NORTHERN MICHIGAN REGIONAL ENTITY BOARD OF DIRECTORS MEETING 10:00AM, WEDNESDAY, FEBRUARY 25, 2015 CROSS STREET BUILDING GAYLORD BOARD MEMBERS IN ATTENDANCE: BOARD MEMBERS ABSENT: STAFF IN ATTENDANCE: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Terry Larson, Jack Mahank, Gary Nowak, Jay O Farrell, Dennis Priess, Richard Schmidt, Karla Sherman, Joe Stone, Don Tanner, Nina Zamora Gary Klacking Dave Beck, Chip Johnston, Alexis Kaczynski, Karl Kovacs, Ed LaFramboise, Sara Sircely, Dave Schneider, Christine Taylor, Carol Balousek 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 Klacking is absent with notice on this date and all other Board Members are present. PLEDGE OF ALLEGIANCE Let the record show that the Pledge of Allegiance was recited as a group. APPROVAL OF PAST MINUTES The January NMRE Board Meeting minutes were included in the materials packet for the meeting on this date. MOTION MADE BY DENNIS PRIESS TO APPROVE THE JANUARY 28, 2015 MINUTES OF THE NORTHERN MICHIGAN REGIONAL ENTITY BOARD MEETING, SECOND BY GARY NOWAK. MOTION CARRIED. APROVAL OF AGENDA Let the record show that no additions to the Agenda were noted. MOTION MADE BY GARY NOWAK TO APPROVE THE AGENDA FOR THE FEBRUARY 25, 2015 NORTHERN MICHIGAN REGIONAL ENTITY BOARD MEETING, SECOND BY ROGER FRYE. MOTION CARRIED. CORRESPONDENCE Mr. Schneider distributed the draft minutes of the Michigan Association of Community Mental Health Boards (MACMHB) PIHP Board Leadership meeting dated February 10, 2015. Mr. Stone and Mr. Schneider were both in attendance. The Winter 2015 edition of the Consumer Newsletter was included in the materials packet for the meeting on this date. ANNOUNCEMENTS Let the record show that no announcements were made during the meeting on this date. PUBLIC COMMENTS Page 1 of 6
Let the record show that no members of the public were in attendance for the meeting on this date. REPORTS Board Chair Report Mr. Stone reported that the Plan for PIHPs to join MACMHB has been finalized; there will be no dues but fees will be charged as applicable. Questions were raised with regard to the eligibility of the entity for 501(c)(3) status. Legal counsel review by PIHPs will be part of the revised Bylaws. Mr. Stone also shared that he has been appointed for an additional three-year term to the AuSable Valley Community Mental Health Board of Directors. CEOs Report Mr. Schneider included his monthly summary in the materials packet for the meeting on this date. Mr. Schneider thanked Mr. Stone for his work on the MACMHB PIHP Board Leadership Committee. MOTION MADE BY KARLA SHERMAN TO RECEIVE AND FILE THE FEBRUARY 2015 NORTHERN MICHIGAN REGIONAL ENTITY CHIEF EXECUTIVE OFFICER S REPORT, SECOND BY RICHARD SCHMIDT. MOTION CARRIED. SUD Policy Oversight Board Mr. Stone reported the Montmorency County Agreement will be signed today as it had been misplaced due to oversight. The NMRE SUD Policy Oversight Board had decided to meet monthly until March 2015, at which time meetings will be moved to every other month. Ms. Sircely stated she is following up with Leelanau County with regard to the liquor tax fund balance. Minutes of the February 2, 2015 were included in the materials packet for the meeting on this date. Financial Report The FY15 Q1 Board Spending by Funding Source report was included in the materials packet for the meeting on this date. Of most significance is the final column Favorable/Unfavorable Expend to Budget. Traditional Medicaid: Centra Wellness is overspent by $63.6k due to one-time purchase of computer and related items; Northern Lakes is overspent by $212.7K; North Country is underspent by $354.2K; Northeast Michigan is overspent by $44.7K; and AuSable Valley is underspent by $378.2K. Mr. Schneider stated the risk reserve cannot be used until revenue has been used for the year. Healthy Michigan Favorable/Unfavorable Expend to Budget show all Boards underspent with a total of $1.3M. Favorable/Unfavorable to payment shows $535K underspent. These figures will be monitored carefully. Last month agreement was reached to shift payments to Boards to the actual PMPM, with quarterly adjustments made as needed. Ultimately, the risk reserve will be hit. Mr. Kamps requested percentages to be added to the report if feasible (for the favorable/unfavorable to budget); this will be done. The Managed Care Administration for Three Months Ended December 31. 