JOINT HEALTH AND HUMAN SERVICES COMMITTEE and EXECUTIVE COMMITTEE

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1 Date & Time of Meeting: Monday, July 18, 2016 at 4:30 p.m. Meeting Location: Courthouse Assembly Room B-105 Courthouse Health & Human Services Committee Members: Matt Bootz, Chair, John Robinson, Vice-chair, Bill Miller; Orval Quamme; Katie Rosenberg, Maynard Tremelling, Dave Wysong Committee Members: Committee Members: Kurt Gibbs Chair; Lee Peek, Vice-Chair; Matt Bootz; Sandi Cihlar; Kurt Kluck; Bill Miller; Craig McEwen; John Robinson, Jeff Zriny Marathon County Mission Statement: Marathon County Government serves people by leading, coordinating, and providing county, regional, and statewide initiatives. It directly or in cooperation with other public and private partners provides services and creates opportunities that make Marathon County and the surrounding area a preferred place to live, work, visit, and do business. (Last updated: ) Health & Human Services Committee Mission Statement: Provide leadership for the implementation of the strategic plan, monitoring outcomes, reviewing and recommending to the County Board policies related to health and human services initiatives of Marathon County. Executive Committee Mission Statement: The Executive Committee of the Marathon County Board exists for the purpose of implementing the County s Strategic Plan by coordinating policy formation among the Committees, and providing leadership for all County Board policies through supervision of Administrative staff. 1. Call Meeting to Order 2. Public Comment (15 minute limit) 3. Approval of the June 27, 2016 Health & Human Services Committee Minutes 4. Educational Presentations/Outcome Monitoring Reports - None 5. Policy Issues Discussion and Committee Determination to the County Board for its Consideration A. How does the Health and Human Services Committee recommend that the County move forward in delivering behavioral health care and alcohol and drug treatment in light of the Morningside Report and the discussion among board members on July 11? 1. Options identified in the report or during the County Board discussion are: a. Retain the current NCHC structure with changes to provide better oversight. b. Terminate the current agreement with Lincoln and Langlade Counties and adopt a purchased services model. c. Terminate the agreement with Lincoln and Langlade Counties and create a Marathon County Human Services Department. 1. Create a regional Human Services Department 6. Next Meeting Logistics and Topics: A. Committee members are asked to bring ideas for future discussion B. Next Scheduled Meeting: Monday, August 15, Announcements 8. Adjournment JOINT HEALTH AND HUMAN SERVICES COMMITTEE and EECUTIVE COMMITTEE AGENDA Any person planning to attend this meeting who needs some type of special accommodation in order to participate should call the County Clerk s Office at or infomarathon@mail.co.marathon.wi.us one business day before the meeting. SIGNED /s/ Matt Bootz Presiding Officer or Designee FAED TO: Wausau Daily Herald, City Pages, and NOTICE POSTED AT COURTHOUSE FAED TO: Other Media Groups FAED BY: M. Palmer BY: M.. Palmer FAED DATE: DATE: FAED TIME: TIME:

2 Program Area: Health Ranked from highest to lowest priority. Overarching goals for Health and Vulnerable Populations 1. People practice proactive behaviors, prevention and early intervention to delay or lessen the impacts of aging, disease and chronic physical and mental health conditions. 2. People with life threatening health emergencies are responded to in a timely and effective manner. 3. Systems are in place that rapidly identify and control the spread of infectious disease. 4. People reach their optimal physical, mental and social health potential. Program Area: Vulnerable Populations Ranked from highest to lowest priority. 1. People who are at risk are identified early and receive interventions that promote their safety and well being. 2. Marathon County s systems will assure access to basic needs programs on a timely basis. 3. Vulnerable populations live in safe and healthy social, emotional, and physical environments. 4. Families and their support systems provide for the safety and well being of vulnerable populations. 5. Residents know how to access services available for vulnerable populations. 6. Vulnerable populations are provided the opportunity to reach their full social, educational and emotional development.

