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State Executive Council / State & Local Advisory Team

DRAFT MINUTES

STATE EXECUTIVE COUNCIL (SEC)
COMPREHENSIVE SERVICES FOR AT RISK YOUTH AND FAMILIES
Dining Hall, United Methodist Family Services
3900 W. Broad Street, Richmond, VA
Wednesday, March 25, 2009

SEC Members Present:
Secretary Marilyn Tavenner, Office of Health and Human Resources
Raymond Ratke, Special Advisor for Children’s Services Reform
Delegate Phillip Hamilton, Virginia House of Delegates
Trudy Ellis, Parent Representative
David Canada, City Manager, City of Petersburg
Woody Harris, Councilman, City of Emporia
Tony Conyers, Commissioner, Department of Social Services
Barry Green, Director, Department of Juvenile Justice
Tim Howard, Deputy Director for Community Programs, Department of Juvenile Justice
Karen Remley, Commissioner, Department of Health
Cindi Jones for Pat Finnerty, Director, Department of Medical Assistance Services
Doug Cox for Superintendent Patricia Wright, Department of Education
Greg Peters, Virginia Coalition of Private Providers Association
Mike Mastropaolo, Chair, State and Local Advisory Team

SEC Members Absent:
Senator John Edwards, Virginia Senate
Lelia Hopper, Office of the Executive Secretary of the Virginia Supreme Court

Office of Comprehensive Services Staff Present:
Charlotte McNulty, Executive Director
Dave Nichols, Technical Assistance Coordinator
Marsha Mucha, Executive Assistant

Call to Order
Ray Ratke called the meeting to order at 9:40 a.m. He called for introductions and noted that Secretary Tavenner would arrive shortly. It was noted that this was the first SEC meeting since Charlotte McNulty was hired as Executive Director of the Office of Comprehensive Services (OCS). Secretary Tavenner arrived and remarked that last year had been a busy year for the SEC and that this year’s efforts would focus on training development and implementation. A quorum was present.

Approval of Minutes
The minutes of December 19, 2008 were approved on a motion from Mr. Hamilton, seconded by Cindi Jones and carried.

Budget and Legislative Session
Secretary Tavenner reported that her office had worked closely with Mr. Hamilton and Senator Hanger, during the 2009 General Assembly Session on Comprehensive Services Act (CSA) bills. She personally thanked Mr. Hamilton for his work during the Session. Secretary Tavenner reported on the following bills and budgetary items that directly impact CSA:
Legislation
SB 1179A (Hanger) – Expands State Executive Council (SEC) membership by four. The bill provides for one additional local government member (currently there are 2); two additional private provider members (currently there is 1); and includes the Special Advisor on Children’s Services Reform as an ex-officio member. Additional memberships will be appointed by the Governor for three-year terms with a two-term limit.
SB 1180 (Hanger) – Requires the SEC to report and analyze expenditures associated with children who do not receive pool funding and have emotional and behavioral problems. The bill also requires the Council to identify funding streams used to purchase services in addition to pooled, Medicaid, and Title IV-E funding. Both reporting requirements would be included in the biennial state progress report on comprehensive services to children, youth and families delivered to the General Assembly and Community Policy and Management Teams (CPMTs).
SB 1181 (Hanger) – Requires the Executive Director of OCS to report to the SEC all expenditures associated with serving children who receive pool-funded services. The report shall include expenditures for (i) all services purchased with pool funding; (ii) treatment, foster care case management, and residential care funded by Medicaid; and (iii) child-specific payments made through the Title IV-E program. (SBs 1181, 1182, 1183 and 1184 were incorporated into SB 1181.)
SB1506A (RB) (Hanger) – Provides that in cases of judicial assignment of services for children under the CSA program where a party requests a level of service not identified or recommended in the report submitted to the court by the Family Assessment and Planning Team (FAPT), the court shall request the CPMT to submit a second report characterizing comparable levels of service to the requested level of service.

CSA Budget Amendments
Item 283 #2c – Adds language to require local CPMTs and Community Services Boards (CSBs) to work collaboratively on developing local plans for intensive care coordination (ICC) for children placed in, or at risk of placement in, residential care and to determine the service provider for these services according to guidelines adopted by the SEC. Also, requires the SEC and OCS to develop guidelines for reasonable rates for ICC services and provide training and technical assistance for these services.
Item 283 #3c – Requires OCS to develop a plan for conducting training sessions during the fiscal year. Language also requires reporting on training session dates, programs, trainers, evaluations and funds expended beginning December 1 of each year.
Item 283 #4c – Adds language to CSA to clarify that local match rates for Medicaid-funded services provided through the CSA program are not reduced during the 2008-10 biennium. Any increases in local Medicaid match rates would violate local cost sharing requirements included within the federal American Recovery and Reinvestment Act of 2009, thus jeopardizing $962 million in federal Medicaid revenue to the Commonwealth.

