WASHINGTON COUNTY 1 SAMARITAN COMMITTEE 2

3 Samaritan Health Center May 21, 2015 4 West Bend, WI 7:00 a.m. 5 6 Present: Michael Bassill, Jeffrey Geib, Ralph Hensel, Roman Schulteis, and Daniel Stoffel. 7 8 Also Present: Campus Administrator Matt Furno, Samaritan Accountant Jeff Werner, 9 Accounting Assistant Trisha Holbrook, The Fields House Manager Jessica Trapp, Director of 10 Nursing Kathie Braun, County Board Chairperson Herbert Tennies, and Chief Deputy County 11 Clerk Linda Doro. 12 13 Chairperson Stoffel called the meeting to order at 7:00 a.m. and read the Affidavit of Posting. 14 15 MINUTES 16 Moved by Mr. Schulteis, seconded by Mr. Hensel to approve the Samaritan Committee minutes 17 of April 23, 2015, as presented. Motion carried. 18 19 SAMARITAN FINANCIAL REPORTS 20 Mr. Furno reviewed the cash balances for the Samaritan and Fields for the months ended March 21 31, 2012, through March 31, 2015. Ms. Holbrook and Mr. Werner reviewed the accounts 22 receivables through March 2015, for the Skilled Nursing Facility, RCAC, and the CBRF. 23 24 CAMPUS ADMINISTRATOR'S REPORT 25 Current Census 26 Mr. Furno reported on the current census for the Skilled Nursing Facility, RCAC, and the CBRF. 27 28 Develop Standard Certified Nursing Assistant Agency Contract 29 Mr. Furno discussed establishing a standard contract for pool agencies supplying certified 30 nursing assistant staff to the Samaritan Health Center. 31 32 Chapter 55 Protective Placement Update 33 Mr. Furno reported the Memorandum of Understanding with the Aging & Disability Resource 34 Center, Human Services Department, and Samaritan Health Center regarding Chapter 55 35 Placement Reimbursement and Admissions is ready for signatures and he discussed the 36 upcoming meeting with Clearview Nursing Home Administrator Jane E. Hooper regarding 37 contracting for Chapter 55 placements. 38 39 Leading Age Spring Conference & Special Meeting Updates 40 Mr. Furno reported funding of long term care for the geriatric population and concerns with State 41 regulations requiring a defined distance between CBRFs and/or RCACs were discussed at the 42 Leading Age Spring conference. 43 44

Samaritan Committee May 21, 2015 Page 2 of 2

Samaritan Health Center Bonding Status 1 Mr. Furno reported the Finance Committee, at the May 20, 2015, meeting approved proceeding 2 with the refinancing of not to exceed $6,000,000 general obligation bonds for the Samaritan 3 Health Center remodeling project, with the parameters outlined in 2014 Resolution 59. 4 5 Samaritan Committee Meetings Evaluation 6 Moved by Mr. Schulteis, seconded by Mr. Geib approve the scheduling of Samaritan Committee 7 meetings on a bi-monthly basis. Motion carried. 8 9 Announcements 10 Mr. Furno reported the Samaritan flower sale pick up date is today starting at 12 noon and the 11 golf outing is Monday, July 20, 2015. 12 13 NEXT TENTATIVE MEETING DATE 14 The next Samaritan Committee meeting is tentatively scheduled for Thursday, July 16, 2015, at 15 7:00 a.m. 16 17 ADJOURNMENT 18 Moved by Mr. Bassill, seconded by Mr. Geib to adjourn the meeting at 8:07 a.m. Motion 19 carried. 20 21

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Brenda J. Jaszewski, County Clerk 24

SAMARITAN COMMITTEE REPORT To: Samaritan Committee Members From: Matt Furno, Campus Administrator Date: July 16, 2015 RE: Report: Samaritan Health Center - Department of Quality Assurance (DQA) Survey ACTION QUESTION:

A. None DISCUSSION:

A. The Department of Quality Assurance Survey, regarding the Skilled Nursing Facility at the Samaritan Campus started on June 23, 2015 and ended on June 29, 2015