3 MARATHON COUNTY HEALTH AND HUMAN SERVICES COMMITTEE MEETING MINUTES Monday, June 27, :00 p.m. Courthouse Assembly Room B-105, 500 Forest Street, Wausau Attendance: Present Absent Matt Bootz, Chair E John Robinson, Vice Chair x Bill Miller x Orval Quamme x Katie Rosenberg Maynard Tremelling x Dave Wysong E Also Present: Deb Hager, E.J. Stark, Kurt Gibbs, Vicki Tylka, Amy Arlen 1. Call Meeting to Order The Health & Human Services meeting was called to order at 4:10 p.m. by Vice Chairman Robinson 2. Public Comment None 3. Approval of the Minutes of June 13, 2016 Health & Human Services Committee Meeting MOTION BY TREMELING; SECOND BY ROSENBERG TO APPROVE THE MINUTES OF THE JUNE 13, 2016, HEALTH & HUMAN SERVICES COMMITTEE MEETING. MOTION CARRIED. 4. Educational Presentations/Outcome Monitoring Reports - None 5. Policy Issues Discussion and Committee Determination to the County Board for its Consideration A. Resolution to Establish a Segregated Transportation Capital Improvement Program Account Discussion Earlier today this was postponed until August, 2016 by Finance Committee. Better definition is needed as to which dollars would apply to this fund. Action: MOTION BY MILLER SECOND BY ROSENBERG TO POSTPONE THIS AGENDA ITEM UNTIL THE JULY, 2016 HEALTH & HUMAN SERVICES COMMITTEE MEETING;. MOTION CARRIED. Follow through To be discussed at the July, 2016 Health & Human Services Committee meeting. B. Resolution to Establish a Trust Fund Account for Transportation Grant Funds Discussion The Department of Transportation allows for excess grant funds to be held until a future date if a trust account is created. In 2015 the County experienced excess grant funds due to Metro Ride not providing rides in the Rothschild, Schofield, Weston areas. The Metro Ride grant dollars were reduced by $15,000. Action: MOTION BY ROSENBERG, SECOND BY MILLER TO CREATE A TRUST FUND FOR TRANSPORTATION GRANT FUNDS. MOTION CARRIED. Follow through Move to County Board for their action. 1

4 C. Addressing Capacity in Child Protective Services (Vicki Tylka) 1. Request for 3 FTE Social Workers Discussion Vicki Tylka addressed the committee as to the County s responsibility to receive and assess allegations of abuse and neglect of children. If it is determined that the allegation is founded a Social Worker creates a plan for the child(children) s safety and care. This may result in out of home placement. The goal is the reunification of the family if at all possible. Social Services has seen a significant growth in the number of referrals of alleged abuse/neglect. In 2015 Social Services moved a juvenile Social Worker to increase capacity of this unit. The County continues to experience increased volume over last year. The maltreatment reports have increased by 54% from 2012 to present. At the same time CHIPS (Children in need of protective services) petitions increased 80%. By June 3 rd of this year County had 99 petitions which are as many as the County experienced in all of The County exceeds all recommended staffing for caseloads for ongoing services by Social Workers. The increase in workload also impacts Corp Counsel s office as well as the addition to the new added legal work of defending appeals through the administrative hearing process as a result of a federal court case. In the past fifteen years Corp Counsel had two in 2016 Corp Counsel has defended six or seven cases through administrative hearing process. Request is for one Social Worker for Access/Assessment, one Social Worker for Ongoing, and one to serve as a Lead Social Worker who will have a 50% caseload and then assist with case planning and review from Social Worker. Fill the ongoing Social Worker for the remainder of this year. The other two positons would begin in Action: MOTION BY MILLER; SECOND BY ROSENBERG TO APPROVE AND REFER TO FINANCE COMMITTEE FOR CONSIDERATION OF THE THREE POSITIONS AND FILL THE ONGOING SOCIAL WORKER FOR THE REMAINDER OF THIS YEAR THE REMAINING TWO POSITIONS AS A PART OF 2017 BUDGET PROCESS. MOTION CARRIED. Follow through Refer to Finance Committee for their consideration. 6. Next Meeting Logistics and Topics: A. Committee members are asked to bring ideas for future discussion Juvenile Justice and mental health issues (DSS will present to board) NCHC Issues B. Next Meetings: July 18, 2016 at 4:30 p.m. 7. Announcements - 8. Adjournment There being no further business to discuss, MOTION BY TREMELLING; SECOND BY MILLER; TO ADJOURN THE HEALTH & HUMAN SERVICES COMMITTEE MEETING. MOTION CARRIED. Meeting adjourned at 5 05 p.m. Respectfully submitted by, Deb Hager 2

