Rick Wheat motioned to approve the January 16, 2013 Board minutes. Shannon Ost seconded the motion. The Board unanimously approved the Minutes.

Transcription

1 Magellan in Louisiana Louisiana Behavioral Health Partnership Governance Board Minutes of February 27, 2013 PRESENT: Community Members of Governance Board: H. T. Ted Cox, Juvenile Court/Shreveport, Community Member at Large Joan Guillory-Williams Board Co-Chair, The Extra Mile Region IV, Adult Service Recipient Kimberlyne Roundtree, Primary Care Solutions, Inc., Adult and Child/Youth Service Provider Rick Wheat, Louisiana United Methodist Children and Family Services, Child/Youth Provider Magellan Members of Governance Board: Dr. Craig Coenson, Board Chair, Chief Executive Officer, Magellan in Louisiana Neal Cohen, Chief Operating Officer, Magellan in Louisiana Dr. Richard Dick Dalton, Chief Medical Officer, Magellan in Louisiana Kathleen Coenson, VP of System Transformation, Magellan in Louisiana Shannon Ost, Network Development Administrator, Magellan in Louisiana Dr. Seth Kunen, Quality Management Administrator, Magellan in Louisiana Staff to Governance Board Jill Dyason, Governance Board Lead, System Development Manager, Magellan in Louisiana Lisa Faust, Chief of Staff, Magellan in Louisiana Deborah Hernandez, Executive Assistant, Magellan in Louisiana Governance Board Members Present via Conference Phone Judy Disotell, NAMI, Parent of Child/Youth Receiving Services Kimberlyne Roundtree, Primary Care Solutions, Inc., Adult and Child/Youth Service Provider ABSENT: Lisa Schilling, South Central Louisiana Human Services Authority, LGE Guests: Anita Byrne, SSA Consultants Amy Schuten, Magellan in Louisiana IN SESSION: This meeting was called to order at 1:00 pm Board minutes submitted for January 16, 2013 Rick Wheat motioned to approve the January 16, 2013 Board minutes. Shannon Ost seconded the motion. The Board unanimously approved the Minutes. Board Announcements None 1

2 BOARD UPDATES Louisiana Behavioral Health Advisory Council Update Joan Guillory-Williams, Board Co-Chair, The Extra Mile Region IV, Adult Service Recipient presented background information to Board Members on the Louisiana Behavioral Health Advisory Council. The Council was developed to fulfill a requirement from the Federal Government of the development of a planning body so the state would be eligible to receive Block Grant funds for mental health and addictive disorders. Formerly known as the Planning Council and in existence since the 1980 s, the Council is now known as the Behavioral Health Advisory Council. The Council consists of a forty (40) member Board with representation from State Agencies (OBH, OJJ, Children and Family Services, Rehab Services and Housing), State Agencies in the standing rule, six (6) Advocacy agencies, Regional Advisory Council representation mirroring the statewide Council, and individual representation. Guillory-Williams stated that the agenda from the last meeting held on February 4, 2013 has been included in the information. All meetings follow the same format of reporting the various committees of the executive group (Advocacy, Finance, Membership, and Program and Services). Guillory-Williams stated that she serves on the Program and Services Group. The Executive Members term of service is one (1) year. She noted that during the last meeting, Dr. Tony Speier and Dr. Dunham gave a series of reports on information that she had already received from the Magellan Governance Board Meeting. Each of the forty (40) members present a report during the BH Advisory Council Meeting. Only key items from each report are brought to the attention of Council Members and the remaining reports stand as submitted. Guillory Williams pointed out that the major functions of the Council include review of the submitted plans for the Block Grants advocate and monitor, and review and evaluation of the allocation of services through the State. The reports submitted from the February Louisiana Behavioral Health Advisory Council meeting are available to the Governance Board if interested. Of interest to our Governance Board Members, the Program and Service Committee conducted a survey of the RAC and found that the highest priority of services are 1) Hospitals; 2) Prevention; and 3) Integration of Mental Health and Addictive Disorders. Guillory-Williams suggested that we possibly discuss what Magellan provides toward prevention services at a future Governance Board Meeting. System Transformation Update Kathy Coenson, VP of System Transformation, Magellan in LA, announced that transformation is moving in the right direction with DCFS and OJJ. Both agencies are referring children and Magellan is working with their staff to provide avenues of treatment, appropriate residential treatment, and PTRF. Communication towards claims, billing, and authorization is moving forward. Coenson announced that a MY LIFE event will be held Thursday, February 28 at the Family and Youth Service Center in Baton Rouge. Regarding the CSoC enrollment, 750 children were enrolled at the end of January. An increase in enrollment is occurring fairly rapidly. Coenson stated that some Regions have enrolled 40, where Region 9 has enrolled 186 children so it is varied. She continued that Foley Nash, Children s System Administrator, has begun working with OCDD for the Developmental Disabled, even though there is not a contract with them. Coenson announced that Magellan has begun implementation of the Parent Café Program under the Family Involvement Group with Danielle Marshall as the lead on this project. She noted that this program will start in Baton Rouge and Shreveport and then branch out to Orleans, St. Bernard and Plaquemine Parishes. The program s purpose is for parents to have a place to meet, learn from one another and share community education and resources while they support each other. Magellan will sponsor this program and will host them on a regular ongoing basis. 2

