Loading...
HomeMy WebLinkAboutHealth & Human Services 09-16-09 Berenschot will review vouchers. Revised 09/10/09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 16, 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 - 08/19/09 DATE OF NEXT MEETING — 10/21/09 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 Health and Human Services receivable report 3. Nursing Home Administrator's Report 4. Resolution Amending the 2009 Health and Human Services Budget 5. Review of Resolution amending 2009 Nursing Home Budget II 6. Tobacco -free grounds resolution 7. Resolution to Publicly Support the Tobacco Prevention and Control Program 8. Proposed 2010 Agency Rate setting 9. Personnel Issues a. New employees /vacancies 10. Proposal to conduct Medicaid maximization assessment 11. Review and adjustments to the Health and Human Services, St. Croix Industries, and Nursing Home's 2010 budget request 12. HIN1 flu update and corresponding County planning 13. County Board reorganization 14. Annual Report 15. Review of agency planning for guardianship expense ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval riust be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 9/10/2009 9:14 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 16, 2009 The St. Croix County Health and Human Services Board met on September 16, 2009 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Richard Marzolf Gerald Peterson Dr. Lisa Ramsay MEMBERS ABSENT: Deb Rasmussen, excused Linda Luckey, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Frank Robinson, Nursing Home Administrator Ron Kiesler, Behavioral Health Coordinator Kathy Dunlap, Family and Children's Coordinator Wendy Kramer, Public Health Officer /Public Health Coordinator Geralyn Karl, Health Educator Mary Squyer, Economic Support Supervisor Malva Sirek, Secretary OTHERS PRESENT: Roger Rebholz, County Board Chair Chuck Whiting, Administrative Coordinator Art Tobin, Building Services Director Dave Ostness, County Board Supervisor Norm Matzek 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, October 21, 2009 at 8:30 AM. Wentz 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 Marzolf, seconded by Larson, and unanimously adopted: That the minutes of the 08/19/09 Health and Human Services Board meeting be approved with the change requested by Marzolf. REVIEW OF RESOLUTION AMENDING 2009 NURSING HOME BUDGET II Robinson reviewed the resolution that was passed by the Health and Human Services Board at the August meeting. This resolution will be presented to the County Board at their September 22 meeting. The computer server will separate the Nursing Home from Health and Human Services and will assist with the goal for the Nursing Home to become paperless with electronic medical records. The computer kiosks on each wing will allow staff to chart immediately versus charting at the end of the shift. This will allow more accurate charting which should increase revenue. The van does not fit bid criteria but the price reflected in the resolution is St. Croix County Health and Human Services Board Page 2 September 16, 2009 the State contract rate and is the actual cost of the van delivered to the Nursing Home. RESOLUTION AMENDING 2009 NURSING HOME BUDGET II St. Croix County, Wisconsin WHEREAS, the County Board considered a resolution to amend the 2009 nursing home budget at its August 18, 2009 meeting; and WHEREAS, a budget amendment resolution requires an affirmative vote of two- thirds of the entire membership of the County Board; and WHEREAS, the resolution received 20 votes in favor of adopting the resolution and 5 votes in opposition; and WHEREAS, the resolution was declared adopted; and WHEREAS, after further review on August 19 th , it was discovered that the resolution failed to obtain a two- thirds vote of the entire membership of 31 of the County Board, which would have been 21 votes; and WHEREAS, some affirmative action is required of the County Board regarding disposition of unbudgeted revenues received by a County department; and WHEREAS, in the 2009 Nursing Home budget, a zero amount was budgeted in the Certified Public Expenditure revenue item because any revenue arising under this item could not be verified; and WHEREAS, the County will receive revenue in 2009 under the Certified Public Expenditure totaling $139,551.00; and WHEREAS, in the 2009 Nursing Home budget an amount of $350,000.00 of revenue was anticipated as a supplemental payment, but the actual revenue is now anticipated to be less - $310,000.00; and WHEREAS, net additional revenue is anticipated to be $99,551.00; and WHEREAS, the Health and Human Services Board met on August 19 and updated a motion to make unbudgeted expenditures in 2009 utilizing the unanticipated revenue for the following items for the Nursing Home: Computer server $ 6,500.00 Computer kiosks 9,000.00 Van 52,948.00 Total $68,448.00 and WHEREAS, the receipt of these unanticipated revenues, the expenditure of funds for these unbudgeted expenses, or another disposition for these unanticipated revenues, require that a budget amendment be authorized by a two - thirds vote of the entire membership of the Board of Supervisors; and WHEREAS, the Finance Committee has reviewed this matter. Si. Croix County Health and Human Services Board Page 3 September 16, 2009 THEREFORE, be it resolved that the St. Croix Board of Supervisors authorizes an amendment to the 2009 Nursing Home budget for receipt of a Certified Public Expenditure in the amount of $139,551.00. FURTHER, be it resolved that the St. Croix County Board of Supervisors authorizes an amendment to the 2009 Nursing Home budget for expenditures for the items identified above in amounts not to exceed the amounts shown, and for expenditures budgeted to be paid with the supplemental payment that are not now covered because of the supplemental payment shortfall. FURTHER, be it resolved that the amount of the balance remaining, taking into account the approximately $40,000.00 shortfall in the supplemental payment (a balance of approximately $31,103.00) be retained in the Nursing Home fund to be applied to its 2010 budget. NURSING HOME ADMINISTRATOR'S REPORT Robinson said the July average Medicare census was 6. He said there is also one insurance payor