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HomeMy WebLinkAboutHealth & Human Services 02-13-03 Feb 11 03 02:50p St Croix Ca DHHS 715 246 8225 p.1 LOIS BURRI WILL REVIEW VOUCHERS AT B:00 AM REVISED 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: 02/13/03 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: 03/14/03 ACTION ON PREVIOUS MINUTES: 01/10/03 ANNOUNCEMENTS APPOINTMENTS : UNFINISHED BUSINESS: 1. Approval of Juvenile Foster Care manual 2. Participation in Child Welfare Managed Care Initiative NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Program Reports a. Mental Health/AODA b. General Relief/W-2 c. Nursing Home 4. Action on bids for Nursing Home MA/Medicare Cost Reports 5. Personnel Issues 6. Closed session per Wisconsin Statute 19.85 (1) (c) and (f) for employee review-9:00 AM. 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 February 13, 2003 The St. Croix County Health and Human Services Board met on February 13, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Chris Bethke Lois Burri James Craig Esther Wentz MEMBERS ABSENT: Fern Johnson-Schmidt, excused Mary Louise Olson, excused Ralph Swenson, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Fred Johnson, Family and Children's Supervisor John Bretl, Foster Care Coordinator Ron Kiesler, Mental Health/AODA Coordinator Steve Kirt, Mental Health/AODA Clinical Services Supervisor Kristie Tellijohn, Director of Nursing Mary Squyer, Economic Support Supervisor Becky Ruka, Accounts Receivable Supervisor Malva Berg, Secretary OTHERS PRESENT: Deb Kathan, Personnel Director 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, March 14 at 8:30 AM. Wentz will review vouchers at 8:00 on March 14. The February 27th meeting will not be held unless important agenda items arise. AGENDA: Motion: A motion was introduced by Berenschot, seconded by Bethke, 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 01/10/03 Health and Human Services Board meeting be approved with the following addition to page 6, paragraph 3: "Borup and Krieger will give a report summarizing the Wipfli report to the County Board on March 18, 2003." APPROVAL OF JUVENILE FOSTER CARE MANUAL: The Foster Care Handbook was reviewed at a previous Board meeting. A concern regarding use of automobiles by foster children because of potential liability to the County was discussed and the Board asked that this issue be further reviewed with Corporation Counsel and the County's insurance carrier. In consideration of Corporation Counsel and Risk Manager's recommendation, children in foster care will not be allowed to drive while in placement. This would include not allowing St. Croix County Health and Human Services Board Page 2 February 13, 2003 foster parents to sponsor children (for driver's license) while in placement. If children in foster care obtain their license, they need to get the license with their parents, drive while under the parent's supervision, and have insurance under their parents. Corporation Counsel recommended that we do not formally address youth obtaining their license if they remain in placement beyond their 18th birthday as they can legally sponsor themselves. Johnson said there is only one youth in care that is over 18 and this happens on a very limited basis. Corporation Counsel also recommended that we not address specific issues (such as trampolines) as issues such as that fall under statute 895.485 which deals with civil liability exemptions. Foster parents make a good faith effort to make sure kids are safe while in care. Johnson indicated the handbook is not in final form. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: That the Board approves the above recommendations made and the handbook be brought back to the Board when it is in final form. PARTICIPATION IN CHILD WELFARE MANAGED CARE INITIATIVE: Previously interest was reported to the Board regarding joining a 13-county Western Wisconsin Child Welfare "Capitation" Program intended to reduce out-of-home costs for juveniles. This project is for counties to contract with a single agency to provide or arrange for full range of in-home and out-of-home programming, including residential care centers, group homes, foster homes, shelter care, counseling, therapy, tutors, mentors, parents and family, aides, etc. An agreed upon capitated rate is paid regardless of the actual cost of services for the child and the child is approved for this service for a one-year period. Johnson met with the Consortium Counties to review proposals. The Consortium recommends the 2002-3 RFP for Western Region Child Welfare Managed Care Initiative be awarded to Lutheran Social Services (LSS) with a capitated rate of $4,200 per month. This rate is guaranteed for 12 months. Johnson said only high need cases will be referred to this program and we will only pay if the service is used. Board members were concerned if all counties refer the worst cases, the program would fail. Johnson explained LSS has experience with this program in the southern region and has been successful in providing treatment to high need cases in a cost effective manner. He said one case last year cost the county approximately $140,000 and with this program the cost could have been $50,400 if the case was accepted for services. LSS does have the ability to reject a certain percentage of cases that are referred. Borup said he supports this program as it is a win/win situation and can be funded through current program budgets allocated for placement expenses. Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the Board approves participation in the Child Welfare Managed Care Initiative. 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. St. Croix County Health and Human Services Board Page 3 February 13, 2003 Roll call vote: Thomas Dorsey-yes Leon Berenschot-yes Chris Bethke-yes Lois Burri-yes James Craig-yes Fern Johnson-Schmidt-absent Mary Louise Olson-absent Ralph Swenson-absent Esther Wentz-yes Six yes, three 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). The Board recessed from 9:25 to 9:45 AM. PERSONNEL ISSUES: The Personnel Committee met on 02/12/03. Kathan reported that letters will go out next week to all social workers. Social worker positions will be non-union effective 03/01/03 and wages and benefits are approved at Grade 7 in the pay grid according to time in the position. The difference in wages and fringes amounts to $79,900 for 10 months and the Personnel Committee agreed these monies would come from the contingency fund for the remaining ten months of 2003 and will be built into the 2004 budget. Borup announced that Mary Martinson has accepted the Financial Assistant position in the Accounts Receivable Unit. CONSIDERATION OF CLAIMS: The following reports were distributed to the Board: January cash report, December and January unemployment report, and January fixed asset report. Ziegler distributed a November financial operation report for Board review. Health and Human Services Board member, Burri, reviewed the following vouchers: HUMAN SERVICES: 17444: $9.12, W-2 Job Search. For clients on the W-2 FSET (A Federal Employment and Training Program) program we are able to reimburse W-2 clients mileage for job searches and education. This voucher was pulled not because of the amount of the check but because of the number of checks issued under this program. Last year at this time we had approximately 15 clients compared to 28 clients currently. The increase in clients reflects the problems with the economy. Motion: A motion was introduced by Burri, seconded by Bethke, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services voucher 17364, dated January 10, 2003 in the amount of $1,340.37. St. Croix County Health and Human Services Board Page 4 February 13, 2003 Human Services vouchers 17366 through 17442, dated January 16, 2003 in the amount of $392,423.33. Human Services vouchers 17458 through 17485, dated January 23, 2003 in the amount of $69,420.09. Human Services vouchers 17504 through 17549, dated January 30, 2003 in the amount of $124,535.48. Human Services vouchers 17569 through 17594, dated January 31, 2003 in the amount of $5,353.26. Human Services vouchers 17026 through 17028, dated January 02, 2003 in the amount of $323,125.00. Human Services vouchers 17355 through 17363, dated January 10, 2003 in the amount of $6,996.33. Human Services vouchers 17743 through 17457, dated January 16, 2003 in the amount of $5,185.42. Human Services vouchers 17486 through 17503, dated January 23, 2003 in the amount of $6,749.30. Human Services vouchers 17550 through 17568, dated January 30, 2003 in the amount of $155,334.71. Human Services vouchers 17595 through 17671, dated February 06, 2003 in the amount of $89,170.24. Human Services vouchers 17673 through 17782, dated February 13, 2003 in the amount of $219,410.91. Human Services vouchers 17783 through 17909, dated February 13, 2003 in the amount of $108,909.60. Nursing Home vouchers 2486 through 2493, dated January 16, 2003 in the amount of $9,756.84. Nursing Home vouchers 2495 through 2500, dated January 23, 2003 in the amount of $4,388.82. Nursing Home vouchers 2505 through 2508, dated January 30, 2003 in the amount of $20,291.12. Nursing Home vouchers 2501 through 2504, dated January 23, 2003 in the amount of $23,843.00. Nursing Home vouchers 2511 through 2513, dated February 06, 2003 in the amount of $20,216.46. Nursing Home vouchers 2514 through 2554, dated February 13, 2003 in the amount of $45,039.90. Human Services, Workshop, Public Health, Social Services vouchers 1 through 29, dated January 14, 2003 in the amount of $314,816.16. St. Croix County Health and Human Services Board Page 5 February 13, 2003 Human Services and Nursing Home vouchers 1 through 30, dated January 14, 2003 in the amount of $222,412.36. Human Services, Workshop, Public Health, Social Services vouchers 30 through 49, dated January 28, 2003 in the amount of $274,576.17. Human Services and Nursing Home vouchers 31 through 48, dated January 28, 2003 in the amount of $161,924.31. Borup said five bids have been received for the 1979 Dodge plow