North Carolina



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BRAIN INJURY ADVISORY COUNCIL (BIAC)

Date: 9/7/2016 Time: 9:30-3:30 pm Location: Alliance Behavioral

Healthcare – Wake Site

5000 Falls of Neuse Rd; 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 | |Jeanne Preisler | |Carol Ornitz |

|Jerry Villemain | |Jenny Still | |David Forsythe |

|Carol Gouge | |Jim Swain | |Courtney Schenck |

|Lynn Makor | |Alan Dellapenna | |Laura O’Neal |

|Craig Fitzgerald | |Spencer Clark | |Diane Harrison |

|Martin Foil | |Deb Goda-Kenneth Bausell, Rep | |Erin Whitely |

|Ana Messler | |Amy Douglas | |Betsy MacMichael |

|Thomas Henson | |Cindy DePorter | |Norman Case |

|Ken Jones | |Chris Egan | |Thomas Goldsmith |

|Evelyn McMahon | |Michele Elliott | |Laurie Stickney |

|Sara Stroud | |Dreama McCoy | |April Groff |

|Kenneth Wilkins | |Jim Prosser | |Sara Wilson |

|Vicki Smith | |Jerome Frederick | |Donald McDonald |

|Carmaletta Henson | | | |Marilyn Lash |

|Brandon Tankersley | | | |Susan Johnson |

|Janice White | | | | |

|Donna White | |Staff to Council | | |

|Jean Anderson | |Scott Pokorny | | |

|Pier Protz | |Travis Williams | | |

|Karen McCulloch | |Sandy Pendergraft | | |

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1. Agenda topic: Welcome, Review of Minutes and Introductions Holly Heath Shepard

|Discussion |The Chair welcomed the attendees and introductions were made by all the Council members and guests. |

| |Minutes from the previous Council Meeting (6-8-16) were reviewed and approved by all with a motion from Thomas Henson and |

| |seconded by Brandon Tankersly. |

| |Holly Heath-Shepard, Chair gave an update on current Council seats, which she stated that all seats are currently filled with |

| |the exception of the last two, which include Spencer Clarks’ seat – Spencer stated that he is unable to attend the meetings, but |

| |is interested in continued involvement by working “behind the scenes” with Scott Pokorny. Scott Pokorny talked to group about |

| |the person from DMH/DD/SAS who may be filling this seat. Scott spoke with the acting Director of DMH/DD/SAS to identify staff |

| |member within the substance abuse section who works with the veteran population. The position is currently being filled. |

| |Hopefully, this person will be hired and available for the seat by the council’s next meeting. The other seat is one left by Dr.|

| |Erwin Manalo – he moved to Kentucky. Will be looking for a MD with expertise in trauma, neurosurgery, neuro-psychology, |

| |physical, medical, rehabilitation or emergency medicine. New appointments: Jerome Frederick has been approved as a council |

| |member. Carol Gouge is a survivor of brain injury from eastern North Carolina is filling the seat left vacant by Brian Volk and |

| |Jim Prosser, Assistant Secretary of Veterans Affairs is filling the seat left vacant by Ilario Pantano. |

| |Ken Jones from BIANC announced the annual professional conference, “Life after TBI – It takes a Community” on October 28, 2016 at|

| |Wake Med Hospital. He also announced the CBIS course coming up November 30, December 1 & 2, 2016. More information available on |

| |the BIANC website – . |

| |Holly reminded everyone that according to the Council’s bylaws we will follow Robert’s Rules of Order. If you have |

| |questions/comments, please raise your hand and wait to be acknowledged. |

|Conclusions |The minutes were adopted as presented. |

| |Two seats to be filled on BIAC. |

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

|Two BIAC seats to be filled |Holly Heath-Shepard & Scott Pokorny |12/7/16 |

2. Agenda topic: State Fund Expenditures for fiscal year to date; Annual data from LME/MCOs; Claims data reviews; ACL Grant Update; TBI State Plan Scott Pokorny

|Discussion |Scott Pokorny presented information on the TBI Program Report, which included: |

| |TBI State Funds |

| |Total TBI state funds legislative appropriation for SFY15-16 was $2,373,086. This includes all LME/MCO allocations, BIANC and TBI|

