Navarro County Texas Legal Forms - DOC

							                             North Texas Behavioral Health Authority
                             Minutes of the Board of Directors Meeting
                            Date of Meeting: June 10, 2009 at 12:00 PM
2009 Attendance                  Jan    Feb      Mar    Apr   May    Jun   Jul    Aug    Sep   Oct   Nov   Dec
Judge Michael Chitty, Chair       X       X       X      X     X      X
Ka ufma n County
Mackie Owens, Vice-Chair          X       X       X      L      X     X
Ellis County
Ryan Brow n, Treasurer            -       X       X      X      X     X
Da llas County
Richard Scotch, PhD, Secretary    X       X       X      X      X     X
Da llas County
Pat Lawson                        X       X       X      X      X     X
Collin County
Susan Miles                       X        -      X      X      X     X
Collin County
Ron Stretcher                     X       X       X      X      X     X
Da llas County
Zachary Thompson                   X       X       X     L     X       -
Da llas County
Matt Wolff                         X       X       X     X     L      X
Hunt County
Commissioner Kit Herrington        X       -       X     X     X       -
Navarro County
Andrew Dillard, M.D.               X       X       X     X     X      X
Rockwa ll County
              Attendance Legend:
              X = Attended monthly BOD meeting.
              L = Late arrival, missed votes to approve minutes and financial reports.



                Item #1
                Call to Order and Declaration of Quorum
                Judge Michael Chitty, Chair:
                Judge Chitty brought the meeting to order at 12:02 p.m. and a
                quorum was declared.
                Attendance included:
                 Board members as noted above.
                 NTBHA staff: Alex Smith, Alice Watson, Brandy Ruckdeschel, Lisa
                   Whaley and Teresa Handel.
                 Approximately 30 visitors and speakers.


                Item #2
                Secretary’s Report
                Richard Scotch, Secretary, reported:
                 Dr. Scotch moved that the May minutes be approved as circulated.
                   This was seconded by Andy Dillard and the motion carried.
NTBHA Board of Directors Meeting                       June 10, 2009   2

Item #3
Finance Committee Report
Ryan Brown, Treasurer, reported:
 Ryan presented the financial report for the eight (8) months ending
   April 30, 2009. Ryan stated that he would be meeting with Alex and
   KJ to discuss any outstanding balance that NTBHA may have at the
   end of the fiscal year. A motion was made by Dr. Scotch to approve
   the financial report, was seconded by Matt Wolff, and the motion
   carried.


Item #4
Public Commentary
 None.


Item #5
Executive Director’s Report
Alex B. Smith, NTBHA’s Executive Director, reported:
 Meetings have been held to discuss how legal fees for indigent
   patients should be handled. A resolution has been proposed which
   would involve declaring Green Oaks Hospital as part of the public
   access for mental health in Dallas County. If passed, legal fees
   would be waived. One suggestion was made that if legal fees were
   assessed, the Dallas County match funds could be used, reducing
   NorthSTAR service funds by $500K-$600K annually.
 Provider contract negotiations continue for a couple of large SPNs.
   A contract for Dallas Metrocare Services is expected to be finalized
   in a couple of weeks.
 NorthSTAR supplemental funding, according to DSHS, may be about
   $5M. VO was expecting $7.2M.
 A presentation was given to Collin County Commissioners last
   month demonstrating a 20% increase in utilization of NorthSTAR
   Services in Collin County between SFY08 and SFY09. Funding by
   the Commissioners to one of the NorthSTAR providers has been
   provided for many years to cover indigent care. Allegedly it is to be
   applied to mental retardation, but there is some concern that it is
   being used for mental health. Collin County may stop that subsidy,
   which would impact NorthSTAR.
NTBHA Board of Directors Meeting                      June 10, 2009   3


