Minutes

Long Term Support Planning Committee

NOVEMBER 19, 2007

Members Present: Robert Walerstein Mary Deluca

Lee Schlenvogt Jim Schendel

Ginger Ayres Ellen Zonka

Peter Duncan

Members Excused: Margaret Sheldon Katie Callen

Karen Nadolski Suzanne Brunner

Gail Bruss

Guests: Robert Haupt, Director, Ozaukee County Department of Human Services

Frank Peterson, LTS Division Co-Manager, Ozaukee County Human Services

Michelle Pike, Director, Aging and Disability Resource Center

Bob Walerstein called the meeting to order at 1:00 pm. Frank Peterson indicated proper meeting notice was given.

Frank Peterson indicated that as part of the recently passed State budget, new Medical Assistance rules go into effect in early 2008 regarding divestment of assets and calculating the divestment penalty. Wisconsin will then match the Federal rules that were changed in 2006.

Motion to approve the minutes of September 17, 2007 was made by Mary Deluca and seconded by Jim Schendel. Motion Carried / Approved.

Frank Peterson reported that we are on target with our COP spending.

In the COP-Waiver program it appears that we are overspent but this is what we want to have happen so that the county makes maximum use of its COP funds which supplement the COP-Waiver program services. The COP-Waiver spending is $880,465 (101% spent in 83% of the year).

CIP II spending is $810,074 year to date (67% spent in 83% of the year).

The CBRF spending for COP and COP-Waiver is $597,332 (89% spent in 83% of the year). CIP II spending in CBRF’s is $585,770 (56% in 83% of the year).

Frank reported that at the current time there are 4 individuals from the Physically Disabled list who are pending services. 14 additional persons with physical disabilities are on the waiting list. There are currently 7 elderly individuals also in "pending" status to be opened for services. An additional 37 elderly individuals are on the waiting list.

Michelle Pike announced that she has been named the ADRC director. The Committee reviewed policies the ADRC is establishing. Michelle provided a packet of draft policies and is seeking input before finalizing and submitting to the state by December 1, 2007.

Michelle indicated the ADRC will have the enhanced functions in place beginning January 2008.

There are two positions that will be filled in January, An Information and Assistance Specialist and the Physical Disabilities Benefit Specialist. Office space in the ADRC is still being addressed.

Now that the State Budget is passed, Ozaukee County is scheduled to begin Family Care implementation March1, 2008. Community Care is the care management organization that has been selected. Information was shared with the Committee about Community Care and the Family Care implementation timelines. A draft of the notice to go to current Waiver participants was reviewed by the Committee. The suggested changes will be incorporated into the letter Ozaukee County will submit for State approval.

Frank shared a chart showing the rates paid to Personal Care Workers in Milwaukee, Washington and Sheboygan Counties. Ozaukee County is the highest. Jim Schendel stated the need for a cost of living increase for workers in the fiscal agent program. These workers have not seen an increase in several years. Jim is concerned that in order to maintain quality workers, it is necessary to increase wages. Bo Haupt indicated that with the coming of Family Care we may receive a better contract rate for Personal Care. Currently we receive $15.84 per hour of personal care. We have reason to expect a rate about $17.00 per hour from Community Care for each hour of personal care. Jim Schendel asked if the workers would see a percentage of that increase. Frank indicates that is the intention of Human Services. No action taken at this time. Further action will depend on the County’s contract rate with Community Care.

None needed.

None indicated.

Next meeting is scheduled for Monday January 21, 2008 at 1:00pm.

Lee Schlenvogt moved to adjourn the meeting at 2:30pm. Seconded by Mary Deluca

Minutes Respectfully Submitted,

Frank Peterson, LTS Committee Liaison

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Plan Update Sub-Committee Called to Order by 2^nd Vice-Chairperson Haas at 6:30pm.

Members present:  David Haas, Glenda Madlom

Others Present:  Mary Fitzgerald

Members reviewed the Off-Site Emergency Response Plans for Ross-Wells, Inc. (Final Update), Grafton Water and Wastewater Treatment Plant, Thermoset Inc. (Final Update), Port Washington Water Filtration Plant, Barthel Fruit Farm (Final Update), Charter Steel and Jeneil Biotech Inc.

Sub-Committee adjourned at 6:55 pm.

LEPC meeting called to order by Chairperson Kelley at 7:05pm.

Members Present:  Ron Zabransky, David Haas, David Barrow, Fran Myers, Gus Wirth Jr., Mark Mitchell,

Dean Kelley, Glenda Madlom

Members Absent: William Stolte, Sgt. Vargo, Paul Schumacher

Others Present:  Mary Fitzgerald, Trina Rabida

None

Dave Haas reported that the Plan Update Sub-Committee met, reviewed, accepted, and recommend acceptance by the full LEPC of the following facilities:

Ross-Wells, Inc (Final Update), Grafton Water and Wastewater Treatment Plant,

Thermoset, Inc. (Final Update),

Charter Steel,

Port Washington Water Filtration Plant,

Barthel Fruit Farm (Final Update),

Jeneil Biotech Inc.

Motion by Fran Myers, second by Chief Mitchell to accept the plan updates. All members present voting AYE, motion carried.

