Albemarle CPMT Charlottesville CPMT Joint Committee Meeting Minutes Wednesday, April 18, 2018 County Office Building 401 McIntire Road Second Floor County Executive Conference Room Present: Jennifer Wells, Chelsie Wilson, Christa Galleo, Mike Murphy, Erin Callas, Bill Letteri, Kevin Kirst, Katie Ralston, Phyllis Savides, Kaki Dimock, Neta Davis, and Kendra King. Absent: Diane Kuknyo Albemarle: Yes Charlottesville: Yes Kaki Dimock called the meeting to order at 3:34 Agenda Item: Review & Approval of the Agenda/ Acceptance of Consent Agenda Presenter: Chair Discussion/Summary: Kaki Dimock asked if there were any addition or changes to the agenda. Hearing none, she asked for motions to approve the consent agenda from Albemarle and Charlottesville. Documents/Resources: April 2018 Agenda, February 2018 Minutes, Feb/March Financial Reports sent by email. Next Steps/Action(s) Taken: Bill Letteri made motion for Albemarle to approve the consent agenda; which was seconded by Phyllis Savides. Erin Callas made motion for Charlottesville to approve the consent agenda; which was seconded by Mike Murphy. Both motions passed unanimously. Agenda Item: Action: CSA Provider Agreement Revisions for April Presenter: CSA Coordinators Discussion/Summary. There were no agreement revisions for Charlottesville or Albemarle for this month. Documents/Resources: Next Steps/Action(s) Taken: N/A Agenda Item: Action: Approval of FAPT Private Provider Representative Extension (Alb/Cville) Presenter: CSA Coordinators Discussion/Summary: The CSA Coordinators ask that CPMT consider approving a one-year extension for the Private Provider Representatives serving on Albemarle and Charlottesville FAPT (Kelly Greer for Albemarle and Lisa Cooley for Charlottesville). Currently the provider representatives are serving the second year. Policy allows the representative to serve a two year term with a one year extension for a total maximum of three years. Kaki Dimock asked for motions from both CPMT’s. Documents/Resources: none Next Steps/Action(s) Taken: Phyllis Savides made a motion to approve one more year for the private provider representative to serve on Albemarle FAPT, which was seconded by Erin Callas. Kaki Dimock made a motion to approve one more year for the private provider representative to serve on Charlottesville FAPT, which was seconded by Erin Callas. Both motions passed. Agenda Item: Action: Policy Revision for Mentors (Albemarle only) Presenter: CSA Coordinators Discussion/Summary: Katie Ralston talked with Allyson Davies (Charlottesville City Attorney) and essentially Allyson feels that if we are asking individual providers to complete training then the agencies should be doing the same. She is fine if we are not asking them to do something different than other providers providing the same service. If Charlottesville CPMT would like to move forward with having the same requirements then the City Attorney has given permission to move forward. Phyllis Savides confirmed that agencies follow the same requirements as the expectations being requested for independent mentors. Mike Murphy wants to be sure that this language be added with an amendment that these changes are included in the vendor agreements for FY2019. Phyllis Savides suggests that vendors are sent a notice of the changes and advising them that the training requirements must be met by July 1st. Documents/Resources: Next Steps/Action(s) Taken: Phyllis Savides asked if Albemarle CPMT had concerns. Hearing none, Phyllis Savides made a motion to approve the policy revision regarding mentoring requirements, which was seconded by Christa Galleo. Mike Murphy made a motion for Charlottesville CPMT to approve the policy revision regarding mentoring requirements including adding language with an amendment that these changes are included in the FY2019 vendor agreements which was seconded by Erin Callas. Both motions passed. Agenda Item: Action: Policy Revisions for Parental Contributions (Alb/Cville) Presenter: CSA Coordinators Discussion/Summary; There was a great deal of work done several years ago and the print in purple summarized what work was done. (The purple print will not be included in the policy revision.) This is to clarify that we do exempt parental contribution on community based services, per the OCS auditor’s recommendation. This is not a change in practice, but states in policy what we have been practicing with regards to parental contributions. Kaki Dimock asked for motions to adopt this revision for Albemarle and Charlottesville. Documents/Resources: Next Steps/Action(s) Taken: Kevin Kirst made a motion for Albemarle to approve revisions, which was seconded by Phyllis Savides. Erin Callas made motion for Charlottesville to approve the revisions, which was seconded by Christa Galleo. Both motions passed. Agenda Item: Action: Approval of FY19 Provider Agreement Documents Presenter: CSA Coordinators Discussion/Summary: Approval of FY19 Provider Agreements tabled today. The County Attorney recommended adding language to D-8 regarding mileage reimbursement limitation after the City IV-E audit cited that mileage reimbursement cannot be higher than the allowed IRS rate, which OCS follows. Mike Murphy suggests some rules regarding transportation should be reviewed in the future. There is no official policy in place as of yet regarding this. Kaki Dimock asked for motions from Albemarle and Charlottesville with the addition of language limiting mileage. Katie Ralston and