B. There was 1 surveyor from the OFFICE OF PLAN REVIEW AND INSPECTION DIVISION OF QUALITY ASSURANCE inspecting the physical plant and safety records

C. There were 8 surveyors from the HEALTH CARE SURVEYOR DIVISION OF QUALITY ASSURANCE observing actual cares and inspecting medical, safety, and procedural records

D. Actual Citations with Scope and Severity will be issued to the Facility in July 2015 E. When the Citations are received, a correction plan will be developed and sent to the DQA

for their acceptance F. As items were identified, by the surveyors, the staff began to correct them whenever

possible

COST: A. None

ATTACHMENT:

A. None RECOMMENDATION:

A. The recommendation is to complete the correction plan and the actual correction as soon as reasonably possible.

SAMARITAN COMMITTEE REPORT To: Samaritan Committee Members From: Matt Furno, Samaritan Campus Administrator Date: July 16, 2015 RE: Chapter 55 Protective Placement at the Samaritan Health Center - Update ACTION QUESTION:

A. What is happening with the Memorandum of Understanding (MOU) and Chapter 55 Protective Placements at Samaritan Health Center?

DISCUSSION:

A. The Samaritan Health Center has admitted 5 Chapter 55 Protective Placements in 2015. B. A Memorandum of Understanding (MOU) with the ADRC, Human Services and the

Samaritan Health Center was signed on May 27, 2015. C. The Samaritan Health Center is providing Chapter 55 Protective Placements for

Washington County residents whenever it can be safely accomplished. D. The funding of the Chapter 55 placements to Samaritan Health Center has not been

determined to date.

COST: A. Unknown

ATTACHMENT:

A. Memorandum of Understanding (MOU) RECOMMENDATION:

A. None

SAMARITAN COMMITTEE REPORT To: Samaritan Committee Members From: Matt Furno, Samaritan Campus Administrator Date: May 21, 2015 RE: Chapter 55 Protective Placement at the Clearview Facility ACTION QUESTION:

A. What is happening with the Chapter 55 protective placements for Washington County residents whenever the Samaritan Health Center can not safely admit?

DISCUSSION:

A. The Samaritan Health Center has admitted 5 Chapter 55 protective placements in 2015. B. The members of the Washington County Chapter 55 Task Force met with Jane E.

Hooper, Administrator of Clearview – Dodge County Specialized Nursing Home and Mental Illness Center. This meeting took place to ascertain the possibility of contracting for back-up coverage regarding Chapter 55 protective placements.

C. We are evaluating the costs and benefits to Washington County with problematic Chapter 55 placements to Clearview.

D. There has been an Alliance [Marsh Country Health Alliance (MCHA)] established by Clearview with other counties addressing this issue.

E. On August 31, 2015 there will be a special joint meeting of the members of the MCHA and the MCHA Commission Board. At this meeting, the request of Washington County will be addressed. If possible, a committee member from the Health & Aging Committee, Human Services Board, and the Samaritan Committee along with an employee from each department should attend the joint meeting.

F. Meeting Date: August 31, 2015 at 10:00 PM in Rooms 1H and 1I, at the Dodge County Administration Building, located at 127 East Oak Street, Juneau, Wisconsin

G. The funding of the Chapter 55 protective placements to Samaritan Health Center and/or to the Clearview Facility has not been determined to date.

COST: A. Unknown

ATTACHMENT:

A. Special MCHA Joint Meeting Agenda B. MCHA Policy Statement and Procedure

RECOMMENDATION:

A. Washington County should consider the possibility of contracting with Clearview to care for Chapter 55 residents who are beyond the care scope of the Samaritan Health Center.

MCHA\County of Responsibility

MARSH COUNTRY HEALTH ALLIANCE

PROCEDURE: Determination of County of Responsibility POLICY STATEMENT: Prior to admission to Clearview or the Individuals with Intellectual Disabilities household, all residents who are not MCO members (regardless of pay source) will be screened to determine county of responsibility for purposes of determining responsibility for the appropriate Marsh Country Health Alliance Assessment Rate. PROCEDURE: 1. Clearview staff will review all potential admissions to determine county of responsibility.

