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Helen Farabee Centers Board of Trustees Minutes - 03/04/2010 HELEN FARABEE REGIONAL MHMR CENTERS \(t4 BOARD OF TRUSTEES • March 4,2010 4\� 11:00AM Child and Adolescent Services 516 Denver Street Wichita Falls,Texas Board of Trustee Ken Andrews, Chair; Carla Kay Ainsworth; Robert Clement; Bill Coombs, Members Present: Vice-Chair; Sue Nunn, Secretary/Treasurer; Shelley Owen; Sara Rugeley; Bobby Smith; Billye Ruth White - Board of Trustee None Members Absent: Senior Roddy Atkins, Executive Director; Rod Brennan, Chief Financial Officer; Management Staff Gianna Harris, Essential Services and Clinical Accountability Director; Lynn Present: Hartje, Behavioral Health Services Director; Lauren Parsons, M.D.,Medical Director ; Ralph Whaite,Management Information Systems Director; Rose Wilson, Mental Retardation Services Director Other Staff and Jan West, Administrative Assistant/Board Liaison, Recorder Guests Present: AGENDA TOPICS 030410-1 CALL TO ORDER Bill Coombs, Vice-Chair called the meeting to order in open session at 11:04 AM with a quorum of five present. A)Introduction of Guests There were no guests present. 030410-2 PRESENTATIONS A) Open Citizen Comment to the Board No citizen comment was offered. 030410-3 APPROVAL OF MINUTES RECOMMENDED ACTION: That the Board of Trustees approves the minutes of the February 04, 2010 Board of Trustees meeting. The Board of Trustees approved the minutes of the February 04, 2010 Board of Trustees meeting. Motion: Ms. Nunn Affirmative: 4 Second: Mr. Smith Negative: 0 Citizen Comment: None 030410-4 TRAINING A)Medical Services This agenda item is postponed pending the arrival of Dr. Parsons. B)Financial Management 11:06 AM Billie Ruth White arrived at the meeting. 11:07 AM Ken Andrews arrived at the meeting and assumed chairmanship upon his arrival at the meeting. Board of Trustee Meeting Minutes 1 March 4,2010 11:07 AM Shelley Owen arrived at the meeting 11:08 AM Robert Clement arrived at the meeting Rod Brennan, Chief Financial Officer provided annual Financial Management Training (on file). THE BOARD OF TRUSTEES RECESSED FOR LUNCH AT 11:32 AM. THE MEETING WAS RECONVENED BY KEN ANDREWS AT 12:15 PM WITH NINE BOARD OF TRUSTEE MEMBERS IN ATTENDANCE. 030410-5 RECOMMENDATIONS A. BOARD OF TRUSTEES No Agenda Items B. BUDGET AND FINANCE 1)Financial Statements RECOMMENDED ACTION: That the Board of Trustees approve the financial statements for January 2010. Rod Brennan, Chief Financial Officer presented the financial statements for January 2010 (on file). The Board of Trustees approved the financial statements for January 2010. Motion: Ms. White Affirmative: 8 Second: Ms. Owen Negative: 0 Citizen Comment: None 030410-4 TRAINING (CONTINUED) A)Medical Services Lauren Parsons, M.D., Medical Director, stated we are fully staffed. We still want a child psychiatrist. We are using telemedicine. We are working on a contract with UTMB (University of Texas Medical Branch)to provide services to our Medicaid kids. We are still using JSA Health,but are using them less due to our being able to hire psychiatrists. We are in a position where we can afford to make sure the psychiatrists do what we need done and that they are doing it how we need it done. We are working to balance the funding aspects of New Generation Medications. It is not easy to put on the brakes and take off the brakes. According to the literature, not all of the new medications are all they cracked up to be. We have to look at the New Generation Medications and the older medications and balance the effectiveness and the side effects. TIMA (Texas Implementation of Medication Algorithms)is going away. It has a black eye from litigation claiming undue influence on determination of medications. Dr. Emilie Becker, Medical Director for Behavioral Health, Department of State Health Services, is talking about new guidelines. We will use the Medication Audit Criteria and Guidelines from the DSHS (Department fo State Health Services) Formulary Committee. It includes protocals to follow. We have adopted these as our guidelines. The Executive Formulary Committee is adding new drugs to the formulary. Newer is not necessarily better. We are holding off adding patients to the new drugs but we can continue them on the drugs if they come to us on them. Board of Trustee Meeting Minutes 2 March 4,2010 B. BUDGET AND FINANCE (CONTINUED) 2)Fiscal Year 2010 Budget Amendment RECOMMENDED ACTION: That the Board of Trustees approve the revised budget for Fiscal Year 2010. Rod Brennan, Chief Financial Officer presented the revised budget for Fiscal Year 2010 (on file). The attachments are out of order and should be page 44, then page 46, page 47, and then page 45. The Board of Trustees approved the revised budget for Fiscal Year 2010. Motion: Mr. Clement Affirmative: 8 Second: Ms. Ainsworth Negative: 0 Citizen Comment: None C. CONTRACTS AND PLANS No Agenda Items D. FACILITIES AND EQUIPMENT 1)Email Server RECOMMENDED ACTION: That the Board of Trustees ratify the purchase of a replacement email server in the amount of$3,490.20. Ralph Whaite, Management Information Systems Director presented the information on the purchase of the replacement email server(on file). I have to give Kudos to Scott Reeves for getting the system up and working quickly. The Board of Trustees ratified the purchase of a replacement email server in the amount of$3,490.20. Motion: Ms. Nunn Affirmative: 8 Second: Ms. Rugeley Negative: 0 Citizen Comment: None 2) Childress County Mental Health Center Facility RECOMMENDED ACTION: That the Board of Trustees