NC Commission for MH/DD/SAS Meeting on Thursday, November 18, 2010

The NC Commission for MH/DD/SAS met on Thursday, November 18, 2010.  The agenda for the meeting is posted on the Commission website here.

Luckey Welsh, Director of the NC Division of State Operated Healthcare Facilities (DSOHF) addressed the Commission:

• Funds have been allocated for education and training in facilities – doing an assessment throughout the facilities asking what needs are beyond what is already being done. Started doing specialized training for managers and supervisors.

• Residential Schools Transfer – 156 teachers, 8 schools. Need to make sure teachers have their licenses, evaluations. Kathy Roades from OES will work for DSOHF to oversee education in the state facilities (psych hospitals and DD Centers).

• Walter B Jones undergoing Joint Commission survey soon.

• Blackley moving into new building in January – a lot of difficulty getting completed.

• DD Centers – TRAC program at Murdoch has 6 beds. Waiting list 6-12.

• O’Berry converting from ICF-MR to SNF. 3d cottage renovation on hold.

• Long Leaf converted a nursing unit into “Main Street" - a grant funded project that provides the residents with a main street type environment.

• Whitaker did outstanding on Joint Commission survey and received accreditation.

• New Cherry schedule to open January 2013.

• Broughton groundbreaking still scheduled for Spring.

• JIRDC incident: in a particular cottage, there was an individual who was being investigated, thought incidents were accidents until someone came forward and said they weren’t accidents. Several people in the cottage knew what was going on. In last quarter, only 4 instances of physical abuse. Each dealt with swiftly with the zero tolerance policy.

• Insko visit to Dix – No safeguards, administration not informed, policies not followed. She was not removed from the hospital. She met with everyone she wanted to. The next day, 4 representatives, including Insko, toured the facility. Secretary met with the representatives then as well.

• Delays of Care – Mr. Welsh believes do not have enough beds. State closed 450 beds, community closed 200 beds. Demands increasing. Laura White spoke about the delays as well. With Dix closure, charged with maintaining capacity and to not increase delays. (Handout with average patients on delay) Not tracking number of people presenting to ERs. Hospitals are on delay almost every day, but not every unit – i.e., a geriatric might be admitted right away, so we don’t know # of people who present and are admitted right away. Average wait is 51 hours. Commission member Don Trorbrough spoke about how patients should be treated during their wait. Chaining someone to the bed is not the way a person should be treated. Magistrate education program started in Catawba to educate on options short of IVC to state hospitals. Also working with Mobile Crisis Teams to try and avoid in-patient at state hospital if appropriate. ERs feel hamstrung by EMTALA. They are collecting data from local ERs on who these folks are. 50-58% coming into ER have no connection to mental health system. City police approach differently than sheriffs. In some areas, MCTs are working with local law enforcement for back-up when they have safety concerns. Victoria Wit in Sandhills has an ER training on array of services, etc. LME should be contacted after 24 hours, and DMH should be called after 48 hours in ER (this started in past two months). Pitt has a 10 bed MR/MI diversion unit. DMH is checking up on treatment providers who are supposed to be first responders to ensure they are available 24/7.

• Laura White spoke about cost reduction matters at Dix – in the process of transferring current patients to Cherry and CRH, to be done by end of December. Forensic Minimum, child outpatient and outpatient clinical research program will remain on Dix campus. They started with patients in long-term unit – 11 CRH, 24 Cherry – all transferred by earlier this week. Transfers to Cherry over 6 weeks, in very deliberate manner. Transferring people with significant behavioral needs to CRH now. Sandhills and Wake admissions will stop to Dix on Dec 3 at 8 pm, rolls over to CRH. Folks on Dix admission unit will be discharged over the next two weeks. Anyone remaining on Dec 20 will be transferred to CRH. 99% of staff (all but 3) have been offered positions at CRH. There were a few supervisory positions where individuals weren’t offered the same job. Established a priority in hiring at all facilities. Cherry is hiring the most so far, don’t know total number, in 30 range. Our system will be stronger with highly qualified Dix staff in other hospitals.

Steve Jordan, Director of NC Division of MH/DD/SAS:

• CABHA – biggest driving issue for them right now. Transferring 19,000 people from non-CABHA to CABHA agencies. 8/31 deadline to have application processed to continue services after 12/31. 300 applications came in the last two days. Processed all but 20 of those. In September issued benchmarks for transition for those who did not qualify or did not apply. By 10/15, those agencies had to submit a transition plan to local LMEs. LMEs review for appropriateness, 77% deemed appropriate. Of those denied, some providers just moved everyone over to outpatient therapy. Over the whole process 900 applications processed for over 600 agencies (3 chances to get attestation letter through desk review). 20 agencies still under consideration.

o There was a question from a member from Cumberland County - only 1 CABHA showing approved in Cumberland County.  Jordan said 96 now approved statewide – 4 now approved in Cumberland County (can be satellite offices of CABHA HQ’d elsewhere). Cumberland is well positioned because just went through the major transition with all of their level iii and iv group homes.
• 1915 (b)/(c) waivers – Mecklenburg has a 1 year extension. Looking to see if any other programs interested in going forward sooner. Need to establish momentum and move these forward. Using Mercer as external review to set tasks and timeline for Western Highlands.

