HEALTH AND HUMAN SERVICES BOARD
Tuesday, October 9, 2007
Administrative Center – Room 3220
6:00 p.m.
MEMBERS PRESENT: Tara Johnson, Al Thompson, Loren Kannenberg, Margaret Wood, Sharon Hampson (arr @6:03), Jill Billings (arr @6:04), Brad Pfaff (arr 6:08), Dr. James Glasser (arr 6:25)
MEMBERS EXCUSED: None
MEMBERS ABSENT: Patrick Schippers
GUESTS AND STAFF PRESENT: Doug Mormann, Jerry Huber, Dean Ruppert, Sara Koopman, Patrick Killeen, Maryellen Paudler, Jane Klekamp, Chris Sander, Al Graewin, Linda Lee, Laura Gambino, Steve O’Malley, Gary Ingvalson, Mary Powell, Cheryl Stephen
CALL TO ORDER
Tara Johnson, HHS Board Chair, called the meeting to order at 6:06 p.m.
ANNOUNCEMENTS
Jerry Huber introduced Sara Koopman as the new Human Services Fiscal Manager who replaced Davita Molling.
Human Services Milestone Anniversary Recognition Luncheon, Tuesday noon, November 6th at CMO; Chairperson Johnson encouraged attendance.
CONSENT AGENDA
MOTION by Hampson/Wood to approve the following Consent Agenda items:
Minutes:
· Health and Human Services Board of 9/11/07
· Joint Meeting – HHS Board and Aging & Long Term Care Committee of 9/10/07
· Coulee Region Public Health Consortium of 8/1/07
· Criminal Justice Management Council of 9/19/07
· Criminal Justice Management Council Executive Committee of 9/19/07
· Dental Care Advocacy Committee of 9/24/07 (not handed out/referred to next meeting)
· Health & Human Services Labor/Management of 9/25/07
Fiscal:
· 2007 Summary of Contract Approvals
· 2008 Summary of Contract Approvals
· Vendor Audit Policy Step 2 Notification
· Care Management Organization Summary of Revenue and Expenses
Department Reports:
· Health Director’s Written Report
· Human Services Director’s Written Report
Miscellaneous questions, comments, and some clarification on some of the above items - relating to: (1) membership on MCO Governance Board; (2) two contract renewals that are out of compliance that require an audit; Dean Ruppert noted that they are in 2nd step procedure with payment being withheld and if they go to 3rd step, the County will do the audit; (3) all Health Dept. resolutions as submitted to WCA were acted on at the WCA Conference; (4) Child Protective Services and parents with mental illness (editorials and community discussions); (5) request not to use acronyms in contracts; and (6) living wage ordinance; Steve O. reported that because of the affects on the County, in particular on contracts, that the two Supervisors who had requested it have since withdrawn their request, but may come back with a different version in the future.
Motion carried unanimously; Schippers absent.
PUBLIC COMMENT
None requested.
POLICY ISSUES
Urban Transportation Growth – Chris Sander reviewed. Human Services has a contract with La Crosse MTU to provide paratransit services which is provided by Laidlaw; this arrangement with the City allows a 39% savings in costs through state and federal funding which they apply for on an annual basis. Due to continued growth in CMO and increase in MA trips, the original estimate used for the contract will have a shortfall by yearend. The 39% savings will not apply to the shortfall which is estimated at $90,773 - $66,000 will be reimbursed by CMO, and the remaining will be covered by MA funding known as sum sufficient which the state pays for most, if not all, of the expenses incurred. Human Services workers are encouraged to review client caseloads and try to utilize less expensive transportation options. For 2008, the estimated rides were increased based on this information. Informational.
