Sandhills Center for MH, DD & SAS

Sandhills Center for MH, DD & SAS

Consumer and Family Advisory Committee

August 21, 2012

Present: Michael Ayers, Stephen Cohen, Loida Colonna, Leann Henkel, Ron Huber, Marianne Kernan, Chris Laughlin, Beth Ann Mellinger, Anthony Pugh, Lori Richardson, Irma Robledo, Ron Unger and Ashley Wilcox

Excused Absence: Debra Collins, Elaine Hayes and Libby Jones

Unexcused Absence: Carol DeBerry and Allen Little

SHC Staff Present: Mike Markoff; Customer Service Coordinator, and Joni Nall; Customer Service Administrative Assistance

Guests: Anthony G. Carraway, M.D., Medical Director/Chief Clinical Officer; Wendy Deacon, CM/UM Manager; Pam Morgan, Medicaid Waiver Contract Project Coordinator; Carol Robertson, QM Director; Eric Fox, Division Representative and Stacey Harward, Consumer Empowerment Team staff member.

Presenter & Topic / Discussion / Outcome/Follow-Up Plan /
Ron Huber, CFAC Chairperson
·  Call to order
·  Review of Minutes
·  Vote in Member / Ø  The meeting was called to order at 6:15 p.m.
Ø  Ed Daniels requested to rejoin the CFAC committee following health problems which have improved at this time.
A motion was made by Ronald Unger and seconded by Marianne Kernan to accept Edward Daniels
as a member of the CFAC committee. The motion carried. / The June 19, 2012 minutes were reviewed and a motion was made by Ronald Unger and seconded by Marianne Kernan to accept the minutes as written.
The motion carried.
Anthony G. Carraway, M.D. – Medical Director/Chief Clinical Officer –
·  Clinical Advisory Committee – Overview / Ø  Dr. Carraway presented a PowerPoint presentation outlining the following information regarding the Clinical Advisory Committee:
·  Purpose – A forum for discussion and approval of clinical treatment practices and community standards of care that are used in the SHC provider network. Additionally, the committee will serve a collaborative/consultative role for all clinical departments of the SHC MCO/LME.
·  Subcommittees – Credentialing, Provider Disputes/Appeals
·  Membership – In Network Licensed Practicing Clinicians; Out of Network Licensed Practicing Clinicians who reside within the SHC geographic area ad who will service as Community Experts and The SHC Clinical Leadership Team.
Wendy Deacon, CM/UM Manager
·  Care/Utilization Management Service Certification Request Reviews
·  Service Code Description Support Tool / Ø  Wendy outlined the following information on the SHC Care/Utilization Management Service Certification Request Reviews:
·  Certification Review Types, Materials to Submit and When
·  Direct Bill Services (not initially requiring a TAR submission)
·  Services Requiring a TAR submission
·  This report provided a Legend, which helped the committee understand the multiple abbreviations and their meaning.
·  B-3 Services that also require the identified documentation.
Ø  Wendy presented the Service Code Description Decision Support Tool with an overview of the following:
·  Review Type – Initial/Prospective – 1st, 2nd, 3rd Concurrent and Additional Reviews
·  Age Requirements – Service Restrictions – Dx Requirements – CALOCUS/LOCUS – ASAC
·  Tx History – Medication Review – Updates: LOCUS/ASAM/PCP – Cert Utilization Ratio
·  Certification Level / Michael Ayers requested a list of abbreviations and definitions used by SHC. Mike Markoff directed the committee to the SHC website for a glossary of abbreviations and following the meeting, Mike sent Michael Ayers copies of NCDHHS a (30) page glossary and an addition abbreviations and symbols list. These lists will be included in September’s CFAC packets.
Pam Morgan, Medicaid Waiver Contract Project Coordinator – Medicaid Waiver Update / Ø  Pam informed the committee the Sandhills Center Operations/Readiness Review will be conducted on August 24, 2012 which is approximately 30 days from our “go live” date of October 1, 2012. SHC has submitted the requested desk top review materials, along with the Plan of Correction on items from the March visit.
Ø  Our Information Technology Section has identified data analyst staff within the Departments. Finance/Claims analysis, along with HP Enterprises, are developing the necessary capability to review claims data to assure correctness of payments.
Ø  SHC has a Clinical/Financial Risk Management Team that meets weekly. The Team is guided by a Clinical/Financial Risk Management Plan and chaired by our Medical Director/Chief Clinical Officer.
Ø  SHC is developing all of the management reports required by the DMA Contract.
Ø  Authorization guidelines have been developed and staff has been oriented. / Three of our CFAC members will be participating in the August 24, 2012 review: Anthony Pugh, Lori Richardson and Ron Unger.
