1 of 2 www.wakegov.com Wake County Human Services and Environmental Services Board January 26, 2012 AGENDA Human Services Ctr - 220 Swinburne St. 2nd Fl., Rm. 2132 Standing Time: 7:30AM – 10:00AM Dianne Dunning, Chair Pablo Escobar, Vice Chair Purpose: Advocacy, Policy, Advisory, Accountability Public Health Committee: Mr. Benny Ridout, Chair 7:35 am • Request for Individual Support: Resolution in Support of Recurring Funding for Tobacco Use Prevention & Cessation Programs 7:30 am Meeting Called to Order Invocation Approval of Minutes: December 15, 2011 Next Board Meeting: February 23, 2012 220 Swinburne St., 2nd Fl., Rm. 2132 Regular Agenda 7:45 am LME/Managed Care Organization (MCO) Merger Update - Mr. Joe Durham, Mr. Ramon Rojano, Dr. Carlyle Johnson 8:00 am Discussion on HS&ES Board Composition – Chair Dianne Dunning 8:25 am Board Advocacy Workgroup Update - Dr. Sharon Foster, Chair 8:35 am State/Local Budgets Update - Mr. Paul Gross, HS Finance Officer 8:50 am Environmental Services Acting Director's Q & A 9:00 am Human Services Director's Q & A 9:20 am Chair's Report
77
Embed
Wake County Human Services and Environmental Services ...€¦ · 1 of 2 Wake County Human Services and Environmental Services Board January 26, 2012 AGENDA Human Services Ctr - 220
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1 of 2
www.wakegov.com
Wake County Human Services and Environmental Services Board
January 26, 2012 AGENDA
Human Services Ctr - 220 Swinburne St. 2nd Fl., Rm. 2132
Wake County Human Services in partnership with the community will anticipate and respond to the public health, behavioral health and the economic and social needs of Wake County residents. We will coordinate and sustain efforts that assure safety, equity, access and well-being for all. - December 2006 _____________________________________________________________________________
Environmental Services Mission Statement
To protect and improve the quality of Wake County’s environmental and ensure a healthy future for its citizens through cooperation, education, management and enforcement. Environmental Services combines:
• water quality
• air quality
• solid waste (recycling, landfills, etc.)
• environmental health and safety (sanitation inspections, pest management, swimming pool regulations, animal control)
Environmental Services – Library Admin., 4020 Carya Dr.
14
15 16
BOC 2pm----
17
Noon – 2pm - LME
Advisory, 401 E. Whitaker Mill Rd., Rm. 210
18
Board Packet
Distribution
19
3:30pm – 5:15pm - Housing
& Cmty. Revitalization, Rm. 5032
20
11:30am – 1pm LME Human
Rights, HS Millbrook Ctr., 2809 E. Millbrook Rd. __________
Noon – 2pm Public Health, Rex Women Ctr.,
Rm. 100C*
21
22 23
12:45pm – 2pm HRC
– Rm. 1145
24 25 26
7:30am – 10am HS & ES
Board Mtg. Rm. 5032
27 28
29 30
Assignments to Committees
Executive
Committee 2nd Thursday
8am – 10am
Rm. 5032
Community and
Public Health 3rd Friday, noon
Rex Women Ctr.
Environmental
Services 2nd Fri., 11:30am, Library
Admin. Carya Dr.
Social Services 1st Friday
9am – 10:30am
Rm. 5032
LME Advisory 3rd Tues., Noon,
401 E. Whitaker Mill Rd.
Rm. 210
Dianne Dunning
Pablo Escobar
Frank Eagles
Leila Goodwin
Melissa Jemison
Paul Norman
Benny Ridout
Stephanie Treadway
Staff:
Regina Petteway
Joe Durham
Ramon Rojano
Bob Sorrels
Benny Ridout
Alexander Herring
Burton Horwitz
Sharon Foster
Staff:
Michelle Ricci
Sue Lynn Ledford
Brent Myers, EMS
Peter Morris
Regina Petteway
Andre Pierce
Yvonne Torres
Community:
Laura Aiken
Kevin Cain
Barbara A. Hughes
Anne McLaurin
Leena Mehta
Ann Rollins
Heidi Swygard
Penny Washington
Leila Goodwin
Dianne Dunning
Frank Eagles
Benny Ridout
Melissa Jemison
Jeff Smith
Staff:
Sue Lynn Ledford
Deborah Peterson
Andre Pierce
Matt Roylance
Community:
Rodney Dickerson
Les Hall
Glenn Harris
Suzanne Harris
Don Haydon
Bryan Hicks
Lana Hygh
Buck Kennedy
Jacob Reynolds
Bob Rubin
Henk Schuitemaker
John Sowter
Paula Thomas
Liz Turpin
Kenny Waldroup
Julie Wilkins
Phillip White
John Whitson
Paul Norman
Jim Edgerton
Burton Horwitz
Julian Smith
Staff:
Katherine Williams Giang Le
Liz Scott
Natasha Adwaters
Martha Crowley
Vielka Gabriel
Warren Ludwig
Jenny Wheeler
Community:
Lisa Bireline
David Cottengim
Pam Dowdy
Lisa Draper
Dudley Flood
Glenn Harsh
Marjorie Menestres
Rick Miller
John Parker
Bob Robinson
Georgia Steele
Lynn Templeton
Cherie Thierrault
Brandon Trainer
Tracy Turner
Angie Welsh
April Womack
Marc Zarate
Stephanie Treadway
Pablo Escobar
George Corvin
Kent Earnhardt
Jim Edgerton
Melissa Jemison
Staff:
Carlyle Johnson
Ann Wood
Patsy Coleman
Beth Nelson
Community:
Ann Akland
James Hartye, WakeMed
Marc Jacques
Lou Mitchell
Rhonda Spence
Affordable
Housing &
Community
Revitalization 3rd Thursday
3:30pm – 5pm, Rm. 5032
Regional
Networks
Development Rm. 5040
Human Rights/
Consumer Affairs 4th Mon., 12:45-2pm
Rm. 1145
LME
Human Rights
Subcommittee 3rd Friday, Varying Times
HS Millbrook Ctr.