| |Project Star contracts. |

| |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, $1,938,409.40 was spent. This leaves $75,458.60 unspent. |

| |Reasons for unexpended funds: |

| |provider staff turnover/open positions |

| |consumer hospitalizations during times services were scheduled to be delivered |

| |services provided but provider agency did not submit invoices by billing cut-off date |

| |money transferred from one LME/MCO to another did not get expended |

| |A combined total of $1,001,330.78 was used from other funds in order to meet consumer service and support needs. |

| |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 |

| |New annual TBI program report - 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 |

| |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. |

| |SFY 15-16 Contracts – Brain Injury Association of NC |

| |HRSA Grant Contract (June 1, 2015 - May 31, 2016) |

| |83% expended |

| |Primary reason for reduced expenditure: trainer position vacant for majority of the contract year. |

| |All deliverables were met |

| |State Contract (July 1, 2015 - June 30, 2016) |

| |98% expended |

| |All deliverables were met |

| |Carolina’s Healthcare/TBI Project Star |

| |State Contract (July 1, 2015 - June 30, 2016) |

| |82% expended |

| |Primary reason for reduced expenditure: coordinator position vacant for six months of the contract year. |

| |All deliverables were met. |

| |ACL Grant Contract - $246,984 |

| |State Contract - $359,218 |

| |SFY 16-17 LME/MCO allocations |

| |All LME/MCO’s will maintain the same allocation they had last fiscal year except Cardinal. That LME/MCO will receive their |

| |previous allocation plus the allocation that had gone to CenterPoint last year as a result of the merger. |

| |HRSA grant highlights |

| |BIANC website |

| |2308 contacts -- 62% from professionals and 32% from survivors and family members |

| |17,169 sessions by 11,954 users -- 67% were new visitors and 33% returning visitors |

| |Screening data |

| |Alliance |

| |May 1, 2015 through May 31, 2016 - 210 individuals screened as possibly having a TBI. |

| |June 1, 2016 through August 31, 2016 - 31 individuals screened as possibly having a TBI. |

| |Resource Facilitation |

| |June 1, 2015 to May 31, 2016 there were 228 technical assistance contacts. |

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

| |Collaboration |

| |New partnerships continue to be developed with NC Governor’s Group for Veterans, Independent Living Council, NC Coalition on |

| |Aging and many others. |

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

| |Education/Training |

| |Trainings continue to be provided regularly to mental health/substance use providers, residential providers, medical centers, |

| |LME/MCO’s and many other entities. |

| |Training curricula have been updated. |

| |Training library is being developed. |

| |Proposals submitted to present at conferences and workshops. |

| |The updated online TBI training at is being managed by BIANC effective July 1, 2016. |

| |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 is being integrated into all LME/MCO systems. |

| |Additional sustainability activity will be explored. |

| |Other grant updates |

| |TBI grant moved from HRSA to ACL effective June 1, 2016. |

| |NC began Year 3 of the grant on June 1, 2016. |

| |ACL has advised that state grantees are required to continue to execute the plan they provided in their HRSA grant applications |

| |to provide information and referral services, professional training, screening for TBI, and resource facilitation to increase |

| |access to these services |

| |There have been four core components to a TBI infrastructure that include: |

| |A statewide TBI advisory board, |

| |A lead state agency for TBI, |

| |A statewide assessment of TBI needs and resources, and |

| |A statewide TBI action plan. |

| | |

| |Establishing or sustaining these four core components was required by previous Implementation Partnership Grant Program funding, |

| |but is not required by the funding released in 2014. However, federal statue continues to require these from states. |

| |Other TBI program initiatives |

| |TBI Screening |

| |Will occur at most of the LME/MCO’s. Some will conduct the screening through their access centers while others will implement |

| |through their contracted assessment agencies throughout their catchment area. |

| |The participating LME/MCO’s will use the Ohio State Screening Tool. |

| |Data will be submitted to the TBI program at 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. |