Public Service Commission Universal Service Fund Grant for Medical Telecommunications Equipment – Jerry Huber reviewed. The Public Service Commission has offered grant dollars for Telemedicine Equipment for nonprofit medical clinics, hospitals and public health agencies. Clinical Services applied for and received notification of grant award of $30,000; the County match is $6,300. The plan is to purchase four (4) telehealth units, placing one unit in Health & Human Services Bldg., two units at Lakeview, and one at Trempealeau County Health Care Clinic, and the Sheriff’s Dept. is purchasing Human Services’ old unit. The purpose is to enhance access to medical care, in particular for Lakeview and Trempealeau clients; it will allow psychiatric services such as medicine adjustments and behavioral planning – all being done via telecommunications; it will also assist in emergency admissions. It can also be used for staff meetings with Lakeview staff, and save on travel expense and staff efficiencies. MOTION by Thompson/Wood to approve the acceptance of the Public Service Commission Universal Service Fund Grant for medical telecommunications equipment in amount of $30,000, and to approve the bid/quote form to purchase Polycom videoconferencing equipment in amount of $36,281.29. Noted this is sole source purchase based on State Contract; also noted $6,300 is in the 2007 budget. Motion carried unanimously; Schippers absent.
Appointed Members to the Aging & Disability Resource Center of Western WI and the Implementation Council for the Long Term Care Managed Care Organization – Jerry noted the state has accepted the region’s proposal for the MCO development and the ADRC for Western Wisconsin is moving forward in its final plans for implementation. The West Central Consortium Steering Committee agreed to HHS Board’s request of having 50% consumer representation with two members from La Crosse County as well as at least one business representative from the County; this is in addition to one board member being appointed to the Implementation Council of the MCO. Dean reviewed the consumer representation process. Chairperson Johnson asked the members for input on how they want to handle. Lengthy discussion followed. MOTION by Glasser/Kannenberg to thank the WCC Steering Committee for accepting the HHS Board’s membership recommendation, and also approve the composition of La Crosse County membership on the ADRC Board and on the Implementation Council of the MCO Board. Motion carried unanimously; Schippers absent.
After further discussion, general agreement to have the HHS Board Chair solicit membership on the Implementation Council of the MCO Board which will be appointed by the County Board Chair with County Board approval. As the ADRC Board is an advisory committee, the HHS Chair can make that appointment and will seek interested membership(s).
Budget Discussion and Planning for 2008
Health Dept. – Steve O’Malley reviewed the budget challenges for the Health Dept. Noted the impact on Home Health Care due to increase in CMO clients; this issue is still unresolved; the plan is to address during the budget approval cycle in November. In other budget areas, there are additional staff hour requests: .2 in Medical Records and .2 in Emergency Services (no tax levy requirement).
At this time, Laura Gambino, Public Health Nursing Supervisor, reviewed an “Oral Health Program” for children ages 14 and younger. A 17-page report was distributed that included dental care history and MA reimbursement information, goals/objectives, measurable outcomes, work plan description, key work staff, and 3-year budget worksheet. The program is strictly for dental screenings and prevention services; the plan is to serve over 1,400 children over 3 years. The proposal is to hire 2 FTE dental hygienists, 1 part-time dental assistant, 1 FTE Nurse and 1 part-time clerical. Equipment would be purchased and services provided within the Health Dept., including some portable equipment to service those in outlying areas. Total projected cost over three years is approximately $900,000+ of which all or most could possibly come from various grants, including La Crosse Community Foundation. Lengthy discussion followed. Chairperson Johnson noted the decision to be made is whether or not the HHS Board approves all or portion of the proposal, and if so, the budget would have to be amended on County Board floor in November. All agreed the service is needed; general agreement that MA reimbursement needs to be increased in order to get more dentists involved in providing dental services. Steve noted this as a non-mandated service and it’s not included in the 2008 budget; there is no funding source for this and it would have to come from the Health Dept. Fund Balance which is needed for cash flow and other reasons, or set a placement holder dollar figure for such. He suggested further review and for staff to meet with La Crosse Community Foundation to consider all options. Chairperson Johnson suggested referral with revised proposal given to HHS Board members before the next meeting.
Doug distributed a revised 2008 Health Dept. fees list. He noted most fees were based on actual service costs. Discussion on home health. Kannenberg noted some years ago, there were no other providers for home health other than the Health Dept. Pat Killeen noted two others - REM and Caregivers.
