Alexis Kaczynski, David Schneider, Donna Wheeler, Christine Gebhard, Joan Booth, Jane Sundmacher, Health Dept. of NW Michigan

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1 MINUTES OF THE BOARD September 18, 2014 North Country Community Mental Health Board Room 1420 Plaza Drive Petoskey, Michigan BOARD MEMBERS PRESENT: Ed Ginop, Gary Averill, Louis Scholl, Sr. Augusta Stratz, Dan Plasencia, Paul Liss, Sue Allor, Bob Boyd, Karla Sherman, Joel Evans, Christian Marcus, Dennis Priess BOARD MEMBERS ABSENT: STAFF: GUESTS: Craig Crambell, George Anthony Alexis Kaczynski, David Schneider, Donna Wheeler, Christine Gebhard, Joan Booth, Jane Sundmacher, Health Dept. of NW Michigan Mr. Ginop called the meeting to order at 4:35 p.m. ROLL CALL Mr. Ginop welcomed everyone to the meeting. PUBLIC COMMENT There was no public comment. CONSENT AGENDA Financial Statement Provider Operations - North Country CMH: Balance on Hand, July 31, 2014 $6,195, Receipts, Adjustments & Transfers, Aug. $3,768, Total Disbursements & Adjustments, Aug. $3,442, Increase in Cash Balance $ 325, Balance, August 31, 2014 $6,521, *Approximately $3,819,373 has been advanced from the State of Michigan and has been encumbered for outstanding bills. Financial Statement Managed Care Operations - North Country CMH: Balance on Hand, July 31, 2014 $3,502, Receipts, Adjustments & Transfers, Aug. $ 376, Total Disbursements& Transfers, Aug. $ 140, Decrease in Cash Balance $ 235, Balance, August 31, 2014 $3,738, *Included in the balance is the Medicaid Internal Service Fund balance of $2,809,997.

2 MOTION BY BOB BOYD, SECOND BY LOUIS SCHOLL, TO APPROVE THE CONSENT AGENDA. MOTION CARRIED. Information (I) Items from Committee Reports Information items were included in the committee minutes. Privileging Recommendations There was one privileging recommendation this month. COMMITTEE RECOMMENDATIONS BOARD ACTION Finance Committee Mr. Plasencia reviewed the Initial Budget for FY2015. MOTION BY DAN PLASENCIA TO APPROVE THE INITIAL BUDGET FOR FY2015. MOTION CARRIED. Mr. Plasencia reviewed the draft contract for software housing and support. This contract is being negotiated with Northeast Michigan CMH and AuSable Valley CMH, who are partners with North Country CMH in the Avatar electronic health record project. MOTION BY DAN PLASENCIA TO APPROVE THE CONTRACT FOR SOFTWARE HOSTING AND SUPPORT. MOTION CARRIED. A question was asked about why there are only two partners and Ms. Kaczynski explained that Northeast Michigan CMH and AuSable Valley CMH made up the original Northern Affiliation along with North Country CMH. It was these three agencies that developed the current electronic health record used by all of them. As it turns out, Northern Lakes CMH also uses the Avatar software for this purpose, and she will be approaching them to see if they would like to partner in this venture. Personnel Committee Mr. Scholl reviewed the results of the Director s evaluation. The evaluation was excellent and complimentary and he reviewed the comments. He received eight completed evaluation forms of the 14 forms possible. After reviewing the director s annual salary, and comparing it to the average salaries paid by other CMH boards across the state, the committee is recommending an increase of $5,000 to the director s annual salary. MOTION BY LOUIS SCHOLL TO INCREASE THE DIRECTOR S ANNUAL SALARY BY $5,000 A YEAR. MOTION CARRIED. Ms. Kaczynski stated that she couldn t possibly accept a salary increase without having a final budget and without knowing if it is possible to offer the staff a cost of living increase.

3 MOTION BY LOUIS SCHOLL TO AMEND THE ORIGINAL MOTION TO SAY THAT, IF THE BUDGET ALLOWS, THE DIRECTOR S SALARY WILL BE INCREASED BY $5,000 AND WILL BE RETROACTIVE TO THE BEGINNING OF THE FISCAL YEAR. It was further discussed as to whether the Director should get a $5,000 increase or a 2% increase if that is the COLA staff receives. A question was asked about whether the union contract is up for renewal. LOUIS SCHOLL MOVED TO TABLE THE MOTION AND REVISIT THIS LATER BASED ON THE BUDGET SITUATION. MOTION CARRIED. ACTION ITEMS WITHOUT COMMITTEE REVIEW There were no action items this month. PRESENTATION State Innovation Model (SIM) Jane Sundmacher, from the Health Department of Northwest Michigan, introduced herself. She distributed a handout and referred to the State Innovation Model (SIM) as the blueprint for health innovation. The State of Michigan received a large grant from the federal government. There were many representatives from the public who served on the advisory agency council and Linda Yaroch, from the Health Department, was one of the individuals who served. The blueprint recommended some changes to improve health with less waste in the healthcare system and provide better values for providers and families who are paying for health care. Health care spending has grown a lot and insurance premiums have increased a lot. She explained that 18% of Michigan residents report they are in poor health and smoking and being overweight contribute to this. The document has five major elements and is a plan to test innovation on a small scale. She explained the components and the possibility of a large amount of funding. A community approach is needed. The patient-centered medical home is one component, along with accountable systems of care in a community health innovation region. There are different payment models and she explained about the different ways that providers can be reimbursed for the services they provide. There needs to be a statewide structure to align policies, payments and programming. The blueprint shows the state having three pilot projects and in urban areas some of these are being implemented. She referred to a map and showed the northern and northwestern areas that have the population that can be funded for some of these components. This region was suggested to the state to fund one of the pilot projects. A public health alliance is being formed and funded through the Robert Wood Johnson Foundation. Ms. Sundmacher discussed ten public health services that the health department handles and explained the health department s role. They work with the Northern Physicians Association. The timeline on the SIM proposal is coming up soon. They will know in about 6 weeks if their region is one of the regions picked. It is a birth to death kind of approach. She explained how the health department conducted surveys to gather data through different kinds of focus groups.

