Sites.magellanhealth.com



Magellan in Louisiana – Louisiana Behavioral Health Partnership

Governance Board Minutes of September 18, 2013

PRESENT:

|Community Members of Governance Board: |Magellan Members of Governance Board: |

|H. T. “Ted” Cox, Juvenile Court/Shreveport, Community Member at Large |Kathleen Coenson, VP of System Transformation, Magellan in Louisiana |

|Judy Disotell, NAMI, Parent of Child/Youth Receiving Services |Dr. Richard “Dick” Dalton, Chief Medical Officer, Magellan in Louisiana |

|Joan Guillory-Williams – Board Co-Chair, Adult Service Recipient |Shannon Ost, Network Development Administrator, Magellan in Louisiana |

|Kimberlyne Roundtree, | |

|Primary Care Solutions, Inc., Adult and Child/Youth Service Provider | |

|Rick Wheat, Louisiana United Methodist Children and Family Services, Child/Youth | |

|Provider | |

|Staff to Governance Board |

|Jill Dyason, Governance Board Lead, System Development Manager, Magellan in Louisiana |

|Deborah Hernandez, Executive Assistant, Magellan in Louisiana |

|Governance Board Members Present via Conference Phone |

|Lisa Schilling, South Central Louisiana Human Services Authority, LGE |

|ABSENT: |

|Dr. Craig Coenson, Board Chair, Chief Executive Officer, Magellan in Louisiana |

|Neal Cohen, Chief Operating Officer, Magellan in Louisiana |

|Deborah Warren, Interim Quality Management Administrator, Magellan in Louisiana |

|Lisa Faust, Chief of Staff, Magellan in Louisiana |

|Guests: |Amber Disotell, MYLIFE Co-Chair |Neill Rose, Coastal Harbor |

|Chris Boling, Magellan |Michelle Kulpa, Magellan | |

|Wendy Bowlin, Magellan | | |

|Anita Byrne, SSA Consultants | | |

IN SESSION:

This meeting was called to order at 12:00 pm

Board minutes submitted for August 21, 2013

Rick Wheat moved that minutes be approved. Ted Cox seconded the motion. The Board unanimously approved the Minutes.

Board Announcements

•

|BOARD UPDATES |

Developing Therapeutic Group Homes (TGH) Progress/Follow-Up

Shannon Ost, Network Administrator, Magellan in Louisiana updated Board Members on Therapeutic Group Homes progress.

From the service definition manual, a TGH provides a community-based residential service in a home-like setting of no greater than eight beds, under the supervision and program oversight of a psychiatrist or psychologist. Since the beginning of the partnership, the State would like to transfer children from youth residential to a TGH environment.

Despite various group efforts at recruitment, we have only been able to convert one (1) provider including eight (8) beds, who is VOA. No other providers have committed to date in maintaining sustainable operations of a TGH. There has also been an overall shift since this process began in terms of Children’s Residential Care in Louisiana.

• Several Non-Medical Groups Homes have closed or decreased in size due to a lack of census as more options for community-based and other levels of care emerge

• PRTF has also been added to the service array for higher need children with 108 beds and more are on the way.

Ost stated that with these issues it really prompted Magellan to perform an in-depth analysis of model, barriers and options to move forward with the TGH program.

Ost discussed that Magellan has been researching several TGH models in other States (Montana, Nebraska, North Carolina, Florida and Louisiana). She explained that Magellan has conducted a comparative analysis along with hosting NMGH provider forums and statewide agency focus groups to help determine the root cause and identify potential solutions for Louisiana Therapeutic Group Homes in Louisiana. Magellan compared staffing models, bed counts, and rate per diems.

The barriers found were:

• Per diem rate

• Upfront costs

• Bed count

• Occupancy rate used to factor cost

• Number of Evidence Based Practice requirements

• Active treatment hours required

• Timing requirement for Supervisor/Practitioner assessments

• Frequency requirements for on-going psychiatric visits

A comparative analysis regarding rates (Louisiana, Montana, Nebraska, North Carolina and Florida) showed:

Nebraska: All Non-Medical Group Homes transitioned to TGH. Within a year, most were out of business due to the rate per diem. They now have a few specialized TGHs paid at

$247.47/day; Treatment - $158.74 and Room/Board - $88.73 with a range of 4-8 beds.

