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Helen Farabee Centers Board of Trustees Minutes - 04/07/2011 HELEN FARABEE REGIONAL MHMR CENTERS BOARD OF TRUSTEES \Cte RECEIVED IN April 07,2011 11:00 AM • CITY CLERK'$ OFFICE Childress Mental Health Center DATE: 5-1/ ` / / 8150 US Highway 287 East Childress,Texas BY: 1%1- TIME: $ 3 cl Via Televideo Sue Nunn Conference Room 1000 Brook Wichita Falls,Texas Board of Trustee Ken Andrews, Chair; Carla Kay Ainsworth; Verner Hayhurst; Sue Nunn, Members Present: Secretary/Treasurer; Shelley Owen,Vice-Chair(via Televideo); Bobby Smith; Billye Ruth White Board of Trustee Robert Clement; Sara Rugeley Members Absent: Senior Roddy Atkins, Executive Director; Gianna Harris, Associate Executive Management Staff Director of Operations, Recorder Present: Other Staff and Sue Duckworth, Regional Service Manager, Intellectual and Developmental Guests Present: Disabilities Services; Kirk Findley,Director of Clinical Services Wichita County; Edna Tipa Jones, Center Manager, Childress Mental Health Center; Kymm Putnam, Veterans Services Peer Provider Luncheon Guests: Mike Pigg, Childress County Sheriff; Childress County Jailer AGENDA TOPICS 040711-1 CALL TO ORDER Ken Andrews, Chair called the meeting to order in open session at 11:00 AM with a quorum of five present. A)Introduction of Guests There were no guests present. 040711-2 PRESENTATIONS A) Open Citizen Comment to the Board No citizen comment was offered. B) Childress County Mental Health Center Edna Tipa Jones, Center Manager, distributed a hand out about Childress Mental Health Center(on file) and reported I was first hired as a case manager in December, 1991, 19 years ago. Three years later I became the Center Manager and have continued to serve in that capacity to the present time. In addition to administrative duties, I also carry the entire adult caseload and perform crisis intervention. I provide day time crisis in Childress and for Region 1 which means I respond to a lot to calls from Vernon and Quanah. Staff who office here in Childress includes Janis Walker, Secretary and Darla Anderson, Monitoring and Compliance Specialist. Janis, who will celebrate her first anniversary on May 3`d, after our long time secretary retired after many, many years. Janis serves as receptionist, transcriptionist, administrative assistant and medication clerk. We have a local contract physician, Dr. Mike Henderson. He volunteers his time and service and has since the inception of the center in December, 1971. Board of Trustee Meeting Minutes 1 April 7,2011 11:06 AM Billye Ruth White arrived at the meeting He is quite an asset to us because we only have the Center psychiatrist here every other month through videoconference. It is helpful to have a local doctor right here, so we can take medication orders out to him, and he is available so we can use sample medications which saves a lot of money for our Center. He leaves his practice and comes here for two hours once a month; he sees a lot of patients in that short period of time. Darla began in April, 1991 and is the Monitoring and Compliance Specialist for Quanah and Vernon as well as Childress. She now supervises all Monitoring and Compliance Specialist. She does a lot of traveling. Darla is our go to girl; that is how she is perceived at every Center. We are very grateful to have her. Other staff that work in Childress but are not based here are our Child and Adolescent Caseworker for Region 1 which includes Vernon, Quanah, and Childress is Navauda Miller; she just recently transferred from Wichita Falls and I have not had an opportunity to meet her yet. Cindy Smiley is our LVN, she is here today doing lab; Kathy Neal, RN is our nurse. As I mentioned Dr. Ed Luke is here via videoconference every other month. We have been in our current location about five years and about a year ago Helen Farabee Regional MHMR Centers purchased the building from the county. We are serving at the present time a total count of 66, 59 adults and seven children. We thought it was interesting when we ran those numbers this morning that we actually have ten from Cottle County now. That is the highest number we have had from there in a good while. Childress is proud to have an excellent medical clinic that serves as the hub for a 60 mile radius and we have always felt that may be why our numbers are lower in this area. Because we have so many family doctors that are willing to serve and so a lot of people are seen there instead of coming here. But, they are also very good to refer to us if they feel like they need more than what they can provide to them. Being a very small Center, there are only three of