North Carolina



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BRAIN INJURY ADVISORY COUNCIL (BIAC)

Date: September 6, 2017 Time: 9:30-3:30 pm Location: Alliance Behavioral Healthcare

5000 Falls of Neuse Road, Room 310

Raleigh, NC

|TYPE OF MEETING | Quarterly Meeting |

|FACILITATOR |Holly Heath Shepard, Chairperson |

|ATTENDEES |

| NAME |PRESENT |NAME |PRESENT | |

|Voting Council Members | |Non-Voting Council Members | |GUESTS |

|Holly Heath-Shepard, Chair | |Alan Dellapenna | |Susan Johnson |

|Jerry Villemain | |Cindy DePorter | |Carol Ornitz |

|Jean Andersen | |Amy Douglas | |David Forsyth |

|Craig Fitzgerald | |Chris Egan | |Laurie Stickney |

|Martin Foil | |Michiele Elliott | |Karen Luken |

|Jerome Frederick | |Deb Goda | |Mya Lewis |

|Carol Gouge | |Dreama McCoy | |Beth Callahan |

|Carmaletta Henson | |Jim Prosser | |Robin Embler |

|Thomas Henson, Jr. | |Jeanne Preisler | | |

|Ken Jones | |Jim Swain | | |

|Lynn Makor | |Dennis Williams | | |

|Karen McCulloch | |Kenneth Bausell | | |

|Evelyn McMahon | |Christine Fernandini | | |

|Ana Messler | | | | |

|Vicki Smith | | | | |

|Sarah Stroud | | | | |

|Brandon Tankersley | |Staff to Council | | |

|Pier Protz | |Scott Pokorny | | |

|Donna White | |Sandy Pendergraft | | |

|Jan White | |Michael Brown | | |

|Melinda Munden | | | | |

|Dr. Ryan Lamb | | | | |

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1. Agenda topic: Welcome, Review of Minutes & Introductions

Update on new and/or pending Council Members

Q-metis Information Holly Heath Shepard

|Discussion |Holly welcomed all to the meeting. Minutes from last meeting (6-14-17) were presented for approval. Thomas Henson made a motion|

| |to approve the minutes, and Brandon Tankersley seconded the motion. All approved. Minutes were approved as written. |

| |Introductions were made by all in attendance. Holly gave an update of new Council members. New Council members include: Dr. |

| |Ryan Lamb (replacing Dr. Manalo); Christine Fernandini, Nurse Manager; and Kenneth Bausell, IDD manager (replacing Deb Goda). |

| |Holly read bios for each new Council member. The Council is currently looking to fill a seat vacancy for a veteran or family |

| |members of a veteran who has a TBI. There was some discussion on possible individuals to fill this vacancy. |

| |Vicki Smith announced her retirement from Disability Rights NC, effective September 30, 2018. Vicki stated that she will remain |

| |in the executive director role while the Disability Rights NC board searches for her replacement. Vicki will continue to |

| |represent Disability Rights NC on the Brain Injury Advisory Council (BIAC) until there is new leadership or until September 30, |

| |2018. |

| |Holly presented information about Qmetis, which is an interactive Quality Assurance (QA) software system that identified |

| |strengths and weaknesses of hospitals and medical staff and allows for self-correction and more team interaction. This system |

| |measures compliance levels, identifies areas of non-compliance, and offers feedback about approved treatment guidelines almost |

| |immediately. This makes the clinical team more interactive, responsive, and efficient. This software is designed for more |

| |severe head injuries with a Glasgow Score greater than 8. Qmetis is funded by a $450,000 grant from the General Assembly for the|

| |pilot program. For more information – |

|Conclusions |Minutes from 6-14-17 meeting were approved as written. |

| |New Council Members (Dr. Ryan Lamb; Christine Fernandini; and Kenneth Bausell. |

| |Introduced to the Council, Qmetis, which has an assessment tool to help improve patient outcomes and possibly reduce the cost of |

| |long-term care. |

|Action Items |Person(s) Responsible |Deadline |

|N/A | | |

2. Agenda topic: Integrated, Collaborative Care Karen Luken

|Discussion |Integrated, Collaborative Care for People with Disabilities: |

| |How can it offer help, hope, and a voice for people with brain injury and their families |

| |As an individual’s needs become more complicated, the system is more challenged to respond |