truck and bills will be opened and awarded at 4:00 PM on Friday. Borup met with the Finance Committee and the internal loan for a bussette for St. Croix Industries was approved. St. Croix Industries will be putting one- fourth down and three-fourths of the amount for the bussette will be on the loan. Berenschot announced Rich Loney has retired from the Finance Department. Recruitment process is underway. MENTAL HEALTH/AODA: Mental Health continues to experience a growing shortage of psychotherapy resources. The number of distinct clients (unduplicated client count) served each month has grown by 60 from two years ago (i.e. from 160 to 220 different clients each month). There is currently a five to six week wait for new clients to receive services. A year and a half ago the Mental Health Unit was reorganized by eliminating the In-Home Team and shifting staff to Outpatient Mental Health and CSP. Despite the reorganization, the Outpatient Mental Health Clinic continues to experience a demand for psychotherapy services that cannot be met at current staffing levels. From experience, when a consumer has to wait more than three weeks for psychotherapy services, several things begin to occur, which have an adverse effect on both the consumers and County revenues/expenses. They include: ■ Increased "no show" rates. ■ Increased cancelled appointments. ■ Insured clients seek services elsewhere. ■ Decreased County revenue (due to the previous 3 occurrences). ■ Increased numbers of psychiatric hospitalizations. ■ Increased numbers of hospital days per admission. ■ Increased numbers of residential placements. ■ Increased number of residential days per placement. ■ Increased County expenses (due to the previous 4 occurrences). ■ Increased frustration and decreased efficiencies from other services entities (i.e. County Court System, Family and Children's Services, Long Term Support Services, etc.) due to inability to access psychotherapists for client referrals and staff consultation. Kiesler said there are several options that need to be considered: ■ Do nothing. (This would lead to the adverse effects outlined above, namely, falling revenues and increased hospitalization costs.) St. Croix County Health and Human Services Board Page 6 February 13, 2003 ■ Only serve clients with no other provider options. (This would eliminate the privately insured client, which would mean revenues would drop dramatically.) ■ Add staff. (Lack of office space would mean displacing contracted vendors.) As these options involve Board policy decisions, this information is being brought forward so an informed decision can be made. Kiesler said these trends are alarming when combined with the fact that St. Croix County grew by over 25% in the decade of the 90's and another 5.1W (U.S. Census Bureau estimate) in 2001 alone. Kiesler asked the Board for direction regarding this issue, to allow management to more effectively plan for the upcoming budget. The Board questioned Kiesler on how far ahead he could project needs. Kiesler said he likes to use trending information and regression analysis as a way to project future demand. Kirt said there is a five to six week wait for appointments, and there are enough clients waiting for appointments to fill another therapist position now. Kirt said the Department is mandated to serve the indigent and there are few other options for clients with Medicaid/Medicare to access services in St. Croix County. Kiesler said costs of serving the indigent are offset to a large degree by clients with insurance. Craig requested approximate cost to the County on serving the Medicaid/Medicare and indigent clients over the insured clients. Kiesler will report back to the Board. UPDATE ON THE COMMUNITY SUPPORT PROGRAM WAITING LIST GRANT POSITION: As requested, an annual financial status report regarding the CSP Waiting List Grant due to the sunset provision included in the approval of the position was presented to the Board. The grant was offer to St. Croix County to help reduce waiting lists for services. Kiesler distributed a financial cost/ benefit analysis report showing the granted position netted a profit in the first year. Kiesler requested the Board consider using the profits to reduce the waiting lists in CSP and Mental Health Outpatient Programs. This will be brought to the Board as an action item in March. GENERAL RELIEF: Squyer said General Relief has not been a mandated program since 1996; however, St. Croix County chose to keep the program but to administer a less extensive program. Squyer indicated that many counties have eliminated General Relief. She said General Relief is not a mandated program and when funding is depleted, the county can terminate the program with a 15- day notice to the State. General Relief is the payer of last resort serving adult clients with no children. All participants must apply for all other benefits they may be eligible for. There are two areas of payment for General Relief: The first is medical payments for life threatening situations and to assist the