Loading...
HomeMy WebLinkAboutHealth & Human Services 10-21-09 Wentz will review vouchers. Revised 10/07/09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: October 21, 2009 at 8 :30 LOCATION: (Board Room, St Croix County DHHS Building, 1445 N. Fourth Street, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 09/16/09 DATE OF NEXT MEETING – 11/18/09 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. Nursing Home Administrator's Report 4. Nursing Home diversification of revenue to meet changing needs 5. Foster Parent Banquet- November 5th 6. Review of pre - vocational services for St. Croix Industries 7. Review and adjustments to the Health and Human Services, St. Croix Industries, and Nursing Home's 2010 budget request 8. Annual Report 9. County Board reorganization 10. Personnel Issues a. New employees /vacancies 11. Rate Setting- Public Health and Administrative cost allocation methodology 12. Public Health Volunteer Medical Advisor 13. ECHO conference report (10:00 AM) ** 14. Economic Support – Energy Assistance applications 15. HINT update ** 16. Resolution Amending the 2009 Health and Human Services Budget — Public Health Emergency Preparedness Funding ** 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. 10/7/2009 8:08 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD October 21, 2009 The St. Croix County Health and Human Services Board met on October 21, 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 Dr. Lisa Ramsay Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Frank Robinson, Nursing Home Administrator Wendy Kramer, Public Health Officer /Public Health Coordinator Mary Squyer, Economic Support Supervisor Clark Schroeder, St. Croix Industries Director Tim Markgraf, YCSS Lead Social Worker Tammy Wilson, Medical Records Supervisor Kim Dupre, Information Systems Analyst John Bretl, Alternate Care Coordinator Malva Sirek, Secretary OTHERS PRESENT: Roger Rebholz, County Board Chair Norm Matzek Loyla Waskul 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, November 18, 2009 at 8:30 AM. Marzolf will review vouchers. Wentz displayed and explained a new meeting attendance form that will be piloted and asked each member to sign the form. Peterson requested the November 18 agenda include the following item: Discussion and consider construction of a 20 -unit assisted living apartment. He also requested that all future agenda include the following item: Possible agenda items for the next meeting. Peterson expressed frustration that discussion and construction of a 20 -unit assisted living apartment was not on the agenda today as he requested and he was uncertain how to get an item on the agenda. Johnson said this was going to be discussed under agenda item #4 Nursing Home diversification of revenue to meet changing needs. Peterson expressed concern discussing this issue under this agenda item due to the open meeting law and that the public should be aware of what is going to be discussed. Johnson will contact Corporation Counsel regarding an opinion on whether this item meets open meeting law requirements for the agenda today. St. Croix County Health and Human Services Board Page 2 October 21, 2009 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 Marzolf, seconded by Larson, and unanimously adopted: That the minutes of the 09/16/09 Health and Human Services Board meeting be approved as distributed. FOSTER PARENT BANQUET - NOVEMBER 5 T " : Bretl introduced himself as the Alternate Care Coordinator. He said the Foster Parent banquet is scheduled for November 5 from 5:30 to 7:30 PM at St. Croix National Golf Club. Invitations have been sent. The banquet is held to recognize foster parents and thank them for the commitment these individuals make to the kids of our county. Bretl said five service awards will be given. He said one of the parents received the Governor's award and another will be honored for over 20 years of providing foster care. Marzolf has agreed to represent the Board and offer comments of thanks and support to the foster parents. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Wentz reviewed the vouchers. 