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HomeMy WebLinkAboutHealth & Human Services 08-19-09 Marzolf will review vouchers. REVISED: 08/10/09 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 19, 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 - 07/15/09 DATE OF NEXT MEETING — 09/16/09 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. Health and Human Services Governing Body By -laws Review 4. Nursing Home Administrator's Report 5. Personnel Issues ** a. New employees /vacancies b. New position requests for 2010 6. Juvenile Treatment Court grant applications 7. Nursing Home and Health and Human Services Audit Reports (8:30 AM) 8. Nursing Home and Health and Human Services strategic planning 9. Proposed 2010 Health and Human Services and Nursing Home Rate setting 10. Collaborative agreement between St. Croix Industries and Aging transportation to purchase a van for 2010 ** 11. Change to Chapter 51.15 approval for emergency detentions ** 12. Health and Human Services and Nursing Home 2010 budget request 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. 8/10/2009 8:11 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 19, 2009 The St. Croix County Health and Human Services Board met on August 19, 2009 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Linda Luckey Richard Marzolf Gerald Peterson Deb Rasmussen MEMBERS ABSENT: Dr. Lisa Ramsay, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Ron Kiesler, Behavioral Health Coordinator Kathy Dunlap, Family and Children's Coordinator Wendy Kramer, Public Health Officer /Public Health Coordinator Frank Robinson, Nursing Home Administrator Tammy Wilson, Medical Records Supervisor Brad Beckman, ADRC Manager Connie Sarauer, Nursing Home, Contracted Director of Nursing Tim Markgraf, YCSS Lead Social Worker Mary Squyer, Economic Support Supervisor Clark Schroeder, Director, St. Croix Industries Malva Sirek, Secretary OTHERS PRESENT: Roger Rebholz, County Board Chair Tammy Funk, Human Resource Administrator Chuck Whiting, Administrative Coordinator Michelle Pietrick, Finance Director Trenton Fast, CPA, Larson /Allen Wendell Adams, CPA, Larson /Allen Kim Dupre, Information Systems Analyst 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, September 16, 2009 at 8:30 AM. Berenschot will review vouchers. 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 Larson, seconded by Marzolf, and unanimously adopted: That the minutes of the 07/15/09 Health and Human Services Board meeting be approved with the changes requested by Marzolf. St. Croix County Health and Human Services Board Page 2 August 19, 2009 NURSING HOME AND HEALTH AND HUMAN SERVICES AUDIT REPORTS Fast reported on the Nursing Home audit. He said the audit focused on risk areas. An unqualified audit opinion was given for the Nursing Home, the highest level of assurance that can be given. Fast reported a late supplement payment of $206,000 for the Nursing Home was recognized in December, 2008 versus January, 2009. Johnson said the State payments are based on a different calendar year than what is budgeted in the County as the State budget year is different. Fast reported management staff worked well with the auditors. Fast said occupancy levels for the Nursing Home overall for recent years have declined compared to the industry average. He reported the Nursing Home has higher nursing costs due to the physical plant of the Nursing Home. Also, staffing costs are higher than the norm due to higher health insurance costs, retirement, etc. Fast reported Medicare occupancy rates for the Nursing Home are trending higher than the industry norm for the past three years. The Nursing Home has been consistently low in days of revenue outstanding for accounts receivable and continues to improve. Fast complimented the accounts receivable staff on doing an outstanding job. The average age of plant, equipment and building is 24 years. Fast reported reinvestment is needed in these items around 15 to 17 years. This reinvestment will be tough to do with the cash on hand. Maintaining cost levels is a constraint. Fast explained the cash flow ratio has remained strong over the recent years with a decline from 2007 to 2008. Adams presented the Health and Human Services (HHS) audit report. A qualified opinion was given for the audit. Adams reported there was a decrease in accounts receivable net due the write offs. He said there was a significant effort to gain more control over accounts receivable to get to a more realistic level. Write offs were moved to doubtful accounts, which is deferred revenue that is not recognized until collected. Adams reported there was a decrease in the fund balance. WIMCR net take backs decreased from 2007 to 2008. He reported the audit went well. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Marzolf reviewed the vouchers. Motion A motion was introduced by Marzolf, 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 154539 through 154542, dated July 15, 2009 in the amount of $19,198.12. Human Services vouchers 155873 through 155911, dated July 08, 2009 in the amount of $56,628.93. Department on Aging and ADRC vouchers 154431 through 154440, dated July 15, 2009 in the amount of $16,544.99. Human Services, St. Croix Industries, Government Center and Nursing Home vouchers 154441 through 154492, dated July 15, 2009 in the amount of $30,673.53. St. Croix County Health and Human Services Board Page 3 August 19, 2009 Human Services, Government Center, St. Croix Industries, and Nursing Home vouchers 154697 through 154793, dated July 22, 2009 in the amount of $112,136.25. Department on Aging and ADRC vouchers 154794 through 154810, dated July 22, 2009 in the amount of $2,538.05. Department on Aging and ADRC vouchers 155156 through 155163, dated July 29, 2009 in the amount of $718.16. Human Services, Nursing Home, and St. Croix Industries vouchers 155164 through 155228, dated July 29, 2009 in the amount of $60,858.90. Department on Aging and ADRC vouchers 155280 through 155318, dated August 05, 2009 in the amount of $7,599.73. Human Services, Nursing Home, St. Croix Industries, Government Center, and ADRC, vouchers 155319 through 158644, dated August 05, 2009 in the amount of $26,006.17. Government Center voucher 1038683, dated August 05, 2009 in the amount of $697.84. Human Services, Department on Aging, and ADRC vouchers 156018 through 156097, dated August 12, 2009 in the amount of $13,102.82. Human Services, Nursing Home, St. Croix Industries, and Government Center vouchers 156098 through 156170, dated August 12, 2009 in the amount of $74,090.32. Human Services, Nursing Home, and St. Croix Industries, vouchers 155913 through 156017, dated August 12, 2009 in the amount of $75,655.90. Nursing Home vouchers 154493 through 154538, dated July 15, 2009 in the amount of $51,011.63. Nursing Home vouchers 155378 through 155405, dated August 05, 2009 in the amount of $14,939.93. Nursing Home vouchers 156171 through 156194, dated August 12, 2009 in the amount of $58,235.35. FINANCIAL REPORT Johnson reported there is no county levy in the St. Croix Industries financial statement. St. Croix Industries is a separate enterprise fund. St. Croix County Health and Human Services Board Page 4 August 19, 2009 St. Croix Industries - 2009 SUMMARY Total OF REVENUES Budget June 30, 2009 Balance % WS Operations 1,342,765.00 800,094.60 542,670.40 59.6% WS Production 423,499.00 253,802.82 169,696.18 59.9% WS Helping Hands 71,726.26 37,001.16 34,725.10 51.6% WS Pop/Vending 7,250.00 4,244.57 3,005.43 58.5% WS Ram 76,743.00 25,191.19 51,551.81 32.8% WS Vocational Placement 375,560.42 156,821.85 218,738.57 41.8% WS Comm Based Day Prog 185,204.03 78,065.34 107,138.69 42.2% REVENUES 2,482,747.71 1,355,221.53 1,127,526.18 54.6% SUMMARY Total OF EXPENDITURES Budget June 30, 2009 Balance % WS Operations 1,342,664.56 671,891.56 670,773.00 50.0% WS Production 422:286.84 153,044.18 269,242.66 36.2% WS Helping Hands 71,726.26 30,787.30 40,938.96 42.9% WS Pop/Vending 7,250.00 2,880.47 4,369.53 39.7% WS Ram 77,443.00 17,987.98 59,455.02 23.2% WS Vocational Placement 371,831.60 159,771.53 212,060.07 43.0% WS Comm Based Day Prog 183,214.95 90,565.61 92,649.34 49.4% EXPENDITURES 2,476,417.21 1,126,928.63 1,349,488.58 45.5% Total S 228.292.90 The following financial report for Health and Human Services through June, 2009 was distributed. The State has not amended the contracts to agencies for Long Term Support funds. The State will take back the monies in the Long Term Support line. The 2007 surplus funds have been applied to the Administration budget line to give a more accurate idea of where operations are at. Long Term Support expenditure line will see an increase with the payment to the state in August. St. Croix County Health and Human Services Board Page 5 August 19, 2009 HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget June 30, 2009 Balance % Administration 1,038,854.00 (379,140.37) 1,417,994.37 -36.5% AODA Services 760,671.16 370,199.51 390,471.65 48.7% Long Term Support 2,631,402.00 3,003,683.03 (372,281.03) 114.1% Mental Health 3,448,843.99 1,541,699.51 1,907,144.48 44.7% Family & Children's 2,911,874.13 1,675,733.51 