Dave Beck, Ed LaFramboise, Greg Paffhouse, Dave Schneider, Sara Sircely, Carol Balousek

Transcription

1 NORTHERN MICHIGAN REGIONAL ENTITY MEETING OF THE BOARD OF DIRECTORS WEDNESDAY, JULY 23, :00AM CROSS STREET CONFERENCE ROOM GAYLORD BOARD MEMBERS IN ATTENDANCE: BOARD MEMBERS ABSENT: STAFF IN ATTENDANCE: PUBLIC IN ATTENDANCE: Roger Frye, Ed Ginop, Randy Kamps, Gary Klacking, Terry Larson, Jack Mahank, Gary Nowak, Jay O Farrell, Dennis Priess, Richard Schmidt, Karla Sherman (via conference call), Joe Stone, Don Tanner, Nina Zamora Annie Hooghart Dave Beck, Ed LaFramboise, Greg Paffhouse, Dave Schneider, Sara Sircely, Carol Balousek Jenny O Farrell, Sue Winter Call to order Mr. Stone called the meeting to order at 10:00AM. Roll Call Let the record show that Annie Hooghart is absent for today s meeting. All other members are recorded as present noting that Karla Sherman is attending via conference call. Pledge of Allegiance Let the record show that the Pledge was recited as a group. Approval of Past Minutes The June meeting minutes were included in the meeting packet and were reviewed. A typo was noted and a mistake in a motion/support will be corrected. A discussion about the motion to review the Bylaws with no recommended changes followed. It was determined it was accurately recorded. MOTION MADE BY NINA ZAMOREA TO APPROVE THE JUNE 25, 2014 NMRE BOARD MEETING MINUTES, SECOND BY ROGER FRYE. MOTION CARRIED. Approval of Agenda Mr. Schneider reviewed the meeting Agenda. Discussion of smoothing will be added as (b) under Old Business. MOTION MADE BY DENNIS PRIESS TO APPROVE THE AGENDA, SECOND BY JACK MAHANK. MOTION CARRIED. Correspondence The Summer 2014 NMRE Consumer Newsletter was included in the packet for the meeting on this date. Mr. Schneider discussed the MDCH/PIHP Contract Attachment to allow for the provision of Medicaid State Plan Health Home Services for Individuals with Behavioral Health Conditions. This will be discussed in more detail under New Business on the Agenda.

2 Announcements Let the record show that no announcements were made on this date. Public Comment Let the record show that there was no public comment on this date. Reports Board Chair Report Mr. Stone announce that he attended the Chairpersons meeting of the Regional Entities. A protocol was drafted for Regional Entity Directors to join MACMHB with voting privileges. The protocol will be going before the Executive Committee. In Mr. Stone s estimation, the NMRE is above schedule when compared to other Regional Entities in the State. Mr. Stone mentioned that other Regional Entities are essentially being run by the CMH Boards. Mr. Tanner asked how much longer that can go on. Mr. Stone responded that he feels Department is making it clear that the PIHPs are established to perform separate functions. In time, consistency is expected. Mr. Mahank asked why the Department seems to be sending one message to CMH Directors and another message to the Regional Entities. Mr. Schneider responded there is clearly a mixed message though it may become clearer after the November elections and expects moving forward with the SIM Model will be a priority after November. The minutes of the July 11 meeting of CMH Directors was requested. Mr. Kamps asked Mr. Paffhouse whether he also perceives a difference in the message being conveyed to the CMHs vs. the PIHP. Mr. Paffhouse responded affirmatively. CEO s Report Mr. Schneider included his report in the packet for the meeting on this date. Mr. Schneider called attention to the ISCAT review by HSAG which was held on July 17, 2014 to review the validity of the processes of reporting Performance Indicators. Overall the results were positive though more information will be requested next year. Representatives of the Office of the Inspector General visited the NMRE on July 14, The NMRE was the first PIHP to be visited though the intent is for the team to visit all ten PIHPs. Data is being collected for analysis and to aid in quality improvement. Mr. Mahank inquired about the June 22, 2014 meeting to learn more about the SIM project. Mr. Schneider responded the Health Departments have gone through the process and are receptive to including the PIHP in discussions. Mr. Tanner added the Health Departments are undergoing a sharing process, but is lacking the input of behavioral health. MOTION MADE BY JACK MAHANK TO RECEIVE AND FILE THE CEO S JULY 2014 REPORT; SECOND BY RICHARD SCHMIDT. MOTION CARRIED. SUD Services Transition Committee The minutes of the July 17, 2014 meeting of the SUD Transition Committee were included in the packet for the meeting on this date. Two action items will be discussed later in the agenda under New Business. New Business Health Home Contract Amendment Section of the MDCH/PIHP Master Contract was included in the packet for the meeting on this date. Mr. Schneider noted a problematic issue in his cover letter with the signed Amendment. Bullet three pf , Services provide by the PIHP, states: forward the entirety of all HHBH payments received from MDCH to the designated CMHSP Health Home (less any amount required to satisfy applicable HICA and/or Use tax) Mr. Schneider responded: It is problematic for two

