HEALTH AND HUMAN SERVICES BOARD
Tuesday, November 6, 2007
Administrative Center – Room 3220
6:30 p.m.
MEMBERS PRESENT: Tara Johnson, Al Thompson, Margaret Wood, Sharon Hampson, Jill Billings, Brad Pfaff, Dr. James Glasser, Patrick Schippers
MEMBERS EXCUSED: Loren Kannenberg
MEMBERS ABSENT: None
GUESTS AND STAFF PRESENT: Doug Mormann, Jerry Huber, Dean Ruppert, Sara Koopman, Patrick Killeen, Maryellen Paudler, Jane Klekamp, Lindsey Schwarz-Nichols, Karen Odegaard, Michelle Olson, Matt Strittmater, Sara Halverson, Anne S., Jessica Hulberg, Dave Geske, Bridgett Todd, Connie Eide, Steve O’Malley, Gary Ingvalson, Mary Powell, Don Meyer, Don Bina, Cheryl Stephen
CALL TO ORDER
Tara Johnson, HHS Board Chair, called the meeting to order at 6:30 p.m.
ANNOUNCEMENTS
Joint Meeting with Aging & Long Term Care Committee on December 10th at 5:00 p.m. – CANCELLED. There is another meeting of the Lakeview Collaboration counties in which both committees (HHS Board and Aging & Long Term Care) are invited to, that being on December 5, 6:00 p.m. at Lakeview.
Secretary Hayden will join the December 11th HHS Board meeting to discuss Family Care initiative/expansion and dental care initiatives – Jerry noted any additional information that the HHS Board may request, Jerry needs to share this with Sec. Hayden prior to next month’s meeting.
Wisconsin County Human Services Association Fall Conference is December 7th in Stevens Point – Jerry encouraged attendance; focus will be on child welfare. Renee will take care of the arrangements.
CONSENT AGENDA
MOTION by Glasser/Thompson to approve the following Consent Agenda items:
Minutes:
· Health and Human Services Board of 10/9/07
· Coulee Region Public Health Consortium of 10/3/07
· Joint Meeting of Criminal Justice Management Council, Judiciary & Law Committee, and LEC Addition Committee of 10/10/07
· Criminal Justice Management Council Executive Committee of 10/10/07
· CMO Advisory Committee of 9/11/07
· Dental Care Advocacy Committee of 9/24/07
· Family Policy Board Management Council of 9/20/07 and 10/18/07
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
· Human Services 2008 Fee Schedule
· 2008 Vendor Contracts Exceeding 2% Increase in Rate
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 Reporting
· Human Services Quarterly Appendix D Reporting
Miscellaneous questions, comments, and some clarification on some of the above items. Motion carried unanimously; Kannenberg excused.
PUBLIC COMMENT
None requested.
BOARD EDUCATION
Policy, Practice, People of Comprehensive Community Services (CCS) - Sara Halverson, a Social Worker in CCS/Clinical Services, introduced Anne S., a consumer of the CCS program. CCS is a new case management program in Clinical Services offered to adults as it is specifically designed to empower consumers in their journey to recovery. CCS develops a network of unique and innovative psychosocial rehabilitation services that can be mobilized to meet consumer needs. Sara provides case management, coordinates services and works with the consumer from the beginning to identify a Recovery Team that is unique to each consumer.
Anne S. noted that she has received services for 1 ½ years. She was diagnosed with bi-polar, is divorced, mother of 2 children, and has an RN degree. She shared her thoughts on how CCS helped her and how it is a valuable part of her continuum of care. She wrote her own treatment plan and has more control of her life. She is serving on several committees, one being the Consumer Advisory council. Chairperson Johnson thanked Anne for sharing her story.
Policy, Practice, People of Vector Control – Dave Geske, Vector Control Officer, introduced Jessica Hulberg, a student of Luther College and one of the 15 part-time seasonal Vector Control employees that worked with mosquito control during the summer.
Jessica reported on her efforts to control disease vectors and monitoring for the possible invasion of Aedes albopictus and Ochlerotatus japoncus mosquito species that have invaded the United States, but not prevalent in this area. In 1998, the two species came into the U.S. via imports, such as inside tires or in the water of wholesale houseplants; since that time, there is better control. Both species are vectors for West Nile Virus and the La Crosse Virus. During the summer, Jessica collected samples from 10 counties, mostly along the Mississippi River, including Fort McCoy which does not have adequate vector control, noting the storage of many tires, etc. She collected and identified many species. The continuation of this type of work reduces exposure of the public to disease carrying mosquitoes. Chairperson Johnson and HHS Board members commended Jessica for her dedicated work in this area.