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 158359 through 158360, dated September 16, 2009 in the amount of $17,478.00. Human Services voucher 156921, dated August 26, 2009 in the amount of $645.00. Human Services vouchers 159434 through 159473, dated October 07, 2009 in the amount of $54,208.74. Human Services, ADRC, and Department on Aging vouchers 158259 through 158268, dated September 16, 2009 in the amount of $3,313.89. Human Services and St. Croix Industries vouchers 158269 through 158317, dated September 16, 2009 in the amount of $35,307.31. Department on Aging and ADRC vouchers 158623 through 158626, dated September 23, 2009 in the amount of $770.24. Human Services, Nursing Home, Government Center and St. Croix Industries vouchers 158627 through 158730, dated September 23, 2009 in the amount of $95,370.47. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 158836 through 158950, dated September 30, 2009 in the amount of $70,186.85. Human Services, Department on Aging and ADRC, vouchers 158951 through 158962, dated September 30, 2009 in the amount of $711.25. Human Services, Department on Aging and ADRC, vouchers 159563 through 159641, dated October 07, 2009 in the amount of $13,228.53. St. Croix County Health and Human Services Board Page 3 October 21, 2009 Human Services, Nursing Home, St. Croix Industries, Government Center, Department on Aging, and ADRC vouchers 159642 through 159723, dated October 07, 2009 in the amount of $74,512.74. Human Services, Nursing Home, and St. Croix Industries, vouchers 159474 through 159562, dated October 07, 2009 in the amount of $74,199.82. Human Services, Nursing Home, St. Croix Industries, and Government Center, vouchers 159917 through 159981, dated October 14, 2009 in the amount of $62,847.05. Human Services, Department on Aging and ADRC, vouchers 159982 through 160018, dated October 14, 2009 in the amount of $4,691.89. Nursing Home vouchers 158318 through 158358, dated September 16, 2009 in the amount of $42,469.44. Nursing Home vouchers 159724 through 159755, dated October 07, 2009 in the amount of $16,910.41. Human Services, Workshop, Public Health, Social Services vouchers 529 through 556, dated September 17, 2009 in the amount of $392,113.08. Human Services and Nursing Home vouchers 495 through 519, dated September 17, 2009 in the amount of $153,737.84. Workshop vouchers 110 through 115, dated September 17, 2009 in the amount of $14,940.60. Human Services, Workshop, Public Health, Social Services vouchers 557 through 586, dated October 01, 2009 in the amount of $392,599.80. Human Services and Nursing Home vouchers 520 through 546, dated October 01, 2009 in the amount of $162,790.43. Workshop vouchers 116 through 121, dated October 01, 2009 in the amount of $13,059.77. Human Services, Workshop, Public Health, Social Services vouchers 587 through 615, dated October 15, 2009 in the amount of $395,844.30. Human Services and Nursing Home vouchers 547 through 571, dated October 15, 2009 in the amount of $153,033.77. Workshop vouchers 122 through 127, dated October 15, 2009 in the amount of $9,154.06. FINANCIAL REPORT The following financial report for Health and Human Services through August, 2009 was distributed. To be on budget the percentage should be 66 %. These reports are also shared with Michelle Pietrick, Finance Director. Health and Human Services is above average for revenues as monies for Long Term Support have not yet been recouped by the State. St. Croix County Health and Human Services Board Page 5 October 21, 2009 St. Croix Health Center August 2009 Budget Actual Difference Percentagf Census 0 Operating Revenue: Medicare $903,252.00 $767,137.56 $136,114.44 84.93% Medicaid $2,481,432.00 $1,568,640.47 $912,791.53 63.22% Private Pay $760,413.00 $556,825.50 $203,587.50 73.23% Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGTfSupplemental Funds $350,000.00 $348,738.00 $1,262.00 99.64% All Other Sources $216,041.00 $142,730.48 $73,310.52 66.07% Total Operating Revenue $4.723.138.00 $3,383,072.01 $1.339.0 65.99 71.65% Operating Expenses Daily Patient Services $3,397,317.36 $2,215,191.83 $1,182,125.53 65.20% Special Services $284,262.00 $171,776.27 $112,485.73 60.43% General Services $1,148,672.04 $710,692.60 $437,979.44 61.87% Administrative Services $628,277.68 $462,667.32 $165,610.36 73.64% Unassigned: Depreciation (% Based) $0.00 Others: $402,923.00 $193,070.57 $209,852.43 47.92% Utilities $202,080.00 $69,646.15 Workers Comp, Computer Tech $133,400.00 $32,767.42 Insurance $67,443.00 $90,657.00 Total Operating Expenses $5,861.452.08 $3,753,398.59 $2.108,053.39 64.04% Net From Operations ($369,326.58) (Cost of doing business prior to applying levy & outstanding rev) County Revenues Co Allocations (% Based) $947,314.08 $631,542.72 $315,771.36 