RETAINED COUNTY AUTHORITY (RCA) COMMITTEE OF LANGLADE, LINCOLN, AND MARATHON COUNTIES

Transcription

1 RETAINED COUNTY AUTHORITY (RCA) COMMITTEE OF LANGLADE, LINCOLN, AND MARATHON COUNTIES AGENDA Date & Time of Meeting: Thursday, May 25, 2017, 2:30 p.m. Meeting Location: Marathon County Courthouse, Assembly Room B-105, 500 Forest St, Wausau In addition to attendance in person at the location described above, Board members and the public are invited to attend by telephone conference. Persons wishing to attend the meeting by phone should contact Marathon County Administration at , 24 hours prior to the start time of the meeting for further instructions. Committee Members: Lance Leonhard, Chair (Marathon County), Robin Stowe (Langlade County), Nancy Bergstrom (Lincoln County), Chad Billeb (Marathon County) 1. Call the Retained County Authority (RCA) Committee Meeting to Order 2. Approval of the April 27, 2017 RCA Minutes 3. Approval of the May 12, 2017 RCA Minutes 4. Approval of the May 19, 2017 RCA Minutes 5. Educational Presentations/Outcome Monitoring Reports None. 6. Policy Issue Discussion and Possible Committee Action A North Central Health Care (NCHC) Budget Priorities and Guidelines 7. Next Meeting Time, Location and Agenda Items: A. Discussion of Future Agenda Items and Meeting Times B. Next Meeting: Friday, June 9, 2017 at 9:00 a.m.at Marathon County Courthouse C. Announcements 8. Adjournment of the RCA Committee meeting Any person planning to attend this meeting who needs some type of special accommodation in order to participate should call the Marathon County Clerk s Office at or e mail infomarathon@mail.marathon.co.wi.us one business day before the meeting. SIGNED /s/ Lance Leonhard Presiding Officer or Designee FAED TO: Wausau Daily Herald, City Pages, NOTICE POSTED AT COURTHOUSE FAED TO: and Other Media Groups FAED BY: M. Palmer BY: M. Palmer FAED DATE: DATE: FAED TIME: TIME:

2 JOINT MEETING OF THE RETAINED COUNTY BOARD AUTHORITY COMMITTEE (RCA) OF LANGLADE, LINCOLN and MARATHON COUNTIES AND THE NORTH CENTRAL HEALTH CARE EECUTIVE COMMITTEE MINUTES Thursday, April 27, :30 p.m. Marathon County Courthouse Assembly Room (B-105), 500 Forest Street, Wausau Attendance: Present Absent Nancy Bergstrom Chad Billeb Lance Leonhard Robin Stowe Also Present: Brad Karger, Michael Loy, Jean Burgener, Bob Weaver, Jeff Zriny, Kurt Gibbs, Sue Matis, Rick Seefeldt 1. Call Joint Meeting of the RCA and the North Central Health Care (NCHC) Executive Committee to Order Meetings were called to order by RCA Chair Lance Leonhard and NCHC Executive Committee Chair Jeff Zriny at 2:35 p.m. 2. Policy Issue Discussion and Possible Committee Action A. NCHC CEO (Chief Executive Officer) Selection Plan and Time Table The discussion was held jointly with members of the NCHC Executive Committee (Jeff Zriny, Bob Weaver and Robin Stowe) Robin Stowe opened the conversation by indicating that our governance would be stronger and NCHC will have more stability once we move beyond an Interim CEO and have a CEO in place. Others supported the notion that there is benefit to policy-makers to be planning with the person that will be responsible for implementation. All committee members and the Executive Committee members of NCHC expressed high regard for the work of Michael Loy as Interim CEO. All indicated that Michael had met and exceeded all performance expectations. Jeff Zriny went further to say that Michael demonstrated outstanding business acumen and made tough decisions during difficult times. Jeff continued by saying that Michael had recently earned his MBA and in Jeff s mind has all the qualifications/characteristics needed to succeed as NCHC CEO. The Tri-County Agreement calls for an open recruitment process. Lance Leonhard indicated that it is important that the contractual process be followed. Jeff Zriny agreed that due diligence required us to see what is available in the labor market and make a business decision with an eye toward the long term. Jeff added that NCHC functions more like a business than do the member counties with bottom line accountability, but its decision-making processes are very much like that of a government organization. It will take a special person to bring those two worlds together. Witt-Keifer was paid $30,000 to initiate a selection process for a NCHC CEO. As an executive search firm they typically can help identify candidates who are not actively seeking a change, but with a little push might be willing to explore the right opportunity. The next step of the process is to update a job description that will serve as the basis for all subsequent selection steps. Jean Burgener questioned how a job description can be developed