customer in returning to work. Payments are based on the Medical Assistance Reimbursement rates. The second is for shelter payments for the homeless. Shelter payments are only paid during the moratorium months (Nov-March), and paid directly to the landlord. Maximum shelter costs are $160.00 for one person and $220.00 for two persons. St. Croix County Health and Human Services Board Page 7 February 13, 2003 General Relief also pays medical Assistance rates for burials. WISCONSIN HOME ENERGY ASSISTANCE PROGRAM (WHEAP) FUNDING: Squyer informed the Board that $6.6 million was approved for Wisconsin February 1 for emergency energy assistance. ECONOMIC SUPPORT INCREASED CASELOAD SIZE: Due primarily to medical Assistance and food stamp cases, Economic Support caseloads have grown significantly over the past year. The same trend has been seen throughout the state. She said Income Maintenance allocations have not been increased in 17 years but mandates continue to increase without funding for them. Squyer said Badger Care is due to end in April as there was a cap on the program when it was started. She said there are 500-600 people on Badger Care now. NURSING HOME-WIPFLI REPORT: Krieger gave a power-point presentation that will be presented to the County Board in March regarding follow up to the Wipfli Study. Board members gave suggestions for a few changes and complimented Krieger on the presentation. HIPAA: The County as well as Health and Human Services continues to work towards becoming HIPAA compliant for the Privacy Standard. A walk-through has been completed of St. Croix Industries and Health and Human Services. Additional locks are needed for cabinets/desks and some furniture will need to be moved so computer monitors cannot be seen from hallways or when someone walks in the room. Some doors will also need to be locked. Chuck Whiting will assume the role of privacy officer and will delegate duties relating to Medical Records of Health and Human Services to the Medical Records Supervisors on site. The HIPAA policies and procedures will be reviewed by Greg Timmerman, Corporation Counsel. A Transaction Compliance Plan will be submitted to the State by February 14th that will outline plans for compliance relating to Long Term Support role as a health plan. Board members questioned installing combination locks on the file cabinets. NURSING HOME: Krieger distributed a report on trends in long-term supportive services for older Americans with disabilities issued by AARP Public Policy Institute for Board members to review. Also distributed for Board member review was a report from Wisconsin Health Care Association (WHCA) and WAHSA regarding nursing home funding in the 2003-05 biennium. This document will be submitted to the governor and will used for the new state budget. Nursing homes across the State are in crises and legislators need to learn more about the nursing home dilemma. The Nursing Home census today is 85. Krieger said the 07/01/02 MA rate has been approved. The State will calculate the amount for 07/01/02 to 12/31/02 and issue a check for approximately $103,000. Krieger said we will receive the banked beds for the Nursing Home back in July. She said bed banking and the incentive to bank beds is gone. When discussing downsizing the nursing home, many things will need to be considered. The State is offering incentives to have more private nursing home beds. Also it is possible to negotiate with the State to help cover cost incurred while downsizing. 50-bed facilities are offered more St. Croix County Health and Human Services Board Page 8 February 13, 2003 incentives as it costs more to run a 50-bed facility than a larger facility. Once a decision is made to downsize, the downsizing isn't immediate. It is difficult to predict what the Nursing Home census will be in the future. ACTION ON BIDS FOR NURSING HOME MA/MEDICARE COST REPORTS: Krieger said the Nursing Home has received two bids for cost report completion as follows: Medicare Medicaid BDO Seidman $3,500 $3,000 Wipfli $2,000 $2,000 It has been difficult for Judy Ziegler to work with BDO Seidman because of the distance. The person at that firm has now left. Larry Lester is the contact for Wipfli and would be doing the cost report for the Nursing Home if awarded the bid. Previously Judy Ziegler has done the MA cost report for the Nursing Home. The MA formula continues to change each year. The State is progressing from a cost- based formula to a price-based formula. The changes will require constant attention to maximize the MA rate. Due to Judy's workload, it is recommended that Larry Lester complete both cost reports. Judy's time will be better utilized creating better financial reports for the Nursing Home. Tracey and Thole declined to bid as they do not operate in this area. Motion: A motion was introduced by Bethke, seconded by Berenschot, and unanimously adopted: That the Board approves Wipfli to complete the Medicaid/ Medicare cost reports. 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: 11:25 AM Chair: Attest: (Secretary)