HEALTH AND HUMAN SERVICES BOARD

Tuesday, February 6, 2007

Administrative Center – Room 3220

6:30 p.m.

MEMBERS PRESENT:  Tara Johnson, Sharon Hampson, Jill Billings, James Glasser, Anita Froegel, Margaret Wood,  Loren Kannenberg (arr @6:32), and Brad Pfaff (arr @6:32)

MEMBERS EXCUSED:  Patrick Schippers

MEMBERS ABSENT:  None

GUESTS AND STAFF PRESENT:  Doug Mormann, Jerry Huber, Dean Ruppert, Davita Molling, Pat Killeen, Jane Klekamp,  Renee Weston, Mary Kaufmann, Patty Dayton, Fran Hegenbarth, Donna Gunnarson, Heather Kujak-Coon, Melissa Gilbert, Ron Berg, Becky Barnes, and Cheryl Stephen     

CALL TO ORDER

Tara Johnson, Board Chair, called the meeting to order at 6:30 p.m.

ANNOUNCEMENTS

• Countywide Reception and Recognition for Human Services Staff – March 12^th from 10:30-12:30 in HHS Auditorium

• March - National Nutrition Month

• Board Performance Evaluation Summary (handout) – Board Chair Johnson noted more attention is needed on the following:  (1) Assists the County Administrator in completing Department Head performance evaluations, (2) Work with administrator to secure and maintain sufficient staff, and (3) Board meetings are completed in a reasonable amount of time.

• Joint Meeting of HHS Board and Aging & Long Term Care Committee - March 5^th at 5:00 p.m. in HHS Bldg. Auditorium; food will be provided as authorized by County Board Chair.

• 360° Feedback Questionnaire to HHS Board Members – Fill out and return directly to Renee Weston who will compile the results.

• Announcement by the Governor – as noted by Jerry Huber, the Governor announced this morning - $32 million added to Child Support over the biennium and $27 million added to Youth Aides – good news.   

CONSENT AGENDA

MOTION by Glasser/Billings to approve the following consent agenda items: 

Minutes

·        Health and Human Services Board of 1/9/07

·        Coulee Region Public Health Consortium of 1/3/07

·        Dental Care Advocacy Coalition of 1/2/07

·        Health and Human Services Labor/Management of 12/9/07

·        Consumer Advisory Council of 1/19/07

·        Family Policy Board Management Council of 1/18/07

·        Joint Meeting of Criminal Justice Management Council, Judiciary & Law Committee, and LEC Addition Committee of 1/17/07

Fiscal

·        2007 Summary of Contract Approvals

·        Vendor Audit Policy Update – Step 3

·        Report on Contract Increases over 2%

·        Care Management Organization Summary of Revenue and Expenses

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Department Reports

·        Health Director’s Written Report

·        Human Services Director’s Written Report

·        Health Department Quarterly Fiscal/Activity Report

·        Human Services Quarterly Fiscal/Activity Report

·        Health Department Quarterly Appendix D Report

·        Human Services Quarterly Appendix D Report

Comments and questions as follows.  Supervisor Billings questioned decline regarding in-home foot care.  Doug noted foot care has increased at the health clinics which is working well.  Supervisor Wood noted in set of minutes that Harvey House residents need to be gone from 8:00 am to 3:00 p.m. – is that true in these cold winter days?  Jerry noted answer unknown but will check into.  Supervisor Hampson noted two bars went smoke free; is there feedback on that?  Noted one is for just 1 night/week; no known feedback.  Supervisor Hampson noted increase in numbers in JDF secure/county residents:  31 in 2006, 8 in 2005 and 11 in 2004 – why the increase?  Jerry will have Family and Children Section give a report next month.  Supervisor Billings suggested the Carey Group also look at JDF situation.  Board Chair Johnson said this is another scope of work, but can have staff check into it.  Supervisor Wood questioned the disposal of unused drugs.  Doug suggested this as a possible future agenda item.   

Motion carried unanimously; Schippers excused.  

PUBLIC COMMENT

Patty Dayton, a County employee and union representative, spoke on the Clean Air ordinance that is on the agenda.  The ordinance if passed will make all county owned property smoke free.  She noted that she was a member of the work group that came up with a livable/workable policy and when it was introduced to this Board, it was rejected and the Board is now proceeding with this new ordinance.  She feels the new ordinance will have fiscal impact on the parks and also unenforceable.                 

