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QUALIFIED PROVIDER NETWORK
SUBCOMMITTEE
OF THE LME
June
30, 2003
3:00 p.m.
711 Executive Place - Room 426
MEMBERS
PRESENT: Betty Washington, Pearl’s Angel Care, Inc.
Linda Brai
Karen Campbell, Campbell and
Associates
Wallace Morris, Our House
David Richards, Woodbridge
Alternatives
Sera Gilmore, Wilson-Gilmore Services
Tricare
Home
David Haqq, Diyah’s Home Inc.
Carmen Davis, Caring Family
Network
Rose Ferguson, Fergie’s Behavioral Center
Tracey Jackson, Lutheran Family
Services
Ann T. Newell
Rashad A. Rahmaan, Sunlight Behavioral
Center
Ebony Corley, South of Rae, Inc.
Kelly P. Lampkin, Evergreen Health
Services
Charles Lakin III, Trinity Home Care
Melissa McAllister, Precious Haven,
Inc.
Benjamin Powell
Stephanie Blanton, Peterkin & Associates,
IPA Laura Lloyd, Davis,
Lloyd & Associates
Louis Gloston, Peterkin & Associates,
IPA
Michelle Davis, Davis, Lloyd & Associates
Iris Middleton, The Reaves
House
Celena Turner, Trinity Adolescent Homes,
Inc.
Whitney A. Medena, New Horizons Residential
Treatment
Celeste Humphries, New Horizons Residential
Treatment
STAFF Vince Wagner, Managed Care Director, CCMHC
PRESENT: Debbie Jenkins, Child and Family Services
Director, CCMHC
William H. McDougal, Substance Abuse Services Director, CCMHC
Terry Eads, Management Information Services, CCMHC
Doris La Pella, Administrative Assistant to Administrative Services
Director,
CCMHC
I.
Welcome/Introductions
·
Mr. Wagner thanked everyone for their participation
and members introduced themselves.
II. Agenda Adjustments
·
None.
III.
Announcements
·
Mr. Wagner announced that Mrs. Stacy Martin is no
longer employed with the agency and introduced Mrs. Doris LaPella
who will begin recording the minutes until further notice.
IV.
Approval of Minutes 6-16-03
·
Minutes were approved as written.
V. Update from “Training/Technical Assistance/Education
Subcommittee”
·
The committee has not met since its last update.
VI. Summary of IPRS Target Population Changes for FY 03/04
·
Mr. Wagner distributed to members a Summary of IPRS
Target Population Changes for FY 03/04 handout for their review
(Attachment A) and informed them that Mr. Eads and Mrs. Jenkins can
answer any questions regarding this information.
·
Mrs. Jenkins reported that the State made changes to
the target populations and format which can be viewed on the
Division’s website and encouraged members to read the information.
These go into effect tomorrow (July 1, 2003). It clarifies who is
eligible for certain services and the array that matches up with the
target populations.
·
Mrs. Jenkins advised members to ensure they are
looking at what the definitions are of the services as they are
currently defined and then where the client fits in as far as the
target population is concerned.
·
Mr. Wagner encouraged members to make copies of this
handout to distribute to concerned others and informed members that
any acronyms they are unfamiliar with are spelled out in the
website.
VII. Senate Bill 163 (Monitoring Rules effective 7-1-03)
·
Mrs. Jenkins attended a meeting with the State last
week to inform area programs and newly formed LME’s what the
monitoring rules entail under Senate Bill 163/926 that go into
effect 7-1-03. The State will be sending out a packet with this
information at a later date.
·
Mrs. Jenkins distributed various handouts to share
some of the information with members (Attachments B – G) for their
review. Lengthy discussion followed highlighting various areas.
·
The Area Authority or County Program Monitoring of
Facilities & Services handout (Attachment B) – They shall
receive and review critical incident reports and identify trends
based on the reports; receiving, mediating, investigating or
referring complaints concerning the provision of services; or
monitoring of providers of services to improve the quality of care
received by clients. The only area where it is a may
is the routine monitoring.
·
One change in the rules is that area programs
shall investigate any complaint related to Category A and
Category B providers. Category A – licensed providers and Category
B - CAPP providers and unlicensed service providers such as CBS.
(Attachment C)
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It is unknown at this time what the process is going to be
for consumers to be made aware of the role of the LME in complaint
mediation.
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The area authority or program shall respond to any complaints
in its catchment area meaning Cumberland County. It doesn’t matter
where the consumer is coming from, it will be the catchment area
where the service is provided.
-
Mrs. Jenkins informed that the State will be providing a list
of all the service providers in the area - licensed and unlicensed
that are receiving any kind of State, Federal or Medicaid money
which will determine who it is we need to be involved with.
