Kevin Hartley, Chip Johnston, Alexis Kaczynski, Karl Kovacs, Ed LaFramboise, Sara Sircely, Dave Schneider, Carol Balousek Trina Edwards

Transcription

1 NORTHERN MICHIGAN REGIONAL ENTITY BOARD OF DIRECTORS MEETING 10:00AM, WEDNESDAY, MARCH 25, 2015 CROSS STREET CONFERENCE ROOM - GAYLORD BOARD MEMBERS IN ATTENDANCE: BOARD MEMBERS ABSENT: STAFF IN ATTENDANCE: PUBLIC IN ATTENDANCE: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Gary Klacking, Terry Larson, Jack Mahank, Richard Schmidt, Joe Stone, Don Tanner, Nina Zamora Gary Nowak, Dennis Priess, Jay O Farrell, Karla Sherman (all with notice) Kevin Hartley, Chip Johnston, Alexis Kaczynski, Karl Kovacs, Ed LaFramboise, Sara Sircely, Dave Schneider, Carol Balousek Trina Edwards CALL TO ORDER Let the record show that Mr. Stone called the meeting to order at 10:00AM. ROLL CALL Let the record show that Gary Nowak, Dennis Priess, Jay O Farrell, and Karla Sherman are absent with notice on this date. All other Board Members are in attendance. PLEDGE OF ALLEGIANCE Let the record show that the Pledge of Allegiance was recited as a group. APPROVAL OF PAST MINUTES The February NMRE Board Meeting minutes were included in the materials packet for the meeting on this date. It was noted that the individual who made the motion to approve the NMRE Customer Services Plan was not identified (page 3); this will be corrected by NMRE staff. MOTION MADE BY GARY KLACKING TO APPROVE THE FEBRUARY 25, 2015 MINTUES OF THE NORTHERN MICHIGAN REGIONAL ENTITY BOARD OF DIRECTORS MEETING AS AMENDED, SECOND BY ROGER FRYE. MOTION CARRIED. APPROVAL OF AGENDA Let the record show that Mr. Schneider requested permission to move the Presentation to just after Comments on the agenda; members agreed to the change. MOTION MADE BY DON TANNER TO APPROVE THE MARCH 25, 2015 NORTHERN MICHIGAN REGIONAL ENTITY BOARD MEETING AGENDA AS REVISED, SECOND BY JACK MAHANK. MOTION CARRIED. CORRESPONDENCE A Memorandum dated February 27, 2015 from Thomas Renwick, Director of the Bureau of Community Based Services at MDCH to PIHP Executive Directors offering training for up to three individuals at each PIHP to receive training in Mental Health First Aid. Page 1 of 10

2 A letter dated March 4, 2015 from Thomas Renwick, Director of the Bureau of Community Based Services at MDCH to Dave Schneider granting approval to Region 2 (NMRE) for providing adequate wraparound services through its Member CMHSPs. A letter dated March 16 th from Dave Schneider to Judge Christopher P. Martin from the Iosco County Family Court explaining the intent for the NMRE to open its provider panel before the end if the current fiscal year. Mr. Kamps asked what prompted the letter. Ms. Sircely answered the judge, in his experience with a Iosco County family, felt that there was limited capacity. This was acknowledged. A letter dated March 16 th from John Duvendeck, Manager of the Financial Management & Rate Setting Section of the Division of Program Development, Consultation, and Contracts at MDCH stating the Risk Management Strategy submitted by the NMRE was reviewed and found to be in compliance. The February 2015 minutes of the PIHP CEO Meeting were distributed to the Board Members on this date. MOTION MADE BY JACK MAHANK TO RECEIVE AND FILE THE CORRESPONDENCE AS PRESENTED AND REVIEWED ON THIS DATE; SECOND BY NINA ZAMORA. MOTION CARRIED ANNOUNCEMENTS Let the record show that no announces were made during the meeting on this date. PUBLIC COMMENTS Let the record show that no comments were made by the public during the meeting on this date. PRESENTATION - NMRE Audit Trina Edwards, CPA with Dennis, Gartland, Niergarth was in attendance to provide a review of the NMRE Financial and Compliance Audits for fiscal year Financial Statements Report Ms. Edwards directed Members attention to page ii, Financial Analysis of NMRE. At the close of fiscal year 2014, the NMRE s total revenue was $113,792,106. Total expenses for fiscal year were $113,792,106 resulting