BOARD EDUCATION

Policy, Practice, People of COMPASS 3 – Doug Mormann and Becky Barnes reviewed.  COMPASS is a community assessment process as developed by the United Way of America; it assists communities to analyze the need for health and social services.  Compass 3 is to identify health and social needs for the period 2007-2011 within a 5-county region.  Becky was hired by the Great Rivers United Way to assist with COMPASS 3 and the County Health Dept. is also assisting based on State requirement of community assessment being done every 5 years.   There is a Partnership Committee consisting of 25-35 persons within the geographical area of Houston County and Counties of La Crosse, Vernon, Monroe and Trempealeau); from this group, subcommittees were formed:  Communication, Data Collection, Resource Development, and Group Process.  And each county has a subcommittee COMPASS Charge that will provide guidance to the Partnership.  Plan to do household surveys and try to reach certain populations (those needing services).  Also plan to get HHS Board input within next couple of months.  A final report will be available in Fall 2007 in time for the fundraising campaign and for the 2008-2009 Community Investment Process.  Becky distributed copies of “Project Plan Timeline” for Compass 3.  

Policy, Practice, People of Intoxicated Driver Program and OWI Treatment Court – Donna Gunnarson and Jane Klekamp shared information with the Board regarding the program and the OWI Court.  Per State Stats., anyone convicted of OWI must have an alcohol and drug use assessment and must contact the designated agency (County Clinical Services) within 72 hours of conviction.  The program is set up as revenue neutral; the current assessment fee is $318 which is required upfront.  Staff then assesses the person’s substance use/abuse patterns and determines if an “irresponsible user” or is

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“addicted”.  The recommendations are put into their Driver’s Safety Plan which needs completion by the participant in order to reinstate or maintain their driving privileges.  It’s a one year plan which is

monitored by staff as to progress with treatment and compliance of the plan.  Currently have 4 Social Workers doing assessments.

The OWI Court serves those convicted of 2^nd or higher OWI offense; the La Crosse County OWI Court started 6 months ago and Justice Sanctions provides the administration as well as the drug and alcohol testing that is required at various intervals.  The incentive for offenders to participate is to reduce their fines and decrease jail time; unlike Drug Court, those in OWI Court can opt out at anytime.  There is a Court Team that meets weekly to review each case and make decisions regarding incentives, sanctions, special requests, phase changes and commencement.  There are currently over 120-130 participates in OWI Court.  Supervisor Billings commended Jane in getting the OWI Court up and running; it’s a known fact that the court reduces recidivism.

IT Demo on Paperless Board Packet – Heather Kujak-Coon reviewed the potential of the Board receiving an electronic packet which can be accessed by home computers or computers/laptops located in County-owned buildings.  This is less work for staff in putting together as well as less costly due to no printing or mailing costs.  It was noted that Village of Holmen and Town of Onalaska currently doing it this way for their trustee/commission meetings as well as La Crosse School District.  After minimal discussion, general agreement by the members to support the idea and try the electronic packets – become a pilot committee for the County Board.  

Orientation Manual Updates – New manual information was distributed to each member.  Supervisor Wood who is in charge of keeping the manuals up to date along with staff, went through the manual page by page as to which ones to throw, replace and add new information.

WALHDAB Strategic Plan – A draft of the strategic plan for Wisconsin Association of Local Health Departments and Boards (WALHDAB) was sent with the agenda packet.  Supervisor Hampson briefly reviewed.  The strategic plan includes:  purpose statement, vision, values, customers, analysis of strengths/weaknesses/opportunities & strengths, and objectives.  The WALHDAB also agreed on the need for administrative management services and to update their website.  Anita Froegel suggested less use of the word “will” in the mission statement/objectives.

POLICY ISSUES

Family Care Expansion Updates – Jerry Huber, Dean Ruppert and Melissa Gilbert reviewed regional expansion of Family Care per State initiative.  The regional proposal includes 5 counties:  La Crosse, Buffalo, Trempealeau, Monroe, and Vernon.  Highlights of discussion as follows:

• Employment of staff and issues associated with public employment and collective bargaining.  For employees with union contracts, the contracts will be honored until end of contract date and all employees will be eligible for WI Retirement System (WRS).

