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Wake County Human Services and Environmental Services Board

January 26, 2012 AGENDA

Human Services Ctr - 220 Swinburne St. 2nd Fl., Rm. 2132

Standing Time: 7:30AM – 10:00AM Dianne Dunning, Chair

Pablo Escobar, Vice Chair

Purpose: Advocacy, Policy, Advisory, Accountability

Public Health Committee: Mr. Benny Ridout, Chair

7:35 am • Request for Individual Support: Resolution in Support of Recurring Funding for Tobacco Use Prevention & Cessation Programs

7:30 am Meeting Called to Order

Invocation

Approval of Minutes: December 15, 2011

Next Board Meeting: February 23, 2012 220 Swinburne St., 2nd Fl., Rm. 2132

Regular Agenda

7:45 am LME/Managed Care Organization (MCO) Merger Update - Mr. Joe Durham, Mr. Ramon Rojano, Dr. Carlyle Johnson

8:00 am Discussion on HS&ES Board Composition – Chair Dianne Dunning

8:25 am Board Advocacy Workgroup Update - Dr. Sharon Foster, Chair

8:35 am State/Local Budgets Update - Mr. Paul Gross, HS Finance Officer

8:50 am Environmental Services Acting Director's Q & A

9:00 am Human Services Director's Q & A

9:20 am Chair's Report

http://www.wakegov.com/

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Human Services Mission Statement

Wake County Human Services in partnership with the community will anticipate and respond to the public health, behavioral health and the economic and social needs of Wake County residents. We will coordinate and sustain efforts that assure safety, equity, access and well-being for all. - December 2006 _____________________________________________________________________________

Environmental Services Mission Statement

To protect and improve the quality of Wake County’s environmental and ensure a healthy future for its citizens through cooperation, education, management and enforcement. Environmental Services combines:

• water quality

• air quality

• solid waste (recycling, landfills, etc.)

• environmental health and safety (sanitation inspections, pest management, swimming pool regulations, animal control)

________________________________________________________________

FY 2011 Board’s Top Six Priorities:

#1 Prevent Child Abuse and Support Families

#2 Housing for Vulnerable Populations

#3 Obesity Prevention and Nutrition

#4 Access to Mental and Physical Health Services

#5 Protect Wake County’s Water Resources

#6 Human Capital Development (added 10/28/10)

9:30 am Adjournment

Information Packet Items

2012 HS&ES Board/Committee Meeting Schedule

HS&ES Board

Monthly Meeting 4th Thurs., 7:30 – 10am

*3rd Thurs in Nov./Dec.

Rm. 5032

Executive

Committee 2nd Thursday,

8am – 10am

Rm. 5032

Human Rights/

Consumer Affairs 4th Mon.,

12:45 – 2pm,

Rm. 1145 *3rd Mon. in Nov./Dec.

Community and

Public Health 3rd Friday,

Noon – 2pm Rex Women’s Center

Rm. 100B

Environmental

Services 2nd Fri.,

11:30am – 1:30pm Library Admin.

Carya Dr. Rm. 102

Jan. 26

Feb. 23

Mar. 22

Apr. 26

May 24

Jun. 28

Jul. 26

Aug. 23

Sept. 27

Oct. 25

Nov. 15* Dec. 20*

Jan. 12

Feb. 9

Mar. 8

Apr. 12

May 10

Jun. 14

Jul. 12

Aug. 9

Sept. 13

Oct. 11

Nov. 8 Dec. 13

Jan. 30*

Feb. 27

Mar. 26

Apr. 23

May 28 (holiday)

Jun. 25

Jul. 23

Aug. 27

Sept. 24

Oct. 22

Nov. 19*

Dec. 17*

Jan. 20

Feb. 17

Mar. 16

Apr. 20

May 18

Jun. 15

Jul. 20

Aug. 17

Sept. 21

Oct. 19

Nov. 16 Dec. 21

Jan. 13

Feb. 10

Mar. 9

Apr. 13

May 11

Jun. 8

Jul. 13

Aug. 10

Sept. 14

Oct. 12

Nov. 9 Dec. 14

LME Advisory 3rd Tuesday

Noon – 2pm

401 E. Whitaker Mill Rd. Rm. 210

LME

Human Rights

Subcommittee 3rd Friday

Millbrook Ctr., 2nd Fl.

2809 East Millbrook Rd *See Varying Times*

Social Services 1st Friday

9am – 10:30am Rm. 5032

Affordable

Housing &

Community

Revitalization 3rd Thursday

3:30pm – 5:15pm Rm. 5032

Regional

Networks

Development Quarterly or as

Called, 2nd Thurs.,

10am – 11am, Rm. 5040

Jan. 24*

Feb. 21

Mar. 20

Apr. 17

May 15

Jun. 19

Jul. 17

Aug. 21

Sept. 18

Oct. 16

Nov. 20 Dec. 18

11:30am – 1pm:

Jan. 20

Mar. 16

Apr. 20

Jun. 15

Jul. 20

Sept. 21

Oct. 19 Dec. 21

10:30am – Noon:

Feb. 17

May 18

Aug. 17

Nov. 16

Jan. 6

Feb. 3

Mar. 2

Apr. 6 (holiday)

May 4

Jun. 1

Jul. 6

Aug. 3

Sept. 7

Oct. 5

Nov. 2 Dec. 7

Jan. 19

Feb. 16

Mar. 15

Apr. 19

May 17

Jun. 21

Jul. 19

Aug. 16

Sept. 20

Oct. 18

Nov. 15 Dec. 20

Feb. 9

May 10

Aug 9:

9:30am – Noon

Joint Mtg. w/

CAC,

Commons Bldg

Nov. 8

* = exceptions

2012 County Holiday Schedule:

Jan. 2

Jan. 16

Apr. 6

May 28

Jul. 4

Sept. 3

Nov. 12, Nov. 22&23

Dec. 24, 25, 26

Human Services and Environmental Services Board Quarterly Meeting Schedule

February 2012 SunSunSunSun MondayMondayMondayMonday TuesdayTuesdayTuesdayTuesday WednesdayWednesdayWednesdayWednesday ThursdayThursdayThursdayThursday FridayFridayFridayFriday SatSatSatSat

1

2

3

9am-10:30am Social Services,

Rm. 5032

4

5

6 BOC 2pm----

7

8

9

8am – 10am Bd. Executive

Cmte. Rm. 5032 __________

10am – 11am Regional

Networks Cmte., Rm. 5040

10

11:30am – 1:30pm

Environmental Services –

Library Admin., 4020 Carya Dr.

11

12

13

14

15

Board Packet

Distribution

16

3:30pm – 5:15pm - Housing

& Cmty. Revitalization, Rm.

5032

17

10:30am – Noon LME Human

Rights, HS Millbrook Ctr., 2809

E. Millbrook Rd. __________

Noon – 2pm Public Health, Rex Women Ctr.,

Rm. 100B

18

19

20 BOC 2pm----

21

Noon – 2pm - LME

Advisory, 401 E. Whitaker

Mill Rd., Rm. 210

22

23

7:30am – 10am HS & ES

Board Mtg. Rm. 5032

24

25

26

27

12:45pm – 2pm HRC – Rm. 1145

28

29

March 2012

SunSunSunSun MondayMondayMondayMonday TuesdayTuesdayTuesdayTuesday WednesdayWednesdayWednesdayWednesday ThursdayThursdayThursdayThursday FridayFridayFridayFriday SatSatSatSat

1 2

9am-10:30am Social Services, Rm. 5032

3

4

5

No BOC Mtg.----

6 7 8

8am – 10am Bd. Executive Cmte. Rm. 5032

9

11:30am – 1:30pm Environmental Services –

Library Admin., 4020 Carya Dr.

10

11 12 13 14 15

3:30pm – 5:15pm - Housing & Cmty. Revitalization, Rm.

5032

16

11:30am – 1pm LME Human Rights, HS Millbrook Ctr., 2809

E. Millbrook Rd. __________

Noon – 2pm

Public Health, Rex Women Ctr., Rm. 100C*

17

18 19

BOC 2pm----

20

Noon – 2pm - LME

Advisory, 401 E. Whitaker Mill Rd., Rm. 210

21

Board Packet

Distribution

22

7:30am – 10am HS & ES

Board Mtg. Rm. 5032

23 24

25 26

12:45pm – 2pm HRC

– Rm. 1145

27 28 29 30 31

April 2012

SunSunSunSun MondayMondayMondayMonday TuesdayTuesdayTuesdayTuesday WednesdayWednesdayWednesdayWednesday ThursdayThursdayThursdayThursday FridayFridayFridayFriday SatSatSatSat

1 2

BOC 2pm----

3 4 5 6 (County Holiday)

9am-10:30am Social Services,

Rm. 5032

7

8

9 10 11 12

8am – 10am Bd. Executive

Cmte. Rm. 5032

13

11:30am – 1:30pm

Environmental Services – Library Admin., 4020 Carya Dr.

14

15 16

BOC 2pm----

17

Noon – 2pm - LME

Advisory, 401 E. Whitaker Mill Rd., Rm. 210

18

Board Packet

Distribution

19

3:30pm – 5:15pm - Housing

& Cmty. Revitalization, Rm. 5032

20

11:30am – 1pm LME Human

Rights, HS Millbrook Ctr., 2809 E. Millbrook Rd. __________

Noon – 2pm Public Health, Rex Women Ctr.,

Rm. 100C*

21

22 23

12:45pm – 2pm HRC

– Rm. 1145

24 25 26

7:30am – 10am HS & ES

Board Mtg. Rm. 5032

27 28

29 30

Assignments to Committees

Executive

Committee 2nd Thursday

8am – 10am

Rm. 5032

Community and

Public Health 3rd Friday, noon

Rex Women Ctr.

Environmental

Services 2nd Fri., 11:30am, Library

Admin. Carya Dr.

Social Services 1st Friday

9am – 10:30am

Rm. 5032

LME Advisory 3rd Tues., Noon,

401 E. Whitaker Mill Rd.

Rm. 210

Dianne Dunning

Pablo Escobar

Frank Eagles

Leila Goodwin

Melissa Jemison

Paul Norman

Benny Ridout

Stephanie Treadway

Staff:

Regina Petteway

Joe Durham

Ramon Rojano

Bob Sorrels

Benny Ridout

Alexander Herring

Burton Horwitz

Sharon Foster

Staff:

Michelle Ricci

Sue Lynn Ledford

Brent Myers, EMS

Peter Morris

Regina Petteway

Andre Pierce

Yvonne Torres

Community:

Laura Aiken

Kevin Cain

Barbara A. Hughes

Anne McLaurin

Leena Mehta

Ann Rollins

Heidi Swygard

Penny Washington

Leila Goodwin

Dianne Dunning

Frank Eagles

Benny Ridout

Melissa Jemison

Jeff Smith

Staff:

Sue Lynn Ledford

Deborah Peterson

Andre Pierce

Matt Roylance

Community:

Rodney Dickerson

Les Hall

Glenn Harris

Suzanne Harris

Don Haydon

Bryan Hicks

Lana Hygh

Buck Kennedy

Jacob Reynolds

Bob Rubin

Henk Schuitemaker

John Sowter

Paula Thomas

Liz Turpin

Kenny Waldroup

Julie Wilkins

Phillip White

John Whitson

Paul Norman

Jim Edgerton

Burton Horwitz

Julian Smith

Staff:

Katherine Williams Giang Le

Liz Scott

Natasha Adwaters

Martha Crowley

Vielka Gabriel

Warren Ludwig

Jenny Wheeler

Community:

Lisa Bireline

David Cottengim

Pam Dowdy

Lisa Draper

Dudley Flood

Glenn Harsh

Marjorie Menestres

Rick Miller

John Parker

Bob Robinson

Georgia Steele

Lynn Templeton

Cherie Thierrault

Brandon Trainer

Tracy Turner

Angie Welsh

April Womack

Marc Zarate

Stephanie Treadway

Pablo Escobar

George Corvin

Kent Earnhardt

Jim Edgerton

Melissa Jemison

Staff:

Carlyle Johnson

Ann Wood

Patsy Coleman

Beth Nelson

Community:

Ann Akland

James Hartye, WakeMed

Marc Jacques

Lou Mitchell

Rhonda Spence

Affordable

Housing &

Community

Revitalization 3rd Thursday

3:30pm – 5pm, Rm. 5032

Regional

Networks

Development Rm. 5040

Human Rights/

Consumer Affairs 4th Mon., 12:45-2pm

Rm. 1145

LME

Human Rights

Subcommittee 3rd Friday, Varying Times

HS Millbrook Ctr.

