Board Meeting Minutes - February 10, 2003

Meeting Held at
Fourth Street Station
401 4th Street N.W.
Charlottesville, Virginia

Members Present
Peter L. Sheras, Ph.D., Chairman
Barbara Barrett
Paul Belair
Rev. David M. Cameron
Rudolf A. Kaufmann, Ph.D.
Rodney D. Kibler, Ph.D.
Irene S. Rebholz
John J. Trippel
Carole Z. Wernstrom, RN, MSN
Stephen Wunsh

Members Absent
Susan B. Garrett
Carol Johnston
Michael C. Murphy
Roxanne White

Others Present
James R. Peterson, Executive Director
Downing Miller, Director, Access and Quality Assurance
David T. Moody, M.D., Medical Director
John Pezzoli, Director, Behavioral Health Services
Reed Banks, Director, Community Support Services
Evelyn Cotton, Mental Retardation Residential Services Program Manager
Martha Maltais, Recruitment and Training Specialist
Margurite Murray, Director, PACT
Linda Wells, Consumer Advocate


I. CALL TO ORDER

Dr. Sheras, chairman, called the meeting to order at 6:13 p.m.

II. WELCOME AND INTRODUCTIONS

Dr. Sheras reported that Ms. Johnston and Ms. Garrett are out of town, Ms. White is attending another meeting, and Mr. Murphy will be late and may not be able to attend.

Mr. Peterson introduced Ms. Linda Wells, Region Ten’s consumer advocate. Ms. Wells said that she is a native of Charlottesville, and that she has extensive volunteer service with the American Cancer Society and in political campaigns. She worked for nine years at the American Red Cross and then for five years with the Green Thumb program through the Department of Labor. She also worked as an ombudsman at JABA in the assisted living program dealing with human rights issues.

III. COMMENTS FROM THE PUBLIC ON ITEMS NOT ON THE AGENDA

Dr. Sheras asked if there were any comments from the public. Hearing none, he proceeded to the next agenda item.

IV. SPECIFICATION OF OTHER ITEMS TO BE ADDED TO THE AGENDA

Dr. Sheras asked if there were other items to add to the agenda. No items were added to the agenda.

V. CHAIRMAN’S REMARKS

Dr. Sheras thanked Ms. Garrett in her absence for so ably running the meeting last month when he was out of the country. He said there are so many wonderful and competent people on the board. He added that he had a fabulous trip and at some point would like to talk about the holistic approach followed in India where the mental health component is completely integrated into everything, and how we could take a lesson from their approach.

VI. APPROVAL OF THE JANUARY 13, 2003, BOARD MEETING MINUTES

ON A MOTION BY MS. BARRETT, SECONDED BY MS. REBHOLZ, THE MINUTES OF THE JANUARY 13, 2003, BOARD MEETING WERE UNANIMOUSLY APPROVED AS DISTRIBUTED.

VII. PRESENTATION ON REGION TEN’S EMPLOYMENT SERVICES AT PACT
(PROGRAM FOR ASSERTIVE COMMUNITY TREATMENT)

Dr. Sheras announced that the item shown on the agenda--a presentation on Western State Hospital by Mr. John Beghtol--has been rescheduled for the April board meeting.

Mr. Reed Banks, director of Community Support Services, said that PACT began three years ago, and that although the employment services are headquartered at Blue Ridge House (BRH), the PACT program also has an employment services component. Ms. Margurite Murray, PACT director, said that Mr. Steve Davis with the PACT program is the employment specialist, and he works with Ms. Melissa Garth at BRH and is therefore able to access Department of Rehabilitative Services (DRS) funding for employment services. There are now 11 PACT members working and three in non-paid work situations and 3 students.

Ms. Rebholz asked if there were also non-PACT consumers who also do not participate in BRH. Mr. Banks responded that there are a few consumers who choose to not come to BRH, and that it is not a requirement to be a BRH member.

Ms. Wernstrom asked how the PACT services can be put together with employment services given the intense level of treatment required for PACT participants, by definition they would not be functional enough to be employed. Ms. Murray replied that participation in PACT is ongoing, so after three years of program operation with intensive treatment, some consumers have progressed far enough to get employment, and that is why the job support component is so important. There are little triggers that can throw the consumer off such as transportation problems and even in one case, help with how to handle the free time during breaks at the consumer’s job site. She described one consumer who is employed at Harris Teeter as “a superstar at his job.”

Dr. Sheras asked about the current census in the PACT program, and Mr. Banks said there are 80 of which 17 are engaged in work or work-like activity.

VIII. EXECUTIVE COMMITTEE REPORT

Dr. Sheras said that the minutes of the meeting were on the table, and that the brief meeting primarily addressed final arrangements for the upcoming CARF visit.

IX. FINANCE COMMITTEE REPORT

Mr. Wunsh said that the FY 2002 audit report presented and accepted at last months meeting was placed back on the agenda for this evening in case anyone had any more questions or comments on the FY 2002 audit report. Dr. Sheras asked for questions and there were none.