| | |

| |What is Provided … and What is Needed? |

| |Your Experiences |

| |Your Recommendations |

| | |

| |Stakeholders |

| |Individuals with disabilities and families |

| |Advocates |

| |Health care providers |

| |Long term service and support providers |

| |LME/MCOs |

| |Government |

| |Business |

| |Educators |

| |Community |

| |Technology and Data |

| | |

| |Systems Change |

| |CMS Quadruple Aim |

| |Improving the health of the population |

| |Enhancing the patient experience of care |

| |Reducing the cost of care |

| |Improving the work life of health care providers |

| |NC DHHS Program Design for Medicaid Managed Care |

| |Advance high-value care |

| |Improve population health |

| |Engage and support providers |

| |Establish a sustainable program with predictable costs |

| | |

| |5 Broad Aspects of the Transition to Medicaid Managed Care in NC |

| |Creating an innovative, integrated, and well-coordinated system of care |

| |Supporting providers and beneficiaries during the transition |

| |Promoting access to care |

| |Promoting quality and value |

| |Setting up relationships for success |

| | |

| |Pressures for Change |

| |Increasing demand for services and supports |

| |Budgets |

| |Policies |

| |Evidence-Based Practices |

| |Changing Demographics |

| |Values and Expectations |

| |Politics |

| | |

| |Complexity of Factors Experienced by Many People with Disability |

| |Misdiagnosis and diagnostic overshadowing |

| |Complex health conditions and chronic diseases |

| |Co-occurring psychiatric conditions |

| |Poly-pharmacy |

| |Less favorable social circumstances |

| |Navigating across multiple systems of care |

| |Limited access to health promotion opportunities |

| |Aging with a life-long disability |

| |Aging caregivers |

| |Fragmented Health Care Delivery System |

| |Lack of communication between providers |

| |Emphasis on acute, episodic care |

| |Limited focus on long-term health needs |

| |Lack of consumer responsive system |

| |Financial models and incentives do not promote whole person care and collaboration |

| | |

| |Terminology Confusion |

| |Definitions are |

| |complex and evolving |

| |mean different things to different audiences |

| |Confusing terms and definitions can lead to: |

| |misunderstanding |

| |discounting viewpoint of some stakeholders |

| |faulty planning and conclusions |

| |disengagement |

| | |

| |What Words Are You Hearing? |

| |Some of the Terms |

| |Whole Person Care |

| |Integrated Care |

| |Collaborative Care |

| |Medical Home |

| |Advanced Medical Home |

| |Health Home |

| |Chronic Care Model |

| |Behavioral Health Home |

| |Others??????????? |

| | |

| |Medical Home |

| |Comprehensive primary care that replaces episodic care with coordinated care for all stages of life; long-term therapeutic |

| |relationship |

| | |

| |Core elements: |

| |Accessible |

| |Person-centered, family centered |

| |Continuous |

| |Comprehensive |

| |Coordinated |

| |Compassionate |

| |Culturally effective |

| | |

| |Whole Person Care |

| |Coordination of heath, behavioral health, I/DD, TBI services and supports AND community services in a |

| |person-centered manner |

| |Goal is improved outcomes and efficient use of resources |

| |Emphasis is on consideration of ALL life domains and needs |

| |Six dimensions of care |

| | |

| |Collaborative Leadership |

| |Target Population |

| |Patient-centered care |

| | |

| |Collaboration across sectors |

| |Shared data |

| |Financial flexibility |

| | |

| | |

| |Integrated Care |

| |Team of primary care and behavioral health working together with individual and families |

| |Provides person-centered care using systematic and cost effective approach for defined population |

| |Addresses life stressors and crises, chronic health issues, ineffective patterns of health care utilization |

| |Co-location model (primary care + behavioral health) |

| | |

| |Collaborative Care |

| |Ongoing working relationships between providers |

| |Shared responsibility for treatment |

| |Combining expertise and skills of providers |

| |Active communication, information sharing, clinical documentation |

| | |

| |IMPACT model: |

| |Systematic diagnosis and outcomes tracking: use of screening tools and disease registry |

| |Stepped Care: change is treatment according to evidence –based algorithm |

| |Primary care + psychiatrist consultant + BH therapist |

| | |

| |Health Home |

| |Integrated, person-centered, and coordinated service delivery system that links primary, dental, acute, specialists, |

| |behavioral health, and long-term services and supports |

| | |

| |Fundamental Elements |

| |Ongoing relationship with health care provider and care team |

| |Person-centered and whole person orientation |

| |Care and support is tailored to needs of individual and family |

| |Patient is an active participant |

| |Comprehensive case management and transitional care |

| |Coordination with other providers and community resources |

| |Sustainable business model; appropriate incentives; accountability |

| |Use of Information Technology and data to improve care |

| | |

| |Advanced Medical Home |

| |Patient-centered physician guided model of care based on Chronic Care Model |

| |Evidence-based guidelines |

| |Health information technology |

| |Best practices |

| |Accountable for quality and value of care provided |

| |Focus on strengthening and supporting the patient–physician relationship |

| |Competent team: physician specialist in complex, chronic care management |

| |Coordination and active involvement by informed patients |

| |Delivery of care in a variety of care settings according to the needs of the patient and skills of the medical provider |