2014 report was included in the materials packet for the meeting on this date. It was noted that the NMRE Administrative costs are overbudget in a couple of areas though the overall percentage is 20% for 25% of the fiscal year. Mr. Kamps questioned the underbudget amount under Data Analytics. Mr. Schneider responded a proposal will be presented for approval later in the agenda on this date that will account for the budgeted funds. The SUD Budget vs. Actual Year to Date as of December 31, 2014 report was included in the materials packet for the meeting on this date. The Managed Care Administration cost is at 13% at 25% of the year. Page 2 of 6
MOTION MADE BY JACK MAHANK TO RECEIVE AND FILE THE FINANCIAL REPROTS AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY KARLA SHREMAN. MOTIN CARRIED. NEW BUSINESS Customer Services Plan The State requires the Customer Services Plan be updated annually. Proposed changes largely to reflect the NMRE taking over substance use disorder services coordination. MOTION MADE BY ROGER FRYE TO APPROVE THE NORTHERN MICHIGAN REGIONAL ENTITY CUSTOME SERVICES PLAN AS REVISED AND REVIEWED ON THIS DATE, SECOND BY RANDY KAMPS. MOTION CARRIED. The revision date of February 25, 2015 will be added to the Plan. CMT Statement of Work The Statement of Work (SOW) from Care Management Technologies (CMT) for Data Analytics was included in the materials packet for the meeting on this date. Mr. Schneider presented the Opportunity Analysis prepared by CMT during the December 23, 2014 Board Meeting. The PIHPs in Michigan have identified CMT and Zenith Technologies are the primary vendors for data analytics; the state will be fairly evenly split between the two. Mr. Schneider noted $25K of customized report writing was added to the SOW due to the late start in the year to implement the Agreement. Questions have been addressed along the way. Operations Committee asked for custom reports by county in addition to CMHSP which will be added to the language. Mr. Mahank asked about the deliverables. Mr. Schneider responded that fifty licenses will be issued to use the ProAct software to identify high risk individuals based on health conditions using claims data. It is essentially the algorithms that are being purchased; the algorithms are the deliverables. Custom reports can be added to the library. The intent is to improve outcomes and lower costs through population health management by identifying individuals who have high risk indicators; and to better address integrated care needs and identifying and treating comorbid conditions. Care Connect 360 continues to be fine-tuned and may eventually replace the need for the CMT contract (which can be terminated with ninety days notice); NMRE has been invited to be a pilot site. MOTION MADE BY JACK MAHANK TO APPROVE THE STATEMENT OF WORK AGREEMENT BETWEEN THE NORHTERN MICHIGAN REGIONAL ENTITY AND CARE MANAGEMENT TECHOLOGIES AS PRESENTED ON AND REVIEWED ON THIS DATE WITH THE REQUEST FOR REPORTS TO INCLUDE COUNTY BREAKDOWNS IN ADDITION TO BREAKDOWNS BY COMMUNITY MENTAL HEALTH SERVICES PROGRAMS, SECOND BY KARLA SHERMAN. Discussion: Mr. Kamps stated his observation/concern lies with NMRE data as the deliverable is contingent on the proper submission of data and the training of the end user. Mr. Schneider responded NMRE is working to verify the completeness of data. He then clarified that, for this project, data is derived from claims for both physical and behavioral health for identified individuals from the State. Mr. Schneider stated, The more we use the data the better the data gets. The drawback is it does not include individuals dually enrolled in Medicare/Medicaid. Mr. Tanner requested clarification about the optional additional fees; Mr. Schneider clarified the custom reporting fees only apply if pursued. Roll call voting on Mr. Mahank s motion took place. Yea votes: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Terry Larson, Jack Mahank, Gary Nowak, Jay O Farrell, Dennis Priess, Richard Schmidt, Karla Sherman, Don Tanner, Nina Zamora, Joe Stone Page 3 of 6
