- Proposed Lakeshore Regional Partners Executive Board Community Mental Health of Ottawa County 12265 James Street, Holland, MI June 26, 2014 1:00 PM WELCOME AND INTRODUCTIONS Mr. Snider called the meeting to order at 1:00 p.m. He welcomed Mr. Grit, serving as alternate from Network180 ROLL CALL Present at Roll Call: Mr. Belco, Ms. Bird, Ms. Gonzalez, Ms. Kehrwecker, Mr. Ponstein, Mr. Prince, Mr. Sanders, Mr. Snider Absent: Mr. Disselkoen, Mr. Oberst Alternates: Mr. Grit, Ms. Cartwright CONFLICT OF INTEREST QUESTION Mr. Snider No conflicts of Interest were declared. CONSENT ITEMS: LRE 14-024 Motion: To approve by consent the following items. a. June 26, 2014 LRP Board of Directors meeting agenda b. May 15, 2014 LRP Board of Directors meeting minutes c. LRP Policies d. Board Resolution and COI Waiver for Mr. Nelson Grit Moved by: Sanders Support: Ponstein Mr. Snider reported that Policy 9.07 was removed from the consent agenda as additional information will be included and the policy will be presented at a later date. Approval of the Board resolution and COI Waiver for Mr. Grit was added to the consent agenda. UPDATES FROM THE BOARD CHAIR Mr. Snider a. Dispute resolution request from Allegan CMH Services Mr. Snider reported correspondence from an attorney representing Allegan CMH Services seeking dispute resolution as outlined in the LRP Operating Agreement has been received. Mr. Snider shared details of the complaint and read from a prepared statement his recommended responses to the complaint. A written copy of Mr. Snider s comments is attached to these minutes. The Board requested that Mr. VandenHeuvel place this matter on the agenda for discussion at the next Operations Committee meeting scheduled for July 11, 2014. The Operations Committee was charged with providing a written decision with respect to the Step 2 disputes. Remaining allegations will be handled in accordance with LRP policies and procedures. b. Annual election of officer and appointment of Nominating Committee LRP 14-025 Motion: To have Mr. Snider appoint a committee to nominate Board members to fill officer seats for the coming year. Moved by: Prince Support: Bird
CEO REPORT Mr. VandenHeuvel a. Strategic/Organizational Planning i. Updates from Meeting with MDCH (1) State Direction: 2011 meeting with MDCH (2) Federal Direction (i) ICRC Integration Options (3) 6/17/14 Meeting between MDCH and PIHPs (4) Future meeting between MDCH and CMHSPs ii. Current Strategic Implications (1) LRP and Systemic Strategies (i) MACMHB Leadership and Visioning White Paper Mr. VandenHeuvel shared information for the future of the LRP so that the Board may more clearly understand current and future policy pressures. He reviewed four proposed integration models that MDCH has shared in 2011. MDCH has shared that the fourth option is the most likely model for which the PIHP should prepare. MDCH is engaged in a contract with MPHI to provide technical support for the PIHP s. The PIHP is a public managed care entity that is responsible for integration at the management level and promoting/supporting integration at the service level. It is critical that the Board understands that PIHP s are not providers of services, but a system for managing the benefit. At the provider level, care coordination is the core function of integrated care and the most significant expertise and opportunity for CMHs. Mr. VandenHeuvel will make himself available prior to the regular monthly meeting of the board for a work session to assist members in more clearly understanding current policies and issues and staffing implications. The work sessions will be scheduled one half-hour prior to the start of monthly Board meetings. Mr. VandenHeuvel commented on current issues with state general fund. It has not been clearly articulated what is and is not covered by general funds. General funds are not managed by the region and are addressed in a separate contract with CMHs from MDCH. The impact of General Funds and general fund reductions are, however, relevant to the region and the LRP as General Fund reductions have a direct impact on our members and communities. Mr. VandenHeuvel will continue to participate in meetings and discussions to represent the Region on this topic. (2) LRP Operational Implications (i) LRP Responsibilities from January of 2014 (ii) LRP Strategic Outcomes (iii) LRP Staffing Proposal Current Business Model 1. Operations Committee Business Model, Staffing and Strategic Discussions Mr. VandenHeuvel reviewed the strategic outcomes which were approved by the Board during the May meeting. The staffing proposal has been developed and reviewed by the LRP Executive Staff and the Operations Committee. The LRP is committed to be as mindful and strategic as possible as it relates to staffing. These positions outline the capacity needed in order to perform all of the required functions of the PHIP and represents the current understanding of what is needed in order June 26, 2014 Page 2 of 6
