name: Roseau, MN Telephone #:

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1 Roseau County: County administration: Agency name: Director's name: Address: Human Services Roseau County Social Services David Anderson 208 6th Street SW Public Health Agency name: LifeCare Public Health Director's name: Address: Julie Pahlen 715 Delmore Drive Roseau, MN Roseau, MN Telephone #: County agency contacts: Area of Responsibility Name Title Telephone # Social services Karla Langaas Social Work Supervisor Public health Julie Pahlen Director Mental health Karla Langaas Social Work Supervisor Chemical Karla Langaas Social Work Supervisor dependency Transportation Jodee Haugen Financial Assistance Supervisor County Demographics Roseau County has a rather unique economic situation in that two major employers (Polaris and Marvin Windows) are both located in the county, providing a total of approximately 5,000 jobs to a relatively small population base. The county population is approximately 16,000 persons. What this means is that when either of these two major employers experiences a down turn in sales, the ripple effect is quite significant. The flip side of this, of course, is that the significant number of people employed by these two manufacturers provides a positive economic base for Roseau County. There are few ethnic minorities in Roseau County, the most significant being approximately 225 Southeast Asian, and about 350 American Indians. There are a very few older Lao family members who do not speak English; and so far, all have family members who provide translation services for them. County Service Delivery and Access Issues Located on the Canadian border, Roseau County is largely a rural county. The population tends to be centered around four towns, all located on Minnesota Highway 11. The nearest large towns are Grand Forks, ND and Bemidji, MN, both about 135 miles away. Thief River Falls, MN is 64 miles away and Roseau County residents also make use of the medical and mental health services there. Residents have access to limited specialty medical services in our local clinic located in Roseau. Other specialty services are accessed at Sanford in Thief River Falls or Altru in Grand Forks. Lifecare Roseau offers

2 kidney dialysis for some patients as deemed appropriate for their setting. There is limited public transportation within our county, and none to towns outside our county. There are two providers of public transportation: Far North Transit and Senior Medical Travel. Both operate throughout the county and Senior Medical Travel provides transportation to other cities for senior citizens needing transportation. MCO(s) must identify how they will address this issue through an accessible service network within the county. Health Care services currently unavailable or of limited availability to the county s MA recipients: There is difficulty accessing dental services; there is no radiation therapy for cancer patients (also a trip to Grand Forks;) and other specialty services are not always available, however, the aforementioned items are the issues we hear about most often. Other health care resources, service and access issues affecting Roseau County s MA recipients: Medical specialties are generally not available locally. If a specialist is needed for a patient, the usual referral is to Grand Forks, and occasionally to the Twin Cities. Dental There are approximately six (6) dentists providing care in Roseau County. The issue is that they take a limited number of MA patients. Specialty dental services (surgery, orthodontic) are generally not available locally. County recipients use any of the dentists available locally or in the surrounding area that will accept MA. Some MA enrollees go to a provider in Deer River or Fergus Falls. The MCO(s) are encouraged to contract with the local dentists in such a fashion that they would accept more MA patients. Chemical Dependency There is currently one (1) outpatient provider in Roseau County, Glenmore Recovery Center. Persons on MA are generally eligible for funding through the Consolidated Chemical Dependency Treatment Fund, (CCDTF) and thus are assessed and referred to treatment programs based on their level of problem, treatment provider dynamics, and other individual needs. At this point, in reality the only issue is local lack of choice, which is probably not economically feasible given the low numbers in outpatient therapy at any one time. Roseau County provides Rule 25 assessments by agency staff. The county thinks it would be ideal to have a local detox (currently we use Glenmore which is 110 miles away) and a local halfway house (closest is Glenmore in Thief River Falls, 65 miles away.) However, it is unlikely that the MCO(s) would be able to justify either of those services, given the fairly low number of persons using these services. Mental Health Services Roseau County values and supports a spirit of cooperation and an integrated approach to providing services. MCO(s) are asked to assure continuity of care for individuals receiving mental health services. LifeCare Medical Center Behavioral Health in Roseau employs one Licensed Psychologists and three Licensed Social Workers. The major employers have Employee Assistance Plans to assist their employees needing mental health services. Roseau County s major mental health provider is the Sanford Medical Center Thief River Falls. It holds a Rule 29 license and provides a variety of mental health services. These include individual, group, family, and marital counseling, psychological and psychiatric evaluations, court-ordered evaluations, acute mental health hospitalization, and secure beds. The majority of Roseau County police holds are transported to the Sanford Mental Health Division. We contract with the division to