| | |

| |Chronic Care Model |

| |Team based care |

| |Productive interactions between providers and informed patients |

| |Care coordination |

| |Self-management support |

| |Reduce low value, unnecessary care |

| |Utilize evidence-based strategies |

| |Decision support and clinical information systems |

| | |

| |Core Elements Across Multiple Models |

| | |

| |Person centered |

| |Comprehensive assessment |

| | |

| |Relationships |

| |Integrated plans |

| | |

| |Informed and engaged patient |

| |Life concerns (SDOH) |

| | |

| |Family Support |

| |Care coordination, case management, navigation |

| | |

| |Competent providers |

| |Evidence-based |

| | |

| |Multi-disciplinary Team |

| |Complex needs |

| | |

| |Valued outcomes |

| |Data, decision supports |

| | |

| | |

| |Social Determinants of Health |

| |Conditions where people live, learn, work, play, worship and age affect a wide range of health, functioning, and |

| |quality-of-life outcomes |

| |Social and environmental determinants of health account for 70% of health outcomes |

| |Food insecurity, housing, transportation, income, job security, working conditions, education, early childhood |

| |development, social exclusion |

| | |

| |Evolving Service Delivery Model |

| | |

| |Move From |

| |Move To |

| | |

| |Admit/discharge |

| |Engagement/follow-up |

| | |

| |Acute—in the moment focus |

| |Long-term , life course |

| | |

| |Specific presenting condition |

| |Whole person |

| | |

| |Compliance |

| |Support, Adherence |

| | |

| |Physician decision-making |

| |Shared decision-making |

| | |

| |Passive patient |

| |Active, engaged individual |

| | |

| |Episodic documentation |

| |Registries, alerts and reminders |

| | |

| |File audits, episodic events |

| |Outcomes—clinical, financial and member |

| | |

| |Disease coping |

| |Disease management and health behaviors |

| | |

| |Individual provider |

| |Service team |

| | |

| |Volume financial model (FFS) |

| |Value financial model (shared risk) |

| | |

| | |

| |Family Support and Collaboration |

| |Support families as they help their family members achieve their full potential |

| |Help families make critical connections to other families and resources in the community |

| |Provide individualized, family-centered support that respects family culture, values, and preferences |

| |Share responsibility for treatment with individual and family |

| |Combine expertise and skills of providers |

| |Promote active communication, information sharing, and documentation among providers and with families |

| | |

| |Needs and Recommendations – Anna 65 years old |

| | |

| |Health – History of hypertension, poorly controlled with medications. Recent fall, ED visit, did not evaluate for TBI. |

| |Discharge to primary care. Anna complains of forgetfulness, frequent crying, irritability. |

| |Family and Community – Lives alone, husband died 5 years ago. Daughter and son live out of state. 4 grandkids. |

| |Has not attended church since fall due to “my bad memory, crying spells, and anxiety |

| |about driving”. |

| |Services & Supports – Just enrolled in Medicare, does not understand coverage and benefits. Medical practice |

| |Merged with hospital system. No formal “services”. |

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| |Medical Health Homes |

| |Key recommendations |

| |Consultation infrastructure with multi-disciplinary team focus |

| |Navigation services and assistance |

| |Data analysis and sharing |

| |Demonstration pilot programs with evaluation |

| | |

| |Navigation |

| |Direct assistance in “navigating” array of programs and services. Assistance can be offered in real time and in multiple |

| |venues. |

| |Identify and assist with problem solving and implementation of solutions to remove physical, communication, and/or |

| |program access challenges. |

| |Connect people with resources, streamline referral and treatment process, and associated paperwork |

| |Address ongoing psychological, social and community living concerns of individuals, families and caregivers |

| |Promote resilience of individuals and families |

| | |

| |2 Demonstrations with Evaluation |

| |Primary Care Pediatric Telephone Consultation for Children and Youth with I/DD |

| |Provide telephone consultation within 30 mins. to support primary care providers and behavioral health teams caring |

| |for children 3 to 22 years (MCPAP model) |

| |Consultation team: child and adolescent psychiatrists, resource coordinator, medical specialists, behavioral health |

| |specialists, community resource liaisons |

| | |

| |Specific Aims |

| |Establish telephone consultation infrastructure and staffing plan to provide timely consultation from Duke, UNC, |