3 The Warm Line is also in the implementation stage. An RFP for staffing the Warm Line is in the development stages for non-profits to apply. We are hoping to partner with the State in developing and using technical assistance for this and potentially have the State own the certification and training process. Magellan is currently working with the State on the statewide Family Support Organization rollout. Magellan is assisting them with the preparation of running a successful business model. The organization is in the process of hiring staff and organizing. They will start in Region 1 (Jefferson Parish) as their agency is currently housed in New Orleans and branch out across the state from there. Guillory-Williams asked Kathy Coenson on behalf of statewide peer support specialists, where we are regarding receiving Medicaid reimbursement for peer support services? She explained that the concern is that, at this time, the services are not billable. Coenson stated that Margaret Mitchell is working closely with Amy Schuten to assure inclusion of peer support within the PSH program. They are attempting to receive buy-in from Medicaid for placing peer support itself under PSH as PSR. As part of this transition, next steps would be for Medicaid to cover a specialized peer support as a billable service. At this time, it is in a go between phase where we are encouraging that peer support be included in the service authorization and guidelines under the psychosocial rehab to become a standalone service as peer support. Tied with this will be a standardization certification for stand-alone peer support services. Medicaid will want standardization before agreeing to reimbursement of services. PSH Implementation Presentation Amy Schuten, Adult System Administrator, Magellan in Louisiana presented a summary of Permanent Supportive Housing (PSH) to the Governance Board Members. PSH has been existence in Louisiana for five (5) years and stemmed from grant funding following hurricanes Katrina and Rita. PSH was developed primarily to focus on and address the most vulnerable individuals who were displaced from their homes and not in standard housing. The program provides housing vouchers and supportive services to these individuals and families (3300 units are allocated). The vouchers are managed through the LA Housing Authority including Project based Vouchers (PBV) Shelter and Care Vouchers (S+C) and tax credit and other vouchers. Applications and services have previously been managed by Local Lead Agencies (LLA) under the PSH program in the Office of Community Development. Services have been provided by Housing Support Teams utilizing the Community Development Block Grant (CDBG). Under the PSH program standards, individuals can choose where they want to live as units are available in their general community. Support services are provided in the community and available regardless of the type of disability a person has. Services are individualized to the person s unique needs, wants and circumstances. The Louisiana PSH program is unique and nationally recognized for providing services across disabilities and for its success in assisting people by maintaining their housing once they are in the program. To be eligible for the PSH program the financial and functional requirements must be met. An individual must meet income levels as established by HUD for the area in which they choose to live. The income eligibility is established and conducted annually by review of a subsidy administrator. An individual must have long-term disability as defined by one of the DHH program offices, which include the Office of Behavioral Health (OBH), Office for Citizens with Developmental Disabilities (OCDD), Office of Adults and Aging (OAAS), and the Office of Public Health (OPH). The individual should be able to maintain a household in the community with the provision of support services available in the program. The State of Louisiana has developed a plan to ensure services will remain available to participants of this program by moving the funding of services from the grant to services provided through Medicaid waiver program initiatives for sustainability. Participants with behavioral health disabilities will have housing services funded by the 1915i waiver using CPST and PSR services. The other program offices of OCDD and OAAS are in the process of modifying and 3

