Meeting Minutes - Magellan of Virginia

Magellan Behavioral Health of Virginia
Governance Board Meeting Minutes
May 13, 2014
PRESENT:
Tuckahoe Public Library
1901 Starling Drive
Henrico, Virginia 23229
Community Members of Governance Board:
David Coe – Board Co-Chair, Colonial Behavioral
Health/CSB Executive
Joseph Hudson, Adult Service Recipient
Marjorie Yates, SAARA of VA/Advocate for Substance Abuse
Services
Kimberly White, Creative Family Solutions, Inc./Association
Representative
Kimberly Imanian, Parent of Child/Youth Receiving Services
Alternate Member:
Stephany Melton Hardison for Mira Signer, NAMI
Virginia/Advocate for Mental Health Services
Magellan Members of Governance Board:
William Phipps, Board Co-Chair, General
Manager/Project Director, Magellan of VA
Varun Choudhary MD, Medical Director,
Magellan of VA
Jim Forrester EdD, Director System of Care, Magellan of VA
Suzanne Gellner JD, Director QI, Magellan of VA
Stacie Fischer RN, MCO Liaison, Magellan of VA
Robay Stroble-Lucas, Director of Customer Service,
Magellan of VA
Ajah Mills, Provider Network Director, Magellan of VA
Staff to Governance Board
Paula Gomolla, Executive Assistant, Magellan of VA
Shellie Archer, Public Relations & Communication Manager, Magellan of VA
Governance Board Members Present via Conference Phone: None
ABSENT:
Mira Signer, NAMI Virginia/Advocate for Mental Health Services
Rene Cabral-Daniels, Community Care Network of VA/Community Health Center Representative
Guests:
Sandy Brown, Program Manager, Office of BH, DMAS
IN SESSION:
The meeting was called to order at 10:00a.m. EDST by David Coe, Co-Chairman.
BOARD WELCOME AND INTRODUCTIONS
The Governance Board members introduced themselves to the alternate board member and community audience.
Bill Phipps summarized the agenda for the day.
BOARD MINUTES
Board minutes for the April 8 Governance Board meeting were submitted for approval. Ajah Mills motioned to approve minutes
as presented. Dr. Varun Choudhary seconded the motion. All board members unanimously approved minutes as presented.
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ROBERT’S RULES OF ORDER
Suzanne and David presented a simplified Robert’s Rules of Order to the Board, with the intent to create basic procedural
structure for how the Board can manage its meetings. These rules allow for one discussion at a time with one topic settled before
moving to the next to maintain order throughout the Board meeting.
Purpose of Robert’s Rules
• Allows fair and full discussion
• All members have equal rights, privileges and obligations
• The goals are fairness and good faith
Procedural Aspects
• Quorum must be present for voting on any actions (Quorum is defined in the Charter)
• Begin by calling the meeting to order
• Motion for approval of previous minutes
– Any additions or changes?
• Proceed by following the agenda
– Agenda to be distributed 2-3 days prior to governance board meeting for preview
Consent, Discussion, Action Items – if the Board moves to more complex issues, this format may be useful:
• Consent Agenda – is for informational items
• Discussion Agenda – is for items requiring feedback
• Action Items – is for items requiring decision
Making a Motion
• Main Motion – only one topic at a time
– Introduces items to the members for consideration
– Cannot be made when any other motion is on the floor
• Subsidiary Motions (the main ones)
– Change or affect how a motion is handled and is voted on before a main motion can be voted on
– Postpone Indefinitely – can be used to kill a motion
– Amend – motion to change an original motion. An amendment to an amendment is allowed, but no more than that.
– Refer – To refer a matter to a committee to examine
– Limit Debate – total time to debate or time for each member
– Previous Question (Calling the Question) – to close the debate on a question – a vote is required
– Table – Can be used to kill a motion or to lay it aside until there is a motion to take it up again
• Privileged Motions
– To bring up urgent matters unrelated to pending business – takes precedence
– Orders of the Day – used if the order of business is not being followed to get back to main topic
– Questions of Privilege – to raise an urgent issue – can be used to speak to a matter with or without action needed
– Recess - for intermission
– Adjourn – to close the meeting
– Fix Time To Which To Adjourn – set time limit on meeting
• Incidental Motions
– Provide a means of questioning procedure concerning other motions and must be considered before the other
motion
– Point of Order – to bring attention to a perceived error in procedure or lack of decorum
– Objection to Consideration – if a member believes it could be harmful for the GB to discuss a main motion
– Consideration Seriatim – to consider the motion that has multiple parts, in each part individually
– Motions Related to Nominations – to specify a nomination method
– Motions Related to Methods of Voting
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Ballot mostly - keeps each vote anonymous
If not unanimous then dissenting may want to be identified – known as “Polling”
The Procedures of Motions
• Only a voting member may make a motion
• Standing Committee motions do not require a second
• Debate or discussion then begins
• Members should raise their hands to speak
• No one should speak twice until everyone has had the desire to speak once – co-chairs should control this
• The Governance Board can limit two comments per item per member
• After everyone who desires to speak does so, the Chairman calls for a vote
• All motions must be voted on. Majority vote wins
David shared a grid with the Board that provides direction on structuring discussions, interruptions, requests for additional
information, motions, decision appeals and voting options to help guide them. Bill requested a motion from the Board to accept
these simplified rules of order. Dr. Varun Choudhary motioned to accept. Jim Forrester seconded the motion. Bill requested a
vote from the Board. All were in favor to unanimously accept the rules as described.
