Division of Community Health and Prevention
1112 S. Wabash, 4th Floor
Chicago, IL 60606
Date and Time
January 23, 2008
11:00 a.m to 2:00 p.m.
1-800-864-4804 and Passcode 6155860#
- Welcome and Introductions
- Overview of the Opening Meetings Act (Legal staff)
- Review of the Family Case Management Act
- Impact of New Federal Rules on Family Case Management (Ralph Schubert)
- Restructuring Recommendations
- Report of the Family Case Management Restructuring Committee
- Draft Amendments for Restructuring FCM
- Review of Draft Risk Assessment Tools
- Recommendations for Charter and Infant Mortality Summit
- The Selection of Family Case Management Providers
- Discussion of future meeting dates
- Discussion of the selection of new members
- Ethics Training for Boards and Commissions
- Board attendees (in person): Stephen Laker, Doris Lomax, Agatha Lowe, Kathy Bennett, Patricia Donald, Myrtis Sullivan, Elizabeth Patton, Mary Lou England, Paul Kuehnert, Karen Ayala.
- Board attendees (phone): David Remmert, Miriam Link-Mullison
- Staff attendees: Vivienne Dawkins, Glendean Sisk, Jerry Wynn, Ralph Schubert.
- Public attendees: Jim Nelson
Myrtis Sullivan opened the meeting at 11:00 a.m. with welcome and introductions.
Open Meeting Acts
Dr. Sullivan gave an overview of the Open Meetings Act. Ralph reminded everyone that meetings will have to be posted 48 hours prior to the meetings at the meeting location and on the Internet. It was noted that a quorum has to be present to vote on issues of the board. There are a total of 29 members on the board with on 18 being appointed, until the rest of the appointments have been made only 10 members have to be present to vote on board issues. Also, the size of the subgroups determines whether or not subgroup meetings would be under the Open Meetings Act. With a membership of 29, a subgroup of 9or more would fall under the Open Meetings Act.
Review of the Family Case Management Act
Glendean Sisk reviewed the Family Case Management Act with members. Term of appointment is 3 years. Purpose is to advise the Secretary on matters regarding rate structure and other activities related to maternal and child health and infant mortality reduction programs in Illinois. Members shall represent public health agencies, IHFS, IDPH, DCFS, legislators, IDHS, physicians specializing in pediatrics and in obstetrics and gynecology, nursing, community- based agencies, and consumers of maternal child health services. The Board will review and make recommendations to the Department and the Governor in regard to the system of maternal and child health services in Illinois, including collaboration and interrelations among FCM, WIC, TIPCM, and HWIL. The Board may hold hearings throughout the state, and will submit an annual report to the General Assembly on January 1 of each year. This report will include a list of activities taken in regard to Act, other activities related to maternal and child health and infant mortality reduction, and recommendations regarding funding and reimbursement levels to adequately support family case management programs.
Impact of new federal rules on FCM
Ralph explained the federal rules on Optional Targeted Case Management services under Medicaid and the impact that they may have on FCM. Ralph agreed to send the new federal rules to board members electronically. Many states amended their Medicaid plans to implement Optional Targeted Case Management services. Many states also took advantage of this option to obtain Medicaid reimbursement for services similar to case management that were part of other state- or federally-funded programs. The federal Center for Medicare and Medicaid services is now hoping to cut Medicaid expenditures by $1.3 billion by 2012 through these new rules. Illinois did not establish Family Case Management as a Targeted Case Management service, so this change shouldn't affect FCM directly.
The State of Illinois considers Family Case Management expenditures as a part of the cost of administering the state's Medicaid program. Nevertheless, some aspects of the new federal rules may cause concern, including:
- The new rules prohibit states from treating case management programs that have a comprehensive definition of case management as administrative expenses. FCM has used a comprehensive definition of case management for some time, but its cost allocation plan conforms to federal requirements for administrative claiming.
- States may only claim the overhead or operating cost of organizations whose sole purpose is the administration of the state's Medicaid plan. This may require us to exclude the outreach and operating expenses of FCM grantees from our claim. Ralph is still investigating the impact this will have.
- The new rules prohibit states from defining child welfare services as Targeted Case Management. This may affect Illinois' ability to claim matching funds for HealthWorks Medical Case Management, since these services are provided by IDCFS employees (and DCFS contractors) for children who are over six years of age.
- The new rules require that case management services be provided by a single case management provider in order to ensure that services are comprehensive and to avoid duplicate payments. This may require the Department to adopt policies to preclude dual participation in programs such as FCM and Early Intervention.
- The new rules prohibit states from using "bundled reimbursement" methods to pay for targeted case management services. This will have a significant impact on the Early Intervention program (which pays for case management using a monthly rate).
While the public has an opportunity to comment on the rules, they will become effective on March 8, 2008 regardless of public comment.
- Ralph will get new rules and distribute to board members.
- Ralph will obtain a copy of the comments that IDHFS submitted to the federal Center for Medicare and Medicaid Services .
- Subcommittee will write letters to Senator Durbin, Obama, Governor Blagojevich, and Legislatures asking for support as the new rules affect every program under DHS. Ralph will draft a letter from Secretary Adams to the members of Illinois' Congressional delegation. David Remmert will hand deliver the letter to Senator Durbin. The subcommittee will contact professional organizations to address these issues as well. Deadline to have letter completed for distribution is January 30, 2008.
Restructuring FCM/Draft Risk Assessment Tools
Ralph reviewed the work of the Family Case Management Restructuring Task Force. The task force was formed to address the financial viability of the program. Other than a three percent increase to reflect the increasing cost of operating the program, the appropriation for Family Case Management has remained essentially unchanged for more than a decade. At the same time, rising costs have forced local service providers to increase caseloads, decrease costs and direct staff resources to participants at the greatest risk. The task force was convened to recommend changes to the program that would make it economically feasible for local agencies to continue providing services.