3 with uncertainty about the future of the Marathon County Nursing Home. Bob Weaver wondered if a state-wide recruitment might be preferable to a nation-wide search because of the variance of how mental health services are delivered among the states. Brad Karger suggested surveying the most comparable Wisconsin Counties to obtain: Job Descriptions Salary Information Executive Contacts Scope of Prior Recruiting Efforts Whether a Search firm was Utilized No action was taken. Brad Karger and Sue Matis were asked to work together and put together some information and ideas about how the selection process might be organized. The two committees (RCA and NCHC Executive Committee) will meet again on May 25, 2017 at 2:30 p.m. to discuss again the recruitment process for the NCHC CEO position. 3. Adjournment of the North Central Health Care Executive Committee meeting 4. Approval of the March 21, 2017 Minutes MOTION BY BERGSTROM; SECOND BY BILLEB TO APPROVE THE MINUTES OF THE MARCH 21, 2017 MEETING. MOTION CARRIED. 5. Educational Presentations/Outcome Monitoring Reports A. Mount View Care Center (MVCC) Operational Analysis and Strategic Plan Development - Timing of a Decision on a Management Agreement with NCHC Brad Karger described good progress in the forming of a Marathon County Committee to govern the Marathon County Nursing Home. The new committee is chaired by John Robinson and has started meeting monthly. Additionally, Clifton, Larson, Allen (CLA) has been retained to do an operational analysis and help officials build a strategic plan for Mount View Care Center. Regular updates were requested. B. Marathon County Health and Human Services Committee Review of Aquatic Therapy and Funding Brad Karger described the work of the County s health and Human Services Committee in gathering facts and public opinion about aquatic therapy. It is expected that the Marathon County Board will be asked to approve an initial borrowing authorization resolution at their June meeting. Sometime later, probably September, the County Board will be asked to approve a borrowing authorization resolution which will require a super majority. If the borrowing is not approved, plans will be created to de-commission the aquatic therapy pool. Regular updates were requested. C. Tri-County Agreement Conflict Resolution Protocol This item was not discussed. None. 2

4 D. Case Management Plans for Involuntary Participants in Community Programs Committee members stressed the importance that case management for involuntary clients be implemented. Once developed and operational, the case managers will take significant pressure off the Crisis Center, which is currently responding to issues without the familiarity to the person that a case manager would have. Michael Loy agreed and said that the NCHC Management Team is researching practices in other counties and best practices. This is a high priority. A progress report may come as early as the May meeting. It was asked that this topic be added to the agenda of a May meeting. E. Presentations and Possible Acceptance of the Annual Financial Audit of NCHC Committee members reviewed the audit report prepared by Wipfli and had a few questions but no areas of major concern. Michael Loy was asked to prepare a Request for Proposal for next year s audit.. F. Application for Youth Crisis Stabilization Group Home Michael Loy described a plan to create a new eight bed youth crisis stabilization program: Serve youth locally and more economically. Cost can be covered by funds currently used to send youth to Winnebago for the same service State dollars might be available to offset some start-up costs Discussion followed on whether NCHC will automatically operate the new facility or contracting with a non-profit agency should be considered. Chad Billeb said a new facility needs to be operated trauma informed. Chad Billeb and Lance Leonhard will share this information with Marathon County s Health and Human Services Committee. G. Explanation of Upcoming Potential Program Creation or Modification Applications Committee members learned that NCHC will soon be bringing a request to create a new CBRF and expanding alcohol and drug inpatient treatment. The applications will be added to a future RCA agenda when received. 6. Next Meeting Time, Location, Agenda Items and Reports to the County Board A. Discussion of Future Agenda Items and Meeting Times B. Next Committee Meeting The next regular meeting is scheduled for Thursday, May 25, 2017 at 2:30 p.m. in the Assembly Room at the Marathon County Courthouse. Agenda items will include conflict management procedures and case management for involuntary clients C. Announcements: None 7. Adjournment MOTION BY BILLEB; SECOND BY STOWE TO ADJOURN THE MEETING. MOTION CARRIED. Minutes Prepared By Brad Karger 3