us that are here a majority of the time. So we wear lots of hats and do lots of different things to make sure our people are served. Everybody does a good job and I am proud of my staff. Sue Nunn asked how is the cost of gas affecting your travel, because I know you travel a lot. Edna Tipa Jones we are able to use Center vehicles, we utilize them all the time. When we moved to this building we knew that was going to be an issue because we are out. We have changed the way Transit is utilized in this area. There are no more spur of the moment calls and they will come and get you. You have to give them a 48 hour advance notice now. We have had to learn to plan better. We do pick up and provide transportation for those that need it. We make do. It is a factor, especially for our people that live in Paducah. There are a lot of times that they probable could use more services and yet they do not have the ability to get to the Center to receive them. Roddy Atkins transportation is a huge issue,particularly out in the rural areas. Edna Tipa Jones I do go to Paducah and make some home visits but I really cannot justify doing that a whole lot. I do it when needed. They have to come here to see the doctor and do their lab. There are those times that they still have to travel here to the Center. Roddy Atkins folks sometimes ask, what is the ongoing impact of the big cuts that occurred in 2003? The biggest change was to transportation and the folks who did the transportation for our rural areas. Because we use to have folks that would go out and bring people in from outlying areas that had difficulties. That disappeared when they made the major cuts back in 2003 and that is never going to come back. Edna Tipa Jones the Intellectual and Developmental Disabilities side is using our building a lot more, I noticed recently and that might be because of the fuel cost. They are picking them up and bringing them here for movies and activities. Sue Duckworth we are very fortunate that our cars that we have get good gas mileage. I am guessing that the car for Day Hab in Vernon gets over 30 miles per gallon. Board of Trustee Meeting Minutes 2 Apri17,2011 11:15 AM Shelley Owen arrived at the meeting via televideo C)Intellectual and Developmental Disabilities Services in Childress Sue Duckworth,Regional Service Manager for for Intellectual and Developmental Disabilities Services. Cheryl Rogers provides Day Hab (Rehabilitation) and Training in Childress to four people. Two of them are General Revenue(GR) that we can justify because we have three in contract that pay for our services. We are trying to cut back on gas. We have to; there is nothing else we can do. We are doing the same thing in Quanah. Quanah is served out of Vernon. We have two in Quanah and four in Childress, and three of those are contract. We have one in Quanah that is contract so it justifies picking up another two that are there. The rest of them are in Vernon and they are Foster Care so their providers bring and pick them up. Cheryl also provides training for individuals here and in Quanah. We are focusing on our gas usage. In our big van we were going to pick up one or two people. For Day Hab (Rehabilitation) in Vernon we are utilizing the car. Roddy Atkins when she says contract, she is talking about the HCS (Home and Community—Based Services) private providers that contract with us and pay us to do Day Hab (Rehabilitation) for them. Do you have any folks in Supported Employment in this region? Sue Duckworth I am not over Supported Employment anymore but I know that we have several that are still working that we placed. 1 can think of six that have been working for a long, long time. Bobby Smith you are talking about consumers that cannot afford to drive, are there some consumers that actually cannot drive and have to depend on someone else for transportation? Edna Tipa Jones yes. Sue Duckworth do you have Sharp Line here? Edna Tipa Jones Sharp Line is in Paducah, we have Transit. Sue Duckworth we utilize Sharp Lines a lot in the rural areas. They will provide transportation to the doctor and dentist. Edna Tipa Jones they will take them to see the doctor or the dentist,but they will not bring them just to meet with me. Roddy Atkins it is a challenge. You try and figure out where they can get friend or family member to bring them in. They do have to be a Jack of All Trades. Things got more difficult when we were not able to furnish routine transportation,but now there is no reimbursement source for that. Staff are aware of what is available in terms of transportation. It is a huge issue in our rural areas. It is an issue everywhere, even in Wichita Falls. Public