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					                     HAMMOND COMMISSION ON
               COMMUNITY SERVICES AND IN-PATIENT CARE
                           MARCH 4, 1999

The Hammond Commission on Community Services and In-Patient Care met on
Thursday, March 4, 1999, in Lower Level Training Rooms 1 and 2 of the Theatre Row
Building, 730 East Broad Street, Richmond, Virginia. The meeting was called to order by
the Chairman, Catherine Hammond, at 10:15 A.M. Mrs. Hammond welcomed everyone
and asked Richard Kellogg, Commissioner of the Department of Mental Health, Mental
Retardation, and Substance Abuse Services, to introduce the Department’s new Deputy
Commissioner, Cathleen J. Newbanks.

Mrs. Hammond announced that Governor Gilmore has appointed Dr. Anita Everett,
formerly a consulting psychiatrist to the Commission, to the position of Inspector
General, and that Virginia Pomata, Commission member, had been appointed Chairman
of the Alzheimer’s Commission. She also announced that Jim Martinez, Director of
Mental Health Services, would replace Dr. Larry Latham as Department liaison to the
Client Services Committee. Dr. Latham is the new Director of Central State Hospital.
Mrs. Hammond noted that the Virginia Alliance for the Mentally Ill honored the
Governor on February 11 at the Jefferson Hotel with a dinner and tribute.

MEMBERS PRESENT:
    Mrs. Catherine Hammond                          Mrs. Angela Gregory
    Mr. Henry Altice                                The Honorable Franklin P. Hall
    Mr. Raymond F. Burmester                        The Honorable Emmett W. Hanger
    The Honorable Thelma D. Drake                   The Reverend David Martin
    Ms Vicky Fisher                                 Mrs. Virginia Pomata
    Mr. Beverly Fleming                             Mr. James Stewart
    Mrs. Olivia Garland                             Mr. Anthony Vadella

MEMBERS ABSENT:
    The Honorable Vincent F. Callahan, Jr.          The Honorable Stephen H. Martin
    Mr. David Carter                                Dr. Louis F. Rossiter
    The Honorable Charles J. Colgan

There were no public comments offered.

The minutes of the November 30, 1998 Commission meeting were adopted on a motion
by David Martin.

Report on the General Assembly Session:
Mrs. Hammond reported on the recent General Assembly session, and thanked the
legislators for their support of the Commission bills, especially Senators Hanger and
Martin. There were many bills passed that will affect the publicly funded system, such as
mental health parity and a revised human rights Protection and Advocacy agency. Copies
of the bills recommended by the Commission, summaries of the bills that the
DMHMRSAS followed, and budget information were distributed and are filed with these
minutes.

The three bills recommended by the Commission were successful and will further the
principles and goals adopted by the Commission. SB 1054 will require state facilities to
report data to Virginia Health Information and will assist the POMS project to obtain
needed data. SB 1055 provides that new facility directors will be employed under
flexible contracts that specify their terms and conditions of employment and will be
exempt from the Virginia Personnel Act. SB 1302 provides that, in grievances arising out
of DMHMRSAS which challenge allegations of patient abuse, the employer will be able
to appeal to DERC. The Director of DERC shall determine whether the decision is
consistent with law.

Mrs. Hammond thanked Delegate Hall for his work on the House Appropriations
Committee and the generous increase that the General Assembly provided for mental
health, mental retardation, and substance abuse services. All of the Commission’s
December 1998 recommendations for additional staff and programs were included in the
budget.

Mr. Kellogg reported that the appropriations for community funding increased by
$82,200,000. Including federal participation, this is a 35% increase, an historic amount.
He said that it is exciting and presents a challenge to insure that the money is spent
appropriately. Approximately 64% of the increase will go to consumers in communities.
Some of the additional funds will go toward new medications, PACT teams, MR
community waiting lists, more community placements, supported employment, addiction
services, and MH services for children.

Presentation: Managed Systems of Care: The Massachusetts Experience by Marylou
Sudders, Commissioner, Massachusetts Department of Mental Health.
Ms Sudders explained the agency roles and responsibilities for the Massachusetts Mental
Health Department and the Department for Medical Assistance, the state designated
Medicaid agency. The public behavioral health program was implemented in 1992
pursuant to a 1915B Waiver, and in 1996, the DMH entered into a joint agreement with
DMA to provide a single system of high quality, publicly funded mental health services.