5 JOINT MEETING RETAINED COUNTY BOARD AUTHORITY COMMITTEE (RCA) OF LANGLADE, LINCOLN and MARATHON COUNTIES and NORTH CENTRAL HEALTH CARE EECUTIVE COMMITTEE MINUTES Friday, May 12, 2017, 9:00 a.m. Marathon County Courthouse, Employee Resources Conference Room, 500 Forest Street, Wausau Attendance: Present Absent Nancy Bergstrom Chad Billeb Lance Leonhard Robin Stowe Also Present: Brenda Glodowski, Laura Scudiere, Kurt Gibbs 1. Call meeting to Order Meeting was called to order at 9:00 a.m. 2. Policy Issue Discussion and Possible Committee Action A. Application for Youth Crisis Stabilization Group Home Committee reviews the discussion from last meeting and each of the two proposals from NCHC regarding institution of a Youth Crisis Stabilization Group Home. Leonhard explains that in further correspondence with NCHC CEO Loy, it was reiterated that each of the two models are predicted to be cost neutral for NCHC to operate based on anticipated savings to the members counties from related areas of operation (i.e., youth diversions to state institutions). Leonhard explains that Marathon County RCA committee members appeared before Marathon County Health and Human Services Committee and provided context of the NCHC request and the Marathon County RCA members position that given the program is anticipated to be cost neutral, and may in fact result in overall cost savings, it was the Marathon County RCA members intent to vote in favor of NCHC building the establishment of the group home into the 2018 NCHC budget. Stowe raised the idea that perhaps this program may lead to future discussions between the member counties regarding the prospect for increased cooperation on the issue of high cost outof-home placement resources for children in our respective social service systems. MOTION BY LEONHARD; SECOND BY BERGSTROM TO APPROVE NCHC TO MOVE FORWARD WITH BUILDING THE DEVELOPMENT AND IMPLEMENTATION OF AN EIGHT (8) BED YOUTH CRISIS STABILIZATION GROUP HOME INTO THE 2018 NCHC BUDGET. MOTION CARRIED. NCHC to continue its budget preparation process, continue to pursue potential funding through the State of Wisconsin, and determine potential cost of privately contracting for this service. B. Notification and Application for the substantial modification of the Community Treatment Program 1. Proposed staffing model for Comprehensive Community Services (CCS)