| |TBI screening – implementation schedule |

| |Alliance – May 1, 2015 |

| |Eastpointe – July 15, 2016 |

| |Trillium – October 1, 2016 |

| |Sandhills – September 1, 2016 |

| |Cardinal – December 1, 2016 |

| |Partners – Unknown |

| |Smoky – Will not be participating |

| |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). |

| |TBI program has submitted application to have two questions included in survey related to TBI for the 2017 calendar year survey |

| |period. |

| |There have been questions asked in prior years. |

| |The proposed TBI questions were suggested by the CDC who plans to use them for other surveys at a national level. |

| |BRFSS TBI Questions Submitted for Consideration |

| |Thinking across your entire life, has a doctor, nurse, or other medical professional ever told you that you had a concussion or |

| |any other type of brain injury caused by a blow to the head? |

| |1. Yes |

| |2. No |

| |97. Don’t Know/Not sure |

| |99. REFUSED |

| |A concussion has occurred anytime a blow to the head caused you to have one or more symptoms, whether just momentarily or lasting|

| |a while. Symptoms include: blurred or double vision, seeing stars, sensitivity to light or noise, headaches, dizziness or balance|

| |problems, nausea, vomiting, trouble sleeping, fatigue, confusion, difficulty remembering, difficulty concentrating, or being |

| |knocked out. |

| |In your lifetime, do you believe that you have ever had a concussion or other type of brain injury other than those diagnosed by |

| |a medical professional? |

| |1. YES |

| |2. NO |

| |97. DON’T KNOW/NOT SURE |

| |99. REFUSED |

| |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). |

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

| |Source of data will 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). |

| |CDC supplied list of diagnosis codes that correspond to TBI (ICD-9-CM and ICD-10-CM). |

| |ICD-10-CM code list is provisional so we will look at results for ICD-9 and ICD-10 both separately and combined.   |

| |Some of the LME/MCO’s will also be conducting claims data analysis. |

| |In the process of updating the 2010 NC TBI State Action Plan with Council subgroup and other stakeholders. |

| |Have held two meetings so far. |

| |The plan will have three to five overall goals with corresponding objectives. |

| |Council will review the final draft. Then it will be submitted to upper management at DMH/DD/SAS for final review/approval. |

| |The plan will be reviewed annually with possible updates/changes made. |

| |The plan will be formally updated every five years. |

| |Online training module development |

| |Goal is to create online training modules for professionals, family members and individuals with TBI across the State (online |

| |training resource library). |

| |Offer Continuing Education Credits (CE’s) for professionals when they complete each training module. |

| |Met with representatives from Michigan to discuss potential and logistics for tailoring their current online training modules for|

| |North Carolina. Michigan Online training includes: |

| |TBI and Public Services |

| |Pediatric TBI |

| |Cognitive and Behavioral Consequences of TBI in Adults |

| |TBI and Substance Use |

| |Discussions have occurred regarding the TBI and professionals module we will be developing as part of ACL grant. |

| |Meeting with AHEC and discussions with BIANC continue to occur on |

| |where to host the modules, who will be responsible for administering the CE’s and other related topics. |

| |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. |

| |A TBI specific MFP workgroup meets almost monthly. 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. |

| |Surveys are being sent out to providers and individuals with TBI/family members to get feedback on knowledge about TBI, current |

| |service processes and service access challenges. |

| |TBI Waiver |

| |Meetings with DMA and Alliance weekly to discuss TBI waiver preparation and roll-out logistics. |

| |Meetings 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. |

|Conclusions |Questions/Comments: |

| | |

| |There were questions regarding the TBI eligibility criteria. Vicki Smith asked that historical information about eligibility for|

| |services be made available to the TBI Specialist – wants the council to put something in place so that this information is |

| |available to whomever is in the TBI Specialist position. Also, recommended that this information be stored in a central location|

| |for easy access. This information should be available not only to the TBI Specialist but also to the Brain Injury Advisory |

| |Council. |

| | |

| |Need to make sure there are strategies in place to make sure all LME/MCO allocated money is spent. |

| | |

| |TBI Waiver – people who can’t get services. Has it been noted somewhere - the services that are needed and where the people are|

| |who need the services? |

| | |

| |Any State restrictions on grant – regarding reallocating money? |

| | |

| |What about individuals on the waitlist – LME/MCO – will these individuals be served? |

