) STOKES COUNTY GOVERNMENT
COUNTY OF STOKES ) DANBURY, NORTH CAROLINA
) MARCH 22, 2006
The Board of Commissioners of the
County of Stokes, State of North Carolina, met
for
special session to discuss Mental Health Issues in Stokes County in the
Commissioners’
Chambers
of the Ronald Wilson Reagan Memorial Building (Administrative Building)
located
in Danbury, North Carolina on Wednesday, March 22, 2006 at 5:30 pm with the
following
members present:
Chairman Leon Inman
Vice-Chairman
Joe Turpin
Commissioner Sandy McHugh Commissioner
John Turpin
Commissioner
Jimmy Walker
County
Personnel in Attendance:
Clerk to
the Board/Interim County Manager Darlene Bullins
Budget
Director Dennis Thompson
DSS Jan
Spencer
Health
Director Don Moore
Assistant
EMS Director Greg Collins
Captain
Craig Carico – Jail
Captain
Al Tuttle – Sheriff’s Department
District Resource Director
Tony Hill
Others
in Attendance:
CEO
Betty Taylor - CenterPoint
Paul
Caldwell - Triumph LLC
Kathy
Lindner - Triumph LLC
Billy
West - DayMark Recovery Services, Inc
Cathy
Long - Director – Stokes Opportunity Center
Chairman Leon Inman called the Special Session to discuss Mental Health
Issues in
Stokes
County to order.
Chairman Inman delivered the invocation.
Chairman Inman opened the
meeting by inviting the citizens in attendance to
join
the Board with the Pledge of Allegiance.
Chairman
Inman opened the special session by expressing the Board’s appreciation
to those in attendance to discuss mental health issues in
Stokes County.
CEO Betty
Taylor presented the (FY 2006) 2nd Quarter Report for CenterPoint
Human Services.
(Members of the Board were given a copy of the 2nd Quarter
Report).
Ms. Taylor
spoke briefly on the following issues regarding the 2nd Quarter
Report:
·
Funding pressures – Nationals Cuts ($39 billion in
cuts including $6.4 billion from Medicare and $4.8 from Medicaid)
·
North Carolina cuts – to date less than $20,000,000
has been transferred instead of the targeted $43,980,200 to LMEs
·
LME Management funds – state will cut these funds to
Local Management Entities in Fiscal Year 2007 by $28 million
·
CenterPoint has been informed that its current LME
allocation of $6,553,968 will be reduced in Fiscal Year 2007 by 31% or
$2,010,137
·
Effects on CenterPoint’s Reduction in Funding
Ms. Taylor discussed in detail the
following additional information provided to the
Board:
Mental Health Reform
Overview
·
Pamphlet which explains the following – Local
Management Entity for
Mental
Health, Developmental Disabilities and Substance Abuse Services
and
answers the following questions:
o
What is Mental Health Reform?
o
What are LMEs?
o
What is CenterPoint?
o
Why is the LME Important?
o
Who Does the LME Serve?
o
What About Funding?
·
Screening, Triage, Referral (STR) in Transition
o
STR will be performed in house by CenterPoint
effective 7-01-06
o
STR will be a 24hour/7 day operation
o
STR will be overseen by CenterPoint’s medical
director
·
Status of the Utilization Review (UR) Contract with
Guilford
·
Projected LME Management Funding Cuts
o
Meeting scheduled with State Legislative Representatives
to try to obtain Systems Management allocations and PCPM amounts to equal $1.54
instead of CenterPoint’s current rate of $1.38
Future of Mental Health Reform from CenterPoint’s
Perspective
·
Consolidation of Administrative Functions
·
Crisis Response Network
o
Awarded $100,000 grant from the State to start up the
operation of the mobile crisis center for this fiscal year
·
Stabilization of Psychiatric Services
o
NC is more than 70 psychiatrist short especially in
child psychiatry
o
Rate are not sufficient for reimbursement for
psychiatric services
·
Shrinking Funding/Need for Expanding Community
Resources
·
Durham Litigation
Stokes County MH/DD/SA Services
·
Consumers Served/Services Provided
o
Service data from CenterPoint is based on the billing
that has been processed through CenterPoint
·
Future of the First Opinion Waiver Pilot Program
Mr. Paul Caldwell, Triumph LLC discussed
the following information:
·
Currently providing outpatient services to 276
individuals (ages 3-82)
·
Funding sources for clients are: 56% Medicaid; IPRS (90% adults), 10%
Medicare, and 10% other
·
Case Management (soon to be Community Support) is
being provided 81 individuals, 42 adults, and 39 children
·
Outpatient services at King and Danbury locations (2
locations in King)
·
Seeing approximately 80 individuals in Danbury
locations
·
Currently have 4 – full time Outpatient Therapists
and 2 part time Outpatient Therapists – all of whom have “Q” status
·
Currently have 5 Case Managers, all of whom have “Q”
status
·
Triumph and DayMark work together with each other due
to not performing the same services in Stokes – to ensure services are
available to the citizens of Stokes County
·
Since August 29, 2005 through February 2006, Triumph
has loss $154,000 in Stokes County
·
Provides daily services every day
·
Possible future request for additional funding from
either CenterPoint or Stokes County
·
Provider concerns/issues
o
Limited opportunity for Stokes County residents to
receive in-county emergency mental health, substance abuse treatment
o
Limited funding resources for uninsured Stokes County
adults. Division consistently exhausts all IPRS funds by the 3rd
week and has been continuing services uninterrupted
o
Limited transportation opportunities for residents
resulting in difficulty engaging treatment.
Given that 24% of our client population is IPRS, they are not entitled
to utilize YVEDDI
o
Ongoing and escalating concerns about levels of
funding for the provision of adequate services in three locations in the County
o
Concerns about the ability of the mental health system
to adequately process and pay private providers in a timely fashion.
