HEALTH AND HUMAN SERVICES BOARD

Tuesday, March 11, 2008

Administrative Center – Room 3220

6:30 p.m.

MEMBERS PRESENT:  Tara Johnson, Sharon Hampson, Jill Billings, Loren Kannenberg, Dr. James Glasser, Al Thompson (arr @6:40), Brad Pfaff (exc/arr @7:55)       

MEMBERS EXCUSED:  Margaret Wood

MEMBERS ABSENT:  Patrick Schippers  

GUESTS AND STAFF PRESENT:  Jerry Huber, Doug Mormann, Dean Ruppert, Maryellen Paudler, Jane Klekamp, Steve O’Malley, Sara Koopman, Mary Ellen Prinsen, Abby Poppie, Janet Holter, Connie Dunlap, Jodi Widuch, Pam Bendel, Mandy Bisek, Megan R. (Girls Circle), Gretchen Scharringhausen, Kimberly Erickson-Nichols, Cheryl Stephen  

CALL TO ORDER

Tara Johnson, HHS Board Chair, called the meeting to order at 6:31 p.m.   

ANNOUNCEMENTS           

March Appreciation for HS Staff:  March 26 from 12:00-1:00 p.m. and March 27 from 8:00-9:00 a.m.  Most HHS Board members have signed up to attend one of the events.

March Appreciation for Health Dept. Staff:   Doug Mormann said their event on March 6^th was well attended; he also noted that staff appreciated the recognition letters as individually signed and sent by the HHS Board.

PUBLIC COMMENT

None requested.

POLICY ISSUES

Accounts Receivable Policy Changes and Collection Policy Changes – Sara Koopman reviewed.  As a result of rules developed by GASB (new government accounting system), the County’s independent Auditors indicated certain changes should be made in the area of accounts receivable for Human Services.  If approved, the changes would become effective May 1, 2008.

Proposed policy changes relating to accounts receivable:

• On an annual basis, write off charges greater than 3 years old located only in the Human Services billing database.  Currently have charges going back as far as 1994; for past 10 years, the amount of write off is estimated from $10-12 million; for accounts greater than 3 years old, estimated collections are around $27,000.  At the end of each year, these charges are analyzed to determine the portion that is deemed collectible.  This is the amount that is actually recorded on the financial statements.  In the past this has typically ranged from $500,000-600,000 when you add both past and current accounts.
• If a consumer has an ongoing ability to pay equal to -0- that extends beyond a year, all charges will be written off retroactively.
• Collection efforts will continue for those accounts already sent to Collections. 
• This will not affect County or Human Services financial statements as the accounts being written off were not in the books, but only on the Human Services billing database.

Proposed policy changes relating to collection:

• Proof of income will be required on an annual basis for all clients or for previous clients with outstanding balances; this will annually re-determine their ability to pay.

• Clients not currently receiving services will be expected to make payments based on their ability to pay.  Fiscal Services will review accounts to see if at least one payment equal to or greater than the client’s ability to pay amount was made within the past 90 days.  If no such payment was received, they will be considered for referral to Collections.
• Clients have the ability to contact Fiscal Services and set up a payment plan or revise their payment plan based on their ability to pay.

Miscellaneous questions and answers.  Sara noted the write-offs will not affect Human Services financial statements.  Jerry also noted that staff is doing an analysis on the “frequent flyers.”

MOTION by Glasser/Billings to approve as presented the revised Accounts Receivable Policy AR6.3.  Motion carried unanimously; Wood and Pfaff excused; Schippers absent.  

MOTION by Thompson/Glasser to approve as presented the revised Accounts Receivable Policies AR6.4 and AR6.8.  Motion carried unanimously; Wood and Pfaff excused; Schippers absent.

Women’s Community-Based Correctional Program Update – Jane Klekamp reviewed.  Overview as follows:

·         In December, 2007, YWCA was chosen as the provider of women’s community-based services.

·         YWCA just finished their 2^nd round of interviews for staffing the program.

·         Justice Sanctions has held regular meetings with YWCA relating to implementation and monitoring of the program.

·         County IT Dept. is establishing a network between YWCA and Justice Sanctions.