• Governance of the Managed Care Organization (MCO) will be created by s. 46.2895, State Stats., Long Term Care District.  A draft copy of the proposed “Declaration of Policy” was reviewed in detail with key points highlighted in yellow.  It included:  1) creation, 2) jurisdiction, 3) care district board, 4) powers, 5) limitation on powers, 6) duties, 7) director/duties, 8) employment and employee benefits of certain employees, 9) confidentiality of records, 10) exchange of information, 11) obligations, 12) assistance to long term care district, 13) dissolution, and 14) dissociation.

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• Discussion on the complexity of organizational structure of the regional Aging & Disability Resource Centers (ADRC); some counties may share an office.

• As part of the educational process, a regional County Board Retreat is planned for March 9 at the Midway Hotel in La Crosse from 9:30 am to 3:30 p.m.  Would be beneficial for board members to discuss the advantages of a regional family care program with their peer group.  Need to encourage all County Board members to attend.     

• At the request of the State, the current Long Term Care Council would dissolve and a new committee formed.

• Noted timelines.  2007:  April-May - county decision making; July - submit proposal to the State; Dec. – become MCO certified; 2008 - enrollment and transition begins.

• Reviewed organizational chart.

Carey Group Phase II – Jane Klekamp reviewed.  The Carey Group was hired to analyze the County criminal justice system and make recommendations to the County Board.  Pointed out by Supervisor Hampson that this was to be done “prior” to hiring a Construction Manager and Architect.  Jane noted thus far, the group has completed the jail analysis, interviewed treatment providers, reviewed previous reports by consultants, and held discussions with representatives of the courts, Justice Sanctions, Dept. of Corrections, and related others.  Additional tasks over next few months include:  jail population re risk assessment, population profile, determine gaps in community programs and system, IT system, develop a collaborative justice system decision making process for future use, and present a list of services for enhancement or implementation as well as suggestions for building/remodeling a facility, if determined to be necessary.  They are focusing on more evidence based practices.  Their final recommendation will be presented to the County Board in June.  

RESOLUTIONS AND ORDINANCES

Resolution re Authorization to Amend Care Management Organization 2007 Budget and Business Plan and Add Staff – Pat Killeen reviewed in detail.  The 2007 budget was prepared using capitation increase of 2%; the actual increase was 8%.  Also seeing increase in membership ranging from 5-8 each month with result of 40+/year which is why the need for additional Social Worker and RN.  And the State has always indicated that administratively have low staff numbers and that is why the need for Fiscal Accountant, IT Application Developer and Secretary I; the cost for said positions will be covered by the additional State capitation rate and as result of the additional membership.  MOTION by Hampson/Wood to approve the resolution which authorizes said changes in CMO 2007 budget, change in business plan and hiring of additional staff.  Some discussion on the development of the MCO and transition as it relates to CMO.  Motion carried unanimously; Schippers excused.

Ordinance to Amend and Create Sections in Chapter 12 and Chapter 13 of the General Code of La Crosse County, Wisconsin re “Sanitation Code” and “Licenses and Permits” – Ron Berg reviewed.  Most of the needed changes are for language clean up relating to State Stats.  In addition, need additional procedures for dealing with the failure of “private on-site wastewater treatment systems” (POWTS) and the requirement to treat or renovate per State approved product stipulations.  And per new Administrative Code requirement regarding POWTS maintenance program, systems installed after July 1, 2000 shall be inspected and/or pumped every 3 years; submitted certification forms will also be required; in addition, there is a $15 POWTS Management Fee for the County.  MOTION by Kannenberg/Froegel to approve the amendments and creation of new sections, as presented, in Chapters 12 and 13 of the General Code of

La Crosse County, Wisconsin.  Motion carried unanimously; Schippers excused.

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Resolution re Authorization to Transfer Funds to Pay for Court-Ordered Placement of Patient at Lakeview Health Center – Doug Mormann reviewed.  He noted a citizen as having a communicable disease that was not taking the required medications.  Due to public health risks, this lead to court ordered confinement as a patient at Lakeview Health Center.  Estimated funding for such is $50,000 which is unbudgeted but available from the Health Dept. Undesignated Fund Balance.  MOTION by Hampson/Glasser to approve the resolution.  Motion carried unanimously; Schippers excused.  