Mary Fitzgerald sent Mr. Filter of the Agricultural Society, Tom Meaux and Mike Baier, Cedarburg’s Building Inspector a copy of the guidance that was developed for them to use in developing a tornado plan for the County Fair Grounds. Copy of letter was passed around. Dean Kelley would like an update on this issue at our next meeting.

Discussion regarding the three (3) vacancies on the committee.

Mary Fitzgerald gave the committee an update on the South East Region Evacuation Plan and where we are in starting an evacuation plan for Ozaukee.

Members were given a handout on the responsibilities, goals and objectives of the LEPC. This item was tabled until our next meeting so members can study the handout.

Mary Fitzgerald reported on the following incidents:

1. 5-29-2007 Jet Fuel Cedarburg

2. 6-3-2007 Sodium Hydroxide Saukville

ICS 400 classes will be held on July 28 and August 4 at Thiensville Fire Department and August 13 and 14 at the Justice Center.

Exercise with Milwaukee Engine 25 on September 29, 2007. We also will be participating in a Pandemic Preparedness Tabletop on July 31.

None.

Next meeting scheduled for September 13th, 2007 at the Justice Center.

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MINUTES OF MAY 21, 2007

Members Present: Bob Walerstein,  Susan Zuege, Gail Bruss, Jim Schendel , Ginger Ayres,  Ellen Zonka, Karen Nadolski,  Katie Callen, Mary De Luca,  Margaret Sheldon, Peter Duncan,  Lee Schlenvogt

Members Absent: Suzanne Bruner

Guests Present: Tom Meaux, County Administrator

Michelle Pike, LTC Program Coordinator/ Ozaukee County DHS

The meeting was called to order by Robert Walerstein, Committee Chairperson at 1:02pm. Frank Peterson indicated proper meeting notice had been given. Mr. Walerstein distributed information for the committee on Zero Lifting Program as well as an article titled Wisconsin Public Nursing Homes from a publication titled The Wisconsin Taxpayer.

Welcome to Lee Schlenvogt, County Supervisor, newly appointed to the Committee.

Frank Peterson shared a letter to the editor in the Ozaukee Press written from a grandson who’s grandmother was at risk of Nursing Home placement due to her decreasing asset levels.

Nursing Home Diversion funds were available at the time this letter was received. This individual was able to utilize the Diversion funding and thus avoided Nursing Home placement.

Motion to approve the minutes of March 19^th, 2007 was made by P. Duncan, seconded by K. Nadolski

Motion for unanimous ballot for R. Walerstein to continue as chair made by K. Nadolski seconded by M. Deluca. No other nominees. Motion carried. Congratulations Bob!

2006 Has been put to bed. 2006 budget had $10,010 unspent funds that will need to be returned to the State. The reason for this is due to the MA Personal Care Program in the CBRF’s . The MA Personal Care meant that extra COP funds were not needed to supplement costs.

CBRF spending for 2007 thus far reflects the Dept is very close to being on target budget wise.

There were 97 total LTS cases in Jan 2007. To date, 16 new cases have been opened in 2007. Six cases closed in 2007. Total elderly and physically disabled cases in LTS Division as of May of 2007 is 107 individuals. A portion of the new cases that were opened were because the State offered additional slots for Nursing Home Diversion funded clients.

Currently there are 16 Physically Disabled, 41 Elderly, and 8 individuals waiting for CBRF funding. 3 of the individuals waiting for CBRF funding are also captured in the elderly statistics so there are a total of 62 individuals waiting for funding.

The ADRC met with the County’s Finance Department earlier today to begin reviewing the cost model the State published for the ADRC. Ginger Ayres reported that the State will only fund the ADRC at 85% for the first 6 months. The plan at this time is for Ozaukee County to submit the ADRC proposal to the State in July 2007. The State historically has taken 2-3 months to review, comment, and make decisions regarding the proposals. The hope is that by Nov 2007, the ADRC in Ozaukee County would be funded and would begin full implementation.

Presentation to the County Board regarding the CMO was given by Bob Haupt on 5/16/07. The Board will vote on the resolution on June 6^th.

Three Public presentations have been held to get the word out regarding the LTC Reform efforts in Ozaukee County. These three sessions were geared toward consumers and advocates. Additionally, there was one presentation held specifically for Providers of services in Ozaukee County.

There was a question about the risk reserves of the CMO. It was decided that the question regarding risk reserves would be posed to Community Care for them to answer as it relates to the CMO and Family Care. A response to the inquiry will be provided at the next committee meeting.

The client that High Cost funds were approved for a few months ago is currently not doing well. The 1:1 staffing this client received as a result of the approval of the High Cost funds was very helpful at a time when the client was in crisis. The individual is now undergoing a complete medical evaluation at Central Wisconsin Center. The consensus at this time seems to be that his brittle diabetes severely affects his obsessive compulsive behaviors. The thought is that if the diabetes can be better controlled, his negative behaviors would decrease. Howard Mulloy thanked the committee via a written message for having approved the High Cost funds for this individual.