6 Scudiere and Glodowski provide additional information regarding the cost recovery (billing) potential for the CCS program, explaining that the reimbursement for this program is quite good and that the staffing model proposed to the RCA would allow NCHC to remain flexible to respond to demand for the program while also representing a cost neutral staffing model. Glodowski explained that the key to the program is that individuals that are eligible for Medical Assistance (MA) are enrolled. In response to Leonhard s question as to whether the reimbursement received through MA covered the true cost of the program (i.e., proportional share of overhead and indirect service expenses), Glodowski expressed that the reimbursement does in fact cover the true cost of delivering the program, including transportation or travel time. Scudiere explained that currently NCHC is unable to satisfy its desired access wait period of 60 days; however, it is anticipated that with implementation of the proposed staffing model, it would be able to do so. Bergstrom expressed that this expansion is directly related to the Case Management concerns that the RCA has repeatedly expressed to NCHC. MOTION BY BERGSTROM; SECOND BY STOWE TO APPROVE THE PROPOSED STAFFING MODEL WITH REGARD TO NCHC S DELIVER OF THE CCS PROGRAM. MOTION CARRIED. NCHC to move forward with implementation of the staffing model. C. Presentation and Possible Acceptance of the Annual Financial Audit of NCHC All members of the RCA Committee had been provided with the 2016 annual audit. Glodowski provided an overview of the following areas that had been identified as areas of potential high risk within the audit: - Accounts Receivable This area is of focus because of significant estimates that must be made throughout the year in numerous programs. Moreover, within each of the programs there is often significant variance regarding reimbursement. Glodowski also explained that NCHC is making strides in improving days in account receivable, which had experienced a significant increase due to changes in billing software and practices at NCHC; however, Glodowski explained that those issues have been rectified and - Self-insured health insurance Glodowski explained that NCHC experienced a significant increase in costs in this area in 2016; however, it continues to work with a consultant to minimize costs and it has instituted several changes, including adjustments co-pays and out-of-pocket expenses, and the introduction of health savings accounts, in an attempt to limit risk and control cost. - GASB 68 adjustment This is an adjustment through the State related to the retirement fund risk that must be carried on the NCHC books. This is nothing within the direct control of NCHC, rather it is simply an annual adjustment. Glodowski explains that following comments from NCCSP Board, NCHC has collateralized funds within its accounts. She further explains that NCHC s write-off rate is below the industry average due to their extensive efforts at seeking out payment. MOTION BY BILLEB; SECOND BY STOWE TO ACCEPT THE NCHC FINANCIAL AUDIT. MOTION CARRIED. No follow through requested. 3. Next Meeting Time, Location and Agenda Items: A. Discussion of Future Agenda Items and Meeting Times 1. Upcoming time deadlines under the Tri-County Agreement and potential need for special

7 meetings Based on the upcoming deadlines for the RCA (i.e., June 1 submission of Budget Guidelines and Priorities; July 1 submission of Performance Standards), the committee elected to schedule the following additional meetings to discuss the topics listed: - May 19 at 9:00 am Anticipated topics of discussion: (1) Review of RFP for 2017 NCHC Audit, (2) the form of discussion regarding budget priorities and guidelines, and (3) explanation of progress on gathering information relevant to planning for CEO recruitment. - May 25 at 2:30 pm - June 9 at 9:00 am - June 21 at 9:00 am 2. Approval of the Minutes for the April 27, 2017, meeting will be addressed at the next meeting B. Next Meeting Friday, May 19, 2017, at 9:00 a.m. in the Marathon County Courthouse Employee Resources Conference Room at 500 Forest St., Wausau, WI C. Announcements - None 4. Adjournment of the RCA Committee meeting MOTION BY STOWE; SECOND BY BILLEB TO ADJOURN THE MEETING. MOTION CARRIED. Meeting adjourned at 10:20 a.m. Minutes Prepared By Lance Leonhard On May 12, 2017