4 developing their own waivers to encompass this level of service. Until these waivers are fully realized, Magellan will assist in managing the services provided through the CDBG funding. With this said, Magellan has agreed to manage some aspects of the PSH program. They include outreach, screening and processing applications, tenant services management, care management, network management, data management and payment of claims. Magellan s goals are to partner with the various state agencies. It is important to coordinate services across disabilities through the provider agencies. This can be met by streamlining and assuring consistency from the application process to the service delivery for individuals across the region and across disabilities. By increasing efficiency and effectiveness, the management of available funding will be proficient. Magellan will continue to meet and exceed the established success of the PSH program by enabling participants to live independently in a home of their choice with the support to make them successful. Mobile Phone Initiative Overview Neal Cohen, Chief Operations Officer, Magellan in Louisiana presented an overview summarizing the status of the mobile phone initiative and next steps on strategy. Cohen stated that this is an opportunity for Magellan to partner with a mobile phone company offering mobile phones to adult (19 and older) members without a contract and for these members to receive Health Life text messages. The objective for this is to have the member improve communication with Magellan and their providers. The member will be able to contact Magellan or their provider at no charge and these minutes will not count against their allotment. Within the offer, a member will have 250 free minutes per year that may be used to call anyone and unlimited texting will be provided as well. If the free minutes are depleted before the year-end, they can purchase additional time at the member s discretion. Cohen stated that there are multiple ways that a member can obtain a phone. Magellan will be mailing a flyer to qualified members that are on the 1915i waiver. The mobile phone information will also be posted on Magellan s website. The mobile phone company that Magellan has partnered with will be accepting the applications from Medicaid members. Reporting and surveys will be conducted to members querying if there are positive gains on receiving a mobile phone. Magellan s goal is to improve member outcomes for those who are actively in treatment. Cohen emphasized that there are no Medicaid or tax dollars attached to this partnership. Public Forums Update Lisa Faust, Communications Director, Magellan in Louisiana, updated Board Members on the Magellan Public Forums that began February 18 in Shreveport, LA. The Forums have been very open dialogues regarding the challenges of transforming a system and the seismic shift that we are undertaking on how Behavioral Healthcare is delivered. Forums conducted so far have been in Shreveport, Monroe, Lafayette and Lake Charles. The participant turnout has been good thus far, with Lafayette being the largest group to date. Faust noted that the diversity of participants has been good. She noted that the Monroe participants were mostly providers, but the other Forums consisted of many individuals from the Member and Advocacy groups as well. Faust explained that Anita Byrne will provide summaries of each Forum when the rounds have been completed on attendance and feedback. The summaries will also be shared with OBH and Medicaid for them to share with CMS. Quality and Improvement Report 4

5 Performance Guarantees Seth Kunen, Quality Management Administrator gave an overview on the monthly reported indicators for performance guarantees that have financial accountability by matching goals to year-end performance. Dr. Kunen reported that we have met all but one (1) performance guarantee, which are the Ambulatory follow-up rates. A work group has been convened to address the follow-up issues. Provider satisfaction survey First year goal is seventy-five percent (75%) that the provider is satisfied or very satisfied we are currently at seventy-four percent (74.4%). Another roll out of survey will be sent out due to a low response. Only forty-five (45) providers out of two-hundred (200) providers responded to Magellan s request for feedback on services. Kunen reviewed the highlights from the Quality Improvement Committee meeting. QIC reviewed and approved onehundred and thirty-nine (139) corporate policies last year and the next year policy review will begin in March. He also clarified that LA CMC will use the State approved criteria (SAC) regarding the provision of services and not the medical necessity criteria. Kunen followed that Utilization Management reported that Inpatient hospitalization rates have declined by twenty percent (20%) over the past few months. He stated that the Member Services Committee reported that all of the performance guarantees have been met. From the Network Strategy Committee Report, Dr. Kunen stated that we have five-hundred and fifty-seven (557) credentialed in-state facilities now with an additional sixty-two (62) facilities in the credentialing process. There are eight-hundred and ninety-seven (897) fully contracted practitioners on board. Kunen continued that the Race and Equity Committee is in the process of developing an initial cultural competency self-assessment tool for providers regarding cultural readiness. QI is currently conducting treatment record reviews (TRR s) for Inpatient Psychiatric Hospitals, Residential Substance Abuse Treatment Facilities, Outpatient Facilities, and Wrap-Around Agencies. We have identified one-hundred and eighty-five (185) providers as high-volume providers in the network. Seventy-two (72) providers have been audited to date and seventeen (17) audits are in progress. The aggregate compliance rate is currently eighty-six percent (86.56%). Dr. Kunen stated that forty-six (46) Inpatient Psychiatric Hospitals were reviewed and the overall network compliance score is ninety-one percent (91.2%). He stated that ten (10) Residential Substance Abuse Facilities have been reviewed with the overall network compliance score at this level of care being eighty-nine percent (89.3%). He also noted that a review of fourteen (14) Outpatient facilities was conducted with an overall network compliance score of sixty-seven percent (67.8%). A work group has started to address this low score and confirm why it is occurring. One (1) Wrap- Around Agency was reviewed with an overall network compliance score of eighty-eight percent (88.7%). Kunen reviewed the Quality of Care and Adverse Incident Report. In 2013, there have been twenty-six (26) adverse incidents (15 in January and 11 in February). The types of incidents occurring have ranged from restraints at seventeen (17), seclusion at four (4), deaths at three (3), and elopement at one (1). OBH requires that Magellan report out on the incidents. An action plan has been developed regarding the elopement and two (2) site visits are planned that will pertain to the other incidents. To date in 2013, Magellan has received fifty-three (53) quality of care concerns reported (31 in January and 22 in February). The concern types were professional behavior at two (2), complete documentation at one (1), 5