66.67% Nursing Home Carry Over $191,000.00 $127,333.36 $63,666.64 66.67% Total Outstanding $1,138.314.08 $758,876.08 $379.338.00 Net from all Sources $389,549.50 AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through August was reviewed. Pempek noted the total receivables per month are improving. The following financial report for St. Croix Industries through August was distributed. At the beginning of the year St. Croix Industries accounts were separated from Health and Human Services. When that was done there was $190,000 in receivables at year end that would have been credited back to St. Croix Industries if they had stayed with Human Services. Because of this separation, St. Croix Industries shows a negative figure on the following report. St. Croix County Health and Human Services Board Page 6 October 21, 2009 St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget August 31, 2009 Balance WS Operations 1,342,664.56 783,838.68 558,825.88 58.4% WS Production 422,286.84 201,763.14 220,523.70 47.8% WS Helping Hands 71,726.26 69,660.96 2,065.30 97.1% WS Pop/Vending 7,250.00 6,422.44 827.56 88.6% WS Ram 77,443.00 25,588.07 51,854.93 33.0% WS Vocational Placement 371,831.60 200,452.35 171,379.25 53.9% WS Comm Based Day Prog 183,214.95 92,682.06 90,532.89 50.6% REVENUES 2,476,417.21 1,380,407.70 1,096,009.51 55.7% SUMMARY Total OF EXPENDITURES Budget August 31, 2009 Balance % WS Operations 1,342,664.56 863,272.06 479,392.50 64.3% WS Production 422,286.84 196,053.14 226,233.70 46.4% WS Helping Hands 71,726.26 41,459.82 30,266.44 57.8% WS PopMending 7,250.00 3,920.50 3,329.50 54.1% WS Ram 77,443.00 19,471.01 57,971.99 25.1% WS Vocational Placement 371,831.60 211,849.78 159,981.82 57.0% WS Comm Based Day Prog 183,214.95 119,258.01 63,956.94 65.1% EXPENDITURES 2,476,417.21 1,455,284.32 1,021,132.89 58.8% Total 3 (74.876.62) REVIEW AND ADJUSTMENTS TO THE HEALTH AND HUMAN SERVICES, ST. CROIX INDUSTRIES, AND NURSING HOME'S 2010 BUDGET REQUEST Johnson said health insurance numbers apparently came in higher than expected for all departments as follows: increase of approximately $289,000 for Health and Human Services, increase of $69,000 for Nursing Home, increase of $24,000 for St. Croix Industries, and increase of $11,000 for ADRC. Johnson said these are significant adjustments that will need to be made to the budget and it would be nice to get these numbers sooner. Other budget adjustments include Public Health who will receive $182,381 to run the vaccination campaign for H1N1. A resolution will be presented to the Board to amend the 2009 Health and Human Services budget with $127,781 of the funding being added to the 2009 budget and $54,600 being moved to the 2010 budget. $30,000 has been added to Behavioral Health to fund clients under the age of 21 or over the age of 65 who are hospitalized for mental health issues. This is an estimated allocation as we have not received a final notification. Health insurance costs resulted in an increase of $69,000 for the Nursing Home, which if added as levy, will not meet the 30% reduction in levy goal. Robinson said the best area to make an adjustment in the budget due to the health insurance increase is to add another Medicare individual to the census for the last six months of the year. He feels it is possible to do this with the creation of a Medicare wing and creating more private rooms. Robinson said the 2009 budget was built on a census of six Medicare residents and today the Nursing Home is at 10 without the Medicare wing being opened yet. The Nursing Home will continue to work towards the 30% levy decrease. St. Croix County Health and Human Services Board Page 7 October 21, 2009 Discussion at the Finance Committee meeting was that they will hold the Nursing Home harmless due to the increase in insurance. A list of items totaling $972,923 pulled from the budget was distributed at yesterday's County Board meeting. Items on the list will need to be reprioritized and evaluated between need and want items to help balance the budget due to the health insurance increase. The County may be able to borrow to fund these capital items and there may be stimulus money available to borrow at reduced interest rates. Johnson said some items are for New Richmond buildings but are listed under the Building Services budget. The Finance Committee meets again on October 27 RATE SETTING - PUBLIC HEALTH AND ADMINISTRATIVE COST ALLOCATION METHODOLOGY The Board reviewed