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HomeMy WebLinkAboutHealth & Human Services 12-14-11 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD December 14, 2011- 8:30 A.M. Board Room, St. Croix County DHHS Building 1445 N. 4ch Street, New Richmond Wisconsin L CALL TO ORDER II. ROLL CALL III. APPROVAL OF MINUTES OF PREVIOUS MEETING: 11/16/2011 IV. BUSINESS ITEMS 1. Financial Report for Nursing Home and Health and Human Services 2. Income Maintenance Regionalization Report 3. Community Health Improvement Process-Healthier Together Report 4. Nursing Home Administrator's Report 5. Nursing Home Operational Changes Report 6. Recruit Nursing Home Administrator 7. St. Croix County Website Resource List 8. Community Options Funding V. ANNOUNCEMENTS & CORRESPONDENCE VI. ADJOURN DATE OF NEXT MEETING: 01/18/12 at 8:30 A.M. REVIEWED AND APPROVED BY: Committee Chair and County Administrator DATE APPROVED: 11/30/11 A quorum of the St. Croix County Board of Supervisors (County Board) may he present at this meeting. Therefore, this notice also serves as notice of'a meeting of'the County Boardfor the purpose of'ohtaining information relaxing to subjects listed above for use at future County Board Meetings. 11/30/2011 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD December 14, 2011 The St. Croix County Health and Human Services Board met on December 14, 2011 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Roger Larson Richard Marzolf Dr. Lisa Ramsay Alfred Schrank MEMBERS ABSENT: Frederick Horne Linda Luckey Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Human Services Director Cindy Anderson, Nursing Home Administrator Wendy Kramer, Health Officer/Public Health Coordinator Deb Suchla, Financial Manager Malva Sirek, Clerical Supervisor OTHERS PRESENT: Pat Thompson, County Administrator Art Tobin, Building Services Director Heather Wolske, Assistant Corporation Counsel Tammy Funk, Human Resources Daryl Standafer, County Board Chair Kim Dupre, Information Systems Analyst Sharon Norton-Baumann, County Board member Dave Ostness Jeff Holmquist, New Richmond News Chair Wentz 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 Wednesday, January 18, 2012 at 8:30 AM. MINUTES: Motion: A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted: That the minutes of the 11/16/11 Health and Human Services Board meeting be approved as distributed. FINANCIAL REPORT FOR NURSING HOME AND HEALTH AND HUMAN SERVICES: The following financial report for Health and Human Services, Nursing Home, St. Croix Industries, St. Croix County Health and Human Services Board Page 2 December 14, 2011 Aging and ADRC through November, 2011 was distributed. He reported expenses have been posted through November, however, Health and Human Services percentage is lower due purchase of service contracts billings that come in after this report is run. Novendw2D77 AnntgA N vem6er Ackols % of Revenues BLOW Axe TO Date BANI e audw Heats & Human Services S 15,971,121 S 1,153,103 S 11,599,291 S 4,371,830 726% St Croix Mushier 418182 243,505 335104 83,078 96.6% AgIFIg 943,3B2 69,047 854,849 88,513 90.6% ADRC Z274,50 56,296 364195 (89,595) 103.9% Nursi Fig Home 6,499,631 367,972 4 928 925 1570 706 75.8% Total Progarn Reve- S 28,106"5 = 1.M,922 $ 22,082,364 S 6,024,531 78.6% Eames Heakh & Human Services S 15,975,121 S 1,073,789 S 12,268,878 S 3,706,243 76.8% St Croix tdlstries 2,418,182 176,568 2,047,597 370,585 84.7% Aging 943,362 72,283 82,815 122,547 87.0% ADRC 2,274,599 75,560 2,154,890 119,709 94.7% Nursing Home 6,499,631 431,039 5,478,972 1,020,659 84.3% Total PMWa Eames S 28,110 5 S 1,M,2A1 S 22,771,152 S 5,338,743 81A% Re nums Onw(thadag E*amN aes S 60.681 S 688.788 Peraerâ–ºtaef 91.7% Johnson reported Deb Suchla has been hired on a short-term contracted employee basis to fill the Health and Human Services (HHS) Financial Manager position. Suchla has a background in HHS and will be working on claiming revenue for year-end 2011. Johnson reported HHS has until March to do the final claims. Johnson reported efforts are still in process to recruit a permanent financial manager for HHS. Johnson highlighted ADRC revenue is higher as staff have been billing to Medicaid at 100% of time and claim rate of Medicaid related functions is greater than budgeted. Johnson indicated $219,000 in Intergovernmental Transfer Funds (IGT) for the Nursing Home have been received but are not recorded in the above report. Johnson reviewed the monthly report with the finance department and at this time anticipates approximately $150,000 deficit in the Nursing Home. He reported the Nursing Home has made operational adjustments in staffing and the census has held steady. INCOME MAINTENANCE REGIONALIZATION REPORT: Act 32 of the Governor's Biennial Budget requires that the service delivery model for Income Maintenance (IM) programs be regionalized beginning January 1, 2012. It is hoped to be able to maximize services and gain administrative efficiencies by centralizing some services