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HomeMy WebLinkAboutHealth & Human Services 06-17-09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD And COUNCIL ON AGING AND DISABILITIES June 17, 2009 at 6: 00 PM (Head Start area, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL OLD AND NEW BUSINESS 1. Open Hearing- Review letters and take public testimony regarding the 2010 Health and Human Services budget process 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. 5/27/2009 1:58 PM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD AND COUNCIL ON AGING AND DISABILITIES PUBLIC HEARING June 17, 2009 The St. Croix County Health and Human Services Board conducted an "Open Hearing" on June 17, 2009, at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair, HHS and Council on Aging and Disabilities Deb Rasmussen, Secretary, HHS Roger Larson, HHS Linda Luckey, HHS Gerald Peterson, HHS and Council on Aging and Disabilities Richard Marzolf, HHS Dr. Lisa Ramsay, HHS Lois Burri, Council on Aging and Disabilities Alfred Schrank, Council on Aging and Disabilities OTHERS PRESENT: See attachment Wentz called the Open Hearing to order at 6:00 PM noting that the meeting was properly and legally publicized. Wentz welcomed everyone to the hearing. Roll call was held. Johnson stated it is important that the people who came to provide testimony have an opportunity to do so as we begin preparing the 2010 budget for the Health and Human Services and the Aging and Disability Resource Center. Johnson stated that commentary from the public is important. Johnson cited an example of how input can help with service delivery. As of February lst we transitioned our last long term support consumer to private care management organization. In a two year period those consumers from the wait list will be eligible for services in their home or community as we are processing approximately 5 to 8 cases per month through the ADRC. Staff and the board received feedback on every year before we began work on the budget and now these wait lists will be eliminated. Johnson stated some of these changes have been generated because of open hearings like this. Johnson stated that even though there is a small group attending tonight's meeting, it should not diminish the importance of the feedback. Johnson stated we will be preparing our 2010 budget that will be inclusive of Health & Human Services, St. Croix Industries, St. Croix Health Center and the Aging and Disability Resource Center. Department supervisors introduced themselves and gave a brief summary of their department. Johnson stated it is important to have staff introduce themselves because they do a significant amount of work when putting the budgets together. Johnson stated he has the privilege of working with staff day in and day out and they will take to heart the comments that are made today at this meeting when putting together the budget. In addition the budget will be brought forth to the various committees and those committees will review budgets and forward to the Finance committee. Budget hearings will held in front of the full County Board in November. Johnson introduced County Board members Roger Rebholz and Dave Ostness and stated he appreciated their time and any input they would have tonight. Johnson stated there were people attending who would like to give testimony and invited all those who wished to speak to do so. Johnson introduced Patty Draxler, Executive Director of the Family Resource Center in St. Croix County. She thanked Johnson and the Board for the 1 opportunity to speak. Draxler stated they have had a long partnership with St. Croix County and the Department of Health & Human Services. The Family Resource Center has worked in direct partnership with the Department of Health & Human Services and other organizations to maintain the system of support. Draxler asked Board members to read the overview of the organization and the programs they provide. She said she looks forward to continuing our work together for children and families in St. Croix County and would appreciate financial support to continue the services provided by the resource center. Johnson stated there were letters that would be read from those who could not attend or did not wish to speak. See attachments in minute book. Frank Robinson, Nursing Home Administrator, read a letter from a consumer that stated that the Nursing Home is a great facility and wants the Nursing Home services to continue. She stated her father has been a resident for two years and had good quality care. Johnson read another letter from a consumer about the Nursing Home whose comments were around the physical plant issues that we have such as lighting, paint, etc.. Johnson stated we have a two day planning to address the Nursing Home future and how we provide services. This may also include discussion on facility issues addressed in this letter, but staff will work with building services to address these needs. Deb