HEALTH AND HUMAN SERVICES BOARD

 

Tuesday, April 8, 2008

Administrative Center – Room B190

6:30 p.m.

 

MEMBERS PRESENT:  Tara Johnson, Sharon Hampson, Jill Billings, Dr. James Glasser, Loren Kannenberg, Margaret Wood (exc @7:20)       

MEMBERS EXCUSED:  Brad Pfaff and Al Thompson

MEMBERS ABSENT:  Patrick Schippers  

GUESTS AND STAFF PRESENT:  Jerry Huber, Doug Mormann, Dean Ruppert, Maryellen Paudler, Jane Klekamp, Steve O’Malley, Steve Doyle, Nancy Schmidt, Sara Koopman, Mary Ellen Prinsen, Lori Mueller, Connie Eide, Renee Weston, Bill Adams, Patty Dayton, Sarah Peterson, Claude Potvine, Nancy Pohlman, Jamie Schloegel, Melissa P. (foster youth), WTC students: “Social Welfare Programs & Policies” (Jerry Huber’s class), Cheryl Stephen

 

CALL TO ORDER

Tara Johnson, HHS Board Chair, called the meeting to order at 6:35 p.m.   At this time, Tara noted two agenda items will be taken out of order to accommodate HHS Board members, staff and guests, those being the first two items as listed under Board Education.

 

ANNOUNCEMENTS

Tara Johnson Recognition for Service – Tara’s term is ending on the Health & Human Services Board as of April 30, 2008, and because she cannot be reappointed due to her appointment to the Western Wisconsin Cares Board (the new board under MCO), the following people gave recognition for her service as a member and as Chair of the HHS Board:

·         Sharon Hampson, Vice Chair of the HHS Board, presented a card and noted members of the HHS Board will be making a donation in her honor to the Women’s Fund of the La Crosse Community Foundation.

·         Doug Mormann presented a card signed by Health Dept. staff.

·         Jerry Huber presented a recognition plaque.

·         Steve Doyle as Chairman of the County Board and as past HHS Board Chair.

·         Patty Dayton on behalf of Local 2484 -AFSCME.

 

PUBLIC COMMENT

None requested.

 

BOARD EDUCATION

Policy, Practice, People of Pioneering Healthier Communities Project:  Homeless Coalition of La  Crosse County – Sarah Peterson, Public Health Nurse, and Claude Potvine, formerly homeless person, gave an update on the Homeless Coalition of La Crosse County and how the project would benefit the homeless population.  Sarah noted the coalition started in October 2006, and recently adopted a new name change.  Their purpose is to increase the services to the homeless population in the County and focus on need for a day shelter.  Two important long-term goals include:  1) strengthen the network of coalition members so that all members are active supporters of the work of the coalition and 2) use the coalition as a forum to increase public awareness of the need for services in the homeless population.  The coalition is focusing on community awareness and a day shelter.  Sarah noted Claude, as a former homeless person, is a valuable member of the coalition; he noted some needed services.  He and Sarah noted some day shelters that are working well in Madison and Milwaukee and they would like to visit them to get more valuable information; they are not only day shelters, but also known as places to better themselves, including the offering of GEDs, health, etc.  Funding for a shelter will be an issue, but hope most will come from donations, such as churches, grants, etc.  Sarah welcomed HHS Board members involvement.

 

Policy, Practice, People of Children Aging Out of Foster Care – Mary Ellen Prinsen introduced Nancy Pohlman, Jamie Schloegel, and Melissa P. (foster youth) all of whom gave an overview of the Independent Living Program services for youth that reside in out-of-home care between ages 15  to 21, which is a federal requirement.  Nancy noted Human Services contracts with The Family and Children’s Center (FCC) for providing these services.  FCC uses a standardized independent living assessment and develop individualized plans for each youth; a tiered system is used in providing the most intense services to youth for ages ranging from 17-18.

 

FCC has developed a transitional housing program (Healthy Transitions) for youth 17½ that allows youth who are employed to transition from out of home care to living independently in an apartment.  Youth are required to sign a contract and abide by a strict set of rules; they are monitored routinely by their County social worker and Youth Development Specialist of FCC.  Between the foster parents and FCC, they are committed and responsible for improving the outcomes of youth in transition, noting the importance of trusting interpersonal relationships and providing resources to them and to help them become successful citizens within the community.