and still have a local presence. Brown- Anderson presented a map of the counties in the 10 statewide consortia. St. Croix County is in the Great Rivers Consortia, which consists of ten counties. The Great Rivers Consortia will oversee the call center, which is a requirement of the consortia. The local agencies will also oversee ongoing case management and reception/lobby services. Ongoing case management for each county includes IM applications, renewals, new program requests, and all related eligibility functions. With the consortia model, counties have implemented universal caseloads, which St. Croix County Health and Human Services Board Page 3 December 14, 2011 means appointments and general questions will be designated to a team and not an individual worker. St. Croix County has two teams; one is the Economic Support Family Team and the other is Economic Support EBD-LTC Team, which includes Elderly, Blind and Disabled Medicaid and Long Term Care. Notices of the changes will be made by mail between December 26 and December 30. The notices will indicate it is not necessary for clients to contact the new agency/current worker and that the changes will not affect his/her enrollment or benefits. During this transition to a consortia model local counties also started receiving cases from the Enrollment Services Center on 11/01/11 with the target to have all cases transferred from Enrollment Services Center to counties by 03/31/12. Brown-Anderson said there have been problems with some of the cases that have been transferred into St. Croix County with inaccurate benefit determinations and overpayments, etc. that the Economic Support staff will need to work to correct. Another major change is in the Wisconsin Funeral and Cemetery Aids Program (WFCAP). This will become a State-administered program versus county-administered beginning January 1, 2012. State staff will determine eligibility and reimbursement for WFCAP requests. Another new process in Income Maintenance Administration is the Centralized Document Processing Unit (CDPU) managing the majority of document processing. The return address and fax number on many local agency forms will be changed to the CDPU address for the CDPU to handle. St. Croix County will not have access to the documents until the CDPU processes them. Other shared work in the consortia will be fraud work. St. Croix County is currently part of a smaller consortium but will continue to transition fraud work to align with the Great Rivers IM Consortia. St. Croix County is doing a great job in fraud activities. Other areas that will be shared and/or centralized include second-party reviews, benefit recovery efforts, subrogation, and fair hearings and grievances. Wisconsin Works (W2) and FoodShare Employment and Training (FSET) will continue to be managed by a private agency and will not be impacted by the consortia model at this time. Also Wisconsin Shares Child Care (CC) Subsidy program will not be impacted by the consortia model. These programs will continue to be served by their county of residence. Thompson indicated regionalization may be the wave of the future and may move to other service deliveries. St. Croix County is a leader in this area. He applauded Brown-Anderson and her staff for being a leader in this effort. Brown-Anderson indicated the Economic Support web page will be revised to reflect all the changes occurring. Johnson introduced Deb Suchla as the contracted Health and Human Services Financial Manager. She comes from Sauk and Monroe Counties and has worked with Health and Human St. Croix County Health and Human Services Board Page 4 December 14, 2011 Services. She will be focusing on year-end close out for claims. Suchla was welcomed by the Board. COMMUNITY HEALTH IMPROVEMENT PROCESS-HEALTHIER TOGETHER REPORT: Kramer presented a national webinar with Karen Hanson from Hudson Hospital on Association for Community Health Improvement. Five top health priorities were picked for St. Croix County, which included access to primary and preventive health services; overweight, obesity, and lack of physical activity; adequate and appropriate nutrition; alcohol and other substance use and addiction; and tobacco use and exposure. Kramer explained how the process moved from priorities to taking action to implement. The Healthier Together Plan for St. Croix County was implemented to the community in June, 2011. Access: She reported work is still ongoing and is moving forward slowly. The hope is to have a mobile unit for health and dental with shared services with the hospitals. The dental group is also working with communities that do not have fluoridated water. Behavioral Health completed three different surveys; one for consumers, one for consumers waiting for service, and one for providers. A committee was formed to address identified barriers from these surveys and to make recommendations. Overweight, Obesity, and Lack of Physical Activity: The group has been working with schools in the county for