transportation is not the easiest thing to navigate. The further out you get, the harder it gets. 040711-3 APPROVAL OF MINUTES RECOMMENDED ACTION: That the Board of Trustees approves the minutes of the March 03, 2011 Board of Trustees meeting. The Board of Trustees approved the minutes of the March 03,2011 Board of Trustees meeting. _ Motion: Mr. Hayhurst Affirmative: 6 Second: Mr. Smith Negative: 0 Citizen Comment: None Board of Trustee Meeting Minutes 3 April 7,2011 040711-4 TRAINING A) Veterans Services Kirk Findley,Director of Clinical Services Wichita County introduced Kymm Putnam,Veterans Services Peer Provider. Kymm came to us with 14 years of military service in the Air Force. She has been a pre and post deployment specialist and has been deployed herself to Iraq. We are happy to have her on board. Kymm provided the Veteran Peer Provider training(on file). Kirk distributed and provided the Post Traumatic Stress Disorder training(on file). 040711-5 RECOMMENDATIONS A. BOARD OF TRUSTEES No Agenda Items THE BOARD OF TRUSTEES RECESSED FOR LUNCH AT 11:55 AM. THE MEETING WAS RECONVENED BY KEN ANDREWS AT 12:40 PM WITH SEVEN BOARD OF TRUSTEE MEMBERS IN ATTENDANCE. B. BUDGET AND FINANCE 1)Financial Statements RECOMMENDED ACTION: That the Board of Trustees approve the financial statements for February 2011. Roddy Atkins, Executive Director presented the financial statements for February 2011 (on file). The Board of Trustees approved the financial statements for February 2011. Motion: Ms. Nunn Affirmative: 6 Second: Ms. Ainsworth Negative: 0 Citizen Comment: None 2)External Audit Firm RECOMMENDED ACTION: That the Board of Trustees approve the selection of Davis Kinard as the external audit firm to perform our annual audit at a cost of$24,000. Vernon Hayhurst, Board of Trustee presented the information on the external audit firm (on file). The Board of Trustees approved the selection of Davis Kinard as the external audit firm to perform our annual audit at a cost of$24,000. Motion: Ms. White Affirmative: 6 Second: Ms. Nunn Negative: 0 Citizen Comment: None Board of Trustee Meeting Minutes 4 Apri17,2011 C. CONTRACTS AND PLANS No Agenda Items D. FACILITIES AND EQUIPMENT No Agenda Items E. POLICIES AND PROCEDURES No Agenda Items F. PROGRAM AND PERSONNEL No Agenda Items 040711-6 QUARTERLY REPORTS A. ESSENTIAL SERVICES AND CLINICAL ACCOUNTABILITY 1) Second Quarter Report RECOMMENDED ACTION: Information item only. Gianna Harris, Associate Executive Director of Operations reported on the second quarter fiscal year 2011 report findings (on file). _No action required, for information only. Citizen Comment: None B. PLANNING AND NETWORK ADVISORY COMMITTEE No Agenda Items C. EXTERNAL AUDITS No Agenda Items 1:00 PM Shelley Owen left the meeting 040711-7 EXECUTIVE DIRECTOR'S REPORT 1)Service Volume by County Report Service Volume by County FY 2011 Quarter 2 Report (on file)was distributed. This is the report we put together that goes out to our legislative delegation and our sponsoring agencies. Page one, Adult Mental Health Services and Child and Adolescent Mental Health Services presents an unduplicated number of client served in each county; the number of events; and the duration is the actual hours of service in a given county. Page two is a reflection of our Substance Abuse Services in Wichita County, in Adult Services we have served 100 unduplicated clients; 19 through our Criminal Justice Program called SAFP (Substance Abuse Felony Placement), and 17 COPSD (Co-Occuring Psychiatric and Substance Use Disorder), individuals who have a major psychiatric illness. Adolescent Services you can see the unduplicated client count; the number of At Risk Youth we have served through the United Way Grant; how many we have seen through the Truancy Court; and how many COPSD (Co-Occuring Psychiatric and Substance Use Disorder)kids we have served, kids with a serious mental health issue and a co-occurring substance abuse disorder. Page three you will see individuals with Intellectual and Board of Trustee Meeting Minutes 5 April 7,2011 • Developmental Disability by county, non residential versus residential. Non residential are folks that are living either by themselves or with their family in the community. Residential is either in one of our group homes or they are living with one of our Foster Care Providers. You can see by County where those folks are. Again it is an unduplicated count, number of events,and number of hours. Page four you can see the Hotline figures by county broken out between adults and kids. You can see the number of calls and where it says Number of On Call Activations is when the hotline calls the clinician out