Item #6
NorthSTAR Director’s Report
KJ Scheib, DSHS Contract Manager for NorthSTAR, reported:
 The running MLR direct service expenditures and utilization were up
   last month. The most impact is still in increased MH outpatient and
   drug costs.
 The legislature has closed, but a special session is forthcoming. SB1
   passed and awaits Governor Perry’s signature. $400K has already
   been distributed to VO. Medicaid enrollments are up, providing
   more premium dollars. New money includes a $5M supplemental
   award for this contract biennium. DSHS is also able to waive some
   penalty fees and not recoup certain funds from the last contract
   period. Regarding new biennium contract for SFY10 and SFY11, SB1
   will provide additional money in the general revenue fund for the
   whole state and DSHS anticipates just under $9M for NorthSTAR to
   provide transitional and ongoing services. New Medicaid premiums
   are expected to provide an increase of $2M-$4M across the next
   biennium period. Crisis redesign funding will remain the same.
   There may be some increase in TCOOMMI funding, but will be
   allocated to increase specific services. Potential loss of Dallas
   County match funds is approximately $400K per year or $800 over
   the next biennium contract period. Rider 37 (aka SB1 Rider 35) is
   expected to allow excess SGA funds to be reinvested in direct
   services as long as no SGA wait list exists.


Item #7
Behavioral Health Organization Report
Jack   Szczepanowski,    Vice   President    of   ValueOptions’
NorthSTAR Program reported:
Jack Szczepanowski was not present, but two of his staff members
spoke:

Felicia Spaulding, Clinical Director of ValueOptions’ NorthSTAR
Program reported:
 VO is involved in discussions in the community regarding recovery-
  orientation. Recovery myths were addressed. Recovery does not
  necessarily mean that a client will be able to return to full
  functionality and eventually not need services or medication.
  Recovery is a means of regaining functionality by learning and
  receiving information, developing coping skills and utilizing plans
  and support mechanisms that bring quality to their lives. Evidence-
  based practices, quantitative outcomes and person-centered
NTBHA Board of Directors Meeting                         June 10, 2009   4

    services were designed in the recovery-oriented RDM model. VO is
    now looking at the processes and has met with providers over the
    past four to six months to develop a formal Recovery Advisory
    Committee to make improvements. They are developing curriculum
    that reflects philosophy of recovery, providing a common language
    to be used with community members and new clinicians. The
    committee is comprised of representatives from SPNs, NAMI and
    CFAC. Invitations have been sent to Wellpoint as well as
    consumers. They have spoken to community and state hospitals.
    Peer support, consumer-established recovery plans and advocacy
    training are being used at TSH. The recovery model uses services
    that better match the consumers’ needs.
   Ron asked about concerns that the movement toward recovery
    focus resulted in more denials. According to Felicia, intensive
    utilization management, determining medical necessity criteria,
    became more intensified due to the system funding crisis , but has
    always been part of VO’s ongoing process for the clinical team. The
    recent increase in denials is still extremely low. Out of almost 8,000
    requests per month, the highest denial rate was about 250. Many of
    those resulted in approval into a different level of service than that
    requested, but not complete denial of all services. Judge Chitty
    suggested that NTSPP and Project Transform be involved and Felicia
    agreed to invite them.

    Dr. Conway McDanald, Medical Director of ValueOptions’
    NorthSTAR Program reported:
   The NorthSTAR formulary was developed that allowed generic drugs
    widely used in MH to be prescribed without pre-authorization (PA).
    Celexa and the alternative of Wellbutrin were selected as the
    preferred agents since no data indicated that one SSRI was better
    than another. The PA process was put in place for exceptions.
   The SGA capitates fund requires that the BHO spend a certain
    percent in direct pharmacy costs and the remainder in direct care
    costs, provided there is no waiting list.
   There has been progressive availability of antidepressants and
    mood stabilizers. Most SSRIs and SNRIs are now available in
    generic forms as is the antipsychotic Risperidone.
   VO is working on an automated PA process, but it is still a paper
    process. Dr. McDanald will look into alternatives, such as e-mail in
    lieu of faxes, if the automated system is not available soon.
   Increased Medicaid enrollment shifts consumers off the NorthSTAR
    formulary onto Medicaid and provides cost savings.
NTBHA Board of Directors Meeting                        June 10, 2009   5

   Medicare D and 340B are programs that have brought cost savings,
    but no new program is forthcoming to relieve increasing medication
    costs to NorthSTAR.
   Medication denials are low (less than 8% this fiscal year), but occur
    when:
       o New SGAs are prescribed prior to the use of generics, such as
          Risperidone
       o The prescription is used to treat non-priority diagnoses (such
          as adult ADHD, seizures, dementia, sleep, etc.)
       o Non-formulary brand name medications are ordered
          (example: brand-name extended-release versions of the
          same medication available as a formulary generic)


