Office of County Administrator
Memo To: La Crosse County Board of Supervisors
From: Steve O’Malley, County Administrator
Date: July 1, 2009
Re: July Monthly Report to the County Board
Attached is the July Monthly Report to the County Board, providing monitoring information about department activities to the full County Board instead of reporting only to governing committees.
REMINDER Monthly Reporting by roughly half the organization every other month. While you will receive this report each month, the reports do not cover every department each time.
State Budget Approved
With the approval of the State Budget by the Governor this week, Wisconsin becomes one of the few states in the nation to adopt their budget in time for the beginning of the July 1, 2009 to June 30, 2011 biennium. Of the 46 states whose fiscal year ends July 1st, 32 did not have budgets passed and approved by their governors as of Monday afternoon, according to the National Conference of State Legislatures.
While the impact of cuts to Wisconsin Counties is significant, the situation could have been much worse. La Crosse County will be able to meet the challenges ahead for the 2010 and 2011 budgets and I look forward to presenting options for the County Board to consider in the coming months.
Jail Medical Review
The Jail medical provider Health Professionals Ltd. (HPL) recently completed their review of the report by the National Commission on Correctional Health Care (NCCHC). HPL’s written response report will be provided to the Judiciary & Law Committee and the members of the County Board by next week. A review and discussion of recommendations to improve the medical care of inmates at the County Jail will be an agenda item at the next Judiciary & Law Committee meeting Tuesday July 9, 2009, 2:30 PM. Any County Board member is encouraged to attend. Andrew Walter, Regional Director of Operations for Health Professionals, Ltd will be attending the meeting to answer questions.
If you have any questions, feel free to contact me by phone or e-mail as soon as possible.
County Administrator direct line: 785-9789, cell phone 608-385-3316
or e-mail firstname.lastname@example.org
MONTHLY REPORT TO THE COUNTY BOARD
Aging & Long Term Care
Veterans Service Office
Lakeview Health Center
Person Directed Care
As consumers have become more “savvy” there is a movement in the long-term care industry towards person directed care. Person directed care is based on resident preferences and staff taking responsibility for the care and quality of life of a specific group of residents. Lakeview Health Center has begun our journey towards this type of care, by re-aligning our residents by level of need and assigning staff to a distinct group of residents via consistent assignment. We are now tackling the next step, which includes incorporating our work routines into the residents’ needs and wants. Person Directed Care is a whole new way of doing business and I will keep you posted on our progress.
Hillview Health Care Center
Carroll Heights Census has been good in June; we have just a couple open apartments. With the turnover to assisted living and to nursing homes it takes a month or so for a new tenant to move in.
The possibility of assisted living senior housing to complete our continuum of care on the Hillview Campus is still in process. We are meeting the architects and with our committee. The total cost for the project is not yet determined. A complete report and potential vote will be presented this fall to the county board.
Resident Satisfaction Survey Results -We are completed a 30 question resident satisfaction survey covering all aspects of the nursing home. Virtually all areas were above a 90% satisfaction rate, with a just few areas of at least 75% satisfaction rate. Some residents were unable to respond and/or do not make use of some services. On a related note the state’s volunteer ombudsman program has begun at Hillview, two volunteer ombudsman visit Hillview every week and their reports have been excellent regarding care and satisfaction.
Budget Nursing Home MA Rate Increases/Bed Tax Increases – In the state budget nursing homes did not get cut as much as other Medicaid providers. The Governor vetoed $1 million out of GPR annually in MA supplemental payments to county and municipal nursing homes in 2009-11. This resulted in an increase in those supplemental payments to county and municipal homes from the current $37.1 million level to $38.1 million over the next biennium. In addition, the Governor left in tact the $10.2 million increase in supplemental payments in 2008-09. The other major issues of interest to WAHSA members contained in Act 28 include: A doubling of the nursing home bed tax, from $75/bed/month to $150/bed/month in 2009-10 and $170/bed/month in 2010-11, to fund a 2% MA rate increase for nursing homes in each year of the biennium.
MONTHLY REPORT TO THE COUNTY BOARD
Health & Human Services
Human Services Department
Impact of the State budget on county human services programs:
In February, Governor Doyle came out with his biennial budget plan facing a $5.9 billion deficit. Since then, the budget deficit for the state grew to be over $6 billion over the next biennium. In the Governor’s proposed budget, there was an estimate of over $75 million to be cut in county human services programs. Due to the work of WCA and many of the counties, the Joint Finance Committee reduced these cuts to counties, primarily through the application of one time federal stimulus dollars to offset cuts in Income Maintenance and programs in Family and Children. The Department has attached the most recent analysis done through our Fiscal Unit to determine the cuts that are still in the budget proposals submitted by the legislature. The goal in preparing the 2010 budget for the Department is to find ways in which the Department can absorb these lost revenues and yet maintain required and expected services that have been offered in the community. For more information regarding the impact of the state budget on county human services programs, please feel free to contact Jerry Huber at 785-6094 or email@example.com.