Carol Robertson, QM Director – Quarterly Incident Report – 4th Qtr. (April – June 2012) / Ø  Carol provided the committee with the SHC Level II and III Quarterly Incident Report – 4thd Quarter
detailing the following information:
o  Type of Incident: Level II - 186, Level III - 16 = 202
o  Consumer Deaths: Level II - 6, Level III - 4
o  Restrictive Interventions: Level II - 19
o  Consumer Injuries: Level II - 30
o  Allegations of Abuse, Neglect, Exploitation: Level II - 42, Level III - 6
o  Consumer Behavior and Other Incidents were outlined
·  No further trends or patterns were noted in the types of providers submitting reports or the consumers representing the reports.
·  All Level III Incidents are reviewed by the Critical Incident Report Sub-Committee on a monthly basis. These reports that involve a need for a higher level of care are also presented to the Sub-Committee. Information regarding Level III Incidents is forwarded to Dr. Carraway when received by the Incident Reporting Manager. / The committee requested a detailed report regarding the incident reports in which a member died specifically those with the notation that their death was “unknown”. This report is being presented to our Client Rights committee next month and will be included in our CFAC packets nest month.
Carol Robertson, QM Director – Quarterly Monitoring Reports –Routine & Targeted - 4th Qtr. (April – June 2012) / Ø  Carol presented the following overview of the quarterly monitoring reports as follows:
·  Routine: 1 Provider was monitored during this reporting period
4 AFL site reviews
·  Targeted: 35 referrals for Targeted Monitoring were received
o  16 from Incident Reports
o  4 from First Responder/After Hours calls
o  15 from Complaints
Carol Robertson, QM Director – Quarterly Complaint Report – 3rd Qtr. (January - March 2012) / Ø  Carol reviewed the Quarterly Complaint Report - 3rd Quarter outlining the following:
·  Summary of Complaints Made
o  19 Received by LME
o  13 By or On Behalf of a Consumer
o  6 Not by or On Behalf of a Consumer
·  Re: Primary Nature of complaints
o  6 Abuse, Neglect, Exploitation
o  3 Quality of Care
o  5 Access to Services
o  1 Other Issues
o  4 Administrative Issues
Information was provided outlining: person making complaint, age of consumer, disability of consumer, primary nature of complaint and type of services.
·  Summary of Actions Taken and Final Disposition
o  14 Resulted in an Investigation
o  5 Did Not Result in an Investigation
o  3 Investigations were Substantiated
o  5 Partially Substantiated
o  6 Not Substantiated
Information was provided outlining: complaints not investigated final dispositions and number of working days from receipt by LME to completion.
·  Total # of working days to resolve - 0-30 days (13)
·  Total # of working days to resolve – 31-60 days (4)
·  Total # of working days to resolve – 61-90 days (2)
Ø  Examples of how the LME is analyzing patterns and using complaint data including, were presented for both quarterly reports:
o  Analyses (patterns)
o  Strategies Developed
o  Actions Taken
o  Evaluation of Results of Actions Taken
o  Next Steps
Ø  Charts and graphs were presented detailing each complaint received for the quarter.
Ø  Carol provided comparison data from same quarter last year.
Mike Markoff, Customer Service Coordinator – Consolidated Balance Sheet and Income Statement – July 31, 2012 / Ø  Reviewed SHC Consolidated Balance Sheet and Income Statement dated 07/31/12, noted the following:
·  Total Revenues (YTD) $ 3,167,966
·  Total Expenditures (YTD) $ 2,217,313
·  Change in Fund Balance (YTD) $ ( 950,653)
Eric Fox, Division Representative - Consumer Empowerment Team Updates – August 2012 / 1.  . As per legislation, CFAC members who had their second terms end on or before July 11th, 2012 must rotate off the CFAC. CFAC members actively serving on July 12, 2012 are now eligible to serve a third, three year term.
2.  The following are updates within the leadership of DHHS:
a.  Mike Watson is now the Director of DMA
b.  Beth Melcher is now the Deputy Director of Health & Human Services
c.  Jim Jarrard is now the Acting Director for MH/DD/SAS
d.  Luckey Welch is the Director of DSOHF (Division of State Operated Healthcare Facilities) and the Director of Cherry Hospital
3. The CFAC shall undertake all of the following:
(1) Review, comment on, and monitor the implementation of the local business plan.
(2) Identify service gaps and underserved populations.
(3) Make recommendations regarding the service array and monitor the development of additional services.
(4) Review and comment on the area authority or county program budget.