Ramacher who works with families that have children with emotional needs and is also a mother of a child with special needs gave testimony. She stated that caring for children with special needs is a burden on families financially and the services provided by Health & Human Services are invaluable to the consumers in the County. Ramacher also read a letter from Pat & Deb O'Flanagan who has a child with autism. They stated they know that the County has had hard times but parents need funding for children with special needs Ninette Nolan gave testimony on the value of this meeting. Nolan stated that families are hurt when budgets are cut. Nolan has gotten help from our Community Support program but she would like to see us broaden programs to help transition consumers and help prevent them from having to come back for help. Marzolf stated how incredibly well the Nursing Home staff works together. The Nursing Home has received a third survey with no marks against them and he thanked them for all the hard work that they do. Johnson stated the comments given tonight will be given to committees and we will do the best we can to serve the needs of the community. Wentz thanked Board members, staff and the community for attending. Wentz stated they are very appreciative of all the hard work that staff does. Hearing adjourned at 6:55 PM. Chairman: Attest: Secretary 2 r Wentz will review vouchers. Revised: 06/08/09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD June 17, 2009 at 3:30 PM (note time change) (Board Room, Sk Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 05/22/09 DATE OF NEXT MEETING — 07/15/09 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. Personnel Issues a. New employees /vacancies b. Preliminary discussion on new positions for 2010 ** 4. Update on State budget 5. Preliminary planning for 2010 Capital Outlay Plan for Health and Human Services and Nursing Home 6. Nursing Home Report 7. Nursing Home Long Range Planning 8. Medical Records Department Report 9. Public Health 140 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. 6/8/2009 9:13 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD June 17, 2009 The St. Croix County Health and Human Services Board met on June 17, 2009 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Roger Larson Linda Luckey Richard Marzolf Gerald Peterson Dr. Lisa Ramsay Deb Rasmussen MEMBERS ABSENT: Leon Berenschot Charles Grant STAFF PRESENT: Fred Johnson, Health and Human Services Director Wendy Kramer, Public Health Officer /Public Health Coordinator Frank Robinson, Nursing Home Administrator Fay Strenke, Accounts Receivable Supervisor Tammy Wilson, Medical Records Supervisor Kathy Leisch, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Dave Ostness, County Board member Roger Rebholz, County Board Chair Norm Matzek Chair Wentz called the meeting to order at 3:30 PM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, July 15, 2009 at 8:30 AM. Peterson will review vouchers. AGENDA Motion A motion was introduced by Marzolf, seconded by Larson, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Peterson, seconded by Rasmussen, and unanimously adopted: That the minutes of the 05/22/09 Health and Human Services Board meeting be approved with the following changes requested by Luckey: Page 7, paragraph 2, first sentence should read as follows: Kiesler said of outpatient clients, approximately one -third are indigent, one -third -hare covered by Medicare /Medicaid which require a 40% match, and the remaining third are covered by insurance. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Wentz reviewed the vouchers. Johnson stated that the signature sheet summarizes the vouchers for Health & Human Services, Nursing Home and Workshop and this summary includes salary and fringe. Johnson stated this month we are now breaking out ADRC and Aging vouchers so the ADRC committee can review those St. Croix County Health and Human Services Board Page 2 June 17, 2009 vouchers. This break out of expenses will also include salary and fringe for the ADRC staff. Motion A motion was introduced by Wentz, 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 151548 through 151588, dated June 03, 2009 in the amount of $58,185.99. Human Services, Government Center and Nursing Home vouchers 151127 through 151210, dated May 21, 2009 in the amount of $114,979.83. Human Services and Nursing Home vouchers 151211 through 151231, dated May 21, 2009 in the amount of $15,371.72. Human Services, Government Center and Nursing Home vouchers 151354 through 151421, dated May 28, 2009 in the amount of $52,018.08. Department on Aging and ADRC vouchers 151422 through 151434, dated May 28, 2009 in the amount of $2,965.14. Human Services, Nursing Home, Government Center, ADRC, and Department on Aging vouchers 151520 through 151547, dated June 03, 2009 in the amount of $57,934.85. Human Services, Nursing Home, ADRC, and Government Center vouchers 152038 through 152149, dated May 07, 2009 