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HomeMy WebLinkAboutHealth & Human Services 07-15-09 Peterson will review vouchers. REVISED: 07/10/09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 15, 2009 at 8:30 (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 06/17/09 DATE OF NEXT MEETING — 08/19/09 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. aged receivable report 3. Health and Human Services authority and criteria to determine Nursing Home private pay resident rates. 4. Update on Public Health Preparedness Exercise 5. Nursing Home and Health and Human Services Audit Reports 6. Review of budget time lines for 2010 budget review for Health and Human Services Board 7. Discussion on Open Hearing for 2010 budget planning 8. Capital outlay plans for Health and Human Services and Nursing Home for 2010 9. Building Services report on facility repairs and 2010 capital planning 10. Personnel Issues -New Position Requests a. New employees /vacancies b. New position request for 2010 11. Nursing Home Administrator's Report 12. 2009 Nursing Home purchase requests for non - budgeted items. ** 13. Nursing Home and Health and Human Services strategic planning 14. Health and Human Services Governing Body By -laws Review ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 7/10/2009 10:22 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD July 15, 2009 The St. Croix County Health and Human Services Board met on July 15, 2009 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Linda Luckey Richard Marzolf Gerald Peterson Deb Rasmussen MEMBERS ABSENT: Dr. Lisa Ramsay, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Ron Kiesler, Behavioral Health Coordinator Kathy Dunlap, Family and Children's Coordinator Wendy Kramer, Public Health Officer /Public Health Coordinator Frank Robinson, Nursing Home Administrator Tammy Wilson, Medical Records Supervisor Malva Sirek, Secretary OTHERS PRESENT: Roger Rebholz, County Board Chair Loyla Waskul Art Tobin, Building Services Director Kim Dupre, Information Systems Analyst Greg Timmerman, Corporation Counsel Tammy Funk, Human Resource Administrator 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, August 19, 2009 at 8:30 AM. Marzolf will review vouchers. A second tentative August meeting is planned for August 26 at 8:30. AGENDA Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Luckey, seconded by Rasmussen, and unanimously adopted: That the minutes of the 06/17/09 Health and Human Services Board meeting and 06/17/09 Open Public Hearing be approved with minor modifications requested by Luckey. NURSING HOME AND HEALTH AND HUMAN SERVICES AUDIT REPORTS Johnson announced after discussion with Steve Tracey, it was decided the audit reports will be delayed until the August meeting. HEALTH AND HUMAN SERVICES AUTHORITY AND CRITERIA TO DETERMINE NURSING HOME PRIVATE PAY RESIDENT RATES Timmerman reported to the County Board in June St. Croix County Health and Human Services Board Page 2 July 15, 2009 regarding the authority and criteria to determine private pay resident rates. Timmerman's report indicated that there is no one specific statute that will say a county board can run a nursing home and choose how to charge for the services; however, the county has the authority to be in the nursing home business, to set the private pay rates and to identify how the levy would be used. Johnson reported that current private pay rates are competitive with the market and the nursing home competes with the private sector. Timmerman said the county may compete with the private sector as long as it is for a public purpose. The planning committee will likely make a recommendation on how the nursing home will remain in the business with management to be handled by Health and Human Services staff. Luckey questioned if the document showing the possible financial affects of losing private pay residents was shared with the County Board. Johnson indicated that the document was shared with the County board and will review that information at the next meeting. Johnson publicly thanked Timmerman for his help and appreciated his assistance in answering this issue. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Peterson reviewed the vouchers. Motion A motion was introduced by Peterson, seconded by Larson, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 153121 through 153122, dated June 24, 2009 in the amount of $18,910.00. Human Services vouchers 153430 through 153468, dated July 08, 2009 in the amount of $55,670.08. Human Services and Nursing Home vouchers 152738 through 152832, dated June 19, 2009 in the amount of $69,648.96. Human Services and Nursing Home vouchers 152985 through 153001, dated June 19, 2009 in the amount of $37,696.23. Human Services, Government Center, St. Croix Industries, and Nursing Home vouchers 153018 through 153112, dated June 24, 2009 in the amount of $114,862.22. Department on Aging vouchers 153113 through 153120, dated June 24, 2009 in the amount of $3,752.34. Human Services, Nursing Home, and St. Croix Industries vouchers 153285 through 153347, dated July 01, 2009 in the amount of $130,108.81. Human Services, ADRC, and