Magellan Behavioral Health of Virginia

Transcription

1 Magellan Behavioral Health of Virginia Governance Board Meeting Minutes August 12, 2014 Tuckahoe Public Library 1901 Starling Drive Henrico, VA Present: Community Members of Governance Board: David Coe Board Co-Chair, Colonial Behavioral Health/ CSB Executive Joseph Hudson, Adult Service Recipient Kimberly White, Creative Family Solutions, Inc./Association Representative Kimberly Imanian, Parent of Child/Youth Receiving Services Betty Long, Community Care Network of VA/Community Health Center Representative Alternate Member for Mira Signer, Stephany Melton-Hardison, 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 Suzanne Gellner JD, Director QI, Magellan of VA Robay Stroble, Director of Customer Service, Magellan of VA Ajah Mills, Provider Network Director, Magellan of VA Stacie Fischer RN, MCO Liaison, Magellan of VA Jim Forrester EdD, Director System of Care, Magellan of VA Staff to Governance Board: Paula Gomolla, Executive Assistant, Magellan of VA Candy Sonck, Administrative Assistant, Magellan of VA Shellie Archer, Public Relations & Communication Manager, Magellan of VA Governance Board Members Present via Conference Phone: None Absent: Marjorie Yates, SAARA of VA/Advocate for Substance Abuse Services Guests: Brian Campbell, Senior Policy Analyst, Office of BH, DMAS IN SESSION: The meeting was called to order at 10:02a.m. EDST by Bill Phipps, Co-Chairman. BOARD WELCOME AND INTRODUCTIONS Bill Phipps introduced and welcomed Betty Long to the Board as the newest community Board member. Bill Phipps announced that Marjorie Yates has resigned from the Board due to other conflicting commitments. Bill and David reordered the agenda items to prioritize addressing the selection process for new Community Board Members and then reviewed how the remaining agenda would be managed for the day. BOARD MINUTES Bill submitted the Board minutes for the July 8 Governance Board meeting to the Board for approval. Jim Forrester motioned to approve minutes as presented. Dr. Varun Choudhary seconded the motion. All board members unanimously approved and accepted minutes as presented. 1

2 COMMUNITY BOARD MEMBER SELECTION PROCESS David Coe shared some history of how the original board members were selected. Board representation is recommended by groups (mental health advocate, substance abuse & recovery advocacy, health plan/system, parent of a child member) constituents. A standard, formal process needs to be defined to solicit, review, recommend and select replacement community Board Members. David asked the community Board members if they d like to press through to address this today or come together at a later date. Bill emphasized this should be expedited to have representation on the Board. Only community Board members would be involved in the process of selecting a new community Board member. Community Board members elected to address this issue in a separate conference call. Bill will attend to ensure guidelines are followed, but will not have voting rights. Bill shared details of what other Magellan locations do regarding their Board processes and was asked to send language to David to assist him and the community board members with creating this process. Information will be reviewed and a conference call will be scheduled. Minutes and outcomes will be brought back to the entire Board at the next meeting. Any new process created will be added to the Charter as an addendum. Bill clarified that Magellan s Board members are title-driven; a new hire would fill the Board position that the exiting Magellan staff member vacated so this formal process is already in place to address Magellan employee Board member replacements. QUALITY IMPROVEMENT REPORT Suzanne Gellner presented the Quality Improvement update which focused on a data summary for Reconsiderations, Grievances, and Quality of Care issues collected from December 2013 through June Grievances were reported to the Quality Improvement Department in June 2014: 6 were from Providers about Magellan: Provider complained the provider portal is not user friendly. Provider complained about inconsistencies in determining payment for services. Two providers complained about a claim denial for services rendered. Provider wants better communication and notification when processes or forms are to be changed. Provider wants the website modified and to use other contact resources for authorization information. 5 were from Members about Providers: Alleged provider stopped giving member their medication and was rude. Found this was not an in-network provider, so grievance was closed. Alleged provider not providing recommended hours of counseling and not returning calls. Forwarded to SIU. Alleged provider was disrespectful to member because of member s race. Forwarded to SIU, member discharged and set up with new provider. Provider was aggressively pursuing member to return for services after member started with a new counselor, however, member failed to follow provider procedure or sign the discharge papers. Allegation the member was not treated respectfully and that the provider was taking her money. An audit was performed to ensure member was receiving appropriate services. 4 were from Family Members about Providers Provider refused to supply records of daughter who was a minor and member not receiving correct amount of treatment. Sent to SIU, however, HIPAA regulations allow providers to not disclose information if they believe it can cause potential barriers of treatment for the member. Alleging the provider was not providing required services. Forwarded to SIU and Quality of Care department. Alleging the provider is not providing services for the member over a couple of months and is uncaring. Forwarded to SIU and resolved with member discharging provider. Family member discharged provider because they were uncomfortable and distrusted them. 2