BOARD CHARTER
The Board reviewed the Charter draft that has previously been approved by both DMAS and Magellan’s Legal Department. Both
David Coe and Kimberly White requested additional revisions clarifying Board composition, term limits and rotation; including
Articles and Sections to refer to supporting information within the Charter, as well as creating an addendum to the Charter to clearly
define the annual Board appointments which could be revised as needed. Bill requested for this topic to be moved to the June Board
meeting to allow time for revisions and review. The revised charter will be distributed to the Board for review prior to sending to
DMAS and Magellan Legal Department for approval.
QUALITY IMPROVEMENT REPORT
Suzanne Gellner presented the Quality Improvement update that focused on data for Reconsiderations, Grievances, and Quality of
Care issues collected from December 2013 through March 2014. She reminded the Board of the one month lag time in providing
this data each month. Bill noted that Suzanne should not share any confidential information as this is an open Board meeting. She
provided a handout to the Board Members and confirmed she will not share PHI (Protected Health Information) in her monthly
updates. Her report included the Committee Reporting Structure, Committee Activity, Incident Reporting and a list of acronyms
that was requested by the Board last month.
Committee Structure
• Five subcommittees:
1. Utilization Management (UMC)
2. Member Services (MSC)
3. Compliance and Policy (CPC)
4. Consumer, Family, & Stakeholder Advisory Group (CFSAG)
5. Regional Network and Credentialing (RNCC)
• Subcommittees are all interrelated and will need to regularly communicate with one another.
• Subcommittees report to QIC on a monthly basis.
• Goal is to receive a substantive monthly report to demonstrate that the CMC is making a positive impact and identifying
opportunities for improvements.
Committee Activities
• Virginia Quality Improvement (QIC) Activities
– Each subcommittee has been tasked with providing trended data in their monthly reports to the QIC to identify
opportunities for improvement and potential enhancements to the CMC’s programs.
– QIC is currently identifying potential trends for Grievances and Reconsiderations, but still finalizing the use of a
database.
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QIC has already begun working closely with other departments (Clinical and Compliance) with those identified
areas of opportunity.
QIC has referred several cases to Compliance for suspected fraud, waste, and abuse.
Subcommittee status was reviewed.
Utilization Management Committee (UMC) Activities
– In March, voted to formally accept the MNC delineated in the DMAS manuals, InterQual, and Virginia Codes and
Regulations.
– Discussed planning for QIAs, Treatment Record Reviews (TRR) and Clinical Practice Guideline (CPG) Reviews, and
inclusion of member, family, and provider input on committees in March.
– Reviewed and accepted recommended changes for the Utilization Management Program Description. This is a living
document that can change as the business changes.
– In April, began review of key indicators, including Ambulatory Follow-up after Hospitalization and Rates of
Readmission after Hospitalization. Key measures tracked - outpatient appointment within 7 days of discharge and
readmission within 30 days of discharge. This information can then be compared to others within the industry to
measure improvement. Magellan Follow-up Specialists are on-site to manage this process.
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Quality Improvement Activities (QIAs) - is an intervention that is developed to improve care and service delivery.
Magellan will use the DMAIC process (Six Sigma) to complete QIAs. The steps include:
o Define the problem: Look at existing data to identify opportunities for improvement.
o Measure: Collect more specific data on the identified improvement area.
o Analyze: Perform Root Cause Analysis to determine why the problem is happening.
o Improve: Identify and implement solutions.
o Control: Make sure solutions are working and that the progress is maintained.
o At this stage in the contract, Magellan is still collecting preliminary data to identify opportunities for
improvement. Six months of data is needed to detect trends and ensure process change is solidified.
Suzanne shared several graphs that illustrate readmission rates and 7/30 day follow-up after hospitalization, both trending in
the right direction. Bill noted that this is claims-based data and because providers have 365 days to file, does not give a full
picture as this impact the results. We will see more actual results as we move forward. Kimberly W. asked if the 7/30 day
follow-up after hospitalization report could be broken down by area (rural vs. urban). Suzanne confirmed this can be done by
“hospital” and there are already plans to do this so the Clinical Liaisons can work with providers to come up with solutions
and care coordination. Looking at this holistically and taking possible medical issues into account when managing the care of
members may be reason for decline/trend in right direction.
