BROWN COUNTY HUMAN SERVICES 111 N. Jefferson Street P.O. Box 22188 Green Bay, WI 54305-3600 Phone (920) 448-6005 Fax (920) 448-6126 Brian Shoup, Executive Director U>Human Services Board>2010>Agendas>20111208 Mtg. Agenda for Board.doc MEETING OF THE HUMAN SERVICES BOARD Thursday, December 8, 2011 SOPHIE BEAUMONT BUILDING, BOARD ROOM A 111 NORTH JEFFERSON, GREEN BAY, WI 54311 5:15 P.M. AGENDA 1. Call Meeting to Order. 2. Approve/Modify Agenda. 3. Approve Minutes of November 10, 2011 Human Services Board Meeting. 4. Review and Comments of Brown County’s 2012 s.85.21Specialiized Transportation Application. 5. Executive Director’s Report. 6. Study Topic: Economic Support Services Future. 7. Financial Report. 8. *Community Treatment Center Statistical Update. 9. *Bellin Hospital Statistical Update. 10. *Contract Update. 11. Other Matters. 12. Adjourn Business Meeting. *Note: The following are attached as written reports: 1. Community Treatment Center Statistical Update 2. Bellin Hospital Statistical Update 3. Contract Update Notices: Notice is hereby given that action by the Human Services Board may be taken on any of the items, which are described or listed in this agenda. Please take notice that additional members of the Board of Supervisors may attend this meeting of the Human Services Board, resulting in a majority or quorum of the Board of Supervisors. This may constitute a meeting of the Board of Supervisors for purposes of discussion and information gathering relative to this agenda. Any person wishing to attend the Human Services Board meeting who, because of a disability, requires special accommodations, should contact the Human Services Department at (920) 448-6006 by 4:30 p.m. on the day before the meeting so that arrangements can be made. Page 1
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BROWN COUNTY HUMAN SERVICES 111 N. Jefferson Street P.O. Box 22188 Green Bay, WI 54305-3600 Phone (920) 448-6005 Fax (920) 448-6126 Brian Shoup, Executive Director
U>Human Services Board>2010>Agendas>20111208 Mtg. Agenda for Board.doc
MEETING OF THE HUMAN SERVICES BOARD Thursday, December 8, 2011
SOPHIE BEAUMONT BUILDING, BOARD ROOM A
111 NORTH JEFFERSON, GREEN BAY, WI 54311 5:15 P.M.
AGENDA
1. Call Meeting to Order. 2. Approve/Modify Agenda. 3. Approve Minutes of November 10, 2011 Human Services Board Meeting. 4. Review and Comments of Brown County’s 2012 s.85.21Specialiized Transportation Application. 5. Executive Director’s Report. 6. Study Topic: Economic Support Services Future. 7. Financial Report. 8. *Community Treatment Center Statistical Update. 9. *Bellin Hospital Statistical Update. 10. *Contract Update. 11. Other Matters. 12. Adjourn Business Meeting.
*Note: The following are attached as written reports:
1. Community Treatment Center Statistical Update 2. Bellin Hospital Statistical Update 3. Contract Update
Notices: Notice is hereby given that action by the Human Services Board may be taken on any of the items, which are described or listed in this agenda. Please take notice that additional members of the Board of Supervisors may attend this meeting of the Human Services Board, resulting in a majority or quorum of the Board of Supervisors. This may constitute a meeting of the Board of Supervisors for purposes of discussion and information gathering relative to this agenda. Any person wishing to attend the Human Services Board meeting who, because of a disability, requires special accommodations, should contact the Human Services Department at (920) 448-6006 by 4:30 p.m. on the day before the meeting so that arrangements can be made.
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Page 1 of 6 U>Human Services Board>2011>Minutes>20111110 Minutes.doc
PROCEEDINGS OF THE BROWN COUNTY HUMAN SERVICES BOARD
Pursuant to Section 19.84 Wis. Stats, a regular meeting of the Brown County Human Services Board was held on Thursday, November 10, 2011 in Board Room A of the Sophie Beaumont Building – 111 North Jefferson Street, Green Bay, WI Present: Tom Lund-Chair, Paula Laundrie-Vice Chair Craig Huxford, Susan Hyland, Helen Smits, Carole Andrews,
JoAnn Graschberger Excused : Alison Draheim, Bill Clancy
Also Present: Brian Shoup, Executive Director Tim Schmitt, Budget and Finance Manager Jenny Hoffman, Economic Support Administrator Bonne DeBauche, Economic Support & Fraud Supervisor Robyn Gillis, Economic Support Supervisor & Trainer Kristy Warden, Economic Support Supervisor 1. Call Meeting to Order:
The meeting was called to order by Chair, Tom Lund at 5:17 pm.