5 MARATHON COUNTY HUMAN SERVICES NEEDS ASSESSMENT BOARD OF SUPERVISORS WORK SESSION SUMMARY OUTCOME OF MARATHON COUNTY BOARD OF SUPERVISORS DELIBERATIONS JULY 11 TH, 2016 After a presentation of three options to consider for the delivery of behavioral health services in Marathon County, the Board of Supervisors identified key interests that a new structure should meet. The Board of Supervisors also identified a fourth option to consider. Interests are the needs that must be satisfied for a solution to be fully accepted. The significant interests for each option are shown below. OPTION 1: RETAIN NCHC STRUCTURE WITH SIGNIFICANT MODIFICATIONS TO THE CURRENT AGREEMENT TO IMPROVE THE MANAGEMENT AND OVERSIGHT OF THE ORGANIZATION OPTION 1 SIGNIFICANT INTERESTS: Least disruptive for employees and patients New NCHC management team should get a chance Strong foundation for making changes NCHC has established relationships with state, federal, regulatory, payors, and other stakeholders OPTION 2: TERMINATE THE AGREEMENT THAT CREATED NCHC IN JANUARY 2018 AND CONTRACT FOR BEHAVIORAL HEALTH SERVICES OPTION 2 SIGNIFICANT INTERESTS: Quality assurance Control of services Control of costs OPTION 3: TERMINATE THE AGREEMENT THAT CREATED NCHC IN JANUARY 2018 AND INCORPORATE NCHC SERVICES INTO A MARATHON COUNTY HUMAN SERVICES DEPARTMENT OPTION 3 SIGNIFICANT INTERESTS: County in control of services Avoids conflict with an external service provider OPTION 4: A FEW BOARD MEMBERS IDENTIFIED A FOURTH OPTION, WHICH IS OPTION 3 ABOVE, EPANDED TO INCLUDE MULTIPLE COUNTIES AS THEIR SERVICE AREA. Option 4 significant interests: Regionalization allows new relationships with partners/counties Could allow assumption of staff Better cooperation within department Morningside Research and Consulting, Inc. Marathon County Human Services Needs Assessment Board of Supervisors Work Session Summary 1

6 GOALS OF THE NEW STRUCTURE Morningside Research and Consulting reviewed the interests identified and summarized them into the following goals for a new structure: Enables County to measure and ensure quality standards are met Enables County to ensure services are provided cost effectively Ensures services provided are transparent and accountable to taxpayers Minimizes disruption to clients, employees, and stakeholders Well defined mutual expectations Minimizes disruption to state, federal, regulatory, and payor relationships. OUTCOME OF THE EECUTIVE COMMITTEE DELIBERATIONS JULY 12 TH, 2016 The Executive Committee decided to establish a joint committee workgroup which will develop a recommendation for a new structure for delivery of behavioral health services for Marathon County. The joint committee is comprised of Health and Human Services Committee and Executive Committee members and is set to begin the week of July 18 th JOINT COMMITTEE DELIVERABLES: 1. Recommendation of proposed structure 2. Timeline for approving a new structure 3. Engagement strategy for communicating and receiving input on the new structure OUTCOME OF THE TRANSITION OVERSIGHT COMMITTEE MEETING JULY 12 TH, 2016 The Transition Oversight Committee recommended that the current contract with NCHC be terminated and a new contract be negotiated. The new contract may be structured as a performance based contract solely with NCHC or as a performance based contract with multiple providers. Morningside Research and Consulting, Inc. Marathon County Human Services Needs Assessment Board of Supervisors Work Session Summary 2