Montana: Rate - $243.98 Treatment - $183.98 Room/Board - $60.00 Max no. of Beds - 8

North Carolina: Rate - $275.88 Treatment - $232.88 Room/Board - $43.00 Max no. of Beds - 4

Florida: Rate - $340.00 Treatment - $180.00 Room/Board - $160.00 Max no. of Beds - 12

Louisiana: Rate - $228.69 Treatment - $143.99 Room/Board - $84.70 Max no. of Beds - 8

Ost gave a comparative analysis on staffing ratio and the programs and staffing patterns for each state as well.

Ost stated that Magellan has developed a proposal of the model for TGHs to be successful in Louisiana. The recommendations to move towards a more sustainable and programmatic model for Louisiana are:

|Challenge |Proposal Solution |Rationale |

|2 EBP’s required |Reduce the mandated EBP’s to 1 |The cost of training staff on 2 EBPs and monitoring the fidelity of 2 EBPs is a burden for providers |

|Number of active |Reduce the number of active |A typical schedule in a child’s life makes this requirement for “active treatment” as allowable by Medicaid |

|treatment hours |treatment hours from 21 to 14 or |unrealistic. Between school, travel, homework, meals, recreation and healthy sleep time there are not enough |

| |16 to account for the hours of |hours available to meet the 21-hour requirement for “active treatment” as currently defined. |

| |treatment required | |

|24 hour assessment|Increase the timeframe for initial|Higher level of care such as hospitalizations require an initial assessment within 72 hours of admit. It would |

|by a SP prior to |assessment of SP from 24 hours to |provide for standardization across levels of care to allow the TGH to provide an initial diagnostic assessment |

|admission and |72 hours |within 72 hours of admit or use a psychiatric evaluation from a hospital if completed within 30 days of admit to|

|service delivery | |TGH, while still ensuring the child’s assessment is valid toward the treatment plan. |

|SP must assess |Reduce psychiatric visits from |This standard can be burdensome given schedules and costs of psychiatrists. This recommendation is in line with|

|every 14 days |1:14 days to 1:month or 1:28 days |several other states. |

|Rate |Increase rate to the $270 to $290 |Even with programmatic changes, we do not believe any rate below $270 is sustainable. The costs simply outweigh|

| |range; with increases in both |the potential reimbursement. The state should reconsider its calculations based on the more standard 80% |

| |treatment and room/board |occupancy rate rather than the current 95%. |

|Bed Size |Increase the maximum bed size to |Florida was one of the states where we found a successful and apparently sustainable model and it includes the |

| |12 |12-bed maximum. |

|Up Front Costs |Include upfront costs in the per |Staffing Costs (MD/MP, RN, LMHP and 2 minimum on duty), active treatment, EBP and accreditation - These costs |

| |diem rate or provide a “ramp up” |are required upfront, are part of licensing and present barriers to all providers, NMGH or new. |

| |rate for providers. Also, | |

| |consider a transition process for | |

| |NMGHs to fund them at TGH rates | |

| |during transitioning to TGH. | |

Ost concluded that TGH is a difficult level of care to build and sustain as evidenced by other states’ struggles. The rates are a most critical piece of the puzzle. Certain program changes should be made regardless of other changes and sustainability is the key. Magellan presented the findings to the state (DCFS, OJJ and OBH) and they are taking the findings to Medicaid to consider the purpose of the TGH level of care and its long-term impact on the system of care.

Rick Wheat stated that this level of care (Therapeutic Group Home) is what Louisiana needs. He confirmed that there is a gap with stepping out of the PTRF into a Non-Medical Group Home. He stated that whether we are able to achieve this or a more intensive Therapeutic Foster Care system (limited beds) across the state, we need to close this gap and the shelter care gap as well.

