SRI/ASO Committee Minutes - 02/14/08 

Attendees

  • Bryce Goff, Value Options
  • Cassie Ayres, IARF
  • Cheryl Boyd, Franklin-Williamson Human Services
  • Chris Power, DMH
  • Frank Anselmo, CBHA
  • Frederica Garnett, Delta Center
  • Janet Stover, IARF
  • John Banks Brooks, DMH
  • Linda Denson, Co-Chair
  • Lora McCurdy, IARF
  • Lora Thomas, NAMI Illinois
  • Lynn O'Shea, Co-Chair AID
  • Mike Mulvany, Value Options
  • Mike Nance
  • Ray Connor
  • Tom Troe
  • Tony Kopera, Community Counseling Centers of Chicago
  • Tony Mundy, Interim CEO, Illinois Mental Health Collaborative for Access & Choice

Meeting Minutes

  1. Introductions
    1. Membership List
      1. Email Lynn O'Shea if you have any corrections to the list.
      2. Please let the group know if you have any suggestions for the two vacancies. (One ICG parent and one adult consumer).
  2. Committee Purpose
    1. Archived Information 
      1. Tony Kopera reminded the group that there is access to archived documents from the original Systems Restructuring Initiative Committee which serve as nice reference points and give context to the progress made in fee-for-service transition.
        Chris Power will email Lynn O'Shea the link to the archived information: http://www.dhs.state.il.us/page.aspx?item=32594
    2. Approval of the draft of the committee purpose.
  3. Report from Dr. Power and Tony Mundy.
    1. Change

      1. The purpose of the ASO is to improve services to consumers.
      2. DMH has the responsibility to ensure access to services, that services are appropriate, and that the services are cost effective.
    2. Three Streams of Change
      1. System Restructuring
        1. Despite large (roughly 40%) reduction in staff in January 2003, DHS/DMH wanted to continue with changes in line with the principles from the President's New Freedom Initiative and the Surgeon General Report.
          1. Recovery and resiliency focused
          2. Consumer and family driven services and system
        2. The agency was instructed to move toward fee-for-service.
          1. The state believed that this system would garner more federal funding - $25 million was the target given to DMH by the Governor's office.
          2. It would also increase accountability for the state funding received by agencies.
      2. Transition from Grants Based System to Fee-for-Service
        1.  "Pros" and "Cons" associated with each system
          1. Grants are good for starting up programs but they lack an efficiency and/or productivity incentive.
          2. A fee-for-service system encourages productivity, efficiency, accountability, and allows money to follow the need.
            1. The drawback of fee-for-service is that there is an incentive to produce and deliver services which may not be related to the need.
      3. Contracting with the ASO
        1. Consultants recommended that DMH have a contract with an organization that could help the division manage a fee-for-service.
        2. The division selected Value Options.
          1. Not managed care because contract lacks a financial incentive for the company to limit costs, as is typical of "managed care contracts".
          2. There is no benefit to Value Options for providing financial savings.
    3. Fee for Service and Contract Reductions
      1. Per the FY 08 contract, for the last six months of the fiscal year there could be a 10% fee-for-service component in agencies' contracts that had to be earned.
      2. DMH elected not to have a January adjustment, but did apply this provision for the January payment.
      3. Agency is currently looking at March payments.
        1. 6 of the roughly 70 agencies have fully recovered the reductions in their payments in February, with additional agencies achieving partial recovery.
      4. One concern is that as pressure increases for agencies to increase the number of billed hours, what safeguards are in place in order to prevent shortcuts?
        1. DMH designed the system to minimize those effects.
        2.  Agencies must provide adequate documentation.
        3. Readiness Reviews to identify issues and barriers.
    4. Value Options
      1.  Background
        1.  Headquartered in Norfolk, Virginia.
        2.  Privately owned.
        3.  Operates in almost every state, with Illinois being the twelfth state where a public sector contract is held.
      2. Infrastructure
        1. Helping DMH build infrastructure in Illinois.
          1. Offices in Chicago and Springfield.
          2. Local decision-making authority.
    5. Activities
      1. DMH announced the selection of Value Options.
      2. Developed and implemented prior authorization process for ACT/CST.
        1. Phone line is operational.
          1. Can this be anonymous?
            1. Yes.
        2. Following obtaining stakeholder feedback on the process, completed training on prior authorization process in January.
        3. Website is functional.
        4.  Consumer Handbook.
          1. First edition will be available soon.
          2. More developed and detailed handbook will be available early spring.
          3. Available in both English and Spanish versions.
          4. Value Options will distribute handbooks to agencies.
            1. Need to be available anywhere where consumers collectively gather.
          5. Provide additional comments regarding the handbook to Chris. UPDATE: New DHS/DMH lead staff on this has been identified: Eldon Wigget at ELDON.WIGGET@illinois.gov.
      3. ICG Grants
        1. Working on concurrent review system to ensure that services are appropriate.
    6. Quality Improvement
      1. Quality committee within the division looks at the whole system.
      2. Training and Monitoring.
      3. Took several databases, resolved inconsistencies then pre-populated forms and sent to providers for verification.
      4. Need access analysis for each service to reveal if there are gaps in the state.
      5. Need to move toward better accountability.
      6. Increase quality of services to ensure that it is benefiting the consumer.
      7. Recovery Focus.
      8. Need organized, understandable, and creative ways to look at data to achieve a better understanding of consumer populations, measurements, and accountability.
    7. Implementation Challenges noted by Committee members
      1. Identifying services that are billable.
      2. Training on codes.
      3. Rates are inadequate.
      4. Unknown start up cost.
      5. Contract structure needs adjusted.
      6. Have to sell it to consumers.
    8. Access and Utilization
      1. Starting to get historical data and looking at trends.
    9. Provider Focus Group
      1. IT met on Feb 4th to see the tools and process available to the Collaborative through Value Options and provide feedback on barriers/challenges.
      2. Good representation of agencies.
    10. Input requested by DMH from this group
      1. Consumer Handbook
      2. Provider Handbook
      3. Collaborative processes
      4. Provider Survey
        1. In the spring.
        2. In regards to service needs and prior authorization processes and how they are working.
    11. Utilization Management.
      1. Recovery Orientation
      2. Medical Necessity
      3. Redirection of Resources
        1. Appeal Process
      4. Balance between choice, medical necessity, and recovery orientation.
        1. Approaches.
          1. Education
          2. Recovery Indicators
          3. Feedback/Grievances
          4. Provider Education
    12. Tentative Agenda for Next Meeting-March 13
      1. Consumer Handbook
      2. Quality Improvement
      3. Training Update
      4. Data Warehouse Update
      5. Children's Services