K. Callen moved to adjourn the meeting at 2:25pm. Seconded by P. Duncan

Respectfully Submitted,

Frank Peterson / Long Term Support Planning Committee Liaison

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MINUTES OF MARCH 19^TH, 2007

Members Present: Ellen Zonka, Susan Zuege,Suzanne Bruner, Ginger Ayres (for Sharon Gilman), Robert Walerstein,  Karen Nadolski, Margaret Sheldon, Peter Duncan, Kathlyn Callen,  Mary Deluca

Members Absent: Gail Bruss, Jim Schendel

Guest: Michelle Pike, LTS Program Coordinator, Ozaukee County Human Services

The meeting was called to order by Robert Walerstein, Committee Chairperson at 1:00 pm. Frank Peterson indicated proper meeting notice had been given. Motion by K. Callen, second by S. Bruner to adopt the agenda. Motion approved by voice vote.

Frank Peterson shared a newspaper article that one of the committee members had sent him regarding a young man who had been involved in a motorcycle accident in late 2006. Frank shared information that this young man was receiving MA Personal Care assistance through the County and was also receiving assistance through NH Diversion funding.

Frank also shared a letter (received 2/8/07) written by a daughter regarding her 98 year old mother residing at Belgium Gardens. The 98 year old is currently on the LTS Waiting List. She has run out of money and is at risk of NH placement. Ozaukee County will be asking the State to consider this situation for NH Diversion funding.

Another letter was also received in February, 2007 regarding a 90 year old man currently residing at Washington Heights. This man, who is also on the LTS Waiting List will be out of funds by May 2007 and is also at risk of NH placement.

On 2/19/07 the Grandson of a client who is on the LTS Waiting List visited DHS and stated his grandmother, who resides currently at Harbor Club, will be out of private funds in another 3 months.

Ozaukee County can request NH Diversion funds from the State for these individuals, but it is not a guarantee that funding will be made available from the State.

Motion to approve the minutes of January 29, 2007 was made by K. Callen, seconded by P. Duncan. Motion carried.

The Committee reviewed the 2006 expenditure report showing COP expenditures of $312,284 (100% in 100% of the year). $114,286 of COP funding was available to be match for COP-Waiver and CIP II federal funds. The $75,000 on County Levy was not needed as local match in 2006. COP-Waiver spending of $1,056,420 (128% in 100% of the year) and CIP II spending of $788,675 (107% in 100% of the year. The COP-Waiver and CIP II spending in CBRF’s was significantly reduced by the addition of Medicaid funds collected for personal care. Adjustments will be made in 2007 to add additional clients from the waiting list to increase the Waiver spending and serve more persons..

Wait list was reviewed. Frank Peterson mentioned that DHS may soon be able to take several new clients off the wait list and provide funding for them. At this time it is looking like possibly 7 new clients will be able to be served.

Ginger Ayres announced that on March 7, 2007 the County Board unanimously approved a resolution to begin an enhanced ADRC.

The ADRC will serve as the "gateway" to Long Term Care services and funding in the future. The ADRC will determine whether individuals are financially and functionally eligible for LTC funding. It is expected that about 85% of individuals who contact the ADRC will not be eligible for LTC funding. These individuals will still need assistance in locating and obtaining resources to best utilize their private resources. This in turn keeps these individuals from having to access public dollars for as long as possible.

At this time Ozaukee County expects to submit an ADRC application to the State by mid summer. ADRC expects to be up and running and fully operational by November 1^st, 2007. It is anticipated that the service piece of LTC Reform (the Care Management Organization) will begin January 1^st, 2008.

There is a public meeting scheduled for March 20^th, 2007 from 5-7pm for Providers who are currently contracting with Ozaukee County DHS. The meeting will focus on providing these agencies and individuals with information on how LTC reform will work with their businesses and how contracting may differ in the future.

A copy of the handout

Meetings to discuss LTC Reform/Family Care will be held in the future for consumers, family members, guardians, advocates, etc. The committee shared ideas on how to get the word out regarding these upcoming meetings. The following suggestions were made:

Contact the Parkinson Association

Contact Pharmacists in the County

Place information on the County Website

Contact Durable Medical Equipment providers

Notify EDS who then might be able to get the word out to physicians

Send information to PT/OT clinics

Invite individuals who are on the current LTS Waiting List to attend the sessions

MA Personal Care is provided in 3 ways:

In CBRF’s –PC serves as an extra revenue source

Certified Nursing Assistants (4 Part time individuals) employed by Ozaukee County

4-U Fiscal Agent Program where the Family or Client hires workers directly and the 4-U Program handles the payroll portion of the program.

Currently Ozaukee County receives $15.84 reimbursement for every hour billed for the MA Personal Care Program. With the administrative activities the county has to add to run this program (calculating with-holdings and FICA, W-2’s, scrutinizing time sheets, etc) the county actually ends up supporting this program with a small amount of tax levy to keep it operating.

Would like to see an expansion in the MA-Personal Care Program but it is such a labor intensive program to administer expanding it is a very difficult task to accomplish.

The MA Personal Care workers in Ozaukee County currently receive no benefits. They may receive higher pay per hour than other surrounding counties but they receive no vacation or health insurance benefits.

There is a current movement to try to get a 5% reimbursement rate increase across all LTC funding sources. The Washington, Ozaukee, and Waukesha County LTC Workforce Alliance has submitted a request to Senator Alberta Darling to consider supporting this 5% increase.

It is thought that if this program is not able to offer workers either additional benefits or higher wages, that it will become increasingly difficult to find Personal Care workers at a time when more of this workforce is needed due to the baby boom generation as well as LTC reform.