Melissa Jemison

Dianne Dunning

Staff: Annemarie Maiorano

Bob Sorrels

Community:

Emmett Curl

Steven Hess

Michele Grant

Teresa Piner

José M Serrano

Mark Shelburne

Trace Stone-Dino

Yolanda Winstead

Frank Eagles

Benny Ridout

Staff:

Darryl Blevins

Rosena West

Ross Yeager

Regina Petteway

Staff:

Matt Burton

Sharon Brown

Andre Pierce

Bob Sorrels

Community: Arsenio Carlos, ERC

Rev. Lenwood Long, NRC

Eugenia Pleasant, NRC

Lunette Vaughan, SRC

Pablo Escobar

Kent Earnhardt

Osama Said

Staff:

Brian Gunter

Leticia Mendez

Fabiola Sherman

Jeff Woodward

Community:

Laura Goddard

Phillis Ross

John Sowter

Don Wiseman

Rich Greb Laura Goddard

Bruce Benedict

Martha Brock

Kent Earnhardt

Marc Jacques

Ronnell McGill

Martha Pitts

Diane Waye

Staff:

Miki Jaeger

WHEREAS, the use of tobacco products is the leading cause of preventable death and disability in North Carolina1 and nearly 11,100 NC children will become regular daily smokers this year2; and,

WHEREAS, the primary purpose of the 1998 Master Settlement Agreement (MSA) was to provide states with funding to remedy the public health problems and increased health costs posed by tobacco use; and,

WHEREAS, in a 1999 law the North Carolina General Assembly dedicated 25% of the state’s annual MSA payments to health programs, including tobacco use prevention programs; and,

WHEREAS, in 2011 $138 million in MSA funds came to the state, thus 25% of MSA funds would amount to approximately $34.5 million for tobacco use prevention and cessations programs in NC; and,

WHEREAS, the U.S. Centers for Disease Control and Prevention (CDC) recommends that North Carolina spend $106.8 million a year to have an effective, comprehensive tobacco use prevention program3; the tobacco industry spends $396 million annually to market its products in our state4; and,

WHEREAS, smoking costs North Carolina taxpayers $2.46 billion in direct healthcare costs ($769 million in Medicaid expenses alone), and $3.5 billion in lost productivity annually5; and,

WHEREAS, since North Carolina initiated its youth tobacco prevention programs in 2003, the middle school smoking rate in has been cut by more than half (from 9.3% to 4.3%), and the high school smoking rate has dropped by a third (from 27.3% to 16.7%). This reduction accounts for 53,000 fewer smokers since 20036; and,

WHEREAS, comprehensive statewide tobacco use prevention and cessation programs promote reductions in smoking levels among both adults and kids7, thereby producing substantial state health care cost savings and reductions in other smoking-caused expenditures8; and,

WHEREAS, the Campaign for Tobacco Free Kids estimates that if current tobacco prevention funding (now at $17.3 million) is eliminated in North Carolina, the youth smoking rate will increase by 2.8%, 17,500 more North Carolina kids will grow up to become addicted adult smokers and future healthcare expenditures in the state will increase by $306.2 million9;

NOW THEREFORE BE IT RESOLVED that the undersigned supports the dedication of 25% of NC’s annual MSA payment to fund evidence-based tobacco use prevention and cessation programs in North Carolina. I am signing as:

___ an individual: Individual Signature ______________________________________________ Date: ___________

OR by Electronic Signature at:

Link: http://www.ncallianceforhealth.org/Tobacco-Prevention-Funding-Resolution.aspx

Printed Contact Name: ______________________________________________________________________

Address: _______________________________________________________ Phone: ________________

City: __________________________ State: _______ Zip Code: ___________E-mail:___________________

Resolution in Support of Recurring Funding

For Tobacco Use Prevention

and Cessation Programs

January 2012

http://www.ncallianceforhealth.org/Tobacco-Prevention-Funding-Resolution.aspx

1 North Carolina Institute of Medicine, Task Force on Prevention, May 2008 2 Campaign for Tobacco-Free Kids, Key State Specific Tobacco Related Data and Rankings ,November 22, 2011, http://www.tobaccofreekids.org/research/factsheets/pdf/0176.pdf 3 Centers for Disease Control, Best Practices for Comprehensive Tobacco Control Programs—2007 p. 54-55. http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm 4 U.S. Federal Trade Commission (FTC), Cigarette Report for 2007 and 2008, 2011, http://ftc.gov/os/2011/07/110729cigarettereport.pdf. 5 Campaign for Tobacco Free Kids; STATE TOBACCO-RELATED COSTS AND REVENUES. June 15, 2010. http://www.tobaccofreekids.org/research/factsheets/pdf/0178.pdf 6 NC Department of Health and Human Services, 2009 North Carolina Youth Tobacco Survey, 2009, http://www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/yts09/ncytssummarytablesstatewide2009.pdf 7 Institute of Medicine, Ending the Tobacco Problem: A Blueprint for the Nation, National Academy of Sciences, 2007; http://www.nap.edu/catalog.php?record_id=11795 8 Lightwood, J & Glantz, S, “Short-term Economic and Health Benefits of Smoking Cessation: Myocardial Infarction and Stroke,” Circulation 96:1089-1096, 1997. Campaign for Tobacco Free Kids, Comprehensive Statewide Tobacco Prevention Programs Save Money, January 24, 2011, http://www.tobaccofreekids.org/research/factsheets/pdf/0168.pdf. 9 Campaign for Tobacco Free Kids, Impact on Youth Smoking, Deaths & Related Health Costs from Changes to North Carolina Tobacco Prevention Funding, December 12, 2011, http://issuu.com/ncahadmin/docs/nc_funding_level_zero_out_12-12-11.

http://www.tobaccofreekids.org/research/factsheets/pdf/0178.pdf

http://www.tobaccofreekids.org/research/factsheets/pdf/0168.pdf

http://issuu.com/ncahadmin/docs/nc_funding_level_zero_out_12-12-11

February March October April May June July 2012

August September November December January 2013

2012 Merger Activities- CHART

Merger Preparation Wake-Durham Agreement- Staff Recruitment –

Board Development

MCO Starts- MCO Performs LME Legacy Functions

MCO Starts

Managing Waiver

WCHS-LME-CLOSING ACTIVITIES

Reduction in Force- Staff Placement- Inventory Financial Issues –Contracts, etc.

WCHS-LME-RESIDUAL ACTIVITIES

Paying Claims- Contract Mgmt. Issues - Records, Information Technology split, etc

WCHS-MCO COLLABORATION Beginning of long-lasting relationship between Wake DPH & DSS with the MCO

WCHS-NEW CONSOLIDATION Redesigning the new consolidated entity

(PH & SS)- Legislative action

Board of Commissioners Board of Commissioners Board of Commissioners Board of Commissioners

Work SessionWork SessionWork SessionWork Session AgendaAgendaAgendaAgenda

Monday, January 9, 2012 Monday, January 9, 2012 Monday, January 9, 2012 Monday, January 9, 2012 ––––2:00 p.m.2:00 p.m.2:00 p.m.2:00 p.m.

Wake County Office Building, Ground Floor Conference Room

MEETING CALLED TO ORDER: Chairman Paul Coble

Item II: Wake County and Durham County LME Merger Update – Denise Foreman, Assistant to the County Manager, Ellen Holliman, The Durham Center CEO and Carlyle Johnson, Wake County LME Manager

On November 7, 2011, the Wake County Board of Commissioners approved a merger proposal between the Wake County LME and the Durham Center and authorized the County Manager to negotiate an Interlocal Agreement. The new entity, a multi-county area authority, will provide public management of a system of care for the delivery of mental health, developmental disabilities and substance abuse services. The new entity will represent Durham and Wake Counties. It will have contractual relationships with Cumberland and Johnston Counties for the management of federal and state funds. The new entity will be responsible for the management of over $400 million in federal, state and local funds for the four county area. The new entity will begin LME operations for Durham and Wake counties as of July 1, 2012 and will begin MCO operations for the four county area as of January 1, 2013. Staff will provide the Commissioners with an update on the Interlocal Agreement between Durham and Wake counties. If negotiations are completed, the Board of Commissioners will be asked to approve the ILA on January 17, 2012 or February 6, 2012.

Attachments:

1. Presentation (Will be provided at Work Session)

Wake and Durham LME Merger UpdateLME Merger Update

January 9, 2012

Work Session

• Background

• Process

• Merger Issues

• Draft Agreement

Agenda

• Draft Agreement

• Next Steps

2

• Management of Medicaid funds for mental health, development disabilities and substance abuse (MH/DD/SA) is shifting from state level to local level by January 1, 2013

• Medicaid waiver provides local flexibility in:

Background

• Medicaid waiver provides local flexibility in:

– Provider network

– Service authorizations

– Rate setting

– Pre-defined funding rates

3

• Wake County was unsuccessful in application to manage Medicaid funds and transition to a managed care organization as single county

• Pursuing merger with Durham County to create new entity to manage all MH/DD/SA funding

Background

new entity to manage all MH/DD/SA funding sources and services for both counties

– Will contract with Johnston and Cumberland counties

– Services for over 185,000 Medicaid eligible clients and total population of over 1.6 million

4

• New entity will manage over $400 million

Background

Funding Sources

Federal/Medicaid ~$300 million

State ~ $50 million

• Estimating 400 employees

5

State ~ $50 million

Local ~ $30 million

Durham ~ $6 million

Wake ~ $23 million

• November 7, 2011 approval to negotiate with Durham

• Agreement developed by representatives from both County Manager’s Offices, LME’s and County Attorney’s Offices

Process

and County Attorney’s Offices• Updates to Human Services Board, LME

Advisory Committee, Consumers and Families Advisory Committee

• January 5, 2012 - goal to have agreement completed– Most terms confirmed with only a few outstanding

6

• Dissolution of Wake County LME

– Continue LME Services until June 30, 2012

– 110.75 positions eliminated; 96 currently filled

• Developed Reduction in Force Plan

Merger Issues

• Developed Reduction in Force Plan

• Assisting employees with job placement in new MCO and in Wake County

– Negotiated “internal” candidate recruitment status for Wake and Durham LME employees and comparable benefits

• Employees eligible for severance when position eliminated

7

• Creation of New MCO– Hiring process has begun

• Management Team Selection - December/January• Unit Managers Selection - January• Supervisors Selection – January/February• Line Staff – February/March

Merger Issues

• Line Staff – February/March

– Work teams established• Location• Technology• Communications• Care Coordination• Customer Service• Provider Network Operations

– Selecting and implementing technology systems

8

• State law provides guidance

• Effective Date – March 1, 2012

• Name – To Be Determined

• Chief Executive Officer

Draft Agreement

• Chief Executive Officer

– Ellen Holliman

• Location

– Central Office

– Wake/Durham Offices

9

Consumer and Family Advisory Committee (CFAC)• MCO CFAC with membership from all four

counties

Draft Agreement

– Advises the area authority/MCO

– Self governing, self-directed, self-appointed

– Receive support from MCO

• Local CFACs can continue if desired– Advise MCO CFAC

– Receive support from MCO

10

Start-Up Funds

• Total = $8 million

– Facilities, IT systems, staffing, etc.