1,236,140.62 57.5% Public Health 1,976,209.95 1,000,367.93 975,842.02 50.6% Economic Support 1,152,939.29 343,347.61 809,591.68 29.8% General Relief 0.00 0.00 0.00 0.0% Coordinated Services /SED 2,836,586.35 1,126,518.97 1,710,067.38 39.7% ARDC 632,000.00 166,858.00 465,142.00 26.4% Department on Aging 846,623.00 236,056.77 610,566.23 27.9% 2007 Surplus 1,312,360.00 656,180.04 1,312,360.00 50.0% REVENUES HUMAN SERVICES PROGRAMS 18,236,003.87 9,741,504.51 9,150,679.40 53.4% SUMMARY Total OF EXPENDITURES Budget June 30, 2009 Balance % Administration 1,029,711.52 507,376.25 522,335.27 49.3% Alcohol -Drug Abuse 755,822.52 350,398.89 405,423.63 46.4% Long Term Support 2,631,098.96 280,753.11 2,350,345.85 10.7% Mental Health 3,445,706.61 1,720,358.92 1,725,347.69 49.9% Family & Children's 2,908,835.69 1,465,422.27 1,443,413.42 50.4% Public Health 1,976,028.13 923,926.07 1,052,102.06 46.8% Economic Support 1,140,696.47 591,287.46 549,409.01 51.8% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service /SED 2,835,374.19 1,069,944.56 1,765,429.63 37.7% ARDC 632,000.00 251,666.43 380,333.57 39.8% Department on Aging 846,623.00 343,004.61 503,618.39 40.5% EXPENDITURES HUMAN SERVICES PROGRAMS 18,201,897.09 7,504,168.16 10,697,728.93 41.2% Total S 2,237.336.35 The following financial report for the Nursing Home through June, 2009 was distributed. This report will be changed to report revenue sources except for levy in the report so it is easier to track levy used and will be easier to see the decrease in levy. St. Croix County Health and Human Services Board Page 6 August 19, 2009 St. Croix Health Center June 2009 Bridget Actual Difference peicerrtaij Census 0 irpeiating Revenue: Medicare $903,252.00 $581,801.25 $321,450.75 64.41% Medicaid $2,481,432.00 $1,153,463.83 $1,327,968.17 46.48% Private Pay $760,413.00 $420,477.75 $339,935.25 55.30% All Other Sources $216,041.00 $97,486.54 $118,554.46 45.12% Total Opeiating Revenue $4.361.138.00 $2.253.229.37 $2,107908.0 51.67'"- Opeiating Expenses Daily Patient Services $3,397,317.36 $1,645,508.34 $1,751,809.02 48.44% Special Services $284,262.00 $129,488.91 $154,773.09 45.55% General Services $1,148,672.04 $528,500.38 $620,171.66 46.01% Administrative Services $628,277.68 $332,387.10 $295,890.58 52.90% Unassigned: Depreciation (% Based) $0.00 Others: $402,923.00 $173,464.33 $229,458.67 43.05% Utilities $202,080.00 $62,975.99 Workers Comp, Computer Tech $133,400.00 $19,831.34 Insurance $67,443.00 $90,657.00 Total (" peiating Expenses $5.$61.452.08 $2.809.349.06 $3.052.103.02 47.93".) Poet From Opeiations {$55ti.1'19.1i91 (Cost of doing business prior to applying levy & outstanding rev) Additional Revenues Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGT /Supplemental Funds $350,000.00 $105,250.00 Co Allocations (% Based) $944,665.00 $494,448.00 $450,217.00 52.34% Nursing Home Carry Over $191,000.00 $95,500.00 Total Outstanding $'1.497.065.00 $599.698.00 $462.217.00 Net from all Sources 1:43.578.31 AGED HEALTH AND HUMAN SERVICES RECEIVABLES REPORT: The aging Accounts Receivable report for Health and Human Services through June was reviewed. Four main payment sources are tracked, Medicare, Medicaid, insurance and self -pay. It was questioned what the turn around time is for accounts receivable compared to other counties. It would be difficult to impossible to track this as many other counties do not bill the indigent population such as Community Support Program clients, etc. and St. Croix County bills all clients. Staff will look to see if the system can track date billed with date payment received. HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW Revised by -laws were distributed to Board members last month. There were minor changes with department being renamed to be consistent with current titles. References to St. Croix County Health and Human Services Board Page 7 August 19, 2009 the farm land were also removed from the by -laws. Motion A motion was introduced by Berenschot, seconded by Rasmussen, and unanimously adopted: That the updated Governing Body By -laws be approved as recommended. JUVENILE TREATMENT COURT GRANT APPLICATIONS Tim Markgraf, Youth Community Support Services Lead Social Worker, submitted a request for grant monies from Federal stimulus dollars to work with the juvenile treatment court. The grant is for $150,000 with no County match for three years to develop a juvenile treatment court process. Judge Vlack has been a strong supporter of this grant. The juvenile treatment court will work with a group of children that don't get out of the system. The