Kathyn Callen will be attending the Governor’s budget hearing in Milwaukee on 3/20/07 and will support the idea of a 5% increase for this program.

A brief explanation of the situation of the Developmentally Disabled individual whom COP High Costs funds were requested in February was provided.

Committee would like an update from Howard Mulloy at the next LTS Planning Committee Mtg on May 21^st, 2007 as to the outcome of the use of these COP High Cost Funds.

Motion for approval for use of the high cost funds was made by S. Bruner and seconded by G. Ayres. Motion carried.

NEXT MEETING SCHEDULED FOR May 21^st, 2007 at 1:00 PM

Respectfully Submitted,

Frank Peterson, Long Term Support Planning Committee Liaison

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MINUTES OF JANUARY 29, 2007

Members Present: Jim Schendel,  Suzanne Bruner, Ellen Zonka, Peter Duncan ,Karen Nadolski, Margaret Sheldon,

Susan Zuege, Robert Walerstein, Kathlyn Callen, Mary Deluca

Members Absent: Gail Bruss, Ginger Ayres (for Sharon Gilman)

Guest: Tom Meaux, County Administrator, Michelle Pike, LTS Program Coordinator, Ozaukee Human Services

The meeting was called to order by Robert Walerstein, Committee Chairperson. Frank indicated proper meeting notice was given. Motion by Karen Nadolski, second by Suzanne Bruner to adopt the agenda. Motion approved by voice vote. No public comments

APPROVAL OF MINUTES- Motion by Suzanne Bruner, seconded by Karen Nadolski to approve the minutes of November 20, 2006. Motion approved by voice vote.

2006 PROGRAM UPDATE/CBRF SPENDING - The Committee reviewed the 2006 expenditure showing COP expenditures of $359,112 (99% in 100% of the year). COP –Waiver spending of $1,094,274 (139% in 100% of year) and CIP II spending of $808,391 (110% in 100% of year). The County Levy allocation and unspent COP funds are projected to cover the local match costs in the Waiver Programs. CBRF spending is projected to be within the limits established by the Committee.

WAITING LIST UPDATE- The Committee reviewed the current Waiting List showing 23 physically disabled persons under 65, 41 elderly persons seeking community services and 11 persons waiting for CBRF funding.

AGING AND DISABILITY RESOURCE CENTER UPDATE – Planning continues for the development of an ADRC. Sheyboygan County ADRC was toured. Ozaukee County is discussing possibly sharing expenses with one or several additional County ADRC’s for marketing and shared technology. Ozaukee County will likely apply to be a separate ADRC rather than jointly operated with several counties.

LONG TERM CARE REDESIGN INITIATIVE UPDATE - The Committee discussed the planning Ozaukee County is involved in with the Family Partnership Care Management Coalition. Handouts were given to Committee showing the Family Partnership Coalition website. Discussion of the Ozaukee Press article concerning the young disabled man needing services.

COP PLAN UPDATE FOR 2007 - The Committee reviewed the COP Plan Update as far as it was completed. Motion by Peter Duncan seconded by Katie Callen to approve the COP Plan update for 2007 as discussed. Motion approved by voice vote.

Next meeting scheduled for March 19, 2007

Respectfully Submitted

Frank Peterson, Long Term Support Planning Committee Liaison

Table of Contents

MINUTES OF NOVEMBER 20, 2006

Members Present: Jim Schendel,  Suzanne Bruner, Ellen Zonka, Peter Duncan, Karen Nadolski, Margaret Sheldon, 

Susan Zuege,  Robert Walerstein, Kathlyn Callen, Ginger Ayres (for Sharon Gilman), Mary Deluca

Members Absent: Gail Bruss

Guest: Tom Meaux, County Administrator, Bob Haupt, Director Human Services

The meeting was called to order by Robert Walerstein, Committee Chairperson. Frank indicated proper meeting notice was given.

No public comments. Correspondence: Frank read the resignation letter from Sharon Gilman, former director of Aging Services Department, now the Aging and Disability Resource Center. Frank also acknowledged the approval letter for our 2006 Cop Plan Update.

APPROVAL OF MINUTES- Motion by Katie Callen, seconded by Suzanne Bruner to approve the minutes of the September 11, 2006 meeting. Motion approved by voice vote.

2006 PROGRAM UPDATE/CBRF SPENDING - The Committee reviewed the 2006 expenditure showing COP expenditures of $304,646 (79% spent in 83% of year). COP –Waiver spending of $905,464 (109% spent in 83% of year) and CIP II spending of $651,497 (89% spent in 83% of year). The County Levy allocation and unspent COP funds are projected to cover the local match costs in the Waiver Programs. CBRF spending is projected to be within the limits established by the Committee.

WAITING LIST UPDATE- The Committee reviewed the current Waiting List showing 22 physically disabled persons under 65, 44 elderly age 65 or older waiting for services in their own home and 9 persons waiting for CBRF funding. Human Services has allocated $25,000 of Special Funding in 2006 for persons on the waiting list.

AGING AND DISABILITY RESOURCE CENTER UPDATE – Note the Aging Services Department changed its name to Aging and Disability Resource Center. The timing of State funding for ADRC’s is dependent upon the local group’s preparation and readiness for LTC Redesign – Family Care.

