Illinois Mental Health Planning and Advisory Council

SRI-ASO Committee

June 12, 2008

  • Amy Starin, DMH
  • Cassie Ayres, IARF
  • Cheryl Boyd, Franklin Williamson Human Service
  • Denise Daum, Community Resource Center
  • Eldon Wigget, DMH
  • Frederica Garnett, Delta Center
  • Judy King
  • Jackie Manker, DMH
  • Kathy Roberts, CBHA
  • Linda Denson
  • Lydia Tuck, CEO, Illinois Mental Health Collaborative for Access & Choice
  • Lynn O'Shea, Co-Chair AID
  • Mike Nance
  • Ray Connor
  • Robin Garvey, Mildred Berry Center
  • Sondra Frazier
  • Sandy Lewis, McHenry County Mental Health Board
  • Stephanie Hanko, HFS
  • Tom Troe
  • Tony Kopera, Community Counseling Centers of Chicago
  1. Introductions
    1. Membership recruitment update - revised list enclosed
    2. Consumer and family recruitment update
      1. Kathy will confirm if Kim Adams is going to join IMHPAC SRI-ASO committee.
  2. Review and approval of documents
    1. May 8th meeting minutes
      1. i. Accept and approve the minutes
      2. ii. We need to share our minutes with other committees to ensure that duplicate work is not going on.
    2. Committee Goals and Objectives
      1. If this committee is making recommendations about services, we need to coordinate with other committees before going to the larger IMHPAC or DMH.
      2. Motions could be sent one way or another to committee members.
        1. Make a separate document of motions to be sent to committee chairs.
      3. Goals and Objectives document is approved and accepted by the committee.
        1. Needs to be forwarded to the IMPHAC committee. It fulfills the larger groups need to have objectives and goals.
  3. Children's services
    1. Questions on C & A presentation - Amy Starin
      1. Does this include the system of care?
        1. Yes, we have two systems of care projects. We have applied for a third. They are covered under DMH.
      2. Funding and Age limits on transitioning.
        1. Motion made at IMHPAC meeting to look at expanding age limit 25.
      3. Brenda Hampton has a project on Permanent Supportive Housing
        1. It is difficult for transitioning youth to have somewhere to live.
        2. Presented to ICG parents group last Saturday.
          1. Looking at private buildings
          2. Individual apartments within a community
        3. Brenda will discuss Permanent Supportive Housing on June 30, 2008.
      4. How does the move to the Collaborative impact Children's Services?
        1. Individual Care gGrant Program - The Collaborative has the ICG phone line.
        2. The Collaborative sends out ICG applications and reviews them for eligibility.
        3. Quarterly reviews of ICG residential
        4. Annual reviews for all ICG
        5. Collaborative authorizesd Community Support Team service
          1. Only 1 CST in Illinois that serves children
      5. Could you please talk about non-traditional needs -SASS Flex funding?
        1. These are needs beyond the scope of traditional case management and therapy. Includes after school programs for kids, recreational programs, parents trainings, broad range of services that could be provided under SASS flex funds.
        2. Amy Starin will mail out SASS Flex Funds handbook
        3. Approved for 90 days at a time but can be renewed.
      6. How is a determination made as to how long someone is in the transitional stage?
        1. Division has assigned the age as 18. At 18, the individual enters the adult system.
        2. From a clinical perspective, it depends on the individual.
        3. For ICG, developmentally an individual might be 21 but intellectually is not.
        4. Does there need to be some sort of grading to make these decisions?
          1. Individual treatment plan would help decide.
          2. Criteria/Policy change that would impact all was discussed.
            1. Would a Rule need to be developed?.
            2. Responsibility assigned. ??
    2. A Capacity to Care for Our Children - Kathy Roberts
      1. Summary of key issues identified by CBHA that need to be considered to ensure that all of a child's needs are met.
      2. Not everything that a child needs fits in a fee for service environment.
      3. List of next steps that are necessary.
      4. Has this document been shared with the Child and Adolescent Committee?
        1. On the agenda for the next C & A committee meeting.
        2. Can the C & A committee address these issues?
          1. C & A committee will develop action plan and will bring back to SRI-ASO committee.
      5. Postpone any action from this committee until Terry Carmichael is available.
    3. NCCP Report Discussion - Sandy Lewis
      1. Tracks how financial funding has shifted to almost all federal Medicaid dollars.
        1. Implication on the program
      2. Legislative discussion
        1. How different states do things. (waivers)