Capacity and funding concerns within Behavioral Health in the county:
At the same time that the Department of Human Services is planning to address revenue cuts coming from the state, we are also faced with the realities of the current demand for services within our programs and the capacity to deliver these services. For this year, this concern is most relevant in several of our programs. Within the Clinical Section of the Department, the cost of providing psychiatric services to our customers has been a major issue over the past year. Due to the lack of availability of local psychiatrists, the Department has attempted to recruit a nurse practitioner who could prescribe medications. Our recruitment attempts have not resulted in any hires as of yet, and the Department is working with a national agency to assist us in finding an NP who, if hired, could reduce our cost in psychiatry over time. The county is also seeing a challenge in more clients being placed in residential or institutional settings than in past years, primarily due to challenging behaviors which prevent them from remaining in the community. The Department has been involved in examining all residential and institutional placements through Utilization Review Committees and intends to add to these review processes within the context of the Department’s Management Team (see attached).
The Department has also seen this year an increased in the number of juveniles placed outside of their parental homes. Many of these placements are in residential or institutional type settings due to the seriousness of the crimes that have been committed in the community. The vast majority of the cost of these placements comes from local tax levy and adds to the complexity of the budget process.
Badger Care Core (Childless Adult) expansion:
La Crosse County was chosen to highlight the kickoff of the new expansion of the Badger Care Core program for childless adults this past month. Secretary Timberlake from the Department of Health Services was in town to announce the program and showcase the work done by Lindsey Schwarz-Nichols in the Health Department, St. Clare Mission, Economic Support of La Crosse County, and others in the community who have marketed the program. The county has provided training for people to come in and use the county computers to apply for this program online. Although there are a number of bugs in the state online application system, it appears that many who are eligible are hearing about the program and applying online themselves or coming into the county. For more information regarding this program, please contact Lindsey Schwarz-Nichols in the Health Department at 785-5841 or firstname.lastname@example.org; or Lorie Graff in Economic Support at 785-6061 or email@example.com.
Planning for a Crisis Assessment Center in La Crosse:
The Department in the Fall of 2008 began to plan for the feasibility of creating a Crisis Assessment Center in La Crosse to respond to behavioral health crises occurring in the community. The rationale for the development of a Crisis Assessment Center was based on the following:
(1) The rate of emergency detentions under Chapter 51 of WI statutes for psychiatric emergencies in La Crosse is one of the highest in the state. Much of the cost of these detentions falls on local property taxes to pay for if insurance is not available.
(2) Both hospitals in La Crosse have struggled to maintain an array of behavioral health services in the community due to issues with reimbursement for services rendered. There has been a downsizing of inpatient psychiatric beds over the years putting the potential of more clients being brought to state institutions outside of the community which are paid almost entirely through the county.
(3) The Governor and Joint Finance have placed in the next biennial budget, the responsibility of counties to pay for the non-federal share of Medicaid for most placements in the state institutions for psychiatric patients. The Governor has proposed language and possible funding requiring law enforcement to work with county human services departments to divert unnecessary placement in the state institutions or hospital emergency rooms those who could have a mental health crisis responded to in less restrictive ways.
(4) The current approach to addressing psychiatric and substance abuse crises in the community is out of date and essentially unconstitutional in terms of the use of less restrictive options for services. This is based on the federal Olmstead Decision in 1998 and the Judy K. decision from the WI Supreme Court coming shortly after the federal ruling on using least restrictive services when available and appropriate.
The Department has issued out a Request for Interest (RFI) in June to potential organizations who would be interested in being part of a Crisis Assessment Center. The intention for this program is that it would be multi-collaborative with law enforcement, the hospitals, consumers, multiple agencies and the county all being partners in order to have this initiative become a successful model and meet with needs of the citizens of the county, including the taxpayers who pay for the services. The Department has attached a grid which outlines the recommendations coming from a multi-agency steering committee on key decisions that have to be made regarding the model for the center. This information was shared with over 70 people who attended the second focus group meeting for this initiative on June 18th. The Department intends to issue out a Request for Proposal (RFP) in late July or early August in regards to this project. If anyone has questions related to CARE (Crisis Assessment Recovery and Empowerment), please contact Melissa Gilbert, Project Coordinator, at 785-6093 or firstname.lastname@example.org.