Melissa Jemison
Dianne Dunning
Staff: Annemarie Maiorano
Bob Sorrels
Community:
Emmett Curl
Steven Hess
Michele Grant
Teresa Piner
José M Serrano
Mark Shelburne
Trace Stone-Dino
Yolanda Winstead
Frank Eagles
Benny Ridout
Staff:
Darryl Blevins
Rosena West
Ross Yeager
Regina Petteway
Staff:
Matt Burton
Sharon Brown
Andre Pierce
Bob Sorrels
Community: Arsenio Carlos, ERC
Rev. Lenwood Long, NRC
Eugenia Pleasant, NRC
Lunette Vaughan, SRC
Pablo Escobar
Kent Earnhardt
Osama Said
Staff:
Brian Gunter
Leticia Mendez
Fabiola Sherman
Jeff Woodward
Community:
Laura Goddard
Phillis Ross
John Sowter
Don Wiseman
Rich Greb Laura Goddard
Bruce Benedict
Martha Brock
Kent Earnhardt
Marc Jacques
Ronnell McGill
Martha Pitts
Diane Waye
Staff:
Miki Jaeger
WHEREAS, the use of tobacco products is the leading cause of preventable death and disability in North Carolina1 and nearly 11,100 NC children will become regular daily smokers this year2; and,
WHEREAS, the primary purpose of the 1998 Master Settlement Agreement (MSA) was to provide states with funding to remedy the public health problems and increased health costs posed by tobacco use; and,
WHEREAS, in a 1999 law the North Carolina General Assembly dedicated 25% of the state’s annual MSA payments to health programs, including tobacco use prevention programs; and,
WHEREAS, in 2011 $138 million in MSA funds came to the state, thus 25% of MSA funds would amount to approximately $34.5 million for tobacco use prevention and cessations programs in NC; and,
WHEREAS, the U.S. Centers for Disease Control and Prevention (CDC) recommends that North Carolina spend $106.8 million a year to have an effective, comprehensive tobacco use prevention program3; the tobacco industry spends $396 million annually to market its products in our state4; and,
WHEREAS, smoking costs North Carolina taxpayers $2.46 billion in direct healthcare costs ($769 million in Medicaid expenses alone), and $3.5 billion in lost productivity annually5; and,
WHEREAS, since North Carolina initiated its youth tobacco prevention programs in 2003, the middle school smoking rate in has been cut by more than half (from 9.3% to 4.3%), and the high school smoking rate has dropped by a third (from 27.3% to 16.7%). This reduction accounts for 53,000 fewer smokers since 20036; and,
WHEREAS, comprehensive statewide tobacco use prevention and cessation programs promote reductions in smoking levels among both adults and kids7, thereby producing substantial state health care cost savings and reductions in other smoking-caused expenditures8; and,
WHEREAS, the Campaign for Tobacco Free Kids estimates that if current tobacco prevention funding (now at $17.3 million) is eliminated in North Carolina, the youth smoking rate will increase by 2.8%, 17,500 more North Carolina kids will grow up to become addicted adult smokers and future healthcare expenditures in the state will increase by $306.2 million9;
NOW THEREFORE BE IT RESOLVED that the undersigned supports the dedication of 25% of NC’s annual MSA payment to fund evidence-based tobacco use prevention and cessation programs in North Carolina. I am signing as:
___ an individual: Individual Signature ______________________________________________ Date: ___________
1 North Carolina Institute of Medicine, Task Force on Prevention, May 2008 2 Campaign for Tobacco-Free Kids, Key State Specific Tobacco Related Data and Rankings ,November 22, 2011, http://www.tobaccofreekids.org/research/factsheets/pdf/0176.pdf 3 Centers for Disease Control, Best Practices for Comprehensive Tobacco Control Programs—2007 p. 54-55. http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm 4 U.S. Federal Trade Commission (FTC), Cigarette Report for 2007 and 2008, 2011, http://ftc.gov/os/2011/07/110729cigarettereport.pdf. 5 Campaign for Tobacco Free Kids; STATE TOBACCO-RELATED COSTS AND REVENUES. June 15, 2010. http://www.tobaccofreekids.org/research/factsheets/pdf/0178.pdf 6 NC Department of Health and Human Services, 2009 North Carolina Youth Tobacco Survey, 2009, http://www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/yts09/ncytssummarytablesstatewide2009.pdf 7 Institute of Medicine, Ending the Tobacco Problem: A Blueprint for the Nation, National Academy of Sciences, 2007; http://www.nap.edu/catalog.php?record_id=11795 8 Lightwood, J & Glantz, S, “Short-term Economic and Health Benefits of Smoking Cessation: Myocardial Infarction and Stroke,” Circulation 96:1089-1096, 1997. Campaign for Tobacco Free Kids, Comprehensive Statewide Tobacco Prevention Programs Save Money, January 24, 2011, http://www.tobaccofreekids.org/research/factsheets/pdf/0168.pdf. 9 Campaign for Tobacco Free Kids, Impact on Youth Smoking, Deaths & Related Health Costs from Changes to North Carolina Tobacco Prevention Funding, December 12, 2011, http://issuu.com/ncahadmin/docs/nc_funding_level_zero_out_12-12-11.