LONG TERM CARE REDESIGN INITIATIVE UPDATE - Robert Walerstein mentioned the Statewide Wisconsin Counties Association (WCA) meeting on Long Term Care Redesign on November 9^th. Tom Meaux provided a written summary of this meeting. Bob Haupt spoke about the efforts of our Family Partnerships Consortium consisting of 12 counties and 3 partnership agencies. The group is choosing a governance model to recommend and is seeking stakeholder input before a final plan is developed. The Family Partnerships Consortium will have a web site running soon. More information will be available there.

SSI – MANAGED CARE EXPANSION TO OZAUKEE COUNTY – Frank mentioned this initiative is coming to Ozaukee County January 1, 2007. Persons with SSI only, no Medicare, will be enrolling in one of 4 Managed Care Organizations and have their Medical Assistance Health Care Coverage through one of these organizations. It is possible that Human Services will contract with one or more of these Managed Care Organizations to provide Personal Care services.

COP HIGH COST REQUEST - The Committee heard there was an additional $230 cost for a hitch on the family vehicle to accommodate a lift for a scooter. COP Exceptional Expense funds are being requested to cover this cost. Motion by Kathlyn Callen, seconded by Karen Nadolski. Motion was approved by voice vote. Note, Jim Schendel abstained from vote.

Next meeting scheduled for January 15, 2007

Respectfully Submitted,

Frank Peterson – Long Term Support Planning Committee Liaison

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MINUTES OF SEPTEMBER 11, 2006

Members Present: Jim Schendel,  Suzanne Bruner, Ellen Zonka,  Peter Duncan, Karen Nadolski,  Margaret Sheldon, Susan Zuege,  Robert Walerstein, Kathlyn Callen,  Gail Bruss

Members Absent: Mary Deluca

Guest: Tom Meaux, County Administrator

The meeting was called to order by Robert Walerstein, Committee Chairperson. Frank indicated proper meeting notice was given.

No public comments or correspondence. However, Sharon Gilman announced she will be retiring at the end of 2006.

APPROVAL OF MINUTES OF JULY 10, 2006 - Motion by Katie Callen, seconded by Suzanne Bruner to approve the minutes as written. Motion approved by voice vote.

2006 PROGRAM UPDATE/CBRF SPENDING - The Committee reviewed the 2006 expenditure showing COP expenditures of $235,768 (61% spent in 62.5% of year). COP-Waiver expenditures of $696,647 (84% spent in 62.5% of the year) and CIP II expenditures of $468,246 (64% spent in 62.5% of the year). The $75,000 of County levy will be used to offset the spending in COP-Waiver funds. CBRF spending is projected to be within the limits established by the Committee.

CBRF RATES FOR 2007 - The Committee discussed the maximum rate cap for CBRF funding in 2007. The new monthly rate cap for 2007 is proposed at $3,020 for Class A facilities and $3,470 for Class C facilities. This is a 2% increase over 2006 rates. In addition, the Committee approved an amount of $200 per month for persons on Medical Assistance Personal Care if the facility private pay rate is higher than the CBRF cap. Motion by Jim Schendel, second by Karen Nadolski to approve the 2% increase in CBRF cap for 2007 as proposed. Motion approved by voice vote.

WAITING LIST UPDATE - The Committee reviewed the current waiting list showing 22 physically disabled persons under 65 years of age; 44 elderly persons 65 or older waiting for services in their own home and 7 elderly persons 65 or older waiting for CBRF funding.

AGING AND DISABILITY RESOURCE CENTER ADRC UPDATE - Sharon Gilman gave the Committee updated information on planning for the Resource Center. This is anticipated to be operated by Ozaukee County. The decision has not yet been made if the ADRC will be a multi-county entity or a single Ozaukee County entity. The function of the ADRC needs to be separate from the Managed Care Organization that will provide services to the disabled and elderly population. A timetable for State funding of the ADRC is not known at this time. Concern was expressed that the union representing the County employees be part of the planning process.

LONG TERM CARE REDESIGN INITIATIVE UPDATE – Frank gave the Committee members a packet of information concerning the State-wide initiative. Concern was expressed for service delivery in a managed care environment. Ozaukee County continues to participate in the Family Partnerships Consortium made up of 12 counties and 3 managed care entities. The planning effort will not be concluded until July, 2007.

UPDATE ON PATHWAY SENIOR LIVING RCAC PROPOSAL- Bob Walerstein gave the Committee an update. Because of the LTC redesign planning efforts, Pathway Senior Living will push back their time-table by one year. An article from the Ozaukee Press was also shared with the Committee.

Next meeting scheduled for November 20, 2006

Respectfully Submitted,

Frank Peterson – Long Term Support Planning Committee Liaison

Table of Contents

JULY 10, 2006

Members Present: Robert Walerstein Susan Zuege

Members Absent: Sharon Gilman, Margaret Sheldon

Guests: Tom Meaux, County Administrator

Thomas Richart, County Supervisor

The meeting was called to order by Robert Walerstein, Committee Chairperson. Frank indicated proper meeting notice was given.

No public comments or correspondence

APPROVAL OF MINUTES OF JUNE 12, 2006– Motion by Jim Schendel, seconded by Peter Duncan to approve the minutes as written. Motion approved by voice vote.