| |NC START regarding medical and behavioral health needs of youth with IDD |

| |Provide referral support for youth with IDD to connect with appropriate resources |

| |Conduct evaluation focused on feasibility, acceptability and outcomes including health care utilization |

| | |

| |Increasing Access to Autism Spectrum Disorder Specialty Care in Rural North Carolina: A Project ECHO Pilot |

| |Develop a pilot Project ECHO program in North Carolina targeting Autism Spectrum Disorder |

| |HUB: Raleigh TEACCH Center |

| |SPOKES: rural primary care providers in Eastern NC in rural areas: |

| |Families are more likely to receive treatment from family medicine physicians than pediatricians or specialist |

| |providers |

| | |

| |Specific Aims: |

| |Improve ASD-specific knowledge and treatment self-efficacy of rural primary care providers in North Carolina |

| |Improve the quality of lifespan care received by individuals with ASD by increasing provider diagnostic screening |

| |and treatment of common medical and behavioral health comorbidities |

| | |

| |Program Re-Design Keys and Questions |

| |Patient population to be served |

| |Enhanced access and continuity of care |

| |Team composition: staffing and expertise |

| |Shared responsibilities |

| |Standardized screenings and assessments |

| |Care focus; integrated plan of care |

| |Communication: information sharing |

| |Use of population data |

| |Outcomes |

| |Payment and incentives |

| |Workforce development |

| |Innovation |

| | |

| |The Fundamentals |

| |Everyone has the right to the best possible health status and quality of life |

| |Everyone needs to know how to protect, preserve and improve their health |

| |Comprehensive orientation to health, health care, wellness, quality of life, self-determination: |

| |Health shifts back and forth on a continuum and throughout our lifetime |

| |Health must be aligned with personal goals, plan of care, long term services and supports, community living |

| |Provide the right information and resources to support self-care decisions that improve quality of life |

| |Knowledge of and partnering with the community |

| | |

| |Some Things We Have Learned |

| |It is critical that “we” are at table and help set the table, to ensure the needs and concerns of people with disability |

| |are addressed as health care and disability services are reformed |

| |The landscape is still changing |

| |There is not ONE model for integrated care, but everyone should have access to primary care, a medical home, |

| |necessary specialists, and community supports |

| |Process and structures may need to be modified or enhanced to achieve valued outcomes at individual and population |

| |levels |

| |Partnerships and community are essential ingredients |

| | |

| |Moving Forward |

| |Leverage existing resources and partnerships |

| |Identify and utilize expertise in our state |

| |Engage stakeholders throughout the process |

| |Commit to transparency, equity, and fairness |

| |Align incentives |

| |Focus on accountability |

| |Implement and evaluate demonstration activities |

| |Stay engaged in state reform |

| |Monitor and learn from national activities |

| | |

| | |

| |“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” |

| | |

| |Martin Luther King Jr. |

| | |

| |Thank You |

| | |

| |Karen Luken |

| |karenluken@ |

|Conclusions |Holly introduced Karen Luken to the committee. Karen presented a presentation on Integrated, Collaborative care for |

| |Individuals with disabilities. Karen’s email address is: karenluken@ should you need further information. |