WCHS-MCO COLLABORATION Beginning of long-lasting relationship between Wake DPH & DSS with the MCO
WCHS-NEW CONSOLIDATION Redesigning the new consolidated entity
(PH & SS)- Legislative action
Board of Commissioners Board of Commissioners Board of Commissioners Board of Commissioners
Work SessionWork SessionWork SessionWork Session AgendaAgendaAgendaAgenda
Monday, January 9, 2012 Monday, January 9, 2012 Monday, January 9, 2012 Monday, January 9, 2012 ––––2:00 p.m.2:00 p.m.2:00 p.m.2:00 p.m.
Wake County Office Building, Ground Floor Conference Room
MEETING CALLED TO ORDER: Chairman Paul Coble
Item II: Wake County and Durham County LME Merger Update – Denise Foreman, Assistant to the County Manager, Ellen Holliman, The Durham Center CEO and Carlyle Johnson, Wake County LME Manager
On November 7, 2011, the Wake County Board of Commissioners approved a merger proposal between the Wake County LME and the Durham Center and authorized the County Manager to negotiate an Interlocal Agreement. The new entity, a multi-county area authority, will provide public management of a system of care for the delivery of mental health, developmental disabilities and substance abuse services. The new entity will represent Durham and Wake Counties. It will have contractual relationships with Cumberland and Johnston Counties for the management of federal and state funds. The new entity will be responsible for the management of over $400 million in federal, state and local funds for the four county area. The new entity will begin LME operations for Durham and Wake counties as of July 1, 2012 and will begin MCO operations for the four county area as of January 1, 2013. Staff will provide the Commissioners with an update on the Interlocal Agreement between Durham and Wake counties. If negotiations are completed, the Board of Commissioners will be asked to approve the ILA on January 17, 2012 or February 6, 2012.
Attachments:
1. Presentation (Will be provided at Work Session)
Wake and Durham LME Merger UpdateLME Merger Update
January 9, 2012
Work Session
• Background
• Process
• Merger Issues
• Draft Agreement
Agenda
• Draft Agreement
• Next Steps
2
• Management of Medicaid funds for mental health, development disabilities and substance abuse (MH/DD/SA) is shifting from state level to local level by January 1, 2013
• Medicaid waiver provides local flexibility in:
Background
• Medicaid waiver provides local flexibility in:
– Provider network
– Service authorizations
– Rate setting
– Pre-defined funding rates
3
• Wake County was unsuccessful in application to manage Medicaid funds and transition to a managed care organization as single county
• Pursuing merger with Durham County to create new entity to manage all MH/DD/SA funding
Background
new entity to manage all MH/DD/SA funding sources and services for both counties
– Will contract with Johnston and Cumberland counties
– Services for over 185,000 Medicaid eligible clients and total population of over 1.6 million
4
• New entity will manage over $400 million
Background
Funding Sources
Federal/Medicaid ~$300 million
State ~ $50 million
• Estimating 400 employees
5
State ~ $50 million
Local ~ $30 million
Durham ~ $6 million
Wake ~ $23 million
• November 7, 2011 approval to negotiate with Durham
• Agreement developed by representatives from both County Manager’s Offices, LME’s and County Attorney’s Offices
Process
and County Attorney’s Offices• Updates to Human Services Board, LME
Advisory Committee, Consumers and Families Advisory Committee
• January 5, 2012 - goal to have agreement completed– Most terms confirmed with only a few outstanding
6
• Dissolution of Wake County LME
– Continue LME Services until June 30, 2012
– 110.75 positions eliminated; 96 currently filled
• Developed Reduction in Force Plan
Merger Issues
• Developed Reduction in Force Plan
• Assisting employees with job placement in new MCO and in Wake County
– Negotiated “internal” candidate recruitment status for Wake and Durham LME employees and comparable benefits
• Employees eligible for severance when position eliminated
7
• Creation of New MCO– Hiring process has begun
• Management Team Selection - December/January• Unit Managers Selection - January• Supervisors Selection – January/February• Line Staff – February/March
Merger Issues
• Line Staff – February/March
– Work teams established• Location• Technology• Communications• Care Coordination• Customer Service• Provider Network Operations
– Selecting and implementing technology systems
8
• State law provides guidance
• Effective Date – March 1, 2012
• Name – To Be Determined
• Chief Executive Officer
Draft Agreement
• Chief Executive Officer
– Ellen Holliman
• Location
– Central Office
– Wake/Durham Offices
9
Consumer and Family Advisory Committee (CFAC)• MCO CFAC with membership from all four
counties
Draft Agreement
– Advises the area authority/MCO
– Self governing, self-directed, self-appointed
– Receive support from MCO
• Local CFACs can continue if desired– Advise MCO CFAC
– Receive support from MCO
10
Start-Up Funds
• Total = $8 million
– Facilities, IT systems, staffing, etc.