2006 PROGRAM UPDATE/CBRF - The Committee reviewed the 2006 expenditures showing COP expenditures of $164,767 (42% spent in 46% of year). COP-Waiver expenditures of $522,231 (63% spent in 46% of the year) and CIP II expenditures of $320,291 (44% in 46% of the year). Frank projects all $75,000 of County Levy will be used as local match for COP-Waiver funds in 2006. CBRF spending shows we are within the new CBRF levels set at our June Committee meeting. CBRF spending projected to be $1.23 million in 2006 because of the increase in diversion fund.

DIVERSION FUNDING UPDATE- The Committee reviewed the report showing 11 persons were approved for the new nursing home diversion funding. That is the highest number for any County in the State! The additional funds approved to serve the 11 individuals is $156,048 in 2006 and $247,368 in 2007 if all cases remain open at that time. All 150 slots Statewide are now filled.

WAITING LIST UPDATE AND SPECIAL FUNDING STATUS – The Current waiting list has 18 physically disabled persons, 41 elderly persons needing services at home and 7 elderly persons needing CBRF funding. The number on the CBRF waiting list has been reduced because of the diversion funding we received. The Health and Human Services Board has allocated $25,000 of undesignated fund balance to be used in special circumstances for people on the waiting list. 6 persons have received the special funding in 2006.

UPDATE ON PATHWAY SENIOR LIVING RCAC PROPOSAL - Robert Walterstein reported that the City of Cedarburg has approved the zoning necessary for the RCAC assisted living facility to be built on the Lasata grounds. The suggested location has changed to the front of the property along Wauwatosa Road instead of behind Lasata Heights. The funding issues have not been resolved with the State. The request for a pilot program to provide funding for persons to cover costs of services in the RCAC was turned down by the State. The Long Term Care Redesign effort may ultimately address the funding need, but is not in place at this time.

LONG TERM CARE REDESIGN INITIATIVE - Frank shared information with the Committee on the Long Term Care Redesign planning efforts we are involved in. The State website has a significant amount of information on this Statewide effort: http://dhsf.wisconsin.gov/Mangaged LTC/. Frank will continue to keep the Committee informed on the progress of this planning effort. Some concern was expressed about the status of County staff such as case managers and direct services workers because there is no assurance the County will continue to be a direct service provider to the elderly, physically disabled or developmentally disabled. Frank indicated Ozaukee County Human Services is involved in the intensive planning efforts with a desire to be a service provider in the future. Some concern expressed that the quality or quantity of services might decrease if services are turned over to a managed care system. Frank indicated planning with the Family Partnerships Group of Counties will be addressing these issues. Karen Nadolski indicated Jim Hoegemeyer with the State ARC will speak to the Ozaukee ARC Chapter in August on the Long Term Care Redesign Initiative. All consumers, family members, and service providers are interested in this issue.

Next meeting scheduled for September 11, 2006

Meeting Adjourned,

Respectfully Submitted,

Frank Peterson – Long Term Support Planning Committee Liaison

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JUNE 12, 2006

Members Present: Jim Schendel, Suzanne Bruner, Ellen Zonka, Peter Duncan, Karen Nadolski, Margaret Sheldon, Susan Zuege, Robert Walerstein

Members Absent: Sharon Gilman, Katie Callen, Gail Bruss, Mary Deluca

The meeting was called to order by Jim Schendel, Committee Chairperson. Frank indicated proper meeting notice was given.

No public comments or correspondence.

ELECT COMMITTEE CHAIRPERSON– Jim Schendel declined to continue as Committee Chair. The Committee thanked Jim for his service as Chairperson. Nominations were opened to the Committee members. Motion by Suzanne Bruner, seconded by Karen Nadolski that Bob Walerstein be nominated for Chairperson. After calling for additional nominations and there being none, Bob Walerstein was elected Chair by a voice vote. Congratulations Bob!

APPROVAL OF MINUTES OF MARCH 20, 2006 - Motion by Bob Walerstein seconded by Suzanne Bruner that the minutes be approved as written. Motion approved by voice vote.

2005 FINAL NUMBERS - The Committee received a final report for 2005 expenditures. COP funds of $508,887 were spent in the following ways: $25,992 for Administration, $23,414 for COP Assessments and case planning, $81,249 was used as local match for Cop-Waiver funding and $378,232 was spent on direct client services. Cop-Waiver funds of $1,165,053 were spent on client services and $78,865 was used for administration. $740,410 of CIP II funds were spent on client services and $51,828 was spent on administration. In addition to the $34,500 of budgeted County Levy, another $19,623 from Human Services budget was needed to cover the local match costs for Cop-Waiver funds. A total of $2,463,794 was spent on long term care from these funds.

2006 PROGRAM UPDATE - The Committee reviewed the 2006 expenditures showing COP expenditures of $133,682 through May (34% spent in 42% of the year). Cop-Waiver expenditures total $426,643 (52% spent in 42% of the year). CIP II expenditures total 258,146 (44 % spent in 42% of the year). We have $75,000 of County levy allocated for 2006 to bring in an additional $103,317 in Cop-Waiver federal funds.