approve and accept the attached Quit Claim Deed for the Childress County Mental Health Center facility. Rod Brennan, Chief Financial Officer presented the information on the Quit Claim Deed for the Childress County Mental Health Center facility(on file). The Board of Trustees approved and accepted the Quit Claim Deed for the Childress County Mental Health Center facility. Motion: Ms. Nunn Affirmative: 8 Second: Ms. Ainsworth Negative: 0 Citizen Comment: None Board of Trustee Meeting Minutes 3 March 4,2010 1 E. POLICIES AND PROCEDURES No Agenda Items F. PROGRAM AND PERSONNEL No Agenda Items 030410-6 QUARTERLY REPORTS l A. ESSENTIAL SERVICES AND CLINICAL ACCOUNTABILITY No Agenda Items B. PLANNING AND NETWORK ADVISORY COMMITTEE No Agenda hems L C. EXTERNAL AUDITS 1)First Quarter Report Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) 1 RECOMMENDED ACTION: Information item only. Rose Wilson, Mental Retardation Services Director presented the findings on the Intermediate Care Facilities for Persons with Mental Retardation(ICF/MR)recertification audit completed at Chanute Circle in September, 2009(on file). No action required, for information only. Citizen Comment:None D. TEXAS COUNCIL RISK MANAGEMENT FUND MEETING 1)Report on February Meeting RECOMMENDED ACTION: Information item only. Bill Coombs distributed and discussed the Texas Council Risk Management Fund power point, Above& Beyond the Call of Duty, Value Added Services from TCRMF (on file). The Risk Management Fund is solvent; there have been no major issues with funding. The Texas Council Risk Management Fund is a small part of the statewide Workers' Compensation network. From time to time other insurance companies solicit the Community Centers to provide insurance and Workers' Compensation. They may be able to provide this service for a couple of years; but then they will have to increase their premiums. My belief is the Texas Council Risk Management Fund is the best for our Center. There are a number of items that are not tangible they provide, such as Loss Control Consultation; Training; and Legal Services. One of my concerns is we are not using the training. They will be moving the training, no longer providing it in Houston. Rod Brennan it is not cost effective for us to send our staff to Houston or San Antonio for one day training. Roddy Atkins they will come here for some training. We anticipate asking them to provide Management Training for our staff. Bill Coombs Legal Services reported there was a discharged contractor from Tropical Texas Behavioral Health that filed for Unemployment. It was determined that the Center was responsible for Unemployment even though it was a contracted service. The Texas Council Risk Management Fund has Board of Trustee Meeting Minutes 4 March 4,2010 a special fund set up to help the system. They are taking this item on as a special project allocating the money for research, networking and mitigation. The Workforce Commission has threatened to get the IRS (Internal Revenue Service) involved. Roddy Atkins this is primarily our Respite Care Providers. Historically families were able to pay family members, friends, etc to provide respite care. Department of Aging and Disability Services (DADS) decided we needed to contract with these individuals and provide them with training. If it is determined that they do not meet the criteria for an independent contractor,then we have two alternatives. We can make them a temporary relief employee. There is only a limited amount of money to provide this service. If we are required to pay them minimum wage,then we will have to decrease the number of hours they can provide the service. The second alternative will be to open a Respite House and staff it. We can only open one, so that will pose an access issue since we provide respite care throughout our region. We will be presenting this information to the PNAC (Planning and Network Advisory Committee) for them to discuss and decide which direction they want us to go. Department of Aging and Disability Services (DADS) forced us to provide the training and put them under contract. This is a non traditional contract. They have to decide if we have to follow the TWC (Texas Workforce Commission)guidelines or the IRS (Internal Revenue Service) guidelines. If they are taking care of a disabled individual they are not required to report the income to the IRS (Internal Revenue Service). We provide them with a 1099 if they request it. Rod Brennan in some cases they contract with a relative for$50.00 for the weekend. Paying minimum wage will really limit their options. Roddy Atkins we do not want a knee jerk reaction. We will get the PNAC (Planning and Network Advisory Committee)opinion and look for the best opportunity to maximize our respite care. There is not an unlimited amount of money so there will be less respite care available. Rod Brennan from my perspective; Bills presence on the Texas Council Risk Management Fund Board will be missed. I want to thank you for representing us so well. Bill Coombs Brian Crews said you have to reconsider. I have not received a better compliment in my life, that coming from an old country attorney. No action required, for information only. sCitizen Comment: None E. OUTPATIENT MEASURES ADULT SUBSTANCE ABUSE SERVICES No Agenda Items 030410-7 EXECUTIVE DIRECTOR'S REPORT 1)Budget Cuts HHS (Health and Human Services) as part of their budget cuts is recommending a 2% cut in rates for Targeted Case Management and Rehabilitative Medicaid. They are also recommending cutting 150 State Hospital beds including 50 from the