to be prepared to pass the test moving forward. Some positions will be recruited now and others will be in place by October 1, 2014. Positions will be directly hired, through service agreements, or via contract. Ms. Bird expressed concern that this might be a cost that affects the consumer and would like a clearer understanding of what cost is being relieved to the counties as we increase our administrative costs. Mr. Snider suggested that this might be a good discussion item for the pre- Board meeting work session. b. MDCH/N180/LRP Meeting Mr. Snider and Mr. Labun joined Mr. VandenHeuvel at a meeting with Network 180 and Kent County Officials to discuss general fund reductions and how that is impacting member boards. Due to the significant reductions, CMH s are unable to continue many of the community programs. The impact of regionalization and the regional rebasing have also been discussed, but it was noted that these impacts are separate from General Fund reductions. c. SUD Pre-Delegation Assessment and CA Transition ROAT Update With the exception of finalizing the financial review, the pre-delegation assessment has been approved and the LRP will move forward with the Board approved recommendation. d. PIHP Discussions with MASACA and MACMHB The PIHP s continue to discuss representation needs of the ten regions. MACMHB is considering a plan to offer membership to the PIHP s. Although the ten are generally in favor of membership, there may be needs which cannot be fully met by the Board Association. Mr. VandenHeuvel has been selected to be spokesperson for the ten PIHP s. MDCH is pursuing a three-month extension on the Medicaid (b and c) waivers (through December 2014). There likely won t be any changes to the rates. It has been reported that the use of Medicaid dollars for IMD s will no longer be permitted under renewed or alternative waivers. This is currently the case for Healthy Michigan Medicaid. UPDATE FROM THE OPERATIONS COMMITTEE Mr. VandenHeuvel i. Budget Development and Financial Picture (1) Regional Standards and Definitions (i) Budgeting (ii) Administrative/Service Cost Allocation and Tracking (2) General Fund -Healthy Michigan, Impact and causes of Re-basing January of 2014, and LRP Costs vs. Savings (3) Modeling of revised funding methodology (4) LRP role in ensuring beneficiary services The Operation Committee has been focusing on budget and funding issues. Mr. Labun is working with the Finance ROAT to develop regional standards for budgeting projections and processes in an effort to develop consistent definitions in order to measure and track data. There has been a great deal of discussion related to funding methodology as outlined in the Operating Agreement. Mr. Labun is working on funding methodology proposals for a 3, 4, & 5 year phase-in of PEPM funding. June 26, 2014 Page 3 of 6
CFO REPORT Mr. Labun FY2014 May Funds Distribution LRP 14-026 Motion: To approve the FY2014 May Funds Distribution Moved by: Ponstein Support: Gonzelez FY2014 May Finance Reports Mr. Labun reviewed the financial reports as presented. The region has received $1.2 more in Medicaid than originally anticipated and $2.1 million in Healthy Michigan funds have been received. Administrative expenses are under budget LRP 14-027 Motion: To accept the FY2014 May Finance Reports as presented Moved by: Ponstein Support: Gonzalez The current projection is excess Medicaid in the amount of $2.2 million. Healthy Michigan payments have been received for April, May and June. Enrollment for the region is higher than originally projected by the state. Mr. Labun is analyzing the data to use as comparisons for 3, 4 and 5-year phase in funding models. The SUD Finance ROAT is now integrated into the regular Finance ROAT to make sure we are on top of the SUD financials. An audit firm will need to be selected. Consideration is being given to utilizing a member s firm for one year while engaging in a three-year RFP process. COO REPORT Mr. Hofman a. Autism Site Review Update b. SAG Review Preparation c. Compliance Update Mr. Hofman reported that the performance measures report is ready to be submitted to the state. Overall the data is favorable. The LRP will require a plan of correction from members whose indicators fall below the benchmark for two consecutive quarters. The Performance Improvement Project is due to the State in mid-july. The project requires a plan for integration of physical and behavior health. The LRP s project will focus on looking at certain medications with risk factors associated with diabetes and blood sugar with the goal to determine if individuals prescribed these medications are having the follow-up blood work to monitor their health factors. Provider network committee is working on inpatient contracts and is coordinating efforts toward standardization of the contract language. The group has been discussing the next step in training reciprocity and will assess the Medicaid continuum of services available across the region. During the month of July there will be an external quality review around provider network, Quality, Utilization Management, and Customers Services. The Autism Waiver review was conducted in early June and identified both strengths and areas for improvement within the region. A formal report has not yet been issued and the results will be shared with the Board upon receipt. June 26, 2014 Page 4 of 6