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If a complaint is made, the area program will ask the person
making the complaint to talk the provider to try and resolve the
issue. If the person making the complaint says they can’t talk to
the provider, it automatically becomes an investigation. If the
area program has to investigate the complaint, then they have within
10 working days to submit a report to the provider. The provider
will then have within 10 days to submit a plan of correction.
Monitoring will then take place to follow up with their plan of
correction.
·
DMHDDSAS Suspension & Revocation Decision & Appeal
Process handout (Attachment D) - The Division of Medical Assistance
can recommend suspension of admissions to a facility if an area
program or county program does monitoring or complaint investigation
and finds that there is significant concern about the health and
well being of consumers being served. The area program or
monitoring team will need to make sure they are validating and
documenting what the concerns are.
·
Critical Incident and Death Reporting form handout
(Attachment E) - The State developed a new form that must be used to
report all critical incidents up through the area program within 72
hours by mail, fax or protected email. This does not replace an
incident report form that an area program may ask you to fill out or
something you may be filling out internally.
-
Mrs. Jenkins informed members that Mr. Eads is working on
setting up a way for these to be sent to the Cumberland County
Mental Health Center (CCMHC). If it is faxed, it will come to Mrs.
Jenkins. Based on the information received, it may need to be
investigated.
-
CCMHC will have to do quarterly reports to the State
categorized by type, frequency, severity, provider, who sends in
complaints and who doesn’t.
-
There is also the routine monitoring to ensure providers are
following the policies and procedures. APSM-31 has now changed.
That is now in 27G, not 14V. Mrs. Jenkins advised members to ensure
their policies and procedures reflect that they are using 27G.
-
If monitoring or an investigation is done, they will look
various things such as QI plans and projects, minutes of your
meetings, regular maintained data and trend analysis done. They
will look at what kind of changes have been made to issues that have
come up, client outcomes, evidence of improvement with clients and
system problems.
·
Mrs. Jenkins discussed the high points with some of
the new Service Definitions and protocols and urged members to
familiar themselves with these (Attachment F).
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“Provider” means any person or entity authorized to
provide publicly funded services. Important to note that the
Division of Medical Assistance has a set of rules under Senate Bill
163/926 that talks about an owner, affiliate or partner and they’re
considering somebody who has an interest of 5% or more of the
provider entity, they are included in this.
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When applying for enrollment, they’ll be asking for total
disclosure of everyone who is involved. The State will have some
type of database that will track individuals that have had financial
penalties.
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“Substantial failure to comply” – If in your reports, you
show you have substantial failure to comply, then that can be a
recommendation to service revision.
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“Summary suspension” – If you have a problem in one service
area and based on how serious it is, there can be a recommendation
for suspension of service. It could be sight specific or it could be
for everything you do. The provider may contest the order of
summary suspension by filing an appeal or grievance with DMH/DD/SAS
or by requesting a contested case hearing pursuant to G.S. 150B.
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“Revocation and Communication procedures for Out of Home
Community Placement” – Mrs. Jenkins urged members to read these
areas and informed them that the State will be taking the money out
of the school systems for out of county children. If a report is
submitted, and after doing the investigation, some of the
information is incorrect, you need to make sure you notify them of
this.
·
Ms. Tracey Jackson gave an update on behalf of the
Technical Training Committee – A free training is being put together
to try and address some of these issues, person centered planning
and outcome measures. If anyone is interested, please see her with
their names. She will inform members and interested parties with
the location and dates at a later date. Also, would like the
committee and any other providers to meet to conduct low cost
training that they feel could help support the community.
·
Mrs. Jenkins advised members to look at their computer
systems, analyze their data, set up protocols, identify trends and
address them before investigations or complaints come up.
·
One of the members informed that she has background in
quality systems and offered her help to anyone who needs assistance
in this area.
·
Mrs. Jenkins informed members that Consumer Family
Advisory Committee (CFAC) and some providers have expressed a strong
interest in there being a team approach to monitoring, just not
something for an LME staff to go out and do the monitoring or
investigation. CFAC has indicated they feel they have a role with
this.
VIII.
Round Robin
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Member asked whether there will be a change in the Y
Code. Mrs. Jenkins responded that the State is not going to open it
up to anymore direct enroll providers. That if you have a certain
number, you can direct bill to Medicaid and the State is not at this
point going to change the requirements. They have looked at if they
were able to have providers direct bill for more things but the cost
would be astronomical.
IX.
Next Meeting
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The next meeting will meet on July 14, 2003 at 3:00
p.m. The meeting for July 28, 2003 has been cancelled.
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