·         County recently received $50,000 grant from La Crosse Community Foundation for the housing component.  The County Purchasing Manager sent RFP’s to real estate agents to procure housing – leased or purchased.  Hopefully by the end of March, a real estate agent can be secured.

·         In the May meeting cycle, plan to bring a housing solution (lease or purchase) to the HHS Board, Judiciary & Law Committee, and County Board.  Estimated housing occupancy is June.

·         Once YWCA community-based staff on-board, female inmates will be interviewed for appropriate referrals.

Miscellaneous questions and answers followed.  Reason Judiciary & Law Committee as part of the approval process is based on closing of the female jail and renovation of current jail for females, if needed; extra committee support is beneficial.  Steve O’Malley also noted that a Board Member suggested an item for a future County Board Planning session relating to contracted services for Justice Sanctions.    Several HHS Board members noted that this has already been dealt with by holding a joint meeting between HHS Board and Judiciary & Law Committee on February 12^th and those minutes were distributed to the County Board at the monthly February meeting.

BOARD EDUCATION

Policy, Practice, People of Female Adolescent Youth Offenders/Girls Circle – Mary Ellen Prinsen, Gretchen Scharringhausen, Kimberly Erickson-Nichols (Franciscan Skemp Behavioral Health), and Megan R. (former client of Girls Circle) were present to review the Girls Circle Program.  Overview as follows:

·         In 2006, the County was awarded $55,860 in grant funds from OJA and JABG to be used for implementation of the Girls Circle Program, a national, researched based, promising program. 

·         The County Girls Circle Program began in January 2007, and is facilitated by Franciscan Skemp Behavioral Health.

·         The program targets adolescent females ages 12-16 years with medium to high risk in the juvenile justice system and relating to offenses, family, education, peer relations, substance abuse, leisure, personality and behavior, and attitudes.

·         Three groups meet per year with maximum of up to 8 girls per group.  They meet 10-12 weeks;  each group meets 1.5 hours per week with a therapist plus 1 hour per week for individual/family session.

·         Therapy sessions provide safe, secure place for girls to address painful experiences; they learn that they are not alone in dealing with similar issues.  During individual and family sessions, parents are educated on the causative factors, child risk factors, parenting issues, etc.

·         Upon completion of the sessions, referrals are made to outside resources to continue supportive services.

·         Thus far, 20 girls were referred to the program with approximately 10 having successfully completed it. 

·         Megan was introduced as being a successful candidate of the program; she was in the 3^rd group of girls.  She briefly reviewed her experience in the program and answered questions.  She viewed the program as being helpful.

Questions and answers followed.          

Policy, Practice, People of Community Response Program – Mary Ellen Prinsen, Janet Holter, Connie Dunlap, Jodi Widuch, and Abby Poppie reviewed the Community Response Program.  Overview as follows:

·         In 2007, received over 1600 referrals with concerns of child abuse and neglect.

·         Each referral/report is screened and some are then referred for further investigation; some are then determined as urgency based on potential danger threats – same day, 24-hour, 48-hour, or within 5 days.  There is no requirement to notify families that a report was made on them.

·         Human Services contracts with Family Resources staff to offer the Community Response Program services in conjunction with Child Protective Services (CPS).

·         For those select families considered as being screened out (non-urgency), letters are sent informing them that there was a referral to CPS.  The letter offers to visit with them about available programs and services in the community. 

·         If there is no response from these families, Community Response staff may follow up with a phone call, a 2^nd letter, or an unannounced home visit.

·         In 2007, 298 families were referred to the Community Response Program; 154 families (52%) accepted services.  Noted that this is a voluntary program.

·         There are 3 levels of Community Response services:  1) involves 1-2 meetings with the family with majority of outcomes being referrals to existing services within the community, 2) involves 30-60 days of on-going services with the family to support them in their identified needs, and 3) is referral back to CPS.  In 2007, 62% received option 1, 36% received option 2, and one family was referred to CPS.