• $4 million from Wake and Durham

Draft Agreement

• $4 million from Wake and Durham

• Payback within 5 years – 1% interest

• 7-Year Pro-forma developed

11

Operating Funds• After January 1, 2013, provided by Federal and

State funds

– Administration = 9.5%

Draft Agreement

– Risk Reserve = 2%

– Services = 88.5%

• Local funding – services only

– Annual contract between Wake County & MCO

– Identify service expectations

12

Board of Directors

• Anticipating 16 members

– 8 Appointed by Durham • 1 business, 1 finance, 1 clinical,

Draft Agreement

• 1 business, 1 finance, 1 clinical, 2 consumers/advocates/family

– 6 Appointed by Wake• 1 business, 1 finance, 1 clinical,

2 consumers/advocates/family

– 2 Appointed by MCO Board• 1 representative each for Johnston and

Cumberland

13

Board of Directors

• Initial terms staggered

– 1/3 1-year, 1/3 2-year, 1/3 3-year

• Term limits

Draft Agreement

• Term limits

– Two terms

• Dual categories

– Any member may concurrently fill two categories of membership

14

Board of Directors

• 2/3 Majority on significant decisions

– Budget approval

– CEO employment

Draft Agreement

– CEO employment

– Personnel policy

– Provider Network policies

– Service plan policies

– Office locations

15

• January – March 2012

– Finalize terms of agreement

– Agreement approval by Wake and Durham BOCC – Early February

Next Steps

BOCC – Early February

– Receive approval from NC Secretary of Health and Human Services

– Appoint Board members – February/March

– Continue implementation plans

16

• March – June 2012

– MCO Board Begins

– Counties provide start-up funds

– Negotiate Wake-MCO FY2013 Local Funding

Next Steps

– Negotiate Wake-MCO FY2013 Local Funding Contract

– Seek Legislative Approval to Change Structure of Consolidated Human Services

– Anticipate Proposals to Modify G.S. 122C in Short Session

17

• July – December 2012

– Begin LME operations as joint entity

– Prepare for MCO operations

– Identify and establish locations for Wake and

Next Steps

– Identify and establish locations for Wake and Durham County operations

• January 2013

– Begin MCO operations

18

Wake County Human Services Board Representation Criteria 25 Member Board

• *Person with Mental Illness • *Person with Developmental Disability • *Person Recovering from Substance Abuse • *Family Member of Person with Mental Illness • *Family Member of Person with a Developmental Disability (vacant) • *Family Member of Person with Substance Abuse • *Psychiatrist • *Psychologist (vacant) • County Commissioner • Consumer of Other Human Services (2). (One is vacant) • Pharmacist • Engineer • Dentist • Optometrist • Veterinarian • Social Worker (vacant) • Registered Nurse (vacant) • Other Physician • General Public (6). (Two are vacant) * = Eight MH/DD/SA Categories

Wake County Human Services

FY 2012 Budget/Actual Report

As of January 3, 2012

FY 13 Budget

Type Description Amended

Budget

YTD Actual % of

Budget

Target Base (excluding reductions)

Expenditures 1000 Salary / Benefits 104,345,336 46,746,545 45%

2000 Contractual Services 98,027,406 41,556,670 42%

3000 Other 12,708,546 5,807,961 46%

6000 Capital Outlay 987,727 329,606 33%

8000 Budget Reserves (381,861) - 0%

Expenditures Total 215,687,153 94,440,781 44% 212,966,006

Revenues 2000 Federal 14,296,759 4,273,030 30%

3000 State 97,886,059 35,838,004 37%

4000 Local 2,226,912 872,750 39%

5000 Charges For Services 26,386,926 8,772,755 33%

7500 Interest Income 23,654 (6,644) -28%

8000 Miscellaneous 42,500 21,686 51%

8800 Other Financing Sources 318,600 - 0%

Revenues Total 141,181,410 49,771,580 35% 138,978,684

County Share 74,505,743 44,669,201 60% 73,987,322

*Total FY12 Salary/Benefits reflect (11) pay periods out of (24) = 45%

Fiscal Year 2012 Budget Data

INFORMATION

ITEMS

• Board Fund Report (Separate)

• Articles

• Link to Environmental Health & Safety Division Report – 12/2011

• Wake LME Annual Reviews & Performance Reporting FY’11

• Committee Reports/Minutes

• Commissioners’ Agenda Items Related to HS&ES January 17, 2012

State closes Wake Forest assisted-living center BY THOMAS GOLDSMITH - [email protected]

PUBLISHED IN: WAKE COUNTY

WAKE FOREST In an unusual move, state human services regulators Thursday ordered a Wake Forest

assisted-living center to shut down and move all residents by Monday.

Wake Forest Care Center has a long history of violations, including several involving the deaths of two residents who wandered off unattended, one in 2006 and one last month.

The shutdown and an order to admit no more residents was based on a state finding that emergency action was required to protect the residents, Barbara Ryan, chief of the adult care licensure section of the Department of Health and Human Services, said in a letter to the care center's owner, Richard Cresenzo.

Cresenzo was told that he must find new locations for residents by 5 p.m. Monday or whenever the last resident has been safely placed.

Cresenzo, a Burlington lawyer, said, as he has in the past, that he was surprised at being found at fault and especially at having the home closed.

"I feel like I've been wronged," he said in a telephone interview. "My facilities run deficiency-free. I've been in this business for 30 years."

Only a handful of assisted-living centers, which are less medically intensive and regulated than nursing homes, have been shut down on the spot by North Carolina in recent years. To keep from displacing residents, regulators typically give operators time to correct infractions and pay sometimes substantial fines.

The action follows the December death of McKinley High, 79, a retired farmer from Spring Hope who was a resident of the center. A driver not far from the center struck High in the middle of a suburban street after he wandered off from the facility. High suffered fatal injuries in the collision.

"The man had no indication that he had dementia," Cresenzo said. "It's not a locked facility."

Fines since 2006

The 80-bed center at 306 S. Allen St. has been fined more than $40,000 since 2006 for violations found by county and state inspectors. In a recent survey that Cresenzo said lasted five or six days, inspectors found violations in giving out medications, using restraints, residents' rights, food services, and training on caring for residents with diabetes, state records showed.

The previous fatal incident happened in 2006, when Miklos Ankhelyi, 67, wandered away while living at the home and drowned in a nearby creek. That incident cost the center a state fine of $12,000. Like High, Ankhelyi had been previously seen by neighbors, walking away from the home unattended.

"We hate that it happened," Cresenzo said of High's death at the time.

Piles of clothes, neatly placed on hangers or stored in boxes, sat alongside Christmas decorations near the entrance Thursday night, ready to be moved out. Teary-eyed staff spoke often with residents.

Despite years in which the center had racked up tens of thousands of dollars in violations, one resident who called The News & Observer and another introduced by management both said they wanted to stay in the home.

"Am I worried? Of course I am," said Pat Webb, 69. "I'm worried for other people."

Webb said she would like the center to stay open, as did Mary Dolan, 60, a former president of the home's residents council.

"I was supposed to have a special birthday party next week," Dolan said in the manager's office. "I've never had problems with the employees or the residents.

"This is not a charity home, and sometimes the residents can be demanding. But the whole community should not be punished, and the employees need a job."

Polly Williams, a retired N.C. State University professor who advocates for older people at the legislature and elsewhere, said the state is generally very reluctant to close assisted-living facilities because even sub-par centers often feel like home to the residents.

"I'm sure that it's serious, but whether they could find someone else to take over I don't know," Williams said of the center. "The residents' health is often fragile enough that being moved is really bad for them."

Goldsmith: 919-829-8929

Insuring kids brings N.C. $21 million reward BY LYNN BONNER - [email protected]

PUBLISHED IN: HEALTH/SCIENCE

The state has earned a $21 million bonus from the federal government for enrolling more children in a public-private health insurance program and making it easier for them to stay in it.

North Carolina was one of 23 states sharing $296 million in bonuses awarded for cutting application paperwork and exceeding enrollment targets.

N.C. Health Choice, the state version of the national Children's Health Insurance Program, enrolls about 150,000 children, according to the state Department of Health and Human Services. That's up from about 134,000 in 2010.

The program offers free or reduced-price insurance to children whose parents cannot afford private insurance. It was approved in 1997 and was reauthorized in 2009.

When the federal law was reauthorized two years ago, it included incentives for states that adopted at least five of eight strategies for streamlining applications and increased enrollment above set targets.

"Access to health insurance is one of the keys to starting children on the path to a healthy life," said Marilyn Tavenner, acting administrator at the federal Centers for Medicare & Medicaid Services, during a conference call with reporters on Wednesday.

The federal government covers about 75 percent of North Carolina's costs. Some families pay part of the medical bills.

"Part of the reason for the bonus is that it helps defray the costs the state has already incurred by adding more kids to the program," Cindy Mann, a deputy administrator with the Centers for Medicare and Medicaid Service, said during the conference call.

North Carolina did not qualify for a bonus last year, but this year was credited with cutting down on paperwork applicants fill out, using electronic databases to verify family information, and keeping children enrolled for a year at time.

The state does not require in-person interviews, which federal officials said are difficult for working parents to schedule.

North Carolina, like most other states, does not consider a family's assets, other than income, when determining children's eligibility.

"We know the only way children can succeed in education is if they show up to school healthy and ready to learn," said Mark Johnson, a spokesman for Gov. Bev Perdue.

"The Governor has made expanding health care coverage for eligible children a high priority in her administration, and today's announcement shows that work has paid off."

Adam Searing, director of a health-care advocacy group, applauded the work the state did on Health Choice to get the extra money.

Making sure parents don't have to repeatedly file paperwork may seem like a small administrative change, but it can make a significant difference in how many children have health insurance, he said.

"They're making changes that make things more efficient and more effective, and that's resulted in more kids getting enrolled," said Searing, director of the N.C. Health Access Coalition.

North Carolina was one of seven states that earned a bonus for the first time.

Bonner: 919-829-4821

Attached is a link to the Wake County Environmental Health and Safety Division

Report for December 2011:

ftp://wakeftp.co.wake.nc.us/ES/EHS/FY12/201112%20EHS%20monthly.pdf

The Animal Care Control and Adoption Center became a Division in July 2011. That report is available

at: http://www.wakegov.com/pets/shelter/acreports.htm

Points of interest:

• Net operating facilities continue to increase year over year. (page 2)

• Critical violations by CDC type are shown for Wake County establishments (page 3)

• Complaints soared in December, 20 more than usual. Most reports alleged foodborne illness

(FBI) (page 4)

• Average transitional permits increase on average (page 5)

• Asthma investigation data is presented (page 6)

• Wake County Food Service Advisory Committee met on December 2, 2011 (page 8)

• Plan reviews average 57 per month (page 9)

• Pool construction visits average 22 per month for 2011 (page 12)

• 2353 swimming pool inspections were performed in 2011 (page 13)

*Please advise if you would like to be removed from this distribution, or if you know of someone who

might be interested in receiving this report. Also please report if you are unable to open the link, and I'll

be glad to email you the attachment.

Andre C. Pierce, MPA, REHS Wake County Environmental Services Environmental Health and Safety Director [email protected] 919-856-7440 - Phone 919-743-4772 - Fax

ftp://wakeftp.co.wake.nc.us/ES/EHS/FY12/201112%20EHS%20monthly.pdf

WAKE LME

ANNUAL REVIEWS

AND

PERFORMANCE REPORTING

FY 11

I. Accessibility Plan Review

II. Health And Safety Plan Review

III. Utilization Review Team Annual Review

IV. Call Center Satisfaction

V. Access Center Annual Review

VI. Care Coordination Annual Review

VII. Consumer Perception of the LME 2008 – 2011

VIII. Internal Performance Indicators

WAKE LME PERFORMANCE REPORTING AND ANNUAL PLAN REVIEWS FY11

Wake LME Page 2 of 18 FY11

I. ACCESSIBILITY PLAN REVIEW:

Introduction

This annual report is based on the Wake County Local Management Entity’s (LME) accessibility plan,

which is designed to promote accessibility, and the removal of barriers for person served, employees

and other stakeholders.

Accessibility is evaluated across the following areas: architecture, environment, attitudes, finances,

employment, communication, transportation, community integration, and other barriers by persons

served, personnel and other stakeholders.

When a barrier to accessibility is found, the following will occur:

1. The staff member identifying the barrier will report this to his/her manager who will report to

the LME Management Team immediately upon discovery.

2. If the barrier is detrimental to health and safety of staff, consumers or the community the LME

Administrator will immediately report to the appropriate personnel for removal of the barrier

3. Other accessibility barriers will be discussed at the next LME Management Team (or within 14

days of discovery) and referred to the appropriate manager/team for correction for timely

removal.

4. A weekly update on the status of the barrier removal will be made to the LME Management

Team.

5. Within 90 days of the successful removal of the barrier, the implementation will be reviewed

for continued successful implementation.

6. An annual report of the Accessibility Plan will be presented to the LME Management Team and

the LME Committee of the Human Services Board for review.

Architecture and Environment

All of the following inspections were completed and reported to the LME Health and Safety

Committee:

Building Fire Inspections

Risk Management Safety Inspection Checklist

ADA Existing Facilities Checklist

Fleet Operations

Surveys related to building accessibility were completed for the following buildings and for the following

groups:

Buildings Community

Members

LME Staff

401 East Whitaker Mill Road X X

3010 Falstaff Road X X

2809 East Millbrook Road X X

Results from these surveys are attached.