application has been sent; however, we will not know until mid - September if the grant has been awarded to St. Croix County. If the first grant is not successful, staff will apply for a second grant for $70,000 but this grant requires a loo County match. Funding beyond the first year is not guaranteed and the local match requirement increases. The first grant targets youth ages 14 to 18. Targeted case management will be built into the planning to draw down revenues. Approximately 200 of the clients in this caseload are open for a year or longer and this is the group the juvenile treatment court program intends to target. The program will start with juvenile delinquents only at first and maybe add child protection at a later time. Juvenile treatment court is not drug court. The program will be implemented even if the grants are not received, however, it will be on a much smaller scale. Rebholz encouraged members to see what Judge Vlack has done with adult drug court and the success that has been realized with low recidivism. Juvenile treatment court will work with the parents and children to reinforce parent and family involvement in the court process and place more accountability on the parents. The program will start with 10 -12. Under the current law, youth age 17 are tried as an adult for criminal activity; however, the legislature is looking to move the under 18 youth back to juvenile court, which could increase the numbers for juvenile treatment court. Juvenile treatment court will follow the Coordinated Family Services Model program, which would work with the family to build natural supports in the community. The funds from the grant are not included in the current budget requests due to not knowing the outcome of the grant funding, which, if awarded, may need a budget amendment. This would include the need to bring on additional staff to manage the program and caseload. As St. Croix County's population grows, it is hard to draw comparisons to needs; however, attempts are being made to create service models to serve client needs. Johnson expressed his appreciation for staff effort to get the application submitted and appreciation to Judge Vlack for his contribution to look at innovative ideas to make the juvenile treatment court work. PERSONNEL ISSUES /NEW POSITION REQUESTS New position requests for 2010 were approved at the July HHS meeting. After a staff resignation on the Adult Community Support Services (ACSS) unit and review of coverage alternatives, the St. Croix County Health and Human Services Board Page 8 August 19, 2009 new YCSS (Youth Community Support Services) social worker position request is being withdrawn for 2010. The open position on the ACSS unit will be transferred to the YCSS unit (allowing us to withdraw the position request on this unit in 2010) . The current employee agreement on the YCSS unit will be transferred to the ACSS unit. It is anticipated there will be more referrals for the newly certified CCS (Comprehensive Community Services) Program in the future and it will better serve the program to hire someone under an employee agreement to specifically serve the CCS Program since the employee agreement will allow us more flexibility with the position. The Board recessed from 9:52 - 10:20 AM. NEW EMPLOYEES /VACANCIES Jessica Bethke has resigned from the Behavioral Health Unit and will leave at the end of August. Johnson announced Connie Sarauer will be leaving as the contracted Director of Nursing. The position will be filled with a full -time County employee. The facility has been in good hands with Connie Sarauer in the position of Director of Nursing and the Board thanked Sarauer for the work she has done for the facility. Connie will not be leaving the Health Center until the new Director of Nursing is hired. Applause. NURSING HOME AND HEALTH AND HUMAN SERVICES STRATEGIC PLANNING: Nursing Home Staff have high hopes that things will change for the Nursing Home and are moving forward in 2010 with strategic planning. Goals are being assigned and operational plan developed. NURSING HOME ADMINISTRATOR'S REPORT During the recess a discussion was held with Greg Timmerman regarding the vote on 08/18/09 at County Board meeting to amend the Nursing Home budget. The statute reads that budget amendments require a 2/3 vote of the whole body of 31 members to pass. Several members were absent at the 08/18/09 meeting. There were 20 aye votes, not 21 as required, so the resolution for the budget amendment did not pass. Robinson explained when he left the County Board meeting on 08/18, he was under