source in the Nursing Home at this time. Staff are working on strategic planning and putting items into action plans with identifying steps needed to accomplish goals. Strategic planning goals will be tracked for the Board and it is anticipated updates will be ready to present to the Board by October or November. One item identified in strategic planning was to open beds on second floor so a rehab unit could be opened in the Nursing Home. Robinson expressed frustration on accomplishing this part of the plan due to waiting for a response from building services. It is past the date when this part of the plan was supposed to be done. The Nursing Home needs the support of building services to get this done. Wentz questioned if it would be possible to contract services to get this done. These rooms need to be completed to get the Medicare patients needed to meet the proposed 2010 budget. Robinson said some of the walls in these rooms need to be repaired. Some of the equipment in these rooms has been cannibalized and they need to get back to being resident rooms. Peterson recommended going directly to the County Board with this problem, not the Finance Committee, as Tobin reports to Finance. It was suggested having a separate maintenance department for New Richmond as New Richmond is a large facility. Currently, it is set up so that New Richmond maintenance staff have to receive directions from Tobin to get work orders done. Robinson said if the 2010 Nursing Home budget is going to work, this work has to be done in order to create a rehab wing. Whiting said the concerns need to be brought to the Finance Committee and this item will be added to the 09/22/09 Finance Committee agenda. Motion A motion was introduced by Larson, seconded by Grant, and unanimously adopted: That the Board will put the Building Services issue on the Finance Committee agenda for 09/22/09 to get Tobin on the same page to get work orders done or that Building Services employees in New Richmond can do the work that needs to be done without going through Tobin. Efforts need to be made to work more cooperatively and collaboratively to get the work done. Robinson indicated it is important to the Nursing Home that the work gets done as six more Medicare residents are needed to fill beds by January 1, 2010 to meet the proposed 2010 budget. The longer the project is delayed, the more pressure is put on staff. Peterson again recommended that New Richmond have its own separate maintenance department. St. Croix County Health and Human Services Board Page 4 September 16, 2009 RESOLUTION AMENDING THE 2009 HEALTH AND HUMAN SERVICES BUDGET The State issued a notice on 08/31/2009 that $18.6 million were allocated to serve youth on the Youth Community Support Services (YCSS) waiting list. St. Croix County's portion of these funds is $270,905. Once this money is used, it becomes part of the base allocation and will be received every year. If the money is not used by July, 2010, the State will do corrective action plans. The State has outlined that all the money can be used in the first year. A staff person will need to be hired to meet these needs. The State also offered that since billing for this staff person cannot be set up in the first six months, the State will work with St. Croix County to provide additional start up funds for the new staff person. Staff are requesting a budget amendment to accept the $270,905 and to add a staff person to the 2010 budget. The resolution also requests to add a staff in 2009 as the funding is available now. Confirmation of St. Croix County receiving the $270,905 has been received in writing; however, written confirmation has not been received for the additional start up fees. St. Croix County will receive these funds every year; however, if you don't spend the monies, you will not get the money. These funds are good for the community and residents. St. Croix County has a need for these funds. There are no county levy dollars involved in this resolution. Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the Board approves the following resolution with the funds received being $207,905: RESOLUTION AMENDING 2009 HEALTH AND HUMAN SERVICES BUDGET St. Croix County, Wisconsin WHEREAS, the St. Croix County Department of Health and Human Services received a Division of Long Term Support information memo on August 28 2009 that identified an allocation of new waiver funds for Children's Long Term Support Waivers (CLTS); and WHEREAS, this allocation was part of the 2009 -2011 biennial budget and included significant new resources to expand services to children with Long Term Support needs; and WHEREAS, the State allocated funding for Children's Long Term Support State - funded waiver slots for new children is available as of July 9, 2009; and WHEREAS, the 2009 -2011 biennial budget bill provides $18.6 million over the biennium to increase funding for the CLTS waivers; and WHEREAS, St. Croix County's allocation of new CLTS waiver annualized base funding is $270,905; and WHEREAS, St. Croix County Department of Health and Human Services anticipates serving children with this additional funding based upon current wait lists and routine referrals to the CLTS waiver; and WHEREAS, St. Croix County Department of Health and Human Services Youth Community Support Services department currently administers all of the CLTS waivers and will need additional social work staff to administer these new waiver slots; and St. Croix County Health and Human Services Board Page 5 September 16, 2009 WHEREAS, this new social work position will not require additional County levy but will be funded through a 6 month start up funding allocation and will be sustained in the future through case management billing; and 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 Children's Long Term Support Waiver allocation in the amount of $270,905; 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 eligible children with long term support needs and for an additional social work staff to administer services. Dunlap reported notice has been received that St. Croix County did not receive the $150,000 grant for Juvenile Treatment Court. Staff are working on a second grant that will be submitted by September 23, 2009. The Board