)                    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




            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




Step One/Partnership


ARC of Stanly






Pharmacy Vouchers




Total Expenditures




Remaining Balance




            Budget Director Dennis Thompson suggested setting up a meeting with CEO Betty

Taylor, Interim County Manager Darlene Bullins to possible discuss 3 alternatives such



(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


(3) If services were provided exactly as today, what would be the cost to the  



            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













_________________________                                  _____________________________

Darlene M. Bullins                                                    J. Leon Inman

Clerk to the Board                                                  Chairman