• $4 million from Wake and Durham
Draft Agreement
• $4 million from Wake and Durham
• Payback within 5 years – 1% interest
• 7-Year Pro-forma developed
11
Operating Funds• After January 1, 2013, provided by Federal and
State funds
– Administration = 9.5%
Draft Agreement
– Risk Reserve = 2%
– Services = 88.5%
• Local funding – services only
– Annual contract between Wake County & MCO
– Identify service expectations
12
Board of Directors
• Anticipating 16 members
– 8 Appointed by Durham • 1 business, 1 finance, 1 clinical,
– 6 Appointed by Wake• 1 business, 1 finance, 1 clinical,
2 consumers/advocates/family
– 2 Appointed by MCO Board• 1 representative each for Johnston and
Cumberland
13
Board of Directors
• Initial terms staggered
– 1/3 1-year, 1/3 2-year, 1/3 3-year
• Term limits
Draft Agreement
• Term limits
– Two terms
• Dual categories
– Any member may concurrently fill two categories of membership
14
Board of Directors
• 2/3 Majority on significant decisions
– Budget approval
– CEO employment
Draft Agreement
– CEO employment
– Personnel policy
– Provider Network policies
– Service plan policies
– Office locations
15
• January – March 2012
– Finalize terms of agreement
– Agreement approval by Wake and Durham BOCC – Early February
Next Steps
BOCC – Early February
– Receive approval from NC Secretary of Health and Human Services
– Appoint Board members – February/March
– Continue implementation plans
16
• March – June 2012
– MCO Board Begins
– Counties provide start-up funds
– Negotiate Wake-MCO FY2013 Local Funding
Next Steps
– Negotiate Wake-MCO FY2013 Local Funding Contract
– Seek Legislative Approval to Change Structure of Consolidated Human Services
– Anticipate Proposals to Modify G.S. 122C in Short Session
17
• July – December 2012
– Begin LME operations as joint entity
– Prepare for MCO operations
– Identify and establish locations for Wake and
Next Steps
– Identify and establish locations for Wake and Durham County operations
• January 2013
– Begin MCO operations
18
Wake County Human Services Board Representation Criteria 25 Member Board
• *Person with Mental Illness • *Person with Developmental Disability • *Person Recovering from Substance Abuse • *Family Member of Person with Mental Illness • *Family Member of Person with a Developmental Disability (vacant) • *Family Member of Person with Substance Abuse • *Psychiatrist • *Psychologist (vacant) • County Commissioner • Consumer of Other Human Services (2). (One is vacant) • Pharmacist • Engineer • Dentist • Optometrist • Veterinarian • Social Worker (vacant) • Registered Nurse (vacant) • Other Physician • General Public (6). (Two are vacant) * = Eight MH/DD/SA Categories
Expenditures Total 215,687,153 94,440,781 44% 212,966,006
Revenues 2000 Federal 14,296,759 4,273,030 30%
3000 State 97,886,059 35,838,004 37%
4000 Local 2,226,912 872,750 39%
5000 Charges For Services 26,386,926 8,772,755 33%
7500 Interest Income 23,654 (6,644) -28%
8000 Miscellaneous 42,500 21,686 51%
8800 Other Financing Sources 318,600 - 0%
Revenues Total 141,181,410 49,771,580 35% 138,978,684
County Share 74,505,743 44,669,201 60% 73,987,322
*Total FY12 Salary/Benefits reflect (11) pay periods out of (24) = 45%
Fiscal Year 2012 Budget Data
INFORMATION
ITEMS
• Board Fund Report (Separate)
• Articles
• Link to Environmental Health & Safety Division Report – 12/2011
• Wake LME Annual Reviews & Performance Reporting FY’11
• Committee Reports/Minutes
• Commissioners’ Agenda Items Related to HS&ES January 17, 2012
State closes Wake Forest assisted-living center BY THOMAS GOLDSMITH - [email protected]
PUBLISHED IN: WAKE COUNTY
WAKE FOREST In an unusual move, state human services regulators Thursday ordered a Wake Forest
assisted-living center to shut down and move all residents by Monday.
Wake Forest Care Center has a long history of violations, including several involving the deaths of two residents who wandered off unattended, one in 2006 and one last month.
The shutdown and an order to admit no more residents was based on a state finding that emergency action was required to protect the residents, Barbara Ryan, chief of the adult care licensure section of the Department of Health and Human Services, said in a letter to the care center's owner, Richard Cresenzo.
Cresenzo was told that he must find new locations for residents by 5 p.m. Monday or whenever the last resident has been safely placed.
Cresenzo, a Burlington lawyer, said, as he has in the past, that he was surprised at being found at fault and especially at having the home closed.
"I feel like I've been wronged," he said in a telephone interview. "My facilities run deficiency-free. I've been in this business for 30 years."
Only a handful of assisted-living centers, which are less medically intensive and regulated than nursing homes, have been shut down on the spot by North Carolina in recent years. To keep from displacing residents, regulators typically give operators time to correct infractions and pay sometimes substantial fines.
The action follows the December death of McKinley High, 79, a retired farmer from Spring Hope who was a resident of the center. A driver not far from the center struck High in the middle of a suburban street after he wandered off from the facility. High suffered fatal injuries in the collision.
"The man had no indication that he had dementia," Cresenzo said. "It's not a locked facility."
Fines since 2006
The 80-bed center at 306 S. Allen St. has been fined more than $40,000 since 2006 for violations found by county and state inspectors. In a recent survey that Cresenzo said lasted five or six days, inspectors found violations in giving out medications, using restraints, residents' rights, food services, and training on caring for residents with diabetes, state records showed.
The previous fatal incident happened in 2006, when Miklos Ankhelyi, 67, wandered away while living at the home and drowned in a nearby creek. That incident cost the center a state fine of $12,000. Like High, Ankhelyi had been previously seen by neighbors, walking away from the home unattended.
"We hate that it happened," Cresenzo said of High's death at the time.
Piles of clothes, neatly placed on hangers or stored in boxes, sat alongside Christmas decorations near the entrance Thursday night, ready to be moved out. Teary-eyed staff spoke often with residents.
Despite years in which the center had racked up tens of thousands of dollars in violations, one resident who called The News & Observer and another introduced by management both said they wanted to stay in the home.
"Am I worried? Of course I am," said Pat Webb, 69. "I'm worried for other people."
Webb said she would like the center to stay open, as did Mary Dolan, 60, a former president of the home's residents council.
"I was supposed to have a special birthday party next week," Dolan said in the manager's office. "I've never had problems with the employees or the residents.