CBRF SPENDING CAP LEVELS – Frank told the Committee that our 2006 COP Plan Update has not yet been approved pending a further decision on our CBRF spending limits. The State is no longer accepting our tracking of "new funds" spent on CBRF’s outside of our 40% limit. The State wants the Committee to set a CBRF cap counting all funds. Frank gave the Committee two versions of the CBRF cost sheet for 2006. The one sheet shows the original 40% allocation ($583,028) on top and the "new funds" (Cop-Waiver and CIP II) tracked separately on the bottom ($637,757). The second CBRF cost sheet shows COP and Cop-Waiver funds together and CIP II funds separately. Most of the "new" funds have been CIP II funds. Total CBRF funds anticipated to be spent in 2006 is $1,170,000 combined. If the 40% CBRF cap was used across all funding, the limit would be $787,885. Frank proposed a COP/COP-Waiver CBRF limit of 50% and a CIP II limit of 80%. These suggested limits will cover current levels of spending. After considerable discussion, motion to set the COP/COP-Waiver CBRF cap at 50%, and CIP II CBRF cap at 80% for 2006 was made by Peter Duncan, seconded by Bob Walerstein. Motion approved by voice vote.

NEW DIVERSON FUNDING - The Committee received handouts showing 150 slots statewide were created out of Relocation funding. These 150 slots can be used by persons at imminent risk of nursing home placement. Only elderly or physically disabled persons on Medicaid are eligible. Ozaukee County has received written approval for 9 of the 150 slots. We expect approval for 3 more. The 9 slots give us an additional $121,248 for 2006 and $191,154 for 2007. Long Term Case Managers and Economic Support Staff worked diligently to gain approval for 12 of the 150 slots. (8% statewide). Ozaukee was awarded the most slots of all the Counties!

WAITING LIST UPDATE - The current waiting list has 18 physically disabled, and 47 elderly, (6 are waiting for CBRF funding). The new diversion funds greatly reduced our waiting list!

PATHWAY SENIOR LIVING RCAC PROPOSAL ON LASATA GROUNDS – Bob Walerstein gave the

Committee an update on the proposed RCAC for the Lasata Campus. The proposed location has changed to the front of the property on Wauwatosa Avenue, instead of behind Lasata Heights. Pathway Senior Living is looking for assurances that Long Term Care funding will be available when the facility opens in fall of 2008 at the earliest. Ozaukee County officials and Pathway Partners have had two meetings with State officials in Madison concerning Long Term Care funding and the WHEADA Tax Credit process.

LONG TERM CARE REDESIGN INITIATIVE – Ozaukee County is participating in 2 planning groups looking at planning for long term care funding with a "Family Care" model or an "integrated" model including acute and primary medical care. The State is promoting a managed care approach to long term care. One planning effort is with the South East Wisconsin Counties, Racine, Kenosha, Waukesha, Washington and Ozaukee. The other planning group includes 13 counties in the center of the state. Several managed care organizations are part of the planning effort as well. Planning will continue through mid 2007.

OTHER BUSINESS – COP High Cost request; Peter explained the need for a 26 year old man to have a manual wheelchair. He has an electric wheelchair but now does not have the strength to navigate the power chair. He has difficulty breathing and is on a respirator so a "sip and puff" system won’t work either. The manual wheelchair cost $2,500. Ozaukee County would like to request COP High Cost funds for this purpose. Motion by Karen Nadolski, seconded by Margaret Sheldon to approve the COP High Cost application. Motion carried by voice vote.

Discussion of Variance Request for Gables on the Pond II, CBRF in Random Lake. A variance is required for this 28 bed facility. Ozaukee County could not find an appropriate CBRF or Adult Family Home for the couple that needed care when Sally’s Place AFH closed. Gables on the Pond in Sheboygan County is appropriate. Long Term Support Planning Committee approval is needed for the CBRF variance request so COP-Waiver funding can be used in a CBRF larger than 20 beds. The State approval has been given. Motion by Suzanne Bruner, seconded by Margaret Sheldon to approve variance request for Gables on the Pond II in Random Lake. Motion Carried by voice vote.

Next meeting scheduled for the second Monday in July, so we will meet on July 10^th instead of July 17.

Respectfully Submitted,

Frank Peterson – Long Term Support Planning Committee Liaison

Table of Contents

MINUTES OF MARCH 20, 2006

Members Present:       Margaret Sheldon

Peter Duncan            Robert Walerstein

Karen Nadolski        Katie Callen

Suzanne Bruner         Ellen Zonka

Susan Zuege              Mary Deluca

Sharon Gilman

Members Absent: Jim Schendel, Gail Bruss

The meeting was called to order by Frank Peterson in the absence of the Chairperson. Frank indicated proper meeting notice was given.

No public comments or correspondence

APPROVAL OF MINUTES OF JANUARY 9, 2006 – Motion by Mary Deluca, seconded by Sharon Gilman that the minutes be approved as written. Motion approved by voice vote.

2005 PROGRAM UPDATE - The Committee reviewed the 2005 expenditures showing COP expenditures of $408,221 (100 % spent), COP-Waiver expenditures of $1,141,448 (132% of allocation), and CIP II expenditures of $741,461 (108% of allocation). The budgeted County Levy of $34,500 has been spent. Possible need for $81,000 additional funds from Human Services undesignated fund balance. CBRF spending for 2005 was reviewed by the Committee.