7 TRANSITION OVERSIGHT TASK FORCE MEETING MINUTES Tuesday, July 12, :00 a.m. Courthouse Assembly Room, Wausau WI Attendance: Present Absent Kurt Gibbs, Chair Matt Bootz Craig McEwen Scott Parks Jeff Zriny Also Present: Brad Karger, Michael Loy, True Lor, Sheri Holland, Orval Quamme 1. Call Meeting to Order The Transition Oversight Task Force meeting was called to order at 9:00 a.m. by Chair Gibbs. 2. Public Comment None 3. Approval of the June 7, 2016, Minutes MOTION BY MCEWEN, SECOND BY ZRINY TO APPROVE THE JUNE 7, 2016 MEETING MINUTES. MOTION CARRIED. 4. Educational Presentation None 5. Policy Question and Possible Action by the Task Force A. Having Heard a Report on the Preliminary Report by Morningside Consulting, What Are the County Board s Unmet Informational Needs in Relation to the Evaluation Criteria: 1. Public Accountability a. The Options Provided to the County Under Wisconsin Statutes 2. Change Resiliency a. Organizational Culture b. Transparency and Participation in Decision-Making 3. Transitional and Ongoing Costs a. Medicare and Medicaid Reimbursement b. Economics of Scale c. Administrative Duplication d. State Incentives for Regional Organizations e. Wisconsin Medical College Psychiatry Residency Program B. Who is Assigned Responsibility for Generating the Information Needed and Who Will Pull the Information Gathered into a Single Document that Will be Understandable? Discussion Task Force members discussed how the NCHC issues can be moved forward. The Executive Committee meeting ended with little consensus or direction. At the July 11, 2016 County Board meeting it seemed that there was no clear consensus among County Board members other than there was little or no support for a Marathon County Human Services Department and little or no support for just maintaining the status quo. This seemed to be a viable plan that might result in a consensus among board members: 1. Terminate the current Agreement with Lincoln and Langlade Counties with the intention of creating a new Agreement with the same partners. A. The new Agreement will permit Marathon County to enter into performance based contracts and to contract with other organizations for behavioral health and AODA 1

8 treatment services. 1. For the first three years (2018, 2019, 2020) NCHC will be the sole provider of behavioral health and AOSA treatment services for Marathon County and services and payments shall be communicated through time limited contracts which include financial penalties for non-performance. 2. Thereafter, Marathon County will be free to contract with NCHC or any other organization for behavioral health and AODA treatment services utilizing its procurement code. The Task force members said that this approach can: 1. Put the County in control of the services provided through well-defined mutual expectations. 2. Enables the County to measure and ensure quality standards are met. 3. Minimizes disruption to clients, employees and payor relationships. Task force members noted that the Morningside Report calls for the County to expand its contract development and monitoring expertise. Additionally, Staff was asked to contact representatives of Counties that report using contracts for mental health services and asking (Brown, Rusk, Dane): Who are their providers? How well is this working? Action: MOTION BY MCEWEN; SECOND BY ZRINY TO SUSPEND THE FINANCIAL ANALYSIS OF THE COUNTY HUMAN SERVICES MODEL. MOTION CARRIED. 5. Next Meeting: None scheduled. 6. Adjournment There being no further business to discuss, MOTION BY MCEWEN; SECOND BY ZRINY; TO ADJOURN THE TRANSITION OVERSIGHT TASK FORCE MEETING. MOTION CARRIED. Meeting adjourned at 10:00 a.m. Minutes prepared by Brad Karger on 7/14/16 2