Of interest is the fact that at the Millbrook building the back entrance where there was handicapped

parking access was closed to consumers and limited to staff. The addition of new handicapped spaces

to the front of the building was accomplished but not without delay. The LME at the Millbrook building



I. ACCESSIBILITY PLAN REVIEW (cont’d):

joined with other co-located departments to persistently address the issue with Wake County General

Services until the issue was resolved.. Loss of handicapped parking was not noted by community

members but was by staff in the building access surveys.

Environmental

The Whitaker Mill building required repairs this past year due to a leaking roof. This repair was

completed.

LME staff members serve on the building Committees for their respective buildings in order to monitor

environmental concerns for the LME in conjunction with any other building residents.

Attitudinal

There were no issues or complaints concerning attitudinal issues this past year.

In FY2011, an LME Human Rights Committee was created by the LME Advisory Committee in order to

eliminate any conflict of interest with the Wake County Human Services organization. Reports related

to Human Rights issues have been reported to various committees on which consumers serve, but this

year a committee exclusively devoted to human rights issues was put into place.

The LME continues to have a liaison to the Wake County Consumer and Family Advisory Committee

and attends monthly meetings to assure that CFAC input is solicited and used. The LME also solicits

feedbacks from consumers during the annual/semi-annual perception of care surveys fielded by the

Division of MH/DD/SAS.

LME materials including the LME brochure are updated and reviewed to assure accessibility for all

consumers.

In order to assure that consumers have clear understanding of information concerning appointments

with providers, the Access Center created a “Welcome Packet” which is sent to all consumers who are

scheduled an appointment through the access center. The packet includes directions to the

appointment and other useful information.

Community Awareness and Education

The LME participates with multiple committee groups and agencies to educate the community and

actively seeks opportunities to do so.

The LME website is reviewed regularly and updated to maintain evergreen information for the

community. A training calendar where providers and the LME can post training events was created to

enhance provider education.

The following are some of the community events where the Access Center staff made presentations to

educate the community about the LME and the Access Center:

• Wake Med Pediatric Grand Rounds

• WCHS Child Service Coordinators at Millbrook Center WCHS Public Health Pediatricians (

• Wake Co. Adult Care Home Management Collaborative

• Wake Co. Clerk of Court - training for newly assigned guardians

• Occupational Course of Study students (potential consumers) at Broughton High School

• First in Families of NC Annual Conference - presentation on DD Services thru Wake County

• Juniper Level Baptist Church - presentation during Sunday worship at congregation's request in

honor of National Mental Health Awareness month




Further the LME participates in multiple community collaboratives.

Staff Education

In order to assure that all LME staff members receive training even if they are unable to attend a face-

to-face training event, the LME makes the Powerpoint presentation and other information available to

LME staff. Staff are expected to complete post training tests.

The LME recognizes the importance of a trained and culturally sensitive workforce. The LME Training

Committee assesses the training needs of LME staff and coordinates educational sessions based on

both required and identified needs. (Refer to LME specific training plan). To that end, it requires,

encourages and supports numerous training activities including, but not limited to:

Completed in

FY11

Consumer Rights Yes

Cultural Competency Yes

Health & Safety Training including: Yes

Workforce Violence Prevention Yes

Emergency Response Procedures Yes

Risk Management Processes Yes

Required Trainings by Job Functions At hire

Confidentiality Yes

Code of Ethical Conduct/Professional Conduct Yes

Organizational Compliance Yes

Public Records No

Record Retention and Destruction No

Financial Accessibility

There were no issues this year related to financial accessibility. Quarterly reports were presented to

the LME Advisory Committee of the HS Board for review, as well as to the LME Management Team.

Employment Accessibility

Work Flexibility:

There were no issues that went unresolved this year concerning work flexibility. Employees have the

option of working flexible hours if approved in advance by their supervisor.

Reasonable Accommodations:

Ergonomic studies can be completed for individuals so as not to compromise, hinder or impede the

individual employee’s performance. The LME has looked into and purchased a workstation that allows




the staff member to adjust the computer’s keyboard and monitor for work in a sitting or standing

position.

The LME will investigate the feasibility of offering this workstation for others during FY11.

Communication

There were no issues related to communications access or restriction to communications this year. All

system functioned as planned, with adequate resources on line and in print for consumer, staff and

stakeholders alike.

The LME has undertaken and completed a restructuring of its website to assure ease surrounding

accessing information.

Transportation

Transportation remains a barrier to consumer access to services. Limited public transportation

in a county that is both rural and urban continues to be identified as a barrier.

This issue has been identified by multiple groups as one that remains in need of attention by the

county and its municipalities.




Wake LME Community Accessibility Survey (in percents)

Total 49=100%

CSC 20=100%

Falstaff 8=100%

Millbrook 21=100%

Yes No NA Yes No NA Yes No NA Yes No NA

Does this building have

adequate parking? 82 18 0 75 25 0 62 38 0 95 5 0

Is this building handicap

accessible? 88 8 4 80 15 5 75 13 12 100 0 0


appropriate signage? 86 14 0 85 15 0 75 25 0 90 10 0

Do you feel there is

adequate lighting around

the exterior of the

86 6 8 80 10 10 75 0 25 95 5 0

Is this building easy to

find? 86 14 0 80 20 0 62 38 0 100 0 0

Using the directions/map

on the Wake LME

website, are the

directions easy to follow?

53 14 33 45 5 50 13 12 75 76 24 0

Is the property well kept

and maintained? 98 2 0 95 5 0 100 0 0 100 0 0

Are the exits clearly

marked? 92 4 4 90 5 5 88 0 12 95 5 0

Do you believe there is

adequate conference

room space? 73 10 17 70 10 20 38 12 50 90 10 0

Do you have any safety

concerns in this building? 8 87 4 15 80 5 0 88 12 5 95 0




Wake LME Staff Accessibility Survey (in percents)

Total 71=100%

CSC 34=100%

Falstaff 26+100%

Millbrook 11=100%

Yes No NA Yes No NA Yes No NA Yes No NA


adequate parking? 84% 16% 0 86% 14% 0 85% 15% 0 82% 18% 0

Is this building handicap

accessible? 90 7 3 97 0 3 100 0 0 45* 45 10


appropriate signage? 82 28 0 74 26 0 73 27 0 63 37 0

Do you feel there is adequate

lighting around the exterior

of the building? 37 63 0 35 65 0 36 65 0 45 55 0

Are you fully aware of

emergency exit procedures? 93 7 0 94 6 0 88 12 0 100 0 0

Do you know the location of

the closest fire extinguisher

to your office? 79 21 0 74 26 0 77 23 0 100 0 0

Do you feel you have

adequate work space? 68 32 0 65 35 0 61 39 0 90 10 0

Is this building appropriately

located for the population

you serve?

92 5 3 94 3 3 92 8 0 81 5 4

Do you have any safety

concerns in this building? 52 39 9 65 29 6 50 38 12 18 73 9



II.HEALTH AND SAFETY PLAN REVIEW:

The Health and Safety Committee is responsible for assuring that the Health and Safety Plan is

implemented and assessed annually. This Committee evaluates LME efforts to maintain a safe and

healthy workplace. The Committee is responsible for:

• Planning, implementing and reviewing safety activities and inspections that occurred to date

• Informing the LME Management of risks discovered at any time as well as during inspection and

drills.

• Recommending activities to address issues of concern

• Communicating with the WCHS Incident Reviewing Committee

• Maintaining and updating the Business Continuity Plan Services Delivery Plan

• Assuring staff is adequately and appropriately trained in health and safety concerns

Inspections:

The Safety Committee performed semi-annual self-inspections of each LME site. No problems were

found at 3010 Falstaff or Millbrook. At CSC, two extension cords were replaced with power strips and a

work order was issued for a loose outlet cover.

Training:

The annual Health and Safety training was completed by the Training committee

Drills:

LME Safety Committee performed annual safety drills. The drills covered Fire Evacuation, Bomb Threat,

Medical Emergency, Natural Disasters, Utility Failure, and Violent/Threatening Situations.

• Millbrook location: No corrective actions were required at Millbrook.

• 3010 Falstaff: Roles and responsibilities of the person who receives the call, the Official in

Charge, the Emergency Coordinator and the Hall Monitors required review.

• 401 East Whitaker Mill/CSC: The following corrective actions were implemented

o Hall Monitors will keep "Sametime" open on their computer screens to receive

emergency notices. T

o The location of the AED devise and its appropriate use was reviewed.

o Role players were asked to be more professional so staff will not assume they are

someone playing around.

o The designated meeting place for a fire evacuation was reviewed with Resources for

Seniors staff.

Security:

The Security Management System was upgraded to a more efficient system at all LME sites.

• Millbrook: an electronic security system was activated (card readers) and duress buttons were

added. Access to staff areas was restricted and only accessible with employee escort. Training

for the new system was completed.

• 3010 Falstaff/CSC: Duress buttons were installed and staff training was completed; after hour

escorts were arranged through Mobile Patrol rear parking lot (located on Swinburne Street) has

been repaved and Access staff was assigned individual workspaces.

• 401 East Whitaker Mill/CSC: Parking lot lights behind the building were replaced and “Staff

Only” signs were added to the doors of each wing



II. HEALTH AND SAFETY PLAN REVIEW (cont’d):

Business Continuity Plan:

The LME Safety Committee updated Business Continuity Plan information for each LME site. An

Emergency Contact list for each site was given to GSA Security.

Other items:

• The LME Safety Committee developed and administered Community and Staff Accessibility

Surveys at all three locations. Results are attached to the annual accessibility report.

• Handicap signs and an access ramp were added to the front of the building at the Millbrook

location. .

Plans for FY12:

In FY12, the Health and Safety Committee will become a subcommittee if the Compliance

Committee and will as such report to that Committee no less than quarterly plans and activities

related to the LME Health and Safety Plan.



III. UTILIZATION REVIEW TEAM ANNUAL REVIEW:

The Utilization Review Team expanded by one additional Care Manager during FY 2011, finishing the

year with three IDD Care Managers, seven MHSA Care Managers, and one Care Manager dedicated to

the Holly Hill/Wake County contract. Nine Care Managers are licensed North Carolina clinicians, and

two are Master’s level Qualified Professionals.

During the fiscal year, 23,909 service authorizations were issued by the UR Team. 2,159 service denials

were issued, with 90% of these being necessary because of retractions of service requests or duplicate

requests that cannot be deleted from Avatar. Appeal rights letters were sent to 207 consumers, with

115 notifications of denials, 8 service reductions, and 84 suspensions of services. Behavioral health

outpatient therapy accounted for 75% of the denials/suspensions/reductions, consistent with the

distribution of basic and enhanced services during the fiscal year. The frequency of adverse

authorization determinations has been reduced as the result of a clarification by the DMH Hearing Office

that administrative suspensions based on inadequate or missing information do not require a written

notification to the consumer if the provider has been notified. Providers are notified of such decisions

via CareLink, the Wake LME web-based data system. The majority of suspensions are resolved in this

manner. This procedural change was reiterated in Implementation Update #85.

Eight appeal requests were made to the LME by consumers during FY 2011. Clinical reviews were

conducted in response to the appeal requests, with six decisions being upheld, and two cases having the

original decision modified based on additional information received. No appeal hearings were held with

the DMH Appeal Office, although one request for a state level appeal is pending and will carry over into

FY 2012.

1,282 Person Centered Plans were tracked for quality during the past fiscal year, with 71 (5.5%) found to

be inadequate. Service providers were notified and asked to correct inadequate PCP’s. No trends were

noted that indicated any clustering of PCP documentation problems within any specific provider

agencies.

$22,435,627 in community-based service was purchased for IPRS and County funded consumers in FY

2011, including $15,703,609 for outpatient services, and $6,732,018 for inpatient services at Holly Hill

Hospital. During the fiscal year, 1.029 consumers were served at Holly Hill, 4,692 consumers received

outpatient therapy in the community, 1,709 received enhanced services, 227 received residential

services, and 255 were served by Mobile Crisis. The unduplicated count of consumers authorized for

services in FY 2011 was 6,017.