will be updated in the future on the status of the second grant application. The Board recessed from 9:20 - 9:35 AM. NURSING HOME ADMINISTRATOR'S REPORT (continued) Tobin arrived at the meeting at 9:35. He said he will have finalized costs for the Nursing Home by Friday, 09/18/09. He said he has moved 1.5 staff from Hudson to New Richmond to try to alleviate some of the issues in New Richmond. He said PPD hours allow a total of nine hours per day, five days a week for Nursing Home building services staff. He said there have been years of shortcomings to meet Nursing Home building needs. He said building services staff have worked on overtime 4 -5 of the last 7 weekends to get work done. He said there is one building services staff out on leave and the building service department is short of staff. He said he delegates as much as possible to building services staff. He said he has received 129 e -mails in the last three days and tries to get to issues as soon as possible. Wentz questioned contracting out maintenance services for New Richmond; Tobin replied `no'. Tobin said there would be a 30 -day time frame to complete the rooms. It will take about two -weeks to get supplies and hopes to be done with the project by the end of October. More communication and cooperation is expected from building services. The work in the Nursing Home needs to be done in order for the Nursing Home to have a reduction in levy. Tobin took responsibility for missing a deadline and will follow up with his staff that was assigned the project. Tobin said Nursing Home and Health and Human Services have more capital outlay than any other department. He said code issues in the Nursing will be time consuming. Robinson said that the issue here was not getting any response from Tobin. Johnson offered to be flexible with staff assignments. He offered to meet weekly with Tobin as a department management team in Health and Human Services to keep lines of communication open. Johnson offered to help with management of work orders with support staff if needed. Johnson also offered to have building services staff report directly to Robinson in the Nursing Home to expedite work that needs to be completed. Tobin delegates work orders through lead workers. Tobin said he would respond to voicemails/ e -mails within 24 hours versus 48 hours. Tobin said the project would be completed by 10/31/09. Tobin will send information to Robinson and Pempek by Friday, 09/18/09. St. Croix County Health and Human Services Board Page 6 September 16, 2009 It was the consensus of the committee that the previous motion will be brought to the Finance Committee to make them aware of the issue. Marzolf recommended contracting with an outside vendor if the work is not done by a certain date. Peterson recommended using the monies paid for overtime expenses to go for contract services. Johnson expressed concern over the lack of communication and delays in response from building services. He said the Nursing Home budget may need to be amended if the work in the Nursing Home is not done to set up a Medicare unit. Johnson will work with building services with structure to help set priorities. Rebholz recommended contracting temporary staff to help get the job done. Robinson said it is a priority to get the Medicare wing ready and there is currently no plan in place to get the work done. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Berenschot reviewed the vouchers. Motion A motion was introduced by Berenschot, 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 156919 through 156920, dated August 19, 2009 in the amount of $18,910.00. Human Services voucher 156921, dated August 26, 2009 in the amount of $645.00. Human Services vouchers 157802 through 157841, dated September 09, 2009 in the amount of $59,522.36. Human Services, St. Croix Industries, and Nursing Home vouchers 156291 through 156392, dated August 19, 2009 in the amount of $1,848,784.48. Human Services, Government Center, St. Croix Industries, and Nursing Home vouchers 156922 through 157013, dated August 26, 2009 in the amount of $113,813.45. Department on Aging and ADRC vouchers 157014 through 157024, dated August 26, 2009 in the amount of $2,812.03. Department on Aging and ADRC vouchers 157148 through 157163, dated September 02, 2009 in the amount of $5,716.18. Human Services, Nursing Home, Government Center and St. Croix Industries vouchers 157164 through 157257, dated September 02, 2009 in the amount of $96,906.46. Human Services, Nursing Home, St. Croix Industries, Government Center, and ADRC, vouchers 157929 through 158001, dated September 09, 2009 in the amount of $65,662.68. Human Services, Nursing Home, St. Croix Industries, and Government Center vouchers 157842 through 157928, dated September 09, 2009 in the amount of $55,669.60. Human Services, Department on Aging and ADRC, vouchers 158007 through 155101, dated September 09, 2009 in the amount of $18,864.03. S�-. Croix County Health and Human Services Board Page 7 September 16, 2009 Nursing Home vouchers 158002 through 158006, dated September 09, 2009 in the amount of $7,829.59. Human Services, Workshop, Public Health, Social Services vouchers 471 through 498, dated August 20, 2009 in the amount of $396,702.24. Human Services and Nursing Home vouchers 444 through 467, dated August 20, 2009 in the amount of $158,197.77. Workshop vouchers 98 through 103, dated August 20, 2009 in the amount of $8,033.73. Human Services, Workshop, Public Health, Social Services vouchers 499 through 528, dated September 03, 2009 in the amount of $390,431.02. Human Services and Nursing Home vouchers 468 through 494, dated September 03, 2009 in the amount of $160,453.40. Workshop vouchers 104 through 109, dated September 03, 2009 in the amount of $12,003.08. FINANCIAL REPORT There was a further breakout of where funds are at for St. Croix Industries. There is a negative $102,701.27 reflected on the report due to a reversed receivable due to a change in reporting procedure. St. Croix County Health and Human Services Board Page 8 September 16, 2009 St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget July 31, 2009 Balance % WS Operations 1,342,664.56 628,490.48 714,174.08 46.8% WS Production 422,286.84 267,329.01 154,957.83 63.3% WS