|Action Items |Person(s) Responsible |Deadline |

|N/A | | |

3. Agenda topic: Waiver/CMS Update, MFP Update Kenneth Bausell & Trish Farnham

|Discussion |MFP Update – Trish Farnham | | |

| |Trish Farnham gave an update – MFP has pulled together a team to | | |

| |examine how to better coordinate supports for individuals who want to | | |

| |transition. That workgroup sent out the surveys to gather | | |

| |information. MFP supports individuals with disabilities to transition| | |

| |from long-term facilities back to homes in the community. MFP is a | | |

| |demonstration project – over time resources that support the program | | |

| |will no longer be available. Trish talked about MFP’s long-term plan | | |

| |for sustainability. MFP is in the process of reshaping their vision | | |

| |and look for ways to retain momentum. Talking with Medicaid staff and| | |

| |stakeholders about some of the issues that interfere with transition. | | |

| |The results include lack of coordination among department divisions, | | |

| |communication channels about administrative changes or requirements | | |

| |are not user friendly, ambiguity and issue resolution channels, silos | | |

| |within DHHS, where is the front door (how do I start – hard time | | |

| |navigating the system), need for improved understanding about what | | |

| |policies will allow, the service paradox of a person’s circumstance | | |

| |becomes more vulnerable because of economics, transportation, | | |

| |transitions are a lot harder than they should be. | | |

| | | | |

| |NC TBI Waiver Updates – Kenneth Bausell | | |

| |Planning – Currently working on an ongoing basis on the plan for | | |

| |implementation. Also, working on the individual support plan and how | | |

| |that will look for individuals with TBI. | | |

| |HCBS – Home and Community Based Services – need to submit | | |

| |CMS – will submit new plan to CMS next week | | |

| | | | |

| |NC Innovations | | |

| |What just happened? NC Innovations will expire in August, 2018 | | |

| |What is happening? Listening session are scheduled for input on all | | |

| |service definition with a goal to improve services. | | |

| |What is coming up? Waiver amendment to be submitted in December, 2017 | | |

| |for approval by August, 2018. | | |

| | | | |

| |Listening Session Themes and Clarifications – | | |

| | | | |

| | | | |

| |Themes Overview | | |

| |Major theme categories: | | |

| |LME-MCOs | | |

| |Eligibility, Care Coordination, Approval of services, and | | |

| |Reconsideration all through the same agency. | | |

| |Consistency | | |

| |Care Coordinator | | |

| |Confusion over how the LME-MCOs manage funds | | |

| |Relative as Provider | | |

| |Reimbursement Rates | | |

| |Confusion over the LME-MCOs rate setting authority | | |

| |Service rates should be reviewed | | |

| |Supports Intensity Scale (SIS) | | |

| |Consistency | | |

| |Time to administer | | |

| |How do the core deficits of ASD fit in the SIS? | | |

| |Levels and Budget | | |

| |Outside vendor | | |

| |Guideline versus hard limit | | |

| |Algorithm and the level of support needed | | |

| |Request for more transparency | | |

| | | | |

| |Clarifications | | |

| |Supported Living/Residential Supports and the community component of | | |

| |Community Living and Supports | | |

| |Supported Living – Family members receiving services outside the NC | | |

| |Innovations waiver can live with the person receiving Supported Living| | |

| |Supported Living Periodic | | |

| |Clarify the SIS Addendum process | | |

| |Residential Supports and therapeutic leave | | |

| |Community Transition and MFP Functions | | |

| |Budget Limits by Level of Support section in the waiver – list out the| | |

| |“other factors” | | |

|Conclusions |Trish Farnham gave an update on MFP. Kenneth Bausell gave an update | | |

| |on the TBI Waiver and CMS Update. There was discussion about the TBI | | |

| |Waiver. DMA will let BIAC know when people can call Alliance to be | | |

| |put on registry. DMA will submit final comments to CMS within a week.| | |

|Action Items |Person(s) Responsible |Deadline | | |

|N/A | | | | |

4. Agenda topic: Grant Update, Program Expenditure Report, Data Collection

Efforts, Introduction of new TBI Program Coordinator Scott Pokorny

|Discussion |TBI State Funds |

| |Total TBI state funds legislative appropriation for SFY16-17 was $2,373,086. This included all LME/MCO allocations and |

| |the BIANC contract. |

| |Out of this total amount, $2,013,868 was allocated to the LME/MCO’s for individuals with TBI in each of their catchment |

| |areas. Most LME/MCO’s used their total allocation amount. |

| |Out of the total LME/MCO allocation, $2,006,232 was spent. |

| |$509,226.44 was spent out of other funds. |

| | |

| |TBI state funds |

| |Most common services and supports provided through the TBI state funds allocations |

| |Transportation |

| |Residential Facility |

| |Personal Care |

| |Day Program/Day Treatment |

| |Respite |

| |Vocational Supports |

| |Clubhouse |

| |Equipment |

| |Developmental Therapy |

| |Other Therapy |

| |Medication/Supplies |

| |Van Repair |

| | |

| |TBI state funds |

| |Purpose |

| |To obtain data from the LME/MCO’s to better understand demographic information about the TBI state funds programming. |

| | |

| |Data elements |

| |Total amount of funding being requested for the upcoming fiscal year |

| |Total number of people projected to be served in the upcoming fiscal year |

| |Services to be funded |

| |Total number of people served in the previous fiscal year |

| |Total number of people unable to be served in the previous fiscal year |

| | |

| |TBI state funds |

| |Annual TBI program report |

| |How is this data helpful? |

| |Identifies number of individuals that access this program per catchment area in a given year. |

| |Identifies challenges in funding levels statewide. |

| |Provides information about the numbers of individuals that could benefit from the program if increased funding was |

| |available. |

| |Provides information about the funding level needed in order to serve the identified number of individuals with TBI |

| |per catchment area. |

| |Provides information about the specific types of services that are being funded through the program. |

| | |

| |TBI state funds |

| |Annual TBI program report highlights |

| |Total number of individuals served between fiscal years is stagnant. |

| |Increase in the number of individuals that could not be served between the two fiscal years due to allocation amounts. |