"This is not a charity home, and sometimes the residents can be demanding. But the whole community should not be punished, and the employees need a job."
Polly Williams, a retired N.C. State University professor who advocates for older people at the legislature and elsewhere, said the state is generally very reluctant to close assisted-living facilities because even sub-par centers often feel like home to the residents.
"I'm sure that it's serious, but whether they could find someone else to take over I don't know," Williams said of the center. "The residents' health is often fragile enough that being moved is really bad for them."
Goldsmith: 919-829-8929
Insuring kids brings N.C. $21 million reward BY LYNN BONNER - [email protected]
PUBLISHED IN: HEALTH/SCIENCE
The state has earned a $21 million bonus from the federal government for enrolling more children in a public-private health insurance program and making it easier for them to stay in it.
North Carolina was one of 23 states sharing $296 million in bonuses awarded for cutting application paperwork and exceeding enrollment targets.
N.C. Health Choice, the state version of the national Children's Health Insurance Program, enrolls about 150,000 children, according to the state Department of Health and Human Services. That's up from about 134,000 in 2010.
The program offers free or reduced-price insurance to children whose parents cannot afford private insurance. It was approved in 1997 and was reauthorized in 2009.
When the federal law was reauthorized two years ago, it included incentives for states that adopted at least five of eight strategies for streamlining applications and increased enrollment above set targets.
"Access to health insurance is one of the keys to starting children on the path to a healthy life," said Marilyn Tavenner, acting administrator at the federal Centers for Medicare & Medicaid Services, during a conference call with reporters on Wednesday.
The federal government covers about 75 percent of North Carolina's costs. Some families pay part of the medical bills.
"Part of the reason for the bonus is that it helps defray the costs the state has already incurred by adding more kids to the program," Cindy Mann, a deputy administrator with the Centers for Medicare and Medicaid Service, said during the conference call.
North Carolina did not qualify for a bonus last year, but this year was credited with cutting down on paperwork applicants fill out, using electronic databases to verify family information, and keeping children enrolled for a year at time.
The state does not require in-person interviews, which federal officials said are difficult for working parents to schedule.
North Carolina, like most other states, does not consider a family's assets, other than income, when determining children's eligibility.
"We know the only way children can succeed in education is if they show up to school healthy and ready to learn," said Mark Johnson, a spokesman for Gov. Bev Perdue.
"The Governor has made expanding health care coverage for eligible children a high priority in her administration, and today's announcement shows that work has paid off."
Adam Searing, director of a health-care advocacy group, applauded the work the state did on Health Choice to get the extra money.
Making sure parents don't have to repeatedly file paperwork may seem like a small administrative change, but it can make a significant difference in how many children have health insurance, he said.
"They're making changes that make things more efficient and more effective, and that's resulted in more kids getting enrolled," said Searing, director of the N.C. Health Access Coalition.
North Carolina was one of seven states that earned a bonus for the first time.
Bonner: 919-829-4821
Attached is a link to the Wake County Environmental Health and Safety Division
• Net operating facilities continue to increase year over year. (page 2)
• Critical violations by CDC type are shown for Wake County establishments (page 3)
• Complaints soared in December, 20 more than usual. Most reports alleged foodborne illness
(FBI) (page 4)
• Average transitional permits increase on average (page 5)
• Asthma investigation data is presented (page 6)
• Wake County Food Service Advisory Committee met on December 2, 2011 (page 8)
• Plan reviews average 57 per month (page 9)
• Pool construction visits average 22 per month for 2011 (page 12)
• 2353 swimming pool inspections were performed in 2011 (page 13)
*Please advise if you would like to be removed from this distribution, or if you know of someone who
might be interested in receiving this report. Also please report if you are unable to open the link, and I'll
be glad to email you the attachment.
Andre C. Pierce, MPA, REHS Wake County Environmental Services Environmental Health and Safety Director [email protected] 919-856-7440 - Phone 919-743-4772 - Fax
Call to Order The LME Advisory Committee meeting, facilitated by Ms. Stephanie Treadway, opened at 12:10 p.m.
Approval of Minutes
Upon motion by Ms. Ann Akland, seconded by Mr. Jim Edgerton, the committee approved the November 15, 2011, committee minutes.
Agenda Items
Agenda: •Advocacy Priorities •Annual Provider Network Compliance Reports •Merger/Transition Updates •LME Director/Administrator Updates •Committee Workplan and Priorities for Jan.-Jun. 2012 •Good of Order
Chair’s Report The LME Budget/Finance Report was postponed this month. Ms. Patsy Coleman was absent due to the loss of a family member. Chair Treadway said memorial contributions may be made to an Education Fund that has been set up at the State Employees Credit Union on the family’s behalf or given to Jonica Hinton to forward to the fund.
Chair Treadway said the HS&ES Board Advocacy Workgroup has requested that committees develop and submit their advocacy priorities worksheets for consideration at the Board level. Mr. Rojano clarified that after July 1, 2012, the LME Advisory Committee will not exist. Committee Suggestions/Discussion: 1. Transition to the MCO. Ask the HS&ES Board to make sure that the interests of the citizens are not sacrificed during the
transition.
2. The transition to the MCO is the biggest change MHDDSA has gone through in 50 years. Suggested to advocate for an MCO that Wake County deserves and one that will meet Wake’s needs. (How Wake partners, how Wake is represented, how CFAC and CPAC are represented, and what the local presence will look like.)
3. Dr. Johnson and Mr. Rojano suggested that the committee look at the past year’s priorities and determine if there are any carry overs, such as (1) adequate inpatient psychiatric capacity; (2) long waits in E.D.s; and (3) accessibility of services in general.