2. Approve/Modify Agenda: ANDREWS/GRASCHBERGER moved to approve the agenda. The motion was passed unanimously.
3. Approve Minutes of October 13, 2011 Human Services Board Meeting:
GRASCHBERGER/HYLAND moved to approve the minutes dated October 13, 2011. The motion was passed unanimously.
6. Executive Director’s Report:
• Shoup reported that all of the Human Services proposed restructuring moves were approved.
o Shoup said that we were most concerned about the restructuring changes, as this was a package deal and we were happy to see that they were adopted unanimously.
• Maintained the executive cuts however, money was put back into the Teen Pregnancy program.
• Brian thanked the committee for their support early again, especially in the area of Child Protection Services.
Projects / System Changes • Electronic Medical Records (EMR) Phase 1 is on schedule. Phase 1 should be
completed mid December 2011. Phase 2 includes converting all our files into digital files which will take a good share of 2012 and then Phase 3 will be the conversion of files located at the Sophie Beaumont building.
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Brown County Human Services Board Meeting Minutes from November 10, 2011
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• Children’s Waiver is in the middle of changing over to third party billing. This is a significant project and will include training for our employees and our vendors. We are working closely with our vendors to ensure this transition is smooth for all of those involved.
Restructuring Moves: • We will be adding a total of 5 additional positions to Child Protection Services.
This will be done through cost shifting and transferring positions.
• The 2012 budget creates a new child/adolescent 4-clinician behavioral health unit led by a licensed psychologist. This is also funded through cost shifting.
• We will be restructuring our nursing staff at the Community Treatment Center (CTC) to include Charge Nurses.
o Several of the nurses we currently have will be leaving for attrition/retiring. We are expecting the remaining nurses will be able to be converted into Charge Nurses at the beginning of the new year. Shoup said that it is to our advantage to find a way to place the existing nurses we have employed in the Charge Nurse roles, as they are experienced with CTC. However, Shoup said that Human Resources has said that we will have to post for the Charge Nurse positions now, because the current contracts require posting the positions immediately, rather than waiting until our desired time beginning January 1, 2012.
o Shoup said that there could be arguments made for both sides (waiting to post or posting immediately). He said that we are disappointed that we cannot work this out to provide the best care for our clients and also give our existing nurses the opportunities to fill these positions, as they have are the most experienced.
• Shoup expressed the importance of these changes because they are critical to help us provide the best care for our clients, which is our ultimate mission.
Q: Citizen board member Smits asked if some of the current nurses will be placed
in these leadership roles. A: Shoup said yes, that is our intention. In fact we are adding 3 more nurses to this
system. Q: Citizen board member Smits asked if utilizing this EMR system would allow us to
eventually free up more of the doctors time. A: Shoup said yes. Although initially there will be some time associated with a
learning curve, but eventually in the end, the doctors will have more time because there will be efficiencies provided by the EMR.
• Shoup reported that next year (sometime in 2012), the State is going to convert
into using third party billing for the Birth to Three services. We do not know any specifics or details associated with the conversion, but we are expecting the change for next year.
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• Shoup said that we are still interested in pursuing the possibility to restructure some areas of the CTC. We are looking into the possibility of converting some our hospital beds into diversion beds. By doing so, we will be eligible for Medicaid reimbursement.
o Brian said it is very possible that roughly half of our admissions could be managed in residential beds (within the CTC building) but not be hospital patients. And we would be allowed to get reimbursement from an area that falls under crisis, which would help bring more revenue in at the CTC facility.
Q: Chairman Lund asked with Family Care not moving forward, how the employees
are handling it and how are their attitudes toward not moving forward. He said that some staff would have been transitioned into a different role with Family Care and now we are not even sure it will roll out at all.
A: Shoup said that our employees are focused on doing their jobs in Community Options Program (COP) and Community Integration Program (CIP). He said that the morale is pretty high within these two groups. We made an investment in this year’s budget with COP and CIP because we no longer know how long (or if) it will be before Family Care will roll out. Right now, we are focused on providing the best care we can with our waiver programs.
LAUNDRIE/SMITS moved to receive and place on file.