During FY 2011, creative efforts were made to produce meaningful and accurate reports from the Avatar

system. Some data, such as PCP tracking and Appeal information is maintained entirely outside of

Avatar. Other data, such as “authorization turnaround time” has been elusive to capture, and awaits

further enhancements to Avatar by Netsmart to ensure accuracy. Disposition dates are now being

entered into Avatar as authorization decisions are being rendered. This provides an estimate of

turnaround times, but because the system includes some Access and Care Coordination work that

should not be counted, the overall percentage of authorization requests turned around in fourteen days

or less tends to be understated. Netsmart, at the directive of the NC Avatar Users Group, is attempting

to address this problem. Based on Disposition dates, 93% of authorization requests received from

2/1/11-6/30/11 were processed within 14 days.

Data from Avatar is also used by the UR Team to review the percentages of authorized services being

utilized. This data enables the identification of agencies, services, and specific cases in which authorized

services are being under-utilized. This information is particularly useful in Benefit Plan design.

However, without further analysis of Avatar data, it is not easy to differentiate between consumers

using (for example) 50% of services authorized, and situations where half of the consumers are utilizing



III. UTILIZATION REVIEW TEAM ANNUAL REVIEW (cont’d):

little or none of their authorizations while the remaining half use the majority of the service units

authorized. The following is a listing of utilization rates of service types during the past fiscal year:

IIH 82%

ACCT 79%

MHSA TCM 72%

CST 50%

PSR 46%

Assertive Eng. 42%

BHO 40%

Rx Mgmt. 35%

SA Assessment 18%

In FY 2011 the Utilization Review Team participated in a CQI project that focused on the inter-rater

reliability of UR Care Managers. Staff independently reviewed clinical documentation submitted on

three randomly selected cases, and made authorization recommendations. The CQI project found that

UR Care Managers were in almost unanimously in agreement regarding the type and quantity of service

authorized, but in one instance were split regarding whether an authorization should be placed in a

“pending” status until additional supportive clinical documentation was received. The UR Team

subsequently has met with Dr. Keith McCoy, LME Medical Director, to discuss those situations in which

authorizations should be pended, with the general guidance being that authorizations should not be

delayed if medical necessity can clearly be established in the clinical documentation that has been made

available. The UR Team met with Dr. Nerissa Price on 7/20/11 to discuss establishing an ongoing peer

review process. Dr. Price supports using a similar methodology as utilized in the CQI project, but with

Care Managers reviewing clinical documentation and discussing the decision-making process as a group,

with the guidance of Dr. Price. A follow up meeting will be scheduled in autumn.



IV. LME ACCESS CENTER CUSTOMER SATISFACTION SURVEY RESULTS

The following responses come from the 38 responses received since the inception of the project and

September 15, 2011.

Yes No

No

answer

Did you receive the help you were seeking (%)? 95% 3% 2%

Was the access specialist who assisted you (total

responses):

Respectful 35 1 2

Helpful 34 2 2

Courteous 36 0 2

Knowledgeable 36 0 2

Would you recommend our services to others (%)? 92% 3% 2%

Very Somewhat

Dis-

satisfied

No

Answer

Overall, how satisfied were you with our services (%)?

89%

0% 0% 11%



IV. LME ACCESS CENTER CUSTOMER SATISFACTION SURVEY RESULTS (CONT’D):

Positive Comments:

1. “Mr. Blackburn was very helpful and knowledgeable in the areas that we talked about. I will be

very happy to work with him – thanks”.

2. “Keep up the great services”

3. “Laura McCarthy was knowledgeable, helpful and came across as calm & interested in getting to

know me and to be as helpful as possible in my treatment.”

4. “There was a white woman there who help me every step of the way I forgot her name. My

name is Billy P.”

5. “Very impressed w/results Thank you”

6. “Really need it to see Doctor sooner, but understand the wait:

7. “ My specialist was very knowledgeable as well as Helpful”

8. “ Ms. Maye was very helpful, friendly and knowledgeable. Caring for my sister is challenging at

times & Ms. Maye made me feel heard and understood. Thank you. PGH”

9. “No todo muy bien Gracias”

Since June 30, 2011:

10. “Very helpful, great service”

11. “Thank you very much.”

12. “The services was very helpful.”

13. “Decided to seek alternative help.”

14. “Thank you for helping me.”

15. “Service seem efficient looking forward to being sucessful in obtaining treatment to improve

self.”

16. “Everyone was very helpful.”

17. “I would like to start by saying that the Access Specialist who assisted me deserves a raise. She

was very professional in answering my questions and pointed me in the right direction. Thanks.”

18. “Olivia was very kind and patient w/me. She showed a lot of empathy which is rare.”

19. “Very nice people.”

20. “Thank you for having these services.”

21. “Heather was wonderful.”

22. “Excellent job!”

23. “Thank you for careing.”

24. “My company does not offer mental health I their benefits. I told our HR guy how awesome you

are! Thanks!”

25. “mi pregunto es: íes necesario asistir aun a esta cita? porque ya me siento bien.” (Presumed to

translate to: my question is: is it necessary to even attend this appointment? because I already

feel well.)

Negative Comments:

1. “I am a homeless person. I need help. (Consumer then gives her name and address.)

Since June 30, 2011:

None



V. ACCESS CENTER ANNUAL REVIEW

Wake County LME ACCESS Center is the ‘front door’ to the Local Management Entity’s managed care

process. Access to care starts with one phone call to 919-250-3133 or 1-866-518-6784. This call

immediately connects those in need of crisis or routine behavioral health care to a behavioral health

professional 24-hours, 7-days-a-week, 365 days-a-year.

Calls to the Access Center are answered, on average, within 6 seconds by one of 15 qualified

professionals (nine of whom are licensed clinicians) who provide triage, clinical screening and referral

for crisis services or comprehensive clinical assessment depending on presenting problem and severity

of need. There is a Lead Licensed Clinician on-site at all times for consultation and supervision and an

Access Center Supervisor available (on-call) 24/7. Access Specialists receive on-going training and

supervision in crisis response, customer service, clinical screening, the provider network, and

community resources.

During low volume call times (weekends, overnight, and on major holidays) telephonic access to care for

Wake County citizens is provided through a contract with Crossroads Behavioral Healthcare LME.

Crossroads has real time access to the same database (Avatar) and web based calendar (Calcium) that

Wake LME Access staff do. All calls are answered by a licensed clinician and greeted with “Wake County

Access Center, this is….. “ and Crossroads staff follow the same procedures that Wake Access Center

staff follow. During the past year, Crossroads responded to 4,315 (or 10% of total) calls for or from Wake

County citizens seeking assistance on the weekend, a holiday, or late at night.

During FY11, the Access Center responded to 37,028 calls.

The Access Center screened and triaged 12,175 people:

• 2,769 (23%) had emergent needs requiring crisis assistance within two hours;

• 2,050(17%) had urgent needs requiring help within two days;

• 6,550 (54%) had routine needs requiring help within two weeks.

• 971 callers had needs not meeting the threshold for behavioral health services and were

directed to other community resources (e.g. hospice, faith based assistance, vocational

rehabilitation, etc.).

During FY11, the Access Center made 9,870 referrals.

• 6,331 to private Network Providers

• 1,725 to Wake Co. Crisis & Assessment Services

• 1,133 to WCHS Behavioral Health

• 362 to Mobile Crisis Team

• 303 to Wake Co. I/DD Bridging Team

• 16 to 911/CIT Officers

Non-crisis referrals were made for an initial comprehensive clinical assessment by a provider. That

assessment provided a diagnosis, determined eligibility for public funding, and provided treatment

recommendations and transfer referral when necessary (i.e. when the provider conducting the

assessment is not able to provide the treatment determined medically necessary).



V. ACCESS CENTER ANNUAL REVIEW (Cont’d)

Who Calls the Wake County LME Access Center?

In FY 11 12,175 people called the Access Center. Breakdown of service requests were:

Total Seeking Help

12,175 = 100%

52% male/48% female

Adults

9, 984 = 100%

Children

2,191 = 100%

Mental Health issues 74% 85%

Substance Abuse issues 23% 2%

Developmental Disability issues 2% 13%

The majority, by far, of those seeking help were adults without health insurance.

Age Medicaid Non-Medicaid Total

Children 8% 9% 17%

Adults 14% 69% 83%

Total 22% 78% 100%

Timely Access to Care

Timely access to appropriate care is critical to protect consumer health and safety, minimize adverse

consumer outcomes and promote consumer engagement in services. Timely access is a measure of how

long it takes a person seeking help for a mental health, substance abuse, or developmental disability

issue to enter care. Persons with emergent needs are expected, by state performance agreement, to be

seen within 2 hours of requesting help. Those with urgent needs must be seen with 2 days and those

with routine needs within 2 weeks. For FY11 Wake LME Access met state timely access performance

expectations each quarter except for one measure, 1st Quarter Routine.

Percent Seen within Expected Timeframe

Performance

Standard 1

st Quarter 2

nd Quarter 3

rd Quarter 4

th Quarter

Emergent 81% 100% 100% 100% 100%

Urgent 70% 84% 81% 74% 81%

Routine 63% 59% 69% 74% 80%



VI. CARE COORDINATION ANNUAL REVIEW

The Care Coordination Unit total staff numbers did not change during FY 11. There was one program

manager, three supervisors, three IDD Care Coordinators, eight MHSA Care Coordinators, four hospital

nurse liaisons, two Geriatric-Adult Specialty trainers and one executive secretary. Two Care Coordinators

are licensed North Carolina clinicians and all are qualified professionals in one or more disability areas.

The hospital liaisons and their team supervisor are all licensed Registered Nurses.

MHSA Care Coordination Team

During the fiscal year 1,795 consumers with a mental health or substance abuse diagnosis received care

coordination representing 2,194 separate episodes. Of the total number, 1,321 were adults and 465

were children. The team investigated 31 Cases of Concern referred by Value Options. Thirty-one

children involved in the juvenile justice detention system received focused care coordination and

diversion to treatment and/or residential placement. The team researched 16,795 names of people

booked into the Wake County jail, identified 7,264 as mental health consumers which resulted in 3,780

mental health assessments, a 20 % increase over last fiscal year. MH/SA providers were notified of their

consumers that were arrested which led to increased communication with jail staff and continuation of

psychotropic medication and linkage following release. The team also assisted with the transfer or

discharge of 30 youth from a PRTF located out of state when NC Medicaid officials discovered critical

issues of concern that could have resulted in harm to vulnerable youth.

Other highlights for the MHSA Care Coordination team include these community wide collaborative

efforts:

• Launch of Project 77, a program that matches MHSA consumers with housing vouchers for

supportive housing, long term treatment and supports

• Revision of procedures for enforcing compliance with Outpatient Commitment orders following

hospital discharge leading to decreased re-hospitalization and better outcomes

• Weekly High Risk Case Conferences involving providers and other stake holders focused on

consumers most at risk

• Expansion of the System of Care function in the hospital and justice system, promotion of use of

family centered care principles and decreased use of residential placement for youth in favor of

home based or day treatment services

• Development of comprehensive training modules for employees of licensed group homes to

increase knowledge of MHSA conditions and improve quality of care for residents

• Further expansion of partnership with Community Care of NC and the promotion of integrated

care of medical and psychiatric conditions

IDD Care Coordination Team

The IDD team monitored 936 CAP recipients, processed 80 vehicle or home modification requests,

provided care coordination and facility liaison for 80 DD consumers. In addition, this team provided

crucial training to DD providers as well as frequent interpretation of CAP rules and guidelines. The team

responded to many requests for assistance accessing crisis respite, placement or transfer for consumers

with wide ranging needs and limited resources. The IDD team also participated in the Weekly High Risk

Case Conferences. There was increased coordination of care across disability areas for care coordination

of consumers with dual diagnosis.



Hospital Liaison Team

A team of four experienced psychiatric nurses provided on site liaison to three state and one private

hospital. They processed an average of 165 discharges per month, 92 from Holly Hill Hospital and 70

from Central Regional Hospital, Cherry Hospital and RJ Blackley Alcohol and Substance Treatment Center

combined. The team worked with an LME Provider Relations specialist to adapt a service definition and

contract with a provider to deliver Hospital Transition services which included connection with a

consumer while still hospitalized, assistance with transport home and connection to outpatient services.