4. On the state level, there continues to be significant financial pressure that could affect all of the transition. Examples: if MCO does not get adequate state funding during the transition, continued budget cuts, loss of Medicaid Services. Need advocacy for restoring funding and averting further budget cuts. The committee said this is a financial issue that might be the purview of the new MCO board. The advocacy point next year for the HS&ES Board may be around Behavioral Health Services issues.
5. The committee felt that whatever advocacy issues they came up with could be passed on to the new MCO board.
6. Ms. Akland said the impact of the Department of Justice investigation. She believed advocating with the HS&ES Board around housing for people with disabilities are still important.
7. Think about and advocate for people who are not Medicaid recipients. This policy development will have implications for funding long term. Policy development is where mandates and funding come from. Currently Bill 916 contains no mandates for people without Medicaid.
8. New 2014 Healthcare Reform is looking for integration of the Five Axis approach. Therefore there is an issue in separating behavioral health needs, medical needs, and social needs. Advocate for holistic approach.
9. Mr. Jacques said based on changes to G.S. 122c, the Division asked CFACs to comment on G.S. 122c (170 &171). G.S. 122c is the overarching statute for the mental health system. There is advocacy across the state to update the language on recovery, ensuring the MCO has a robust office of consumer affairs, and that the consumer and family participation on the board is not squeezed out amidst changes. He believed this is a perfect example of what the state policy could be asked to put in G.S. 122c.
10. The MCO will have two contracts with the state: • To manage the state Medicaid dollars. • To manage the state dollars. As the system moves forward, for every state dollar, you earn $2 federal dollars. It will be
likely to pull the state dollars into the Medicaid match. If you have no state dollars to manage, and if state dollars are dwindling and limited to what they can cover, what happens to people above 138% of poverty. Forecast is that the state will be forced to use state dollars for mandatory services.
11. Mr. O’Donnell suggested inviting Mr. Steve Jordan (MH Director, DMH/DD/SAS) or Mr. Jim Jarrard (Assistant Director) to give his perspective on the LME aspect by the Medicaid Waiver movement, which takes in the breadth of the population—not just the Medicaid population—and where the flexibility will be and how you might utilize it.
12. There is currently “county” funding for WakeBrook Facilities and HHH psychiatric bed contract. Mr. Escobar asked if this committee will be seen as the policy advising body on how the county dollars are spent? • Ms. Denise Foreman said the current county vision is for almost all of the county funding to flow through the MCO. Then
there will be a contract between the MCO and Wake County. There is a huge and important priority-setting process, what we want the county dollars to buy and then managing to ensure Wake is getting what it is contracting for. She said there is an important question to figure out what is the role of Human Services and the HS&ES Board and how it is all managed. The MCO has a lot of rules to follow on Medicaid management and on conflict of interest. She did not know how formal those roles could be. She believed it would have to be an informal, advocacy, liaison type role between Human Services, the HS&ES Board, and the MCO. Ms. Foreman said she did not know what this will look like right now.
• Ms. Foreman said input from the HS&ES Board and advocates to the new MCO board are critical. She said it is clear that a HS&ES Board member representative cannot serve on the MCO board because Human Services is a service provider. However, maybe informally, a HS&ES Board member liaison could attend MCO board meetings and report back.
13. Wake will go from advocating as a MCO to advocating to a MCO.
14. Is DMA going to take over mental health? There is a trend. Need to look at global needs for emotional, physical and social wellness.
15. The state has said it is critically important to work well with your local social services department because of the Medicaid eligibility determination. Dr. Johnson is pleased of the relationship/interaction between Wake LME and Wake Social Services. Expressed the importance of preserving connections and natural supports already in place. There may be some natural advocacy points from the public health and/or social services side. Mr. Rojano clarified that this means the MCO may advocate to the HS&ES Board to do more things.
16. Will Behavioral Health Services still exist? Yes. The MCO board will decide who it contracts with. Will Wake continue to fund/manage WakeBrook and Wake Behavioral Health Services? Mr. Edgerton pondered whether the 22 million county funds have to be given to the MCO. Wake Behavioral Health Services (WBHS) receives $3 million in IPRS dollars; the remaining $22 million dollars for WakeBrook comes from the county. Ms. Foreman said the county has not decided what the funding split will be yet. Mr. Rojano believed the county dollars will be the only flexible dollars in the future. The county will have to decide the best use for this money based on gaps, what is best for the citizens, and financial viability.
19. Ms. Akland said UNC and Wake County have partnered to identify Wake County community gaps and needs. There is a feeling for strategic planning to determine priorities for the $22 million county funding. She asked what is this process and who will be involved. --Ms. Foreman said Wake is looking for information from the UNC Study; Wake has a gaps analysis, and information from LME and CFAC. However, we are too far away from figuring out how things will work with the MCO and how things will all fall together. The county has started its FY 2013 budget process and looking to carry forward what is in place now. The county will be looking for input on how those prioritizations happen and how the contract between the county and MCO will be developed and what will be included.
20. Ms. Akland said from her viewpoint, it makes sense to first make evaluations of services before RFPs are put out and/or develop a different RFP for a different type of service. Ms. Foreman said the county does not want to put something out in a RFP that is a priority need. She referenced the handout distributed last month on current WBHS list of services provided and how that would pursue as a RFP. The first piece is an evaluation process happening in the January – March 2012 timeframe. She said the county highlighted some of the services currently in existence that might lend themselves to a first tier of RFP. Ms. Akland said she hoped the community and consumers have opportunity to help plan and provide input into what eventually happens. She said this is the opportunity to really make sure we get the best services for citizens as we transition into the MCO. Mr. Rojano clarified that UNC wanted to do the study when they were under pressure from WakeMed to purchase Rex Hospital. UNC’s purpose was to see if they should build a psychiatric facility in Wake County. Therefore the study was based on an analysis of gaps to see what kind of facility they would build. UNC is not under the same political pressure.