Utilization Review of Extended Placement
by HS Management Team
a) a list of placement activity by type and daily cost over the past month and year to date
b) a brief history of placement and treatment history for all placements more restrictive than foster care
c) discharge or transition plans for returning children/adults to homes/ community and barriers from accomplishing the discharge planning
d) court related information pertaining to the placement
CARE Project – Crisis Center Decision Points
Crisis Assessment, Recovery and Empowerment
(Highlighted boxes indicate Steering Committee recommendations)
* Class A license indicates residents are able to respond to a fire alarm by exiting the CBRF without help or prompting.
Class C license indicates one or more residents are not physically or mentally capable of responding to a fire alarm by exiting
the CBRF without help or prompting.
Other Major Issues
Which adults can the center serve and who will the center refer elsewhere?
Who will operate the center?
What other services might be provided on-site?
How long can clients stay?
Where will the center(s) be located?
How many and what type of staff will be utilized?
How will clients be medically cleared for admission? How will a client be transported to the hospital if he/she needs medical treatment?
Mission: Improve the quality of life and health of all people in La Crosse County. The following five goals were approved by the La Crosse County Board and Health and Human Services Board for special emphasis in 2009. A summary of some of the activities completed over the last several months to accomplish these goals is included.
Goal 1: Provide Public Health Services to meet changing needs.
Goal 2: Utilize Technology to Improve Public Health Services
Goal 3: Maintain the Current State of Wisconsin Designation as the Highest Level Public Health Agency
Goal 4: Expand Partnerships to Develop Public Health Services in High Priority Areas
Goal 5: Hire and Retain High Quality Staff by Providing a Positive Work Environment
MONTHLY REPORT TO THE COUNTY BOARD
County Clerk’s Office
Spring Election Publication: I understand the election is old news by now, but in my last report I told you that I expected a significant reduction in the cost of the mandated publications due to my research and change from a retail publication to a legal notice. But I didn’t have the bill yet so could not give you an actual figure. I can tell you now that I saved the County almost $3000. The April 2007 publication was $3552 and the April 2009 publication was $600.25. There is little if any difference between the two elections. There were no referendums or anything that would increase the required size of the publication; in fact there was 1 less contest and 2 fewer candidates in 2007.
Early Voting: The Wisconsin Government Accountability Board/Elections Division is investigating early voting and will be hosting a “listening session” in La Crosse at the Public Library Auditorium on Main St. the afternoon of July 16, 2009 followed by a Clerk’s meeting from 3-5. Following this meeting I may request a resolution to oppose Early Voting due to the expected additional expense it will impose on both counties and municipalities. GAB estimates that Early Voting could cost the municipalities an additional $6500 per election and may also require the County to purchase voting equipment and possibly staff an early voting site.
It appears that the Domestic Parntership will become law with the signing of the Wisconsin budget under Section 770.07 and the Termination of the same under 770.12. If the law passes we are being given 31 days after publication to be prepared to process these declarations and terminations; that could be as early as the first week of August.. I will be requesting a resolution for the July cycle to establish fees in accordance with these statutes, which will be the same as the marriage license fees. I have no estimate at this time of how much revenue may be generated.
Marriage License and Domestic Partnership Waiver Fees
It also appears as though the Budget Bill will authorize an increase in waiver fees (to waive the 5 day waiting period) from $10 to $25 for both the Marriage License and the Domestic Partnership Declaration. I plan to suggest this increase be included in the 2010 budget. We issued 11 waivers in 2008 and 6 so far in 2009 so this will have an extremely minimal effect on my revenue.
The 2009-2010 County Directory of Public Officials is now printed and has been distributed. $682 will be transferred into our revenue account for the directories requested by County departments and $238 has been received from outside entities. We have about 100 directories available for sale over the counter. Updated directory information can be found on our web site at: http://www.co.la-crosse.wi.us/CoDirctry/CoDirctryIndex.htm
Voting Equipment: The team continues to investigate a more efficient and reliable voting system for the Board as well as the possibility of offering live streaming video of each meeting on our web site.
Approved Minutes: Committee Recorders are now providing us with their approved minutes for publication to the website, to replace the minutes published prior to approval. The new process has been working well.
Citations were sent out to 795 dog owners for 967 unlicensed and/or unvaccinated dogs. To date we have licensed or updated over 500 of those dogs. The owners have until 7/10/09 to contact us or be subject to the decision of the judge at Intake Court on 8/13/09 at 1:30 p.m.
Linda Stone, County Clerk
The beginning of June I sent out the reminder notices for the current taxes that are owed to the county on or before July 31st. The amount to be collected is 17,000,000.00. The delinquent taxes to collect for the years 2007 and back are $1,571,700.00 as of June 23rd.