• Budget - At DMH, each 5% cut = 25 mil in state services. 15% cut = $75 mil less in state services. Even if optional mental cut, DMH still responsible for serving all those cut from Medicaid. Starting to look at total system redesign, talking to other states. There are workgroups being held to determine what the core services need to be statewide. Any money that comes out of facilities will disappear, it won’t go to the community. Commitment to keep community crisis on the table. We must see collaboration to get through this.

• Corne gave a speech about Olmstead and ADA pushing people into least restrictive environment. Push to put person into their own home and that is not sustainable (his opinion). The system doesn’t have control over because federal government pushing this. There will likely be a lot of lawsuits. Steve responded that from the federal level, not having enough money to do it is not the answer.

Waiver Requests:

• 10A NCAC 27E .0107 Training on Alts to Restrictive Interventions – Rule addresses staff competencies for alternatives. They are asking that licensed professionals attest to their competency and not have to go through the training. The reasoning is that licensed individuals have to adhere to requirements of their licensure boards.  A thorough discussion ensued among the members of the Commission.  Members made different points and had differing views of the matter: some said that licensed professionals are not taught in a graduate program how to physically manage behavior; there is nothing in the attestation to say that the person’s training addresses restrictive interventions, anything to ensure that the professional is doing this by free choice – need to include documentation. John Owen moved to not approve waiver – motion failed. 2d motion – waiver approved. Copy of license, training certificates will be requested as attachments to the attestation.

• Lynn Jones, oversees DWI services for state – they authorize private providers to provide DWI services – want more time to review applications. Now only 20 business days, asking for 60 business days (got a waiver in May); it’s on the draft rules list but hasn’t gone to public comment yet, so asking for an extension of May waiver. # of applicants increasing – a lot of CABHA applicants and those not approved by CABHAs. Waiver granted.

Rules Committee:

• No October meeting. Prison rules sent over to DOC for review, done pursuant to G.S. 148-19. They got a response just this morning.

• 4 rules up for repeal – 27G .2200 withdrawn because of transitioning concerns for these facilities.

Advisory Committee

• Report on meeting held in October – CABHA, workforce development, veterans services with focus on TBI.

Rules to be Repealed, Amanda Reeder:

• 10A NCAC 27B .0600 Early Childhood Intervention Services for Children with or at risk of developmental delays, developmental disabilities or Atypical Development and their Families – passed in 1979. Rulemaking authority transferred to Div of Public Health, which has already issued rules related to these services. This repeal shouldn’t affect any services. Motion to repeal passed.

• 10A NCAC 27G .2400 Developmental Day Services for Children With or At Risk for Developmental Delays, developmental disabilities or Atypical Development and their Families. S.L. in 2009 amended authority – rules given to child care commission. They published rules effective July 1, 2010. Child Care Commission coordinated with DPI and DMH to draft. Motion to repeal passed.

• 10A NCAC 27G .2500 Childhood Intervention Services for Children with or at risk of developmental delays, developmental disabilities or Atypical Development and their Families. Motion to Repeal Passed.
Marcus Lodge, AG’s Office re Governor’s EO 70 re Rules Modification and Improvement

• Office of State Budget and Management already reviewing current rules and should be inviting public comment soon – the web portal has been established. OSBM will review comments as they come in and then send out to the agencies. Agencies will do a report each year.

• For new rules, OSBM will look at new rules as well to make sure cost benefit analysis done correctly, timely, etc. (all before publication).

Tracy Hayes, DMA AG, CABHA Rules Authority

• State Plan defines optional services, all CABHA services are optional.

• S.L. to implement state plan amendments give authority to issue temporary rules

• Reviewing comments now and will submit rules to RRC

Rule Update, Denise Baker:
• Provider endorsement rules pending for quite some time – initially the Secretary had rulemaking authority, then went to the Commission. Rules have undergone a number of changes. It is now pending (suspended) further revisions to the policy. Policy is in the final version so rulemaking should resume soon.

• DOC rules – DOC gave comments today. Next step should be January Rule Committee meeting to consider DOC comments.

• NCI QA rule – objected to by RRC.

• Several rules in fiscal note process

• Rule related to electronic supervision – waiting for new Medical director to draft.

• TBI rules – pending development by content experts – maybe some language will be generated by the advisory subcommittee.

• Smoking rule expired because it has been more than a year. The pilot study is nearing end – data collected and now analyzing. Commission will need to decide if they want to resume work on the rule.