3 reasons First there is clearly a PIHP administrative expense related to the health home program, I believe that such costs must be charged to this discreet funding stream. Second, we were told early in the planning, that a portion of the case rate identified for administration could be used by the PIHP. Clarification is being sought from the Department. Report on Executive Limitations Mr. Schneider included his report on Executive Limitations in the packet for the meeting on this date per the approved Board Calendar. Mr. Schneider offered to supply more detail as requested. Each limitation was reviewed in order. 1) General Executive Constraint Mr. Schneider asked, How do I document a negative? He reported no illegal or imprudent activities and no violation of common business practices or professional ethics. 2) Treatment of Clients Mr. Schneider noted that site reviews have not been completed for the five Member CMHSPs so he deferred to site reviews conducted by MDCH and the Health Services Advisory Group (HSAG). Mr. Mahank asked Mr. Stone if the Board should weigh in on compliance with each issue. Agreement was made for the Board Members to do so. MOTION MADE JACK MAHANK TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER TWO AS WRITTEN; SECOND BY RANDY KAMPS. MOTION CARRIED. 3) Treatment of Staff Mr. Schneider stated that under the current arrangement staff is leased by two of the Member CMHSPs and subject to those leasing Boards. MOTION MADE JACK MAHANK TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER THREE AS WRITTEN; SECOND BY DON TANNER. MOTION CARRIED. 4) Budgeting Mr. Schneider stated that processes are being developed and issues are being addressed as they are identified. MOTION MADE BY ROGER FRYE TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER FOUR AS WRITTEN; SECOND BY ED GINOP. MOTION CARRIED. 5) Financial Condition Mr. Schneider expressed no violations of the limitations related to Financial Condition. MOTION GARY NOWAK TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER FIVE AS WRITTEN; SECOND BY JAY O FARRELL. MOTION CARRIED. 6) Asset Protection Mr. Schneider reported that bank accounts are at reputable institutions however amounts are not kept under the FDIC insurable amount of $250K. Mr. Mahank said if this is not a prudent business practice then the wording of the Executive Limitation should be changed. Mr. Kamps voiced in favor of changing it. A template to evaluate banks has been shared with the NMRE by

4 Centra Wellness Network. Mr. Schneider proposed discussion the matter further with the Finance Directors during the August 12 th Finance Committee meeting. MOTION MADE JACK MAHANK TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED PARTIAL COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER SIX AS WRITTEN AND WILL WORK COLLABORATIVELY WITH THE FINANCE COMMITTEE TO EITHER 1) BECOME FULLY COMPLIANT, OR 2) RECOMMEND SUGGESTED REWRITE OF THE EXECUTIVE LIMITATION ; SECOND BY GARY KLACKING. MOTION CARRIED. 7) Compensation and Benefits Mr. Schneider stated compliance with the Executive Limitation. He stated the staff leased by North Country CMH are paid in accordance with its salary schedule and benefit structure and the staff leased by Northern Lakes CMH are paid consistent with its salary schedule and benefit structure. The Chief Executive Officer s salary and benefits are contractually those that were approved by the NMRE Board of Directors. MOTION MADE ED GINOP TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER SEVEN AS WRITTEN; SECOND BY JACK MAHANK. MOTION CARRIED. 8) Executive Succession Mr. Schneider noted this Executive Limitation requires further attention. He stated he keeps staff apprised of the operations of the NMRE but does not have a Chief Operations Officer and or a written Succession Plan. Mr. Nowak added he feels there needs to be an identified second in charge. MOTION MADE JACKMAHANK TO AGREE THAT EXECUTIVE LIMITATION NUMBER EIGHT HAS BEEN REVIEWED AS WRITTEN AND THE CEO HAS BEEN FOUND TO BE NONCOMPLIANT ON THIS DATE; SECOND BY RANDY KAMPS. MOTION CARRIED. MOTION MADE BY TERRY LARSON FOR THE NMRE CEO TO WORK WITH THE EXECUTIVE COMMITTEE TO COMPLETE A SUCCESSION POLICY; SECOND BY DON TANNER. MOTION CARRIED WITH ONE NAY VOTE RECORDED BY MR. NOWAK. This meeting will be scheduled in August. 9) Community Resources Mr. Schneider reported he is working with numerous community partners including the Member CMHSP, MDCH, the other state Regional Entity Directors, the Michigan Association of Community Mental Health Boards, Medicaid Health Plans, and numerous Substance Use Disorder (SUD) providers. MOTION MADE RANDY KAMPS TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER NINE AS WRITTEN; SECOND BY DENNIS PRIESS. MOTION CARRIED. 10) Communication and Counsel to the Board Mr. Schneider reported he has communicated consistently and effectively with the NMRE Board of Directors on matters of interest and concern. MOTION MADE JACKMAHANK TO AGREE THAT THE NMRE CHIEF EXECUTIVE OFFICER HAS DEMONSTRATED COMPLIANCE WITH EXECUTIVE LIMITATION NUMBER TEN AS WRITTEN; SECOND BY KARLA SHERMAN. MOTION CARRIED.