Helping Hands 71,726.26 33,830.96 37,895.30 47.2% WS PopMending 7,250.00 5,626.84 1,623.16 77.6 % WS Ram 77,443.00 25,588.07 51,854.93 33.0% WS Vocational Placement 371,831.60 167,012.00 204,819.60 44.9% WS Comm Based Day Prog 183,214.95 78,283.50 104,931.45 42.7% REVENUES 2,476,417.21 1,206,160.86 1,270,256.35 48.7% SUMMARY Total OF EXPENDITURES Budget July 31, 2009 Balance % WS Operations 1,342,664.56 779,886.42 562,778.14 58.1 % WS Production 422,286.84 178,799.93 243,486.91 42.3% WS Helping Hands 71,726.26 36,149.94 35,576.32 50.4% WS Pop/Vending 7,250.00 3,738.24 3,511.76 51.6% WS Ram 77,443.00 18,951.32 58,491.68 24.5% WS Vocational Placement 371,831.60 186,269.13 185,562.47 50.1% WS Comm Based Day Prog 183,214.95 105,067.15 78,147.80 57.3% EXPENDITURES 2,476,417.21 1,308,862.13 1,167,555.08 52.9%'a Total S (102.701.27) The following financial report for Health and Human Services through July, 2009 was distributed. Carryover funds were added to the bottom of the report. Long Term Support is still showing $3,474,542 in revenue. Pempek estimated about $250,000 will remain in Long Term Support revenue after the state takes back money from the account. St. Croix County Health and Human Services Board Page 9 September 16, 2009 HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget July 31, 2009 Balance % Administration (282,648.48) (438,314.57) 155,666.09 155.1% AODA Services 755,822.52 457,724.71 298,097.81 60.6% Long Term Support 2,631,098.96 3,474,542.22 (843,443.26) 132.1% Mental Health 3,445,706.61 2,166,910.56 1,278,796.05 62.9% Family & Children's 2,908,835.69 1,943,364.42 965,471.27 66.8% Public Health 1,976,028.13 1,345,342.72 630,685.41 68.1% Economic Support 1,140,696.47 647,809.74 492,886.73 56.8% General Relief 0.00 0.00 0.00 0.0% Coordinated Services /SED 2,835,374.19 1,685,169.78 1,150,204.41 59.4% ARDC 632,000.00 374,623.00 257,377.00 59.3% Department on Aging 846,623.00 485,694.97 360,928.03 57.4% Carryover Funds 1,312,360.00 765,543.33 546,816.67 58.3% REVENUES HUMAN SERVICES PROGRAMS 18,201,897.09 12,908,410.89 5,293,486.20 70.9% SUMMARY Total OF EXPENDITURES Budget July 31, 2009 Balance % Administration 1,029,711.52 590,237.28 439,474.24 57.3% Alcohol -Drug Abuse 755,822.52 412,859.80 342,962.72 54.6% Long Term Support 2,631,098.96 290,788.73 2,340,310.23 11.1% Mental Health 3,445,706.61 2,059,896.09 1,385,810.52 59.8% Family & Children's 2,908,835.69 1,709,081.32 1,199,754.37 58.8% Public Health 1,976,028.13 1,081,205.02 894,823.11 54.7% Economic Support 1,140,696.47 689,439.86 451,256.61 60.4% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service /SED 2,835,374.19 1,282,559.34 1,552,814.85 45.2% ARDC 632,000.00 298,334.22 333,665.78 47.2% Department on Aging 846,623.00 413,511.48 433,111.52 48.8% EXPENDITURES HUMAN SERVICES PROGRAMS 18,201,897.09 8,827,942.73 9,373,954.36 48.5% Total S 4.080.468.16 The following financial report for the Nursing Home through July, 2009 was distributed. The Nursing Home report reflects a positive $340,514.65 after applying county allocation and Nursing Home carryover. St. Croix County Health and Human Services Board Page 10 September 16, 2009 St. Croix Health Centel" July 20011 Bud��et Actual Difference Pelcentaij Census 0 Upeiatinij Revenue: Medicare $903,252.00 $690,703.60 $212,548.40 76.47% Medicaid $2,481,432.00 $1,370,038.12 $1,111,393.88 55.21% Private Pay $760,413.00 $474,358.50 $286,054.50 62.38% Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGT /Supplemental Funds $350,000.00 $348,738.00 $1,262.00 99.64% All Other Sources $216,041.00 $119,110.93 $96,930.07 55.13% Total 4'1pe1a1i1k4j Revenue $4.723.138.00 }3.002 11411.15 $1.720.188.85 63.58':. Opeiating Expenses Daily Patient Services $3,397,317.36 $1,945,267.56 $1,452,049.80 57.26% Special Services $284,262.00 $152,491.74 $131,770.26 53.64% General Services $1,148,672.04 $624,492.38 $524,179.66 54.37% Administrative Services $628,277.68 $421,877.83 $206,399.85 67.15% Unassigned: Depreciation (% Based) $0.00 Others: $402,923.00 $182,321.49 $220,601.51 45.25% Utilities $202,080.00 $69,646.15 Workers Comp, Computer Tech $133,400.00 $22,018.34 Insurance $67,443.00 $90,657.00 Total fTeiating Expenses $5.861.452.08 $3.326.451.00 $2.535.001.08 Net Fiow ±Fpeuations 1$323.501.851 (Cost of doing business prior to applying levy & outstanding rev) 4 411111 y Revenues Co Allocations (% Based) $947,314.06 $552,599.81 $394,714.27 58.33% Nursing Home Carry Over $191,000.00 $111,416.67 $79,583.33 58.33% Total iFUtstauding $1.138.3'14.08 $664.0'16.48 $474.297.60 Ilet hom all Sources $340.5'14.63 The ADRC Committee requested more detail in their financial reports so some changes were made. The Aging and ADRC reports were also distributed to the Health and Human Services Board. These reports are through 08/31/09 due to the way billing timelines fall. AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through July was reviewed. TOBACCO -FREE GROUNDS RESOLUTION The state -wide clean indoor air act is slated to go into effect 07/05/2010. Kramer and Karl presented a resolution for tobacco - free policy for all county grounds. If this resolution is passed, St. Croix County would be the first county in the state to have 100% tobacco -free St. Croix County Health and Human Services Board Page 11 September 16, 2009 county grounds. Karl recommended support for tobacco cessation, especially for county employees. She said a penalty has not been determined as this is a policy, not an ordinance. Karl said communication and education are the key to compliance. Karl said there is no safe level of exposure to tobacco. Public Health promotes population health and social norm changes and this policy is in line with the vision and mission of the county. Discussion was held on the ownership of the fairgrounds. The fairgrounds are owned by the City of Glenwood City; however the grounds are leased to the County and the County has control of the fairgrounds; however, if the fair moves, the grounds and control reverts back to the City of Glenwood City. Motion A motion was introduced by Peterson, second by Larson and unanimously adopted: That the Board modifies the following resolution to be effective January 1, 2010 and approves the following resolution: RESOLUTION FOR A TOBACCO -FREE POLICY FOR COUNTY GROUNDS WITH GOVERNMENT BUILDINGS, COUNTY -OWNED PARKS, THE FAIRGOUNDS AND COUNTY -OWNED VEHICLES St. Croix County, Wisconsin WHEREAS, the St. Croix County Board of Supervisors passed a resolution in 1992 that directed all County Government buildings and passenger vehicles be smoke -free (with the exception of the day room area of the jail) effective January 1, 1993; and WHEREAS, the St. Croix County Board of Supervisors passed a resolution in May of 2005 indicating: 1. The undersigned hereby requests that the Wisconsin Legislature strengthen state laws to fully protect workers and the public from the known health dangers of secondhand smoke by adopting legislation that creates smoke -free workplaces. 