·
How mental health got to where it is now
o
Mental Health under funded
o
Past mental centers were in financial trouble
o
Reimbursement rates are too low
o
Regulatory requirements from the State
o
Rates have not been changed since 1998-Integrated
payment system
o
Currently, there is more accountability for services
being charged to the appropriate County
Mr. Billy West, DayMark Recovery
Services, discussed the following information:
·
Services provided – Mental Health (psychiatric),
First Opinion Waiver, and some substance abuse services (physicians and nurses
–main staff) and after hour services for phone calls, magistrate, jail
consults, and hospital consults
·
Primary location is in King with one day in Danbury
·
Clients are seen usually about every three months-
sometimes every six months
·
Losing about $10,000 a month
·
Providing services to approximately 400-425 clients
·
Stokes County residents are being served in Forsyth
County
·
Agreed that Integrated payment system rates from the
State are too low and system has not been changed 1998 – system is very costly
to operate
·
Disadvantages of the County being its own LME
·
Receives no reimbursement for no-shows and
cancellations which can be very high numbers
·
NC regulatory requirements very strict
·
Attribute excellent staffing at the County Jail which
reduces after hour services
·
Currently, usual respond is within the hour for after
hour services
·
Non essential services driving up costs
·
Issues with having to call several hospitals to
access bed availability before being allowed to transport to John Umstead
Hospital
·
Possible need to consolidate services within the
county and maybe within the 30 minute or 30 mile ruling to save cost
The Board
discussed the following with CEO Betty Taylor, Paul Caldwell-Triumph,
and Billy West-DayMark Recovery Services:
·
Other options to provide mental health services in
Stokes County
·
Services being offered in Forsyth for Stokes County
residents
·
Services mandated by the State that the County must
provide to citizens
·
Setting priorities for the needed services in Stokes
County
·
Time being spent by Sheriff’s Department personnel
waiting for services
·
Consolidation of services – pros and cons
·
Transportation problems for clients receiving
services
·
First Opinion Waiver Program – value service
Mr. Paul Caldwell-Triumph and Mr. Billy
West-DayMark both expressed the
willingness to try to work with CenterPoint and Stokes
County to continue to provide the
best services available to Stokes County residents.
Captain Al Tuttle-Sheriff’s Department
stated that currently there were no problems
with the present setup being used, only issue with the
judicial system not using Stokes
Reynolds Memorial Hospital and requiring transport to Forsyth
Memorial Hospital. Captain
Tuttle also commented on the issue with having to call
several hospitals to access bed
availability before being allowed to transport to John
Umstead Hospital.
Captain
Craig Carico-Jail stated that currently there were no problems with the
services being provided to Jail. Captain Carico also noted the current financial issues within
everyone’s budget.
Captain Carico suggested that each provider perform a needs assessment
to determine if there are any cost savings that may have
been overlooked.
District
Resources Director Tony Hill stated one problem is that no one really knows
how to get in touch with either provider nor the services
being provided by DayMark and
Triumph. Director
Hill also offered available space to cut cost for Triumph and DayMark.
Ms. Robin Howell-NWPCOG suggested more education to local
facilities regarding services
which are available at specific locations.
Ms. Taylor
noted that all services were listed on the CenterPoint web site and
suggested brainstorming together to find the most effective
way to get this information to
the public.
DSS Director Jan Spencer noted no major problems with
serves being provided to
clients with substance
abuse problems or domestic violence issues.
Health Director Don Moore noted issues in referring
clients for mental health
services was continuing
to get better.
Ms. Taylor noted that the First Opinion Waiver, which was
a pilot program, is
scheduled to end June 30,
2006 unless the Legislative Representatives extend funding for
the services. Ms. Taylor urged Commissioners to contact
state representatives to make the
First Opinion Waiver
Program permanent. The Board discussed
the consequences which
could occur if the First
Opinion Waiver Program is eliminated.
Ms. Taylor noted that the
County can contract the
First Opinion Service with County Funding.
Chairman Inman reviewed the following Allocation of
Stokes County Funds for as
of December 31, 2005:
|
Stokes County Funding |
$398,820.00 |
|
|
|
|
Step One/Partnership |
42,120.00 |
|
ARC of Stanly |
164,313.00 |
|
Triumph |
29,900.00 |
|
DayMark |
16,667.00 |
|
Pharmacy Vouchers |
108,419.00 |
|
|
|
|
Total Expenditures |
$361,419.00 |
|
|
|
|
Remaining Balance |
$37,401.00 |
Budget Director Dennis Thompson suggested setting up a
meeting with CEO Betty
Taylor, Interim County
Manager Darlene Bullins to possible discuss 3 alternatives such
as:
(1) If County allocated
$0 funding in mental health, what services would
citizens be entitled to by state law?
(2) If the County decided
to fund at the Davie County per capita level which
would bring forward approximately
$270,000, what services could be
provided?
(3) If services were
provided exactly as today, what would be the cost to the
County?
Ms. Taylor, Mr. Caldwell, and Mr. West extended their
appreciation for the Board’s
commitment to mental
health services and for taking the initiative to meet to discuss openly
the issues that face the
County, CenterPoint, Triumph, and DayMark.
Chairman Inman expressed his appreciation to all those in
attendance for their
participation in this
special session to discuss mental health issues in Stokes County.
Chairman Inman concluded
that everyone wants to get the most services available for the
tax dollar.
There being no further business to come before the Board,
Chairman Inman
entertained a motion to
adjourn the special session. Vice
Chairman Joe Turpin moved to
adjourn the special
session. Commissioner McHugh seconded
and the motion carried
unanimously.
_________________________ _____________________________
Darlene M. Bullins J. Leon Inman
Clerk to the Board Chairman