Jennifer Wells will also add the language regarding the Mentoring requirements on both documents. Documents/Resources: Next Steps/Action(s) Taken: The licensed and non-licensed provider agreements will be brought back to the May meeting during the business portion of the Retreat with revisions noted above. Agenda Item: Presentation-CDSS-Closed Session Presenter: Discussion/Summary: Kaki Dimock asked that a motion be made that Albemarle and Charlottesville CPMT’s each go into a closed meeting pursuant to sections 2.2-3700 and 2.2-5210 of the Code of Virginia to consider the appropriate provision of services and funding for a particular child or family or both who have been referred to FAPT and whose case is being reviewed by the CPMT. For the Charlottesville CPMT, Mike Murphy made a motion, which was seconded by Erin Callas. For the Albemarle CPMT, Kevin Kirst made a motion, which was seconded by Bill Letteri. Kaki Dimock declared that CPMT was in closed Session. The CDSS case was presented to the CPMT group. Kaki Dimock asked for a motion that CPMT does certify by recorded vote that to the best of each team members knowledge only public business matters lawfully exempted from the open meeting requirements of the Virginia Freedom of Information Act and identified in the motion authorizing the closed meeting were heard, discussed or considered in the closed meeting. For the Charlottesville and Albemarle CPMTs, motions and seconds were made to come out of the closed meeting. The Secretary took a public recorded vote of each CPMT to certify that only public business matters lawfully exempted from the open meeting requirements the Virginia Freedom of Information Act were heard, discussed or considered in the closed meeting. Charlottesville CPMT: Kaki Dimmock-Yes Mike Murphy-Yes Christa Galleo-Yes Neta Davis-Yes Erin Callas-Yes Kendra King-Yes Albemarle CPMT: Phyllis Savides-Yes Bill Letteri-Yes Kevin Kirst-Yes Christa Galleo-Yes Erin Callas-Yes Chelsie Wilson-Yes Neta Davis-Yes Kaki Dimock declared that both CPMT’s were officially out of closed meeting session. Documents/Resources: IFSP sent out password-protected email for CPMT review Next Steps/Action(s) Taken: informational Agenda Item: FAPT Update Presenter: CSA Coordinators Discussion/Summary: CSA Coordinators handed out results from the FY18, quarter 3 FAPT surveys to share with CPMT. They changed the format this time around to make the scale more clear to the those filling them out. Overall, the feedback is positive. The County has a higher return rate because they have more parents attending FAPT. The City dockets more cases. The County does 5-10 minute staffings. The City does 15-20 minute staffings. Neta Davis asked if it was more useful or less useful for parents to attend FAPT for the City? Katie Ralston thinks that there is a different (City vs County) culture that is around parents attending such a short meeting when they have so many other responsibilities. The question to ask: is FAPT an important meeting for the parents? Neta Davis asked what benefit is it to have parents attend one more meeting when we have required them to attend so many meetings? Phyllis Savides says the sense she gets from the workers is that the parents in Albemarle do want to attend FAPT even after attending FPM’s and other meetings. When Phyllis was the Foster Care Supervisor, there was pressure for the parents to attend. And her sense is, there still is. Kevin Kirst said that the School IEP meetings parent involvement is not required but is valued. The schools are required to invite the parents and Kevin is surprised that the parents do want to attend. Documents/Resources: Surveys handed out at meeting Next Steps/Action(s) Taken: informational Agenda Item: Review of Routine Foster Care Expenses Presenter: CSA Coordinators Discussion/Summary: Kaki asked if there were questions about the routine foster care expense forms. No questions Documents/Resources: Albemarle/Charlottesville documents sent by email Next Steps/Action(s) Taken: Informational Agenda Item: CSA Coordinator Update Presenter: CSA Coordinators Discussion/Summary: At the quarterly statewide CSA coordinators meeting, Scott mentioned that North Spring Behavioral Health had an incident where a youth died. Two staff members have been charged with involuntary manslaughter. Immediate response was that the facility would accept no new referrals. (Incident occurred in December). Albemarle was concerned because we do have youth in that facility. Jennifer met with Garrett Hamilton of North Spring today. He advised their license will not be changed to provisional. There are criminal charges pending against the two staff members. The investigation has been completed and their license status will not change. The youth was a teenager but Jennifer did know his exact age. Jennifer said there is potentially $400,000 of SPED wrap available due to other localities not using the funds and we may see more funds available soon. The CSA Roster has been switched over to a web manager effective now. There will be an overhaul on the service fee directory. Scott advised Carol Wilson is working on IL arrangements to take to the SEC to individualize services to the kid. This is to insure agencies do not charge flat rates for services. Documents/Resources: Next Steps/Action(s) Taken: informational Agenda Item: OCS Communications Presenter: CSA Coordinators Discussion/Summary: mentioned in CSA Coordinator update Documents/Resources: Administrative Memo #18-03-CSA Account Management System Next Steps/Action(s) taken: Agenda Item: Program Committee Update Presenter: CSA Coordinators Discussion/Summary: One of the service gaps that Program Committee has been working on is multicultural services. Program wanted to develop a list of expectations to share with providers regarding serving clients from various cultural backgrounds. Program wanted this to go out as a separate document as an FYI with the FY2019 contracts. Katie stated that this is a draft and can be updated. Kendra asked about changes in wording about multicultural practices. Phyllis asked about the practice model wondering how much of these kind of expectations are reflected in that practice model. Katie said that what can be done is go back to Program and ask how the expectations and practice model overlap because the practice model is already mentioned in the contract. Phyllis said maybe we could look at the part that talks about the belief structure. Phyllis would rather tweak the practice model than have a separate document. She concurs with Kendra that this is not specific to people from other cultures. Instead it is to insure that we include diversity and inclusion. Erin asked if the client has the option to decline translation services and if they do, is that documented. Phyllis said for DSS the client would have to sign a document certifying that they did decline services. Kaki is wondering if there are other ways for Program or CPMT to remind providers to improve their services around diversity. Documents/Resources: Next Steps/Action(s) Taken: Katie will take back to Program Agenda Item: Data Committee Report Presenter: Discussion/Summary: nothing to report this month Documents/Resources: none Next Steps/Action(s) taken: there will be discussion at retreat on this subject. Agenda Item: Cost Containment/Quality Control Workgroup Presenter: Phyllis Savides and Jennifer Wells Discussion/Summary: This group was charged with looking at the possibility of rate capping around outpatient therapy providers because of the huge differences in what providers charge. Phyllis Savides, Kaki Dimock, Crystal Lantz, Hope Robinson, Katie Ralston and Jennifer Wells comprised the group. They polled localities and case managers asking which providers they used most often and whether the provider accepted private insurance or were they Medicaid providers. They surveyed the LDSS at Chesterfield finding that vendors were required to submit a written justification when they set or changed their rates. They had an elaborate process, a report to FAPT and different contracts for different providers. Phyllis said they surveyed Albemarle and Charlottesville FAPTs asking what they might want to see in addition to the IFSP. The idea of establishing a capped rate is problematic. They continue getting feedback from case-mangers who fear losing the provider they use often. Strong feedback from case- managers clearly state they do not want to lose ability to look for providers who have a special ability. They want to be able to pick the provider that they feel is successful and has good outcomes in their work with clients. The data group began to look at two strategies. 1. Look at empowering the caseworkers to challenge the providers to have more of a conversation rather than accepting what the provider charges. Crystal said UR folks at Region Ten could help consult and possibly have round table discussions to train the caseworkers. . 2. Making the providers more accountable. Hold the providers to the rates they have on their contracts. A possibility of use of a form requiring the provider to submit a progress report. Having Outpatient Therapists use the progress report to see if it enables FAPT to have a stronger sense of what is happening between client and therapist and is this therapy helping? Phyllis is asking CPMT for feedback and if there is concern about piloting with Outpatient therapists. Bill Letteri asked about frequency of reports. Jennifer said quarterly are currently required by the contract. The pilot would be monthly by outpatient providers only. Christa Galleo said that both FAPTS are looking for well-written documentation describing the progress with the clients. One reason to ask providers to provide documentation is that many of these providers are no longer taking private insurance. They are getting CSA money only and are not providing the documentation they had to provide to private insurance and Medicaid. Phyllis asked if CPMT was in approval to move in this direction. Documents/Resources: none Next Steps/Action(s) taken: CPMT favored moving in this direction. Agenda Item: Retreat Prep Presenter: Phyllis Savides Discussion/Summary: Kaki asked a group to work on the agenda for the retreat and for “treat management”. Items for the retreat should be Utilization Management Outcomes, Data Committee Report, and Programs Role/Structure/Charter Documents/Resources: Next Steps/Action(s): Phyllis, Kaki, Katie and Jennifer will be the group Agenda Item: Other Business from CPMT Presenter: Discussion/Summary: no additional items Documents/Resources: Next Steps/Action(s) taken: Presententation Schedule May-Retreat-Water Street Space June: Private Provider Rep-Hope Robinson for DePaul July: Charlottesville City Public Schools August: TBD Kaki adjourned the meeting a bit after 5:00 pm Next scheduled meeting: May 16, 2018 – Retreat-Water Street Space 12:30-5:00 Respectfully Submitted: Lisa Jordan