3 deliver Adult Community Support Programs, and for two therapists to come into our county twice a month to work with high risk children. We also contract with the Division to provide a 24 hour mental health hotline. We also provide office space for a Physician s Assistant from that Mental Health Unit to be in Roseau one day per month to see local patients. We also participate collaboratively with Sanford and LifeCare to provide crisis mental health services which activate a mental health crisis team with coverage 24 hours per day. Mental Health patients needing a long term inpatient stay are referred to the state CBHHs. Roseau County holds contracts to provide Family-Based Intensive In-Home Services. Lutheran Social Services and Sanford Medical Center are the providers of In-Home Services. This is a M.A. billable service. MCO(s) need to describe how they will work to develop treatment plans and assure continuity of care for this population. Roseau County provides case management services for adults with serious and persistent mental illness and to children with severe emotional disturbance. We conduct pre-petition screenings for commitments and adult protection assessments. As the County Mental Health Authority under the federal OBRA statute, we screen applicants to long-term care facilities to determine mental health needs. Provider Contact Person Address Phone LifeCare Medical Center Jan Carr 715 Delmore Drive Roseau, MN Sanford Medical Center TRF DeeJay Donlin 120 LaBree Thief River Falls, MN Northern Lights Halfway DeeJay Donlin 120 LaBree House Thief River Falls, MN Lutheran Social Services Patty Kline 627 Center Ave. Suite Moorhead, MN Northwestern Apartments Shauna Reitmeier 100 Gretchen Lane Crookston, MN Crisis and Emergency Services. All reports of child abuse are investigated by Social Services and Law Enforcement. Adolescent sexual abuse offenders and victims are seen by a Sanford Medical Center TRF psychologist at our office; third-party reimbursement is sought. Vulnerable adults are to be reported to the County Social Services Common Entry Point (CEP) during office hours and to Roseau County Law Enforcement after hours. The CEP receives the report, screens the information to determine what response is indicated and to which agency the report should be referred. Roseau County Social Services Roseau County Law Enforcement Adults in crisis or requiring emergency services are seen by a county social worker during office hours, County Law Enforcement or City Police after hours. When hospital Emergency services are required, LifeCare Roseau is used. Other resources, including the Mental Health Division of Sanford Medical Center Thief River Falls and Altru Hospital in Grand Forks and Prairie St. John in Fargo, ND may be used on a case by case basis. Patients are transferred by ground and air ambulance to Altru Hospital. The MCO(s) should indicate how they plan to coordinate their efforts with agencies and providers that respond to crisis situations and provide emergency services.

4 Roseau County seeks responsiveness from MCO(s) staff and providers in issues involving the Court system including family and criminal court proceedings, pre-petition screenings, commitment hearings, and other issues including court-ordered treatment. The MCO(s) must indicate how it will work with the County to provide timely response to these issues, including sharing information and being present at hearings if required. Transportation There is no common carrier transportation into or out of Roseau County. At the present time, clients who use their own vehicles for their medical appointments are reimbursed by the county for their mileage after prior authorization by their eligibility worker. Clients who do not have access to their own vehicles or other means are referred to the transportation providers listed below: (includes those with county contracts) MCO recipients must have prior authorization from MCO(s) for medical transportation. Far North Transit provides public bus service to county residents. Flexible and fixed routes are available for passengers in and between the cities of Roosevelt, Warroad, Salol, Roseau, Badger, Greenbush and Strathcona. Reservations are necessary at least one day in advance. Buses are handicapped accessible. Far North Transit Senior Medical Travel coordinates volunteer drivers to provide medical transportation services to elderly and disabled individuals. Transportation for in-county and long-distance medical services are provided on a fee-for-service basis. MCO(s) need to cover ground and air ambulance in medically necessary situations. MCO providers are requested to ensure access and attention to transportation issues due to the distance and rural nature of Roseau County, and need to coordinate with the above providers. Public Health LifeCare Public Health has expressed strong commitment to assuring that the health care needs of its residents are met. LifeCare Public Health has expressed strong interest in working with MCO(s) LifeCare Public Health has made efforts to expand and improve services to individuals and families in the home and community. The MCO(s) must work closely with LifeCare Public Health to insure that services are made accessible for the high risk populations. The populations typically served by LifeCare Public Health include: young parents and single first time parents families with a history of child neglect and abuse children who are behind on their immunization schedule all families with newborns all post-partum mothers low income pregnant and breast-feeding women low income children under age 5 who are at nutritional risk families with multiple needs elderly, frail, ill and disabled of all ages individuals of diverse cultures LifeCare Public Health has developed special expertise in serving many parts of the populations