Council on Reform (CORE) and Children’s Services System Transformation
Ray reported that CORE last met in February. In 2009, CORE will meet quarterly. CORE group membership and meeting participation will consist of the original 13 localities and the members of the state staffs (from across agencies) that are directly supporting their work. The CORE meetings will serve as check-in on implementation for both the state and local implementation teams and will provide an opportunity to troubleshoot and share promising practices together.

Ray further reported that he and Mary Nedell had been on the road hosting a series of Transformation Kickoff Forums across the state. These forums are providing localities an opportunity to learn more about the Transformation work to date, plans for implementation statewide, and how localities can benefit and become involved in the Transformation initiative. These forums are also providing an opportunity for people to provide valuable input on the Transformation process. The next Forum is scheduled for tomorrow in Norfolk.

Regional collaboratives are being planned to begin replicating the results of the Transformation initiative in the CORE localities statewide through a sustainable regionally led structure. Those areas of the state that already have regional collaborative partnerships in place are being identified so that Transformation Regional Collaboratives can be aligned with meetings and/or trainings of those existing groups.

At the state level, the cross-system Transformation workgroup is working on expanding the practice model, discussing how to develop common outcomes that can be used across Virginia’s child serving agencies and how best to expand Transformation to the localities.

During discussion, Mr. Hamilton asked if the Transformation Initiative was working with the residential provider communities to develop community-based services and how residential providers were fairing overall as a result of the Transformation Initiative. Ray and Secretary Tavenner explained that there were some concerns to work through. Some residential providers are expanding into other services and a few residential facilities have closed.

Greg Peters noted that because of the economy it is a difficult time for some residential providers to try to make a shift in the services they provide. An additional problem is the time it is taking to receive licensure from the state for new programs. Also, as noted above, the concern over the local match rates as affected by the federal stimulus monies Virginia will receive.

At the end of the discussion, Secretary Tavenner asked Commission Conyers to see if the Department of Social Services (DSS) could provide assistance to the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) to clear out the backlog of licensure applications.

Public Comment
Marc Jaccard – President of the Virginia Coalition of Private Provider Associations (VCOPPA)
Mr. Jaccard commented that one provider in Winchester has been waiting 6 months for licensure and was told that it might take up to a year. He thanked Ray Ratke for his hard work and noted that he had been at the Transformation Forum yesterday. Mr. Jaccard further commented that as the whole Transformation Initiative has been rolled out it has seemed to focus on the process and not on outcomes. Certain outcome data is not available from DSS for instance on the number of children abused while in kinship care.

Private providers are being asked to seek Medicaid certification but, because of the wide array of services a facility may provide, a facility may be restricted to 16 Medicaid certified beds. The state should treat all provisions for services the same by rolling back the local match rates for all.

Michael Farley – Executive Director of Elk Hill
He is on board with the Transformation Initiative. He has the same concerns as expressed by Marc Jaccard about the Medicaid certification issue. He expressed concerns regarding the many levels of services provided by facilities that would not meet the criteria for Medicaid certification. Because of the federal stimulus funding and the fact that increases in local Medicaid match rates would jeopardize that funding, the local match rates should be rolled back for everyone to treat everyone fairly.

Report on FY 08 CSA Critical Service Gaps Report
Dave Nichols reported that eighty percent of CPMTs participated in the FY 08 assessment. These localities represent approximately 87% of youth served under the CSA. Localities were asked to rank their top 5 service gaps from the list of services from previous surveys. They were asked to indicate which of a list of barriers were impacting their ability to develop community-based services. As requested by the Match Rate Workgroup, a new community services availability section was added with items relating to increased services, strategies and needs. Space was provided for anecdotal descriptions of increased services and strategies utilized to increase service capacity.

Dave highlighted the following areas of the report:
Increased reported needs for ICC and parenting/family skills training - The need for these services rose significantly in FY08.
Decreased reported needs for group home care and residential treatment - These needs were in the top 10 for the previous 2 years but fell from the top 20 list in FY08.
Increased community-based service capacity for school-based mental health day treatment
Strategies for increasing service capacities include annual CPMT/stakeholder retreats and working with existing providers to modify/customize services
Respite and transportation are more highly reported needs in rural than metropolitan areas of the state
Intensive Substance Abuse services are very highly reported needs for the Northern and Western regions of the state.

The top three barriers to community service availability were:
Access to grant or flexible funding for program start up
Need to pool resources and funding across multiple community partners and funding sources for the service
Need for greater collaboration amount community stakeholders

As reported in the new community services availability section:
65% of localities reported an increase of community services
61% of localities reported an increased array of services
81% of localities reported they had taken steps to expand services

The most commonly reported new community services included:
School-based mental health day treatment
Parent and family mentoring
Parent/family skills training
Wraparound services
Intensive in-home services

Strategies for expanding community services included:
CPMT led initiatives – i.e. retreats, case worker training, regional meetings of CSA programs
Juvenile court led initiatives – i.e. stakeholder conference on community services and cross agency school/court service unit trainings on truancy
Funding strategies – i.e. access regional grant funds and strategically coordinating private funds, Safe and Stable Families, VJCCCA and CSA non-mandated funds

A question and answer period followed Dave’s presentation. Questions centered on how the definitions used in the survey are determined, where the data reported comes from, and the manner in which the survey is completed. It was suggested that a category for natural or non-traditional supports for families be included.