21. Per Capita Allocation (MOE). Everybody will be equal under the Medicaid Waiver, so this is the time to advocate for equality in the per capita allocation for the entire state. Big advocacy point would be to change the state formula as of January 1, 2013. Advocate for fair funding formula for non-Medicaid clients.
22. Dr. Hartye said it seems we are talking about (1) what is the right type of service model, and (2) a new firewall between services that will be continued by the county in the county versus those funded by the MCO. Dr. Johnson said there is a commingling of dollars. He said many programs interact, so the utilization on one program impacts on utilization of another. Dr. Keith McCoy said the dollars cannot operate in silos or we’ll end up with a broken system. He believed the county cannot decide what its priorities should be unless it understands what the MCO is funding. This has to be done with regular communication.
23. Dr. Johnson said we need to understand that this is Wake County’s MCO, and Wake needs to own it. Wake and Durham will be partners. Wake will have multiple seats at the table to provide oversight and appraise performance.
24. Ms. Foreman said to stay tuned to the legislative short session and to proposed changes in G.S. 122c in what is on the table in the interest of counties.
25. Mr. Rojano suggested concentrating on advocacy at the state. Many things are not known today with the MCO. Based on this discussion, Chair Treadway suggested continuing discussion of priorities at the next committee meeting. Ms. Treadway, Mr. Escobar and Dr. Johnson will meet before the next meeting and narrow down priorities.
Ms. Foreman said the county is learning more and making more progress and getting more refined everyday. However, the list of undone items is huge.
The goal is to have the interlocal agreement document ready by January 5, 2012. That would then start its way through the review and approval processes of the Wake and Durham Boards of Commissioners. Anticipating to use the January 9, 2012 Wake County Commissioners Work Session to focus on this topic and on the terms of the agreement. If all goes well, anticipate approval at the January 17, 2012 Wake County Commissioners' meeting and at the January 23, 2012 Durham County Commissioners’ meeting. Once approved, staff can figure out the final definition and path for board appointments. The initial recommendation is that the Wake Board of Commissioners can appoint three members to join The Durham Center Board as soon as we have an agreement. Ms. Foreman said there are significant decisions for the MCO during the first five month timeframe, and therefore, the county will need to have great board representatives. The board appointment process is currently proposed to mirror The Durham Center’s (TDC) current appointment process. TDC has a vetting process where candidates meet with representatives of TDC Board and they make sure there are no conflict of interest issues.
There are a number of components of the agreement that we don’t have final agreement on. A lot of this is contingent upon the Performa. The Performa has been a moving target.
Staff is moving forward with a corporate headquarters and a local site in Wake and in Durham. The Durham Center is working through staff hiring process. Dr. Carlyle Johnson has been selected as the Wake County Site Director. This has been an open and competitive hiring process open to Wake, Durham, Johnston and Cumberland LME employees. There have been representatives from Wake Human Services and Durham Human Services on the hiring selection panel. Ms. Ellen Holliman, TDC CEO, is making the final selection decisions for the top management level. To date, there have been five selections made and more selections this week. Once the top level management selections are made, they will refine the organization chart of how/where positions fit, responsibilities/roles, credential requirements, and start working through the hiring process. Envisioning about 400 employees between all four counties, 300 of which are with the MCO. There are lots of job opportunities if staff choose that path.
Ninety-six Wake County LME employees received Reduction in Force (RIF) notifications on December 16. These employees have until December 23 to decide their path forward option: (1) placement with new MCO or Wake County, (2) retirement severance, or (3) termination severance. LME employees will remain Wake County employees until June 30, 2012, as long as Wake is continuing LME operations.
LME staff are continuing LME work, planning for MCO, and serving on work teams.
Mr. Rojano explained the different processes: 1. LME regular activities until June 30, 2012. However, there will be an overlap with contract services until December 2012. 2. From July 1 – December 31, 2012, the MCO will have to perform LME services. Then January 1, 2013, the MCO will
begin the waiver implementation. 3. As of July 1, 2012, LME staff will no longer be county employees. Wake County has made a decision to hold current
vacancies open to accommodate staff who want to continue employment with Wake County. 4. There will be some critical gaps, but Wake County will backfill vacancies to continue LME operations.
5. On paper there are more positions than staff in the MCO organization.
Mr. Rojano said Wake has been a part of the MCO co-creation from the inception. *Note: Also see the LME Administrator’s report.
Committee Workplan and Priorities for Jan.-June 2012
Committee Workplan and Priorities was covered in the discussion on advocacy priorities and will be continued at the January committee meeting.
Annual Provider Network Compliance Reports
Ms. Miki Jaeger, LME Services Program Manager/Quality Assurance, presented and answered questions on the following reports. An information report will be presented to the HS&ES Board at their January 2012 meeting.
1. Wake LME Provider Performance Reporting FY11 I. Compliant Reporting II. Incident Reporting III. Endorsement Status IV. Letters of Support V. IPRS Provider Compliance (new report this FY)
2. Wake LME Annual Review and Performance Reporting FY11
I. Accessibility Plan Review II. Health and Safety Plan Review III. Utilization Review Team Annual Review IV. Call Center Satisfaction V. Access Center Annual Review VI. Care Coordination Annual Review VII. Internal Performance Indicators
Ms. Jaeger noted that the Wake LME CARF Accreditation expires four weeks before the planned MCO merger. Wake will fall under Durham’s accreditation (URAC) for the MCO. Already beginning to work on the new URAC accreditation for Durham. Additional aspects of URAC accreditation will need to be obtained. (note: State is aware of Wake County’s situation and is in agreement.) The committee complimented the detailed information contained in the reports. Committee Advocacy Points: • Trends indicate that in times of crisis, people tend to migrate to areas where services and job market are stronger. Wake
needs to advocate for state allocation dollars, because some of the gaps and needs are coming this way. • Dr. Hartye asked if the cuts affecting need for services are from STR funds or in-service funds. Dr. McCoy said these are
service funds and that STR tells us that more people are being referred for services. Therefore, there is a cut plus an increase in utilization.