This service started just after the end of the fiscal year and data is not yet available on the number of

consumers served nor the impact of the service on consumer connection following discharge or rate of

re-hospitalization. The Hospital Liaison Team also participated in the Weekly High Risk Case

Conferences.

The team leader coordinated collection of data from 5 emergency departments regarding the delay time

for admission to a psychiatric hospital bed. The team leader also collected and reported data on the

average wait time for a state psychiatric hospital bed and monitored the wait list of Wake County

consumers waiting for a bed at Central Regional Hospital.

The Geriatric-Adult Specialty Team

This two person team delivered 1,216 hours of training to staff or caregivers of geriatric consumers and

MH/SA/DD consumers residing in facilities with primarily geriatric consumers such as nursing homes,

rest homes and assisted living facilities. The team spent 304 hours in ongoing program development in

designing new treatment programs. In addition the team spent 903 hours marketing their training and

consultative services. At the direction of the Division of MH/DD/SAS, the focus shifted from rest homes

and assisted living facilities to group homes and family care homes starting July 2011.

Care Coordination staff participated in the following community work groups:

Central Regional Task Force

Crisis Intervention Training for Law Enforcement Officers

Holly Hill Advisory Council

Holly Hill Operations

Holly Hill Steering Committee

N.C. Council Care Coordination Group

N.C. Center of Excellence for Integrated Care-LME Collaborative

System of Care Collaborative

Wake Crisis Collaborative



VII. Consumer Perceptions Of LME 2008 -2011

The following responses were obtained by fielding a Wake LME specific survey concurrent with

the Division of MH/DD/SAS Perception of Care surveys.

All measures were lower than last year, except knowledge of crisis services ,which remained the

same.

There are obvious discrepancies in how consumers answered the questions. Please note, more

consumers responded that they received a copy of the LME Handbook than say they have

heard of the Wake LME.

Questions 3 & 4 could be of concern, however, the LME statistics show that all complaints were

responded to within the required timelines and that there were fewer than five appeals of

complaint findings.

The value of this survey is limited and a new method needs to be identified to survey the our

social marketing.

All

July

2011

(n= 487)

June

2010

(n=260*)

October

2008

(n=409*)

% Yes % Yes % Yes

1. Have heard of the Wake County Local Management

Entity (LME) 36% 41% 28%

2. Knows that a complaint about the services being

received can be made to Wake County Local

Management Entity

37 47 31

3. Have made a complaint to the Wake County

LME and it was responded to in a timely

fashion

9 23 45

4. Have made a complaint to the Wake County

LME and have been satisfied with the results 18 59 49

5. Knows that there is a Wake County Consumer and

Family Advisory Committee (CFAC) 22 38 27

6. Knows that Wake LME has a Human Rights

Committee 26 n/a n/a

7. Knows can get help finding services by calling the

LME 35 n/a n/a

8. Knows how to access crisis services in Wake County 62 62 65

9. Knows how to contact Wake Local Management

Entity if you have a question about your services 38 46 30

10. Current service provider has given consumer a copy

of the Wake County LME Consumer Hand Book? 40 49 37

**In 2008 over 500 State surveys were returned; in 2010, 299 were returned; in 2011, 668 were returned.

**Among those responding to the question.

n/a = not previously asked

1

Wake County Human Services Board

Social Services Advisory Subcommittee

Friday, December 2, 2011

12:00 pm – 1:30 pm

Swinburne Building, Room 5032

Minutes

Board Members:

Paul Norman Jim Edgerton

Guest:

Betsy Moore

Committee Members:

Anna Troutman James Williams Kim Best Lynn Templeton Marjorie Menestres

Staff:

Giang Le Liz Scott Nikki Lyons Ramon Rojano Vielka Maria Gabriel Warren Ludwig

Agenda

Item

Discussion, Conclusions, Recommendations Action,

Follow-up

Responsible

Party

Due Date

I. Welcome & Introductions

The meeting was called to order at 12:00 p.m. Introduction of guest

Paul

Norman

II. Review and approval of the minutes

Minutes were reviewed and were accepted. With the following corrections

• Anna Troutman was not in attendance last meeting but was listed.

• Pg. 2 co-chair listing: Remove Ramon from Program group – Ramon is the co-chair

for the Logistics group.

Vielka

Gabriel

2

III. Business Discussion And Updates

Child Abuse Prevention Summit:

• Wake County Smart Start match summit funding up to $4k. Ramon has committed $2k

from WCHS.

• Summit dates being considered in April “Child Abuse Prevention Month”. April 22-28 –

“Week of the Child”

• Locations under consideration:

o Jr. League

o Andrew’s Center

• Chairs in place for ¾ of the committees. Marketing & Finance group is actively seeking a

chair.

o Recruit co-chairs for each committee

o Plan agenda for coordination committee meeting composed of the 8 co-chairs,

Marjorie and Anna

o Convene co-chairs of each committee to engage in next steps

Current list of co-chairs

• Finance – Recruiting

• Logistics – Giang & Nikki, Ramon

• Marketing – Recruiting

• Program – Marjorie, Anna

December 12th at 9:00 am the Planning Committee will meet

Marjorie & Anna Anna & Marjorie

3

III. Business Discussion And Updates continue…

Serving Seniors: o Internal Services

� Adult Protective Services

� Adult Guardianship

� Case management services

� Representative Payee Serves

� Economic Services (Medicaid, Special Assistance, Food and Nutrition

Services)

o Community Infrastructure

� Contractual Services

• Meals on Wheels

• Resources for Seniors

• Arc of NC (Guardianship)

o Contracts with Resources for Seniors and Meals on Wheels include the local

match for the Home and Community Care Block Grant. These dollars purchase

the following services:

� In Home Aide

� Adult Day Care

� Adult placement services

� Home delivered and congregate meals

� Services to assist seniors to remain in the community such as wheelchair

ramps, home repairs, senior centers, transportation to nutrition sites,

information and referral, medication education, caregiver support.

o The GOLD Coalition is the primary body that works to coordinate services and

provide advocacy for seniors and adults with disabilities. The Coalition also

recommends approval of the County funding plan for HCCBG which is then

submitted to the Board of Commissioners.

o Issues of concern: Increased demand for services: Guardianship caseload up 22%

this year. State funding cuts: State APS fund eliminated cuts to Medicaid services,

changes coming to personal care series and cuts to the Social Services Block

Grant are anticipated. Lack of adequate resource to support individuals to

maintain their independence.

Liz Scott

4


Serving Seniors continue…: o Advocacy issues:

o Supporting seniors/adults with disabilities to live independently

� Flat or reduce funding results in less clients being served

� Waiting lists continue to grow for services designed to provide in

home supports

� Many fall through the cracks as their income is too high for public

benefits, but not high enough to pay privately

o Transportation is regularly cited as most critical problem for seniors/adults

with disabilities

� Demand exceeds supply of transportation services

� Raleigh/Durham metro area recently ranked as 5th worst for senior

transit mobility among metro areas over 1 million population

� In order to utilize available services, people must be able to get to

them

o State funding continues to decrease for senior services

• Elimination of State APS fund

• Increased reliance on Social Services Block Grant, a capped

revenue source

• Trend of cuts to Medicaid covered services

• Increased need for guardianship services

o Partners for advocacy

� Resources for Seniors

� Center for Volunteer Caregiving

� Triangle J Area Agency on Aging

� Meals on Wheels

• “What would a perfect world look like for senior?”

o Change the mindset it’s not a burden rather an honor to be a senior

• What can the committee do?

o Plan a summit to help educate the community

� “By keeping seniors active and healthy we save tax payers money with

health care and services/resources such as nursing homes, in-home health

care, transportation…” (Giang)

Liz Scott

5


Energy Assistance Program:

o There are two types of Energy Assistance Programs in Wake County. CIP (Crisis

Intervention Program) an all year program for heating and cooling funded in part

by the federal government and in part by the state with donations from the utilities

companies, Progress Energy and Wake Electric. The other is LIEAP (Low

income Energy Assistance Program) “one time” assistance for heating, funded

100% by the federal government. To be eligible for LIEAP the household is

130% poverty the same as for the Food and Nutrition Services, and for CIP is

150% poverty rate. To qualify for CIP the household must have a utility

disconnection notice or no heating or cooling.

o The Federal Government reduced the LIEAP budget for the state of NC from $ 71

million dollars to $11 million. Also it changed the criteria for eligibility to give

priority to seniors and disabled households. In addition the checks are now

issued to the utility company instead of the person or household, as in the past.

As a result of these changes approximately 35, 000 households will not receive a

check in February as in the past. We will be able to assist about 3,000 this year.

o The application process for these programs is in person and first come first basis.

It is not an entitlement program. The funding is capped. Applications will begin

on December 1, 2011 for the elderly and disabled and if there are funds available

on February 1st for other populations.

o As a result of the changes in the LIEAP Program we anticipate a higher volume of

people coming in to apply for services, especially in the month of February when

people typically received a LIEAP check.

o Communication efforts were pushed back to the county level to inform their

consumers. WCHS communication efforts were as follows:

� All DHS Email

� Community Partners

� Carolina Now

� Posters in lobby (English and Spanish)

� Word of mouth

o Once an application is processed funds will automatically be pledged to the

energy company if they have a bill it will be paid in 30 days if not a credit will be

issued to their account.

Betsy Moore

6


Social Services Advisory Committee Advocacy Points:

o Committee reviewed and discussed the three priorities of the committee and its

Priority Number What is the Advocacy Issue? Advocacy Points

o Child Abuse Prevention & Supporting Families

o Human Capital Development

o Supporting our Seniors

V. Next Meeting

January 6, 2012 9- -10:30 am ~ Swinburne Building, Board Room.

VI. Adjournment

The meeting adjourned at 10:35 am.

DRAFT Environmental Services Committee

December 9, 2011

Library Administration – Wake County Office Park

11:30 a.m. Wake County Board of Commissioner

Present

Human Services Board Members

Present:

Leila Goodwin

Human Services Board Members

Absent: Frank Eagles

Clarence (Benny) Ridout

Melissa Jemison

Jeffrey Smith

Dianne Dunning

Community Members Present:

Jack Sowter

Bob Rubin

Phillip White

Bryan Hicks

John Whitson

Ed Buchan

Community Member Absent:

Buck Kennedy

Les Hall

Rodney Dickerson

Henk Schuitemaker

Don Haydon

Suzanne Harris

Julian Prosser

Paula Thomas

Kenny Waldroup

Glenn Harris

Liz Turpin

Julie Wilkins

Staff Present:

Matt Roylance

Deborah Peterson

Andre Pierce

Kent Daeke

Dennis McMichael

John Roberson

Sue Ledford

Staff Absent:

Britt Stoddard

Sarah Williamson-Baker

Guests/Others:

DRAFT Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due

Date

I. Call to Order

II. Minutes

III. Introduction of

Animal Services

Director

The December 9, 2011 meeting was called to order at 11:45 A.M.

The October 14, 2011 minutes were approved as written.

Highlights Mr. Dennis McMichael is the new Animal Services Director for the

Wake County Animal Care, Control and Adoption Center effective

November 7, 2011. Mr. McMichael was the Director of Operations at

the Chester County SPCA in West Chester, Pennsylvania. He has a

background in shelter management, volunteer management and

fundraising. Some of the projects Mr. McMichael plans to work on as

the new Director are:

• Develop an Animal Services Community Advisory Committee

(Presently working with Orange County on this project. They

have this type of committee and Mr. McMichael is reviewing

their bylaws.)

• In the process of conducting an independent assessment of the

Shelter Operations

• Focusing on adoption promotion (plans to work with

community partners)

Committee

Member

Matt Roylance

Dennis McMichael

DRAFT Agenda Item


Date

IV. Introduction of

Solid Waste Director

V. Status of Septic

System Study

Highlights

Mr. John Roberson, Senior Facilities Project Manager with Wake

County Facilities Design and Construction Division will be the new

Solid Waste Director effective February 1, 2011. Mr. Roberson has

played a major role in the construction and renovation of many of the

Wake County Solid Waste facilities. His background includes

working with the Triangle Transit Authority as the Engineering

Director and working with the City of Greenville, North Carolina

Public Works Department in the Engineering Section.

Highlights

• The Septic System Study is in progress. Mr. Steve Bristow of

Wake County Environmental Services is working with the

Epidemiologist of Human Services to develop a process. (Dr.