Motion was carried unanimously. 7. Study Topic: Economic Support Services Future:
The second presentation regarding Economic Support Services Future was given by Jenny Hoffman (Economic Support Administrator), Bonnie DeBauche (Economic Support & Fraud Supervisor), Robyn Gills (Economic Support Supervisor & Trainer) and Kristy Warden (Economic Support Supervisor). The complete PowerPoint has been included with these minutes. Please refer to the slides for more detail.
Questions/Discussion Q: Vice Chair Laundrie asked what happens when you find out there is welfare
fraud. A: Bonnie said that if it is a large amount, we will refer the case to the District
Attorney’s office. We meet with them once a month and go over pending cases. If fraud is occurring, then they can be (and are in some cases) charged criminally. In some cases, jail time or probation is sentenced and/or they are ordered to pay back the amount. Bonnie said the District Attorney is very involved with the fraud cases and charges them rather quickly. Chairman Lund Tom said he thinks that these types of prosecutions will start to be processed quicker than non-violent crimes. It is in our best interested to get through these cases quickly and efficiently. He also said that he thinks we will see an increased in the cases judges decide to take off the docket and settle before a trial/hearing.
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Q: Chairman Lund asked if there is any further news or development regarding the State giving counties more money to invest in fraud investigations.
A: Shoup said that we asked the state to divert those resources to the county consortiums however, apparently from what we understand; the State is not interested in using those positions for fraud at the recipient level, rather focused on healthcare provider fraud.
Q: Vice Chair Laundrie asked (regarding the various programs we offer) what do
you look for when people are applying for our services, what makes them qualified to receive help?
A: Robyn Gillis said there is a computer program that asks a series of questions to help determine eligibility. Some of the questions are regarding citizenship, identity, residency, income/unearned income, rent, mortgage, expenses. She said that these questions and the determination of eligibility is standardized state wide, ensure the same questions are asked.
Bay Lake Consortium Shoup said there have been a lot of negotiations with the State and we are still working on developing the best system for our consortium and our clients. Brian said that our consortium, Bay Lake, was instrumental turning these conversations with the State into true negotiations rather than simply giving the State feedback. We have been able to influence and negotiate this contract process to help make this function efficiently. Brian said that Andy Olson has been working with contract details and really been supporting our efforts and standing firm with the State to ensure the contracts are written effectively and properly. Jenny Hoffman said that overall, we have a great relationship with the other managers and supervisors within our consortium. There is a lot of discussion and decision making that is continuing to move us forward. We had an In Service (training even) scheduled for this week that will include all the workers within our consortium. They were able to collectively build a team effort and understanding and it gave them a chance to come together and ask questions and learn what will be happening in the future. It was very successful and many of the staff asked if it would be possible to come together again as things move forward and changes occur.
ANDRES/HUXFORD moved to receive and place on file. Motion was carried unanimously.
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8. Financial Report Community Programs We continue to experience lower costs for alternative care including treatment foster homes and group homes. We are treating more children in lower cost in-home settings and/or settings that are less restrictive and less costly. We have also experienced lower personnel costs and fringe benefit costs ($550K) due to vacant positions not being filled and not paying the employer portion of Wisconsin Retirement for administrative employees. Our ES unit shows lower purchased services for Low Income Home Energy assistance (LIHEAP) ($100K). However, we will see an increase for this assistance in the final quarter of the year. We have a favorable variance of $175K in purchased services for our Adult Behavioral health unit as we treated fewer clients in higher cost out of county settings. We also have reduced purchased service costs in our L-T care unit ($1.6 million) due to higher realized attrition rates than budgeted in our CIP and COP units. Intergovernmetal revenues are lower by $1.9 million as we have lower expenses to claim. Our projected year-end surplus is approx. $500K as we expect lower attrition rates in our L-T care unit and have added 5 clients in high cost out of county care institutions in the 4th quarter of 2011 in our Adult BH unit.
Community Treatment Center As of September 31, 2011 the CTC financial statements show a loss of $167,425, this includes $385,077 of unfunded depreciation. When adjusting for the depreciation the CTC has a surplus of nearly $218K. While the number of out of County inpatient clients is down about 4/day, the Brown County clients are at budget and the increase in revenue of $324k from CTP off sets the loss of other County revenue. In the Nursing Home the increase of private pay revenue more than off sets the shortfall in Medicaid and Medicare income (194K). Overall as of 9/30/2011 revenues are nearly $61K over budget. On the expense side we are $153K under budget. Although salaries are over budget (133K) due to a large number of clients requiring one to one supervision earlier this year, our fringe benefits are under budget because the benefits on overtime hours are less than those on straight time ,as well as the elimination of the retirement credit for administrative staff. Chargebacks from other County departments were under budget by $115K, mainly due to a decrease in cost from Facilities. Medical expenses are also down (47K) due to a decrease in need for medical supplies. Our year-end projections are on budget and show a deficit of approx. $500K which is non-levy depreciation expense.