the impression that the budget amendment had passed. The price for the Ban Koe system expired on 08/18 so Robinson ordered the Ban Koe system yesterday for a savings of approximately $6,000. The current time system will lose support September 1St Timmerman outlined several options to bring back the budget amendment to the County Board for reconsideration. Timmerman indicated the issue could be discussed under the Nursing Home Administrator report. Motion A motion was introduced by Berenschot, seconded by Marzolf, That the Health and Human Services Board requests to bring back to the County Board at the September meeting the budget amendment resolution. Marzolf withdrew the second and Berenschot rescinded the motion. Luckey reported a County Board member who voted in the opposition is the only one that could bring back a request for reconsideration of a resolution at the County Board level. Johnson left the meeting to verify this with corporation counsel. CHANGE TO CHAPTER 51.15 APPROVAL FOR EMERGENCY DETENTIONS Kiesler reported the Mobile Crisis Unit expanded to 24/7 earlier this year. The Statute pertaining to emergency detentions was amended by the Assembly and went into St. Croix County Health and Human Services Board Page 9 August 19, 2009 effect June 30, 2009. Now law enforcement will have to seek approval for emergency detention beds from the county department of community programs in the county in which the individual was taken into custody. If the hospitalizations are not approved by Health and Human Services, Health and Human Services will not pay for the services. This will be written into the 2010 purchase of service agreements for inpatient psychiatric care. Kiesler reported, historically, 750 of the time when emergency detentions are screened, the mobile crisis team is able to divert the client from hospital admission. Due to the new law, there should be 100% utilization of telephone screening and /or mobile crisis. Kiesler reported that notice was received that State Medical Assistance will no longer cover placements at Mendota or Winnebago Mental Health Institute for those individuals under the age of 22. NURSING HOME ADMINISTRATOR'S REPORT Johnson reported that Luckey's discussion on reconsideration of the resolution was correct. Robinson reported $18,400, which was earmarked for air mattresses, beds and broda chairs, remains in the 2009 capital outlay budget. Motion A motion was introduced by Berenschot, seconded by Marzolf, and unanimously adopted: That the Board approves moving $10,750 from the Nursing Home 2009 capital outlay budget to pay for the Ban Koe time system and to spend the balance on beds, air mattresses, and broda chairs. Other items on the resolution included a computer server for $6,500; Computer kiosks for $9,000 and van for $50,245. Robinson said the $10,750 being removed from the 2009 capital outlay budget was intended for beds. New beds would help enhance Medicare revenues. Motion A motion was introduced by Larson, seconded by Berenschot, and unanimously adopted: That the Health and Human Services Board approves a new resolution removing the time reporting system from the resolution and lowering the total amount on the resolution. PROPOSED 2010 HEALTH AND HUMAN SERVICES AND NURSING HOME RATE SETTING The Nursing Home private pay rate increased in February, 2009 and the 2010 budget also proposes another $5 /day increase for Nursing Home private pay rates. COLLABORATIVE AGREEMENT BETWEEN ST. CROIX INDUSTRIES AND AGING TRANSPORTATION TO PURCHASE A VAN FOR 2010 Schroeder and Beckman are working together to purchase a non -CDL van that will fit well with both Aging and St. Croix Industries. The van will be utilized by St. Croix Industries during the day. Aging will pay $35,000 and St. Croix Industries will add $15,000 to that amount to purchase the van. This item is also on the ADRC Committee agenda for 08/20/09. Johnson recommended purchasing the van in 2010. Schroeder invited Board members to attend the annual St. Croix Industries picnic at the Settlement by Somerset on 08/21/09. The Board recessed from 11:28 - 11:32 AM. HEALTH AND HUMAN SERVICES AND NURSING HOME 2010 BUDGET REQUEST The 2010 budget proposal was sent to Board members. Johnson said there is a 5% composite reduction of the total budget on levy when the programs are consolidated versus a 5% levy reduction on individual programs. Johnson said there are over 3,000 St. Croix County Health and Human Services Board Page 10 August 19, 2009 line items in the budget. Johnson said the farm land rent revenue is transferred to the