in the amount of $96,264.65. Human Services, Department on Aging, and ADRC vouchers 152150 through 152243, dated May 14, 2009 in the amount of $14,120.82. Human Services, Government Center and Nursing Home vouchers 151909 through 152037, dated May 07, 2009 in the amount of $96,336.60. Nursing Home vouchers 152244 through 152256, dated May 07, 2009 in the amount of $4,658.93. Human Services, Workshop, Public Health, Social Services vouchers 297 through 325, dated May 28, 2009 in the amount of $392,743.90. Human Services, Workshop, Public Health, Social Services vouchers 326 through 355, dated June 11, 2009 in the amount of $392,460.30. Human Services and Nursing Home vouchers 281 through 305 dated May 28, 2009 in the amount of $146,300.19. Human Services and Nursing Home vouchers 306 through 332, dated June 11, 2009 in the amount of $158,717.48. Workshop vouchers 59 through 64, dated May 28, 2009 in the amount of $9,414.01. Workshop vouchers 65 through 70, dated June 11, 2009 in the amount of $11,546.57. St. Croix County Health and Human Services Board Page 3 June 17, 2009 FINANCIAL REPORT The following financial report for Health and Human Services through April, 2009 was distributed. Johnson reviewed the Health and Human Service monthly financial and made specific note of the Administration line, which states that revenues are negative 24.6 %, will continue every month through the year as a negative allocation for County appropriation which is due to excess carryover revenue (1.3 million). Johnson also noted that the revenue figure for Long Term Support will be adjusted when the State modifies the County contract as we are no longer providing long term care services. Overall, operating expenses are at 29.5% for the first 4 months of the year. HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget April 30, 2009 Balance % Administration 1,038,854.00 (255,147.93) 1,294,001.93 -24.6% AODA Services 760,671.16 261,305.51 499,365.65 34.4% Long Term Support 2,631,402.00 2,631,299.14 102.86 100.0 °% St. Croix Industries 2,482,747.71 685,059.12 1,797,688.59 27.6% Mental Health 3,448,843.99 1,210,761.76 2,238,082.23 35.1% Family & Children's 2,911,874.13 1,253,117.67 1,658,756.46 43.0% Public Health 1,976,209.95 641,631.20 1,334,578.75 32.5% Economic Support 1,152,939.29 290,887.05 862,05224 25.2% General Relief 0.00 0.00 0.00 0.0% Coordinated Services /SED 2,836,586.35 998,289.50 1,838,296.85 35.2% ARDC 632,000.00 166,798.00 465,202.00 26.4% Department on Aging 846,623.00 119,609.59 727,013.41 14.1% REVENUES HUMAN SERVICES PROGRAMS 20,718,751.58 8,003,610.61 12,715,140.97 38.6% SUMMARY Total OF EXPENDITURES Budget April 30, 2009 Balance % Administration 1,029,711.52 339,088.24 690,623.28 32.9% Alcohol -Drug Abuse 755,822.52 234,586.21 521,236.31 31.0% Long Term Support 2,631,098.96 257,386.38 2,373,712.58 9.8% St. Croix Industries 2,476,417.21 821,459.45 1,654,957.76 33.2% Mental Health 3,445,706.61 1,195,432.34 2,250,274.27 34.7% Family & Children's 2,908,835.69 1,024,814.77 1,884,020.92 35.2% Public Health 1,976,028.13 659,461.68 1,316,566.45 33.4% Economic Support 1,140,696.47 401,917.12 738,779.35 35.2% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service /SED 2,835,374.19 730,127.66 2105,246.53 25.8% ARDC 632,000.00 183,947.98 448,052.02 29.1% Department on Aging 846,623.00 250,140.77 596,482.23 29.5% EXPENDITURES HUMAN SERVICES PROGRAMS 20,678,314.30 6,098,392.19 14,579,922.11 29.5% Total S 1.905,218.42 The following financial report for the Nursing Home through April, 2009 was distributed. Johnson stated that Frank Robinson, NH director, will be giving St. Croix County Health and Human Services Board Page 4 June 17, 2009 the financials on the Nursing Home. Robinson reviewed the financial statement and noted that we are ahead of budget on revenues. We are currently at 36% and anything above 33% is ahead of budget on the revenue side. Johnson stated that one of the things that he and Robinson have spent time talking about is how our financials compare to other facilities where Robinson has been administrator. Changes to the monthly financial for the nursing home will be completed over the next couple of months. Johnson stated there may be some adjustments on PPD reports. Robinson stated that they are keeping track of the PPD monthly already so he knows ahead of time if they are having some problems before the financials even come out. Robinson stated he keeps track of it daily. Robinson would like to have the financials show a little different so it makes sense as to how each department breaks out. Robinson will update the Board as it progresses and will work with Pempek on adjustments to this report. St. Croix County Health and Human Services Board Page 5 June 17, 2009 St. Croix Health Center REVISED April 2009 Budget Actual Difference percentaq Census 0 Opeuating Revenue: Medicare $903,252.00 $348,233.56 $555,018.44 38.55% Medicaid $2,481,432.00 $790,175.92 $1,691,256.08 31.84% Private Pay $760,413.00 $277,719.75 $482,693.25 36.52% All Other Sources $216,041.00 $167,781.27 $48,259.73 77.66% Total Opeiating Revenue $4.36 $1.583.9 $2.777,227.50 30.32'o Operating Expenses Daily Patient Services $3,397,317.36 $1,138,888.15 $2,258,429.21 33.52% Special Services $284,262.00 $89,886.80 $194,375.20 31.62% General Services $1,148,672.04 $365,743.69 $782,928.35 31.84% Administrative Services $628,277.68 $237,178.32 $391,099.36 37.75% Unassigned: Depreciation (% Based) $0.00 Others: $402,923.00 $144,289.95 $258,633.05 35.81% Utilities $202,080.00 $34,285.36 Workers Comp, Computer Tech $133,400.00 $19,347.59 Insurance $67,443.00 $90,657.00 Total Operatinj Expenses $5.861.452.08 $1,975,986.91 $3.885.465.17 33.7'1 Net From )perations 4392.076.411 (Cost of doing business prior to applying levy & outstanding rev) Outstanding Revenues Outstanding Rate Appeal rev $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 $329,632.00 $615,033.00 34.89% Nursing Home Carry Over $191,000.00 $63,666.68 Total +rutstanding $'1,497.665.00 $393.298.68 $627.033.00 Net from all Sources $1,222.27 AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through April was reviewed. Strenke reviewed the aged receivable report and noted that this month they have split out the greater than 90 day receivables for 2009. The 2008 and 2007 receivables are separated so the charges from these years can be seen along with the balance of the 2009 charges. Strenke stated on the monthly income statement they are currently working with Forward Health who is our Medicare payer. Last October they switched from EDS • St. Croix County Health and Human Services Board Page 6 June 17, 2009 to Forward Health to a new Portal System on the Internet. They have a couple of items that are still not getting paid and they are working with customer service. PERSONNEL ISSUES Johnson stated there are no new positions or vacancies at this time. Johnson said there will be a preliminary discussion on new positions for 2010 and has sent out position requests to each department. Johnson stated that he understands the fiscal issues the County is facing, but felt that we need to at least go through the process even though new positions may not be a consideration when the full budget is reviewed by the County. Johnson stated he would like to have a dialogue with the board to review what we are considering with regard to positions for 2010. Johnson said the funding source would need to be identified for each new position requested and we need to decide if our contract staff or limited term employees are best meeting our needs. We would look at whether we can use those funds to continue the contracts or to look at other alternatives. Peterson stated we would want to be extremely cautious as to not hire new personnel and then have finance cut positions later on. Peterson stated that everything that we have seen coming out of the legislature is going to be a hit for Health and Human Services. Johnson stated he has some updated information and the budget impact is looking a little more positive than it had been in the past. Johnson stated a new position may require consolidating some services and work we do here on a routine basis. Johnson stated we have recently consolidated our intake process with three departments and will continue to look at ways we can facilitate some efficiencies with the staff that we have. UPDATE ON STATE BUDGET Johnson stated he attended a WCHSA (Wisconsin County Human Services Association) meeting. WCHSA is a professional organization that represents County interests and Wisconsin County Association (WCA) provides staff to assist the association in addressing County needs. It is made up primarily of directors and some County Board Supervisors as well. An overview was provided on the budget as of June 5 One specific item discussed was the certified public expenditure dollars for nursing homes. The governor's initial proposal was to eliminate certified public expenditure revenues but this allocation was reinstated. Johnson will get a clarification about supplemental payment revenues and how the certified public expenditure revenues go together. Johnson stated we did not make 2008 and 2009 plans to increase our revenues by $192,000 (the allocation for certified public expenditure revenue) given the uncertainty of this revenue stream, but hope to account for this revenue in the 2010 budget request for the nursing home. Johnson stated that the cost shift from the State to the County for Mental Health institutional costs is still in the budget. In our last year's budget we estimated an approximate $220,000 expenditure that would increase for institutional placements given this cost shift. We will take a look at how we can work to adjust caseload demands to address institutional placements when they occur to assure individuals are safe and have appropriate resources when they return to the community. This may also include the need to develop more local resources to try to