Nay votes: Let the record show that zero nay votes were cast. LET THE RECORD SHOW THAT THE MOTION WAS CARRIED BY UNANIMOUS VOTE. NMRE/CMHSP Contract The Subcontract between the Northern Michigan Regional Entity and the Member Boards was drafted by Dykema Gossett law firm and included in the materials packet for the meeting on this date. It had previously been sent to Directors for input; changes were implemented asbrequested where appropriate. Mr. Schneider noted the NMRE Finance and Operations Committees did review the document and voted to recommend. MOTION MADE BY ROGER FRYE TO APPROVE THE SUBCONTRACT BETWEEN THE NORTHERN MICHIGAN REGIONAL ENTITY AND THE COMMUNITY MENTAL HEALTH SERVICES PROGRAMS IDENTIFIED AS AUSABLE VALLEY COMMUNITY MENTAL HEALTH, NORTH COUNTRY COMMUNITY MENTAL HEALTH, MANISTEE BENZIE COMMUNITY MENTAL HEALTH D.B.A. CENTRA WELLNESS NETWORK, NORTHEAST MICHIGAN COMMUNITY MENTAL HEALTH, AND NORTHERN LAKES COMMUNITY MENTAL HEALTH FOR MEDICAID MANAGED SPECIALTY SUPPORTS AND SERVICES CONCURRENT 1915(b)/(c) WAIVER PROGRAM(S) AND THE HEALTHY MICHIGAN PROGRAM AND SUBSTANCE USE DISORDER COMMUNITY GRANT PROGRAMS AS PRESENTED AND REVIEWED ON THIS DATE; SECOND BY GARY NOWAK. Roll call voting on Mr. Frye s motion took place. Yea votes: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Terry Larson, Jack Mahank, Gary Nowak, Jay O Farrell, Dennis Priess, Richard Schmidt, Karla Sherman, Don Tanner, Nina Zamora, Joe Stone Nay votes: Let the record show that zero nay votes were cast. LET THE RECORD SHOW THAT THE MOTION WAS CARRIED BY UNANIMOUS VOTE. Training Contract The NMRE Regional Compliance Committee identified that medical staff training on the use of E/M (Evaluation/Management) codes is needed. A proposal for a training conducted by Pamela Pulley was included in the materials packet for the meeting on this date. Although the proposal lists an amount of $1600 for the training, the NMRE Finance and Operations Committees approved an amount up to $4000 to conduct two trainings. The NMRE would own the webinar and could then conduct additional trainings as needed. Mr. Mahank asked about Ms. Pulley s qualifications; NMRE Compliance Coordinator, Christine Taylor, responded that Ms. Pulley has national certification and previously worked for Genesee Health System. MOTION MADE BY DENNIS PRIESS TO APPROVE THE TRAINING AGREEMENT BETWEEN THE NORTHERN MICHIGAN REGIONAL ENTITY AND PAMELA PULLEY AS PRESENTED AND REVIEWED ON THIS DATE FOR AN AMOUNT NOT TO EXCEED FOUR THOUSAND DOLLAS ($4000.00), SECOND BY TERRY LARSON. Roll call voting on Mr. Priess s motion took place. Yea votes: Roger Frye, Ed Ginop, Annie Hooghart, Randy Kamps, Terry Larson, Jack Mahank, Gary Nowak, Jay O Farrell, Dennis Priess, Richard Schmidt, Karla Sherman, Don Tanner, Nina Zamora, Joe Stone Nay votes: Let the record show that zero nay votes were cast. LET THE RECORD SHOW THAT THE MOTION WAS CARRIED BY UNANIMOUS VOTE. Page 4 of 6
Liquor Tax Policy The need for a Policy to clarify the use of liquor tax funds was identified by the NMRE SUD Policy Oversight Board of Directors. The draft Policy was approved by the NMRE SUD Policy Oversight Board on February2, 2015 and included in the materials packet for the meeting on this date. Mr. Tanner recommended sharing the Policy with the twenty-one counties served by the NMRE. MOTION MADE BY ED GINOP TO APPROVE THE NORTHERN MICHIGAN REGIONAL ENTITY LIQUOR TAX POLICY AS PRESENTED AND REVIEWED ON THIS DATE, SECOND BY JACK MAHANK. MOTION CARRIED BY UNANIMOUS VOTE. Annual Summary to the Owners The Annual Summary was discussed during the NMRE Annual Board Planning Session on February 21, 2015 and was distributed to those Members who were not in attendance. Mr. Mahank asked, What is the mechanism to determine whether the Owners are satisfied? Mr. Schneider responded that he plans to visit each of the Member Boards in the coming months and report back in June 