“Covering Kids” – Presentation by Lindsey Schwarz-Nichols – Lindsey coordinates the Community Liaison Program with funding assistance from the La Crosse Community Foundation, Human Services and the Robertwood Johnson Foundation, as part of covering Kids and Families-Wisconsin program. Lindsey introduced Karen Odegaard, from the State Office that oversees this State initiative of “Covering Kids” & Families-Wisconsin. In 2007, La Crosse County was one of several counties chosen to do a CHILD (Connecting Health Insurance to Lunch Data) pilot project within the school districts of the County. The project started June 2007 with funding continuing through June 2010. The project seeks to increase health insurance coverage among Wisconsin’s children by better connecting the outreach, application and enrollment processes for the school’s free and reduced price lunch with the State’s Family Medicaid health insurance programs, including BadgerCare. The families that are eligible for free or reduced lunches at the schools are also for Family Medicaid. This project wants to improve access to care and preventive health services and reduce the likelihood of detrimental health conditions in the future. Wisconsin’s Family Medicaid program provides health insurance coverage for many lower-income children and their families. Currently, the pilot project includes the following schools: La Crosse, Holmen, Bangor and Onalaska. Lindsey reviewed the contact process with the families.
POLICY ISSUES - 2008 BUDGET DISCUSSION
Dental Program Options - The Health Dept. presented a dental proposal at the October HHS Board meeting. Staff was asked to prepare a summary of options for improving dental services in 2008. Five (5) options were presented in an exception analysis that was sent with the agenda; brief overview of each option as follows:.
· 1 – Expand Health Dept. services, that includes additional staff, to provide dental screening, dental cleaning, administer dental sealants and fluoride, and make referrals, if needed. The total cost over 3 years is $800,000 with $300,000 for 2008. This is preventive dental care.
· 2 – Place $25,000 in the 2008 Health Dept. budget that could be taken from the Health Dept. Undesignated Fund Balance. HHS Board would determine a specific activity based upon assured funding from other sources along with a specific work plan, client target, etc.
· 3 – Set aside an amount, such as $50,000 similar to Fond du Lac County, from the tax levy that could be used to subsidize the Medical Assistance reimbursement for restorative dental care. Being able to reimburse the dentist at an acceptable rate should enable more patients to be seen.
· 4 – Joint effort or subsidy to Scenic Bluffs Community Health Center based in Cashton.
· 5 – Wait for potential expansion of Medical Assistance for dental services via State pilot project. This was not approved in the State budget.
Discussion on the various options. Noted current Health Dept. Undesignated Fund Balance is at 13% of its gross expenditures; this fund balance is not required to keep a higher percentage as compared to the General Fund. MOTION by Pfaff/Schippers to accept option 2 which puts $25,000 in the 2008 Health Dept. budget to be used toward dental services which will come out of the Health Dept. Undesignated Fund Balance. Noted that this change will be included on the 2008 budget listing of changes/additions which will go to the County Board for approval. Motion carried unanimously; Kannenberg excused.
Uses of Fund Balance – Steve O’Malley distributed a handout relating to fund balances and amounts applied to 2007 and 2008 budgets. For Health Dept., $66,935 was taken from its fund balance to cover software purchase in 2007; for 2008, $8,082 for additional staff time to assist in electronic health records and an additional $25,000, as just approved, for dental services, which totals $33,082. For Human Services, 2007 budget used total of $523,702 from their fund balance that was used for DRI software, Justice Sanctions chargebacks, and Family & Children increase in costs; and for 2008, the total from fund balance is $685,284 which covers same type of expenses, plus funds for a Residential Diversion Program. Informational.
Youth Diversion Options – Jerry noted placeholder of $100,000 is still in the budget.
Home Health Options – An exception analysis was sent with the agenda. The Home Health Care Program provides home health nursing and aide services to adults needing home care. This service was previously identified as a priority because of lack of private and non-profits providing same service. The County Home Health Care has provided services to CMO members – about 60% of total services. A new home health care agency called REM is beginning to provide services to CMO members; this will divert or enable the County to provide home health care services to those identified by the Family & Children’s division and other agencies in the community. This may require a change in mission statement for the County Home Health Care Program. Steve O’Malley noted CMO is not automatically going to discontinue to use County Home Health Care; there is a vacant nursing position and a .2 position that will not be filled which helps the bottom line - staying within existing levy for Home Health. It was pointed out that Home Health is not a required service. Steve recommended further discussion by HHS Board and staff early in 2008 to determine all options, such as subsidy, continue provider to CMO, downsize, etc.
Women’s Community Based Program/ Women Offender’s Programming Update – Jane Klekamp reviewed. Based on Carey Report recommendation and with the closing of the women’s jail, need to develop a 4-tier system that consists of assessment, residential beds, community programs and secure jail beds. Because the vendor interviews did not occur until the end of October, there was not enough to put all of the information together in time of sending out the HHS Board packet, so staff determined to hold over until the December HHS Board meeting. Also needed time to pull together information for the collaboration and flexibility needs to be obtained and reviewed as well as fully investigate the different aspects of purchasing property vs. leasing property. A team of various department staff and a citizen conducted interviews with three vendors. Bidders submitted information on vocational, personal, family/social, and life needs. Based on team scores, the team recommends the YWCA as the provider for Women Offenders Programming. Additional information will be shared at the December HHS Board meeting. Jane reviewed the process on how the program will work; it will only be for “sentenced women”; it will not be used a funnel for women as that is not the purpose and the Judges seem to understand that. Purpose for the program is to help women change. Chairperson Johnson said the final decision will by the full County Board as a way for them to better understand it.