Human Services – Jerry gave an overview. The department will be establishing budget “benchmarks” for 2008; benchmarks will establish standards or goals for key areas of the budget to monitor fiscal compliance and will provide a system of reporting budget and fiscal compliance to the HHS Board relating to policy and decisions. He noted the following budget drivers:
· Increases in inpatient and residential costs in Clinical Services. Benchmark: the County will experience a 20% reduction in Chap. 51 detentions due to the continuum of crisis services available in the community. Also creating MOU’s with law enforcement and need to push for prior approval.
· Need to enhance ability to collect revenues from private pay, 3rd party insurers and Medicaid Programs in Clinical Services. Benchmark: need to increase MA reimbursement by 15% through improved staff time reporting for claims submitted.
· Out-of-home children placement costs, especially for those requiring more restrictive and treatment orientated placements. Benchmark: continue to meet federal/state standards and
· achieve 15% reduction in cost in out of home placements due to diversion activities to prevent placement.
Steve O’Malley continued Human Services budget review. A basic guideline for all departments was that salaries and benefits were covered, but the departments should try to meet a zero percent increase. There are new positions for CMO, ADRC, Clinical and Family & Children – all with no levy impact. He noted use of Human Services Undesignated Fund Balance for some budget expenditures, such as $198,000 for DRI (new software program), internal chargebacks from Justice Sanctions, portion of Family & Children out-of-home placement costs, and $100,000 for diversion programs as determined by HHS Board and County Board. No specific dollars for Boys & Girls Club; Jerry noted staff are meeting with the new director in looking at options and other models that focus on Human Services diversion objectives. Gary Ingvalson noted $7.1 million in the Human Services Undesignated Fund Balance and auditors recommend such balance for cash flow and as needed for emergency expenditures. Question asked why out-home-placements increasing. Jerry noted economics and drug issues.
Discussion on JDF non-secure. Jerry said he suggests no changes this budget. He noted Winona model/ program that is similar to a group home; he will bring more information to a future meeting. Suggestion to contact ATTIC. Chairperson Johnson suggested the program/service be offered by RFP process.
Female Alternative Program is in the middle of the RFP process; plan to hold interviews on October 30; it will be provided by contracted services.
Chairperson Johnson noted the budget process is improving every year and thanked Steve O’Malley for his leadership. Dr. Glasser questioned effects of state budget on the County budget. O’Malley noted mostly throughout the entire budget, additional funding was not counted on; only problem could be tax levy freeze that is different than the Governor’s, and cuts in Medicaid could affect several areas in the budget.
RESOLUTIONS
Resolution re Transfer of Funds from the Care Management Organization to the Human Services Fund Reserve to Cover Consultation and Personal Computer Hardware Costs – MOTION by Billings/Glasser to approve the resolution. O’Malley reviewed, noting of the $140,367 to be paid back by CMO to the Human Services fund reserve, $100,000 is repayment for TMG consulting services and $40,367 for purchase of personal computers to replace thin clients at CMO. The State was contacted and OK with this transaction. Motion carried unanimously; Schippers absent.
Resolution re Changes in Positions Funded by a Combination of Levy and Outside Sources (Non-tax Levy) for 2008
Informational only.
Resolution re Change in General Operating Levy Positions and Hours for 2008 Budget Informational only.
HANDOUTS AT THE MEETING
· Revised 2008 Health Department fee list.
· Oral Health Program Grant Proposal for children 14 years and younger.
· Celebrate Foster Families on Thursday, October 25 from 5:00-8:00 p.m. at Roncalli Newman Parish.
· Email from DHFS noting WI received FEMA grant funding to help residents in flood-related counties to cope with emotional stress; DHFS is coordinating the Crisis Counseling Immediate Services Program; project counselors will provide up to two months of free supportive counseling and consultation.
· Initial community meeting re “Changing the Culture of Risky Drinking Behavior – reducing alcohol-related injuries among 12-24 year olds in La Crosse County, November 1st from 4:30-6:00 p.m. at the Cleary Center.
ITEMS FOR FUTURE AGENDAS
ADJOURNMENT
There being no further business, Board Chair Johnson declared the meeting adjourned at 8:18 p.m.
Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting.
Cheryl Stephen, Recorder