HHSC Region 15 Meeting Minutes-072512 (00092157-2).DOCX



REGION 15-REGIONAL HEALTHCARE PARTNERSHIPWednesday, March 27, 20131:00 p.m.El Paso First Health Plans, Inc. 1145 Westmoreland DriveEl Paso, Texas 79925PRESENTPRESENTJames N. Valenti, President & CEO, Region 15 AnchorCathy Gibson, CCO, Lead Waiver Representative-UMCMichael Nu?ez, Chief Financial Officer-UMCSue Beatty, City of El Paso Health DepartmentRobert Taylor, El Paso Health DepartmentJim Paul, Hospice of El PasoMiguel Marquez, Hospice of El PasoDomingo Betancourt, Tender Home HealthTom McConell, Tender Home HealthAna Rodriguez-McConnell, Tender Home HealthCynthia D. Horton, VNADavid Palafox, El Paso County Medical SocietyBertha Gallardo, Las Palmas/Del SolFrank Dominguez, El Paso FirstChrystal Davis, EHNRene Navarro, EHNBlas Meza, UMCDavid Smead, UMCLorrie Giessel, UMCLeticia Flores, UMC, ControllerMaj. Mark Morton, Salvation ArmyCharles Handley, Sierra Providence Health NetworkOgi Alozie, M.D., TTUHSCDamian Campos, Sierra Providence EastZulema Carrillo, EPPCSUPPORT STAFFBetsy Castillo, Executive Assistant, CEOMaria Luisa Escobar, Recording Secretary1. CALL TO ORDER & WELCOME Ms. Gibson called the meeting to order at 1:05 p.m. 2. APPROVAL OF THE MINUTES FROM THE JANUARY 29, 2013 MEETING.Ms. Gibson noted that the minutes were on the website at and invited any comments from the audience. Hearing no comments the minutes for February 20, 2013 were adopted as presented.She added that these minutes would serve as a source of reference for the two meetings per month requirement that is part of the project. There was one correction provided by Mr. Jim Paul after the meeting and that correction has been made. 3. CONFIRMATION OF PARTICIPANTS – ROLL CALLMs. Gibson invited the attendees to introduce themselves and the participating agencies to confirm everyone’s presence at today’s RHP meeting. 4. RECAP FROM ANCHOR CALL 3/22/2013 Ms. Gibson informed the attendees that HHSC approved the DSRIP Plan on March 2, 2013 and it will now be forwarded to CMS who has 45 days to provide feedback. Region 15 was one of four regions to submit their plans early. Ms. Gibson explained communication from HHSC and their concern with the “Other Projects”, and the duplication of federal funds. If there is an entity currently receiving funds it is advisable not to claim the project. Valuation may come in to play and they may focus on some of the higher valuations. She went over a couple of items identified for other regions that have been pulled by HHSC. She noted that there were two items that may impact RHP 15 under CMS review on access to specialty care projects, which they did a lot of and it is a broad range of expanding specialty care. They are looking at high intensity procedures that must have a significant focus on the Medicaid indigent population for that project. The need for access must be clear and must be focused on Medicaid and indigent which CMS will likely request the metrics with quantifiable Medicaid and indigent impact for these projects. 5. CMS REVIEW PERIOD FOR REGION 15Ms. Gibson reiterated that the projects were submitted March 2, 2013 and it is a 45 review period by CMS and unlike the HHSC review there is no back and forth feedback provided. The expectation is that word from CMS will be received around April 15, 2013 when they will communicate which of the 54 projects were approved and which need work. If there are some that need additional work there is an additional 30 day time frame to complete. 6. UC AND DSRIP PAYMENT TIMELINES Ms. Gibson noted that because HHSC has forwarded our Plan that triggered the DY1 DSRIP payment for the performing providers and an IGT was submitted for Region 15 for UMC, Texas Tech and EHN as well. Mr. Nu?ez added that the slide presented showed the correct dates as released by HHSC. It is taking 30 days for payment after the IGT has been submitted. 7. LEARNING COLLABORATIVE TOPIC FOR REGION 15El Paso Behavioral Health SummaryMs. Gibson noted that the following information would be utilized to fulfill an educational information processing session for the Region. These topics are all related to behavioral health and she encouraged input from the attendees.Emergence Project PresentationMr. Rene Navarro, Administrator Director of Grants at EHN, and Ms. Crystal Davis, Administrative Director of Forensics and Emergency Services explained that a lot of information was available during the compiling of the various projects. He directed the attendees to their website which contains a detailed review within the organization’s Annual Report. The Center recently hired a Planning Coordinator that will specifically focus on data gathering to be the lead mental health authority and provide research data. By way of the Mental Health Collaborative with the Paso del Norte Health Foundation, UMC, Sierra Providence, Del Sol and El Paso Psychiatric Center; they are about to get a regional plan approved that will develop additional research data. They are working with Centro San Vicente as a HOGG recipient to do Behavioral Medicaid Planning towards the implementation of an integrated model. Ms. Davis did a quick review of the various projects submitted for Region 15 such as the Extended Observation Unit designed to treat and stabilize individuals presenting a psychiatric crisis. The individuals do not have an acute medical need but will be provided with the therapy and medication that they require in order to reduce the number of individuals that present themselves at the various EDs’. This Unit will also be utilized for jail diversion efforts as a drop off or treatment by law enforcement. The location of this 12 bed unit that will serve individuals through a voluntary or involuntary status is at 1600 Montana and will be housed behind the Central Administration building. By utilizing this method of treatment it would avert sanctions placed by the state on providers that are currently over utilizing the system.The Crisis Respite Unit is a 16 bed facility located in Northeast El Paso which will be turned into a respite unit for individuals that are in a non-emergent crisis but have some psychiatric issues that need treatment and stabilization and possibly have housing issues. Mr. Valenti inquired on the implementation timeline and Ms. Davis noted that they have initiated this one to some level but they are waiting for response from DHHS on the modification of funds for remodeling purposes.Increase Behavioral Health Providers is part of an effort to bring additional licensed providers to this area. Currently there is a wait list and this initiative will help with recruitment efforts to