| | |

| |Accurate data/TBI Screening – new individuals who call in – what about individuals who are already in the system – make sure |

| |individuals are not counted twice or many times. |

| | |

| |Adhoc Committee – to look at issues (money not spent) (LME/MCO not screening) (should the screening be required) leaving money on|

| |table – figure out why. |

| | |

| |Motion – Vicki Smith – This Council should recommend that the money from the waiver be allocated for TBI Screening and be part of|

| |their contract. To be addressed by the Adhoc Committee (Adhoc Committee to be formed) |

| | |

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

|At next BIAC meeting – will be discussing the TBI State Plan; the Bylaws; the Statutes; and what this |Holly Heath-Shepard |12/7/16 |

|Council wants to recommend to the legislators (LME/MCO). Specific goals, and what this Council should be | | |

|working towards. | | |

| | | |

|Form Adhoc Committee by the end of this meeting (9/7/16). |Holly Heath-Shepard |9/7/16 |

3. Agenda topic: TBI Waiver Rollout; Medicaid Reform vs. Medicaid Expansion vs. TBI Waiver; CAP C Waitlist Kenneth Bausell

|Discussion |CapC Waiver/Waitlist – For children who are medically fragile and under 21 years of age. Fiver year waiver from July 1, 2010 – |

| |June 30, 2015. CMS granted DMA a temporary extension to allow waiver recipients to continue receiving services without |

| |interruption while DMA works to amend the waiver for another five years. The extension allows DMA to continue administering the |

| |CAP/C program using the projections and regulations approved in the fifth year of the five-year waiver cycle. During the waiver |

| |extension, utilization limits, such as unduplicated participant count and limits on vehicle and home modification must be |

| |followed. An analysis conducted by DMA confirmed the number of waiver participants currently served exceeded the 2010-2015 |

| |projected unduplicated participant count in the CAP/C waiver. Therefore, a temporary statewide waitlist for individuals seeking |

| |approval to participate in the CAP/C program was implemented. The waitlist became effective August 15, 2016. Individuals |

| |applying for CAP/C services on or after August 15, 2016 will be placed on a statewide waitlist if the referral and level of care |

| |requirements are met. DMA will make an announcement with instructions when the statewide waitlist is lifted. DMA has several |

| |ways to share comments and recommendations: One-one meetings; listening sessions; webinars; and work group meetings. |

| | |

| |Medicaid Reform vs. Medicaid Expansion vs. TBI Waiver |

| |Medicaid Reform – In September, 2015 the NC General Assembly enacted legislation for historic reform of its Medicaid Program. |

| |Medicaid is a state and federal program providing medical coverage for low-income and disabled citizens. Seeks to transform and |

| |reorganize NC’s Medicaid and NC Health Choice programs. Bings innovation and new tools into the health system to ensure the |

| |system puts people first, and rewards health plans and providers for making beneficiaries healthier while containing costs. |

| | |

| |Medicaid Expansion – Federal initiative that NC chose not to opt into. NC remains one of 19 states that have thus far declined |

| |to expand Medicaid, which was allowed for under the Affordable Care Act. This expansion would extend health coverage to |

| |individuals at or below 138 percent federal poverty level, which is an annual income of $16,394 for an individual and $33,534 for|

| |a family of four in 2016. In NC, Medicaid remains the same. |

| | |

| |TBI Waiver – 1915 (b) – Waiver; 1915 (c) – Innovation Waiver; 1915 (c) – NC TBI Waiver. TBI Waiver will be administered by the |

| |LME/MCO’s. The TBI Waiver is designed to provide an array of community-based services and community alternatives for individuals|

| |with TBI who are currently in nursing facilities or specialty rehabilitation hospitals or who are in the community and at risk |

| |for placement in nursing facilities or specialized rehabilitation hospitals. The waiver is designed to provide an array of |

| |community-based rehabilitative services and supports that facilitates recovery and promotes choice, independence, and community |

| |involvement. These services provide a community-based alternative to institutional care for persons who continue to require |

| |Neuro-Behavioral level of care or require a Skilled Nursing Facility (SNF) level of care. |