Bob Rubin and Mayor Frank Eagles to provide input to Wake

County staff)

• Monday, December 5, 2011 – Septic Installer/Designers

Meeting held at the Wake County Commons Building to

review septic regulation changes. Attendance was lower than

expected. Field staff is prepared to provide education/training

while working in the field.

Matt Roylance

John Roberson

Kent Daeke

DRAFT Agenda Item


Date

V. Status of Septic

System Study

VII. Public Health

Update

Highlights

• Inspections of 3B Pump Systems were postponed until the

completion of new regulations. These inspections will begin

next week. (Focus will be on the Falls Lake Watershed area –

planning to send out 50 notification letters a month) – will take

about 1 year to inspect them all.

• Water Quality staff have completed over 1,000 swimming pool

inspections. Final inspections to be completed this week.

Highlights Wake County Human Services was awarded accreditation by the North

Carolina Local Health Department Accreditation Board on December

16, 2011. There was a site visit by a multi-disciplinary team that

reviewed certain performance standards to determine accreditation

status. Wake County received many praises during the review. Some

of them were as follows:

• Commended David Cooke and Joe Durham for good

understanding of Agency

• Praised budget processes

• High standard and performance measures

• Very forward thinking and progressive, goo analysis of local

and regional issues

Sue Ledford

DRAFT Agenda Item


Date

VII. Public Health

Report (Continued)

VIII. Human Services

Board Advocacy

Priorities Worksheet

Highlights

• Shared leadership was key highlight

• Liked the Regional Centers model

Complete copies of the report can be received from Sue Ledford

@ [email protected].

Highlights

Environmental Services Committee Members developed a listing of

advocacy agenda priorities to recommend to the Wake County Human

and Environmental Services Board. Some items recommended by

Committee Members were as follows:

• Advocacy Issue – On-site Wastewater

Recommendation – Wake County staff continue to work on

the current path

Leila Goodwin to write up recommendation for this issue.

• Advocacy Issue – Industrial Stormwater Requirements to be

imposed on solid waste activities

Recommendation – Staff research to see how or if this will

effect Wake County

mailto:[email protected]

DRAFT Agenda Item


Date


Board Advocacy


(Continued)

Highlights

• Advocacy Issue – Food Code option for the State of North

Carolina (Significant Control Measures for the risk factors that

were identified in the 2010 Study) Supported by Industries,

Wake County, Environmental Services Committee, Human

Services. The Environmental Services Board wrote a letter of

support on May 27, 2010. There has been discussion about a

local option for fees. The plan is for adoption of the FDA Food

Codes on July 1, 2012 and implementation on October 1, 2012.

Recommendation – Have Representative speak to the

Commission of Public Health.

Motion made by Dr. Bob Rubin to recommend the Human

Services and Environmental Services Board resend letter of

support. Seconded by Dr. Jack Sowter. Unanimously

approved.

Andre to write up this particular issue and its

recommendation for Chair, Leila Goodwin.

Matt Roylance

DRAFT Agenda Item


Date


Board Advocacy


(Continued)

Highlights (Continued)

• Advocacy Issue – Need of Wake County Operation Center in

Western Wake

• Recommendation – Bring this item back before the Advocacy

Committee (Would like this planned and budgeted)

• Sue Ledford stated there is a study group that has completed a

study pertaining to this particular topic and she would be

willing to have them present their information to Committee

Members.

• Advocacy Issue – Animal Licensing Fees

Recommendation – Wake County staff revisit this topic

• Advocacy Issue – Animal Control Fee Changes

Recommendation – Andre Pierce stated there’s preliminary

discussion taking place

Matt Roylance stated preliminary discussion suggested having the

Animal Advisory Committee once it is established bring forth the

Animal Licensing/Fee changes, etc. before Committees/Board after

they have had an opportunity to meet, discuss and review these topics.

DRAFT Agenda Item


Date

IX. Other

VIII. Adjourned

Human Services and Environmental Services Board Operating

Procedures for subcommittees to be adopted by January 2012.

THE NEXT MEETING IS SCHEDULED FOR FRIDAY,

JANUARY 13, 2012 @ THE LIBRARY ADMINISTRATION

BUILDING WAKE COUNTY OFFICE PARK, ROOM 102, 4020

CARYA DRIVE.

Wake County Human Services Board LME Advisory Committee Meeting Community Services Center – 401 E. Whitaker Mill Road, Rm. 210

Minutes – December 20, 2011

Members Present: Staff Present: Guests/Community:

Ms. Stephanie Treadway, Committee Chair / HS Board

Mr. Pablo Escobar, Committee Vice Chair / HS Board

Ms. Ann Akland, Advocate / NAMI

Mr. Jim Edgerton, HS Board

Dr. Jim Hartye, Horizons Healthcare / WakeMed

Members Absent:

Dr. George Corvin, HS Board

Dr. Kent Earnhardt, HS Board / HRC

Ms. Melissa Jemison, HS Board

Ms. Rhonda Spence, Advocate

Ms. Denise Foreman, Assistant to the County Manager

Dr. Tim Isley, Physician Director

Ms. Miki Jaeger, LME Program Manager/Quality Assurance

Dr. Carlyle Johnson, LME Administrator

Dr. Keith McCoy, Psychiatrist/Acting LME Medical Director

Mr. Ramon Rojano, HS Director

Ms. Ann Wood, Mental Health Project Manager

Staff Absent:

Ms. Patsy Coleman, LME/Financial Management

Mr. Eric Fox, NC DHHS MH/DD/SAS

Mr. Marc Jacques, CFAC Co-Chair

Mr. Tad Clodfelter, SouthLight, Inc.

Mr. Mark O’Donnell, State Division of

Mental Health

Guests/Community Absent:

Mr. Grady Britt, Advocate

Agenda Item

Discussion, Conclusions, Recommendations, Follow-up

Call to Order The LME Advisory Committee meeting, facilitated by Ms. Stephanie Treadway, opened at 12:10 p.m.

Approval of Minutes

Upon motion by Ms. Ann Akland, seconded by Mr. Jim Edgerton, the committee approved the November 15, 2011, committee minutes.

Agenda Items

Agenda: •Advocacy Priorities •Annual Provider Network Compliance Reports •Merger/Transition Updates •LME Director/Administrator Updates •Committee Workplan and Priorities for Jan.-Jun. 2012 •Good of Order

Chair’s Report The LME Budget/Finance Report was postponed this month. Ms. Patsy Coleman was absent due to the loss of a family member. Chair Treadway said memorial contributions may be made to an Education Fund that has been set up at the State Employees Credit Union on the family’s behalf or given to Jonica Hinton to forward to the fund.

Agenda Item


Advocacy Priorities

Chair Treadway said the HS&ES Board Advocacy Workgroup has requested that committees develop and submit their advocacy priorities worksheets for consideration at the Board level. Mr. Rojano clarified that after July 1, 2012, the LME Advisory Committee will not exist. Committee Suggestions/Discussion: 1. Transition to the MCO. Ask the HS&ES Board to make sure that the interests of the citizens are not sacrificed during the

transition.

2. The transition to the MCO is the biggest change MHDDSA has gone through in 50 years. Suggested to advocate for an MCO that Wake County deserves and one that will meet Wake’s needs. (How Wake partners, how Wake is represented, how CFAC and CPAC are represented, and what the local presence will look like.)

3. Dr. Johnson and Mr. Rojano suggested that the committee look at the past year’s priorities and determine if there are any carry overs, such as (1) adequate inpatient psychiatric capacity; (2) long waits in E.D.s; and (3) accessibility of services in general.

4. On the state level, there continues to be significant financial pressure that could affect all of the transition. Examples: if MCO does not get adequate state funding during the transition, continued budget cuts, loss of Medicaid Services. Need advocacy for restoring funding and averting further budget cuts. The committee said this is a financial issue that might be the purview of the new MCO board. The advocacy point next year for the HS&ES Board may be around Behavioral Health Services issues.

5. The committee felt that whatever advocacy issues they came up with could be passed on to the new MCO board.

6. Ms. Akland said the impact of the Department of Justice investigation. She believed advocating with the HS&ES Board around housing for people with disabilities are still important.

7. Think about and advocate for people who are not Medicaid recipients. This policy development will have implications for funding long term. Policy development is where mandates and funding come from. Currently Bill 916 contains no mandates for people without Medicaid.

8. New 2014 Healthcare Reform is looking for integration of the Five Axis approach. Therefore there is an issue in separating behavioral health needs, medical needs, and social needs. Advocate for holistic approach.

9. Mr. Jacques said based on changes to G.S. 122c, the Division asked CFACs to comment on G.S. 122c (170 &171). G.S. 122c is the overarching statute for the mental health system. There is advocacy across the state to update the language on recovery, ensuring the MCO has a robust office of consumer affairs, and that the consumer and family participation on the board is not squeezed out amidst changes. He believed this is a perfect example of what the state policy could be asked to put in G.S. 122c.

(Cont.)

Agenda Item


Advocacy Priorities (Cont.)

10. The MCO will have two contracts with the state: • To manage the state Medicaid dollars. • To manage the state dollars. As the system moves forward, for every state dollar, you earn $2 federal dollars. It will be

likely to pull the state dollars into the Medicaid match. If you have no state dollars to manage, and if state dollars are dwindling and limited to what they can cover, what happens to people above 138% of poverty. Forecast is that the state will be forced to use state dollars for mandatory services.

11. Mr. O’Donnell suggested inviting Mr. Steve Jordan (MH Director, DMH/DD/SAS) or Mr. Jim Jarrard (Assistant Director) to give his perspective on the LME aspect by the Medicaid Waiver movement, which takes in the breadth of the population—not just the Medicaid population—and where the flexibility will be and how you might utilize it.

12. There is currently “county” funding for WakeBrook Facilities and HHH psychiatric bed contract. Mr. Escobar asked if this committee will be seen as the policy advising body on how the county dollars are spent? • Ms. Denise Foreman said the current county vision is for almost all of the county funding to flow through the MCO. Then

there will be a contract between the MCO and Wake County. There is a huge and important priority-setting process, what we want the county dollars to buy and then managing to ensure Wake is getting what it is contracting for. She said there is an important question to figure out what is the role of Human Services and the HS&ES Board and how it is all managed. The MCO has a lot of rules to follow on Medicaid management and on conflict of interest. She did not know how formal those roles could be. She believed it would have to be an informal, advocacy, liaison type role between Human Services, the HS&ES Board, and the MCO. Ms. Foreman said she did not know what this will look like right now.

• Ms. Foreman said input from the HS&ES Board and advocates to the new MCO board are critical. She said it is clear that a HS&ES Board member representative cannot serve on the MCO board because Human Services is a service provider. However, maybe informally, a HS&ES Board member liaison could attend MCO board meetings and report back.

13. Wake will go from advocating as a MCO to advocating to a MCO.

14. Is DMA going to take over mental health? There is a trend. Need to look at global needs for emotional, physical and social wellness.

15. The state has said it is critically important to work well with your local social services department because of the Medicaid eligibility determination. Dr. Johnson is pleased of the relationship/interaction between Wake LME and Wake Social Services. Expressed the importance of preserving connections and natural supports already in place. There may be some natural advocacy points from the public health and/or social services side. Mr. Rojano clarified that this means the MCO may advocate to the HS&ES Board to do more things.

16. Will Behavioral Health Services still exist? Yes. The MCO board will decide who it contracts with. Will Wake continue to fund/manage WakeBrook and Wake Behavioral Health Services? Mr. Edgerton pondered whether the 22 million county funds have to be given to the MCO. Wake Behavioral Health Services (WBHS) receives $3 million in IPRS dollars; the remaining $22 million dollars for WakeBrook comes from the county. Ms. Foreman said the county has not decided what the funding split will be yet. Mr. Rojano believed the county dollars will be the only flexible dollars in the future. The county will have to decide the best use for this money based on gaps, what is best for the citizens, and financial viability.

(Cont.)

Agenda Item


Advocacy Priorities

19. Ms. Akland said UNC and Wake County have partnered to identify Wake County community gaps and needs. There is a feeling for strategic planning to determine priorities for the $22 million county funding. She asked what is this process and who will be involved. --Ms. Foreman said Wake is looking for information from the UNC Study; Wake has a gaps analysis, and information from LME and CFAC. However, we are too far away from figuring out how things will work with the MCO and how things will all fall together. The county has started its FY 2013 budget process and looking to carry forward what is in place now. The county will be looking for input on how those prioritizations happen and how the contract between the county and MCO will be developed and what will be included.