in a deficit of $609,739 before transfers. The transfers of operations amount was $11,692,643 (listed on page 15 of the report) which were Medicaid savings passed on to the NMRE from the Northern Affiliation, Centra Wellness Network, and the Northwest Affiliation. This created a net position at the end of fiscal year 2014 of $11,082,904. Ms. Edwards next referenced paragraph two, on page iii of the report: NMRE received $111,935,561 in total Medicaid revenue for FY2014. At fiscal yearend, NMRE overspent its traditional Medicaid budget by $670,699. NMRE carried forward Medicaid Savings to FY14 in the amount of $2,968,038. Medicaid savings were used toward the FY14 overspending deficit on traditional Medicaid. For Healthy Michigan, the NMRE was underspent and had a deposit into ISF of $2,998,046. The NMRE tracked traditional Medicaid and Healthy Michigan as separate funding streams per MDCH directions. NMRE did not return Medicaid capitation funds to the Department of Community Health in fiscal year In a letter to the NMRE Board of Directors dated March 18, 2015 and contained in the Report, the auditing firm of Dennis, Gartland & Niergarth concluded, during our audit, we did not identify any deficiencies in internal control over financial reporting that we consider to be material weaknesses. Page 2 of 10

3 Compliance Examination Ms. Edwards referred to page 18 of the report, Schedule of Findings and Questioned Costs, noting that none of the findings were questioned. Communications Letter Ms. Edwards next read from the Audit Related Communications letter which she said was a requirement of the audit. Under the heading Qualitative Aspects of Accounting Practices, it was noted We noted no transactions entered into by the Entity during the year for which there is a lack of authoritative guidance or consensus. All significant transactions have been recognized in the financial statements in the proper period. Under the heading Corrected and Uncorrected Misstatements, the following was offered: Isolated ISF activity of approximately $8,728,000. We recommend management consider segregating the ISF activity in the general ledger. Kevin Hartley, NMRE CFO, responded this has already been done. Under the heading No Disagreements with Management, it was noted, For purposes of this letter, a disagreement with management is a financial accounting, reporting, or auditing matter, whether or not resolved to our satisfaction, that could be significant to the financial statements or the auditor s report. We are pleased to report that no such disagreements arose during the course of our audit. In the final paragraph of the letter dated March 18, 2015, the following was stated, We also commend the Entity for its excellent record keeping system and appreciate the opportunity to serve the Entity. Mr. Mahank asked if a peer review letter is on file to which Mr. Hartley responded that it is. Mr. Mahank next asked Ms. Edwards, During your audit did you find any instances of fraud? Ms. Edwards replied, No. Mr. Mahank then asked Ms. Edwards how she would rate the audit results on a scale from Ms. Edwards responded she would score the NMER s performance a 10, but added that the financial soundness of the NMRE is potentially jeopardized by the continued expenditure from the risk reserve. She advised the Board Members to be mindful of this as ultimately oversight falls to them. MOTION MADE BY JACK MAHANK TO APPROVE THE NORTHERN MICHIGAN REGIONAL ENTITY AUDIT REPORTS PREPARED BY THE DENNIS, GARTLAND & NIERGARTH, PUBLIC ACCOUNTS WHICH SHOW THE NMRE TO BE IN FULL COMPLIANCE FOR THE TIME PERIOD OF OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014, SECOND BY ED GINOP. Roll call voting took place on the motion. Yea Votes: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Gary Klacking, Terry Larson, Jack Mahank, Richard Schmidt, Don Tanner, Nina Zamora, Joe Stone Motion carried by unanimous vote. REPORTS Board Chair Report Mr. Stone