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.