a portion of the rates at last month's meeting. Johnson would like rates to be reviewed at least annually to keep rates current. He said agent fees were increased to keep levy dollars out of the program. Luckey requested to see what the amount of increase in rates is from last year to this year. Pempek said this is the first time rates have been consolidated to get a basis for comparison and point of reference. Also, rates are based on the Federal Poverty Level (FPL), which can change routinely. Public Health billing has not run through Human Services centralized billing and this will be reviewed in the future to see if changing some of these procedures will create more efficiency, which may be addressed through the billing assessment we will be completing yet this year. Luckey questioned the FPL. Johnson offered to put on a future agenda. Pempek will send FPL site information to Luckey. Johnson further indicated that future rate sheets will have historical rate information so board members can make comparisons. Pempek reviewed the administrative cost plan. The administrative cost plan distributes the allowable costs of Health and Human Services to the various departments within the agency. Administrative costs are added to the actual staff costs to determine the program rates. The Board recessed from 9:58 - 10:07 AM. ECHO CONFERENCE REPORT Kim Dupre, Tammy Wilson and Tim Markgraf gave a report on attending the ECHO conference. Dupre is the database administrator for ECHO. Some things accomplished were the development of an intake screen, which has been running since January, and implementation of automatic call reminder system (City Watch) . Electronic forms have been consolidated. Staff are also able to access the ECHO system remotely. Electronic health records are mandated to be in place by 2014. A Visual Health Record (VHR) upgrade is coming out in November. Electronic billing is being implemented for Medicaid, Medicare and insurance with work on electronic remittances to begin soon. ECHO is geared more for behavioral health type services. It was helpful to attend the conference to network with people who use the system and software. Walworth County in southern Wisconsin is scheduled to go live with the ECHO system January 1, 2010. Walworth County has been able to accomplish state downloads of the ESACWIS and HSRS information. ECHO has an IT person who has a good understanding of HIPAA. Staff will have the ability to track information and audit charts electronically versus manually auditing paper charts, which will benefit the county in the long term. Berenschot commended staff for learning more about the ECHO system and making it work. St. Croix County Health and Human Services Board Page 8 October 21, 2009 NURSING HOME ADMINISTRATOR'S REPORT Robinson said the average monthly census for August was 66 and the September average monthly census was 65. Robinson said it is to the Nursing Home's advantage to have Medicare residents. The Medicare unit is close to completion. Robinson anticipates Medicare residents will begin to be admitted to the unit on October 26. He said the creation of the Medicare unit also created 14 additional private rooms so there are a total of 32 private rooms in the facility. The Nursing Home is doing well with electronic medical records with the move towards a wireless system and adding kiosks on each wing to allow staff to chart immediately. It is anticipated this will also be done by the end of this week with implementation planned for the first part of November. Robinson said Nursing Home residents are also now able to receive and carry on private telephone conversations in their rooms. The former cordless phones did not reach all areas and the new wireless phones allow private phone calls anywhere in the building. NURSING HOME DIVERSIFICATION OF REVENUE TO MEET CHANGING NEEDS Johnson contacted Timmerman to get an opinion on open meetings and a general discussion on options to diversify revenue, including assisted living. Timmerman felt the agenda item as listed was acceptable. If the board was going to have a specific conversation about an assisted living facility only as an alternative to diversify revenue, then the item would need to be specifically identified. A general discussion followed regarding options regarding diversification of revenue. The first option was to create a Medicare unit in the building. This will be done next week. As a result of