| |Approximately $2 million additional dollars are needed to meet all of the needs of individuals with TBI including: |

| |- Increased supports for individuals currently in service |

| |- Individuals identified as needing services/supports, |

| |but funding is not available due to allocation amounts. |

| | |

| |TBI state funds – SFY 16-17 contracts |

| |Brain Injury Association of North Carolina |

| | |

| |ACL Grant Contract (June 1, 2016 - May 31, 2017) |

| |100% expended |

| |All deliverables were met |

| | |

| |State Contract (July 1, 2016 - June 30, 2017) |

| |99% expended |

| |All deliverables were met |

| | |

| |TBI state funds |

| |SFY 16-17 contracts |

| |Brain Injury Association of North Carolina |

| |ACL Grant Contract - $246,984 |

| |State Contract - $359,218 |

| | |

| |SFY 17-18 LME/MCO allocations |

| |All LME/MCO’s will maintain the same allocation they had last fiscal year for a combined total of $2,013,868. |

| | |

| |TBI state funds |

| |SFY 17-18 contracts |

| |BIANC website |

| |2790 contacts -- 59% from professionals and 41% from survivors and family members |

| |16,575 sessions by 11,145 users -- 63% were new visitors and 37% returning visitors |

| | |

| | |

| |Screening data |

| |Alliance- June 1, 2016 through May 31, 2017 – 311 individuals screened as possibly having a TBI. |

| |CommWell (FQHC)- June 1, 2016 through May 31, 2017 - 31 individuals screened as possibly having a TBI. |

| | |

| |ACL grant highlights |

| |Resource Facilitation |

| |June 1, 2016 to May 31, 2017 there were 213 technical assistance contacts. |

| |Provided to Alliance, CommWell FQHC and providers within the pilot area. |

| | |

| |Collaboration |

| |Continued partnerships have been maintained with NC Governor’s Group for Veterans, Independent Living Council, |

| |NC Coalition on Aging and many others. |

| |Quarterly Steering Committee and Evaluation Committee meetings occur. |

| | |

| |Education/Training |

| |June 1, 2016 to May 31, 2017 there were 204 training events with a combined total of 11,511 attendees. |

| |Trainings continue to be provided regularly at conferences, to mental health/substance use providers, residential |

| |providers, medical centers, LME/MCO’s and many other entities. |

| |The TBI and Medical Professionals online training module is complete and ready for viewing at the new TBI training |

| |web portal. |

| |The new TBI training web portal is located at . This web portal is replacing the |

| |website and will host all online NC TBI training opportunities. |

| | |

| |Sustain |

| |BIANC will continue to maintain and update the website, including online resource guide. |

| |BIANC offers Neuro-Resource Facilitation statewide through each satellite office. This statewide service has been |

| |integrated into their contract. |

| |All four BIANC Education and Resource Coordinators offer training statewide. This is an integral part of their contract. |

| |TBI screening has been integrated into five LME/MCO catchment areas. |

| | |

| |Other ACL Grant Updates |

| |NC began year 4 of the grant on June 1, 2016. |

| |The end of the full 4 year grant cycle will be May 31, 2018. |

| |ACL has advised that they are proceeding as if there will be full funding for the next grant cycle. |

| |ACL will be posting the RFP for the next grant cycle at the end of January 2018. They have advised that grant proposals |

| |will be due in March 2018. |

| |ACL will be posting new draft performance measures in the next couple of months for public input. |

| | |

| |Other TBI Program Initiatives – TBI Screening |

| |Has been occurring at five LME/MCO’s during at least half of SFY16-17. |

| |The participating LME/MCO’s are using the Ohio State Screening Tool. |

| |Data is being submitted to DMH/DD/SAS quarterly. |

| |DMH/DD/SAS will provide the data to the legislature as has been requested, BIAC, stakeholders and any other entities |

| |or individuals that are interested. |

| | |

| |Other TBI program initiatives |

| | |

| |TBI screening – implementation schedule |

| |LME/MCO |

| |Implementation Date |

| | |

| |Alliance |

| |May 1, 2015 |

| | |

| |Eastpointe |

| |July 15, 2016 |

| | |

| |Trillium |

| |October 1, 2016 |

| | |

| |Sandhills |

| |September 1, 2016 |

| | |

| |Cardinal |

| |December 1, 2016 |

| | |

| |Partners |

| |Will not be participating |

| | |

| |Vaya |

| |Will not be participating |

| | |

| | |

| | |

| |Other TBI program initiatives |

| |TBI screening results for SFY16-17 |

| |LME/MCO Name |

| |Screening Period |

| |Screening Results |

| | |

| |Alliance |

| |12 months |

| |311 |

| | |

| |Eastpointe |

| |12 months |

| |101 |

| | |

| |Trillium |

| |8 months |

| |34 |

| | |

| |Sandhills |

| |9 months |

| |21 |

| | |

| |Cardinal |

| |7 months |

| |60 |

| | |

| |Partners |

| |N/A |

| |N/A |

| | |

| |Vaya |

| |N/A |

| |N/A |

| | |

| | |

| |Other TBI Program Initiatives |

| |Behavioral Risk Factor Surveillance System (BRFSS) |

| |BRFSS is a random telephone survey of state residents aged 18 and older in households with telephones. Information |