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Compliance and Policy Committee (CPC)
– Subcommittee reviewed customized policies related to Virginia business and Corporate. The subcommittee also had
discussions surrounding how the Magellan policy review process occurs.
– Initial purpose of Compliance subcommittee is a combination of measures on HIPAA and contract compliance and the
secondary function is policy review and approval.
– The Fraud, Waste, and Abuse document was introduced to the subcommittee this quarter and is currently under
review by DMAS.
– Subcommittee reviewed HIPAA compliance measures and the Care Management Center (CMC) overall status.
– Subcommittee reviewed status on Fraud, Waste, and Abuse training and provided a CMC staff licensure.
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Member Services Committee (MSC)
Call Center has exceeded established standards on performance measures.
Subcommittee presented data trending on call types to the committee members.
Claims Customer Service transitioned to the VA CMC as of 4/8/2014. The Claims Resolution Specialist began work at
the VA CMC on 3/24/2014, to provide a local in-house expert to help with complex claims issues. The claims team in
St. Louis, MO merged with VA CMC to enhance our Provider experience.
Regional Network and Credentialing Committee (RNCC)
– Monitors network composition to ensure adequate representation of qualified providers who have experience with
special populations.
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Oversees de-credentialing and re-credentialing processes.
Reviews adverse incidents
o The Quality Improvement Department will begin collecting the incident reports from Residential Treatment Level C (RTC) facilities that are currently reported to DMAS. These incidents will be forwarded to Magellan’s
Legal department for review.
o Residential Treatment – Level C (RTC) facilities will be required to submit attestations that they will comply
with the incident reporting. The attestations must be submitted by 7/1/2014.
o Target Date for incident report collection implementation is also 7/1/2014.
First meeting occurred on April 25, 2014.
Consumer Family Stakeholder Advisory Group (CFSAG) – Jim Forrester explained the goal is to establish peer supports
for Members, as in other parts of the country, to reduce re-hospitalization and remain in the community longer.
– The Consumer, Family and Stakeholder Advisory Group Committee (CFSAG) launched in March.
– Reviewed the Committee Charter and Quality Program Description.
– Reviewed the Magellan of Virginia website handout and Member Handbook.
– Updates were provided on the Peer Bridger Demonstration Pilot Project.
o The Project has selected members for the steering committee.
o The Project has been conducting an environmental scan to identify areas rich in peer recovery resources to
support member linkage.
o The Project has been analyzing data to identify localities where there is high utilization of hospitalization
services and high recidivism rates for hospitalization.
o DMAS has received documents submitted for approval, and has begun review.
o The Project will hold a monthly advocacy stakeholder conference call. The information obtained in this call
will be provided to the CFSAG subcommittee for review.
Suzanne shared information regarding March Reconsiderations, Grievances and Quality of Care Concerns. Several Board
members requested that general information about the issues involved with grievances be shared. Suzanne noted that QI would
be able to provide those general issues.
Stephany asked why there are more complaints from Providers rather than Members. Bill responded that due to overall call
volume and the nature of the relationship, there is more interface between providers and Magellan. Members typically work
directly with Providers although Magellan welcomes interaction with Members. Robay reported that the MSC is working to
support our Members with recent discussion about adding a “How to file a Grievance” information guide to the
MagellanofVirginia.com website so members will know how to communicate directly with Magellan.
Treatment Record Review Update
Suzanne shared this update with the Board. It was noted that some Providers are concerned about what records they would
have to provide. Bill clarified that this is not replacing a DMAS audit. Instead, this tool assesses the utilization of best practices.
This is a review tool practiced across the country; where findings may show opportunity areas to further educate. He noted there
are tools on-line for providers to know exactly what will be requested. David was interested to know if the record review
findings were going to be compared to DMAS audit findings to determine how they match up in terms of measurements and how
effective the review process is for actual audit readiness. Kimberly W. noted that the evidence-based findings could be a good
training opportunity to share with all providers. Bill agreed that there may be a need and that perhaps a webinar could be
created and offered to communicate out to the network.
• The first Clinical Practice Guideline (CPG) Review/ Treatment Record Review (TRR) will focus on services provided to
members with Major Depressive Disorder.
• Files have been identified to develop the “pool” from which the random sample will be drawn.
• The sampling pool includes files from both private providers and CSBs. All service types are represented in the sample.