LAUNDRIE/ANDREWS moved to receive and place on file.
Motion was carried unanimously.
9. Community Treatment Center Statistical Update: Please refer to the packet which includes this information.
10. Bellin Hospital Statistical Update:
Please refer to the packet which includes this information.
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11. Contract Update: Please refer to the packet which includes this information.
12. Other Matters: Next Meeting: Thursday, December 8, 2011 5:15 p.m. – Sophie Beaumont Building, Board Room A Topic: Economic Support Services Future 13. Adjourn Business Meeting:
ANDREWS/HYLAND moved to adjourn; motion passed unanimously. Chairman Lund adjourned the meeting at 6:47 p.m.
Respectfully Submitted, Laura L. Chartier Recording Secretary
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Economic Support Services
11-10-11
∗ Department of Health Services (DHS) contracts with local County and tribal agencies to administer Economic Support (ES)Programs.
∗ Department of Children and Families (DCF) contracts with local County and tribal agencies to administer the WI Shares Child Care Program
∗ Brown County’s Economic Support unit determines eligibility for families, elderly and disabled
∗ Foodshare, Badgercare Plus, Medicaid, Child Care
∗ Fraud Investigations: 11/2/11∗ Total investigations: 161
∗ Citations & DA referrals: 32
∗ $805,000 in savings through 10/31/11
Statistics
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Future Processes
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∗ Governor proposed centralizing the administration of the FoodShare and Medical Assistance programs.
∗ Legislature adopted an alternative proposal.
∗ Under the new model, all counties other than Milwaukee County will be required, no later than October 1, 2011, to organize into no more than 10 multi-county consortia for the purposes of administering economic support programs.
2011 – 2013 State Biennial budget
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∗ Statewide: 10 consortia, MilES, and the Tribes
∗ Certified by DHS by October 31, 2011
∗ Start January 1, 2012
∗ DHS contracts with only lead agency
∗ Centralized functions to create efficiencies such as a statewide scanning unit and regional call centers
∗ Change in allocation methodology and funding levels
KEY ELEMENTS OF IM CONSORTIA
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∗ Continue high quality customer service at the local level while achieving administrative and cost efficiencies statewide to address the state’s difficult fiscal situation.
∗ Increased administrative efficiencies
∗ Continued local presence
∗ Standardization of service delivery
LEGISLATURE’S GOAL
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∗ Operate Call/Change Center
∗ Conduct application processing and eligibility determinations
∗ Provide ongoing case maintenance for participants of ES programs
∗ Provide on-site services at 1 location in each county at least
35 hours per week
∗ Provide fraud prevention & investigation services
CONSORTIUM FUNCTIONS
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∗ 37,000+ Cases
∗ Counties include:
∗ Brown, Door, Oconto, Marinette, Shawano
∗ Change & Information Center – 14 staff∗ Toll Free number
∗ Statewide Call Center Anywhere software
∗ Staffed in multiple counties
∗ 8 dedicated change center staff in Brown County
∗ Application Processing / Ongoing Case Maintenance∗ Processed in County of Residence
∗ 29 economic support workers in Brown County
∗ Caseloads – 700+
∗ Enrollment Services Center – Transition ∗ Single Individuals / Foodshare, Badgercare Core, Family Planning Services
∗ Total of 8,251 cases (5,297 in Brown County)
∗ 11/2011 – 3/31/12
BAY LAKE CONSORTIUM
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Questions?