3 QOCC Outcome Summary 7 Potential QOCCs were reported in June was investigated, and determined not to be a QOCC. 6 remain pended (records have been requested, records are under review or Corrective Action Plan is in development). Monthly Statistics: 57% (4 out of 7) were referred to SIU 57% (4 out of 7) were also part of the Grievance Process 148 reconsiderations were received in June % of reconsiderations processed were completed within 30 days of submission. Reconsideration data collected on July 14, Total Number of Registration & Authorization Requests Received in June: Total Number of Non-Authorizations (denied) in June: 1161 Total Number of Reconsideration Requests Received in June: 148 Percent of Requests Received Resulting in Reconsideration Requests: 0.85% Percent of Non-Authorizations Resulting in Reconsideration Requests: 12.7% *Registration Requests are included here, as they could result in an administrative non-authorization (for instance, due to untimeliness), and could therefore potentially result in a Reconsideration Request. *These statistics represent a ballpark figure. We received 8 Notices of Appeal in June: 1 Appeal was upheld (MHSS). 7 Appeals remain pending hearing. # of Appeals by Service Type: 5 MHSS 2 Credentialing 1 RTC Level C Committee Activity Highlights: Utilization Management Committee (UMC) Training was conducted in June to give an overview for staff regarding Quality Improvement Activities/Performance Improvement Projects. The committee decided to utilize a call survey method to collect data for the Urgent and Routine Accessibility to Services measure. A work group will be defined to organize how this process will occur. Over-Under utilization measures were discussed. A customized report is required to meet the specific needs of Virginia DMAS and has been created. Specific data elements have been identified to be monitored in future meetings. QIC approval requested and awarded on 7/23/2014. Treatment Record Reviews: DMAS and Magellan to collaborate regarding TRR process. Member Services Committee (MSC) CMC performance exceeded contractual goals; Abandonment Rate-.8%, Customer Service Average Speed of Answer-:08 seconds, Care Management Average Speed of Answer-:15 seconds, and Service Levels-99.5%. CMC continues to exceed performance expectations for timeliness of claims. June s percentage will not be available during the August meeting. CMC received 148 reconsiderations in June and the Quality staff continues to look for trends with high overturn rates. CMC received 6 grievances from members and 9 grievances from providers. New member mailings are being mailed in a timely manner and meeting established goals. Cheryl DeHaven reported on Innovation projects and upcoming trainings on cultural linguistics and sign language. 3

4 Regional Network and Credentialing Committee (RNCC) 185 Providers were credentialed in June. No Providers were denied credentialing in June. In June, there was one pending potential QOCC for a provider. However, the case was reviewed and determined it would not impact the medical director credentialing. There was no Compliance meeting in June. Consumer Family Stakeholder Advisory Group (CFSAG) QI provided information to the committee about how providers and members can file a grievance. The standard turnaround time for a grievance is 30 days. A clinically urgent grievance needs to be resolved within 3 business days. Jim Forrester reported about recent dialogue with DMAS regarding initiating a pilot Peer Bridger Program for facilities that have high readmission rates. Peer support would participate with members at these facilities prior to a member being discharged. Quality team will create information about reconsiderations, grievances, and compliments for members. This information will be placed on the member portion of the website. This is a way to further empower and educate our members about advocating for their mental health care. GOVERNANCE BOARD TRAINING Bill asked the Board of their interest in working with a Magellan corporate consultant to further maximize the Board s impact. Everyone was in favor. Bill will get additional information from the corporate team, and offer a four hour availability of 10am 2pm to take the place of a monthly Board meeting. This would be a closed session since it is strictly training, not a meeting. Advanced notice will be provided to Board members for travel and schedule consideration. IT ENHANCEMENT UPDATE Ajah shared this update with the Board. Enhancement has been completed to rectify the issue with unnecessary mandatory questions on SRA on-line forms. Underway (target October 2014) is an enhancement to make the provider search tool user-friendly. Physical location will now be an area search to allow for easier use. Shorten drop downs to limit services displayed only pertinent to VA to eliminate what is not needed. Next week, secured provider portal update demographic info will be more robust to update roster rather than fax or . NETWORK STRATEGY COMMITTEE UPDATE Ajah invitation drafted and is now under review with DMAS, inviting all Providers to participate on the Network Strategy Committee to review issues, drilldown and improve educational needs of provider community. Ajah is targeting the first meeting to be held by the end of September. Survey Monkey will be used to expedite responses to the invitation. VICAP UPDATE Jim provided an update on the VICAP evaluation progress for this clinical assessment for children. VICAP began in July 2011 and there has always been a concern about effectiveness. DMAS has asked that we assess this to recommend improvements. First meeting was used to summarize and review history of existence. This large group of 18 will meet biweekly with the recommendation to be provided by October 1 to get on the General Assembly docket. Now tasked with how we can do the assessment fairly and comprehensively. The bottom line is to ensure the result is what is in the best interest of the child and meets the needs of the child and family. There is advocacy for families in this workgroup. Alternates can be identified and participate by phone to ensure participation. Members and providers can submit feedback through our website to funnel back to the workgroup. 4

5 PROGRAM CHANGES AND UPDATES Bill Phipps provided the update of automation of provider registration for service. Historically they were very manual and were not automated. This enhancement creates efficiency for Magellan and improved turnaround time for the Providers. NEXT MEETING & FUTURE AGENDA ITEMS The next meeting of the Governance Board will be held on Tuesday, September 9, 2014 at the Twin Hickory Public Library, 5001 Twin Hickory Drive, Glen Allen VA Agenda items identified are: 1. Community Board Selection Process David Coe 2. Broad Managed Care Picture invitation to DMAS will be extended to present on this topic 3. VICAP Update Jim Forrester (standing agenda item) 4. Quality Improvement Suzanne Gellner (standing agenda item) 5. Program Changes & Updates Bill Phipps (standing agenda item) COMMUNITY INPUT Bill Phipps opened up the meeting to the community. No questions or comments were provided from the audience. ADJOURN Bill Phipps asked for a motion from the Board to adjourn the meeting. Ajah Mills motioned to adjourn. Robay Stroble seconded the motion. All Board members were in favor. Bill Phipps adjourned the meeting at 11:25 a.m. EDST. /pg 5