the strategic planning session, Frank has assembled a panel to look at diversified revenues and service that the Health Center could provide. The panel is investigating what services will be paid for and what service needs are not being met. Lower income assisted living has been identified as a need. Also identified is a need for adult day care. There are currently `social' models for adult day care but no `medical' models in the area. There is a possibility that Community Health Partners (CHP) will be a payer for these services and a meeting will be scheduled with them to review service needs. Robinson toured Dunn County, who is investigating construction of a 50 -bed nursing home and 10 -unit cottages. He said 40% of the cost of the building will be paid for by the state with enhanced Medicaid rates. More information will be presented at the November meeting with ways to diversify and retool. Board members expressed an interest in receiving a progress report on Spring Valley's project. Spring Valley utilized grant monies for their facility. Peterson said there are stimulus monies available and doesn't want the county to miss out on any possible funds that may be available for this project. Robinson and Johnson will try to arrange for an update from Kevin Larson from Spring Valley Health Center for the November meeting. Rasmussen expressed concerns regarding the quality of care in assisted livings without regulation in place. Robinson reported that an assisted living attached to a nursing home is different than when the assisted living is independent and in the business to make money. Staffing levels and standards are in place for nursing homes that carryover to the attached assisted living. Dr. Ramsay indicated there is a need to provide assistance for people who live in their own home, before they are ready to go to an assisted living. For home care, an actual building structure is not needed as staff go into resident St. Croix County Health and Human Services Board Page 9 October 21, 2009 homes. Staff and supervision are already in place in the nursing home and she suggested exploring expanding the nursing home to also provide home care. PUBLIC HEALTH VOLUNTEER MEDICAL ADVISOR Johnson said Dr. Ramsay is the new volunteer medical advisor for Public Health and thanked her for her willingness to fill this role for Public Health. Schroeder reminded Board members that St. Croix Industries will have an open house on Thursday, 10/22, from 1:00 to 5:00 PM to recognize 35 years of service. REVIEW OF PRE - VOCATIONAL SERVICES FOR ST. CROIX INDUSTRIES Schroeder informed the Board there is a possibility the State will stop funding pre- vocational services. If the State stops funding pre- vocational services, the `choice' of long term sheltered employment will not be an option. Schroeder explained the State intention is not for clients to be in sheltered employment for an indefinite period of time. Concern was expressed as this information was not communicated directly by the state. Day services can be provided but at a higher cost as staffing ratios are generally smaller. The State staff involved in Long Term Care Reform repeatedly indicated there was enough money currently in the system to pay for services when the program was rolled out. The State has now extended the time frame to eliminate waiting lists. Originally the time frame was 24 months, now it is 36 months. Care management organizations are losing money due to long term care reform as consumers in this group often need care 24 -7. More information will be shared with the Board as more information is received. Legislators may need to be further educated as they are not aware of this issue. RESOLUTION AMENDING THE 2009 HEALTH AND HUMAN SERVICES BUDGET — PUBLIC HEALTH EMERGENCY PREPAREDNESS FUNDING Emergency preparedness funding in the amount of $182,381 has been offered. Most of St. Croix County's allocation, $127,781, will be received in 2009, and the balance, $54,600, will be used in 2010. Administration is requesting the Board's approval to accept the funds and amend the 2009 budget. Motion A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the Board approves the following resolution: RESOLUTION AMENDING 2009 HEALTH AND HUMAN SERVICES BUDGET Resolution No. St. Croix County, Wisconsin WHEREAS, the St. Croix County Department of Health and Human Services received notice from the Wisconsin Division of Public Health, Preparedness