La Crosse and Vernon County co-hosted the 2009 WACO Seminar at the Radisson Hotel, La Crosse and was a big success and everyone enjoyed them self’s and just love the La Crosse area.
See TAX Collections below.
MONTH/YEAR TAX INTEREST TOTAL
Jan-09 188,943.60 49,746.85 238,690.45
Feb-09 114,917.76 27,907.26 142,825.02
March-09 134,409.82 48,146.30 182,556.12
April-09 85,134.79 24,218.63 109,353.42
May-09 76,145.75 23,894.18 100,039.93
MONTH/YEAR TAX INTEREST TOTAL
Feb-09 307,303.69 2,967.34 310,271.03
March-09 583,683.22 11,946.90 595,630.12
April-09 303,123.45 7,345.52 310,468.97
May-09 300,489.60 7,272.73 307,762.33
Reported by Donna Hanson, County Treasurer
1. Collective Bargaining
SEIU – ARB AWARD for 2008-09 Local 150 - Hillview Briefs filed April 29, 2009 with Arbitrator Christopher Honeyman. Decision received June 29 – COUNTY FINAL OFFER AWARDED.
AFSCME – SETTLED for 2009-10 Local 2484 Paraprofessional Employees
Local 2484 Professional Employees
Local 1403 Lakeview Employees
Local 1151 Jailers
Local 227 Highway (settled for 2007-2009)
WPPA – SETTLED for 2009-10 - Telecommunicators Association
- Deputies Association – Resolution to May Cty Bd.
2. Bargaining Settlements
The Personnel Department has concluded collective bargaining for the 2009-2010 contracts, except Hillview and Highway which are set through 2009. We have just received the Arbitration decision in the Hillview case setting the terms for 2008-2009. For 2009 and 2010 (where settled) all of the bargaining settlements have followed the base pattern of 2%/1% wage splits January and July of each year and the addition of a 3 Tier Drug Formulary, requiring employee contribution of $10 for Generic drugs; $25 for Preferred Brands on the formulary; and $45 for non-preferred Brand Name drugs not on the formulary. Innoviant, the Pharmacy Benefit Manager (PBM) has a toll free hot line, as well as a personal prescription review plan for employees to get assistance with controlling drug costs. Lisa Wille, the County Benefit Coordinator also works with employees and Innoviant to work through any problems or concerns.
The wage settlement is very similar to settlements in our other comparable size counties in the state, which are also covered by the State Mediation/Arbitration law. Many counties are also establishing 3 tier drug formularies similar to La Crosse County’s. These changes should provide a significant savings for the County in the drug plan and encourage positive change in employee consumerism when purchasing drugs.
3. Health Insurance
We have been aggressively looking at changes in the way the County provides it’s health insurance program including HRA’s or HSA’s and other ways to encourage smart consumerism by employees. We have decided with Steve O’Malley’s direction to wait until we see what options or changes come from the National government. President Obama has indicated a desire to have a plan out before year end, so we are in a holding pattern until we know more.
4. Employee Training
Too frequently we throw new managers into a job without training or preparation. Bob, Mary and Diana have been working on the next round of New Manager training. We have built on a series of power point training modules from last fall. This training is a three meeting course to teach the County perspective on best management and supervision practices. In addition, the department is hosting a telephone conference for new or prospective supervisors to learn in preparation for future positions.
We will be collaborating with Jerry Huber and the Human Services department to build a larger network of training for Human Services supervisors. We are looking at potential partnering also with the School District, the City and WWTC through the current collaboration network if we can get a training course of materials defined.
Management training courses and accompanying tests will be available on the new Training & Learning Center (TLC) software for future reference by managers.
5. Process Improvement Project
The Hiring Process team has completed it’s work and made recommendations to the Personnel Dept for improvements which will simplify and speed up the hiring process. The team came up with some very good recommendations, many of which have already been implemented. One of the main suggestions is for new software which would computerize our application process and speed the screening of the many applications we receive each month. A request has been placed with IT for the 2010 budget for a modest amount. If we can purchase the software this would prepare the County for more modern approach to receipt of applications from people who have become computer savvy and familiar with electronic submissions
6. Record Numbers of Replacement positions
2009 is still seeing a record year for recruitments of new and replacement positions. The past record for a calendar year was
289 requests to fill a position in 2007 and
295 positions filled in 2001.
Through May 2009 LaVonne Johansen, Recruitment Coordinator has documented
135 requests to fill a position through May.
By year end the trend could take us to new records. Needless to say, each recruitment requires much effort in posting, drafting job descriptions and job ads, advertising, screening applications, scheduling interviews, physicals, tests and otherwise setting up the employee for County payroll and benefits by the Personnel Department staff.
Robert B. Taunt
County Personnel Director