Department on Aging vouchers 153831 through 153934, dated July 08, 2009 in the amount of $27,978.65. Human Services, Nursing Home, St. Croix Industries, Government Center, and ADRC vouchers 153935 through 154025, dated July 08, 2009 in the amount of $68,718.67. St. Croix County Health and Human Services Board Page 3 July 15, 2009 Nursing Home vouchers 154026 through 154037, dated July 08, 2009 in the amount of $2,573.96. Human Services, Nursing Home and St. Croix Industries vouchers 153721 through 153830, dated July 08, 2009 in the amount of $34,630.62. FINANCIAL REPORT Johnson reported St. Croix Industries financial statement is separated from the Health and Human Services report as this department will be set up as an enterprise fund similar to the Nursing Home. He noted Long Term Support numbers are now lower in the Health and Human Services report as funds were separated out for St. Croix Industries for the May report. Expenses in the report are up -to -date. St. Croix Industries is doing well financially. Expenses include bussette purchases. The rest area management (RAM) program is closed but there may be a few remaining ancillary charges through the end of the year. St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget May 31, 2009 Balance % WS OPERATIONS 1,342,765.00 671,933.26 670,831.74 50.0!0 WS PRODUCTION 423,499.00 223,514.92 199,984.08 52.8% WS HELPING HANDS 71,726.26 51,216.08 20,510.18 71.4% WS POPNENDING 7,250.00 3,925.22 3,324.78 54.1% INS RAM 76,743.00 28,530.58 48,212.42 37.2% WS VOCATIONAL PLACEMENT 375,560.42 121,083.53 254,476.89 32.2% WS COMM BASED DAY PROG 185,204.03 60,443.10 124,760.93 32.6% REVENUES 2,482,747.71 1,160,646.69 1,322,101.02 46.7% SUMMARY Total OF EXPENDITURES Budget May 31, 2009 Balance % WS OPERATIONS 1,342,664.56 586,400.55 756,264.01 43.7% WS PRODUCTION 422,286.84 130,270.16 292,016.68 30.8% WS HELPING HANDS 71,726.26 24,767.52 46,958.74 34.5% WS POPNENDING 7,250.00 2,605.86 4,644.14 35.9% WS RAM 77,443.00 18,219.40 59,223.60 23.5% WS VOCATIONAL PLACEMENT 371,831.60 134,391.46 237,440.14 36.1% WS COMM BASED DAY PROG 183,214.95 76,574.06 106,640.89 41.8% EXPENDITURES 2,476,417.21 973,229.01 1,503,188.20 39.3% Total S 187,417.68 The following financial report for Health and Human Services through May, 2009 was distributed. Pempek reported the State has not yet adjusted the Long Term Support dollars but it is anticipated monies will be removed in the near future. Additional monies for MA supplement have not been received by the ADRC and they have earned additional MA monies based on 100% time reporting. Johnson alerted the Board that Behavioral Health has an expensive placement at an institution. Johnson indicated there will be an ECHO conference, which was St. Croix County Health and Human Services Board Page 4 July 15, 2009 budgeted for in 2009. The conference will be held in New Hampshire again and recommends that we move forward with staff attending this conference. Staff continues to move forward with electronic medical records using ECHO software and we need to be compliant with government regulations to have electronic medical records in place by 2014. Wilson indicated that this may seem like a long time off, but the process of converting to electronic records will take time. HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget May 31, 2009 Balance % Administration 1,038,854.00 (318,689.96) 1,357,543.96 -30.7% AODA Services 760,671.16 320,150.66 440,520.50 42.1% Long Term Support 2,631,402.00 2,815,763.44 (184,361.44) 107.0% Mental Health 3,448,843.99 1,375,332.87 2,073,511.12 39.9% Family & Children's 2,911,874.13 1,457,844.57 1,454,029.56 50.1% Public Health 1,976,209.95 776,036.93 1,200,173.02 39.3% Economic Support 1,152,939.29 325,148.70 827,790.59 28.2% General Relief 0.00 0.00 0.00 0.0% Coordinated Services /SED 2,836,586.35 1,056,939.74 1,779,646.61 37.3% ARDC 632,000.00 166,858.00 465,142.00 26.4% Department on Aging 846,623.00 162,537.54 664,085.46 21.6% REVENUES HUMAN SERVICES PROGRAMS 18,236,003.87 8,157,922.49 10,078,081.38 44.7% SUMMARY Total OF EXPENDITURES Budget May 31, 2009 Balance % Administration 1,029,711.52 418,616.09 611,095.43 40.7% Alcohol -Drug Abuse 755,822.52 285,986.08 469,836.44 37.8% Long Term Support 2,631,098.96 268,251.35 2,362,847.61 10.2% Mental Health 3,445,706.61 1,434,645.70 2,011,060.91 41.6% Family & Children's 2,908,835.69 1,229,046.05 1,679,789.64 42.3% Public Health 1,976,028.13 788,365.60 1,187,662.53 39.9% Economic Support 1,140,696.47 480,590.53 660,105.94 42.1% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service /SED 2,835,374.19 893,979.39 1,941,394.80 31.5% ARDC 632,000.00 220,180.06 411,819.94 34.8% Department on Aging 846,623.00 303,426.34 543,196.66 35.8% EXPENDITURES HUMAN SERVICES PROGRAMS 18,201,897.09 6,323,116.78 11,878,780.31 34.7% Total S 1.834,805.71 The following financial report for the Nursing Home through May, 2009 was distributed. The May Nursing Home average census was 65. IGT funds will continue with one payment expected mid -year and another at year end. We have only received general numbers for IGT funds thus far and solid figures are expected by