Health and Human Services budget. The amount of that transfer for 2010 is $48,600. Beckman reported the levy has stayed the same for Aging at $205,054; however, services have increased. One time stimulus money was received for the nutrition program for 2009. Adult Protection /Guardianship was added to ADRC for 2010. The unit is doing 100% time and attendance time reporting to draw additional Medical Assistance administration monies. Johnson said earmarked trust fund accounts for transportation and nutrition are not reflected in the budget as there is a separate summary for trust funds. The trust funds cannot be used for expenses in other expense areas. The trust funds are audited and expenses need to be documented. Johnson highlighted some of the changes in the Administration budget. He said there was a carryover of $1,049,211 from 2008, which was applied to the Administration budget. He said a financial assistant staff was moved from Long Term Support to Administration. He reported salary from Economic Support was transitioned to Administration. Also, two limited term positions in Medical Records and one part -time Nursing Home Medical Records position was changed to a full time permanent position with consolidation of Nursing Home and Health and Human Services Medical Records into one department. There is no county levy requested for Alcohol /Other Drug Abuse (AODA) for 2010, which is a reduction of $84,467. The AODA block grant was increased by $35,561. It is anticipated that purchased services will go down in 2010 as Health and Human Services (HHS) will not fund voluntary admissions without agency screening prior to admission. Kiesler reported that other counties are also following this trend as clients who are voluntarily admitted typically do not follow through and seek services from our outpatient AODA program. However, HHS will continue to fund involuntary admissions when law enforcement is involved. Mental Health had a reduction of $77,398 in county levy request for 2010. Kiesler reported that this is largely due to how the State has decided to allocate Basic County Allocation (BCA) dollars. Kiesler reported the County will be expected to pay the State share of long term inpatient stays at Mendota /Winnebago in 2010 for individuals under the age of 22. Budgets for inpatient placements have been increased as costs are anticipated to increase based upon this transfer of cost and based upon current utilization. As reported earlier the Statute pertaining to emergency detentions was amended by the Assembly and went into effect June 30, 2009. Now law enforcement will have to seek approval for emergency detention beds from the county department of community programs in the county in which the individual was taken into custody. This could have a possible dramatic change on the budget due to possible diversion of clients for inpatient hospital stays by mobile crisis system. The State had a goal to limit Mendota and Winnebago admissions and encourages use of mobile crisis. Dunlap reported there was an increase of $128,480 in Coordinated Family Services (CFS) due to staffing change. She reported a loss of $27,000 due to the loss of 4E dollars. Dunlap reported for Family and Children's, State dollars were decreased St. Croix County Health and Human Services Board Page 11 August 19, 2009 $133,319, 4 -E dollars were taken away and basic county allocations (BCA) were reduced. Services are provided to clients based on health and safety, community safety and child safety. Dunlap reported like -sized counties have much higher placements than St. Croix County does. St. Croix County's placements are lower due to a combination of efforts. There will be an increased focus on the development of community options for children. It is anticipated juvenile treatment court will be implemented in 2010 if a grant is received. If it is not awarded, juvenile treatment court will be absorbed and implemented on a smaller basis by current staff. Placement expenses in the residential care line have been increased due to the change in the cost shift to Behavioral Health for youth that are placed in the institutions. If youth are discharged quickly, they may need stabilization in a residential care setting prior to other case planning. Economic Support's County levy request for 2010 increased by $32,782. Squyer said fraud funding of $15,000 was discontinued by the State so Economic Support will no longer have fraud services; the state will take over the program. She reported we are required to have Medical Assistance transportation, refugee assistance