Michael Couty, Division Director, Alcohol and Drug Abuse shared the following updates:

• Percent of Merchants Failing Tobacco Checks, the graph noted that the Synar rate stayed below 10% for 2005 and 2006.
  
• Exemplary Award – Community Partnership of the Ozarks, located in Springfield, submitted a program “The ABCs of Secondhand Smoke” to the CSAP-funded Exemplary Awards program for substance abuse prevention programs.  The reviewers recommended this program for the award; it was the highest-scoring applicant of this year’s batch (of 20).  There were two awards given this year.  For the past 2 years, the agency has employed five program assistants who provided each of 14 Head Start centers creative child lessons about the dangers of secondhand smoke.  In addition to working with children, parents and guardians, interact “homework” is given to the children so that they have the opportunity to review pertinent information on the home with their caregivers and family members who may smoke.  The award will be presented to representatives of the agency at a plenary session at the NPN Conference in Lexington, August 29th.

Dora Cole, Community Services Operations Director for the Division of Comprehensive Psychiatric Services presented the following updates:

• Staffing Updates: 
• New book “Schizophrenia”, co-authored by Anthony A. Menditto
• Virginia Selleck appointed as Clinical Director
• Connie Kirby appointed as Area Adult Manger for West/Southwest
• Jackie Lomax appointed as Area Youth Manager for Eastern Region
• Acute Care Planning
  • Two meetings with CEO's/COO's (Metro Psychiatric Center, Western Mo MHC, Mid-MO MH Center, southeast MO MH Center)
  • Review of Southwest Model
  • Financial/Legal Analysis including need for Medicaid Waiver
  • Next Steps

Bernie Simons, Division Director, Mental Retardation Developmental Disabilities presented highlights on the following topics:

Senate Bill 40 Boards/MACDDS

• Continued discussions for leveraging our individual and collective resources (dollars and human capital) to maximize supports and services for persons with developmental disabilities.
  
• Information obtained from a MACDDS conducted survey indicates seven counties not currently providing Service Coordination indicated an interest in beginning to provide the services.

CMS On-Site Review

• CMS is scheduled to conduct an on-site review of 1915© Medicaid Waiver services in the St. Louis Regional Center area during the week of August 28 through September 1.
  
• CMS is conducting the review in response to articles that ran in the St. Louis Post Dispatch in June and July.

Systems Transformation Grant

• Efforts are underway to pilot crisis intervention services using MRDD Systems Transformation grant funds by December 2006.
  
• A request for information will be developed to solicit broad input from potential bidders, family members and other stakeholders.

College of Director Support

• Missouri is one of eight states piloting and/or implementing the CDS web-based training curriculum statewide.
  
• The thirteen provider agencies participating in the pilot have enrolled 283 staff in the on-line training which consists of 13 courses.
  
• State will evaluate effectiveness of initiative at the end of the three-year period (November 2008).

Felix Vincenz, Facility Operations presented updates on the following:

• The CMS survey team has made regularly scheduled visits to Nevada Habilitation Center; Higginsville Habilitation Center, and South County Habilitation Center.  Certification for each center continues.
  
• A CMS survey team is presently at the Southwest MO Psychiatric Rehabilitation Center with an exit review anticipated at any time.
  
• Dr. Ron Dittemore, Bernie Simons and a legislative delegation of Senators toured Bellefontaine Habilitation Center and St. Louis DDTC on August 2; Higginsville Habilitation Center on August 9.
  
• Facilities Operations has a work plan from the Columbus Group.  The plan is to move forward in early September with skills in the area of risk management as well as how to manage certain clinical conditions in the habilitation centers.
  
• Summary of Rights for Consumers in State Operated Facilities – hand out for consumers and family members
  
• Changes in the Grievance Process
• Clarifying the definition of Neglect
• When a grievance moves from being “informal” to “formal”
• Clarifying that the rights include those afforded by JCAHO accreditation and CMS certification
• Client Rights Review responsibilities
• Modifying time-lines
• Other key changes

Dr. Joe Parks, Medical Director, presented the following update:

• Expect to enter into a proposal with Primaris Pharmaceutical to do a quality chart review of the habilitation centers.  Primaris is the medical peer organization for Missouri.  All hospitals periodically get charts pulled randomly and they are then reviewed for their overall quality of care.  Primaris will do this at the habilitation centers.  This will be an extramural review using the standard quality screens that they would use at hospitals and nursing homes. The last review was done in 1998 and it was concluded that our general medical care was a good or better than other specialty hospitals they had reviewed previously.  This proposed review will look at the medical care not the habilitation services and not particularly at the psychiatric or behavioral services.  In view of all the questions raised during the summer we wanted to take another independent look at habilitation centers.

• Work will begin with the Missouri Foundation for Patient Safety; which will include a three way partnership with Primaries, the Missouri Hospital Association and the Medical Society.  The work is to reduce medical error and improve patient safety.  Many of the incidents identified over the summer were deficits of general medical care as much in the community than under our direct care.

• Medicaid is sun setting in 2008 there are multiple committees working on Medicaid Reform.  There will be changes in enrollment procedures; changes in benefit structure to provide incentive for better health care behavior and changes in life style.  This will have significant impacts since it sun sets in 2008, legislation will need to be passed this session.  This is rapidly moving.

• The St. Louis Post Dispatch requested information on research activities by the department.  The department has an affirmative statutory duty to be supportive of research that would improve treatments and care of people that have the kinds of conditions we care for.  There are usually 2-3 dozen research projects open at any time; we have not had any harm reported to any of the research subjects; we survey quarterly on if anybody has been harmed; the responses have been NO.  The Post asked for that information so presumably they are looking at it. 

Mary Tansey, General Counsel, presented an update on the Investigations Unit:

• At St. Louis DDTC Investigators were observed by federal staff on reporting and interviewing activities and received high compliments in both areas.
  
• Investigation back logs remain a focus and a plan to eliminate the back log by the December 2007 is underway.
  
• Additional FTE will be requested to help eliminate the back log; should the request not be met investigation services will be contracted out.