a school-based physical activity/nutrition pilot program for K-6. A community garden was started at Hudson Hospital and Clinics and a new garden is planned in Baldwin in the spring. Grant monies are being sought. A farm-to-school program has an active workgroup in New Richmond Schools. Adequate and Appropriate Nutrition: The Community Resource Directory was updated. Schools are working on increasing participation in the free/reduced school lunch program. Discussion is taking place on issuing a newsletter regarding information on nutritious foods. Alcohol and Other Substance Use and Addiction: Some of the objectives for this item go out to 2013 so a few of the items this group is working on include reducing citations for underage possession of alcohol; collaborating with AODA with "Parent Who Host Lose the Most" campaign and supporting additional communities to participate. Tobacco Use and Exposure: Due to decreased funding and change in leadership in this area, there will be further discussion on roles, goals and objectives. St. Croix County will continue to be a member of the Western Wisconsin Working Towards Tobacco Free Living Coalition but will no longer be directing activities such as the WI Wins Program. The county-wide cessation brochure will be completed soon and shared with health care providers and schools for distribution. A resource directory is in progress and all health priority groups are involved in providing information for website content for Healthier Together, which is planned to be launched in January, 2012. St. Croix County Health and Human Services Board Page 5 December 14, 2011 These initiatives fit into the County strategic plan as they are geared to protect at-risk populations. Public Health initiative will be a part of the County strategic plan in January. One area identified is body mass index (BMI) of children in the community, both for overweight/obese children and children with low body weight who may have limited access to food. The Community Health Improvement Plan and NALBOH Newsbrief were distributed to Board members. Johnson reported the webinar presented by Kramer and Hanson was broadcast across the United States with approximately 89 participants. Johnson said Kramer does an excellent job leading and implementing community health improvement. Kramer is also going to a conference in Denver, Colorado in March. St. Croix County Public Health has been a forerunner in Community Health Improvement Planning and the work with the local Hospitals has been a great partnership. The Board recessed from 9:57 - 10:07 AM. NURSING HOME ADMINISTRATOR'S REPORT: Anderson thanked everyone who attended the annual Nursing Home bazaar. She reported $1,092 was raised from the bazaar to contribute to the resident donation fund. This is the highest amount ever raised from the bazaar. Anderson invited Board members to attend the annual resident Christmas parties on December 17, 2011. The average monthly census for November was 59, with 7 Medicare, 36 Medicaid, and 16 private pay residents, with two pending approval for Medicaid. She reported there were eight admissions and seven discharges in November so the census count has held steady. Referrals have been monitored since November 17, 2011. There were 14 referrals, six were admitted, three went elsewhere and five were determined that we could not meet referral needs. The second phase of the plan of correction has been inspected by the State of Wisconsin and is considered complete. The third phase of the plan of correction is being finalized by SEH and Building Services. The Medicaid rates have been received. The July rates were higher than the prior quarter. In October, the rates dropped. The government recalculated the rate for therapies and the therapy table was recreated, which resulted in the drop in rates. This resulted in a minus $7 to $8/ day difference in rates. We will be working with Pathway Health Services to complete an audit to make sure we receive reimbursement for services being provided. Anderson reported the Intergovernmental Transfer application (IGT) was submitted and the Nursing Home is awaiting the amount that will be awarded. NURSING HOME OPERATIONAL CHANGES: The operational decision was made to not close a wing of the Nursing Home at this time. Rather, lower census on the second floor was adjusted which allows the facility to save staffing costs that have been previously discussed. St. Croix County Health and Human Services Board Page 6 December 14, 2011 Pathway Health Services did an operational review to analyze that the Nursing Home which included recommendations for the right sizing of the care center. Pathway Health Services indicated a suggested size of 50 or 57 beds could allow for all private rooms with either scenario. Pathway Health Services indicated the current consumer is demanding private rooms. Johnson indicated a request could be made to LarsonAllen for a cost analysis; however, he would like to wait until year end and request