5 eligible for Medical Assistance and MinnesotaCare. It is recommended that MCO(s) make use of this expertise in its contract arrangements for providing health care services to the residents of Roseau County. The services which LifeCare Public Health currently provides either in the home or at clinic sites include: newborn home visits for health assessment and referral when needed medication set-up and compliance assessment immunization clinics/mn Vaccine for Children health promotion and education including work site services prenatal teaching home visits to maternal clients Child and Teen Checkup outreach, screenings and follow-up public health nursing clinics communicable disease services and follow-up jail health services Preadmission Screening early childhood pre-school screening school health (K-12) flu shot clinics home health care/skilled nursing foot care clinics home health aide services home maker/chore services respite occupational therapy physical therapy PCA assessments insurance assessments infant/child health IC senior health education Headstart health screenings AIDS/HIV resource hospice lactation consultant Communities Caring for Children LifeCare Public Health targets population-based interventions focused at the individual, community or system level. Sites used for nursing service include: clinics communities at large correctional facilities day care homes homes hospitals local and state government schools work sites

6 Functions that LifeCare Public Health performs routinely are: advocacy case management collaboration community organizing consultation disease investigation health teaching policy development outreach referral and follow-up screenings surveillance delegated medical treatment and observation In accordance with Minnesota Statutes, 256B.031, subdivision 10 (b), each MCO(s) will be required to develop a contractual relationship with public health agencies. LifeCare Public Health seeks to contract with the MCO(s) to provide services for Roseau County MA recipients. The contract must clearly delineate the criteria for referral to the public health agency and the specific services the public health agency is authorized to provide. The MCO(s) will be required to share county specific information on outcomes and utilization. Among the information requested by counties is data on birth outcomes, prenatal care, C&TC screenings and immunizations. The MCO(s) will collaborate with the public health agency to comply with the MN Vaccine for Children Program. They must include the public health clinics for access to childhood immunizations and C&TC screenings. LifeCare Public Health would provide the following services: home health services diagnostic, screening & preventative services personal care nursing supervision nursing assessment & diagnostic testing nursing treatment administration of injections child and teen checkups skilled nurse visits physical therapy public health nurse services personal care services personal care nursing assessment health promotion and counseling medication management immunizations prenatal high risk services home health aide visits occupational therapy Core Government Function Roseau County Commissioners have delegated core governmental functions to LifeCare Public Health. These functions include assurance, assessment, and policy development. Identification of Limited or Unavailable Health Care Services Adult Day Care Extended home health care hours Corporate Adult Foster Care homes Transportation Adult foster care homes Identification of Community Health Care Planning Efforts and Other Local Projects In 1997 LifeCare Medical Center conducted a needs assessment to determine the unmet needs of the senior population. The next step is a feasibility study.

7 Ongoing councils and projects: Roseau County Early Intervention Interagency Committee Roseau County Local Advisory Committee on Adult and Children s Mental Health Let s Celebrate Families (Child Abuse Prevention Council) Healthy Communities Identification of Local Public Health Goals (Optional) a. Promote healthy lifestyles. b. Promote healthy families. c. Promote the highest level of functioning for ill and disabled people of all ages. d. Prevent and control infectious diseases. Ongoing Communication In order to ensure the viability of the managed care system in Roseau County, it is important to identify at the outset a communication process in which the needs of the h MCO(s), county and DHS are carefully considered. Among the essential components of this ongoing communication process are the following: * The MCO(s) must agree to meet with state and county staff at least monthly during the first 6 months of implementation and be available as requested on a quarterly basis thereafter to discuss and resolve service delivery issues or enrollment issues specific to the county. * A list of contact persons at the county whom the MCO(s) can access for a variety of social service, mental health and public health coordination needs. Providers MA clients may access any provider who is certified by DHS as an MA provider. A list of providers accessed by Roseau County enrolled in a MCO(s) is available in the attached file at the end of the county sections.