Interviews for the Waiver Coordinator have been completed and the position will be filled in the near future. CIO REPORT Mr. Goodrich Utilization Management - Mr. Goodrich reported that the UM ROAT has reviewed and validated the review tool. The LRP has adopted an oversight role and this tool will help to make sure that the CMHSP s are performing required functions. Information Technology Mr. Goodrich introduced Mr. Dave McElfish, IT Lead. Mr. McElfish has been charged with a project to demonstrate how services are provided within a certain geographical area. BOARD MEMBER COMMENTS Ms. Bird reported on the auditor general report on Medicaid funding in the state. Mr. Ponstein thanked everyone for attending. He reiterated that advocacy is important and appreciated. He suggests that we move the public comment portion of the meeting up on the agenda before the general agenda items. Mr. Snider reinforced that the LRP wants to ensure that services are delivered to eligible recipients across the region. UPCOMING MEETINGS LRP Board meeting: July 17, 2014 at Muskegon CMH, 376 E. Apple Avenue, Muskegon PUBLIC COMMENTS Ms. Marianne Huff Allegan County Community Mental Health Services Ms. Huff provided details on Advocacy issues in which ACCMH are engaged. Mr. Wayman Britt Kent County Administrators Office Mr. Britt commented on Kent County s concerns regarding the effects of regionalization on the citizens of Kent County. If issues are not resolved, many services will be effected by these changes. ADJOURN Mr. Snider adjourned the meeting at approximately 3:10 p.m. I. John Snider, Board Chair Larry Oberst, Secretary June 26, 2014 Page 5 of 6
John Snider - Dispute Resolution Recommendations Attachment to June 26, 2014 I have received a letter and a Complaint dated June 6, 2014, from an attorney acting on behalf of Allegan County Community Mental Health Services. The Complaint seeks to invoke Step 3 of the dispute resolution process in Article V of the Operating Agreement of Lakeshore Regional Entity (also known as LRE or LRP), with respect to several disputes described in the Complaint. Step 3 of the dispute resolution process requires presentation of disputes to the LRE Executive Board, which must then provide a written decision regarding the dispute. I would first like to thank ACCMH for bringing its concerns to the attention of LRE s Executive Board. I have reviewed the Complaint, and in consultation with LRE s legal counsel and with LRE s CEO, Rich VandenHeuvel, I have determined that some of the allegations in the Complaint are not covered by the dispute resolution process in the Operating Agreement. I have also determined that other disputes alleged in the Complaint have not yet proceeded through Steps 1 and 2 of the dispute resolution process, and as a result, this Board does not have the authority to address these disputes at this time. Specifically, I have come to the following conclusions: First, ACCMH asserts that it should have, but has not, received a copy of Exhibit C to the Medicaid Managed Specialty Supports and Services Concurrent 1915(b)(c) Waiver Program Demonstration Subcontract Agreement that was signed by Marianne Huff on behalf of ACCMH on July 18, 2013. I have determined that this dispute has not yet proceeded through Step 1 of the dispute resolution process, so I have asked Rich VandenHeuvel to respond to ACCMH with respect to this alleged dispute. Second, ACCMH requests that LRE provide ACCMH with DEG information in HIPAA compliant form. Again, it is my understanding that this alleged dispute has not proceeded through Step 1 of the dispute resolution process, so I have asked Rich to respond to ACCMH with respect to this dispute as well. Third, ACCMH makes several requests pertaining to LRE s funding model, including requests that it be provided with a transition plan from the current funding formula to a DEG model, a revised Medicaid Subcontract Agreement, and a plan from Ottawa CMH to bring its spending into conformity with the DEG. Because the Operations Committee has yet to render a written decision with respect to these disputes, as required under Step 2 of the dispute resolution process, I have determined that they have not yet proceeded through Step 2. I have therefore directed Rich to place these disputes on the agenda for the next Operations Committee meeting which will take place on July 10, 2014, so that the Committee can discuss the disputes and render a written decision as to each dispute. Fourth, the remaining allegations in the Complaint shall be handled in accordance with LRE policies and procedures.