Item #8
Consumer and Family Advisory Council Report
Mike Katz, Chair, reported:
 CFAC met Tuesday, June 2, 2009 and discussed the 81st Legislative
   Session that just concluded. Of the 80+ bills that NAMI-Texas was
   tracking (not necessarily in favor of all), about six or so were
   approved, awaiting the governor’s signature.
 The next CFAC meeting will be held July 7, 2009 at the Dallas
   Metrocare Lancaster/Kiest Clinic with lunch served. A speaker from
   DARS will discuss vocational training for jobs and how going back to
   work affects disability benefits.


Item #9
Provider Advisory Council Report
Myrl Humphrey covered for Liam Mulvaney, PAC Chair,
reporting:
 Providers are concerned that VO is not keeping the promise to
   discontinue or minimize the level of care denials and downgrades.
   Two suggestions were made:
      o Provide better LOC justification up front, preventing denials
         due to lack of information. VO has not provided formal
         training to address this, but give individual counsel regarding
         what they are seeking to make a fair determination.
 Contract renewals and rate adjustments were discussed. Two
   providers had heard nothing yet.
 Providers would like to see NTBHA create a formal Medical Advisory
   Council.
NTBHA Board of Directors Meeting                       June 10, 2009   6

Item #10
Medical Advisory Board, courtesy of NTSPP:
Dr. Ed Nace, President of NTSPP, reported:
 Doctors would like to receive reports to compare their prescribing
   patterns with the state or national system at-large. It was noted
   that PBMs may have some of that data, but not VO.
 They would like to see SGAs used for maintenance for Bipolar
   Disorder, not just to treatment of acute episodes.
 The current PA method involves faxed paperwork, which can get
   lost, leaving the patient in limbo three to five days awaiting
   approval, etc. Consumers, who often have transportation issues,
   are asked to return to pick up medication, imposing difficulty. A
   confidential e-mail system between the requesting doctor and the
   approver would provide a more timely response.
 Medicaid prescription drug policies of 10 states indicated that
   Texas, California and New York were rated better than the other
   seven states. Medication access problems for 48% of patients
   occurred last year, resulting in increased ER visits, jail time,
   hospitalizations, etc. There are consequences for not being on the
   right medication for the right amount of time.


Item #11
Discussions and possible approvals:
 The Dallas County District Attorney’s office is asking for a letter of
   support for a grant to improve community response to commercial
   sexual exploitation of children. No financial commitment or
   oversight is requested of NTBHA. It was motioned by Matt Wolff,
   seconded by Ryan Brown and approved that the letter be given.
 According to Ryan, the completed audit has been submitted to the
   board for review. The financial statement indicates about a $10,000
   cash balance, which we retained and carried over from last fiscal
   year. There were no findings to report. NTBHA now uses the
   services of an accountant who provides clear, timely work, so the
   next audit is expected to run very smoothly.
 SGA medication: No additional discussion
 Collin County MOU: No additional discussion
 LAR: No additional discussion

Open Session Action Items:
 Ryan, Alex and KJ will discuss any outstanding balance that NTBHA
  may have at the end of the fiscal year.
NTBHA Board of Directors Meeting                         June 10, 2009   7

   Ongoing negotiations are under way for any outstanding provider
    contracts. A finalized contract is anticipated for Dallas Metrocare in
    a couple of weeks.
   Felicia will invite NTSPP and Project Transform to be involved in the
    Recovery Advisory Committee.
   Dr. McDanald will look into e-mail as an alternative to faxes if the
    automated pre-authorization system is not available soon.
   The letter of support for the Dallas County District Attorney is to be
    signed by Alex and Judge Chitty.


Item #12
Executive Session (closed)
The Board may go into Executive Session pursuant to chapter
551, subchapter D, Texas Govt. Code:
 The board met in closed session with Alex Smith to discuss
   employee policies and staff performance reviews.


Item #13
Discussion and possible vote in open session of any matters
considered in Executive Session:
 None


Item #14
Next Board Meeting
 July 8, 2009 at 12:00 noon.


Item #15
Adjournment
 The board meeting adjourned around 2:30 p.m.