Resolution re Approve Creation of a Jail Program Coordinator, Several Jail Related Initiatives, and Additional Case Manager in Justice Sanctions – Jane Klekamp was present to answer any questions; detailed explanation was within the resolution.  Also noted that it passed unanimously by the Judiciary and Law Committee at today’s meeting.  MOTION by Billings/Wood to approve the resolution.  Some discussion on the extra psychiatrist services and Social Worker duties in Justice Sanctions.  Motion carried unanimously; Schippers excused.

Resolution re Equality of Mental Health and Substance Abuse Insurance Coverage – MOTION by Hampson/Wood to approve the resolution.  Jerry Huber reviewed.  When privately-insured individuals exhaust their benefits, they turn to the public sector which increases costs to federal, state and local governments – estimated annually at $40 million in additional costs.  The Wisconsin Counties Association also supports adoption of Senate Bill 128 or Assembly Bill 252 which would grant a cost-of-treatment adjustment to the $7,000 cap on mental health and substance abuse benefits enacted in 1985.  Motion carried unanimously; Schippers excused.

Resolution re Support Increasing the Medicaid (MA) Reimbursement Rate 5% - MOTION by Glasser/Froegel to approve the resolution.  It was noted that the Aging and Long Term Care Committee approved the resolution unanimously at its Monday meeting.  Motion carried unanimously; Schippers excused.

Ordinance to Amend Section in Chapter 11 of the General Code of La Crosse County, Wisconsin re “Clean Air Act” – Board Chair Johnson said this was referred from last month’s meeting in order to get more information from Lakeview Administrator, Pam Semb.  Doug contacted Pam and received her comments; those are now incorporated into 2^nd version of ordinance that was included with the agenda packet.  The additional language is:  The following exception shall apply to Lakeview Health Center and any adult group home owned or operated by La Crosse County.  Any adult residents of those facilities shall be permitted to smoke in designated outdoor smoking areas.  Pam also noted current state regulation that current residents who are smoking would need to be grandfathered in and continue to have smoking privileges if they so choose.  Also included in packet was letter from Facilities Department regarding their concerns as it relates to County recreational areas.

Board Chair Johnson noted there are two ordinances that can be acted on, the January version or the one that is presented tonight; or can refer to another meeting for more information.  MOTION by Pfaff/Glasser to consider the ordinance as presented in January.  Lengthy discussion followed.   Supervisor Hampson noted states of MN and CA having similar ordinances, in particular for recreational areas; the County has approved smoke-free dining and smoke free workplace and now is the time to expand to other county areas.  She noted the recommendations per the workgroup that was presented in November as being inadequate by the HHS Board thus directed Health Dept. staff to bring back draft ordinance that incorporates no smoking on all County owned or leased property.  Supervisor Pfaff

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expressed concern of it not passing the County Board and suggested removing the recreational areas; he also noted no other counties in the State have enacted a similar ordinance.  Several members noted this as symbolic even though it may not be enforceable.  MOTION FAILED on 3 to 5 vote:  Johnson-yes, Glasser-yes, Hampson-yes, Billings-no, Froegel-no, Kannenberg-no, Pfaff-no, Wood-no; Schippers excused.

MOTION by Kannenberg/Glasser to approve the 2^nd version of the ordinance as sent with the February HHS Board February packet that includes the Lakeview exception for current residents only.  More discussion followed.   Motion carried on 5 to 3 vote:  Kannenberg-yes, Johnson-yes, Billings-yes, Froegel-yes, Wood-yes, Pfaff-no, Glasser-no, Hampson-no; Schippers excused.        

ITEMS FOR FUTURE AGENDAS

• JDF report re why increase in secure numbers

• County health insurance and needed coverage for prevention

ADJOURNMENT

There being no further business, Committee Chair Johnson declared the meeting adjourned at 9:32 p.m.

Disclaimer:  The above minutes may be approved, amended or corrected at the next committee meeting.

Cheryl Stephen, Recorder