8 RETAINED COUNTY BOARD AUTHORITY COMMITTEE (RCA) OF LANGLADE, LINCOLN and MARATHON COUNTIES MINUTES Friday, May 19, 2017, 9:00 a.m. Marathon County Courthouse, Employee Resources Conference Room, 500 Forest Street, Wausau Attendance: Present Absent Nancy Bergstrom Chad Billeb Lance Leonhard Robin Stowe Also Present: Brenda Glodowski, Laura Scudiere, Sue Matis, Michael Loy, Brad Karger 1. Call meeting to Order Meeting was called to order at 9:02 a.m. 2. Policy Issue Discussion and Possible Committee Action A. Review and Approval of the NCHC request for proposal for the 2017 Annual Financial Audit of NCHC Brenda Glodowski reviews the time frame necessary for the completion of the auditor, expressing that in order to provide the auditor with sufficient time to fully examine the organization and its finances, the selection process needs to proceed relatively quickly. Committee members review the Request for Proposal that has been prepared by NCHC and discuss the level of involvement they would like to have in the interview process. Ultimately, the Committee expresses a general sentiment that it would like to be apprised of the process as it proceeds and be provided by NCHC with the metric by which NCHC ranks the top several responses to the RFP, and have the opportunity to provide questions to NCHC to ask of the vendors during any interviews that are conducted. MOTION BY STOWE; SECOND BY BERGSTROM TO APPROVE THE REQUEST FOR PROPOSAL AS PRESENTED FOR ISSUANCE. MOTION CARRIED. None. B. Discussion of form and process for provision of Budget Guidelines and Budget Priorities to NCHC Committee expresses consensus that budget priorities are best viewed as initiatives that the respective member counties desire NCHC to move forward in the coming year. While budget guidelines are principles that the Committee is asking NCHC to adhere to as it builds its 2018 budget. Ultimately, the Committee expresses consensus that the priority identification process will involve the formation of a large list of new initiatives and the ranking of those initiatives by the Committee. At this time, the Committee has identified the following potential budget priorities for consideration and ranking at the next meeting: 1) Improved Case Management Services for individuals under commitments and settlement agreements 2) Open an 8-Bed Youth Crisis Stabilization Group Home 3) Expand the Medically Monitored Treatment (MMT) Program from 5 to 15 beds 4) Expand the Community Based Rehabilitation Facility (CBRF) Program from 6 to 12 beds 5) Eliminate billing for Crisis Services 6) Increased face-to-face crisis worker contact with law enforcement (Behavioral Health Unit)

9 7) Partnerships to Create CBRF services in each of the member counties 8) Dedication of resources to expanding ability to share information with other stakeholders/partners 9) Improved Court Liaison services With regard to budget guidelines, the following items were identified: 1) Separate levy allocations specifically per program and make separate requests for each program to the three Counties versus one bundled levy request 2) Develop a multi-year forecast as part of the budget Committee members will have the opportunity to bring additional priorities and guidelines to the next meeting. None None C. Update on CEO Recruitment information gathering process Marathon County Administrator Brad Karger and NCHC Interim HR Director Sue Matis explain that they have obtained and reviewed the job description that was previously prepared for the NCHC CEO position and they are in the process of editing the positon description to capture the discussions that were had at the joint meeting of this Committee and the NCHC Executive Committee. Karger and Matis express that one of the next steps will be researching the compensation structures for similar positions in comparable counties. Stowe expresses that some of the NCHC Executive Committee questioned why this item was on the Committee s agenda, as opposed to an update being provided in a joint meeting with the NCHC Executive Committee. Chair Leonhard expressed that the intent of doing so was simply to keep the Committee apprised of the ongoing efforts by Karger and Matis toward developing a job description. All Committee members recognized that pursuant to the tri-county agreement, this Committee s involvement is in the joint planning of the recruitment and that the NCCSP Board is responsible for executing the recruitment process. Both the NCCSP Board and the RCA are each tasked to assessing the candidates for the position and making a recommendation for hiring to the County Boards. None None 3. Next Meeting Time, Location and Agenda Items: A. Discussion of Future Agenda Items and Meeting Times 1. Approval of the Minutes for the April 27, 2017, May 12, and May 19 meeting will be addressed at the May 25 meeting B. Next Meeting Thursday, May 25, 2017, at 2:30 pm in the Marathon County Courthouse C. Announcements - None 4. Adjournment of the RCA Committee meeting MOTION BY BILLEB; SECOND BY STOWE TO ADJOURN THE MEETING. MOTION CARRIED. Meeting adjourned at 10:20 a.m. Minutes Prepared By Lance Leonhard On May 23, 2017