Accreditation Discussion Follow-Up

Michelle Kulpa, Network Supervisor, Magellan of Louisiana gave a follow-up on the accreditation discussion from the August Governance Board Meeting.

There were six (6) hospitals currently identified as being not accredited. There were questions from the last Board Meeting on how many beds this represents. The Board came to an agreement that these hospitals did not require accreditation.

Kulpa spoke on accreditation as a whole for the system to answer the questions that Board Members had from the last meeting.

Accreditation is part of Magellan’s credentialing process. If providers are not accredited, Magellan conducts a site visit to the provider. Magellan currently contracts with 652 organizations (facilities, agencies, hospitals, and FQHC’s) and 308 providers are currently accredited in the overall Louisiana network.

The requirement for accreditation comes from the State. The State asks that providers providing PTRF, TGH, CPST, PSR, Crisis Intervention, and Substance Residential be accredited. The State also does certification around providers, which is another piece of credentialing. When they certify providers, they ask if they are accredited and if not, this is the time to prove that they can provide the services and then have 18 months to obtain the accreditation.

Magellan’s Network Team monitors the accreditation process for these providers. Of the 652 organizations, 419 providers fall into the category requiring accreditation or are in the process of obtaining accreditation. As of today, out of the 419 providers, 256 providers are accredited and 154 providers are in the process. Currently we have nine providers that are concerned about the financial burden of obtaining accreditation. We currently have ten (10) providers who are at the 18 months and are not accredited.

Kulpa stated that she has had discussions with Rusty Siemens, OBH who stated that the re-certification period is July 1 – September 30. She went on that he confirmed that OBH has not declined anyone’s re-certification. As long as the provider is providing proof of working toward obtaining accreditation to OBH, they are moving forward with certification.

Lisa Schilling stated that it was known from the partnership’s beginning that once a partner contracted with Magellan the eighteen months began for becoming accredited.

Kulpa did state that there have been some communication issues around the 18- month timeline and Magellan’s intention is to send out a notification to providers on the guidelines as soon as approval is obtained. Some confusion was around when the 18 months started-the March 1 date when the State signed with Magellan or the date when the specific provider joined the Network. Kulpa’s understanding is that when the provider joins the Network the 18-month timeline begins.

There are 10 providers as of today who were contracted on March 1, 2012 that have not yet met their accreditation and Kulpa provided the details of what their barriers are. She also stated that Magellan will continue to monitor them on their progress on a monthly basis and follow-up on a continuous basis with them as well.

Independent Assessment RFI Follow-up

Shannon Ost provided a follow-up in regards to the Independent Assessment RFI, part of the 1915i Waiver, that was introduced to Board Members last month by Lisa Faust.

A draft of the Independent Assessment RFI was sent to the State for review and was sent back to Magellan with questions. Magellan will compile the answers later this week and then send it back to the State for final approval. Once the State approval is received, Magellan will post the Independent Assessment RFI that will have a 30-day required response. There will be a two-week question/answer period within the 30-day posting.

Permanent Supportive Housing (PSH) Update

Kathy Coenson introduced Chris Boling who recently joined the System Transformation Team with Magellan as the Adult Administrator coming from the Clinical Team. He is responsible for managing all services under the Adult 1915i redesign as well as Permanent Support Housing (PSH).

Boling gave a brief re-orientation of the PSH program initiative. PSH is a program designed to connect the homeless with housing and the supportive services needed to allow them the success to stay in the community. He explained that PSH consists of two pieces, which are housing via vouchers to help pay rent and provide supportive services via home and community based care.

This program currently focuses on the Gulf Opportunity (GO) Zone, which includes the New Orleans, Baton Rouge, Lafayette, and Lake Charles areas. It includes 3,300 units, but approximately 25% are not in use at the present time. Currently, the program is funded entirely from Community Development Block Grant funding (CDBG) that passes through HUD.

The sustainability plan requires shifting most of the program’s cost to Medicaid or State Waivers allowing for sustainability.