______________________________________
Dr. Richard Scotch, Secretary
NTBHA Board of Directors Meeting                           June 10, 2009    8

Acronyms & Terminology
340B                A federal drug pricing program
ACS                 Adapt Community Solutions (Mobile Crisis
                    Provider for NorthSTAR, see MCOT)
ACT                 Assertive Community Treatment
APOWW               Apprehension by a Police Officer Without a Warrant
APAA                Association of Persons Affected by Addiction
BHO                 Behavioral Health Organization
BOD                 Board of Directors
The Bridge          Homeless Assistance Center in Dallas
CAP                 Corrective Action Plan
CBT                 Cognitive Behavioral Therapy
CD                  Chemical Dependency
CFAC                Consumer and Family Advisory Council
CHIP                Children’s Health Insurance Program (aka SC HIP)
CMBHS               Clinical Management of Behavioral Health Services
CRCG                Consumer Resource Coordination Group
CIT                 Crisis Intervention Training (sponsored by the
                    City of Dallas Police Department)
DARS                Texas Department of Assistive and
                    Rehabilitative Services
DBSA                Depression and Bipolar Support Alliance
DPS                 Department of Public Safety
DSCT                Direct Services Cost Target
DSHS                Texas Department of State Health Services
FPL                 Federal Poverty Level
FTE                 Full-time Employee
GOH                 Green Oaks Hospital
GR                  General Revenue
HUD                 Housing and Urban Development
LAR                 Legislative Appropriations Request
LBB                 Legislative Budget Board
LOC-A               Level of Care - Authorized (as specified by
                    Service Packages approved for a client)
LOC-R               Level of Care – Requested (by the SPN)
LPHA                Licensed Professional of the Healing Arts
                    (Graduate degrees with specific licenses)
MCOT                Mobile Crisis Outreach Team (In NorthSTAR, ACS is the
                         MCOT, providing phone or face-to-face intervention.)
MH                       Mental Health
MHA                      Mental Health America
MLR                      Medical Loss Ratio
MOU                      Memorandum Of Understanding
NTBHA Board of Directors Meeting                         June 10, 2009    9

NAMI                     National Alliance for the Mentally Ill
NARSAD                   National Alliance for Research on Schizophrenia
                         and Depression
NTBHA                    North Texas Behavioral Health Authority
NTSPP                    North Texas Society of Psychiatric Physicians
OCR                      Outpatient Competency Restoration
OPC                      Order of Protective Custody
PA                       Pre-authorization
PAC                      Provider Advisory Council
P&Ps                     Policies and Procedures
PESC                     Psychiatric Emergency Service Centers
PBM                      Pharmacy Benefit Manager
QMHP                     Qualified Mental Health Professional (Bachelor’s
                         degree in specific helping field majors)
RDM                      Resiliency and Disease Management
RFP                      Request For Proposal
RFI                      Request For Information
SA                       Substance Abuse
SCHIP                    State Children’s Health Insurance Program
SDC                      Self-Directed Care
SED                      Severe Emotional Disturbances
SP1, SP3, etc.           Service Packages associated with LOCs in
                         RDM—the higher the number, the more
                         intensive the services provided
SFY06, SFY07, SFY09,     State Fiscal Years. SFY09 began September 1,
SFY10, SFY11             2008 and will end August 31, 2009.
SGA                      Second Generation Atypicals (medication)
SME                      Subject Matter Expert
SNRI                     Selective Norepinephrine Reuptake Inhibitor
SP3                      Service Package 3 (RDM-prescribed level of care)
SPA                      Single Portal Authority
SPN                      Specialty Provider Network
SSRI                     Selective Serotonin Reuptake Inhibitor
TCOOMMI                  Texas Correctional Office on Offenders with
                         Medical or Mental Impairments
TLETS                    Texas Law Enforcement Telecommunications
                         System
TP 55                    Type of Medicaid for medically needy clients
                         whose increased medical bills make them eligible
                         for Medicaid (not currently eligible for NorthSTAR)
TRAG                     Texas Recommended Assessment Guidelines
TSH                      Terrell State Hospital
UA                       Uniform Assessment
NTBHA Board of Directors Meeting                      June 10, 2009   10

UM                       Utilization Management
UTMB                     University of Texas Medical Branch
VO                       ValueOptions