      3. Lack of capacity
        1. Reinforces lack of capacity in children services
      4. How do we ensure that these resources are included in policy recommendations?
        1. Getting this information out to the field is the first step.
      5. Have Sandy give a brief report at the upcoming IMHPAC meeting.
      6. Is this report on the C & A Committee agenda?
        1. Ray will report back at the next meeting.
  4. Report from Jackie Manker, DMH and Lydia Tuck, Illlinois CollaborativeCEO
    1. Jackie Manker/ Lydia Tuck Service Access Report update
      1. Collaborative is looking to standardized the forms reviewing national and state access standards.
        1. Evaluating.
        2. Will develop benchmarks
        3. DMH has o not decided on necessarily have a policy. Collaborative is still drafting 1st Network Consumer Access Analysis.Still in data collecting stage and deciding what DMH/Collaborative want it to look like.
        4. DMH/Collaborative is also looking at other states to see how they evaluate their access services.
        5. The SRI Access Workgroup's Ddocument on Access Standards outlines a series of values that may help DMH develop access standards. Hoping that it will be developed into a policy that supports the values.
        6. DMH wWould like providers to have input on the policy before anything is set in stone.
        7. Want to make sure that we have quality services, right amount at the right time.
          1. Take into account that it is accessible ( a service that is 40 miles away)
        8. Geo -Mapping project (i.e. Network Consumer Access Analysis)
          1. Too early to report on that.
          2. Consumers fear that geo-mapping will allow gatekeepers to deflect consumers.
            1. Is there a way to send the message out that this does not impact consumer choice? The Collaborative is preparing a report on where DMH funded services are in Illinois.
            2. Need to reinforce to consumers that this will not impact consumer choice.
            3. Collaborative has a way to track if this happened to a consumer. (i.e. through reports to the 800#)
            4. On the provider side, capacity is an issue.
            5. Collaborative will plot out in a systematic way where the services are so the Department can have a thorough snapshot of what is going on.
            6. Linda will share will SPRAY report - published in 2003 that maps out public funded services.
            7. The Collaborative's Network Consumer Access Analysis Wwill allow the Division to see where there are a moderate amount of services but a high need. Allows the state to indentify where they track the higher needs.
            8. Assess to see if needs and resources match.
            9. FFS will change perceptions of whether you will receive servicesbe let in or not. Once money follows the consumers people to the service (as long as there is no cap), there will be shifts.
            10. Linda is concerned about people coming out of state ops that . Wwill not have the ability to receive services once they leave the hospital because they will not have Medicaid.
              1. Cash flow issue
              2. Providers know that consumers will be Medicaid eligible.
    2. Consumer Issues: Bryce Goff Recovery & Resilience Definitions
      1. Eldon Wigget of DMH presented the DMH vision of recoveryis filling in for Bryce.
      2. Recovery Services Development Group
      3. Definition of Recovery - Need to stay clear of being too rigid in what recovery means. President's nNew fFreedom rReport is used as a guideline.
        1. Process in which people are able to live, work, and learn in their communities. For some, recovery is the ability to live a fulfilling life in their community.
        2. Best left up to the individual to define what recovery means to him/her.
        3. Commonalities in the definition of recovery that the Division has tried to work into the Rule 132 services.
        4. Definition is going to change and grow.
        5. Recovery is a lifelong process for children and adults.
          1. Would like for it to be viewed broadly across the system.
      4. The Collaborative Mary Smith will conducthave a consumer and provider survey of roughly 7,000.
        1. Concern that there was not a lot of outreach.
          1. Concern that there has not been enough consumer input
            1. Eldon participated in the consumer workgroup and right now there is limited input but assures the committee that there are consumers at the table.
          2. Are adolescents or their families included in the survey?
            1. i. Family members of children 11 and under are included in the survey.
        2. Recommendation that a future survey request definition of recovery from the consumers surveyed.
          1. Will help in the educational process for consumers.