an analysis in February to capture all the expense changes at year end. A bed tax of $170/bed is currently in place and this ongoing expense would be eliminated for ten beds if ten beds were de-licensed, but no change in the number of licensed beds has occurred at this time. When the Nursing Home is not at 94% occupancy, the facility also cannot claim bedhold for any residents on leave to home, the hospital, etc. At 50-beds, the facility needs an administrator, but not at full-time. There are financial incentives from the State to go to a 50-bed facility. At 57-beds, a full-time administrator is needed. Norton-Bauman indicated part of the decision to fill the administrator position is whether the position will be full or part time, according to the census. Johnson indicated Leah Killian-Smith, the Pathway Health Services staff who completed the study, highlighted the facility is a good facility, with excellent care, excellent staff, building and county support. Physical plant updates are needed that are cosmetic in nature, such as carpet, paint, wallpaper, etc. The facility currently does not have board and care licensure but is something that could be pursued. Wentz recommended bringing a referendum to the taxpayers to ask if they want to keep the Nursing Home and be in the nursing home business. An excerpt was read from the October 26, 2011 Glenwood City Tribune Press Reporter: "Dunn County approved building a new nursing home... Good citizens are about one another... Citizens who pay make the decision." Marzolf expressed concern of conflict of interest in inappropriately soliciting an opinion from a company the County currently has a contracted employee from. Wentz indicated the person who gave the opinion has a background in the nursing home field and expertise in the field. Wentz expressed the County had a credit with Pathway Health Services, which was used towards paying for the opinion. Johnson reported Wipfli and LarsonAllen have also given reports in the past on the option of a 50-bed facility. RECRUIT NURSING HOME ADMINISTRATOR: Johnson recommended maintaining the current contracted Nursing Home Administrator until a determination is made of the right size of the facility. Until this is decided, it may hamper recruitment of staff as the position could be filled at full-time or part-time dependent upon the number of licensed beds. Johnson recommended evaluating 50 to 57 bed facility budgets to make a sound financial decision. In addition, the facility is monitoring census trends during the operational change which could also St. Croix County Health and Human Services Board Page 7 December 14, 2011 provide some insight on what size the facility should be. He recommended waiting until early next year to monitor financial trends and resident census to make a policy decision on the size of the Nursing Home. Thompson indicated the organization needs to define the right size financially for St. Croix Health Center. He indicated the facility would be better served to hold off hiring a new permanent administrator until it is determined what the right-size would be for the facility. Pathway Health Services did not express an opinion on how to staff or hire for an administrator. Thompson expressed support for Johnson's recommendations to the Board. If a referendum is issued, it would also impact hiring an administrator. It was recommended to start recruitment in February. Thompson indicated it would be money well spent to continue with a contracted administrator versus hiring a permanent employee in the administrator position versus making a mistake. Dupre questioned where the difference in cost would come from. A contracted position is approximately $4,500 more than an internal employee. ST. CROIX COUNTY WEBSITE RESOURCE LIST: Johnson has been working with Brad Beckman to provide quick links to resources in the community under ADRC on the County website. A quick link for community resources and assistance is now on the County website, which will bring the user to the ADRC section and then connect the user to resources. Part of the ADRC strategic plan is to maintain and update a resource directory on the website. COMMUNITY OPTIONS FUNDING: Community Options (COP) Funding is used for Medical Assistance funding. Prior to Long Term Care Reform, a review of COP funding was required and an update presented on how COP dollars were being spent. Dollars are designated in the Mental Health budget to support clients with mental health needs and used towards community residential placements. Wentz asked if there were any other issues to bring before the Board. Johnson indicated there was a water main break in the west parking lot. He indicated there are contractors, the Highway Department, City of New Richmond and Building Services involved in the repair. St. Croix Industries building was without water for one day. Johnson thanked Building Services for the quick repair. Wentz adjourned the meeting. Time: 10:57 AM Chair: Attest: (Secretary)