Currently, all services to PSH members are provided through the CDBG funding. The Block Grant money is time limited and quantifiable and is currently due to exhaust in 2015 at the current usage levels. Shifting cost to sustainable sources is required. Sustainable sources include:

• 1915i to pay for HCBS services for eligible Medicaid Adults

• EPSDT to pay for HCBS services for eligible Medicaid Children

• OAAS Waiver to pay for HCBS services for OAAS Adults not funded by 1915i

• OCDD Waiver to pay for HCBS services for eligible Developmental Disabled Members not funded via EPSDT or 1915i

Magellan’s primary role is to coordinate and deliver community outreach and education. As the previous system has not fully utilized all of the available units for permanent supportive housing, this is one area for improvement. The 25% unutilized has impacted the dollars that the CDBG fund receives from HUD.

Effective on October 9, this program will “go live” with Magellan taking lead managing permanent supportive housing. All inbound applications will go through Magellan. We will bring information through Magellan’s Louisiana website and host forums with providers. Magellan will be the single point of entry for PSH.

We will coordinate efforts between the Louisiana Housing Corporation (LHC) and the PSH service providers to assure:

• Accurate waiting lists for available housing

• Timeliness in connecting members selected from waiting lists to available housing

• Coordinating Home and Community Based Services to meet member’s functional needs

• Coordinating annual recertification efforts to prevent lapses in services

• Provide quantifiable data collection and monitoring related to service authorizations, delivery, and efficacy

Quality Improvement Report

Wendy Bowlin, Quality Improvement Manager, Magellan in Louisiana gave the Quality Improvement Report. She reported on two elements of the Quality Program, which were the Performance Guarantees and the Components of the Quality Improvement Committee Meeting, which was held last month.

Performance Guarantees

The performance guarantee report indicated:

• Claims Administration, Magellan is meeting all requirements for the standards and goals

• Financial payment – all goals met in contract

• Telephone responsiveness goals met showing average speed of answer at 29 seconds and call abandonment rate at 4.02%.

• Clinical portion is reported quarterly so new data is not currently available

o Ambulatory follow-up within 7 days of discharge

o Ambulatory follow-up within 30 days of discharge

• Provider and Member Satisfaction Survey is updated annually –

o First year threshold for the provider and member (adult and youth) satisfaction survey was 75% and we achieved that target at 80%

Bowlin gave an overview of the QI August Committee Meeting where sub-committees reports are given. She explained that the meeting is held on a monthly basis and stated that Dr. Dick Dalton is the Chairman.

The Utilization Committee reported that there has been improvement towards re-admission rates. The committee has been monitoring and identifying high utilizers in an effort to decrease the readmission rates. The committee also reported on Coordination of Care referrals. Bowlin explained that we have developed a process coordinating with the Bayou Health Plans to assure accurate referrals between Magellan and Bayou Health assuring that members are covered appropriately for physical and psychiatric care.

The Member Service Committee and the Regional Credentialing Committee did not present reports, but will within this quarter.

The Network Strategy Committee reported that they are in the transitioning phase of the Non-Medical Group Homes.

The Race and Equity Committee reported that they are conducting a survey by outreaching to community providers on their cultural awareness. There are no results yet from this survey as still in process.

The Family/Member/Stakeholder Advisory Committee reported that they have not met in several months. The committee is being re-tooled and has been challenged. The next meeting will be held on September 27.

The Interagency Monitoring Team (IMT) reported that we are on track with contract deliverables.

The Quality Improvement Department has submitted the URAC accreditation application, which consists of two parts.

• Desktop – submit all documentation for review on August 8 and then URAC conducts an on-site audit scheduled for November 7.

Bowlin reviewed the Treatment Record Review process that the department is conducting. The quality team identifies high utilizers (anyone with 25 authorizations for service) and monitors those members. The first year, beginning in July, was intended for reviewing IP, Residential Substance Abuse, WAAs, and outpatient facilities. Magellan is looking for any facility with a level of care under 80%.

For IP Level of Care, there were 50 facilities identified with high utilizers and 689 records were reviewed with a rate of compliance of 91.3%. For Residential Substance Abuse, 15 facilities were reviewed with a rate of compliance of 88.4%. There were 250 OP providers identified with high utilizers. Only 29 providers were reviewed before the end of the year with a rate of compliance of 76.1%. The WAA facilities were audited with a score of 89.4%.