to go out and do an after hours intervention or face to face intervention. Most of this is after hours, there are a lot of times during the day that the Center gets the call. Those do not go through the hotline. Page five is the number of individuals we have served in response to crisis. Meaning, we have done a Crisis Assessment and now we are delivering some sort of crisis counseling or crisis support service. Page six are folks who are admitted to the Crisis Residential Unit in Wichita Falls by county. You can see most of our counties do have admissions to the Crisis Residential Unit in Wichita Falls. You can see the number of admission and you can see the total number of bed days. Page seven you can see the North Texas State Hospital and Red River Hospital admissions by county. Page eight is Bed Days for adults and kids , at Red River Hospital. We do pay for some children services. We run this and I send it out on a quarterly basis. This is information that I use on a fairly frequent basis with our sponsoring agencies to say this is what we are doing in your county. 2)Behavioral Health Services I want to talk to you about Health Care Reform as it relates to Behavioral Health Services. You have heard me talk about some'of the work we are doing with the Community Healthcare Center in Wichita Falls. I went to Knoxville, Tennessee about a month and a half ago. We are looking at how we begin to integrate physical and mental health care. The FQHC (Federally Qualified Health Care)has hired a behavioral health person. Gianna, Charlie, and Andy have sat down with them and worked out a process where we can expedite referrals, exchange information, and coordinate care. If you are not aware, Medicaid is a huge issue with the State Legislature. The Legislative Budget Board has put forth a bill for the Legislators to consider that would expand Medicaid Managed Care across the state of Texas. Right now you only have Managed Care in the Metropolitian areas, either Star or Star Plus. Star Plus brings in the disabled population. Right now, we are in what is called a Primary Care Case Management. That means that a Primary Care Physician gets a monthly fee to coordinate care for any Medicaid recipient that they are taking care of. What the Primary Care Physician does is refer to specialist. He is the coordinating point for services. What they are looking at expanding to is HMO (Health Maintenance Organization) where health plans will manage all the Medicaid population across the state of Texas by 2012. So instead of us billing Medicaid, we will become a provider in one of the health plans that gets the bid. We have been doing some work in Wise County with a particular health plan because Wise County is in Managed Care. Health Care Plans are already contacting us because they are preparing to bid or do requests for proposals. We have tried to schedule appointments with the Health Care Plans that want us to do letters of intent to contract with them. Before I will complete a letter of intent, I make them come visit us. Their job is to better manage that Medicaid population, keep them out of more expensive services. I want to talk to them about the infrastructure that we have and how we can help them be successful. Talking about how we can provide some value added services and how we are in a good position to coordinate care with Primary Care Physical Health Care. These kind of discussion are going on because by 2014 under the Health Care Reform, the bulk of our folks are going to be on Medicaid. Right now only about 30 to 40% of our Adult Mental Health population is on Medicaid. The rest are indigent or a few have third party insurance. Under the new Health Care Reform, and there is nothing that says that is going to change, about 90% of the current adults that we serve will all be on Medicaid. Regardless of disability. That is how their health insurance is going to be handled. So, it changes how we have to look at doing business. Because, that also means there will not be as much General Revenue dollars coming from the state for indigent care. There are not going to be that many uninsured people that we are serving. That is what we are .re.aring for. We are lookin: at us _oing in ------------ Board of Trustee Meeting Minutes 6 Apri17,2011 • the direction of being a Specialized Health Home. We will become the Health Home for the serious and persistent mentally ill population. Meaning, in our clinics they can also access Primary Care. A lot of the people with serious and persistent mental illness will not go to multiple places to get Health Care. They will come to see us, but they may not go to see a Primary Care Physician. One