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BROWN COUNTY COMMUNITY TREATMENT CENTER
NOVEMBER STATISTICS 2011
Year to Year to Year to Year to
Date Date Date Date
ADMISSIONS November 2011 2010 AVERAGE DAILY CENSUS November 2011 2010
Commitment - Drug 0 0 0 Nicolet Psychiatric Center 600 6855 7979
Court-Ordered Evaluation 0 0 0 TOTAL 600 6855 7979
Emergency Commitment- Alcohol 0 3 0
Emergency Detention - Drug 0 0 0
Emergency Detention - Mental Illness 64 934 1018 BED OCCUPANCY
Court Order Prelim. - Mental Illness 0 2 4 Nicolet Psychiatric Center (21 beds) 54% 55% 114%
Court Order Prelim. - Alcohol 0 11 10 TOTAL (37 Beds) 54% 55% 114%
Court Order for Final Hearing 0 2 1
Commitment - Mental Illness 0 0 1
Return from Conditional Release 12 134 169 DISCHARGES
Court Order Prelim. - Drug 0 0 4 Nicolet Psychiatric Center 121 1656 1727
Other 0 8 3 TOTAL 121 1656 1727
TOTAL 117 1667 1731
ADMISSIONS BY UNITS DISCHARGE DAYS
Nicolet Psychiatric Center 117 1667 1731 Nicolet Psychiatric Center 518 6867 7954
TOTAL 117 1667 1731 TOTAL 518 6867 7954
ADMISSIONS BY COUNTY AVERAGE LENGTH OF STAY
Brown 74 1142 1204 Nicolet Psychiatric Center 4 4 5
Door 4 41 44 TOTAL 4 4 5
Kewaunee 5 47 52
Oconto 8 98 66
Marinette 3 45 57 AVERAGE LENGTH OF STAY
Shawano 3 52 37 BY COUNTY
Waupaca 0 9 19 Brown 3 4 4
Menominee 0 25 22 Door 6 5 5
Outagamie 3 40 34 Kewaunee 2 4 4
Manitowoc 10 131 149 Oconto 5 4 5
Winnebago 0 1 7 Marinette 9 4 4
Other 7 36 40 Shawano 2 4 4
TOTAL 117 1667 1731 Waupaca 0 3 2
Menominee 0 4 4
NEW ADMISSIONS Outagamie 2 6 2
Nicolet Psychiatric Center 50 648 709 Manitowoc 8 5 7
TOTAL 50 648 709 Winnebago 0 0 12
Other 2 2 7
TOTAL 4 4 5
READMIT WITHIN 30 DAYS
Nicolet Psychiatric Center 23 298 302 IN/OUTS Current YTD 2010
TOTAL 23 298 302 14 185 164 Page 54
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Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
NU
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NOVEMBER
BROWN CO. VS. OUT-OF-COUNTY ADMISSIONS- OCTOBER, 2011NICOLET PSYCHIATRIC CENTER
Out-of-County Brown County
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December 5, 2011 Brian Shoup Director of Community Services Brown County Human Services 111 N. Jefferson St P O Box 22188 Green Bay WI 54305-2188 Dear Mr. Shoup: Thank you for agreeing to present this information to the Brown County Board of Supervisors. I have attached an Excel spreadsheet that shows the daily census in the Adolescent Unit per addendum to the memorandum of understanding. Bellin Psychiatric Center did not transfer any involuntary adolescents to other institutions, nor were any admissions refused in the month of November. If you have any questions or concerns, please do not hesitate to contact me. Sincerely, Sharla Baenen, RN MSN President of Bellin Psychiatric Center
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BROWN COUNTY ADOLESCENT CENSUS
NOVEMBER 2011 Sunday Monday Tuesday Wed Thurs Friday Sat
Day 1 - 5 1-Nov 2-Nov 3-Nov 4-Nov 5-NovOther 3 3 3 5 5Brown County Voluntary 0 1 1 1 0Brown County Involuntary 0 0 0 1 1Total 0 Total 4 Total 4 Total 7 Total 6 Total
Day 6 - 12 6-Nov 7-Nov 8-Nov 9-Nov 10-Nov 11-Nov 12-NovOther 6 9 7 6 8 5 4Brown County Voluntary 0 0 0 0 0 0 0Brown County Involuntary 2 2 3 4 3 5 4Total 8 Total 11 Total 10 Total 10 Total 11 Total 10 Total 8 Total
Day 13 - 19 13-Nov 14-Nov 15-Nov 16-Nov 17-Nov 18-Nov 19-NovOther 5 5 2 3 4 4 7Brown County Voluntary 1 2 3 3 3 3 0Brown County Involuntary 4 6 5 3 3 1 1Total 10 Total 13 Total 10 Total 9 Total 10 Total 8 Total 8 Total
Day 20 -26 20-Nov 21-Nov 22-Nov 23-Nov 24-Nov 25-Nov 26-NovOther 7 8 6 3 3 3 2Brown County Voluntary 0 1 1 0 0 0 0Brown County Involuntary 2 2 2 2 0 1 1Total 9 Total 11 Total 9 Total 5 Total 3 Total 4 Total 3 Total
Day 27 - 30 27-Nov 28-Nov 29-Nov 30-NovOther 2 4 4 4Brown County Voluntary 0 0 1 1Brown County Involuntary 2 3 4 4Total 4 Total 7 Total 9 Total 9 Total
