Executive Summary
Missouri Department of Mental Health
1706 E. Elm Street, P.O. Box 687
Conference Room B
Jefferson City, MO 65102
Mental Health Commission Minutes
September 14, 2006
| CALL TO ORDER | Dr. John Constantino, Chair, called the meeting of the Missouri Mental Health Commission to order at 9:07 a.m. on Thursday, September 14, 2006. The meeting was held at the Department of Mental Health, 1706 E. Elm Street, Conference Room B, Jefferson City. | |||||||||||||||||||||||||||
INTRODUCTIONS APPROVAL OF MINUTES
OPEN DISCUSSION |
Introductions were made. Dr. Constantino deferred approval of the August 17, 2006 Mental Health Commission Minutes until the next regularly scheduled meeting. Mary Lou Bussabarger commented on newspaper articles that discussed the low demand for free voter identification. One article said, "there are a number of persons who can't or won't vote such as felons, the mentally ill and people who simply don't register." Mary Lou noted that the articles sent the message of stigma and confusion to the mentally ill community. Dr. Constantino expressed gratitude to the Commissioners and Mary Lou for all the hard work that was done to develop the report, Building a Safer Mental Health System: Report of the Mental Health Commission. The report has had good outcomes in terms of credibility and the response from the public, interested and invested stakeholders. The Commission remains open to additional recommendations or comments. Everyone was encouraged to review the recommendations made in the report which can be accessed on the DMH web site www.dmh.mo.gov. Dr. Constantino reported that student residents in psychiatry, who have their medical education paid for with the premise of working in an underserved area after graduation, cannot find jobs in Missouri. The current scoring system concludes that there is no place in Missouri that scores at the level to allow work of graduate residents in underserved areas. Dr. Parks will work with Dr. Constantino to look into how Missouri is scored and the mapping system to determine if anything can be done to attract and retain quality physicians for mental health. |
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| DMH DIRECTOR SELECTION PROCESS | George Gladis presented an update on the Department of Mental Health Director Selection Process. George introduced Stuart Meyers of the Meyers Group, the firm contracted to do a national search for a director. Key Dates
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DIRECTOR'S UPDATE
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Ron Dittemore, Interim Director, reported on key meetings and appointments. Bob Bax presented an overview on the DMH Communication Plan and provided an outline of the direction that will be taken. Rebuild the Infrastructure
Communication Office Objectives
Not all of the objectives will be accomplished in the short term; some are goals for future expansion. A follow up on the Communication Plan will be presented at a future meeting. Rhonda Haake, CIMOR Project Manager presented a CIMOR Security Overview. Approximately 800,000 consumer records and episode recorders were converted for the CIMOR "live" date of September 13, 2006; a staff of 35 is assigned to the Help Desk to provide end user support. In a handout the following security process was outlined: HIPAA Security Officer
Each level of security officer is responsible for reviewing and approving or denying access requests. Provider contracts include language about complying with HIPAA regulations. The provider organization is responsible for establishing their local policies and procedures for HIPAA, including assigning responsibility for local HIPAA security officer. Requesting Security Access - new users from DMH Facility or Provider must submit a paper form for their first request to DMH systems, providing signed confidentiality statement. This signed form identifies the user, organization of employment, and initiates the user receiving a User ID. User Request - once the user has an ID, s/he can access the web-based DMH Access Request Application (ARA) and select the security roles needed to accomplish job duties. User Request - Supervisor Approval - the user's request is forwarded by email through ARA to the user's supervisor for approval. Supervisors are responsible for closely reviewing the security request and verifying that the roles requested are appropriate for the user's job expectations. User Request - Supervisor Approval - Local Security Officer (LSO) Approval - Approval requests are forwarded by email to the LSO for approval. The LSO is responsible for final verification that the roles requested are appropriate for the user's job expectations. (Provider requests are next forwarded to the ITSD Security Group for implementation.) User Request - Supervisor Approval - LOS approval - Division Security Officer (DSO) Approval - requests from DMH users are then forwarded by email to the DSO. Division level review involves general knowledge of the facility operations and what types of CIMOR functions are appropriate. (DMH requests are next forwarded to the ITSD