open up the accessibility to behavioral health services. Crisis Stabilization for IDD (Intellectual Developmental Disabilities) is a specialized unit that will work with practitioners and family members in the community to give them a treatment modality where they will know how to provide an intervention to their family members affected by these disabilities. Advanced Base Practices focuses on providing education to staff and community providers with several evidence based practices. They are currently working with the SSIST training (Supply Suicide Intervention Skills Training) to identify individuals expressing thoughts of suicide and to be able to direct them to the appropriate care providers. Ms. Zulema Carrillo inquired if the 16 bed unit would replace CASA Solano and Ms. Davis noted that it would replace that facility as it would be towards a higher acuity with some of the same requirements as the previous facility but it will have a nurse and access to a doctor on call to meet DHSS requirements. Mr. Valenti offered to assist with the approval process at the state level and Ms Davis responded that they are moving along with only the review of some additional information requested by the agency. UMC Behavioral Health Project PresentationMr. Blas Meza, UMC ED Director, explained that the organization has been looking at the psychiatric patient population for a number of years and as a Level I Trauma Center there is the tendency to have an extended number of patients admitted to UMC. One initiative done was to assess patients within a 12 month period and it was identified that there were patients that had a co-diagnosis to behavioral health which were overlooked. He added that UMC also has an inpatient consultation service based on the number of patients with a second diagnosis of behavioral health. This program aims to place a trained psychiatric nurse practitioner on the inpatient side to assist with this population in order to hopefully draw the services available while they are admitted and thus reduce their length of stay and dependency towards readmissions. The 5-Year expected outcomes include an improvement in stabilization time, short-term treatment for patients waiting access to EPPC. There would be additional improvement in the identification of those inpatients with behavioral health needs. Some of the target figures would be to increase to 2700 interviews per year by DY 4 and 3240 per year by DY5. A question was posed on the 2700 figure and Mr. Meza noted that during an internal assessment conducted there were a lot of diagnosis with behavioral health influences. He assured the audience that UMC will follow requirements by the State of Texas that all Nurse Practitioners are supervised by a physician and that has been built into the structure.LPDS Behavioral Health Project PresentationMs. Bertha Gallardo shared that the Intervention Project for their organization would seek to establish tele-psychiatric consultation for the ED. This would provide immediate access to a professional to provide interference with the ED staff and place the patient in the appropriate setting as quickly as possible. Currently these patients sit in the ED anywhere from two hours to two days or two weeks as they are unable to access a professional and they end up being admitted until an evaluation can be done. The target population is the psychiatric patients and between the two hospitals they see 1500-1800 of these patients per year and for a private hospital these are high numbers especially since Del Sol is now considered a Level II Trauma Center. They are seeing a lot of these patients in the ED. They plan to extend coverage through the contracting with a vendor that will provide the evaluation of acute behavioral health patients in the ED in an expeditious manner. Texas Tech Behavioral Health Project PresentationDr. Alozie explained that they are looking to extend the Psychiatric Fellowship Program to two a year. Child psychiatric services are very important in the current environment. One of the matrixes in the proposal was to get about 400 unique psychiatric visits for the year for the fellowship which can be easily achieved. A question was posed on “unique” and Dr. Alozie clarified that it would account for each individual child that has visited the program or been interactive with the Child Psychiatric Fellow at any point in time during the DY year. There is no limit on how many patients a fellow can see unlike the ACGME restrictions which are hours based restrictions for residents on call over a 26 hour period. The psychiatric fellows do a lot of outpatient with a lot of ambulatory care and there is no cap on how many patients they can see. Mr. Valenti requested that Dr. Alozie expand on the Child Psychiatric Department and the Fellowship Program. Dr. Alozie explained that the Psychiatric Residency is a three year period after they have completed their general year. The Child Psychiatry Fellowship Program goal is to train general psychiatry practitioners to specific focus on behavioral issues that children will have going into adolescence. Other Region 15 Providers’ Projects that will affect Behavioral HealthMs. Gibson noted that the community anticipates a struggle to recruit this particular skills group. 8. ROUNDTABLE DISCUSSION 9. PERFORMANCE LOGIC-DSRIP TRAINING PROGRAMMs. Gibson noted that a presentation was provided at the last meeting in the form of a webinar on the services provided by this company. After further review of this service; Region 15 is looking towards the purchase of this software to facilitate the tracking of the various projects and the detailed metrics and outcomes required by CMS. Texas Tech has opted to utilize Microsoft Project Management and that data will be pulled in as required to present a report. Any entity will have user access to the system and the company has all the data necessary to load into the program. UMC as the anchor is allowed a percentage of additional funds which will be utilized to purchase the software. She added that this system is being utilized by San Antonio for a number of years on a number of projects. Mr. Valenti strongly encouraged the utilization of this system to provide a professional and accurate reporting venue to CMS. Ms. Leticia Flores stated that she reviewed the presentation and it allows for an easier venue for financial tracking and reporting. 10. Next Meeting Date- 11. ADJOURNMENTMr. Valenti adjourned the meeting at 2:00 p.m. _____________________________________Mr. James N. Valenti, Region 15 Waiver Anchor ................
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