Questions and answers followed.  Mary Ellen noted the successful collaboration between Human Services and Family Resources in regards to this program.  Connie also noted prenatal referrals (a pregnant mother expected of drug or alcohol abuse).  Noted that when a case is closed, a feedback survey is offered to the participant as a way of receiving input on how to improve or modify the program; these are then sent into Madison which compiles the information.  As of to-date, compiled reports have not been returned, though when received, they will be shared with the HHS Board.  Supervisor Billings questioned the future of child welfare services.  Jerry noted a meeting scheduled for April 4 with new Secretary of the Dept. of Children and Family Services, Reggie Bicha, to discuss the potential of taking the Community Response Program to the “second generation.”  Human Services is looking at the potential of having the majority of child neglect cases and less egregious cases of physical abuse to become part of a community response approach to addressing these issues within families; there may be a potential for a pilot program.  Jerry welcomed HHS Board members to attend the meeting on April 4^th.  Discussion on change of services within the County.  Mary Ellen noted more referrals, but able to screen out more cases so less stressful on County staff, being able to do more up front, better outcomes, and fewer CHIPS petitions.  Also discussion on the unknown long-term affects on County funding.

CONSENT AGENDA

MOTION by Kannenberg/Glasser to approve the following Consent Agenda items:

Minutes:

·         Health & Human Services Board of 2/12/08

·         Joint Meeting of HHS Board and Judiciary & Law Committee of 2/12/08

·         Coulee Region Public Health Consortium 2/6/08

·         West Central Consortium Steering Subcommittee of 1/23/08 and 2/13/08

·         West Central Consortium Implementation Council of 2/6/08

·         W-2 Community Steering Committee of 2/26/08

·         Legislative Gathering of 2/18/08

·         Dental Care Advocacy Coalition of 2/25/08

Fiscal:

·         2007 Vendor Contract Approvals

·         2008 Vendor Contract Approvals

·         2008 Vendor Contracts not yet Settled

·         2008 Vendors with Rate Increases over 2%

·         Vendor Audit Policy Update

·         Care Management Organization Summary of Revenue and Expenses

Department/Board Reports:

·         Health Director’s Written Report

·         Human Services Director’s Written Report

·         Quarterly Complaint/Grievance Report from Care Management Organization

Miscellaneous questions, comments, and some clarification on some of the above items.

Maryellen Paudler noted the 1.1% decrease in CMO client capitation rate which will cause a decrease in their reserves; predict $625,000 loss in 2008 based on that rate decrease.  The financial report, as sent with the agenda packet, is preliminary; the pre-audit financial report will be shared at the April meeting, and the 2007 closeout report as well as first 3 months of 2008 will be shared at the May HHS Board meeting.  Jerry noted the Risk Reserves will also start to decrease due to changeover to MCO.  Update on MCO hiring process:  March 12^th 2^nd round interviews for the Executive Director position; March 19^th 2^nd round interviews for the Finance Director position; and March 24^th 2^nd round interviews for the IT Manager position.  Maryellen also noted the Legislature is meeting tomorrow (3/12) on the WI Retirement System 2^nd window option as requested for the employees of long term care districts, and as needed for the new employees of the MCO. 

Per Doug’s monthly report, per recent 2007 report, Trust for America’s Health, as prepared by the Wisconsin Public Health Council, Wisconsin is ranked 47^th in the nation; and ranks last in public health investment – spending ¼ of the average of these states on funding public health.  Supervisor Hampson noted the Public Health Council does have the ear of the Governor.

Per Jerry’s monthly report, Supervisor Billings noted no funding for the Adolescent Center development; what’s happening?  Jerry responded; he also noted that he has contacted Mark Carey to possibly look as juvenile justice continuum of care.  He relayed his concern with the State budget deficit and outcome for the counties.  He suggested further review at the April or May HHS Board meetings.  Mary Ellen reviewed current status and placement options. 

Motion carried unanimously; Wood excused; Schippers absent.

ITEMS FOR FUTURE AGENDAS

• Adolescent Center

NEXT MEETING

Tuesday, April 8^th at 6:30 p.m.

ADJOURNMENT

There being no further business, Board Chair Johnson declared the meeting adjourned at 7:59 p.m.

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

Cheryl Stephen, Recorder