Security Group for implementation). DMH ITSD Security Group compares the access request to the security roles listed before implementing the requested roles (s). If the request is within guidelines, the security role is set up and becomes activated the following day. CIMOR Access - CIMOR Screen where user first enters the system is reminded of the HIPAA protected health information use expectation. Inside CIMOR - once inside CIMOR, the user's security role(s) determine which navigator options are available, including whether the user can add, edit, delete, or only view certain types of data. Some roles allow access to a group of screens. If a user does not need to access each screen in order to perform his/her duties, the user is expected to exercise control and not access those screens. Audit trail information is captured to record. Rhonda to follow up on these recommendations:
Clive Woodward, coordinator for Quality management presented a Draft Safety Snapshot illustrating the following topics:
As a new member to the Executive Team, Clive will present weekly updates related to safety information. Recent discussions included the following:
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| TRANSFORMATION GRANT OVERVIEW | Diane McFarland, Division Director, Comprehensive Psychiatric Services presented an overview of Transforming Missouri's Mental Health System: Creating Communities of Hope. The presentation outlined the following:
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| BUDGET PRIORITIES RANKINGS | Patty Henry, Budget Administrator, highlighted the FY 2007 Supplemental Decision Items and FY 2008 Decision Items that were added or included significant changes since the budget was presented at the August Commission Meeting. The Supplemental Budget Decisions with significant changes included: Accreditation of MRDD Services - this item requests funding and federal authority in FY 07 to begin the accreditation process for MRDD habilitation centers. These funds will be used to hire Quality Assurance and Risk Management staff for the six habilitation centers and to do accreditation readiness assessments for the MRDD habilitation centers. Psychiatrist Recruitment and Retention - this item requests funding to provide for the realignment of psychiatrists into unclassified positions with more competitive rates of pay (6 months funding). Mental Health Transformation State Incentive Grant - will provide infrastructure funding for developing and implementing a Comprehensive State Mental Health Plan throughout Missouri based on the 6 goals of the President's new Freedom Commission Report. The FY 2008 Operating Budget with significant changes and request for additional funding include: Accreditation of MRDD and CPS Services - these funds will be used for Quality Assurance and risk management staff for the six habilitation centers, for the annual Accreditation Survey at MRDD Habilitation Centers, and to conduct the Readiness Assessment on CPS and MRDD community providers. Comprehensive Children's Mental Health System - additional funding has been requested to address
Department Staff Training - increased and ongoing investments in staff training and development is critical to ensuring the safety of consumer and employees, as well as improving service delivery. This item requests funding to support the recommendation of the American Society of Training & Development's 2005 State of the Industry report indicating that average training expenditures should be 2.3 % of payroll. MO Medicaid Mental Health Partnership Technology Initiative - this project uses health information technologies to improve the overall health-care of persons with co-occurring psychiatric and medical illnesses. Disaster Services - this item will allow for Department-wide efforts in disaster related incidents and/or training. Circle of H.O.P.E. System of Care Grant (Northwest) - this is a six year grant with a goal to develop integrated home community based services and supports for children and youth with serious emotional disturbances and their families by encouraging the development and expansion of effective and enduring systems of care. The Ranking of Decision Items proposed by the Executive Team was presented: 1 Core Dr. Constantino lead a discuss on the following decision item rankings. #9 item - Provider Cost of Living Adjustment #6 item - Accreditation of MRDD and CPS services #7 item - MRDD Community Support Services #13 item - Department Staff Training The Commission members unanimously agreed on the adjustment to the decision item rankings. |