minimize our exposure with regard to institutional cost. Johnson stated there was a 1% reduction in Income Maintenance plus a loss of supplemental payment. Johnson stated they have been told that stimulus dollars will fill in that loss. Johnson stated that there was a proposed 5% reduction in the youth aid dollars that go into the Children and Family Services Unit. Johnson stated he believed that allocation was made whole so • St. Croix County Health and Human Services Board Page 7 June 17, 2009 based on the June 5 th conversation we should not see any reductions in our youth aid allocation. Johnson stated these were the primary areas that were discussed at the meeting on June 5 th relating to Health and Human Services funding. Johnson received confirmation that we made it through the initial round of our concept paper for development of a juvenile treatment court. Judge Vlack has been instrumental in working on the adult drug court and Health and Human Service staff has been working with the court on developing a juvenile treatment court for those families that have youth at high risk of placement. We are moving into phase two, which, if we are successful, could mean additional grant dollar to assist in implementation of the program. We are looking at ways to enhance both revenues and service delivery. Johnson reminded the Board that placement numbers in our Family and Children's and Behavioral Health departments are relatively low by comparison of like sized counties in our region. We currently have 25 kids in various placements and development of this service is anticipated to help keep children and their families together. PRELIMINARY PLANNING FOR 2010 CAPITAL OUTLAY PLAN FOR HEALTH AND HUMAN SERVICES AND NURSING HOME Johnson stated a Capital Outlay Plan will be put together as we have in past budgets. Johnson said in previous months the Board had received information on capital or expenditure needs for the Nursing Home and Robinson will be looking at those needs and may be adding items to that plan. Johnson said that they have just started looking at what Health and Human Service capital needs might be and we may end up passing on some things this year. Capital outlay plans will be brought to the board next month. Break from 4:45 - 4 :55 PM. NURSING HOME REPORT Robinson stated the average May census in the Nursing Home was 65 patients per day. 43 were on Medicaid, 9 patients on Medicare and 13 private pay patients. Robinson stated he is working with staff to address enhancing revenue for the facility so we can decrease our dependency on the levy. Robinson stated this will be his focus going forward. Robinson stated they currently have some rooms on the second floor that have been decommissioned or taken out of service and he would like to get those back in service and create some more private rooms and create some specialty units in our Nursing Home which again should enhance revenue. Robinson stated we have never decertified the beds so we are still licensed for 72 beds, so all we did was move where those beds were located and closed down some of the rooms. Robinson stated we need to work internally to improve operations even as we are going through this process of strategic planning. MEDICAL RECORDS DEPARTMENT REPORT Johnson introduced Tammy Wilson, Medical Records Supervisor, to the Board. Board members introduced themselves to Wilson. Johnson stated that Wilson has been in her position for two months and one of the things that is exciting about bringing Tammy on board is the degree she has as a Registered Health Information Administrator. Wilson stated she has passed all of her tests for certification. Wilson stated they are working to consolidate the Nursing Home records with Health and Human Services records for one Medical Records unit so she can oversee both departments. Wilson stated she would like to get everyone on board with electronic medical records and will make this a priority in her work. Johnson stated that the sad news in regard to the Nursing Home is that Barb St. Croix County Health and Human Services Board Page 8 June 17, 2009 Williams passed away. Williams worked in the Nursing Home medical records department a couple of days a week and was ill for an extended period of time. Johnson stated that Williams passing was a loss to our facility. Johnson stated we have a temp from MPS that has experience in the Nursing Home arena to help. Wilson stated there are three staff in Health and Human Services, one full -time and two part -time limited term employees. Wilson stated there is too much paper being used right now and we need to be using the computer more. Wilson said that the Nursing Home currently uses an electronic charting system. She said we can get a better reimbursement rate if specific codes are used for billing in Health and Human Services. Dr. Lisa Ramsay said there are financial incentives with doing electronic medical records. Johnson stated this is a major shift in our operations. PUBLIC