(5) Participate in all quality improvement measures and performance indicators.
(6) Submit to the State Consumer and Family Advisory Committee findings and recommendations regarding ways to improve the delivery of mental health, developmental disabilities, and substance abuse services.
How CFACs accomplish this:
a. receive information from the community, LME/MCO, Division
b. process, analyze, and prioritize the information (use of workgroups)
c. make comment to the Board (advise)
4. Tenancy Support Team Service will be a new state funded service available soon. There are training requirements. The service will be staffed by a team of 3 members, a QP (Qualified Professional) and 2 Peer Support Specialists. This will hopefully provide some support regarding housing to individuals affected by displacement due to the IMD (Institute of Mental Disease) rulings.
5. DWAC (Departmental Waiver Advisory Committee) met on July 24th. The primary topics of discussion were the SIS (Supports Intensity Scale) and Complaints and Grievances. The next DWAC meeting will be on Tuesday, August 28th from 1-3pm at the McKimmon Center in Raleigh. Committee membership, meeting minutes and other info available at http://www.ncdhhs.gov/mhddsas/providers/1915bcwaiver/dwac/index.htm
6. The next State and Local CFAC phone call will be on Wednesday, August 15th from 7:00 pm to 8:00 pm. All CFAC members are invited to listen but it is asked that only the Chair or selected designee speak during the conference call. The number is 1-888-273-3658. The access code is 2490768#.
7. A total of 4 LME/MCOs (57 counties) have gone live under the Waiver: PBH which is now Cardinal Innovations Healthcare Solutions, Western Highlands as of 1/1/12, ECBH as of 4/1/12, and Smoky Mountain as of 7/1/12. Sandhills Center is scheduled to go live on 10/1/12. The remaining 6 entities are all scheduled to go live on 1/1/13.
8. Information about the implementation of the 1915 b/c Waiver can be accessed at the following link: http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/index.htm
9. Consumers and family members can voice their concerns about the Waiver.
Voice concerns through their CFAC Chair or representative who is the active member at the monthly IMT (Intradepartmental Monitoring Team) meetings and at public comment time at local Area Board meetings, DWAC (Department Waiver Advisory Committee) and State CFAC meetings.
Committee Reports / Ø  It was brought to our attention, the following CFAC members attended Suicide Prevention 101 presented at Sandhills Center on August 3, 2012: Carol DeBerry, Lori Richardson and Loida Colonna.
Announcements / Ø  Eric Fox will no longer be assigned to The Sandhills Center as the Consumer Empowerment Team contact. Eric was presented with a Service Award from the committee in appreciation for years of dedication and service advocating for Mental Health. Sandhills Center and the CFAC members will certainly miss Eric as he always kept everyone very informed and also truly cared about our members.
Ø  Stacey Harward will become the new Consumer Empowerment Team contact beginning September 2012.
Ø  Ron Huber requested an AD-HOC committee be formed to review the NC Innovations Managing Employer Handbook – Effective October 1, 2012. Each CFAC member was given a hard copy of the handbook and was emailed an electronic version as well. CFAC members were asked to review the handbook for any revisions they find and bring them to the September 2012 CFAC meeting, as Tena Campbell will be in attendance.
Ø  Community Stakeholder’s Breakfast in Richmond County, scheduled for Thursday September 20, 2012. / The AD-HOC committee members for the NC Innovations Managing Employer Handbook will be LeAnn Henkel, and Michael Myers.
The Richmond Co. Stakeholder’s Breakfast has 3 CFAC members volunteering to attend: Ed Daniels, Lori Richardson and Ronald Unger.
Handouts / Ø  SHC CFAC Meeting Minutes dated 6/19/12.
Ø  Service Code Description Decision Support Tool
Ø  PowerPoint Handouts re: Clinical Advisory Council – Brief Overview
Ø  Care/Utilization Management Service Certification Request Reviews
Ø  SHC Consolidated Balance Sheet and Income Statement July 31, 2012
Ø  Consumer Empowerment Team Updates – July 2012
Ø  SHC Chief Executive Officers Report dated 8/14/12
Ø  SHC Board of Directors Meeting Minutes 7/10/12
Ø  NCDHHS Special Implementation Update #99 – dated 7/09/12
Ø  NC Medicaid Special Bulletin – July 2012
Adjournment / A motion was made by Irma Robledo to adjourn the meeting and was seconded by Chris Laughlin. The motion carried.
Future Meeting / The next CFAC meeting will be held on September 18, 2012 at 6:15 p.m.
Submitted by: Joni Nall

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