and funeral /cemetery accounts. These accounts are sum - sufficient; the county pays for these services and the State will reimburse. Squyer said last year she said we did not need General Relief due to the free clinic; however, since then funeral homes have refused to pick up corpses if there are no funds, a line item for General Relief has been added in the 2010 budget. She asked for $1,500 in County dollars for General Relief. This line item was added in consultation with Emergency Management Director, Casey Swetlik. She said the only way to cut the Economic Support budget further would be to cut a staff member, which would put the County in violation. She said the department is up 869 cases. Two staff have been assigned to intake all day long, every day, with nine appointments per day, five days a week. New cases need to be seen within 30 days. The BadgerCare Plus Core Program began in July, 2009. The state is doing the eligibility for the program instead of the county. The state will also pull all Family Planning Waiver cases from the counties as well as Food Share cases for those who apply for BadgerCare Plus Core Program. It will take up to a year to transfer all the cases to the state. Public Health expects a decrease in state funding in 2010. With the Board's approval of the increase in the agent fee schedule and approved additional inspections for inspecting retail food establishments, there will be increased agent fees in 2010. It is anticipated tobacco control funding will decrease by 45% in 2010 and possible reorganization of the tobacco control program with consolidation of state contract funding. It is possible Birth to 3 may receive stimulus money in 2010 but those funds were not included in the budget due to the uncertainty of receiving the funds. We are state mandated to provide the Birth to 3 program. Due to Long Term Care Reform changes, Birth to 3 was moved into the Public Health structure. Motion A motion was introduced by Grant, seconded by Larson and unanimously adopted: That the Board approves the Health and Human Services budget as presented and approves moving the entire budget to the Finance Committee. The budget will be finalized by the County Board in November. The Nursing Home 2010 budget reflects a 30% reduction in county appropriations. A. Croix County Health and Human Services Board Page 12 August 19, 2009 The budget was configured with a census of 68 and increasing the Medicare patient population from 6 to 12 the first six months and an average of 15 the last six months of the 2010 budget year. There are plans to create a rehab unit in the Nursing Home. Steps are being taken to implement the Nursing Home Strategic Plan in 2010. Robinson is investigating the possibility of obtaining insurance revenue. Discussion was held regarding depreciation. If improvements are being made, funds need to be set aside to make those improvements. Depreciation should only be funded for needed improvements, not to offset operations. It is possible CPE (Certified Public Expenditure) funds will be moved into the Nursing Home for the 2010 budget and those funds could be used to purchase more beds and create a Medicare wing. The capitol outlay plan may be adjusted prior to the November County Board meeting. Motion A motion was introduced by Peterson, seconded by Marzolf, and unanimously adopted: That the Board approves the Nursing Home budget as presented and approves moving the entire budget to the Finance Committee. Schroeder reported St. Croix Industries has noted a 30% reduction in production due to the economy and companies taking business back in- house. As a result, St. Croix Industries has expanded their activities area and opened an in -house rec area. The contract for rest area maintenance (RAM) was lost due to the rest area closing. The majority of the funds for St. Croix Industries come from CHP (Community Health Partners). There is no county levy in the St. Croix Industries budget. Schroeder invited Board members to attend the St. Croix Industries client picnic on Friday, August 28, from 12 :00 noon to 3:00 PM at the Settlement in Somerset. Motion A motion was introduced by Larson, seconded by Marzolf, and unanimously adopted: That the Board approves the St. Croix Industries budget as presented and approves moving the entire budget to the Finance Committee. Johnson said the budget will be an agenda item for the Health and Human Service Committee to review and modify up to the November County Board meeting. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 1:20 PM Chair: Attest: (Secretary)