stated he did not have a report this month but did share that he was nominated for president of association but, according to the Bylaws is not eligible; he is, therefore, running for first vice president. CEO s Report Mr. Schneider included his March 2015 report in the materials packet for the meeting on this date. Mr. Schneider referred to a discussion of the SIM model during March 4 th meeting of PIHP CEOs. The mental health system is trying to integrate community entities, such as primary care providers, the jail system, health departments, private insurance companies, Federally Qualified Health Centers, and Medicaid providers. All of these partners are involved in sharing the risk and reward and should support Page 3 of 10

4 each other. It was noted the eligibility requirements could identify additional consumers. A fee for service payment model would bring additional revenue to compensate for the increased number of consumer, while fixed capitated payments could be problematic for providers. Mr. LaFramboise asked Mr. Schneider if there a public record of organizations who have expressed an interest to become either Accountable Systems of Care (ASC) or Community Health Innovation Regions (CHIR) to which Mr. Schneider responded there is not. Ms. Kaczynski asked about the Inpatient Access Survey. The most common reason for inpatient denial of services was found to be that the facility was at capacity. This finding is being further researched by the State. Mr. Schneider stated he will share survey information when made available by the State. Mr. Mahank inquired the MDCH site review scheduled in April and asked what the Board s role would be. Mr. Schneider responded he believes there will be none. Mr. Mahank asked Mr. Schneider to confirm that with the review team which he agreed to do. MOTION MADE BY JACK MAHANK TO RECEIVE AND FILE THE NORTHERN MICHIGAN REGIONAL ENTITY CHIEF EXECUTIVE OFFICER S REPORT FOR MARCH 2015 AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY RANDY KAMPS. MOTION CARRIED. SUD Policy Oversight Board The minutes of the March 2, 2015 meeting of the Northern Michigan Regional Entity Substance Use Disorder Policy Oversight Board were included in the materials packet for the meeting on this date. Mr. Frye reported that Ken Mills gave a very informative presentation. A discussion of counties returning liquor tax savings from NMSAS to the NMRE followed. Mr. Schneider clarified liquor tax dollars have to pay for services to individuals in or from the county from which the funds came. MOTION MADE BY RICHARD SCHMIDT TO RECEIVE AND FILE THE MARCH 2, 2015 MINUTES OF THE NORTHERN MICHIGAN REGIONAL ENTITY SUBSTANCE USE DISORDER POLICY OVERSIGHT BOARD AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY ANNIE HOOGHART. MOTION CARRIED. Financial Report(s) The minutes of the March 10, 2015 NMRE Finance Committee conference call were included in the materials packet for the meeting on this date as were several financial reports. Managed Care Administration Four Months Ended January 31, 2015 The report continues to show the NMRE overspent in certain areas but overall spending is at 26.8% of the budgeted amount for 33% of the year elapsed. NMRE Revenue FY15 The current status for Traditional Medicaid shows the NMRE overspent by $940K. If rate rebasing is conducted in April, this should benefit the NMRE and help to offset this amount. SUD Budget vs. Actual Expenses Report as of January 31, 2015 The administrative budget for Substance Use Disorder services coordination is a t21% for 33% of the year elapsed. Liquor tax funds continue to be tracked by county. SUD Revenue for FY15 Report The SUD revenue was reported as $72K favorable for five months ending February 28, Page 4 of 10