| |is collected in a routine, standardized manner at the state level on a variety of health behaviors and preventive health |

| |practices related to the leading causes of death and disability such as cardiovascular disease, cancer, diabetes and |

| |injuries. |

| |BRFSS interviews are conducted monthly and data are analyzed annually (on a calendar-year basis). |

| | |

| |Other TBI program initiatives |

| |Behavioral Risk Factor Surveillance System (BRFSS) |

| |TBI program was approved for three questions that are currently being asked in calendar year 2017. |

| |TBI program is being approved to continue the three questions in calendar year 2018. |

| |This initiative contributes to identifying the number of individuals with a potential TBI in NC. |

| |Once two full years of data is obtained, trends can start to be analyzed. |

| | |

| |Other TBI program initiatives |

| |BRFSS TBI Questions |

| |Thinking about any injuries you have had in your lifetime, were you ever knocked out or did you lose consciousness? |

| |What was the longest time you were knocked out or unconscious? |

| |How old were you the first time you were knocked out or lost consciousness? |

| | |

| |Other TBI program initiatives |

| |TBI Claims Data Analysis |

| |Primary purpose is to determine how many individuals with a documented TBI are accessing service systems such as |

| |Mental Health (MH) and Substance Use Disorder (SUD). |

| |Continued collaboration with an epidemiologist from the DMH/DD/SAS Quality Management Section. |

| |Source of data will continue to be NCTracks (July, 2013 forward). |

| |We will identify persons who had at least 1 TBI diagnosis during this period (based on the first 6 diagnoses on the |

| |claim in NCTracks). |

| |First data reviewed was focused on ICD-9-CM codes provided by CDC. |

| |Second data review will focus on ICD-10-CM codes provided by CDC. Date from 10/15/15 forward will be analyzed.    |

| | |

| |Other TBI program initiatives |

| |Additional Program Activities |

| |New TBI program webpage on the DHHS website now available at: |

| | |

| |Updated Brain Injury Advisory Council orientation manual for new Council members now available. |

| |TBI State Action Plan- will be setting up stakeholder meeting in the next 6 months to review plan and determine if |

| |updates or changes are needed. |

| |The new TBI training web portal is located at . |

| |The additional training modules being developed out of the BIANC state funded contract are almost complete. They |

| |will include TBI and Public Services, Pediatric TBI, Cognitive and Behavioral Consequences of TBI in Adults and TBI |

| |and Substance Use. |

| | |

| |Other TBI program initiatives |

| |TBI and Money Follows the Person (MFP) |

| |MFP is a state project that assists Medicaid eligible North Carolinians who live in in-patient facilities to move into |

| |their own homes and communities with supports. |

| |The TBI specific MFP workgroup has reconvened. The objectives of the group include: |

| |To clarify processes, from the TBI beneficiary’s perspective, about accessing appropriate coordinated services |

| |across different service delivery systems. |

| |To identify “low hanging fruit” opportunities for improving/streamlining service access and coordination. |

| |To clarify systemic issues that impede effective coordination that require additional information/policy change. |

| |To develop preliminary guidance for “entry points,” such as DSS and hospital discharge, on how to effectively |

| |navigate TBI service delivery system. |

| |To collaborate with efforts in place to improve TBI screening methods. |

| |The workgroup will continue to meet regularly to discuss next steps, best ways to use survey results, strategies to |

| |address service gaps and other topics. |

| | |

| |Other TBI program initiatives |

| |TBI Waiver |

| |Regular meetings continue to occur with DMA and Alliance to discuss TBI waiver preparation and roll-out logistics. |

| |Meetings have occurred with BIANC to discuss how they can assist with waiver activity such as providing training and |

| |resource facilitation to Alliance staff and service providers throughout the Alliance catchment area. |

| |Collaboration with DMA on waiver preparation activity continues. |

| | |

| |Questions |

| | |

| |Scott Pokorny Michael Brown |

| |TBI Team Lead TBI Specialist |

| |DMH/DD/SAS DMH/DD/SAS |

| |919-715-2255 919-715-2285 |

| |Scott.Pokorny@dhhs. Michael.Brown@dhhs. |

|Conclusions |Scott Pokorny gave TBI Grant Update. There was discussion regarding what kind of services are requested for individuals who |