WAITING LIST CRITERIA/POLICY - Discussion by the Committee of the Waiting List Criteria in the State Waiver Program Manual. The policy manual states the County policy must be fair and equitable to all persons on the Waiting List and ensure movement of persons on the list at a reasonable pace. The County Policy must ensure persons are served in the order they are placed on waiting list. No change made to the waiting list policy. Review of criteria being developed to serve persons in crisis with special county funding from Human Services Undesignated Fund balance. $25,000 has been approved for such use in 2006. Waiting List numbers were reviewed showing: 22 physically disabled persons under 65; 38 elderly persons waiting for community services and 12 elderly persons waiting for CBRF funding. The committee will look at modifying the County Waiting List policy in the future. No change made at this time.

LONG TERM CARE REFORM EFFORTS - Ozaukee County is participating in two consortiums: the SERCMO Consortium consists of Racine, Kenosha, Waukesha, Washington, Ozaukee Counties along with several care management organizations. The second consortium is FPCMC which consists of 14 counties in the South Central part of the state plus several care management organizations. The two consortiums have received planning grants to redesign the delivery of long term care services and possibly acute and primary medical services on a regional basis. The funding would come from a capitated rate that would be established. The State hopes efficiencies will come from such a system and would eliminate waiting lists after several years of savings.

UPDATE ON PERSONAL CARE PROGRAM – The committee received a summary of the personal care program covering 2005.

COP PLAN UPDATE/CONFLICT OF INTEREST POLICY – The completed Cop Plan Update document was given to committee members. Frank pointed out the requirement to have a conflict of interest policy for participants in the COP and Waiver Programs. Examples were discussed and the policy was given to members.

ASSISTED LIVING PROGRAM - The Pathway Senior Living proposal was discussed with the Committee. The initial phase consists of building a Residential Care apartment complex (RCAC) of 80-100 units. Other phases possibly include remodeling Lasata Heights and building cottages for seniors. The County Board will discuss further at the April 5 meeting.

CHANGE IN CIP II FUNDING - The Committee was informed that CIP II funding that was previously awarded in "slots" is now being given to county in a lump sum amount similar to our COP-Waiver funding. This allows us more flexibility with the funding

Motion by Suzanne Bruner, seconded by Katie Callen, to adjourn at 3:00 pm.

Respectfully Submitted,

Frank Peterson

Long Term Support Planning Committee Liaison

Table of Contents

JANUARY 9, 2006

Members Present: Bob Walerstein Ellen Zonka

Peter Duncan Karen Nadolski

Sharon Gilman Gail Bruss

Mary DeLuca Katie Callen

Members Absent: Jim Schendel, Suzanne Brunner, Susan Zuege, Margaret Sheldon

The meeting was called to order by Frank Peterson acting in the absence of the Chairperson. Frank assured the proper meeting notice was given.

PUBLIC COMMENTS - Frank read the letter of reply to the daughter who wrote the Committee because of her mother’s need for CBRF funding. Coincidentally, the mother now qualifies for special Estate Recovery funding because the mother is now under Hospice Care. The Estate Recovery funds are now all committed.

APPROVAL OF MINUTES OF NOVEMBER 21, 2005 - Motion by Bob Walerstein, seconded by Mary DeLuca to approve the minutes as written. Motion approved by voice vote.

2005 PROGRAM UPDATE - The Committee reviewed the 2005 expenditures showing COP expenditures of $400,655 (98% spent in 100% of the year), COP-Waiver expenditures of $1,088,262 (126% in 100% of the year), and CIP II expenditures of $608,896 (89% in 100% of the year). The budget County Levy of $34,500 has been spent. Possibly an additional $39,000 of local match is needed.

WAITING LIST - The Committee reviewed summaries of the waiting lists of Elderly Persons, Physically Disabled Persons and Persons with Developmental Disabilities. Sharon Gilman indicated those persons with developmental disabilities who are over age 60 and on a waiting list can be considered for Aging Services Department funding.

CIP II COMMUNITY RELOCATION INITIATIVE –Frank explained the new State initiative to bring elderly and physically disabled persons out of nursing homes. Long Term Support staff have met with staff at Lasata Care Center and Heritage to identify residents who may qualify. We have had four referrals and community relocation plans are being developed for three out of four persons. When approved, the State gives the County new funds for these relocations.

COP PLAN UPDATE/CONFLICT OF INTEREST POLICY - Frank reviewed the COP Plan update and discussed the areas yet to be completed before the January 30, 2006 deadline. The proposed Conflict of Interest policy (similar to the Kewaunee County Policy) was discussed. Motion by Bob Walerstein, seconded by Katie Callen to give provisional approval to the COP Plan Update as discussed. Motion approved by voice vote.

ASSISTED LIVING PROPOSALS ON LASATA PROPERTY - Discussion of the Pathway Senior Living proposal for an RCAC, Senior Cottages, and remodeling the Heights was discussed. Bob Walerstein explained the thinking behind the Aging and Long Term Care Committee recommendation for the Pathway proposal.

Motion by Bob Walerstein, second by Katie Callen to adjourn. Motion approved by voice vote.

Respectfully Submitted,

Frank Peterson

Long Term Support Planning Committee Liaison