X. CARF COMMITTEE REPORT

In the absence of Ms. Garrett and Mr. Murphy, Mr. Peterson reported on the CARF committee meeting and said that responses to the “Frequently Asked Questions” of board members by the CARF surveyors had been formulated and included in the board mailing. Further, updated copies of sections I, II and III of the CARF Survey Prep Manual were also distributed. Ms. Barrett observed that her copy of Section III was actually another copy of Section I. Mr. Peterson apologized for the copying error and said he would immediately mail out Section III to all board members.

Dr. Sheras said the CARF survey orientation session will be held at 8:30 on Monday, February 24, at Blue Ridge House, and encouraged all board members whose schedules would permit to attend the orientation session. The CARF surveyor will then interview Dr. Sheras followed by an interview of board members. Ms. Garrett, Mr. Murphy and Ms. Rebholz will participate in this. The CARF visit will wind up the next day at 2:00 with an exit meeting at BRH at which time the surveyors will provide feedback on their experience over the two days. This session is open to anyone who would like to attend.

XI. PERSONNEL COMMITTEE REPORT

Mr. Trippel reported for the Personnel Committee and reviewed the minutes of the meeting. The committee approved the revisions to the OSHA exposure plan and then heard from Ms. Jane Lewis, director of human resources, on the process and schedule for the selection of next years health insurance contract. It is likely that there will be significant increases in premiums, possibly ranging from 18 to 25 percent. The committee will probably revisit the issue of single employees’ paying zero toward their coverage given the anticipated increases. The insurance subcommittee will look at all aspects so that a selection can be made in time for the new contract to be implemented in September.

Mr. Peterson called the members attention to the chart of scenarios showing the total costs to the board and employees if rates were to increase as Mr. Trippel had described. The board had included an increase (on an annualized basis) of $168,000 in the initial proposed FY 2004 budget in anticipation of increased premiums. The cost to the board for the various scenarios ranges from $210,000 to $292,000.

Mr. Trippel described the process for the annual performance evaluation of the executive director, and how the committee reviewed and revised the performance survey forms and have sent them out to board members and staff directors. He said that the comments respondents make on the forms are more helpful than the numerical ratings although the latter does provide a mechanism for the board to aggregate responses. The committee may need to schedule an extra meeting in March in order to complete the process in time for the April board meeting.

Ms. Rebholz said that she was glad to see that the insurance would be going out to bid. Mr. Peterson said that a meeting was held earlier today with representatives of MAMSI (the current health insurance plan), the Virginia Association of Counties, and with Mr. Sam Rosenthal, Region Ten’s independent insurance consultant. In order to meet the proposed bid cycle, there would be no experiential data available for the period since we went to the new plan, and therefor companies would have to base their prices on our experience with the previous plans (MAMSI and Trigon). This poses a serious dilemma because it is anticipated that experience will be significantly better under the new plan, but to delay the bid process in order to get current data would put the process too late for the September renewal deadline. One possibility for the future would be to add another 10 months to the next contract so that the renewal would move to July 1 of each year and be in synch with the budget fiscal year. This does not, however, help at all with the present dilemma.

XII. STRATEGIC PLAN UPDATE

Mr. Peterson called the members’ attention to the strategic plan update which incorporated the formatting changes for objectives including their current status. Mr. Peterson noted that the process for updating the State Comprehensive Plan and incorporating new local strategic planning and input will begin at next month’s board meeting. Ms. Wernstrom said that given there were some board members absent, she thought any action on the revisions should be postponed until next month. After some discussion that the revisions were not substantive, Dr. Sheras asked if the board were ready to vote.

ON A MOTION BY MS. BARRETT, SECONDED BY MR. BELAIR, THE REVISED STRATEGIC PLAN WAS APPROVED AS DISTRIBUTED, NINE AYES, MS. WERNSTROM, NAY.

XIII. MENTAL RETARDATION SERVICES ADVISORY COMMITTEE REPORT

No report. The committee did not meet.

XIV. DIVISION UPDATES

Dr. Sheras reported that three board members (Barrett, Sheras, and Wernstrom) attended the two hour Web-Ex and telephone conference data consultation presented by David Lloyd to Region Ten’s directors. The presentation was incredibly interesting in two ways, the extent of the actual information shown through the use of the data, and second, it demonstrated the importance of submitting and coding accurate data. In the not too distant future, Region Ten will be able to see the benefit of this process and help staff to focus in on what programs and staff are doing, and the extent to which Medicaid is playing into the mix.

Ms. Miller reported that Region Ten’s new system of utilization management is now recording the number of authorized visits, and is reauthorizing additional service in a timely manner. There remains a great deal to do, but progress is continually being made.