| |call the LME/MCOs. It was suggested that an Adhoc Committee be formed to brainstorm and break down the available data. |

| |Scott agreed to supply BIAC with information regarding a breakdown of services. |

| | |

| |Scott announced that BIAC is currently looking for a Veteran with a brain injury or a family member of a veteran with a brain |

| |Injury to fill a slot on BIAC. Please let Scott know if you know of anyone who may be interested in serving on the committee. |

|Action Items |Person(s) Responsible |Deadline |

|Scott Pokorny to supply BIAC with information regarding a breakdown of services |Scott Pokorny |3-8-17 |

5. Agenda topic: Discussion of the Executive Committee, Voting of Council Chair, Holly Heath Shepard

Selection of Vice-Chair, other Council matters Jerry Villemain

Council at Large

|Discussion | Holly talked about her role and time as the Chair for BIAC. Holly announced that she would like to step down as Chair. Holly |

| |nominated Jerry Villemain for the next Chair. Holly read to group Jerry’s biography. Holly also read comments from staff at |

| |Neuro-Restorative where Jerry is employed. Marty Foil seconded the nomination. There were no other nominations. Council members |

| |voted, but there were not enough members present for a quorum. Nine members voted for Jerry Villemain – need 7 more votes for a |

| |quorum. According to the bylaws, Holly will have to send out an email for the other members’ votes within 10 days. There will be |

| |an opening for a Vice-Chair. Ken Jones recommended that a nominating committee be formed so that Council members can be nominated. |

| |The nominations must be voting members. Council members volunteering to be on the committee includes: Ken Jones, Jerry Villemain, |

| |Brandon Tankersley. Holly to send out an email to other Council members asking if they are interested in being on the committee. |

| |Jerry Villemain discussed with group the idea of forming an Executive Committee within BIAC to make decisions which need to be made |

| |quickly. Marty Foil suggested that BIANC be represented on this committee. There was a question posed as to whether a member of |

| |BIANC on the committee would pose a conflict of interest due to BIANC receiving funds from the State. On behalf of BIANC, Ken Jones|

| |recused himself from being on the committee. After discussion, it was decided that the Executive Committee will consist of the |

| |chairs from each subcommittee (Children & Youth; Legislative; Prevention; Health Service & Service Delivery; Veterans). Because |

| |members of the Executive Committee must be voting members, there will need to be changes with the chairs for the subcommittees. It |

| |was recommended that these changes be made a ready for the new year. |

|Conclusions | Holly to email members who were not present to vote to get their votes. |

|Action Items |Person(s) Responsible |Deadline |

|Holly to email Council members who were not present to vote to get their vote for Council |Holly Heath-Shepard |9-16-17 |

|Chair. Holly to let Council know the results once the votes are tallied. Holly will also | | |

|send out an email to ask members about being on nominating committee. | | |

|Holly and Jerry to work on forming the Executive Committee. | | |

| |Jerry Villemain & Holly Heath-Shepard |12-13-17 |

6. Agenda topic: Updates from Council Committees Committee Chairs/Co-Chairs

|Discussion |Children & Youth – Thomas Henson gave an update to the committee. Project – parental brochure for concussions in the schools. |

| |Goal – consistent communication with doctors, parents, and school staff regarding concussion management and monitoring. |

| |Legislative – Carol Ornitz gave an update to the committee related to Bills 403, HB 116, HB336, and HB 512. Holly made a |

| |suggestion, due to her experience of being the Council Chair, and recommended that the legislative committee present |

| |ideas/suggestions to DHHS. Working with DHHS has been a positive experience for Holly. Carol commented that sometimes talking to|

| |the legislators is also a learning experience for the legislators. Working with DHHS and the legislators is recommended. |

| |Prevention – no report |

| |Health Service & Service Delivery – no report |

| |Veterans – no report |

|Conclusions | |

|Action Items |Person(s) Responsible |Deadline |

| | | |

7. Agenda topic: Adjourn/Next Scheduled Meeting Holly Heath Shepard

|Discussion |Meeting adjourned at 3:21 p.m. |

| |Next meeting scheduled for December 13, 2017 |

|Conclusions | |

|Action Items |Person(s) Responsible |Deadline |

| | | |

Ms. Heath-Shepard thanked everyone for their participation. There being no further business, the meeting was adjourned at 3:21 p.m. Respectfully submitted: Sandy Pendergraft, Michael Brown and Scott Pokorny.

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