2015 as that was his understanding based on the last Policy Committee Meeting. A survey is being developed to measure level of satisfaction. OLD BUSINESS Operating Agreement The NMRE Operations Committee deferred discussion of the Operating Agreement until the March meeting which will be March 17, 2015 at 9:30AM. Plan Update Let the record show that no update was due this month. PIHP Membership in MACMHB Update As stated previously, the workgroup met on February 16, 2015 to discuss necessary ByLaw changes, fee structure and other issues. The ByLaws have been drafted and the process is moving forward. SUD Transition Update Ms. Sicerly reported the CX360 software is not functioning per the contract; Mr. Schneider has intervened to resolve with the vendor. Counties who have not sent fund balance of liquor tax dollars are being contacted; most want input into the use of the funds, though they do not disagree with sending to NMRE. Site visits for providers are being scheduled. Letters have gone out to stakeholders to communicate the process of getting individuals served. Mr. Stone asked at what point the provider panel will open; Mr. Schneider responded late summer to fall. Ms. Sircely offered to attend staff meetings at the Boards to provide an overview of how to route individuals to SUD system services. PRESENTATION Compliance Report Christine Taylor, NMRE Compliance Coordinator was in attendance to report on compliance program activities and the FY14 Medicaid Claims Verification audit. The Medicaid Services Verification Methodology Report for FY 2014 was reviewed by the NMRE Board of Directors in January. It was ntoed that for Centra Wellness, Ms. Taylor validates the findings of its internal audit rather than conducting her own verification audit. Mr. Schneider noted the verification audit process is being revised by the State for FY16. A total of 9.020 claims for the five CMHSPs were audited in FY14 with 8,621 validated, resulting in 95.6% validation. Only one Member Board required a Corrective Action Initiative for falling Page 5 of 6
below 95% of Medicaid and Healthy Michigan services validation for two consecutive quarters. Documentation/Claim errors accounted for 40.6% of invalid claims, missing documentation accounted for 35.1% and Plan of Services issues comprised the remaining 24.3% Mr. Mahank asked Ms. Taylor, if, in her time conducting audits on behalf of the NMRE she has seen anything that could be considered fraud to which she replied, no. Board Member Terms Expiring Mr. Schneider announced that the NMRE Board of Director appointments expiring in April 2015 are: Joe Stone for AuSable Valley CMH, Don Tanner for Centra Wellness Network, Dennis Priess for North Country CMH, Roger Frye for Northeast Michigan CMH, and Jack Mahank for Northern Lakes CMH. COMMENTS Board Mr. Tanner asked about the status of NMRE Policies & Procedures. Mr. Schneider responded that the Administrative Manual is in the process of being organized with a numbering system implemented and will be posted to the NMRE website when complete. Mr. Priess thanked everyone for their participation during the NMRE Board Planning Session on Saturday, February 21 st. Mr. Mahank asked for a report on the dismissal (with cause) of the Director of Summit Pointe CMH Authority (Calhoun County). Mr. Schneider responded that a situation came to light surrounding the pension plan, no-bid contracts (with consultants with whom he had ties) for consulting, and union contracts. There is potential negative fallout in terms of the public s perception of the CMH system. Staff Dr. Beck announced the Northern Region nominated Mr. Stone run for Chair of the Association Board; he requested support be given to this. Public Let the record show that no members of the public were in attendance for the meeting on this date. MEETING DATES The next scheduled meeting is Wednesday, March 25, 2015 at 10:00AM in the Cross Street Conference Room in Gaylord. ADJOURN MOTION MADE BY ED GINOP TOADJOURN THE FEBRUARY 25, 2015 NORTHERN MICHIGAN REGIONAL ENTITY BOARD OF DIRECTORS MEETING, SECOND BY NINA ZAMORA. MOTION CARRIED. Page 6 of 6