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| DIVISION AND SECTION UPDATES | Michael Couty, Division Director, Alcohol and Drug Abuse reported having been awarded a two year grant from the Robert Wood Johnson Foundation to increase the utilization of evidence-based practices in substance treatment. The partnership is between DMH, Division of ADA and 10 certified, contracted substance abuse treatment providers located throughout Missouri. The first category of evidence-based practice (EBP) to be addressed in the partnership is "use of medications for specific diagnoses." The specific evidence-based practice to be addressed is use of naltrexone and acamprosate to treat alcohol dependence. The second category of EBP to be addressed is the "use of specific psychosocial clinical interventions."Specifically, to increase the use of cognitive behavior therapy (CBT) interventions to treat consumers who experience symptoms related to trauma. Bernie Simons, Division Director, Mental Retardation Developmental Disabilities presented the following updates: Mental Health Commission Recommendation #1 - Accreditation of all habilitation centers should be pursued immediately. The level of accreditation should be commensurate with complex medical and mental health needs of persons that utilize these facilities. This includes provision and oversight for medical personnel and for training of staff to manage mentally ill patients. Similarly, an appropriate and feasible method for accrediting those community service providers who have not yet achieved accreditation must be pursued. ACCREDITATION
RECOMMENDATION: The Division of MRDD recommends the selection of CARF for accreditation of the State Habilitation Centers. The Division of MRDD is in discussion with MO providers who have national accreditation and is working with them on how to engage other providers to become nationally accredited. Currently, all Supported Employment Service Providers (SESP) funded by the Division of vocational Rehabilitation (DESE) are CARF accredited. This is a contractual requirement to become a SESP to receive funding from Vocational Rehabilitation. The Council of Quality Leadership shared that they will no longer be accrediting habilitation centers. Bernie expressed his appreciation for the work done by Becki Carson in coordinating division schedules to discuss accreditation with the Council of Quality Leadership, JCAHO and CARF to address the Commissions’ No. 1 recommendation. The State Medicaid Agency forwarded notification from CMS approving the State’s request to renew the MRDD Comprehensive and Community Support HCBS waivers for a 5 year period ending June 30, 2001. Services for more than 8,000 individuals served by MRDD are funded through these waivers. Staff from the Region VII, Centers for Medicare and Medicaid Services (CMS), Kansas City Office, conducted an on-site review of residential services funded through the MRDD 1915 @ HCBS comprehensive Waiver during the week of August 28 through September 1. The review focused on interviews with staff and a review of provider records. The Division awaits a response from CMS. The Division of Medical Services on behalf of DMH submitted a “letter of intent” to apply for a 5 year Federal grant from the Center for Medicare and Medicaid Services (CMS) called “Money Follows the Person (MFP).” The grant proposal is due in November. States receiving this grant will be entitled to an enhanced federal match rate for up to a year for individuals who transition out of a Medicaid facility into an independent living arrangement in the community. Felix Vincenz, Facility Operations Director presented the following updates: Facility Operations has completed facility reviews on each of the habilitation centers. A complete report will be shared with leadership and the Mental Health Commission by November. Certification Activities
The Columbus Organization has submitted a work plan which has been accepted. Scheduling for training session in risk management will be offered to facilities leadership at all the habilitation centers. Training will be focused on three core clinical issues that will upgrade the quality of treatment and habilitation: 1) choking, swallowing (dysphagia); 2) Pica behaviors; 3) Standardized expectations and training on functional assessment and behavior support plans. Finally, we have received 5 response bids for our contract for developmental aid positions. Discussions are underway with the bidders to begin providing such positions by mid November. |
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| PUBLIC COMMENTS | Dr. Constantino commented that a goal of the Commission is to create more of a forum for public and stakeholder commentary at Commission meetings. Jackie Lukitsch, NAMI presented remarks in reference to a study done by the U.S. Department of Justice on the incarceration of individuals who are in local, state and federal facilities with prevalent mental health issues, i.e., major depression, psychotic disorder, mania, etc. She noted that the report creates an urgent need for anyone who provides mental health services to take a closer look at this issue. Jackie also gave recommendations on budget priorities. |
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| EXECUTIVE SESSION | Mary Lou Bussabarger made a motion that the Mental Health Commission go into Closed Executive Session in accordance with Section 610.021, (3), RSMo., Personnel. Beth Viviano seconded and the motion passed. |
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| ADJOURN | The Mental Health Commission adjourned at 12:45 p.m. APPROVED OCTOBER 12, 2006 John Constantino, Chair |