They will consider the following factors in this review:

a. Is the resident protectively placed by a specific county? b. Is the resident under a Chapter 51 commitment to a specific county? c. If neither a. nor b. apply, what was the resident’s last permanent non-institutional

address (institutional address is defined as Nursing Home, Individuals with Intellectual Disabilities, Adult Family Home, Community Based Residential Facility, Resident Care Apartment Complex)?

2. If the resident to be admitted to Clearview had either a protective placement order or

Chapter 51 Commitment Order through a specific county, then that county would be the responsible county to pay the “assessment rate.”

3. If one of these legal orders does not exist, then the county of responsibility for that

resident would be the county of origin where their last known, non-institutional address was and, therefore, would be the county responsible for paying the “assessment rate.”

4. If the resident is not actually referred by the county determined to be the county of

responsibility (i.e. 1.a. or 1.b. above), Clearview staff will notify the county determined to be the county of responsibility prior to admission of the resident. The notification will include a description of how the determination of county of responsibility was made. Exceptions may be made for short term or respite admissions. The county of responsibility will determine if they wish to initiate case management upon admission.

5. Once the county of responsibility has been established using the above criteria, and they

have in turn been notified that they will pay the “assessment rate,” this determination will not change under any circumstances, and the member county of MCHA will continue to pay the “assessment rate” for that individual as long as that individual is a resident of Clearview, and regardless of whether a court has made an adjudication that the person is a resident of another county and regardless if the State of Wisconsin or another entity or person has made the determination that the individual is a resident of another county.

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MCHA\County of Responsibility

6. Marsh Country Health Alliance member counties have the right to appeal this determination to the Marsh Country Health Alliance Board by submitting a written statement of the appeal to the Commission Board. Unless the appeal is received by the Commission Board within thirty (30) days of the Commission Board’s next scheduled meeting, the Commission Board shall consider the receipt of the appeal as a request for a special meeting of the Commission Board under Section 4.07 of the Intergovernmental Cooperation Agreement, which meeting shall be scheduled as provided therein with the appeal being placed on the agenda as an item of business. If the appeal is received by the Commission Board within thirty (30) days of the Commission Board’s next scheduled meeting, the appeal shall be added to the meeting agenda. A majority of the Commission Board in attendance at the meeting where the determination is noticed for business shall have the authority to affirm or overrule, in whole or part, the initial determination of county of responsibility.

Any person wishing to attend who, because of a disability, requires special accommodation should contact the Dodge County Clerk’s Office at (920) 386-3600, at least 24 hours before the scheduled meeting time so appropriate arrangements can be made. The building entrance which is accessible by a person with a disability is located on the south side of the building adjacent to the parking lot. MCHA\Agenda 6-29-15

Notice of “Special” Joint Meeting of the Marsh Country Health Alliance Commission Members and the Marsh Country Health Alliance Commission Board

There will be a special joint meeting of the Marsh Country Health Alliance Commission members and Commission Board on Monday, June 29, 2015, at 10:00 a.m., in Rooms 1H and 1I, at the Dodge County Administration Building, located at 127 East Oak Street, Juneau, Wisconsin.

Agenda for this special joint meeting is as follows:

1. Call to order by Chairman 2. Roll Call

3. Approve Minutes from August 26, 2014 Annual Meeting and February 24, 2015

Quarterly Board Meeting

4. Discussion and Possible Action of Determination of County of Responsibility

5. Washington County and Outagamie County Membership

6. Discussion of Assessment Methodology and Audit for Placement

7. Assessment Rate Setting for 2016

8. Next Meeting Date: Annual Meeting on August 31, 2015, at 10:00 a.m.

9. Adjourn

*(920) 386-4172 is the call-in number if you cannot attend in person - limited to 12 call-ins total