Unit, for an allocation for Public Health Emergency Response funding; and WHEREAS, this allocation is for implementation of the 2009 H1N1 influenza mass vaccination - related campaign at the state, local and tribal levels; and WHEREAS, the total allocation for St. Croix County is $182,381; and St. Croix County Health and Human Services Board Page 10 October 21, 2009 THEREFORE BE IT RESOLVED that the St. Croix County Board of Supervisors authorizes an amendment to the 2009 Health and Human Services Budget for receipt of the Public Health Emergency Response funding in the amount of $127,781 with the balance to be moved to the 2010 budget in the amount of $54,600; and BE IT FURTHER RESOLVED that the St. Croix County Board of Supervisors authorizes an amendment to the 2009 Health and Humans Services budget for expenditures for implementation of the 2009 HIM influenza mass vaccination clinic. ANNUAL REPORT The Board had no further comments regarding the 2008 annual report, which was distributed at the September meeting. COUNTY BOARD REORGANIZATION Discussion was held regarding the resolution creating the organizational structure and procedural rules for a 19- member Board of Supervisors. The resolution was amended at the County Board. The modification indicated that the County Board will elect the functional committees and the functional committees will elect their own chairs. PERSONNEL ISSUES Johnson said there are no new employees. Johnson has questioned Human Resources regarding the compensation package for non - represented individuals. He has also brought up on -call compensation policy as there are a variety of systems in place throughout the county. ECONOMIC SUPPORT - ENERGY ASSISTANCE APPLICATIONS The Energy Assistance Program began October 1, 2009. The income limits have been raised drastically, which makes more clients eligible for much less in benefits. Benefits last year were $514 and this year it is anticipated benefits will be $212.00. Excel Energy benefits last year were $204 and it is anticipated benefits will be reduced to $115 this year. Walk -in clients for energy assistance are seen Tuesday, Wednesday and Thursday from 8:00 to 11:00 AM. Last season approximately 1,752 clients were seen; to date 487 mail -in and 64 walk -in applications have been submitted. It is projected that WHEAP applications will increase 50 -70% from last season. Squyer reported crisis service will be limited this year and clients are told to not avoid their vendors and every effort should be made to pay their bills. Open communications are needed with vendors and clients should set up payment plans with the vendor if they are having difficulty making full payments. For any crisis help with fuel assistance, clients must apply for the regular allotment first. They also must have paid at least $25.00 to their vendor in the last three months or they will not receive assistance. The maximum paid per client for fuel assistance is $500. Westcap will also weatherize some homes. Squyer reported no more applications are being accepted for Badgercare Core Plus program. The applications already submitted are being processed. H1N1 UPDATE Kramer reported mass vaccination clinics were scheduled for the schools in the county, but less vaccine was received than was ordered so alternate plans are being formed for school -based clinics. The dates for immunization clinics for schools are being pushed back until more vaccine arrives. Staff is following the guidelines from the Center for Disease Control, and from the Department of Health Service, Division of Public Health. St. Croix County Health and Human Services Board Page 11 October 21, 2009 Phase 1 has been implemented and Phase 2 will be implemented when more vaccine is received. Kramer reported the New Richmond School District was reporting a high absenteeism this week due to influenza. It is anticipated legislation will allow superintendent of schools to make the call to close schools due to the health and safety of the students versus the health officer during this state of public health emergency and they can also waive make up days. Public Health has requested volunteers to help run clinics when the vaccine is received. Wentz asked if there were any other issues to bring before the Board. Board members plus Matzek and Rebholz toured the renovated rooms that will be used to create a Medicare unit. Wentz adjourned the meeting. Time: 12:36 PM Chair: Attest: (Secretary)