the end of this week. St. Croix County Health and Human Services Board Page 5 July 15, 2009 St. Croix Health Center May 2009 Budget Actaal Difference Peicentag< Census 0 01yeiating Revenue: Medicare $903,252.00 $461,987.67 $441,264.33 51.15% Medicaid $2,481,432.00 $975,878.56 $1,505,553.44 39.33% Private Pay $760,413.00 $347,539.50 $412,873.50 45.70% All Other Sources $216,041.00 $181,091.30 $34,949.70 83.82% Total i 4pei ating Revenue $4.361.138.00 $1.966.497.03 $2.394.640.97 45.09 °, Opeiating Expenses Daily Patient Services $3,397,317.36 $1,383,871.75 $2,013,445.61 40.73% Special Services $284,262.00 $109,287.36 $174,974.64 38.45% General Services $1,148,672.04 $449,273.33 $699,398.71 39.11% Administrative Services $628,277.68 $263,071.85 $365,205.83 41.87% Unassigned: Depreciation (% Based) $0.00 Others: $402,923.00 $168,275.90 $234,647.10 41.76% Utilities $202,080.00 $57,787.56 Workers Comp, Computer Tech $133,400.00 $19,831.34 Insurance $67,443.00 $90,657.00 Total Operating Expenses $5.861.452.08 $2.373.780.19 $3.487.671.89 40.50 Net Fion► Opeiations j$407.283.16j (Cost of doing business prior to applying levy & outstanding rev) Additional Revenges Rate Appeals $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGT Funds $350,000.00 $0.00 % of Outstanding IGT Rev $0.00 $0.00 0.00% Co Allocations (% Based) $944,665.00 $412,040.00 $532,625.00 43.62% Nursing Home Carry Over $191,000.00 $79,563.35 Total (hitstanding $1.497.665.00 $491.623.35 $544,625.00 Net from all Sources $84.340.19 AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through May was reviewed. The numbers in prior years continue to decrease as the clean up continues. BUILDING SERVICES REPORT ON FACILITY REPAIRS AND 2010 CAPITAL PLANNING Tobin reported an air conditioner compressor in the Nursing Home was lost during a recent storm. This happened about 10:30 AM and the system was working again by 8:30 PM the same day. Tobin complimented Nursing Home and Building Services staff efforts to make the residents comfortable during this time. It took three days to get a total repair of the system. Kristen Ziliak, Risk Manager, is working through insurance to recoup repair costs. Robinson complimented St. Croix County Health and Human Services Board Page 6 July 15, 2009 Tobin for getting a contractor in -house immediately and staying until the system was repaired. Tobin also reported there was a slip and fall on a ramp outside of the transition house. He said repairs are being scheduled for mud jacking and repairing the steps. A railing is needed plus some ramp repair. Cost for contracting was expected to be approximately $14,000. However, most of the work will be done in- house. The capital outlay plan for Building Services for Nursing Home, Health and Human Services and St. Croix Industries was distributed and reviewed. Tobin said for Health and Human Services security card access is the main concern as hardware on a lot of the doors in the buildings is worn out. He recommends going to electronic access in the building. Another high priority is to install security cameras. Tobin is recommending installation of eight additional cameras. One additional major concern is lighting in the parking lots. He said these areas were identified in the security assessment of the building performed by John Shilts. He said there will be continuing repairs to the foundation of Health and Human Services through the remainder of 2009 and through 2010. Tobin reviewed concerns with the old laundry building, which houses an emergency communication sub - station. He said abatement will be needed as the building contains lead paint. The balance of the capital outlay plan was reviewed. PERSONNEL ISSUES Johnson stated a new Public Health RN staff person started on July 8 th and resigned on July 9 Recruitment for the position has begun. NEW POSITION REQUESTS FOR 2010 Youth Community Support Services Social Worker position: Staff prefaced their presentations stating that they realize with the current economic situation, now is a difficult time to ask for a new position. A position of social worker for Youth Community Support Services (YCSS) is being requested. This is currently a contracted position. The position is funded with no county levy dollars so there would be no additional burden on the tax levy. Community Options Program funding of $88,000 is available due to Long Term Support ending. These dollars were earmarked for children during reform and are expected to continue in following years. These funds are targeted towards the children's waiver program to serve children with disabilities on the wait list. Dunlap said clients are served based on health and safety of the client. These children can be at high risk for costly out of home placements if not served. The caseload continues to grow in YCSS. This position would also generate revenue from targeted case management and waiver billing. It also allows the department to access federal funding for services, rather than just accessing county levy. Dunlap and Kiesler emphasized there is more stability for consumers served by this program with a full time county employee versus a contracted