Wichita Falls Campus of North Texas State Hospital. That will also include the loss of 360 staff from the State Hosptals. That does not include administrative cuts. It is not unusual for the State Hospitals to be on diversion, so if you take 50 beds off line,the implications are it is certain that we will be on diversion. The additional problem will be with 150 beds system wide, there will be no available beds. Individuals will have to be housed in jail until a State Hospital bed opens up. What I am hearing from inside sources is that they will back off; we will have to maintan a delicate balance. The State Hospitals are nine million dollars short in funding. DSHS (Department fo State Health Services) is taking back the federal stimulus money, $76,000.00, We had anticipated this request and set that amount aside; so it will not impact us. Board of Trustee Meeting Minutes 5 March 4,2010 • 2) Crisis Services We entered in a competitive grant with DSHS (Department of State Health Services)to be a Psychiatric Emergency Services Center(PESC). Sixteen Centers total were awarded the grants. Initially they lost our request and the request from Tarrant County. When they announced the funding I questioned why we were not approved for funding. That is when they discovered that they had not received ours. They partially funded our grant using lapsed funds. At the end of this Fiscal Year they had no more lapsed funds. They anticipated that new money would be appropriated during the last legislative session, it was not. There is a$327,000.00 short fall our of the 17.6 million dollars awarded. That amounts to 1.85%; so it is not a huge deal. That amounts to $9,500.00 that we will not have for Fiscal Year 2011. We anticipate pulling that money from our Red River Hospital bed days. That will reduce our ability to admit there by two individuals. 3)Intellectual and Developmental Disabilities Services It has been a nightmare trying to find a primary care physician for our Intermediate Care Facilities for Persons with Mental Retardation(ICF/MR)residents. We had a contract with an individual with Clinics of North Texas. They went through some reorganization and one of their primary care physicians was out for an extended period of time with an illness. The individual we were contracting with had to pick up the slack. We were then set up with the Family Health Clinic and they have now said they do not want to do it any more. We have 24 Mental Retardation Consumers in our Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR). We went back to Clinics of North Texas and they said no. Some physicians have issues with Medicaid and Medicare patients and some are not comfortable with the Intellectual and Developmentally Disabled. This is a serious issues that will place us on vendor hold. We can not force physicians to take our patients. The Community HealthCare Clinic gets an enhanced Medicaid rate. I have a call in to talk to the CEO (Chief Executive Officer)to see if they have the capacity to handle our patients. 4) Veterans We are moving forward with addressing the Veterans Mental Health issues. We have 12 licensed employees who received CPT (Cognitive Processing Therapy) Training. We are working on developing the peer support. 5)Mental Health Services We are working with the Community HealthCare Clinic on an incubation grant for Behavioral Health and Primary Care. The potential is for us to put a Behavioral Health clinician at the Community HealthCare Clinic and them put a Primary Care Physician at our Behavioral Health Clinic. We are working with UTMB (University of Texas Medical Branch) on a contract. They received a grant from HHS (Health and Human Services) to expand children psychiatric services to our rural areas for Medicaid kids. They will do the billing and pay us for our efforts on the patient side. We are negotiating a contract with them to provide four hours a week service. We are working on the development of a Community Block Grant that will allow us to place a clinician to provide Mental Health and Substance Abuse homeless outreach services 6)HCS(Home and Community—Based Services) Case Management Conversion We will be providing training on the HCS (Home and Community—Based Services) Case Management Conversion at the May Board of Trustees meeting. The meeting with the Private Providers went well. 7) Texas Council Board of Directors and Executive Directors'Consortium I am chairing a workgroup to work with DSHS (Department of State Health Services) on Contract Management and Oversight Audit issues. We will try to chip away at the audit findings. As you can see we have a ton of stuff going on. Board of Trustee Meeting Minutes 6 March 4,2010 030410-10 ANNOUNCEMENTS A)Next Meeting Ken Andrews announced the next meeting is scheduled for 11 A.M., Thursday, April 1, 2010, at a location to be determined in Vernon. 030410-11 OTHER BUSINESS None 030410-12 ADJOURN The Board of Trustees' meeting adjourned at 1:51 PM. Approved as presented: Approved as corrected: April 01,2010 Board of Trustee Meeting Minutes 7 March 4,2010 H E L E N FARAB E E Wichita Falls Administrative Office kgO. Box 8266, Wichita Falls, TX 76307-8266 Re Tonal MHMR Centers 1000 Brook Street, Wichita Falls, TX 76301 g ITP Phone (940) 397-3100 Fax (940) 397-3150 April 06, 2010 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 Regional MHMR Centers is enclosed for the regularly scheduled meeting held on March 04, 2010. These minutes were approved by the Board at its meeting hel on April 01, 2010. Sin - - , a•> Jan W s Admi strative Assistant/Board Liaison /jw enclosure