5 HSW Enrollment Statistics dated March 19, 2015 All slots are reported as filled though two are currently unpaid. For FY15, 16 clients have passed, 10 have been disenrolled, and 28 have been newly enrolled. Medicaid Enrollment Report(s) Mr. Schneider referred to the graph Population DAB TANF HMP Current Enrollment dated March 18, Reduction in TANF lost 11,233 enrolled individuals (15%)/695 moved from Traditional Medicaid to Healthy Michigan resulting in $647,098 in lost revenue since October 1, Healthy Michigan enrollment data was reviewed; 30% is reported as unpaid which is being addressed with the State. State actuaries are going back to look at data to ensure there is not a drop in (TANF) individuals served. If rates are readjusted, it will make up the shortfall. The completeness of the data reviewed will be a key element. The Total Claim Lines graph shows a significant drop off the first quarter of FY15 which Mr. Schneider stated is unacceptable and is being reviewed by NMRE staff. Mr. Schneider stated Milliman getting quarterly data extracts from the State. It was noted that three PIHPs (including NMRE) indicated the claim paid amount was higher than charge amount. An error was discovered in the Avatar software pertaining to AuSable Valley claims. This is being identified and remedied. A comparison of FY13 to FY14 PMPM shows dollar totals not adding up where they need to be. The NMRE has received the files used by Milliman. Three different data sets are being used; variances in data are being reviewed. Medicaid Utilization and Net Cost Report (MUNC) Reports were distributed for Traditional Medicaid and Healthy Michigan for the top 15 utilized service codes as pulled from the MUNC report. Cost variances are being identified. Mr. Schneider noted it is not an apples to apples comparison but is a useful starting point. Mr. Kamps brought the discussion to the NMRE budget asking, How do we get to a point where we re on the same page (with the State)? Mr. Schneider responded he is not aware of a solid systemic approach to address this with the State. There has been a push for the State to supply data. Mr. Schneider said he sees daily the Department working with the Entities to reconcile disparities in data. Mr. Mahank stressed the need for usable data or the NMRE has little function. MOTION MADE BY DON TANNER TO RECEIVE AND FILE THE NORTHERN MICHIGAN REGIONAL ENTITY FINANCIAL REPORTS AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY ED GINOP. MOTION CARRIED. NEW BUSINESS Contract with Block Grant Sub-Recipients The Block Grant Subrecipient Agreement was drafted by North Country CMH staff and included in the materials packet for the meeting on this date. A similar Agreement will be created for Northern Lakes CMH. Mr. Schneider stated the Agreement did receive approval of the Operations Committee but was not reviewed by the NMRE Finance Committee. The Contract allows the NMRE to pass the block grant funds through to the Boards. MOTION MADE BY JACK MAHANK TO APPROVE THE BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE NORTHERN MICHIGAN REGIONAL ENTITY AND NORTH COUNTRY COMMUNITY MENTAL Page 5 of 10

6 HEALTH IN THE AMOUNT OF ONE HUNDRED THOUSAND DOLLARS ($ ) AND THE NORTHERN MICHIGAN REGIONAL ENTITY AND NORTHERN LAKES COMMUNITY MENTAL HEALTH IN THE AMOUNT OF SEVENTY-FIVE THOUSAND DOLLARS ($75,000.00) AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY ROGER FRYE. Roll Call voting took place. Yea Votes: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Gary Klacking, Terry Larson, Jack Mahank, Richard Schmidt, Don Tanner, Nina Zamora, Joe Stone Motion carried by unanimous vote. CML Agreement for SUD Prevention and Media Campaign A letter dated March 3, 2015 from Charles Lombardo, CML Marketing Communications and the NMRE Prescription Drug Abuse Media Campaign/Communications Plan from CML dated March 3, 2015 were both included in the materials packet for the meeting on this date. The campaign total cost is $168.9K which is in keeping with the NMRE budgeted amount. This was not bid out via an RFP process as continuity with what had been achieved through NMSAS was an established goal. MOTION MADE BY TERRY LARSON TO