of the Health Care groups that I met with was a company named Molina. They are a San Antonio based group, but they do Health Plans out of California. They have actually hired and put Primary Care Physicians in Mental Health Clinics. That is what Jonathon Voelkel, Chief Executive Officer at Wilbarger General Hospital and I have been talking about. Ultimately what I see us doing is being a Health Home for persons with Serious and Persistent Mental Illness. You come into the Wichita Falls Clinic and you have Schizophrenia, you get your Psychiatric Services and you also get your primary care services. It is a comfortable place to be,because some of our folks are not necessarily comfortable in a Primary Care waiting area. Some Primary Care waiting areas are not necessarily comfortable having our folks there. I approached Dr.Susan Sportsman, who is the Dean of the Health Sciences Center at Midwestern State University about doing a project together. They have a Nursing Program and an Advanced Nursing Program. I talked to her about the Batchelor and Masters level Nursing Students coming to our clinic in Wichita Falls to do Health Assessments and Health Education around Diabetes and COPD (Chronic Obstructive Pulmonary Disease) that is tailored to a psychiatric population. They could also do nursing coordination in terms of coordinationg services for their Primary Health Care. She was extremely excited about the possibilities. We are planning to meet again in May to talk this out. She will be looking for funding. We will see how it goes. Basically what I am asking MSU (Midwestern State University) to partner with us on is very similar to two Grants that the Feds funded as pilots in Lubbock and in Austin. Just keep in mind that you will see this evolving over a period of time. 3)Legislative Session Texas Council of Community Centers Legislative Update was distributed and discussed(on file). This is the lastest on the budget. It has been an interesting Legislative Session. I will say that I think we have good support from our Legislators, whether it is Representative Lyne, Representative Hardcastle; or Senator Este. We have been involved with them a lot, Wichita Falls Day at the Legislature that Bobby, Sara and I attended; Vernon—Wilbarger County Day at the Legislature that I attended; as well as office visits and frequent telephone and e-mail contacts. The Texas Council has been working very closely with Senator Estes' and Representative Hardcastles' staff on different issues. Our local stakeholders have made it clear that we are supported. I told you at the last meeting that part of the Chambers' Legislative Agenda had to do with maintaining services, staff and funding for individuals with mental illness and intellectual disabilities. I think there are a lot of good things going on. We were able to again avert two Riders. The House met on the appropriations bill last Friday, on April Fools Day, and it went all week end. Article II which is Health and Human Services started Friday. I was coming back from Austin Tuesday getting calls about Riders or Floor Amendments. There were two from San Antoinio about Equity of Funding. There were two more that would have been worse about privitization of State Hospitals. They have not published those Riders on the Legislative Website yet. Somehow The Texas Tribune got hold of them. I went throught about 300 Riders and found the four and had a discussion with staff in Representative Hardcastle and Representative Lyne's Office. Representative Lyne and Representative Hardcastle visited with Representative McClendon from San Antonio and she tabled the two equity rider amendments and she also dropped her version of privitization of State Hospitals. So they have actually worked very hard on our behalf, it has been a good thing. One of the things that was nice, at the Wichita Falls Day at the Legislature when the Wichitas Falls Community got recognized in the Senate. Typically the Senator will talk about the community and some of the key assets. When Senator Estes started talking about the community of Wichita Falls, the first asset he mentioned was North Texas State Hospital; the second asset he mentioned was Helen Farabee Centers; the third asset was Midwestern State University; and the fourth asset he mentioned was Sheppard Air Force Base, in that order, which was interesting. I think one of his aides had something to do with that. Senator Estes is Board of Trustee Meeting Minutes 7 April 7,2011 • carrying for us and the Texas Council a Rider that we worked on arround flexibility of funding for Mental Health Services. When we get Mental Health funding it comes down for Adult