The task force recommended that the program be restructured so that local agencies could manage their caseloads on the basis of risk. A prenatal risk assessment tool was developed and pilot tested for one month by two local health departments. The pilot test found that the tool divided prenatal clients into three groups (low, medium and high risk) of approximately equal size.
The next steps in the restructuring process include the following:
- Completing risk assessment tools for infants and older children;
- Developing model protocols for use of the tools;
- Incorporating the screening tools into Cornerstone;
- Developing new and modifying existing Cornerstone management reports;
- Conducting a more extensive pilot test of the tools, protocols and management reports;
- Amending the administrative rules for case management (proposed amendments in draft form were distributed during the meeting); and
- Modifying Family Case Management training to reflect the new requirements and procedures.
Glendean suggest forming a committee. Agatha Lowe suggested creating performance measures (follow-up) after the tool is released to track effectiveness. Jo Ann Durkee is in the process of pulling raw data from the first assessment tool piloted to track progress.
Jim Nelson suggested that if the rules are under the old or new FCM Act. The FCM rules need to be promulgated under FCM rules.
- Get input and pilot testing on risk assessment tools
- Change rules and Cornerstone to be able to implement change
- Form subcommittee to revise tools, review, pick six (6) pilot sites, get Cornerstone approval, etc. Glendean will head up committee with Vivienne Dawkins, Miriam Link Mullison, Elizabeth Patton, and Agatha Lowe.
- Glendean/Ralph will provide full copy of restructuring guidelines
- Get legal advice
- Look at data to see what needs to be done for the future
- Subcommittee will provide recommendations to board on how to proceed.
Infant Mortality Summit
The Infant Mortality Summit has gained a lot of support. The last summit focused on needing to start care early in life, a preconception approach. The ten point system suggest, reducing low birth rate and prematurity; preconception care; employment; and taking a more holistic approach to care. Summit II will be held on Wednesday, March 26, 2008 at The University of Illinois at Chicago.
If anyone would like to attend Dr. Sullivan will submit names. Data from summit will be on the website.
Selection of new members
A list was provided (in packet) that listed committee members appointed by the Governor and vacancies that need to be filled on the board. Vacancies should be filled before the next meeting. Dr. Sullivan is asking for suggestions from the board. Vivienne would like to fill the Community-based position. Jerry Wynn suggested Dr. Eddie Swift OB/GYN to fill one of the physician's vacancies. Dr. Swift works for the Stroger Hospital in fetal medicine. Dr. Sullivan will contact DCFS, DHS, and HFS for representatives to fill those vacancies. There is all likelihood that Deb Saunders will take the HFS representative vacancy. Glendean Sisk recommended FQFC such as Chicago Family or Erie Neighborhood House.
Doris suggested contacting Legislatures to get a clarification on the duties and responsibilities (criteria) of the board since the legislation was done in 2005 and the board is just now having its first meetings. There are requirements fro the Board that needs to be met to figure out its criteria and go forth. The Board agreed to get clarification before next meeting.
The Act identifies several things to work on.
Comments made by public
Jim Nelson suggested looking at the "As Is" system. The restructuring of FCM came about because four organizations went to Governor for funding, since there wasn't funding the restructuring came about to suggest ways to make FCM viable with current funding. Jim Nelson would encourage the Board to look at the Legislature intent and the broad scope of the FCM Act.
The Board decided that need someone to work them through the legislation then set goals for Board so that the Board report will be written with substance.
- Get legal update and submit to the Board at next meeting.
- Keep subcommittee's going.
- Historical Summary (submittee) David Remmert, Stephen Laker
- Current info. on Infant Mortality
- Names for new members will be submitted to Dr. Sullivan ASAP (please provide resumes and CV's).
Mary Lou England would like to put the draft tools on hold until the Board has all information. Also, need to ask IDPH for a data person so that the Board can have easy access to data. Dr. Sullivan explained that she has tried to talk with the Director, but until a new law comes forth, the aggregate data cannot be released.
Dr. Sullivan sat in on a Title V Conference call. AMCHP gave an update on the President's budget. There will be a cut in the MCH Block grant. Projecting that Illinois will take a 1 million dollar cut, while the nation takes an overall 7 million dollar cut for MCH Block grant. AMCHP is asking suggestions or strategies to propose to Senate for next budget so cuts won't be present in 2009. The Board should monitor this.
Paul suggested since Illinois is taking cuts, in the FY08 federal budget there has been funds set aside for Evidence Based Model for Home Visitation programs, Illinois should apply for this funding. An RFP is due out soon. Dr. Sullivan explained that Ralph has been following this. Doris would like to know if there will be competitive bidding for FCM. The Board decided to keep it as it is.
- Ralph will give an update at next meeting
- Paul will be on the workgroup with Ralph in applying for evidence based funding.
Future Meeting Dates
The board decided to meet quarterly and workgroups will meet more frequently. Dr. Sullivan will e-mail the workgroups and dates and locations will be worked out among the workgroups. Dr. Sullivan's office can assist with setting up locations.
The next MCH Advisory Board meeting will be held on April 30, 2008 in Springfield at the Hay Edwards Building located at 400 W. Lawrence, Suter Conference Room, from 1:00 p.m. to 4:00 p.m. An e-mail will be sent out for potential dates for the rest of the meetings.
Jim Nelson suggested adding a "Public Comments" section to the agenda for the next meeting.
The meeting adjourned at 2:03 p.m.