position. Funk indicated contracted employees already receive some required benefits such as Wisconsin retirement, worker's comp; however, contracted employees are not eligible for health or life insurance nor paid time off benefits. Peterson questioned if a sunset clause would be attached to this position if the monies go away. Luckey questioned keeping the position as a contracted position and using the remaining money for purchasing services for clients. Motion A motion was introduced by Berenschot, seconded by Rasmussen, and adopted with Luckey voting no, that the Board approves a permanent full time St. Croix County Health and Human Services Board Page 7 July 15, 2009 Social Worker position for the Youth Community Support Services Unit and to forward this position request to the Finance Committee. Medical Records Technician: There is a move to consolidate Health and Human Services and Nursing Home medical records under one department. Wilson requested a move from two part -time contracted LTE medical record technician positions to one permanent full -time medical records technician. Funding for the position will also come from the nursing home medical records supervisor position that will not be filled. Johnson indicated the county's medical record department is very lean in comparison to other medical records units in other facilities. He said funding for this position is currently in the 2009 budget. Johnson said consolidating the organizational structure will make the department more efficient. Motion A motion was introduced by Peterson, seconded by Berenschot, and unanimously adopted: That the Board approves a permanent full time Medical Records Technician position and to forward this position request to the Finance Committee. Break from 9:50 - 10:00 AM. UPDATE ON PUBLIC HEALTH PREPAREDNESS EXERCISE Kramer reported on the preparedness exercise that took place June 15 as part of City Readiness. Grant funding was obtained through the State for this exercise and planning for this exercise has been ongoing for the past year. A brief overview of the exercise was given. Results of the exercise showed improvement needed in communication (both internal and external), a need for more people to manage various areas for extended mass clinic operations, and more alternate distribution sites. A recommendation was made to train more staff along with other people in the community in the incident command structure. Kramer said this exercise may have been good preparation for an H1N1 mass clinic if needed. The information gathered from this exercise will also be shared at a future county department head meeting. Luckey recommended also contacting the town board in each area of the county. Motion A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the Board supports Public Health in preparedness planning to train additional county staff in the incident command structure. REVIEW OF BUDGET TIME LINES FOR 2010 BUDGET REVIEW FOR HEALTH AND HUMAN SERVICES BOARD Johnson distributed copies of the 2010 budget instructions. Budget entry was opened July 6. Staff are currently checking salary and fringe for accuracy. It is anticipated the full Health and Human Services and Nursing Home budgets will be ready to present to the Health and Human Services Board at the next meeting on August 19 but Johnson would like a contingency date set for a second meeting if another meeting is needed. The Board set August 26 at 8:30 AM as a second meeting date /time if a second meeting is needed. DISCUSSION ON OPEN HEARING FOR 2010 BUDGET PLANNING Rasmussen questioned if monies are included in the budget for the Family Resource Center. Johnson said he did not believe there was a current purchase of service contract with the Family Resource Center. Clients receiving services provided by the Family Resource Center are not always connected with the services provided by Health and Human Services. Contracting with the Family Resource Center will be part of the budgetary consideration for 2010. St. Croix County Health and Human Services Board Page 8 July 15, 2009 CAPITAL OUTLAY PLANS FOR HEALTH AND HUMAN SERVICES AND NURSING HOME FOR 2010 Health and Human Services (HHS) capital outlay was created for items that cost over $5,000. Johnson outlined 2010 items listed. Luckey questioned $20,000 on the plan each year for computer software upgrade. The $20,000 is an average yearly figure for software expense, equipment charges, programming time, etc. Further clarification of expenses in this line item will be provided to the Board next month. Johnson reported St. Croix Industries funding was taken out of the general fund as most funding for this program is now from Community Health Partners (CHP) . The capital outlay plan for St. Croix Industries was reviewed. The goal is to obtain funding from places other than the general fund, which would include Community Health Partners, other counties, the state, grants and production fund. The Nursing Home capital outlay plan was reviewed. Robinson said staff is also looking at new beds that are 39" wide versus the current 36" wide beds as the wider beds are generally better for resident safety. He