| | |

| |TBI Waiver Update/Rollout – Meeting with DMA and Alliance weekly for preparation of rollout. We know that the definitions and |

| |general structure will remain the same. CMS has reviewed and are generally happy with basic services. May look a little |

| |different as far as specialized services. |

|Conclusions |N/A |

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

|N/A | | |

4. Agenda topic: House Bill that Creates a Demonstration P&A for Veterans Vicki Smith

|Discussion |H.R. 5128 – 114th Congress (2015-2016) |

| |Introduced in House (04/29/2016) |

| |Protection and Advocacy for Veterans Act |

| |This bill directs the Department of Veterans Affairs (VA) to establish a five-year grant program to improve the monitoring of VA |

| |mental health and substance abuse treatment programs. |

| | |

| |The VA shall award a grant to four protection and advocacy systems under which each recipient shall investigate and monitor VA |

| |facilities care and treatment of veterans with mental illness or substance abuse issues. Criteria for selecting recipients shall |

| |include whether the state in which the protection and advocacy system operates has low mental health, performance, and access |

| |scores. |

| | |

| |During each year in which a protection and advocacy system carries out a demonstration project, the VA shall award a joint grant |

| |to a national organization with extensive knowledge of the protection and advocacy system and a veterans service organization to:|

| |(1) coordinate training and technical assistance, and (2) provide for related data collection, reporting, and analysis. |

| | |

| |"Protection and advocacy system" means the state-established system to protect and advocate the rights of persons with |

| |developmental disabilities. |

|Conclusions |N/A |

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

|N/A | | |

5. Agenda topic: “Their War Came Home” Marilyn Lash

|Discussion |Ms. Lash gave an overview of the video and then presented the Video – “Their War Came Home” to group. Transitioning from military to|

| |civilian life can mean searching for a new identity. Who am I now? This video was developed to help veterans and their families |

| |recognize and understand the invisible wounds of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). This |

| |50-minute documentary produced by Korean and Vietnam veterans Norm Seider, Carl Ohlson, and John Drinkard features the voices of |

| |veterans who have returned home from the wars in Iraq and Afghanistan. View for free at watch?v;BKCmu7nsp5Y. |

| | |

| |Interviews showed how the use of alcohol, illegal drugs, and prescription meds numb and calm the anxiety, hypervigilance, and |

| |flashbacks that are symptoms of PTSD. PTSD can lead to downward spiral of depression, isolation, homelessness, and suicide. Often |

| |coupled with TBI resulting in memory loss, changed thinking, and explosive anger, their combined effects are “the perfect storm” |

| |making it difficult to navigate daily life. Asking for help and seeking treatment can be hard because, “no one wants to admit they |

| |have a problem.” Various choices of treatment and methods of healing are described by veterans, social workers, and counselors – all|

| |searching for a “new normal” after the devastation of war. |

| | |

| |The impact of war spreads to the family. The effects of secondary traumatic stress or compassion fatigue can directly affect the |

| |physical and emotional health of caregivers. A spouse reveals, “we walked on eggshells 24/7. There were times we did not feel |

| |safe.” The emotional pain of what is unfolding on the home front can lead spouses to ask, “what’s happening to me? Am I crazy?” |

| |Those who love and live with someone who has been traumatized can’t help but be affected by it. The process of getting to know this |

| |“new person” who has come home from war while saying goodbye to the old person is what is called “living grief” and can be confusing |

| |because there is no end to it. |

| | |

|Conclusions |To watch “Their War Came Home” on YouTube – watch?v:BKCmu7nsp5Y |

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

|N/A |N/A |N/A |

6. Agenda topic: Overview of VA’s Pilot project/funding treatment for Veterans; Outcome data using the Mayo Portland Jerry Villemain

|Discussion |Veterans Healthcare Administration Assisted Living Pilot Program for Veterans with TBI |

| |The Veterans Administration has made available, a “pilot program” to determine how the VA may have a relationship with private |

| |providers to fund the provision of private (non VA or DoD) community based TBI supports and services. |

