Member Advisory Council: Minutes, June 2009

June 11, 2009
11 King Street, Augusta, ME
12:30 p.m. – 4:00 p.m.

Attendees:  Eric McVay, Stephanie Crystal, Karen Evans, Tricia Lehman, Eric Meyer, Simonne Maline, Brianna Boucher, Priscilla Seimer, Pat Caporino, Gregg Caring, Karolyn Rossein, Leticia Huttman

Introductions:

• Introductions of MAC Members, State Staff and APS Healthcare Staff

• Next Data Forum will be held June 18, 2009.

Review of Common Understandings:

• No Cell phones

• Speak up when talking

• Wait for someone else to finish speaking before you speak

• Maintain a humorous and positive attitude

• Remember that this is an advisory group not an advocacy group; APS Healthcare provides direct feedback on recommendations

• Respect everyone else’s opinion even if you disagree

• Confidentiality

• And of course chocolate at each meeting!

Review of March Minutes:

• Minutes were approved.

Eric Meyer, Executive Director, ASO Updates:

• Eric reflected on where the Maine ASO is and its development.  Right now APS is focused on intensively and carefully managing change.  Due to the State budget crisis, there have been some changes in MaineCare policies that have been directly affecting the services that APS reviews. The plan is to work with Providers, Members and other groups to keep disruptions low.

•  Eric discussed program updates as follows:

  • Adult Services – Has been a change in the criteria. Services such as Case Management, ACT, and DLSS are changing from GAF to LOCUS scores.  Reason for this change is to better gage the level of need. LOCUS and GAF are not the only criteria for Section 17 Services. There was concern about the LOCUS not being done with the consumer

  • Scattered Site/Residential Care – The State is replacing what was a residential service (even if not in a residential facility) with community based services. There are Federal rules that say the way the State was paying for residential services was not appropriate therefore the new changes. This is just the funding mechanism and not the member that is going to be affected. Everyone’s housing is still secure.

  • Pre-Admission Resident Review – This only has to do with admission to Nursing Homes. PASSAR reviews are done to determine if someone being entered into a nursing home has a mental illness. This process will begin starting July 1st, 2009.

  • Children’s TCM – We have developed a process so providers only have to do reporting with just us instead of having to do it in two different places. The idea is to lessen administrative burden.  There will be a CAFAS change which is another tool that is used for children 6-17.  There might also be new procedure codes which would require providers to register under the new codes.

  • Children’s PNMI – State of Maine has been strongly moving away from Residential Care to being with their families and communities, and wrapping the services around the child and families.

  • Treatment Foster Care – Beginning August 1, 2009. There is a state process and an APS process and they are going to stop doing the duplicate parallel process and do it just through APS Healthcare.

  • Baxter Class Member and Long Term Supported Employment – Beginning August 1, 2009.  The review, approval, and invoicing will be handled by APS for the Baxter Program which has about 100 members.  We are adopting the Long Term Supported Employment process. This program has been going for quite a while and is for people who need support to maintain their employment.

  • OQ (Outcome Questionnaire) – This is not being used as a criteria tool, but rather a tool to decide how we can better suite the member.  It gives feedback to the provider and  agency.

• APS Healthcare recently had some visitors.  We had our Executive Team as well as our HIPPA attorney. They carefully audited the office and are doing a detailed review around federal privacy standards. The visit went well.

Clinical Update

• Talked about the changes with children.  If a child gets denied Case Management that does not mean that they are denied completely for services.  They could possibly qualify for another service such as Outpatient Therapy.

•  Case Management – Graduate Program as Support and Recovery.  Ability to have Case Management for when it is needed instead of having services “bundled together.” Some people only need it for short term periods.

Pat Caporino, Data Review

• The Quality Department is starting to work on comparing providers’ services throughout the state.

• Pat gave an overview of the last four months. (Refer to the Dashboard that was distributed at the beginning of the meeting.)

HOPE Conference

• The HOPE Conference is on June 25, 2009

• Simonne, Priscilla, and Karolyn will be presenting.  Focus will be on how to have difficult conversations with your provider.

Updates

• NAMI Walk – APS had 11 team members participate including Eric McVay from our MAC. Our team logo was “Walking the Recovery Road”.

Member Education and Training Plan

• The plan is designed to help educate members in talking their providers about their care, and APS, helping them feel more comfortable having difficult conversations.

• Process; the Work Team is small (members and APS employees), the Advisory Team is larger.  The WT sends the AT material for them to comment on.  The goal is to have a state-wide process to help train members.

Group Discussion

• Good Will Hinckley is closing – what is the role the State or APS is playing in this closure, if any?  APS Healthcare’s approach is always to first help the agency that is closing focus on discharge planning.  APS Healthcare’s role can be to help identify other organizations that might have openings and to make sure there are no gaps in service.

•  Policy on Internal Complaints or Grievances – If someone has an issue with an APS Healthcare employee, they can contact the supervisor of that person.  The complaint will get documented and within five days you would have a response if one has been requested. The supervisor will follow up with the employee.

• What is the difference between an ASO (which APS Healthcare is) and managed care?  As an ASO, APS is contracted with the state to provide utilization management; no dollar amounts are tied to that. APS must fulfill the requirements of the contract, as opposed to having a set amount of dollars with which to authorize care.  Our role is to provide information to the state to help them determine if services are being delivered effectively or not.

• No Show Issue – When consumers are not showing up for three consecutive appointments, some agencies are cutting them off “cold”.  Many agencies have an individual policy which comes down to their own budget constraints.  It is not APS Healthcare’s role to intervene in agencies’ policies.