said the State does not want siderails used. Currently, there has to be a doctor's order to use siderails on resident beds. The beds are not in the current capital outlay plan, but may be added as more information becomes available. NURSING HOME ADMINISTRATOR'S REPORT Robinson stated May census averaged 65 /day with 45 Medicaid residents, 13 private pay, 7 Medicare part A, and 2 Medicare part B. He said the Nursing Home is trending in a positive direction with an average of three more residents /day and three more Medicare residents so far in July. He reported two more residents are expected to be admitted today and one more tomorrow, which would bring the Nursing Home to a census of 71. An ECS workgroup was formed to study the Nursing Home electronic record system. The hope is to eliminate the paper part of medical records and fully utilize ECS for an electronic medical record. This would allow less need for paper storage space and allow for better reporting and management of resident care. Robinson reported he is working with Tammy Wilson to merge medical record departments for the Nursing Home and Health and Human Services. 2009 NURSING HOME PURCHASE REQUESTS FOR NON - BUDGETED ITEMS Robinson reported Certified Public Expenditure (CPE) funds of will be received in July which will add revenue totaling an additional $99,551. These funds were not put in the 2009 budget as we could not attain confirmation from the State on the allocation amounts, if any. Robinson requested consideration to purchase the following capital outlay items in 2009 versus adding them to the 2010 capital outlay request. • New server: The Nursing Home is currently using the Health and Human Services server as the Nursing Home server went down completely several weeks ago. Estimated cost: $6,500. • Time reporting program (Ban Koe): The Kronos system will not be supported after September, 2009. Robinson reported Kronos is a system geared more for larger companies and Ban Koe is geared more towards smaller companies. Robinson said if the system is purchased in July, St. Croix County Health and Human Services Board Page: 9 July 15, 2009 2009, the cost will be $10,750 versus $16,000 if purchased later. Estimated cost: $10,750. • Computer Kiosks: Robinson is proposing a computer kiosk in each hallway to make documentation/ charting easier for staff. This would allow for more accurate documentation, which could result in increased revenue, plus it would support the movement from paper to electronic records. Estimated cost: $9,000. Motion A motion was introduced by Marzolf, seconded by Berenschot, and unanimously adopted: That the Board supports using the CPE funds received for the three purchase requests outlined above. Robinson said the remaining CPE funds amount after the above purchases would be approximately $76,301. He said there is a need for a van for the Nursing Home. The current van has been used to full capacity. The approximate cost of a new van with a wheelchair lift at the state contract price is $50,245. This van would not require a special CDL license as it is 12 -13 passenger van. Johnson said the Nursing Home has been putting off expenditures for years. Peterson said the van represents St. Croix Health Center in the community and public image is critical. Depreciation for the van would be allowed on the Nursing Home cost report. Luckey questioned purchasing a used van rather than new. Motion A motion was introduced by Peterson, seconded by Marzolf, and adopted with Luckey voting no: That the Board approves the purchase of a new van for the Nursing Home using CPE funds. NURSING HOME AND HEALTH AND HUMAN SERVICES STRATEGIC PLANNING A strategic planning sessions for the Nursing Home is being planned for July 29 and 30 at WITC -New Richmond. A questionnaire has been distributed to staff with a requested return of the questionnaire of July 14. Robinson has also been interviewing discharge planners. Duncan McDougall from Pathways will facilitate the planning sessions. The planning session is an open meeting so the public may attend. An agenda will be distributed after Timmerman reviews the agenda. Rebholz encouraged members to attend the meeting with an open mind as the meeting will be structured to develop a direction of what to do regarding the Nursing Home services and is not focused on building a new nursing home. HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW Revised By -laws were distributed with proposed changes noted. Board members will review and revisions will be discussed at the August meeting. CAPITAL OUTLAY PLANS FOR HEALTH AND HUMAN SERVICES AND NURSING HOME FOR 2010 (continued) : Pempek offered further clarification on computer software upgrade expenses included in the capital outlay plan. Motion A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the Board approves the capital outlay plan as presented and approves forwarding the plan to the Finance Committee and Chuck Whiting. St. Croix County Health and Human Services Board Page 10 July 15, 2009 Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Marzolf ended the meeting with a prayer. Time: 11:58 AM Chair: Attest: (Secretary)