| |Congressionally mandated. |

| |There will be a report back to Congress at the conclusion of the Pilot. |

| |NeuroRestorative is one of 21 “contracted providers” |

| |Admission Criteria: |

| |To be eligible for the program, the Veteran |

| |must be enrolled in the patient enrollment system of the Department of Veterans Affairs |

| |must have received hospital care or medical services provided by the VA for a Traumatic Brain Injury |

| |must be unable to manage routine activities of daily living without supervision and assistance |

| |can reasonably be expected to receive ongoing services after the end of the pilot program under this section under another |

| |program of the Federal Government or through other means, as determined by the Secretary. |

| |Must be approved for participation by the Pilot |

| |Program |

| |Ineligibility of Veteran: |

| |A Veteran is ineligible for the program if s/he: |

| |Requires 24 hour nursing care |

| |Is suicidal |

| |Is homicidal |

| |Is a “chronic eloper” |

| |Is actively using drugs or alcohol |

| |Has been charged with a violent crime |

| |Provision of Services |

| |The local Veterans Administration remains the primary provider. |

| |Each participant will continue to have an active VA Case Manager who remains active in the member’s coordination of supports and |

| |services. |

| |The VA Case Manager is an active member of the rehabilitation team, together with the individual, the family and the contracted |

| |provider |

| |The VA Case Manager receives all communication regarding the Veteran’s progress |

| |The VA Case Manager will receive at least monthly reports of progress including measurable goals |

| |Recommended Plan of Care |

| |A Recommended Plan of Care due to VA Case Manager not more than 10 calendar days following referral. |

| |Requires determination of a CLIN No. (level of service we recommend) and approval of the CLIN No. by the referring VA |

| |Levels of Care |

| |0001AA – At least 6 documented hours (i.e. frequency, type, intensity of services) of therapeutic intervention per day with |

| |specific community reintegration goals; must include a minimum of 3 hours of individual therapy interventions, as approved by VA.|

| | |

| |0001AB - At least 4 documented hours (i.e., frequency, type, intensity of services) of therapeutic intervention per day with |

| |specific community reintegration goals; must include a minimum of 2 hours of individual therapy interventions, as approved by VA.|

| | |

| |0001AC - At least 2 documented hours (i.e., frequency, type, intensity of services) of therapeutic intervention per day with |

| |specific community reintegration goals, as approved by VA. |

| | |

| |0002 – Bed hold services |

| | |

| |Mayo-Portland Adaptability Inventory – 4 (to be completed by staff or professional) |

| |Deliverables |

| |Full range of rehabilitation Services as Indicated by the ICP: |

| |PT, OT, ST, Nursing, Social Work, Case Management |

| |Psychology/ NeuroPsychology if requires counseling for PTSD or other combat related stress disorders |

| |Cognitive Therapy |

| |Medication Management |

| |Behavioral Management |

| |Independent Living Skills |

| |Vocational Counseling |

| |Social and Recreational Activities |

| |24 hour security and staff availability |

| |Transportation with Attended Services to appointments and community activity |

| |Cable, computer and internet services available |

| |Access to gym and exercise facilities |

| |Family support services |

| |All DME provided by VA |

| |All Primary Care provided by VA |

| |All prescription medication provided by VA |

| |(note – med changes which require a new Rx may take up to two weeks to process. If an immediate med change is necessary, NR |

| |assumes the responsibility for cost for supplying until the VA is able to process the new Rx request.) |

|Conclusions |N/A |

| | |

| | |

| | |

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

|N/A |N/A |N/A |

7. Agenda topic: Recovery Communities of North Carolina – Reducing the Stigma and Treating the Soil

Donald McDonald

|Discussion |Mr. McDonald, who is the Director of Programs and Services talked about Recovery Communities for NC, which promotes addiction |

| |recovery, wellness, and citizenship through advocacy, education, and support. He talked about addiction as a chronic illness |

| |(comparable to hypertension, asthma, and diabetes) and discussed causes and treatment for each. Discussed and defined stigma and|

| |also talked about internalized stigma. Talked about public perception of addiction (junkies, lushes, crack heads; treatment |

| |doesn’t work; and self-inflicted). |

| |Vision |

| |NC promotes a culture that supports addiction recovery for individuals, families, and communities. |