20. Ms. Akland said from her viewpoint, it makes sense to first make evaluations of services before RFPs are put out and/or develop a different RFP for a different type of service. Ms. Foreman said the county does not want to put something out in a RFP that is a priority need. She referenced the handout distributed last month on current WBHS list of services provided and how that would pursue as a RFP. The first piece is an evaluation process happening in the January – March 2012 timeframe. She said the county highlighted some of the services currently in existence that might lend themselves to a first tier of RFP. Ms. Akland said she hoped the community and consumers have opportunity to help plan and provide input into what eventually happens. She said this is the opportunity to really make sure we get the best services for citizens as we transition into the MCO. Mr. Rojano clarified that UNC wanted to do the study when they were under pressure from WakeMed to purchase Rex Hospital. UNC’s purpose was to see if they should build a psychiatric facility in Wake County. Therefore the study was based on an analysis of gaps to see what kind of facility they would build. UNC is not under the same political pressure.

21. Per Capita Allocation (MOE). Everybody will be equal under the Medicaid Waiver, so this is the time to advocate for equality in the per capita allocation for the entire state. Big advocacy point would be to change the state formula as of January 1, 2013. Advocate for fair funding formula for non-Medicaid clients.

22. Dr. Hartye said it seems we are talking about (1) what is the right type of service model, and (2) a new firewall between services that will be continued by the county in the county versus those funded by the MCO. Dr. Johnson said there is a commingling of dollars. He said many programs interact, so the utilization on one program impacts on utilization of another. Dr. Keith McCoy said the dollars cannot operate in silos or we’ll end up with a broken system. He believed the county cannot decide what its priorities should be unless it understands what the MCO is funding. This has to be done with regular communication.

23. Dr. Johnson said we need to understand that this is Wake County’s MCO, and Wake needs to own it. Wake and Durham will be partners. Wake will have multiple seats at the table to provide oversight and appraise performance.

24. Ms. Foreman said to stay tuned to the legislative short session and to proposed changes in G.S. 122c in what is on the table in the interest of counties.

25. Mr. Rojano suggested concentrating on advocacy at the state. Many things are not known today with the MCO. Based on this discussion, Chair Treadway suggested continuing discussion of priorities at the next committee meeting. Ms. Treadway, Mr. Escobar and Dr. Johnson will meet before the next meeting and narrow down priorities.

Agenda Item


Merger/Transition Updates

Ms. Foreman said the county is learning more and making more progress and getting more refined everyday. However, the list of undone items is huge.

The goal is to have the interlocal agreement document ready by January 5, 2012. That would then start its way through the review and approval processes of the Wake and Durham Boards of Commissioners. Anticipating to use the January 9, 2012 Wake County Commissioners Work Session to focus on this topic and on the terms of the agreement. If all goes well, anticipate approval at the January 17, 2012 Wake County Commissioners' meeting and at the January 23, 2012 Durham County Commissioners’ meeting. Once approved, staff can figure out the final definition and path for board appointments. The initial recommendation is that the Wake Board of Commissioners can appoint three members to join The Durham Center Board as soon as we have an agreement. Ms. Foreman said there are significant decisions for the MCO during the first five month timeframe, and therefore, the county will need to have great board representatives. The board appointment process is currently proposed to mirror The Durham Center’s (TDC) current appointment process. TDC has a vetting process where candidates meet with representatives of TDC Board and they make sure there are no conflict of interest issues.

There are a number of components of the agreement that we don’t have final agreement on. A lot of this is contingent upon the Performa. The Performa has been a moving target.

Staff is moving forward with a corporate headquarters and a local site in Wake and in Durham. The Durham Center is working through staff hiring process. Dr. Carlyle Johnson has been selected as the Wake County Site Director. This has been an open and competitive hiring process open to Wake, Durham, Johnston and Cumberland LME employees. There have been representatives from Wake Human Services and Durham Human Services on the hiring selection panel. Ms. Ellen Holliman, TDC CEO, is making the final selection decisions for the top management level. To date, there have been five selections made and more selections this week. Once the top level management selections are made, they will refine the organization chart of how/where positions fit, responsibilities/roles, credential requirements, and start working through the hiring process. Envisioning about 400 employees between all four counties, 300 of which are with the MCO. There are lots of job opportunities if staff choose that path.

Ninety-six Wake County LME employees received Reduction in Force (RIF) notifications on December 16. These employees have until December 23 to decide their path forward option: (1) placement with new MCO or Wake County, (2) retirement severance, or (3) termination severance. LME employees will remain Wake County employees until June 30, 2012, as long as Wake is continuing LME operations.

LME staff are continuing LME work, planning for MCO, and serving on work teams.

Mr. Rojano explained the different processes: 1. LME regular activities until June 30, 2012. However, there will be an overlap with contract services until December 2012. 2. From July 1 – December 31, 2012, the MCO will have to perform LME services. Then January 1, 2013, the MCO will

begin the waiver implementation. 3. As of July 1, 2012, LME staff will no longer be county employees. Wake County has made a decision to hold current

vacancies open to accommodate staff who want to continue employment with Wake County. 4. There will be some critical gaps, but Wake County will backfill vacancies to continue LME operations.

Agenda Item


5. On paper there are more positions than staff in the MCO organization.

Mr. Rojano said Wake has been a part of the MCO co-creation from the inception. *Note: Also see the LME Administrator’s report.

Committee Workplan and Priorities for Jan.-June 2012

Committee Workplan and Priorities was covered in the discussion on advocacy priorities and will be continued at the January committee meeting.

Annual Provider Network Compliance Reports

Ms. Miki Jaeger, LME Services Program Manager/Quality Assurance, presented and answered questions on the following reports. An information report will be presented to the HS&ES Board at their January 2012 meeting.

1. Wake LME Provider Performance Reporting FY11 I. Compliant Reporting II. Incident Reporting III. Endorsement Status IV. Letters of Support V. IPRS Provider Compliance (new report this FY)

2. Wake LME Annual Review and Performance Reporting FY11

I. Accessibility Plan Review II. Health and Safety Plan Review III. Utilization Review Team Annual Review IV. Call Center Satisfaction V. Access Center Annual Review VI. Care Coordination Annual Review VII. Internal Performance Indicators

Ms. Jaeger noted that the Wake LME CARF Accreditation expires four weeks before the planned MCO merger. Wake will fall under Durham’s accreditation (URAC) for the MCO. Already beginning to work on the new URAC accreditation for Durham. Additional aspects of URAC accreditation will need to be obtained. (note: State is aware of Wake County’s situation and is in agreement.) The committee complimented the detailed information contained in the reports. Committee Advocacy Points: • Trends indicate that in times of crisis, people tend to migrate to areas where services and job market are stronger. Wake

needs to advocate for state allocation dollars, because some of the gaps and needs are coming this way. • Dr. Hartye asked if the cuts affecting need for services are from STR funds or in-service funds. Dr. McCoy said these are

service funds and that STR tells us that more people are being referred for services. Therefore, there is a cut plus an increase in utilization.

• Dr. Hartye said the N.C. Hospital Association is a potential strong ally because they have a great interest in the increase in funding and services. He asked if staff could put these two pieces together in a one-pager for next month discussion.

Agenda Item


• Vice Chair Escobar asked Dr. Hartye and Ms. Denise Foreman to send an email to him and Chair Treadway on their advocacy ideas.

LME Director/ Administrator Updates

Dr. Carlyle Johnson, LME Administrator, made the following comments: • The Merger/Transition Update will be a standing monthly committee agenda item.

• Reinforced that there are many details remaining and that workgroups have been developed to figure out details.

• Reinforced that as staff get new positions, they will be asked to start the new positions right away. Will negotiate with Durham to see if staff can work a split percentage with Durham and with Wake during transition period. Wake will be doing backfilling for staff who have to move on and/or developing creative strategic work with remaining LME staff (e.g., staff may take on additional internal assignments and/or there may be some tasks that the LME will stop doing). Also looking at hiring temporary staff where feasible. If there is enough attrition in some areas, discuss with Durham to start functions as a shared entity before June 30. There also may be shared staffing agreements. This is all contingent upon the approved merger agreement.

• Effective July 1, 2012, it becomes Durham/Wake multi-county LME. Wake is also working on how wrap up/fiscal year responsibilities will be transitioned (audits, contracts, etc.).

• Mr. Fox asked if there will be a function for the LME Advisory Committee. Ms. Foreman said we have not yet worked out how the MCO board will have committees. She said PBH is a different example. Because they don’t have as many representatives from each of the counties on their board, they had to set up mid-level advisory capacity because they represent 15 counties. However, Wake County will have a strong voice on the MCO board, so that advisory role is not as great as with the PBH model.

• Mr. Fox stressed that the Wake/Durham MCO population will be greater than with PBH and believed that a voice is needed for the people.

• Dr. Hartye said the range of needs for representation will be great.

• Mr. Edgerton asked if the revision of G.S. 122c will address the board. Ms. Foreman said it is currently being proposed. She said many different models have been discussed, and N.C. Councils across the state had a list of items that their memberships are interested in addressing. The NC Association of County Commissioners also had a list of items representing interests of the counties. She believed there will be an agreeable blend. Don’t know what will be introduced in the legislative short session.

• Ms. Foreman said that in a good governance model, one would want advisory groups/community input.

• Mr. Edgerton asked if The Durham Center Board or other multi-county area programs have advisory groups now? Mr. Edgerton said this is something this committee could advocate for. The committee asked staff to find out.

• Dr. Johnson believed the MCO will need to have local presence in each area and figure out how in their area they regularly get the advice of their community. Consumer and family input will be through local CFAC subcommittees. The local sites would need to connect and figure out how appointments would work, structure, bylaws, etc.

• Dr. Johnson asked what would be the appointing body of an advisory committee if there is one—would it be a subcommittee of the MCO board or another option? We currently have multiple advisory groups that don’t necessarily tie together, such as the Child Collaborative, the JCPC, and the Wake Crisis Cooperative. He suggested to pull together an inventory and to see how they get tied together.

Agenda Item


Meeting Adjourned

Meeting adjourned at 2:01 pm. Next meeting is January 17, 2012, CSC 12:00 pm– 2:00 pm

Board of CommissionersBoard of CommissionersBoard of CommissionersBoard of Commissioners

Meeting Agenda

January 17, 2012 – 2:00 PM

Meeting Called to Order: Chairman Paul Coble Pledge of Allegiance Invocation: Commissioner Tony Gurley Items of Business 1. Approval of Agenda 2. Approval of the Minutes of the Commissioners' Regular Meeting of January

3rd and January 9th Work Session 3. Recognition of National Arts Program Winners Among Wake County

Employees and Their Family Members

4. Proclamation to Recognize Wake County's Participation in Project

Homeless Connect and to Proclaim January 24, 2012 as Project Homeless Connect Day

5. Retiree Recognition

Consent Agenda All items on the Consent Agenda are considered to be routine and may be enacted by one motion. If a County Commissioner requests discussion on an item, the item will be removed from the Consent Agenda and considered separately. 6. Accept and Appropriate $1,142,904 in Shelter Plus Care Grant

7. Accept and Appropriate $180,000 from Casey Family Programs For the

Wake County Foster Care Program

Regular Agenda 8. Public Hearing and Grant Application Authorization for Wake Coordinated

http://services.wakegov.com/agenda/agdocs.aspx?doctype=agenda&itemid=6199










Transportation Services 2012-2013 Community Transportation Program Assistance

Public Hearing Format: a. Introduction b. Open Public Hearing c. Comments from Interested Parties d. Close Public Hearing e. Board Action

9. EMS Department Request to Apply for the CMS Health Care Innovation

Challenge Grant

Appointments (It is customary for nominations to be made for vacancies on each board or committee, and a collective motion made to accept the nominations.) 10. Eastern Wake Fire Department Board of Directors

Other Items 11. Committee Reports 12. Other Business 13. Closed Session 14. Adjourn Public Comments: Comments from the public will be received at 2:30 p.m. for 30 minutes. A signup sheet for those who wish to speak during the public comments section of the meeting is located in the back of the Boardroom.

Wake County Board of Commissioners meetings are broadcast live on cable channel 11 & rebroadcast on

Fridays at 7 p.m. The meetings are also available via video-streaming on the County’s website –

www.wakegov.com.






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