 

Melissa P., as a participant in the program, gave a brief overview of her life experiences and how the Independent Living Program has helped her; she’s been in foster care for the past 4 years, but plans to graduate from high school and start Viterbo in the fall to seek an accounting major; the only issue she has is the driver’s license requirement.  Jamie noted Melissa as their “super star.”  Jamie also noted funding resources decreasing every year while at the same time youth and their needs continue to grow; continued services will result in lower numbers accessing social service and criminal justice systems later in life, and become healthier, successful and contributing members of the community.  Jamie noted an upcoming event on May 1st at Logan High School starting at 6:00 p.m. – a Foster Care Youth Talent Show.

 

General agreement by HHS Board members to look again at the foster care driver’s license issue.

 

POLICY ISSUES

Request for Proposal Award Recommendation for Residential Live-by Programs – MOTION by Glasser/Hampson to approve the recommendation of the evaluation team to contract with Riverfront, Inc., from May 1, 2008 through December 31, 2008, and ongoing as appropriate for a Live-By Residential Program.  Mary Ellen Paudler and Nancy Schmidt reviewed the request for proposal (RFP) for the Live-By Residential Program.  The objective is to choose a provider in La Crosse that will provide private residences (typically apartments) on a city bus line to CMO membership who are interested in independent living, but still need some support.  RFP’s were solicited and only one returned, that being from Riverfront, Inc.  The proposal was evaluated on the following criteria:  1) agency qualifications, 2) organizational capabilities and program design, 3) staff qualifications, 4) evaluation and documentation methods, and 5) budget and cost information.  Plan to start with four CMO members though it may grow to six or more.  For the contract period, the rate is $69.34 per day/per person and $6.59 start up cost per day/per person, all of which will be paid from the capita per month rate as provided by the State for the CMO.  Motion carried unanimously; Pfaff, Thompson, Wood excused; Schippers absent.

 

Development of Juvenile Justice Services including the Adolescent Center – Jerry Huber reviewed.  Human Services is planning for a comprehensive Adolescent Center to supplement the continuum of services for youth referred to Family & Children’s Section.  The goal is to develop alternatives locally to reduce the need for more costly services outside the County.  Need to look at the following issues before a recommendation can be made:

·         Ability and cost of licensing the center in the current juvenile facility.

·         Analysis of the utilization of the Adolescent Center.

·         Commitment of 2-3 regional counties to lock in a bed to assure revenue source.

·         Analysis of staffing patterns needed for the center and associated costs.

·         Outside analysis from Carey Group and possibly Dept. of Corrections relating to the concept and how it fits into the continuum of care model for juveniles.

·         In addition to the above, need to be concerned about future federal and state funding changes for the Family & Children’s section.

 

Jerry distributed information relating to “scope for consultation” on the County’s juvenile justice system:. 

 

The department will continue the planning and analysis for the feasibility of an Adolescent Center with the goal of including it in the 2009 budget process.

 

Guardianship Backlog and Funding for Corporate Guardians – Bill Adams presented information on guardianship backlog and funding for Corporate Guardians.  The Court & Intervention Unit of Clinical Services works closely with Corporation Counsel to process guardianships as needed by county residents; this is a mandated service for emergency protective placements.  Sometimes the need occurs in non-emergency situations for adults, and also when minors who have developmental disabilities who reach age 18.  Another issue is obtaining recurring need for corporate professional guardians, especially when there is no volunteer guardian; MCO has paid the monthly fee for the corporate guardian, but with the changeover to the new MCO, payment will stop because it’s not included in their benefit set.

 

The waiting list for new volunteer guardians consists of 11 adults and 16 minors who are nearing age 18.  The Court & Intervention Unit is not able to keep up with the rate of referrals for non-emergency guardianship as the demand for emergency guardianships, protective placements, mental health detentions and commitments remain high.  Informational; further review at the June HHS Board meeting with possible recommendation from staff.