Bowlin reviewed the Performance Improvement Plan and explained that this is a way that Magellan can target individual providers for corrective action plan areas that are identified as needing improvement.

• If a score is under 70%, a formal audit is conducted with a corrective action plan. If the correction action plan is not meeting the quality standards, the provider will be referred to RNCC.

• If a score is 70-80%, an informal audit is conducted and the provider is asked to submit a performance improvement plan.

The quality improvement team has restructured the Treatment Record Review Process for Year 2. They have structured a flexible model to mimic a credentialing process to be able to audit each provider within a 3-year scope.

Bowlin gave an update on Complaints/Grievances and Appeals for the month of August.

Reported:

• 20 Complaints and Grievances

• 178 Appeals

• 75 Provider disputes

• 135 Adverse incidents

o 125 with restraints

• 32 Quality of Care issues

|CEO MESSAGE TO THE BOARD |

Kathy Coenson informed the Board that Craig Coenson, CEO, Magellan in Louisiana, would like to present the Magellan Business Review at the October Governance Board Meeting.

Coenson continued by stating that there has been a personnel change in the MY LIFE program. As this position has not yet been filled, Greg Dicharry, National MY LIFE/MY FEST is the interim leader for Magellan and is working along with Danielle Marshall, Family and Youth Coordinator and Maryann Donovan-Mason, Director of Family Involvement. My FEST is scheduled for November 2 and will be a really large event. We are currently in the process of coordinating sponsors and exhibitors, arranging transportation, and recruiting volunteers.

The Youth Blast is a back to school event in St. Landry Parish and will be held on September 20. The Youth Blast will consist of 1,100 seventh graders. Youth Blast stands for Bold Living as Smart Teens. This event has previously been held for eighth graders, but will be hosted for seventh graders this year. They will have a National motivational speaker, Dr. Rani Whitfield and Hollis Conway, the US Olympic high jumper.

Jill Dyason stated that MY FEST Planning Committee members are needed. There are several committees that individuals can sign up for, such as vendors/sponsors that can provide food, drinks, and volunteers. Announcements pertaining to MY FEST will be sent via e-mail blasts statewide and on our website.

Dyason also referenced the Permanent Supportive Housing Provider Re-orientation Meeting announcement in the Board packet. The meetings will be held September 23 at the West Bank Regional Library in Harvey, LA and September 25 at the Lafayette Parish Library Southside Branch in Lafayette, LA. Both dates and locations will have a morning and afternoon meeting opportunities for 9:00 am – 12:30 pm or 1:00 pm to 4:30 pm. She stated that meetings in additional areas will be coming as well.

Dyason discussed the opportunity to combine the November and December Governance Board Meetings due to the holidays and needs consensus from the Board. She explained that the current schedule is for the Board meetings to be held on November 20 and December 18. She continued that last year we combined the two meetings and went to the first Wednesday in December. Dyason asked if there was a consensus to have the combined meeting on Wednesday, December 4. The Governance Board members confirmed that this would be their preference.

|NEW BUSINESS |

▪ None

|PUBLIC COMMENT |

▪ Neill Rose, Coastal Harbor stated that he has been a PRTF provider for 15 years. He explained that Coastal Harbor is a Joint Commissioned, Level 4 PRTF and that they are locked and secured. He stated that he receives calls regarding the high management and hard to place children. He went on to assure that he is very aware that these children are best served within their own community and by local providers. Rose continued by explaining that he believes that there are a few exceptions for children with specific needs and stated that he has worked with 18 states placing some of these children. He explained that he attended the meeting to observe and to meet Dr. Dick Dalton.

|NEXT MEETING |

The next meeting of the Governance Board is Wednesday, October 16, 2013.

|ADJOURN |

Rick Wheat moved to adjourn. Kathy Coenson seconded the motion. The Board voted unanimously to adjourn.

The meeting adjourned at 2:00 pm.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download