William H. McDougal, Substance Abuse Services Director, CCMHC

                         Terry Eads, MIS Director, CCMHC

                         Stacy Martin, Clerk to the Area Board, CCMHC

                         Bert Bleakley, NAMI

                         Cleveland Wilson, Your New Beginning

                         Lena Klumper, Partnership for Children

                         Judy Parker, CREST

                        Alfred Spriggs, L.I.F.E. Concepts

                        Alice Smith, Peterkin & Associates and IPA

Mrs. Jenkins expressed her appreciation to members for taking the time to be part of the LME process.

Mrs. Jenkins asked every one to go around the room and introduce themselves.

Mrs. Jenkins gave an overview of the Mental Health Reform and the process the Cumberland County Mental Health Center is undergoing to transform into a Local Management Entity (LME).

There are numerous subcommittees ongoing to address the various elements necessary in the Local Business Plan. Some committees rely on the work of other committees to build upon.

Service Management Section is due to the State in April.

The Evaluation Section is due to the State in January.

Mrs. Jenkins reported that information from Raleigh is limited. There has been minimal guidance on how to develop provider network. No definition on what "qualified" providers constitutes and whether network will be open or closed network. Additionally, no money has been allocated for this process so far as cost estimates have not been completed. No best practices information provided for monitoring outcomes. Some programs are developing on their own.

Mrs. Jenkins reported that there are some Area Programs that will be fully operational LME’s by next year (Phase I). Some programs are making full divestiture of services. However, CCMHC has chosen not to go forward as LME in first phase because there are too many unknown variables. Will continue to ask State for answers to the many questions arising in this process and gather as much information as possible.

Will submit Strategic Plan in January 2003 and the plan will be graded for implementation in January 2004.

Mrs. Jenkins reported that some providers have been very good about providing information on who they are serving and what services they are providing. However, there have been providers who have expressed no interest in becoming a part of the network and have not provided any information. Unfortunately, if they do not join, then they will be unable to receive payments from the State and/or Medicaid for services they are providing as they will not have consumers entered into the State reporting system.

Discussion on IPRS and what this means for services provided to consumers and to providers. There are still problems for the pilot programs and Phase I programs with IPRS, some due to errors for the area program and others due to lack of information/clarity from the State.

Mrs. Jenkins reported that under IPRS, if a client does not qualify in a target population for the service based on the array of services, then there will not be payment for the service provided.

Mrs. Jenkins said that 12% of clients currently in services through CCMHC’s Adult Services Program won’t qualify for services; 20-25% of clients in Substance Abuse Services won’t qualify, and the array of services available to many DD clients will not be available. Additionally, Mrs. Jenkins reported that children who have mild problems will not be able to qualify for services that they current receive.

Mrs. Jenkins informed members that there is a Consumer and Family Advisory Committee (CFAC) made of 100% consumers and families that equally represent the disability areas. This committee was appointed by the Planning and Collaboration Subcommittee of the LME. The CFAC will write a position paper either supporting or rejecting the plan created by the LME.

Mrs. Jenkins said that the hospital is making dramatic changes to the way they admit patients in hopes of cutting admissions by handling triage differently. She stated that in April the hospital intends to cut its beds down to 16. Mr. Spriggs commented that he also works for BHC and said this transition actually begins in October to less beds but they will move to the new facility in April.

Mr. Eads gave an overview from a three-day Finance and Reimbursement Officer’s Conference he attended this week. He stated that in attendance was a doctor from Michigan who gave testimony of their experience of this process. Michigan has been going through mental health reform since 1996. Mr. Eads commented that the picture painted by the doctor is "very scary." Michigan’s process is still evolving even after six years. The doctor informed the group that in her organization, everyone was laid off and were asked to reapply for positions.

Mr. Eads reported that all Workgroups and Committees at the State level have halted for now.

Mr. Eads informed committee members that the State Plan and other information is available through the State’s website.

Twenty-four hour emergency services are available. However, need a 24-hour-day crisis response team with clinicians available to go out to do face-to-face admissions.

Mr. Spriggs commented that at BHC he frequently sees people who have reported that they presented in the ER but are sent home because they don’t meet criteria for admissions. Oftentimes, clients present at ER requesting help, but because they are not suicidal or currently detoxing, they are sent home.

Mrs. Jenkins reported that length of stay on authorizations are decreasing, too.

Question was posed about managing processes when clients aren’t imminently suicidal or psychotic and therefore don’t meet criteria for inpatient and are discharged.

There is a need to "beef up" outcomes tracking. Be able to define/prove necessity of services; this isn’t done by many providers in the community.

Need to track provisions for face-to-face emergency care.

Need to look at the quality of care and continuity of care to ensure clients are receiving appropriate care. Need to look at gaps in services.

Mrs. Klumper suggested showing the costs on the system, community, and state when continuity of care is not maintained. Clients are shifted to where the resources are available and oftentimes this results in receiving services from multiple locations within short periods of time. These types of incidents/practices create extra expenses.

Mrs. Jenkins reported that all states who preceded North Carolina in Mental Health Reform efforts have no data available that demonstrates through outcomes that clients are any better as a result of the changes brought on by reform efforts. Ms. Klumper shared information on the need for outcomes to support what is working and what does not work, noting that even with clearly defined guidelines and criteria, a great deal of technical assistance is needed.

Mrs. Jenkins said there is a need to address Open or Closed Provider Networks and what providers need to know re: referral potential. If there are too many providers for a certain type of service, the provider may get very few referrals. Ms. Smith discussed how this will impact on the ability of a provider to continue being a provider.

Mrs. Jenkins asked committee members to read through the information to see if there are questions or if additional information is needed.

Mrs. Jenkins reported that the agency will be addressing many elements of the business plan as it is going through the COA re-accreditation process.

Mrs. Jenkins reported that the agency has identified 37 new policies that need to be written in response to the Business Plan.

Mrs. Jenkins informed committee members that the Area Program staff will write information in response to the business plan for consideration by the committees and for edit and review.

The meeting adjourned with the next meeting scheduled for Mondays at 8:30 in the morning, beginning September 30.