Ms Sudders emphasized the importance of stakeholder involvement. The Massachusetts
system is continuing to evolve, with additional challenges and continuing concerns.
Performance standards are reviewed annually with the goals of improving member
experience, strengthening service coordination and delivery, and increasing provider
skills and building the network. Financial incentives for providers are included in the
contracting.

Ms Sudders had been the director of a Massachusetts state hospital and she oversaw the
closure. She said that the savings realized were directed to the community in clinical
services and residential support. Employees were offered the following choices: a
transfer with patients to another hospital to provide a continuity of care and employment;
a buyout package if they remained through the closing; or a program for retraining or
tuition reimbursement. A copy of Ms Sudders’ outline is attached to these minutes.

Presentation: Maryland’s Public Mental Health System, by Marilyn Martin, M.D.,
Medical Director, Maryland Health Partners.
Dr. Martin explained the roles of the Mental Hygiene Administration (MHA), Maryland’s
state government division responsible for the mental health system; the Core Service
Agencies (CSA), the county based agencies responsible for community services, and
Maryland Health Partners, a division of Magellan Behavioral Health (MBHO).

In 1997 Medicaid and MHA merged funds to provide, in conjunction with the CSA, a
mental health services system, according to a common set of principles and guidelines.
Maryland Health Partners won the contract to manage this statewide system. Consumer
needs were a primary concern. A survey conducted last year indicated that consumers
were satisfied overall with the system. A similar survey of provider satisfaction is
currently underway.

Dr. Martin stressed the importance of establishing a strong team to develop the system
model, and to provide for flexibility as the system evolves. She helped to identify some
of the potential problem areas that may need to be avoided or resolved. Funding for
substance abuse services has been a difficult issue in Maryland. A copy of Dr. Martin’s
outline is attached to these minutes.

Presentation: Values-Based Managed Care: Oxymoron? By Behavioral Health
Partners, Inc: Bob Climko, M. D., Jim Eyler, and Greg Schmieg.
Behavioral Health Partners is a subsidiary of PROMINA DeKalb Regional Healthcare
System in Atlanta, Georgia and was founded in 1987 as a behavioral health consulting
firm. BHP currently provides managed healthcare services and information systems as
well as consulting.

The Georgia MHMRSA Division is one of their clients. They explained how the mental
health system is organized in Georgia with regional boards. Some features of managed
care have been adopted, however Medicaid and MHMRSA have not merged funds for
service delivery. One hospital and one mental retardation institution have been closed.

They presented suggestions on how to apply each of the guiding principles adopted by the
Commission to a managed care technology. The following simplified evaluation formula
was offered: clinical outcome times consumer satisfaction over cost. A copy of BHP’ s
outline is attached to these minutes.

Work Plans:
Mrs. Hammond announced that the Executive Committee would meet within the next
three weeks and that written work plans with specific goals will be prepared for each
committee and forwarded to Commission members. Members were encouraged to
contact their committee chairmen if they have issues that they want to address.

Mrs. Hammond identified subjects/tasks for each committee. She asked that the
Management and Operations Committee address several topics: facility information, such
as cost per patient per day and how it compares to the private sector; personnel options
for employees who may be involved in facility smartsizing; and assistance with the
Department’s reporting duty to VHI.

She asked that the Client Services Committee address substance abuse issues and develop
a set of quality indicators for desired outcomes of services. She asked that the Public
Policy Committee concentrate on Medicaid policy, MR waiver revision, and eligibility
issues or standardized access.

The next Commission meeting will be in Roanoke and will center on substance
abuse/addiction services. Mrs. Hammond would like to have members of the
Commission visit Maryland and Massachusetts to continue analysis of managed care by
meeting with providers and consumers.

Mrs. Hammond thanked Senator Hanger for his efforts in introducing two senate
resolutions to continue the work that J&E and the Joint Subcommittee began in
envisioning how the state system should be configured, including optimum number of
state facilities, locations, and services. She stated that she is optimistic that, with the
current leadership in the Executive and Legislative Branches, a solution can be achieved.

Mrs. Hammond thanked Mr. Kellogg and the DMHMRSAS staff especially for their
ongoing support, and the outstanding assistance provided by Julie Stanley and Fran
Sadler.

The meeting was adjourned at 3:45 P.M.

				
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