Services, Children Services, Crisis Services and for New Generation Medications. You can not move money as you need it. He is carrying a Rider that will go before the Senate that basically will give us the ability to move funds based on what we need in our local area. It will not solve any budget cuts,but it makes sense because how we need things in our area is not neceesarily how they need them in Fort Worth, Denton, or Dallas. Even if they were going to give us a 20% increase, this would still be an excellent Rider because it comes back to local control. Senator Estes was willing to carry that Rider so we will see how it carries on. Where we are setting right now, you have the House Bill which has been approved and you have the Senate Bill which has just come out of Senate Finance so it needs to be approved by the full Senate and then you get into Joint Conference Committee. To show you the differences, the first thing that had to be approved or we would have really felt death and destriction, in the House, you know when there is a short fall at the end of one biennium we have to try and budget for it in the next biennium. We are running somewhere in the neighborhood of a four billion dollar shortfall this biennium. What the House did was pass House Bill 275 first, which actually allows them to go into the Rainy Day Fund and pull about three billion dollars out of that to tidy up this biennium and budget. That frees up some money for this next budget cycle,. What was contingent on House Bill 275 was the restoration of some things that the House did that were not there before. I want to talk to you about what they restored. If you recall, the original House Bill cut Intellectual and Developmental Disability Services General Revenue by 50%. The current House Bill since 275 passed, fully restored the Intellectual and Developmental Disability Services General Revenue to 100%. They also fully restored In- Home and Family Support funding. They also came back and restored 60% of the cut in Children's Mental Health Services,the cut is now only about 8% as opposed to 20% in Children's Mental Health Services. They fully funded the Crisis Piece, that was only a 5% cut. They did restore some things in the House, but there is still a 20% reduction for Adult Mental Health Services which is about 1.5 million dollars. We still got the full rate reduction for the House Bill which will equate to 12% for HCS (Home and Community—Based Services); 12% for ICF (Intermediate Care Facilities); and 12% for Card Services. So under the current , House Bill, as opposed to being a 3.4 to 3.5 million dollar cut overall, we are down to 1.6 to 1.7 million dollars. That is where we currently stand in the House. The Senate Bill as it came out of appropriations; is a lot nicer. It fully restores all Mental Health Services including the State Hospitals. Fully restores funds, even though it does not impact us, for outreach screening and referral in Substance Abuse. They are fully restoring any cuts to the Texas Council on Offenders with Mental and Medical Impairments, that is our specialized Probation Services. The biggest thing that it does is it reduces the HCS (Home and Community—Based Services)rate reduction by 7%, so it will be a 5%reduction in HCS (Home and Community—Based Services) as opposed to 12% and it restores the ICF/MR (Intermediate Care Facilities for Persons with Mental Retardation)rate reduction to a 7%reduction as opposed to a 12% reduction, so it restores it by 5%. It almost fully restores Intellectual and Developmental Disability Services General Revenue. The question mark about that is they want to take some of that General Revenue and use it for matching funds to finance people into the Texas Home Living Waiver. Those won't necessarily be people we will provide direct services to, because we are not a Texas Home Living Provider. We do provide Case Management Services to them. They want to use a portion of the money but it is not clear yet how much of that restoration that they want to use to refinance folks. Sue Duckworth does that include the contracts we have with our CLASS (Community Living Assistance Program and Supported Services Program)providers? Board of Trustee Meeting Minutes 8 Apri17,2011 Roddy Atkins no that is for people who are currently in our GR (General Revenue) Services. So we would lose the General Revenue on those refinances. So now they are going to have to figure out how to pull these two budgets together. Senator Estes said the Senate is digging in the couch for money; they are looking for pennies, nickles, selling property, looking at all sorts of ways beside "raising taxes". Obviously, I think there