• The target date for mailing record request letters is mid-May. Reviews will commence upon receipt of records. Providers
will be asked to submit the records within 14 days of receipt of the request letter. The review results may be used to
identify potential Quality Improvement Activities (QIAs).
Clinical Liaison Activities
• Visits have been completed for all CSBs.
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Clinical Liaisons are now attending and participating in the weekly stakeholder calls.
Acronyms:
A follow up request for a one page acronym “cheat sheet” was noted and will be provided to the Board at the June meeting.
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APS
BHA
CANS
CFSAG
CM
CMC
CPC
CPG
CPS
CSB
DBHDS
DMAIC
DMAS
FAPT
HIPAA
IIH
MHCM
MHSS
MIS#
MNC
MSC
NOS
PSR
QIA
QIC
QID
QOCC
RNCC
RTC
SIU
SMI
SRA
TCM
TDT
TFC-CM
TRR
UMC
VACSB
VICAP
Adult Protective Services
Behavioral Health Authority
The Child and Adolescent Needs and Strengths Assessment
Consumer, Family, and Stakeholder Advisory Group
Care Manager
Care Management Center
Compliance and Policy Committee
Clinical Practice Guidelines
Child Protective Services
Community Services Board
Department of Behavioral Health and Developmental Services
Define, Measure, Analyze, Implement, Control
Department of Medical Assistance Services (Medicaid)
Family Assessment and Planning Team
Health Insurance Portability and Accountability Act
Intensive In-Home Counseling
Mental Health Case Management
Mental Health Skill-building Services
Management Information System Number
Medical Necessity Criteria
Member Services Committee
Not Otherwise Specified
Psychosocial Rehabilitation
Quality Improvement Activity
Quality Improvement Committee
Quality Improvement Department
Quality of Care Concern
Regional Network and Credentialing Committee
Residential Treatment - Level C
Special Investigations Unit
Serious Mental Illness or Severe Mental Illness
Service Request Application
Targeted Case Management
Therapeutic Day Treatment
Therapeutic Foster Care - Case Management
Treatment Record Review
Utilization Management Committee
Virginia Association of Community Services Boards
Virginia Independent Clinical Assessment Program
PROGRAM CHANGES AND UPDATES
Bill Phipps introduced Magellan’s new branding including a new logo that will be rolled out in June. The new tag line is Unique
Vision. Better Care. Magellan Health Services will change to Magellan Healthcare pending corporate Board approval. There
will be three separate divisions; Magellan Healthcare, Magellan RX Management (pharmacy) and NIA Magellan (radiology).
Bill shared that claims servicing has migrated to the Virginia CMC and the dedicated Claims Resolution Specialist is now on-site
to work through complex claims issues.
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Dr. Varun Choudhary is launching an Integrated Health Collaborative and is currently assembling a Steering Committee.
Bill noted that ICD-10 has been delayed for one year based on the Federal law passed recently.
Magellan IT is systemically working through the list of enhancements that have been requested by Providers. A web
enhancement where the MIS# is attached to payments reports is complete.
COMMUNITY INPUT
Bill Phipps opened up the meeting to the community and requested feedback/questions from the audience.
Alethea Lambert from HNNCSB asked for a response to several items;
Extending VICAP program to adults - Bill reported there is a process going on now to evaluate VICAP, scheduled to be complete by
end of the year.
Provider Medicaid rates being paid – Bill explained that the rates are set by the General Assembly and are 100% of Medicaid rates.
Magellan does not have the ability to alter them.
Formulary (allowed medications) and managing those medications– Bill explained that Magellan does not manage the pharmacy
benefits for Medicaid members (Managed Care plan is responsible), so cannot control the list of allowed medications and cannot
review or authorize medications. Magellan’s role is to coordinate care for members and the 7/30 day follow-up and monitoring with
providers by our Follow-up Specialists (which is a new support to Virginia members not offered before), will possibly improve this
situation going forward.
Support for Advance Directives: Cheryl DeHaven is representing Magellan in collaboration with UVA on an Advanced Directive
initiative. She can answer any questions you might have about this.
NEXT MEETING & FUTURE AGENDA ITEMS
The next meeting of the Governance Board will be held on Tuesday, June 10, 2014 at the Tuckahoe Public Library, 1901 Starling
Drive, Henrico VA 23229. Agenda items carried forward are:
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5.
Board Charter
Children’s Collaborative Pilot Program Update – Jim Forrester
Provider Training Schedule – Ajah Mills
Quality Improvement – Suzanne Gellner (standing agenda item)
Program Changes & Updates – Bill Phipps (standing agenda item)
ADJOURN
Dave Coe asked for a motion from the Board to adjourn the meeting. Suzanne Gellner motioned to adjourn. Robay
Stroble-Lucas seconded the motion. David Coe adjourned the meeting at 11:59 a.m. EDST.
/psg
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