APPROVE THE NORTHERN MICHIGAN REGIONAL ENTITY PRESCRIPTION DRUB ABUSE MEDIA CAMPAIGN/COMMUNICATIONS PLAN BY CML MARKETING COMMUNICATIONS DATED MARCH 3, 2015 IN THE AMOUNT OF ONE HUNDRED SIXTY-EIGHT THOUSAND NINE HUNDRED DOLLARS ($ ) AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY RANDY KAMPS. MOTION CARRIED. Staffing Changes for SUD Mr. Schneider explained that the NNMRE hired Mike Dunn to be split as.6 FTE SUD Quality Assurance Manager and.4 FTE NMRE Provider Network and Contract Manager. The.4FTE devoted to NMRE Administration accounts for approximately $28K/year. Similarly, Becky Vincent had been contracted to work.5 FTE for the NMRE through its Agreement with Northern Lakes CMH. The new structure with Northern Lakes CMH requires Ms. Vincent full time. She will be removed from the Contract between Northern Lakes and NMRE effective April 1, A new staff will be hired to replace Becky s function at the NMRE and Mr. Schneider plans to move Mike Dunn full time SUD services as greater need than expected has been experienced. Mr. Schneider requested approval to move Mr. Dunn from.6 FTE dedicated to SUD services to 1 full FTE, resulting in a net increase to the SUD budget of.4 FTE. MOTION MADE BY ROGER FRY TO APPROVE AN INCREASE TO THE FISCAL YEAR 2014 NORTHERN MICHIGAN REGIONAL ENTITY SUBSTANCE USE DISORDER SERVICES ADMINISTRATIVE BUDGET BY APPROXIMATELY TWENTY-EIGHT THOUSAND DOLLARS ($28,000.00) OR.4 FTE CURRENTLY BUDGETED TO NORTHERN MICHIGAN REGIONAL ENTITY ADMINISTRATION, SECOND BY RICHARD SCHMIDT. Roll call voting took place. Yea Votes: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Gary Klacking, Terry Larson, Richard Schmidt, Don Tanner, Nina Zamora, Joe Stone Nay Votes: Jack Mahank Motion carried. Mr. Schneider proposed the NMR Board Policy Committee meet to discuss what matters require roll call voting as inconsistencies have been observed. This will be scheduled and members notified. Conflict of Interest Policy The NMRE Board Approved (June 19, 2013) Conflict of Interest Policy was included in the materials packet for the meeting on this date. Mr. Schneider expressed that Dr. Beck has declined to sign the Page 6 of 10

7 Conflict of Interest Statement. Dr. Beck requested the Board call for revision of the Policy. As a meeting of the Board Policy Committee was suggested to look into roll call votes, it was decided this item would be added to the meeting agenda. Mr. Schneider stressed he will also pursue the opinion of legal counsel. Although conflict is inherent to the structure of the Entity, the policy is intended to manage the conflict not eliminate it. MOTION MADE BY JACK MAHANK TO MOVE FORWARD WITH ASSIGNING THE NORTHERN MICHIGAN REGIONAL ENTITY BOARD POLICY COMMITTEE TO ADDRESS THE CONFLICT OF INTEREST POLICY AND SUGGEST POSSIBLE REVISIONS IF DEEMED TO BE NECESSARY, SECOND BY DON TANNER. MOTION CARRIED. Review of Mission and Vision Statements A copy of the NMRE Mission and Vision Statements developed by the Board of Directors during the April 12, 2014 Planning Session were included in the materials packet for the meeting on this date. Pursuant to the Board Calendar, this item is scheduled for review in March. MOTION MADE BY JACK MAHANK TO APPROVE THAT THE NORTHERN MICHIGAN REGIONAL ENTITY BOARD OF DIRECTORS REVIEWED ITS MISSION AND VISION STATEMENTS ON THIS DATE AND RECOMMENDED NO CHANGES, SECOND BY DON TANNER. MOTION CARRIED. New Board Member Orientation Process A process for orienting new Members of the NMRE Board of Directors was developed by Mr. Schneider and Mr. Stone and included in the materials packet for the meeting on this date. MOTION MADE BY JACK MAHANK TO APPROVE THE NORTHERN MICHIGAN REGIONAL ENTITY BOARD MEMBER ORIENTATION PROCESS AS PART OF THE BOARD GOVERNANCE POLICIES AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY ROGER FRYE. MOTION CARRIED. OLD BUSINESS Operating Agreement Pursuant to the process described in the final paragraph of the Operating Agreement, two