4 They put together information and issue briefs and shared them with the communities in the region who ranked what they felt were the most important issues. NORTHERN MICHIGAN REGIONAL ENTITY As Dave Schneider was in the audience, the Chairman asked him if he had a report from the NMRE. Mr. Schneider reported they are reworking budgets. Due to re-based Medicaid revenue, the NMRE experienced about a 2.9% increase (about $4 million) in revenue. On October 1 st. the NMRE will assume responsibility for the management of all substance use disorder services funding. Ms. Sara Sircely was hired as the SUD Services Systems Coordinator, and has done a great job transferring this responsibility from Northern Michigan Substance Abuse Services (NMSAS) to the NMRE. NMRE is hiring some of the NMSAS staff. Mr. Schneider also reported that the Operating Agreement is being revisited and reworked. OLD BUSINESS Ms. Kaczynski referred to the Purchasing Policy that allows the Director to approve purchases up to $10,000. This spending ceiling was approved at the last meeting and it was requested that the policy be revised and brought back to the board for its information. Mr. Priess indicated that this was a more reasonable amount than the previous $5,000. NEW BUSINESS Ms. Kaczynski reported on the preliminary budget. The budget must be presented and approved by the board prior to the beginning of the fiscal year based on requirements of the accrediting organization, the Commission on Accreditation of Rehabilitation Facilities. At this point, there is no General Funds allocation. Based on the Governor s budget (which was approved by the legislature) there would be a draconian cut to GF resources if there was not supplemental appropriation. It is known that there has been an increase in Medicaid from the figure that appears in this initial budget. As has been reported previously, it is the goal in this region to pursue a funding methodology where each agency receives Medicaid funding based on its per enrollee per month (PEPM) revenue (i.e., you get what you earn ). This is difficult for some agencies that are spending more that their PEPM, however, it is felt that this is a goal that can be achieved in about three years. All Medicaid funding was rebased in FY15 and that makes it much easier to get to that PEPM and it will be reflected in the next budget. The Healthy Michigan revenue has been built in. It almost compensates for the GF that will be lost, but is, of course, a different type of revenue. In terms of GF there is some good news, as we are hopeful that there will be a supplemental appropriation for GF. There seems to be some movement from the administration agreeing that the amount of GF appropriated was insufficient. It is not expected that this will happen until after the election. A letter was received from NMRE about the change in management of funding for substance use disorder services and this is a very big change for the system. Another big change that was announced is MI Child revenue will be moved to the PIHP/NMRE. At present, it comes to every CMH board. Starting October 1 (FY 15), it will go to the PIHP, be actuarially based and the state will pick up the match portion. This should help with the GF shortfall, as previously the match for MI Child, and any overspending, was covered by GF. The block grant that Ms. Kaczynski helped write has been funded. This will help in the agency s health integration efforts. This is not just for NCCMH but for its partners in the NMRE. In

5 addition, NCCMH wrote and received funding for a children s federal block grant for the MC3 program. Board members heard a presentation on this program several months ago. It is the Child Collaborative Care Program that brings expert children s psychiatric consultation into primary care practices. In other good news, the Northern Affiliation is the recipient of monetary incentive rewards in two categories for FY The first monetary incentive is for the overall numbers of consumers served that are living in a private residence not owned by the PIHP, CMHSP, or the contracted provider, either alone or with spouse or non-relatives. The first place award of $45,000 for this incentive was earned by the Northern Affiliation. The other monetary incentive was for the overall number of consumers discharged from a substance abuse detox unit and seen for follow up within seven days. This was another first place award of $45,000 and is due to the good efforts of NMSAS. Of course, both of these awards will go to the NMRE, as the Northern Affiliation does not exist anymore, but it is a distinction to be recognized in this way. Ms. Kaczynski reported that, in an effort to help the NMRE, NCCMH is sharing its office space at the Cross Street Building with new SUD staff members hired by the NMRE. Ms. Kaczynski announced that Christine Gebhard is now the Chief Operating Officer of the agency. DIRECTOR S REPORT/COMMUNICATIONS Ms. Kaczynski thanked everyone who turned in performance evaluations for her. Mr. Boyd asked about what is happening at Beacon Center. Ms. Kaczynski indicated that they are still working on stabilizing the center and determining if it is possible to continue operations there. Mr. Ginop appointed Sr. Augusta Stratz and Dennis Priess as voting delegates for the Association conference. LONG RANGE PLAN/QUALITY IMPROVEMENT UPDATES Ms. Gebhard referred to the second and third quarter reports. The open number of clients by population has not changed but open clients by funding source changes are significant. Healthy Michigan Program numbers are at 15% of total, which is significant, and other is at only 5%. She referred to the community inpatient and state inpatient and those figures will not be accurate until the end of the fiscal year. She drew their attention to the new black screen in the Board room and indicated that the agency is video conferencing in Bellaire and Gaylord. The agency is looking at a Polycom system for next year at all of its sites. She would like to demonstrate it at the next meeting in Bellaire. MOTION BY KARLA SHERMAN, SECOND BY LOUIS SCHOLL, TO ADJOURN THE MEETING AT 6:10 P.M. MOTION CARRIED. Ed Ginop, Board Chair