HEALTH 140 REVIEW Kramer distributed paperwork on what is evaluated during this review for the health department. The State requires certain services depending on what level (I, II, or III) the Local Health Department is designated. The State recommends that one or more Board members attend that process. The review is scheduled for July 16 Kramer stated we will be evaluated as a Level II Public Health Department. Rasmussen participated in the last review that was performed in 2005. Rasmussen and Wentz agreed to participate in the review process on July 16 NURSING HOME LONG RANGE PLANNING Johnson stated that Rebholz will be making some appointments from the County Board at large, along with this committee to work with the Nursing Home on long range planning. Rebholz would like the appointed committee members to have background information before the meeting. Rebholz will make the appointments next week and give them to Robinson so he can communicate directly with the appointed members. Wentz stated that all parties interested are anxious to move forward and Duncan McDougall from Pathway Health Services has a good outlook on planning. Wentz said Duncan wants to get organized and move forward. Robinson stated they are doing a lot of work behind the scenes to prepare for the upcoming meetings on July 29 & 30 Robinson stated he will be interviewing discharge planners as well as referral sources to ask if we are meeting their needs or if we can do anything to meet their needs better. Robinson will be surveying his staff to get feedback /recommendations for long range planning. They will be getting all stakeholders involved in this process. Marzolf stated it is important that Nursing Home employees feel ownership in this process and it is critical to get their input. Johnson stated his goal in this is to create a shared vision amongst the County Board members so we can move forward with a specific plan. 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: 5:50 PM Chair: Attest: (Secretary) St. Croix County Health and Human Services Board Page 8 June 17, 2009 Williams passed away. Williams worked in the Nursing Home medical records department a couple of days a week and was ill for an extended period of time. Johnson stated that Williams passing was a loss to our facility. Johnson stated we have a temp from MPS that has experience in the Nursing Home arena to help. Wilson stated there are three staff in Health and Human Services, one full -time and two part -time limited term employees. Wilson stated there is too much paper being used right now and we need to be using the computer more. Wilson said that the Nursing Home currently uses an electronic charting system. She said we can get a better reimbursement rate if specific codes are used for billing in Health and Human Services. Dr. Lisa Ramsay said there are financial incentives with doing electronic medical records. Johnson stated this is a major shift in our operations. PUBLIC HEALTH 140 REVIEW Kramer distributed paperwork on what is evaluated during this review for the health department. The State requires certain services depending on what level (I, II, or III) the Local Health Department is designated. The State recommends that one or more Board members attend that process. The review is scheduled for July 16 Kramer stated we will be evaluated as a Level II Public Health Department. Rasmussen participated in the last review that was performed in 2005. Rasmussen and Wentz agreed to participate in the review process on July 16 NURSING HOME LONG RANGE PLANNING Johnson stated that Rebholz will be making some appointments from the County Board at large, along with this committee to work with the Nursing Home on long range planning. Rebholz would like the appointed committee members to have background information before the meeting. Rebholz will make the appointments next week and give them to Robinson so he can communicate directly with the appointed members. Wentz stated that all parties interested are anxious to move forward and Duncan McDougall from Pathway Health Services has a good outlook on planning. Wentz said Duncan wants to get organized and move forward. Robinson stated they are doing a lot of work behind the scenes to prepare for the upcoming meetings on July 29 & 30 Robinson stated he will be interviewing discharge planners as well as referral sources to ask if we are meeting their needs or if we can do anything to meet their needs better. Robinson will be surveying his staff to get feedback /recommendations for long range planning. They will be getting all stakeholders involved in this process. Marzolf stated it is important that Nursing Home employees feel ownership in this process and it is critical to get their input. Johnson stated his goal in this is to create a shared vision amongst the County Board members so we can move forward with a specific plan. 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: 5:50 PM Chair: Attest: (Secretary)