is going to be a bigger push to use the Rainy Day Fund. The Rainy Day Fund is at an all time high. The Rainy Day Fund does not typically have more than 1'/z to 2 billion dollars in it. Because every barrel of oil has a tax on it, once it reaches a certain per barrel level, they take 25%of that tax and put it in the Rainy Day Fund. So it is based on the price of the barrel. The biggest concern is you can not guarantee that oil will continue to stay at the level that is replenishing it right now. You have such a fluctuation of the price of oil. My guess is that there will probable be a push to use the Rainy Day Fund and probable leave what would have been a traditional level in it. So they will take it back to the 1.5 to 2 billion dollar level. There is concern about spending it all, about how quickly it could replenish itself. Having Senator Estes on Senate Finance has been a positive thing. It would be nice to have a House person on House Appropriations at some point. But Representative Hardcastle has a huge amount of influence in the legislature,just because he has been there so long and folks really like him. He is well respected. Representative Lyne is a really good guy, I think over the long haul we will be really pleased. He has the right mindset and certainly, I think, supports what we do. I think he is going to represent us well. That is the state of the State. Bobby Smith when will they actually debate the two bills? Roddy Atkins some time after the Senate approves their bill. Senate Finance is still working on some other Articles. Remember there are ten Articles that they have to finance. We are Article II of the X, they are still debating either VIII, IX or X. The full Senate Appropriations Bill has to be approved by the Senate. Once it is approved by the full Senate, then it becomes Conference. There is still a lot of belief that they are going to go into special session on this budget. It is nice to see articles like in the Wichita Falls newspaper today about continued increase in tax revenues coming into the cities. So there is still a chance that the comptroller will come back and do an increased revenue projection which would help. I think this is far from being a done deal. Again we are setting in a good position. You can read about what the School Districts are doing. They are having to do some things because they do not have any choice. They have some deadlines they have to deal with. We are setting OK because we can wait until we know what it looks like and then begin to deliberately plan how we want to approach it. Rod and I have sat down and said OK let's say if we had some major cuts, how are we going to do this. Part of my goal candidly with Health Care Reform is not to tear down our infrastructure. Because, this is a temporary situation. So, we have been looking at how long can we go if we didn't, for example, put any money into the Internal Services Fund for two years. What would that do for us? How much of our reserves could we tap into and depending on the cuts how long would that take us. I do not intend to knee jerk this thing what so ever. We will know what the cuts are when they come and we will sit down and try and plan. But my goal is to maintain the infrastructure of the Center so that I have something to negotiate with the Managed Health Plans. They are going to have a difficult time serving the rural areas and they know it. We are a good resource for them ultimately. 040711-8 ANNOUNCEMENTS A)Next Meeting Ken Andrews announced the next meeting is scheduled for 11 A.M., Thursday, May 5, 2011, in Wichitas Falls. Board of Trustee Meeting Minutes 9 Apri17,2011 040711-9 OTHER BUSINESS None 040711-10 ADJOURN The Board of Trustees' meeting adjourned at 1:30 PM. Approved as presented: Approved as corrected: eyL a 7 Ili/ May 05, 2011 Board of Trustee Meeting Minutes 10 April 7,2011 Wichita Falls Administrative Office A H E L E N FA RA B E E P. O. Box 8266, Wichita Falls, TX 76307-8266 1000 Brook Street, Wichita Falls, TX 76301 �AV. Phone (940) 397-3100 CENTERS Fax (940) 397-3150 www.helenfarabee.org May 06, 2011 Darron Leiker City Manager City of Wichita Falls P.O. Box 1431 Wichita Falls, Texas 76307-1431 Dear Mr. Leiker: In accordance with the provisions of Senate Bill 112, a copy of the minutes of the Board of Trustees of Helen Farabee Centers is enclosed for the regularly scheduled meeting held on April 07, 2011. These minutes were approved by the Board at its meeting held on May 05, 2011. Sincerely, 4P )9t. Jan W t Adm istrative Assistant/Board Liaison /jw enclosure Providing Behavioral Health,Intellectual and Developmental Disabilities,and Substance Abuse Outpatient Services