10 MEMORANDUM DATE: May 19, 2017 TO: North Central Community Services Program Board (NCCSP) FROM: Michael Loy, Interim Chief Executive Officer RE: Overview of 2018 Budget Priorities Background The new Tri-County Agreement requires the Retained County Authority to provide budget guidelines and priorities to the NCCSP Board prior to the development of each year s budget by June 1 st. The RCA is slated to approve these budget guidelines and priorities officially at their May 25, 2017 meeting following the May NCCSP Board meeting. The following is a working analysis of guidelines and priorities stated thus far. These fall in no specific prioritized order ranked by the RCA; however, the intention is the RCA will approve both the list and order of the guidelines and priorities. Budget Guidelines Present a formal proposed budget document in a similar format to the 2017 budget document with the following key elements included: 1) Clearly distinguish the definition and application of shared versus direct budgeting decisions as they are applied to each program. 2) Separate levy allocations per program and make itemized levy requests for each program to the three Counties versus one bundled levy request. Counties would incorporate this itemization within their own budgets to reflect this detail as well. 3) Develop a multi-year forecast for programs as part of the budget. Budget Priorities Present a Budget that includes the following priorities for community services programs in addition to a maintenance of effort in all other programs under the jurisdiction of the Retained County Authority Committee: Program Initiative Description Emergency & Crisis Services Develop case management services within the crisis services program for individuals under commitments and settlement agreements and also include broader coordination of the court liaison function The intended result in the development of this service expansion is that individuals not already case managed through the voluntary Comprehensive Community Services program would be assigned a case manager who would coordinate their care and the dynamics within their commitment or settlement agreement. Emergency & Crisis Services Open an 8-Bed Youth Crisis Stabilization Group Home The Youth Crisis Stabilization Group Home would serve adolescents age who reside in Langlade, Lincoln and Marathon Counties. The objective of this service is to ensure safe and healthy

11 Behavioral Health Services Behavioral Health Services Emergency & Crisis Services Emergency & Crisis Services Behavioral Health Services Expand the Medically Monitored Treatment (MMT) Program from 6 to 15 beds Expand the Community Based Rehabilitation Facility (CBRF) Program from 6 to 12 beds Eliminate billing for Crisis Services Creation of a behavioral health team Langlade County Research the scope and potential for the creation of a local voluntary acute crisis stabilization and/or detoxification beds with the local hospital healing spaces for adolescents during times of crisis, by offering longer term placements (up to 5 days, per statutory guidance, and not exceeding 15 days after an additional assessment) in a less restrictive and appropriate setting to the individual s needs. Please refer to the program application approved by the RCA for additional detail. NCHC currently operates a 6-bed MMT 21-day residential program with a significant waiting list of individuals wanting inpatient treatment for their addiction. The expansion would necessitate relocation of the program and additional staff to reach the 15-bed target. Space on the NCHC campus has been identified for this purpose. The expansion of the MMT program would allow the 6-bed CBRF program to expand to 12-beds within its current space with some additional staff required. This program would be expanded to alleviate the need for some inpatient detentions and would also serve as a step down program from the inpatient hospital. Currently Crisis assessments are billed to the patient or guardian of an individual in crisis. Community partners have expressed a desire to avoid the billing function and to provide Crisis assessment without a charge being generated as a community service to increase utilization of services. This is an evidence based program other governmental agencies have implemented as means to avoid hospitalization and to better serve the needs of individuals out in the community. It will be initially piloted with the Wausau PD and the Marathon County Sherriff s department. Essentially, it would pair an officer and crisis worker from NCHC as partners to respond to behavioral health calls and perform followup and preventative work in the community. Langlade County would like to develop more local acute treatment options as an alternative to transportation to NCHC s main campus to better serve the community s needs. This may include expanded face to face resources for crisis services.

12 The aforementioned priorities for the 2018 Budget do not include priorities for single county programs such as the Aquatic Therapy pool or Mount View Care Center. These will be handled through direct discussion with individual County representatives as in years past.