• Dr. Hartye said the N.C. Hospital Association is a potential strong ally because they have a great interest in the increase in funding and services. He asked if staff could put these two pieces together in a one-pager for next month discussion.
• Vice Chair Escobar asked Dr. Hartye and Ms. Denise Foreman to send an email to him and Chair Treadway on their advocacy ideas.
LME Director/ Administrator Updates
Dr. Carlyle Johnson, LME Administrator, made the following comments: • The Merger/Transition Update will be a standing monthly committee agenda item.
• Reinforced that there are many details remaining and that workgroups have been developed to figure out details.
• Reinforced that as staff get new positions, they will be asked to start the new positions right away. Will negotiate with Durham to see if staff can work a split percentage with Durham and with Wake during transition period. Wake will be doing backfilling for staff who have to move on and/or developing creative strategic work with remaining LME staff (e.g., staff may take on additional internal assignments and/or there may be some tasks that the LME will stop doing). Also looking at hiring temporary staff where feasible. If there is enough attrition in some areas, discuss with Durham to start functions as a shared entity before June 30. There also may be shared staffing agreements. This is all contingent upon the approved merger agreement.
• Effective July 1, 2012, it becomes Durham/Wake multi-county LME. Wake is also working on how wrap up/fiscal year responsibilities will be transitioned (audits, contracts, etc.).
• Mr. Fox asked if there will be a function for the LME Advisory Committee. Ms. Foreman said we have not yet worked out how the MCO board will have committees. She said PBH is a different example. Because they don’t have as many representatives from each of the counties on their board, they had to set up mid-level advisory capacity because they represent 15 counties. However, Wake County will have a strong voice on the MCO board, so that advisory role is not as great as with the PBH model.
• Mr. Fox stressed that the Wake/Durham MCO population will be greater than with PBH and believed that a voice is needed for the people.
• Dr. Hartye said the range of needs for representation will be great.
• Mr. Edgerton asked if the revision of G.S. 122c will address the board. Ms. Foreman said it is currently being proposed. She said many different models have been discussed, and N.C. Councils across the state had a list of items that their memberships are interested in addressing. The NC Association of County Commissioners also had a list of items representing interests of the counties. She believed there will be an agreeable blend. Don’t know what will be introduced in the legislative short session.
• Ms. Foreman said that in a good governance model, one would want advisory groups/community input.
• Mr. Edgerton asked if The Durham Center Board or other multi-county area programs have advisory groups now? Mr. Edgerton said this is something this committee could advocate for. The committee asked staff to find out.
• Dr. Johnson believed the MCO will need to have local presence in each area and figure out how in their area they regularly get the advice of their community. Consumer and family input will be through local CFAC subcommittees. The local sites would need to connect and figure out how appointments would work, structure, bylaws, etc.
• Dr. Johnson asked what would be the appointing body of an advisory committee if there is one—would it be a subcommittee of the MCO board or another option? We currently have multiple advisory groups that don’t necessarily tie together, such as the Child Collaborative, the JCPC, and the Wake Crisis Cooperative. He suggested to pull together an inventory and to see how they get tied together.
Meeting adjourned at 2:01 pm. Next meeting is January 17, 2012, CSC 12:00 pm– 2:00 pm
Board of CommissionersBoard of CommissionersBoard of CommissionersBoard of Commissioners
Meeting Agenda
January 17, 2012 – 2:00 PM
Meeting Called to Order: Chairman Paul Coble Pledge of Allegiance Invocation: Commissioner Tony Gurley Items of Business 1. Approval of Agenda 2. Approval of the Minutes of the Commissioners' Regular Meeting of January
3rd and January 9th Work Session 3. Recognition of National Arts Program Winners Among Wake County
Employees and Their Family Members
4. Proclamation to Recognize Wake County's Participation in Project
Homeless Connect and to Proclaim January 24, 2012 as Project Homeless Connect Day
5. Retiree Recognition
Consent Agenda All items on the Consent Agenda are considered to be routine and may be enacted by one motion. If a County Commissioner requests discussion on an item, the item will be removed from the Consent Agenda and considered separately. 6. Accept and Appropriate $1,142,904 in Shelter Plus Care Grant
7. Accept and Appropriate $180,000 from Casey Family Programs For the
Wake County Foster Care Program
Regular Agenda 8. Public Hearing and Grant Application Authorization for Wake Coordinated
Transportation Services 2012-2013 Community Transportation Program Assistance
Public Hearing Format: a. Introduction b. Open Public Hearing c. Comments from Interested Parties d. Close Public Hearing e. Board Action
9. EMS Department Request to Apply for the CMS Health Care Innovation
Challenge Grant
Appointments (It is customary for nominations to be made for vacancies on each board or committee, and a collective motion made to accept the nominations.) 10. Eastern Wake Fire Department Board of Directors
Other Items 11. Committee Reports 12. Other Business 13. Closed Session 14. Adjourn Public Comments: Comments from the public will be received at 2:30 p.m. for 30 minutes. A signup sheet for those who wish to speak during the public comments section of the meeting is located in the back of the Boardroom.
Wake County Board of Commissioners meetings are broadcast live on cable channel 11 & rebroadcast on
Fridays at 7 p.m. The meetings are also available via video-streaming on the County’s website –