 

Benefit Package Reduction for Non-nursing Home Level of Care Members in Family Care – Maryellen Paudler distributed information regarding “benefit package reduction for non-nursing home level of care members in Family Care.”  Maryellen gave brief historical overview of Medicare & Medicaid, noting previously approved waivers for Medicaid services; for every $1 of Medicaid spent, the feds would pay $.60 and the State would pay $.40.  The feds will no longer pay their share for home and community based services for those not in nursing home level of care.  In 2008, CMO’s contract with the State and levels of care have changed; the non-nursing home rate was reduced including a changed/restricted benefit package; these individuals are not entitled to home and community based waiver services, though currently, CMO has been covering the cost or difference in reimbursement.  The intermediate level of care was covered up to $2,100/month and with the new change, is now covered at $650/month.  Some of the affected services include:  home renovation/ramps, mobile meals, transportation, employment, etc.   Maryellen also noted no appeal rights.

 

Alternatives for consideration:

·         CMO staff will analyze the financial impact of the reduced per member per month rate for approximately 100 members that were comprehensive non-nursing home and now at the non-nursing home level of care.

·         Staff will compile the waiver services provided to non-nursing home level of care members and analyze which services may qualify in lieu of Medicaid and total financial impact as denied by Medicaid.

·         Staff will present the results to the Western Wisconsin Cares board and provide recommendations for policy implementation at the start of the new MCO. 

 

Miscellaneous questions and concerns relayed by the HHS Board members.  Concern of staff making the decision to continue coverage for home and community based services.  Supervisor Hampson made quick calculation and noted it could cost $870,000 for six month period.  General agreement by HHS Board members to bring back to the May meeting, including financial impact and projections.

 

BOARD EDUCATION (cont.)

Day in the Life (June) – Suggestion to hold the event toward the end of June; date will be determined at the May meeting as new HHS Board members can give input.  Some new suggestions for on-site visits and some of previous interest include:  Independent Living Program, Health Lab, and St. Clare Mission (possibly later in the day). 

 

New Board Orientation Planning – Doug Mormann reviewed.  There was a suggestion to drop off the HHS Board manuals, or Doug offered to pick them up, so that staff can update the contents.  Discussion on whether or not to continue the mentoring by current HHS Board members.  Should encourage new HHS Board members to tour and visit the departments.  Some discussion on focusing more on department budgets; hold a second meeting or at the Retreat.  Doug also noted upcoming state and national meetings whereby HHS Board members may attend, but need to get travel authorization from the Board Chair Office as these expenses are in the County Board budget.

 

CONSENT AGENDA

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

Minutes:

·         Health & Human Services Board of 3/11/08

·         Coulee Region Public Health Consortium of 3/5/08

·         Dental Care Advocacy Coalition of 3/10/08 and 3/31/08

·         La Crosse County Labor/Management of 3/25/08

·         Family Policy Board Joint Meeting of Governing & Management Councils of 2/14/08

·         Criminal Justice Management Council of 2/20/08 and 3/19/08

·         Criminal Justice Executive Committee of 2/13/08 and 3/12/08

·         West Central Consortium Steering Subcommittee of 2/26/08

Fiscal:

·         2008 Vendor Contract Approvals

·         2008 Vendor Contracts not yet Settled

·         2008 Vendors’ Contracts Exceeding 2% Rate Increase

·         Vendor Audit Policy Update

·         Summary of Revenue and Expenses for Care Management Organization

Department/Board Reports:

·         Health Director’s Written Report

·         Human Services Director’s Written Report

 

Miscellaneous questions, comments, and some clarification on some of the above items.  In Human Services Director’s report, 2% under-utilization of Child Care; Lori Mueller noted the State’s emergency rule is now paying child care providers by the hour vs. daily or weekly; the providers are not happy with this arrangement.  In CJMC minutes of 2/20, mentions report on 17 year olds & juvenile justice, including problem solving and decision making process; please share this same information at a future HHS Board meeting.  Memorandum of Understanding for use of mobile crisis, would like more information on this at a future meeting.  Doug noted $70,000 in Emergency Preparedness budget that cannot be carried forward and need to decide on what or how to spend.  Motion carried unanimously; Pfaff, Thompson, Wood excused; Schippers absent.

 

ITEMS FOR FUTURE AGENDAS

 

NEXT MEETING

Tuesday, May 6th at 6:30 p.m.

 

ADJOURNMENT

There being no further business, Board Chair Johnson declared the meeting adjourned at 8:43 p.m. 

 

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

Cheryl Stephen, Recorder