Update on Implementation Strategy for Intensive Care Coordination (ICC)
Janet Lung from DMHMRSAS reported. Janet reported that DMHMRSAS had been working with CSA for about a year on this project. She noted that ICC is one of the building blocks of the Transformation Initiative.

Janet explained that the 2008 General Assembly directed the SEC to oversee the development and implementation of mandatory uniform guidelines for ICC for CSA children. The Community Policy and Management Team (CPMT) is responsible for establishing polices for providing ICC services. Family Assessment and Planning Teams (FAPTs) should identify children who can be appropriately and effectively served in their homes, relatives’ homes, family-like settings, and communities and coordinate services and develop a plan for returning the child to his home, relative’s home, family-like setting, or community.

The 2009 General Assembly provided further clarification by adding that local CMPTs and Community Service Boards (CSBs) shall work collaboratively to develop a plan for ICC that best meets the needs of the children and families. If there is more than one CPMT in the CSB’s service area, the CPMTs and the CSB may work together as a region to develop a plan for ICC. Local CPMTs and CSBs shall also work together to determine the most appropriate and cost-effective provider of ICC for children in accordance with guidelines developed by the SEC. The SEC and OCS shall develop guidelines for ICC rates.

Janet noted that it takes a considerable amount of time and hard work to provide ICC services and to create a special package of community services that are provided by multiple public and private providers to meet the unique needs of some at-risk children. Therefore, the ICC guidelines established a case load of 7-12 children for each coordinator. Localities have the option of selecting the children to receive ICC services.

ICC has been implemented in three phases:
Phase 1 – Development of Guidelines – Included drafting of the guidelines, broad stakeholder review and a public comment period. The SEC approved three general rules to guide the implementation of ICC:
o ICC is a reimbursable CSA service
o The local CSB is the responsible entity for the provision and oversight of ICC
o All children in or at risk of group care are to receive ICC, but services may be phased in based on local priorities.
Phase 2 – Implementation Workgroup – The SEC called for a workgroup to consider the three broad areas for implementation of ICC. The workgroup co-chaired by Janet Lung and Charlotte McNulty met three times. The workgroup considered in depth the three general rules and also discussed rates and how various community roles should interface to assure best practice. The Workgroup developed products (i.e. toolkit, table on rate information from sample localities, role clarification chart, etc.) to support implementation and recommended moving forward with the technical assistance and training phase in February 2009.
Phase 3 – Technical Assistance and Training – A toolkit and frequently asked questions on ICC have been posted on DMHMRSAS and OCS websites. An Intensive Care Coordinators Network has been developed and is getting ready to have its second meeting. Tracking of the implementation status at each CSB and providing technical assistance is on going.

As of March 2009, 12 CSBs with CPMT collaboration have at least one ICC position and 5 CSBs have more than 1 ICC position. Approximately 90 people attended the first ICC Network/Information session on February 23, 2009. The next ICC Network meeting will be held April 14, 2009 in southwest Virginia at the New River Valley CSB.

A question and answer period followed Janet’s presentation. Several questions were asked concerning outcome measures. Janet noted that currently there are no measures for how successful ICC is in serving families and children. It was suggested to look at localities that have been providing ICC services to see if they are collecting outcome measures.

Potential Transfer of OCS Financials to DMAS
Secretary Tavenner reported that she, Ray and Cindi Jones have been discussing the transfer of the OCS financials to DMAS. The primary reasons for the transfer would be to streamline the CSA billing and reimbursement process and to allow for more accurate CSA cost projections. Secretary Tavenner said that if any of the SEC members wanted to volunteer to work on the project to please let her know.

State and Local Advisory Team (SLAT) Report
Mike Mastropaolo reported, that since Charlotte was hired as the OCS Executive Director, he was elected SLAT chair. Gail Schreiner, Portsmouth CSA Coordinator was elected vice-chair. Mike and Gail will serve until June 30, 2009. He also reported that, at the March 5, 2009 SLAT meeting, SLAT members voted to begin meeting every other month.

Mike placed into nomination the following new SLAT representatives:
Court Services Unit (CSU) Directors Association
o Randy Blevins, Primary
o Frances Brown, Alternate
Virginia Association of Community Services Boards (VACSB)
o Kathy Drumwright, Primary
Virginia Coalition of Private Provider Association (VCOPPA)
o Karen Tompkins, Alternate

The following state agency representatives have also been named:
Virginia Department of Social Services
o Paul McWhinney, Primary
o Denise Dickerson, Alternate
Virginia Department of Education
o Susan Cumbia, Alternate

Mike’s recommendation was seconded by Mr. Hamilton and carried. Secretary Tavenner thanked Mike for his work on behalf of SLAT.

Adjournment
There being no other business, the meeting was adjourned at 11:00 a.m.

 

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