| |North Carolinians seeking addiction recovery have access to the highest quality care, services, and supports. |

| |North Carolinians in addiction recovery are equal and valued members of our State. |

| |North Carolinians in addiction recovery have opportunities to achieve their fullest educational, occupational, and civic |

| |potential. |

| |Recovery from addiction is a celebrated reality. |

| |Advocacy Events |

| |Capital Area Rally for Recovery |

| |Community Recovery Advocacy Day |

| |Access to Recovery |

| |What is ATR? |

| |NC Access to Recovery (NCATR) is a voucher program that extends the current array of services and availability of providers in |

| |the State by providing recovery support services through the use of grant funds so participants can choose their services and |

| |providers freely and independently. |

| |Recovery Support Services |

| |Life Skills Coaching, Employment Services, and Job Training |

| |Peer-to-peer services and Recovery Coaching |

| |Fun & Healthy Sober Living Activities |

| |Spiritual Counseling or Counseling offered by American Indian Tribes |

| |Transportation (Bus/Gas Cards) |

| |Nutritional Counseling |

| |ATR Eligibility |

| |In order to participate in this program, individuals must meet the following requirements: |

| |Be at least 18 years old |

| |Live in Wake, Orange, or Robeson County |

| |Have an annual income of less than $23,500 |

| |Have a current substance use disorder or have been diagnosed with one in the past 12 months |

| |Seeking support for your recovery from addiction to alcohol and/or other drugs |

| |Willing to meet with a NC ATR services staff or authorized provider for an intake interview, create a recovery plan, select up to|

| |three support options, and continue on your path furthering your recovery |

| |Recovery Community Center – You are in the right place. You are with others like yourself. We understand you and the world you |

| |come from. We accept who you are and who you can become. This is a place where magic (change) can happen. |

|Conclusions |For more information contact: |

| |Donald McDonald, MSW, LCAS |

| |Director of Programs and Services |

| |dmcdonald@ |

| |919-231-0248 ext. 105 |

| | |

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

|N/A |N/A |N/A |

8. Agenda topic: Committee Updates

|Discussion |Children & Youth Committee | |

| |Brochure – Return to Learn – Speaking at several conferences – article in | |

| |pediatric medical journal – goal to get information out to medical providers | |

| | | |

| |Health Services Committee | |

| |Met 35 times last year – licensure rules for specific TBI programs – right now | |

| |no decision – meeting set up for 9/22/16 to review this issue. | |

| | | |

| |Legislative Committee | |

| |Post session just setting up committees. Suggesting to Legislative Oversight | |

| |Committee a presentation on status of waiver and request a presentation on the| |

| |scope of available services for persons with TBI to include group homes, | |

| |treatment centers, providers availability and current rules– monitoring | |

| |progress of waiver – Medicaid reform – public safety. Want to stay in their | |

| |minds – we want them to know the issues persons with TBI and families are | |

| |confronting. | |

| | | |

| |Veterans Committee | |

| |Looking for a Chair for the Veterans Committee. | |

|Conclusions | | |

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

| | | | |

9. Agenda topic: Adhoc Committee (Added to Agenda)

|Discussion |Adhoc Committee was formed to look at the TBI State Plan; the Bylaws; the Statutes; and what this Council wants to recommend to |

| |the legislators regarding the TBI screening process at the LME/MCO’s. Also, committee will recommend specific goals for the |

| |Council. Holly asked for volunteers from the Council members. The following will be on the committee: Carol Ornitz, Ken Jones,|

| |Jan White, and Holly Heath-Shepard. Holly will chair this committee. |

| |Health Services Committee, along with Scott Pokorny and Kenneth Bausell to evaluate data and how it should be broken down. |

|Conclusions |Adhoc committee to review issues regarding the TBI screening process, LME/MCO requirements, etc. |

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

|Adhoc Committee and Health Services Committee to present findings/recommendations to BIAC at next meeting. |Adhoc Committee |12/716 |

Ms. Heath-Shepard thanked everyone for their participation. There being no further business, the meeting was adjourned at 3:47 p.m. Respectfully submitted: Sandy Pendergraft, Scott Pokorny, and Travis Williams.

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