          2. Have done that with focus groups.
          3. How do consumers define recovery?
          4. Do they consider themselves in recovery?
          5. Goal of recovery?
        3. Break out the statistics for people newer to the system versus people who have been in the system longer.
    3. Provider Issues
      1. Billing update
        1. 108 agencies at 90% or greater
        2. 19 between 80 - 90%
        3. 8 between 70 -80%
        4. 7 between 60 -70%
        5. 9 agencies less than 60%
        6. Lynn requested to have at the next meeting a report that shows providers at each level next month.
    4. d. MIS/IT update
      1. Plan is for on continued re-trainings
      2. Working to minimize the impact on providers.
      3. Presentation will be posted on Collaborative website once approved.
      4. DHS Notice on Provider Payment ( June 6, 2008 notice)
        1. October 1, 2008 - December 31, 2008, providers will see a rolling 12 month payment.
          1. Will there be reconciliation?
            1. Yes, reconcile later.
            2. Motion to suggest that reconciliation not occur until MIS is up and everyone agree that it is running.
            3. Motion 1/12 of total contract is given to providers until ready to bill and reconcile.
            4. Use a benchmark rather than a date.
        2. If you bill 100% July, August, September, then you will not receive 100% in October.
      5. ROCS will be used for any services delivered before July 1, 2008 and for ICG residential and community post July 1, 2008..
        1. ICG will migrate to the Collaborative eventually.
      6. Will providers have to re-enter billing to reconcile?
        1. Working to prevent this from happening. Do not know exactly what will happen.
        2. IT workgroups are looking at options on what can be done.
      7. Questions about MIS can be sent to DHSROCS@illinois.gov
    5. Community Support Teams
      1. Next meeting the Collaborative will bring in data for CST/ACT
      2. Collaborative will bring in data for call volume on 800 number
    6. f.  Other Updates
      1. Service access may be available to report next month.
        1.  Historical
      2. Quality Management
        1. Will provide an update on reviews/site visit data.
      3. Complaints and Grievances
        1. Report will be available next meeting.
      4. Appeals
        1. Report will be available next meeting.
      5. Provider Network
        1. Unavailable.
      6. Claims Reporting
        1. Unavailable.
      7. ASO staffing
        1. Will provide an update at the next meeting,
      8. Quality Management Committee
        1. Will give an update at the next meeting.
      9. Consumer perspective
        1. Unsure of the target date. Will provide update when available.
  5. Systems Restructuring Initiative
    1. Need progress reports on these issues.
    2. Monitor these issues.
    3. Rate Setting
      1. Defer issues until we have a better understanding.
      2. What is DMH system?
        1. Document that explains how rates are set in the state of Illinois
        2. Recommend to DHS a presentation on the DHS system and the components of model rates.
      3. FQAHC is paid by encounter rather than eventrates.
        1. 1. Should FQAHC be the way psychiatrists are paid in our system?
      4. Audits/Paybacks
        1. Motion: Ask IMHPAC to ask Director Jones - Given the new federal audit environment, are there protocol changes in regards to federal audit recoupment required by the community mental health providers?
        2. Is the state going to come back to the provider for payback on federal audits?
          1. If providers were doing what they were doing as instructed by the mental health authority?
        3. What are the rules? What are the compliance requirements?
    4. Grant Issues
      1. Adjustment to contract service expectation in years without CODB?
        1. Need expectation changes in years without a CODB.
      2. Adjustments to contract targets
        1. Adjust non-Medicaid
      3. Do we find another way to pay psychiatrists?
      4. Waivers
      5. Add this to the finance discussion.
    5. Training
      1. Motion: Would like policy in place to require trainings to take place 90 days before implementation of changes for both providers and consumers.
  6. Miscellaneous
    1. A Chicago agency has a sign stating that the agency requires consumers to pay co-pays for Medicaid clients
      1. Follow up with Stephanie Hanko
    2. Follow up on IT Training Q & A - Tentative - Conference call Wednesday, June 18th 2:00 - 4:00.
  7. Develop August Meeting Agenda
    1. Introductions
    2. Children's Services
    3. Reports from LydiaDMH and the Collaborative
    4. Research Alternatives Funding Sources
    5. Systems Restructuring Initiative

New/next Meeting Date

4th Thursday in August 12 - 4