2. The undersigned also requests that any state legislation or regulation must preserve the right of local levels of government to adopt more restrictive measures to protect citizens from secondhand smoke; and WHEREAS, the St. Croix County Department of Health and Human Services, at the May, 2007 meeting, directed the Health and Human Services Director to send a letter to State legislators indicating support of Senate Bill 150, also known as the Breathe Free Wisconsin Act with the following considerations: • Support a uniform Wisconsin Statute change to ban smoking to include all indoor places but to exclude private passenger vehicles and any private residence. • Smoking ban to exclude outdoor areas except as currently defined in Statute. • That fines and penalties should not be increased; and WHEREAS, the Surgeon General's Report of 2006, "The Health Consequences of Involuntary Exposure to Tobacco Smoke," declares there is no safe level of exposure to tobacco smoke; and St. Croix County Health and Human Services Board Page 12 September 16, 2009 WHEREAS, the provision of tobacco free environments is an effective measure of protecting the health of the employees of St. Croix County and that of the public we serve; and WHEREAS, the St. Croix County Department of Health and Human Services Board met on January 30, 2008 to consider strengthening the County's existing smoke -free policy; and WHEREAS, the St. Croix County Department of Health and Human Services Board selected a January 1, 2010 implementation date of a tobacco -free policy for the St. Croix County Government grounds with Government buildings, including the fairgrounds, County -owned parks and County -owned vehicles and equipment (regardless of location). WHEREAS, the Department of Health and Human Service staff will draft a plan for the stages of implementation of the policies which will include, but not be limited to, meetings with county building, county -owned parks and fairground supervisors, tobacco and secondhand smoke education and smoking cessation assistance /support. THEREFORE BE IT RESOLVED that the St. Croix County Board of Supervisors directs that all County Government grounds with Government buildings, County -owned parks, the fairgrounds and all County -owned vehicles and equipment be tobacco -free effective January 1, 2010. RESOLUTION TO PUBLICLY SUPPORT THE TOBACCO PREVENTION AND CONTROL PROGRAM: Motion A motion was introduced by Grant, seconded by Berenschot, and unanimously adopted: That the Board approves the following resolution be brought to the October County Board meeting: Resolution Supporting Tobacco Prevention and Control Programs St. Croix County, Wisconsin WHEREAS, the Centers for Disease Control (CDC) states that tobacco use is the leading cause of preventable death, disease, and excessive healthcare costs (over $2.02 billion annually in Wisconsin alone); and WHEREAS, tobacco prevention and control programs work and save lives by helping smokers quit and preventing youth from ever starting smoking; and WHEREAS, an investment of one dollar saves nearly four dollars in tobacco - caused healthcare costs; and WHEREAS, the CDC recommends that Wisconsin invest $64.3 million dollars in tobacco prevention and control programs; and WHEREAS, the current funding is $6.85 million, less than 11% of the recommended funding; and Si. Croix County Health and Human Services Board Page 13 September 16, 2009 WHEREAS, without adequate funding of tobacco prevention and control programs, positive trends will reverse, such as the 65% reduction in middle school smoking rates, 36% reduction of high school smoking rates and the adult smoking rate dipping below 20% for the first time ever; and THEREFORE, BE IT RESOLVED that the St. Croix County Board of Supervisors supports adequate funding of tobacco prevention and control programs to ensure the health of all Wisconsin citizens. BE IT FURTHER RESOLVED by the St. Croix County Board of Supervisors that a copy of this resolution be forwarded to the Governor of the State of Wisconsin, St. Croix County's Legislative Representatives, and to the Wisconsin Counties Association. The Board recessed from 10:55 - 11 :02 AM. PROPOSED 2010 AGENCY RATE SETTING A document of all Health and Human Services rates except for Public Health was distributed to Board members. The Uniform Fee System will be applied if fees are not listed below. Motion A motion was introduced by Berenschot, seconded by Peterson, and unanimously adopted: That the Board approves the following rates as presented: ST CROIX COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES FEE SCHEDULE (Effective 1/1/2010) SERVICE RATE ADULT COMMUNITY SUPPORT SERVICES (ACSS) CSP (Community Support) Psychiatrist $ 81.25 15 minutes Psychologist $ 63.75 15 minutes Therapist (Master's Level) $ 52.50 15 minutes Social Worker (Bachelor's Level) $ 37.50 15 minutes Registered Nurse (Bachelor's Level) $ 37.50 15 minutes Mental Health Technician $ 31.25 15 minutes Group (Bachelor's Level) $ 14.25 15 minutes Group (Master's Level) $ 17.50 15 minutes Targeted Case Management - -All Disciplines $ 37.50 15 minutes ALCOHOL OR DRUG SERVICES Initial Assessment $ 350.00 2 hours Individual Counseling $160.00 per hour Group Counseling $53.00 per hour Letters /Reports $160.00 per hour St. Croix County Health and Human Services Board Page 14 September 16, 2009 INTOXICATED DRIVER PROGRAM Assessment $350.00 Flat Fee Amendment to Driver's Safety Plan $160.00 Flat Fee Final Report $160.00 Flat Fee IDP No Show —Late Cancel $350.00 Flat Fee "Must be paid prior to scheduling service BIRTH TO 3 SERVICES Speech Therapy $150.00 per hour Occupational Therapy $150.00 per hour Parental Fee Per Fee Calculation Worksheet Targeted Case Management - -All Disciplines $37.50 15 minutes FAMILY AND CHILDREN'S OUT OF HOME CARE Parental Cost Share Respite Care Based on Family Financial Form Worksheet Shelter Care Based on Family Financial Form Worksheet Foster Care Based on Family Financial Form Worksheet Group Home Based on Family Financial Form Worksheet Secure Detention Based on Family Financial Form Worksheet CCI Based on Family Financial Form Worksheet YES Program Based on Family Financial Form Worksheet MENTAL HEALTH SERVICES PSYCHIATRIST Initial Appointment $216.00 -- 40 Minutes Ongoing Psychotherapy with medication management $325.00 per hour Medication Management $108.00 – 20 Minutes Letters /Reports $325.00 per hour PSYCHOLOGIST Initial Appointment $382.50 – 90 Minutes Testing $510.00 – 2 hours Follow -up Appointment $255.00 per hour Group $85.00 per hour Letters /Reports $255.00 per hour THERAPIST (Master's Degree) Initial Appointment $210.00 per hour Individual Psychotherapy $210.00 per hour Family Psychotherapy $210.00 per hour Group Psychotherapy $70.00 per hour Letters /Reports $210.00 per hour St. Croix County Health and Human Services Board Page 15 September 16, 2009 OTHER SERVICES Atlas House $23.00 per day Inpatient Hospitalizations Per Hospital Contract Inpatient Hospital Physician Fees Per Hospital Contract Residential Treatment Facilities -- Fahrman Center Per Contract - -Arbor Place Per Contract IMD Placements Cost Share Per Fee Calculation Worksheet Late Cancellations /Missed Appointment $25.00 Flat Fee PUBLIC HEALTH Targeted Case Management - -All Disciplines $37.50 — 15 minutes YOUTH COMMUNITY SUPPORT SERVICES Waiver Parental Fees Per Fee Calculation Worksheet Family Support Parent Fees Per Fee Calculation Worksheet Targeted Case Management - -All Disciplines $37.50 -- 15 minutes COURT ORDERED SERVICES Alcohol /Drug Abuse Assessment $320.00 Anger Management (3 sessions) 630.00 MMPI 446.25 OTHER OUTPATIENT CHARGES LATE CANCELLATION/MISSED APPOINTMENT $25.00 LETTERS /REPORTS (I hour) Psychiatrist $325.00 Psychologist 255.00 Therapist (Master's Degree) 210.00 AODA Counselor 160.00 COMMUNITY SUPPORT PROGRAM (Per 15 minutes) Psychiatrist 81.25 Psychologist 63.75 Therapist (Master's Degree) 52.50 Social Worker (Bachelor's Degree) 37.50 Registered Nurse 37.50 Mental Health Technician 31.25 St. Croix County Health and Human Services Board Page 16 September 16, 2009 WAIVER TARGETED CASE MANAGEMENT (Per Hour) All Providers $150.00 *Fees subject to change without notification. SERVICE RATE COMPREHENSIVE COMMUNITY SERVICES (CCS) Mental Health Psychiatrist $ 81.25 15 minutes Psychologist $ 63.75 15 minutes Therapist (Master's Level) $ 52.50 15 minutes Social Worker (Bachelor's Level) $ 37.50 15 minutes Registered Nurse (Bachelor's Level) $ 37.50 15 minutes Mental Health Technician $ 31.25 15 minutes Group (Bachelor's Level) $ 14.25 15 minutes Group (Master's Level) $ 17.50 15 minutes TARGETED CASE MANAGEMENT - -All Disciplines $37.50 15 minutes ADRC AND AGING FEE SCHEDULE BILLING CONTRACT SERVICE CODE RATE Unskilled Respite Care 55102 Per Diem Home - Delivered Meals S5170 $7.70 /meal Congregate Meals (60+ years of age) 59977 $3.75 /meal Congregate Meals (under 60 years of age) S9977 -01 $7.70 /meal Liquid supplement B4150 $30.00 /case Transportation Volunteer Medical transportation Program 50215 $0.585 /mile ADRC Bus /Van Service: *Medical trips, must be scheduled during regularly scheduled hours of operation Twin Cities Metropolitan Area A0110 $15.00 /one -way Between municipalities or senior centers A0110 -40 $5.00 /one -way Within municipalities or senior centers AOO 10 -41 $1.50 /one -way ST. CROIX INDUSTRIES FEE SCHEDULE St. Croix Industries Fee Schedule -2010 Prevocational (Work) Services T2014 $59.46 /day Day Services T2020 $72.72/day Work/Day Services Transportation T2002 $19.38 /day Supportive Employment Job Coaching (Community Placement) H2023 $9.20/15 minute unit Supportive Employment Transportation (Community St. Croix County Health and Human Services Board Page 17 September 16, 2009 Placement) T2003 $14.48 /trip Daily Living Skills Training H2014 $6.00/15 minute unit MEDICAL RECORDS Changes to Medical Records Access in the 2009 -2010 Wisconsin State Budget. The 2009 -2011 Wisconsin State Budget, 2009 WI Act 28 ( "Act 28 "), makes changes to Wisconsin's medical record access statute, § 146.83, Wis. Stats. The effective date for the changes is July 1, 2009. Fee Schedule A health care provider must provide the patient or "person authorized by the patient" with copies of a "patient's health care records" after receiving a request for copies from a patient or person authorized by the patient, an informed consent, and payment of the applicable fees. Refer to § 146.83 (If) (a), Wis. Stats. A health care provider may charge no more than the total of all of the following for providing the copies request by the patient or "person authorized by the patient ": • For paper copies, 35 cents per page. • For microfiche or microfilm copies, $1.25 per page • For a print of an X -ray, $10 per image • For providing copies in digital or electronic format, a charge for all copies requested. • Actual shipping costs. • A fee equal to 10 percent of the total fees charged above, if the person requesting the copies requests delivery within 7 or fewer days and the provider delivers the copies in that time. Refer to § 146.83 (If) (c), Wis. Stats. Since the law is silent regarding sales tax, the organization processing the record requests needs to determine how sales tax will be addressed. If the request is from a person other than a patient or "person authorized by the patient," in addition to the above, the provider may charge the following: • A single $15 processing and handling charge for all copies requested. Refer to §146.83 (1h) (b), Wis. Stats. • $5 for certification of copies. "Patient health care records" definition is revised to include "all records made by an ambulance service provider, as defined in s.256.01(3), an emergency medical technician, as defined in s.256.01(5), or a first responder, as