5 SUD Strategic Plan The three year Strategic Plan for SUD Services was written by Sara Sircely, SUD Services System Coordinator, and included in the packet for the meeting on this date. The Plan is due to MDCH by August 1, The NMRE SUD Transition Committee reviewed the Plan and recommended Board approval during the meeting on July 17, Ms. Sircely discussed the plan with the Board. The increase in the use of opiates has been identified as an area to target for improvement, collaborating with primary care and health departments. Ms. Sircely noted that retention of SUD services is another key area as 31% leave treatment against staff advice. Admissions for pregnant women have remained consistent at 1% for the past 10 years, although physicians report pregnant women admitted with opiate addiction have drastically increased; addressing this gap is an area of concern. Mr. Priess asked whether the increase in opiates/prescription medications includes Suboxone therapy. Ms. Sirecely will research and provide clarification. The Plan also calls for the continuation of the efforts made by successful prevention programs. An increase in the number of staff/providers at all levels who are trained in the use of trauma informed care is also a stated goal. Ms. Sircely clarified that the process of informing potential referral sources about the transition to the PIHP providing SUD coordination has begun. Mr. Kamps asked what the anticipated timeframe is for getting the State s response. Ms. Sircely and Mr. Schneider were unsure but would relay the information during the Board meeting in the month in which it is received. Mr. Mahank suggested the acronym TEDS be identified as Treatment Episode Data Set before it is used in the Plan. This change will be made prior to submission to the State. MOTION MADE BY DENNIS PRIESS TO APPROVE THE THREE YEAR SUD STRATEGIC PLAN; SECOND BY TERRY LARSON. MOTION CARRIED. Mr. Schneider thanked Ms. Sircely for her concentrated work on the Strategic Plan. SUD Job Descriptions Job Descriptions for an SUD Prevention Specialist, SUD Quality Improvement Specialist, SUD Care Manager, and SUD Claims Representative were included in the packet for the meeting on this date. Two Care Manager positions will be recruited according to previously approved staffing plan. MOTION MADE BY TERRY LARSON TO APPROVE THE FOUR JOB DESCRITPIONS REVIEWED [Substance Use Disorder (SUD) Quality Improvement Specialist, Substance Use Disorder (SUD) Prevention Coordinator, Substance Use Disorder (SUD) Care Manager, and Substance Use Disorder Claims Representative] ON THIS DATE; SECOND BY GARY KLACKING. MOTION CARRIED. SUD Software Purchase The software proposals from Care Net and CX360 were included in the packet for the meeting on this date. Mr. Schneider recommended CX360 to the Board based on research on the product and cost of implementation.