Award Recommendation for Consumer Affairs Coordinator – Matt Strittmater reviewed the RFP process. The objective is for an outside agency to hire a Consumer Affairs Coordinator for Clinical Services and be responsible to recruit and support consumer involvement in the design, delivery and implementation of Clinical Services (CS) programs, and also work closely with the Advisory Council. RFP’s were sent to local organizations with history of employing, self-identified consumers of mental health services, and it was posted in the Tribune and also on the county website. Two vendors submitted proposals. An evaluation team of various staff and consumers held interviews. Evaluated criteria: program narrative and philosophy, organization capabilities, agency support of position, quality improvement, mental health systems advocacy, price, and interview. Vendors’ final scores were: Independent Living Resources Inc. with 134 points and Riverfront Inc. with 116 points. MOTION by Thompson/Schippers to approve the evaluation recommendation to contract with Independent Living Resources Inc. from November 7, 2007 through December 31, 2007 for the Consumer Affairs Coordinator position, including a renewable contract up to the next three (3) years. Motion carried unanimously; Kannenberg excused.
Limiting Psychiatric Referrals to Clinical Services – Jerry reviewed. Clinical Services is seeing an increase in number of people seeking psychiatric services and medical prescriptions to address mental health problems. Both private and public providers of mental health services are struggling to find available psychiatrists to meet the growing need. Human Services sent a letter to community agencies that make referrals to the County, making them aware of current limitations within Clinical Services (CS). CS currently contracts for psychiatric hours – 12 per week. Their caseload is very large and follow-up visits after issuing prescriptions can go as long as 6 months. There is a potential liability factor. An option is to recruit a Nurse Practitioner or Physician’s Assistant to assist with the lack of psychiatric coverage. Discussion and miscellaneous questions on all options. Jerry noted possibility of recruitment of two psychiatrists in residency at UW-Madison. Also need to discuss this issue with both hospitals’ behavioral health departments, including St. Clare Health Mission. MOTION by Pfaff/Wood to approve the hiring of a Nurse Practitioner or a Physician’s Assistant and to include this position in the 2008 non-tax levy employee resolution. Motion carried unanimously; Kannenberg excused.
Deer Processing for Distribution to Food Pantries - Supervisor Don Bina addressed the HHS Board. He noted Craig Meats has been the only meat processing vendor doing the processing of donated deer for distribution to the County Food Pantries. This is a State sponsored program and is regulated by DNR with an reimbursement rate of $50 per deer. Craig Meats has indicated that this does not cover their costs, and if there is no increase, they may opt to not participate in the program. Supervisor Pfaff spoke in favor of the program and the need to increase the reimbursement fee. MOTION by Pfaff/Schippers to support the Venison Donation Program and to approve an additional $10.00 per deer for processing up to $3,500 for 2007, to be paid from the General Fund Operating Contingency Fund. General agreement that this additional $10.00 fee, above the regular processing fee as covered by the program that being $50, can be paid to any certified meat processor in the County as long as the meat goes to Food Pantries in La Crosse County. Doug Mormann offered to send a letter to the certified meat processors located within La Crosse County relaying this information. General agreement by the HHS Board members to refer for 60 days any requests for 2008 funding pertaining to the same program. Motion carried unanimously; Kannenberg excused.
RESOLUTIONS
Resolution re La Crosse County Poverty – MOTION by Hampson/Glasser to approve the resolution. Jerry reviewed noting the poverty rate is growing; in 2006, over 14% of the County residents were below the federal poverty level and 17.2% of the County children live under this level. Vision 2020 Campaign seeks to engage and partner with elected officials and others throughout the State to implement practical solutions to end childhood poverty by the year 2020. The approval of the resolution would establish a La Crosse County Task Force on Poverty as an advisory committee to the La Crosse Area Family Policy Board. After some discussion by HHS Board members, general agreement to include a sentence in the resolution that explains that the Family Policy Board is an advisory committee to the HHS Board; and to also include a representative of CouleeCap as a member to this Task Force group. The resolution would be revised to include those two items. Supervisor Billings offered to serve as a member representing the HHS Board. Motion carried unanimously; Kannenberg excused.
HANDOUTS AT THE MEETING
ITEMS FOR FUTURE AGENDAS
ADJOURNMENT
There being no further business, Board Chair Johnson declared the meeting adjourned at 9:38 p.m.
Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting.
Cheryl Stephen, Recorder