CMH Members requested review as motions from each of their Boards of Directors. A proposed revision to the NMRE Operating Agreement was included in the materials packet for the meeting on this date using track changes. The NMRE Operations Committee reviewed the Operating Agreement during its meeting on March 17, 2015 during which it recommended the NMRE Board approve seven (7) changes to more accurately reflect current business practices. Mr. Schneider referred Members to the March 17, 2017 Operations Committee meeting minutes for the numbering of the changes. Additionally, the section under Budget was revised as indicated (change #8) via track changes. Mr. Schneider summarized the changes and provided reasons why he feels change is needed. Mr. Mahank suggested and Fiscal Officer be struck in the fourth paragraph under Human Resources. This would be proposed as change #9 to the Agreement. Discussion followed with the decision made that this change is not needed. Mr. Mahank asked if the CEOs have objections to changes to the Agreement. Mr. Johnston replied he has many objections he did not wish to enumerate but advocated that it not be changed at all. Mr. LaFramboise stated that Dr. Beck opposed change during the March 17 th Operations Committee Page 7 of 10

8 meeting. Mr. Schneider spoke to say he doesn t feel the changes lessen oversight but enable more efficient business practices. Ms. Hooghart spoke on behalf of the Centra Wellness Board of Directors which views the Operating Agreement as a safety feature to ensure oversight of NMRE activities. Mr. Stone asked whether the CWN Board would be agreeable to the changes intended to clean-up language. Ms. Hooghart said perhaps, but oversight of the funds is critical and removal of paragraphs in the Budget section would not be approved. Mr. Schneider emphasized that his added paragraphs address the same topics but with cleaner processes. Ms. Kaczynski stated that the Finance Committee should focus on its field of expertise which is stated in the revised language which creates greater financial oversight without encumbering it with matters out of its scope of practice. Ms. Hooghart stressed the importance of financial oversight. Mr. Schneider asked her to look closely at the proposed language as it requires greater oversight without superfluous reviews of items which were reviewed previously by staff employed to do so. Mr. Klacking asked how Dr. Beck responded to the changes. Mr. Schneider answered that for changes 1-7, Dr. Beck was instrumental in drafting the revised language though opted to abstain from voting on the motion. In terms of the changed under the Budget section, Dr. Beck voted in opposition to change. Mr. Kovacs spoke in favor of the proposed changes. Mr. Stone called for voting on each proposed change to the Operating Agreement as individual motions. MOTION MADE BY TERRY LARSON TO APPROVE ADDING AS THE FOURTH SENTENCE IN PARAGRAPH ONE OF THE NORTHERN MICHIGAN REGIONAL ENTITY OPERATING AGREEMENT, THE REGIONAL ENTITY ALSO SERVES AS THE DEPARTMENT DESIGNATED COMMUNITY MENTAL HEALTH ENTITY (CMHE) FOR SUBSTANCE USE DISORDER PREVENTION, TREATMENT AND RECOVERY SERVICES. SECOND BY GARY KLACKING. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY ROGER FRYE APPROVE THE ADDITION OF A SENTENCE AS THE SECOND PARAGRAPH UNDER SCOPE AND AUTHORITY OF THE NORTHERN MICHIGAN REGIONAL ENTITY OPERATING AGREEMENT TO READ, THE NMRE WILL, IN ACCORDANCE WITH STATUTE, HAVE A SUBSTANCE USE DISORDER POLICY OVERSIGHT BOARD. SECOND BY JACK MAHANK. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY RANDY KAMPS TO APPROVE THE REMOVAL OF SUBSTANCE USE DISORDER ADVISORY COMMITTEE FROM THE LIST OF STANDING COMMITTEES OF THE PIHP, SECOND BY TERRY LARSON. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY GARY KLACKING TO APPROVE SHORTENING THE FIRST SENTENCE UNDER PARAGRAPH ONE, UNDER SUBSECTION (D) HUMAN RESOURCES OF THE OPERATION OF THE REGIONAL ENTITY SECTION OF THE NORTHERN MICHIGAN REGIONAL ENTITY OPERAING AGREEMENT Page 8 of 10