6 MOTION MADE BY JAY O FARRELL TO APPROVE THE PURCHASE OF THE CX360 SOFTWARE PER THE PROPOSAL REVIEWED ON THIS DATE; SECOND BY KARLA SHERMAN. MOTION CARRIED. Mr. Mahank asked if the CX360 system will talk to the other IT systems. Mr. Schneider answered, yes that is one reason the NMRE favors the CX360 product as a long-term vehicle for the entire PIHP operation. Mr. Kamps asked whether the CX360 system carries a cost to the provider. Mr. Schneider responded that there is a potential cost. The license allows for two users, presumably a biller and a clinical staff. If additional licenses are requested, the providers will be responsible for paying for them. Mr. Tanner asked if the two licenses per provider is adequate. Mr. Schneider said in his estimation it is but it is all determined by the providers individual business practices. SUD Policy Oversight Board (Discussion Only) Mr. Schneider consulted with the attorney working with the NMRE to draft the documents included in the meeting packet on this date (SUD Policy Oversight Board ByLaws and Conflict of Interest Policy). Mr. Schneider would recommend these be adopted by the SUD Policy Oversight Board and leave formal approval to that Board. However, they have been included in order for the NMRE Board Members to note areas of potential concern. Mr. Larson said he would suggest including that the Board Member terms will be staggered. Mr. Larson also noted that Removal of Directors at will doesn t seem appropriate; parameters should be identified. Mr. Nowak asked whether there should be something mentioned about a Board Member being removed due to lack of attendance. Mr. Schneider will address the stated concerns with the SUD Poly Oversight Board when it is in place (hopefully in September). Mr. Mahank suggested adding the Board member compensation (stipend and mileage) in the ByLaws. Mr. Mahank also proposed adding, and approved by the NMRE Board of Directors to the end of the sentence under 7.1 to read: Any amendment of these bylaws must be consistent with the Intergovernmental Contract and the Code and approved by the NMRE Board of Directors. Mr. Tanner proposed adding a Secretary under 5.1 Officers. NMRE Database Analyst Job Description The job description for an NMRE Database Analyst was included in the packet for the meeting on this date. The position has been in the budget but has not been filled or posted. MOTION MADE BY ROGER FRYE TO APPROVE THE DATABASE ANALYST JOB DESCRIPTION; SECOND BY DENNIS PRIESS. MOTION CARRIED. Old Business Strategic Plan Update No Items are due in July. Mr. Schneider noted the QAPIP (Quality Assessment and Performance Improvement Program) has not been reviewed yet; Dave will recommend this be moved on the Board Calendar to another month. Smoothing Plan Proposed spending plans for FY15 are due from the CMHSPs to the NMRE by the end of July A ⅓ step toward the PMPM is expected. Once budget proposals and spending plans are reviewed, Mr. Schneider will develop a spending plan working with the Finance Committee and reviewed by the Operations Committee before coming to the NMRE Board for approval; likely in September/October. Mr. Schneider cautioned the NMRE Board is accountable for what the Boards spend, not on what they plan to spend. Mr. Kamps asked whether HAB Waiver slots are awarded based on geographic factors. Mr. Schneider responded historically slots have been used as a means of smoothing, however slots are awarded to individuals, not to Boards and are prioritized based on need by a

7 Regional UM Committee. Mr. Stone inquired about what would happen if a Board plans to cut $1M but doesn t meet that; is the NMRE responsible? Mr. Schneider responded, yes, the Board is responsible as the NMRE bears the risk. Presentation Health Home Pilot Mr. Schneider stated that Section 2703 of the Affordable Care Act (ACA) allows for the creation of health homes for people with SMI/IDD or chronic health issues. Health home will receive a monthly case rate for each individual who receives a HH service. The NMRE received funding to pilot health homes located within Centra Wellness Network and Northern Lakes CMH as they each have collocated with physical health care providers. The monthly case rate is $ per health home enrollee: Centra Wellness has identified 134 individual and Northern Lakes has identified 412. There are seven qualifying categories: 1) congestive heart failure; 2) schizophrenia; 3) diabetes; 4) prescribed two or more narcotics; 5) Chronic Obstructive Pulmonary Disease (COPD); 6) seizure disorder; and 7) identified high hospitalization or emergency department use. Four things are needed to get person enrolled: orientation, document that he/she is not opting out, health risk assessment, and the development of an initial integrated care plan; this triggers PIHP to allow payment. Mr. Schneider summarized the efforts to date by Centra Wellness and Northern Lakes to be up and running. Comments Board Ms. Sherman relayed to the Board via text with regard to high cost IDD cases, VIP discussion The department has had this anecd (anecdotal) info for probably a decade re: aging parents. Makes me crazy. Mr. Larson commented that Board checks are in a lump sum and inquired how it will be broken out on a Mileage and per dies should be listed separately on the Mr. Schneider answered that his understanding is that the amounts are kept separately in a spreadsheet but only one check is issued but he will seek clarification from the accounting department. Staff Ms. Balousek notified the Board that the Minutes of the NMRE Board meetings are now available at Public The record will show that there are no comments from the public on this date. Next Meeting August 27, 10:00AM in the Cross Street Conference Room, Gaylord. Adjourn MOTION MADE BY NINA ZAMORA TO ADJOURN THE MEETING, SECOND BY ED GINOP. MOTION CARRIED. Meeting adjourned at 12:05PM.