Mr. Brown said that the members of the Quality Management Council participated in the regular monthly Web-Ex session this morning but with January data instead of the December data used at the special Web-Ex presentation described earlier by Dr. Sheras. The January data already showed progress in refining data that is essential to effectively manage programs and supervise staff. Dr. Sheras said theat we will probably soon be entering the next phase of budget cuts, and this kind of data and analysis will help with the difficult decisions.

Mr. Wunsh noted that the financial reports included in the board packet showed a decline in fees, but he has subsequently learned that this was due to a posting that occurred after the cutoff date and that in actuality, the fees remain on target and this will be reflected in the January report.

Mr. Pezzoli said that the organization continues to move toward full integration of all services, and that the name that best reflects the overall range of services in the new combined services division is Behavioral Health Services Division. This is the official name of the Community Services Boards which have been converted to authorities (e.g., the Richmond Behavioral Health Authority), and is also the most prevalent name adopted nationwide for similar programs. Mr. Pezzoli said that applications for the new Meadowcreek director position closed today, and the Ms. Barrett will join with him to serve on a small committee to interview applicants. Mr. Pezzoli also observed that the month of January has seen lots of change and confusion with all of the new forms, procedures, etc., with lots of stress and staff anxiety over the new ways of performance measuring, and all of this is going on at the same time that regular business must be maintained in order to achieve service and revenue targets. Although management and staff are continually seeking to work things out, Mr. Pezzoli now sees that it will likely take a full year of process to achieve the promise of the new approach.

XV. VIRGINIA ASSOCIATION OF COMMUNITY SERVICES BOARDS (VACSB)
REPORT

Ms. Rebholz noted that the annual legislative conference in January is relatively short, yet the board members were able to successfully visit many legislators at their offices in the General Assembly. Ms. Rebholz subsequently looked up the boundaries of Senator Frank Ruff’s territory and with the redistricting, he now has Fluvanna County, so Ms. Rebholz followed up with him. Dr. Sheras said that the VACSB and board members have been doing a good job in involving the General Assembly, but unfortunately there are very few resources available this time around. Ms. Rebholz said that it is very encouraging to see that the entire VACSB is working together in a unified approach. M. Belair reported that many of the legislators they spoke with are making an effort to hold the line and not cut community services any further, and much of the credit for this goes to the VACSB. Ms. Rebholz said that there were many interesting workshops, and she suggested in particular that perhaps there should be a presentation on the Advanced Pharmacy Solutions service that is now available in Virginia. Finally, she noted that the next meeting of the VACSB will be held in Williamsburg on May 8 and 9.

XVI. BOARD MEMBERS’ REPORTS ON PROGRAM VISITS AND OTHER
REGION TEN ACTIVITIES

Ms. Rebholz was unable to attend the Executive Committee meeting because she had scheduled to take two members of the Fluvanna County Board of Supervisors on a tour of Friendly Oaks in Mineral. She said it was a real eye-opener for them, and that one of her guests thanked her because she hadn’t understood the vast extent of what Region Ten does. Ms. Rebholz followed up the visits with a letters.

Mr. Banks invited board members to visit the Dual Recover Center (DRC) noting that one of the HUD (Department of Housing and Urban Development) requirements for the grant support is to allow for board members to interact with homeless persons. Region Ten has held a board meeting at the DRC in the past and will hold another there soon, but the board members should also visit during program hours and the morning is the best for that. Mr. Pezzoli invited board members to call him (972-1833) and he would set up visits that are convenient for all.

Rev. Cameron reported that one of the members of Horizon House in Lovingston passed away. The deceased did not have any family or assets, and so the husband of Ms. Marcia Becker (director of Horizon House), held a service at the cemetery. The members then went to Horizon house where they were able to say what they felt about how the community celebrates both life and death.

Ms. Rebholz reminded the board members about the upcoming trial of the Mohr Center staff member to be held on February 27, and how they should attend to show support. Mr. Peterson will send out a written reminder as the date approaches.

XVII. OTHER BUSINESS

Ms. Wernstrom said that it is her experience from Working in the UVa psychiatric inpatient service, that one-half of the persons referred from UVa do not keep their follow up appointment at Region Ten. Ms. Wernstrom has some ideas about this situation, and after seeing the David Lloyd Web-Ex presentation, she sees how data could be accumulated and she will talk with Ms. Miller about this.

Mr. Belair said that he saw in the Richmond Times Dispatch this morning how millions of dollars are owed by Medicaid to transportation companies for transporting consumers to medical appointments and to services at Community Services Boards. He asked if there has been any follow through on the transportation situation he brought up last month. Mr. Pezzoli said that DMAS (the Department of Medical Assistance Services) is very favorable toward improving the transportation service and is working with the individual boards and with the VACSB on this.

Mr. Wunsh reminded the board members of the recognition for Ann White to be held on February 20 at 4:00 p.m. at the Meadowcreek Center.

The meeting was adjourned at 7:41 p.m.

Respectfully submitted,

Paul Belair
Secretary