9 TO READ, THE NMRE WILL DIRECTLY EMPLOY THE CEO. SECOND BY RANDY KAMPS. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY RANDY KAMPS TO APPROVE ADDING AS THE SECOND SENTENCE IN PARAGRAOH ONE, UNDER SUBSECTION (D) HUMAN RESOURCES OF THE OPERATION OF THE REGIONAL ENTITY SECTION OF THE NORTHERN MICHIGAN REGIONAL ENTITY OPERAING AGREEMENT, THE CEO, ON BEHALF OF THE GOVERNING BOARD, WILL EMPLOY, CONTRACT, OR LEASE PERSONNEL NECESSARY TO PERFORM THE FUNCTIONS OF THE ORGANIZATION. SECOND BY JACK MAHANK. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY ROGER FRYE TO APPROVE THE REMOVAL OF THE LAST SENTENCE IN PARAGRAPH ONE UNDER SUBSECTION (D) HUMAN RESOURCES OF THE OPERATION OF THE REGIONAL ENTITY SECTION OF THE NORTHERN MICHIGAN REGIONAL ENTITY OPERAING AGREEMENT: THE OPERATIONS COMMITTEE MAY RECOMMEND TO THE GOVERNING BOARD THE USE OF A CONTRACT OR LEASE TO SECURE OTHER ESTABLISHED POSITION. SECOND BY NINA ZAMORA. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY RANDY KAMPS TO APPROVE REVISING THE SECOND SENTENCE UNDER THE SUBSECTION CONSUMER ADVISORY COMMITTEE OF THE SCOPE AND AUTHORITY SECTION OF THE NORTHERN MICHIGAN REGIONAL ENTITY OPERATING AGREEMENT TO CHANGE THE NUMBER OF PERMITTED MEMBERS PER COMMUNITY MENTAL HEALTH PROGRAM FROM THREE TO FOUR THUS TO READ: MEMBERSHIP WILL INCLUDE AT LEAST TWO BUT NOT MORE THAN FOUR REPRESENTATIVES FROM EACH MEMBER, APPOINTED BY THE MEMBER DIRECTOR, UNLESS OTHERWISE REQUIRED BY CONTRACT OR REGULATION. SECOND BY JACK MAHANK. Motion carried with three nay votes recorded from Annie Hooghart, Richard Schmidt, and Don Tanner. MOTION MADE BY RANDY KAMPS TO REVISE SUBSECTION (A) BUDGET OF OPERATION OF THE REGIONAL ENTITY SECTION OF THE NORTHERN MICHIGAN REGIONAL OPERATING AGREEMENT WHICH WOULD STRIKE PARAGRAPHS ONE, TWO, FOUR, FIVE, AND SIX AND REPLACE THEM WITH THE PROPOSED LANGUAGE AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY ED GINOP. Roll call voting took place. Yea Votes: Roger Frye, Ed Ginop, Randy Kamps,, Terry Larson, Jack Mahank, Nina Zamora Nay Votes: Gary Klacking, Annie Hooghart, Richard Schmidt, Don Tanner, Joe Stone Motion carried with six yea votes and five nay votes recorded. A discussion of the manner in which the items are presented to the Member CMHSP Boards followed. The decision was made that it is up to each Board but individual voting was preferable. Plan Update Let the record show that no update to the Plan was due in the month of March SUD Transition Update Michigan Therapeutic Consultants (MTC) has requested the NMRE utilized the Gaylord methadone clinic. MTC is a licensed substance abuse treatment facility specializing in the treatment of opiate addiction. The NMRE does have a contract with MTCs facility in Mt. Pleasant. Mr. Schneider proposed adding the Gaylord location to the provider panel as an expansion of its services under the existing Contract, which would not reflect an opening of the provider panel. This will be pursued. Ms. Sircely reported that the NMRE is refining internal processes to better coordinate services to individuals. Page 9 of 10

10 COMMENTS Board Let the record show that no comments were made by Board Members during the meeting on this date. Staff NMRE staff distributed the Organizational Chart for the Michigan Department of Health and Human Services, resulting from the merger of the Michigan Department of Community Health and the Michigan Department of Human Services. Public Let the record show that no comments were made by public attendees during the meeting on this date. MEETING DATES The next meeting of the Northern Michigan Regional Entity Board of Directors is scheduled for Wednesday, April 22, 2015 at 10:00AM in the Cross Street Conference Room in Gaylord. ADJOURN MOTION MADE BY DON TANNER TO ADJOURN THE MARCH 25, 2015 MEETING OF THE NORTHERN MICHIGAN REGIONAL ENTITY BOARD OF DIRECTORS, SECOND BY NINA ZAMORA. MOTION CARRIED. Page 10 of 10