defined in s.256.01(9), in administering emergency care procedures to and handling and transporting sick, disabled, or injured individuals ". "Billing statements and invoices for treatment or services provided by a health care provider" are included as "patient health care records." Refer to §146.81 (4), Wis. Stats. Note: "Person authorized by the patient" is a very limited list of people specified in statute that generally refers to those persons who have the authority to make health care decisions for the St. Croix County Health and Human Services Board Page 18 September 16, 2009 patient or who is the survivor of a deceased patient. Also, HIPAA limits the fees that can be charged to patients and the patient's "personal representative" as defined under 45 CFR 164.502(g). Refer to 45 CFS 164.524(c)(4). Therefore, a health care provider cannot charge the processing and handling fee to a "personal representative" ( HIPAA) or "a person authorized by the patient" (Wis. Stats.). Exceptions to the fees outlined above. Copies requested under s.51.30, Wis Stats or the disclosure provisions in U46.82(2), Wis. Stats. None of the above copy provisions apply to s.51.30, Wis. Stats., or copies requested pursuant to the exceptions to confidentiality under § 146.82(2), Wis. Stats. Patient Inspection After the patient (or person authorized by the patient) submits a statement of informed consent, a health care provider must make a patient's health care records available for inspection to the patient or person authorized by the patient without fee, during regular business hours after the health care provider receives notice. Refer to § 146.83 (ld), Wis. Stats. Medical Assistance Patient A health care provider may not charge a fee for providing one set of copies of a patient's health care records if the patient is eligible for Medical Assistance. A health care provider may charge the statutory fees for providing a second or additional set of copies of the patient's health care records. Refer to § 146.83(lf)(d)2., Wis. Stats. Social Security Disabilityy Requests. The Disability Determination Bureau (DDB) is the agency responsible for determining eligibility for Social Security Disability Insurance and Supplement Security Income for Wisconsin residents on behalf of the Social Security Administration (SSA). • flat fee of $26 per submission will be reimbursed to the health care provider, if: • A patient or person authorized by the patient requests copies of the patient's health care records for use in appealing a denial of social security disability insurance or supplementary security income, or • The Department of Health Services requests copies of the patient's health care records for use in determining eligibility for social security disability insurance or supplementary security income. See §146.83 (lh)(c) and (1f)(d)1, Wis. Stats. • Department of Health Services memo is included with this document. Copies in electronic format Upon request, "a health care provider shall provide copies of patient health care records in a digital or electronic format unless the providers' record system does not provide for the creation or transmission of records in a digital or electronic format, in which case the provider must provide a written explanation for why the copies cannot be provided in a digital or electronic format." Time Limits All HIPAA timeframes continue to apply. Health care providers must provide copies of requested health care records within 30 days if the records are stored onsite and 60 days if the records are stored offsite. Refer to 45 CFR 164.524(b)(2). ` St. Croix County Health and Human Services Board Page 19 September 16, 2009 PERSONNEL ISSUES Jill Best started as Public Health RN on 09/14/09. She comes to the facility with previous experience in the Public Health area from Washington and Dakota Counties. PROPOSAL TO CONDUCT MEDICAID MAXIMIZATION ASSESSMENT LaCrosse County has offered an opportunity to join LaCrosse County in a Medicaid maximization assessment that examines Medicaid billing and collection process improvement with the possibility of 5 -15o increase in Medicaid reimbursement after the initial assessment by Open Minds. Johnson reported there is a price break if more counties join this process. So far Chippewa County has responded and Johnson is requesting permission for St. Croix County to participate. Johnson said this would be a good investment for the County and a good thing for the Accounts Receivable Department after all the excellent work our fiscal department has done to improve our billing and receipt of revenues as it could enhance current billing and possibly garner more revenue. Motion A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the Board supports pursuing the Open Minds study to possibly increase Medicaid reimbursement. Johnson will report status of the study back to the Board. REVIEW AND ADJUSTMENTS TO THE HEALTH AND HUMAN SERVICES, ST. CROIX INDUSTRIES, AND NURSING HOME'S 2010 BUDGET REQUEST Johnson said the Farm account has been modified to add $3,000 to revenues due to expenses submitted by Heise. The Coordinated Family Services (CFS) budget will be modified to include $270,905 in the 305 (salary) and 307 (services) line items. There was a $44,000 shift in the Child Care Program with a transfer from Economic Support to coordinate with Family and Children's Foster Care Coordinator. This transfer of duties for child care will allow an additional Economic Support staff to take on a full caseload to meet the ever growing caseload demands for Economic Support. It was discovered worker's comp and liability insurance needed to be updated from Public Health. Tobacco funding was reduced. More monies are expected for immunizations, ARRA reinvestment dollars and stimulus monies. Public Health Emergency Response (PHER) is an additional program for Public Health and will receive one -time funding to operate a mandated emergency response program. These monies will be used to backfill monies lost from tobacco funding due to not being the regional provider for tobacco programming. $131,000 has been designated to implement a mass clinic in 2009. If the grant is awarded for juvenile treatment court, the budget will be changed to accommodate staff and the program. The