenance and indexing. ➢ Control of records in accordance with policy/procedures/regulation so that agency liability is minimized. ➢ Better security. ➢ The long-term goal of moving towards an electronic client record rather than a paper record. ➢ HIPAA compliance. Motion: A motion was introduced by Swenson, seconded by Berenschot, and unanimously adopted: That the Board endorses the Department Medical Record consolidation based on fact sheet information (listed above) and to move to a location at the discretion of the staff. Ruka said $44 million Federal money has been allocated for surveillance of HIPAA compliance nationwide. St. Croix County Health and Human Services Board Page 10 March 14, 2003 CLOSED SESSION: Motion: A motion was introduced by Berenschot, seconded by Wentz, That the Board enter closed session per Wisconsin Statute 19.85 (1) (c) and (f) for employee review. Roll call vote: Thomas Dorsey-yes Leon Berenschot-yes Chris Bethke-absent Lois Burri-yes James Craig-absent Fern Johnson-Schmidt-yes Mary Louise Olson-yes Ralph Swenson-yes Esther Wentz-yes Seven yes, two absent, motion passed. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: That the Board reconvene in open session per Wisconsin Statute 19.85 (2). Dorsey asked if there were any other issues to bring before the Board. Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: that the meeting be adjourned. Time: 12:19 AM Chair: Attest: (Secretary)