6 appropriateness of care at fifteen (15), access to initial, subsequent, specialty services at three (3), inadequate or inappropriate aftercare/discharge planning at fourteen (14), coordination of care at five (5), compliance with credentialing at one (1) and timely submission of evaluations, treatment plans, discharge summaries at one (1). Other concern types included polypharmacy at four (4), involuntary confinement at one (1) and discrepancy in reports of PA with AP, and UR with medical record at six (6). Kunen finished by stating that work continues on the PCP PIP. He indicated that we will be rolling out the project to two (2) hospitals in Shreveport next week. CEO MESSAGE TO THE BOARD Craig Coenson introduced Richard Rick Dalton, MD who is Magellan in Louisiana s Chief Medical Officer. Dr. Dalton presented his background to Board Members. He stated that he is a Child and Adult Psychiatrist and has been a Tulane Faculty Member for thirty (30) years. He was the Medical Director of the LSU Health Care System and managed the Office of Juvenile Justice Secure Facilities. He stated that he then was the Medical Director for the Office of Mental Health for DHH. He has served as a teacher, researcher, and some worked in administrative roles. He stated that he is excited to be with Magellan and serving as the Chief Medical Officer. Coenson continued that Samuel Kelley, MD was hired as Magellan in Louisiana s Medical Administrator and has begun work in the Baton Rouge office as of February 11, 2013, but will begin full time on March 1, Dr. Kelley is presently getting a license in Louisiana and is transitioning from New England. He comes from work as the Medical Director working on the Vermont Blue Cross/Blue Shield account. Coenson stated that Magellan in Louisiana s Public Forum s have begun and the tones are good. Participants have stated that they have learned a lot from the Forums. Lisa Faust gave a full report as well. Coenson reported on the ESS Program. Magellan is working now with the State of the Zero-Five Program. During the Forum held in Lafayette, LA, Foley Nash was able to explain the transition plan for children presently in that program. Dr. Dalton knows the program well from Tulane and will assist with this moving forward with the partnership. Magellan in Louisiana has been meeting with DCFS and OJJ on a regular basis to improve communication. Coenson also stated that Magellan presented at the Drug Court State Conference and carved out drug court care management by designating two (2) care managers. We focused on their specific needs in drug court and this is going well. He stated that we have also met with the CEO s from Volunteers of America and discussed the roles they would like to have moving forward toward the goals of the partnership. Coenson continued by stating that we have been meeting with Legislators and other stakeholders as well knowing that the legislative session will begin soon. Magellan has been conducting interviews with IT candidates and has made an offer to one of the candidates for the position of IT Director. Lisa Faust stated to Board Members that Magellan has conducted a lot of stakeholder outreach. She stated that we have met with Judges across the State and are working on a formalized plan with the Office of Behavioral Health to organize Juvenile Judge Roundtables using the model of the discussion type held in Shreveport, LA. Faust stated that a transformation plan will be developed from this process. Meetings with large hospital providers with discussions particularly around resources and referrals in to the Coordinated System of Care (CSoC) will take place. She stated 6

7 that what we are beginning to see is the move from implementation to the development of a strategy of what the system should be. Faust also announced to Board Members that if a provider has questions on any subject matter, Magellan has a Provider Call (Network/State-wide) every Thursday at noon staffed by subject experts from Magellan. The call in number for providers is posted on the Magellan in Louisiana website. NEW BUSINESS Ted Cox proposed that the Governance Board Meeting time-period change to 1:00pm 3:00pm on the third Wednesday of each month. It was decided, by consensus, that Jill Dyason will receive s from each Board Member so that a decision can be made on the meeting time change going forward. PUBLIC COMMENT None NEXT MEETING The next meeting of the Governance Board is Wednesday, March 20, ADJOURN Joan Guillory-Williams moved to adjourn. Rick Wheat seconded the motion. The Board voted unanimously to adjourn. The meeting adjourned at 3:00 pm. 7