Nursing Home capital outlay request will be dependent on the outcome of the resolution. It is possible 2010 capital outlay requests may have to be adjusted. The Reproductive Health salaries needed to be changed as it appears the APNP Position was included as both a regular employee and contracted employee. Johnson said he does not see any issues in the budget process that would require additional county levy at this time. The 2010 Budget will be a recurring agenda item over the next few months. St. Croix County Health and Human Services Board .. Page 20 ' September 16, 2009 COUNTY BOARD REORGANIZATION Discussion on the County Board reorganization was held at the August 18" County Board meeting. Whiting explained he hopes for a committee of the chairs as the administration committee. State statute requires County Board supervisors and designated persons be on the Health and Human Services Board. ANNUAL REPORT The 2008 annual report was distributed to the Health and Human Services (HHS) Board members. The report will also be distributed to the County Board on 09/22/09 and Council on Aging and Disabilities on 9/17/09. The annual report will be an agenda item for the October meeting. REVIEW OF AGENCY PLANNING FOR GUARDIANSHIP EXPENSE Community Health Partners quit paying guardian fees September 1, 2009. Dunn County also had the same issue regarding guardian fees. It was determined the guardianship fee will come from the ward's income first. Nursing Home resident fees will come from resident income and reduce patient's liability, which the state picks up the difference. All information is already in the Economic Support computers so if clients ask for help with guardianship fees, Economic Support will process. Clients will be responsible for paying any fees incurred for guardianship, unless they make application to the County to pay for all or a portion of the guardianship fees. A determination will be made and if clients are denied help with guardianship fees, clients have the right to a fair hearing regarding fees. Johnson reported Community Health Partners originally said they would pay for guardianship fees and work with the state; however, the state said guardianship was not an allowable expense so the guardianship expense was cut. Two financial staff will be completing guardianship forms. H1N1 FLU UPDATE AND CORRESPONDING COUNTY PLANNING Kramer said as of 09/03/09, there were six reported cases of H1N1 at Public Health; however, things are changing constantly. This week cases have been reported in both the Somerset and Hudson middle schools. St. Croix County has a population of over 79,000 and it is estimated about 49,000 of that number are the targeted population to receive the H1N1 vaccine. Kramer reported Public Health will receive a divided supply of vaccine and will receive $130,000 to initiate mass vaccinations. Public Health staff are working with school districts for mass vaccinations and St. Croix Central School District to hold a mass clinic. Kramer reported meetings have occurred with Government Center staff to create a policy regarding sick employees, addressing sanitizer being available at key locations within the building, getting signage regarding H1N1 posted, etc. It is employees' duty to not come to work if they are sick. Information regarding H1N1 has been posted on the St. Croix County Internet site along with the intranet. Information is being distributed to County churches, schools, farms, etc. The population is being directed to stay home if they have symptoms of temperature, cough, sore throat, etc. The focus for vaccine is more on the young. Wisconsin has a plan to distribute the vaccine when it is available. Vaccination is voluntary. Wentz asked if there were any other issues to bring before the Board. St. Croix County Health and Human Services Board Page 21 September 16, 2009 Wentz adjourned the meeting. Time: 12:04 PM Chair: Attest: (Secretary) St. Croix County Health and Human Services Board Page 4 October 21, 2009 HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget August 31, 2009 Balance % Administration (282,648.48) (501,510.33) 218,861.85 177.4% AODA Services 755,822.52 501,731.83 254,090.69 66.4% Long Term Support 2631,098.96 3,662,984.90 (1,031,885.94) 139.2% Mental Health 3,445,706.61 2,327,829.69 1,117,876.92 67.6% Family& Children's 2,908,835.69 2,073,232.46 835,603.23 71.3% Public Health 1,976,028.13 1,484,864.61 491,163.52 75.1% Economic Support 1,140,696.47 720,884.76 419,811.71 63.2% General Relief 0.00 0.00 0.00 0.0% Coordinated Services/SED 2,835,374.19 1,745,727.47 1,089,646.72 61.6% ARDC 632,000.00 374,623.00 257,377.00 59.3% Department on Aging 846,623.00 607,008.66 239,614.34 71.7% Carryover Funds 1,312,360.00 874,906.67 437,453.33 66.7% REVENUES HUMAN SERVICES PROGRAMS 18,201,897.09 13,872,283.71 4,329,613.38 76.2% SUMMARY Total OF EXPENDITURES Budget August 31, 2009 Balance % Administration 1,029,711.52 667,685.82 362,025.70 64.8% Alcohol -Drug Abuse 755,822.52 463,632.61 292,189.91 61.3% Long Term Support 2,631,098.96 2,057,793.55 573,305.41 78.2% Mental Health 3,445,706.61 2,322,116.31 1,123,590.30 67.4% Family & Children's 2,908,835.69 1,906,537.35 1,002,298.34 65.5% Public Health 1,976,028.13 1,226,771.58 749,256.55 62.1% Economic Support 1,140,696.47 775,870.57 364,825.90 68.0% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service /SED 2835,374.19 1,504,144.29 1,331,229.90 53.0% ARDC 632,000.00 339,577.02 292,422.98 53.7% Department on Aging 846,623.00 470,477.00 376,146.00 55.6% EXPENDITURES HUMAN SERVICES PROGRAMS 18,201,897.09 11,734,635.69 6,467,261.40 64.5% Total S 2,137,648.02 The following financial report for the Nursing Home through August, 2009 was distributed. Again, to be on budget, the percentage should be 66%. The Nursing Home revenues are above this figure due to having a few more Medicare residents in the payer mix. Expenses are below 66%. Robinson explained the Nursing Home is moving in the right direction and the Medicare wing hasn't been opened yet. Robinson said the renovation should be done this week. The Board will take a tour of the rooms later. Robinson said Tobin and his crew have done a wonderful job. Tobin has been ill and out on medical leave. The Board wishes him the best.