The Management and Operations Committee of the Hammond Commission met at Piedmont Geriatric Hospital in Burkeville, Virginia on Thursday, May 20, 1999. The Chairman, Senator Steve Martin, called the meeting to order at 10:15 A.M. and introduced the members of the Committee. Those present were: The Honorable Stephen Martin, Senate of Virginia; The Honorable Emmett Hanger, Senate of Virginia; Olivia Garland, First Health Services, Corp.; and Vickie Fisher, Mental Health Association of Virginia. He also introduced Joy Yeh, Director of Internal Audit for DMHMRSAS and liaison to the Committee.

Senator Martin began by telling the Committee that he felt that they must review the resources available at state facilities and be prepared to help the HJR 225 Joint Subcommittee evaluate the best use of those public resources. He noted that he had brought to the attention of the General Assembly some time ago that restructuring of the facilities was necessary because of the decline in the amount of inpatient services required and provided by the mental health and mental retardation systems. Senator Martin felt that the prioritized responsibilities of the General Assembly are: 1. quality care for individuals in need; 2. stewardship of public resources; and 3. local economic interests.

Mr. Pierce welcomed the Committee and distributed packets of information with copies of newsletters and brochures on Piedmont. He presented an overview of the facility and the educational programs and training available for health care professionals in geriatrics. Mr. Pierce is proud of the care and treatment the staff provides the patients, and said that Dr. Geller had given Piedmont a positive evaluation in his report.

Mr. Moore felt that Piedmont is the best geriatric facility in Virginia and one of the best in the country. He provided information about the hospital and its programs. Piedmont currently serves 150 patients, all 65 or older and mentally ill. It works with the CSB, as a part of the continuum of community services, in admitting individuals who need hospitalization, planning treatment, and determining discharge. Mr. Moore stressed the following strengths of Piedmont:

• Center of clinical expertise for psychiatric treatment for geriatric patients;
• Training for community providers through the Piedmont Geriatric Institute;
• MCV affiliation for research and advancing treatment methods;
• Standard measures to track treatment outcomes;
• Stable staff-patient relationships, high morale, and low turnover.

Mr. Moore also discussed the proposal to study a Transitional Living Center for patients who could be managed in a less restrictive environment than a hospital. This would be a level of care and staffing between a hospital and a nursing home. A copy of Mr. Moore's remarks is filed with these minutes.

Dr. Eisenstein believes that there is a big problem in the state with the lack of expertise in the treatment of the mentally ill elderly. There are many individuals at home and in nursing homes and adult homes that are not receiving the help they need. Medical and psychiatric treatment must be linked, and many can be harmed from inappropriate medication and inaccurate diagnoses. Dr. Eisenstein supports the proposal for a Transitional Living Center pilot project that would build upon the knowledge and resources available at Piedmont. If the pilot is successful, he supports the development of regional centers in the state.

Richard Kellogg, Commissioner of the DMHMRSAS, stated that the Department was very interested in Transitional Living Centers. These programs could help to transition patients from the hospital to the community. The General Assembly has provided some funds for the development of a Medicaid reimbursable program model and expects a report. The Department will seek input from staff at Piedmont.

Ms Bryant said that PAIR applauds the values in the Hammond Commission interim report and appreciates the additional funds for the DMHMRSAS provided by the General Assembly and Governor. PAIR supports the five regional training centers as a choice for individuals with severe or profound mental retardation. She said that PAIR has five areas of priority in resource management:

• Accountability and monitoring investments in service;
• Accurate system data to measure needs and levels of care;
• Streamlined documentation;
• Vulnerable individuals are not commodities; and
• Managed care severely limits reimbursement and can cause loss of service.

Mr. Lewis said that the DMHMRSAS was working on a standardized data collection system called POMS that will be very helpful to the central office and the delivery system. He encouraged the Commission to support the installation of POMS.

Mr. Kellogg reported that POMS will be implemented statewide in July 2000. The Department is currently working on the quality indicators that will be used, as well as developing the software.

Mr. Mills distributed a matrix that his office had prepared showing the current land and buildings at each state facility. It listed information on any surplus available or buildings scheduled to be demolished, based on the recently completed 6-year capital outlay and current trends. The comprehensive master plan for facilities needs to be updated, and the most recent survey of surplus property was prepared in 1996. A copy of the matrix and a weekly census summary for May 6 is filed with these minutes.

Mr. Kellogg thanked Mr. Mills and his staff for their work in identifying for each facility the core of buildings and land necessary to efficiently deliver quality care to those individuals projected to need treatment. Mr. Kellogg said that the Department is working to standardize the quality of care at all facilities, according to well-accepted standards. He stated that the most important resource in the system was the staff and that he appreciated their commitment.

He felt that contracting for the management of state facilities should be an option for the

Some of the advantages Mr. Kellogg discussed were:

• Provides access to expertise and skills that may not be readily available to the facility;
• More flexibility in solving problems and making work force changes; and
• Cost / benefits through competition and economy of scale savings.

Some of the disadvantages were:

• Loss of institutional knowledge;
• Initial disruption of the workforce and costs of retraining; and
• Apprehension of the public.

2. Can we identify factors relevant to analyzing the problem of excess capacity in state facilities?

• Individuals should not remain in facilities beyond the clinical need for such;
• Any proceeds from the sale of surplus property should be reinvested within the services system;
• Capital planning has centralized each facility's operations around a core campus;
• Appropriate staffing levels will be maintained and layoffs avoided through attrition or transition;
• Alternative uses for surplus property will be explored; and
• Appropriate private sector availability is being encouraged.

2. Can successful transition to community-based care be achieved on a patient-by-patient basis before significant capital expenses are required?

1. What should the priority populations be for state controlled funds in the mental health, mental retardation, and substance abuse services system?

Priority populations for state-controlled funds, as determined by standardized

assessments, should be those individuals with the most serious disabilities. These would include MR, substance addiction or dependence, adults with SMI, and children and adolescents with SED.

2. Should CSB services be accessible to people who have private health insurance?

CSBs should not provide services with public funds for individuals with private insurance, except for priority populations or when other options are not available. There is no policy at this time, but some would oppose state-supported providers competing with private vendors.

3. Should the publicly funded MH and SAS system serve anyone in addition to Medicaid enrollees and uninsured citizens?

Acute or "safety net" services should be available to all who need them.

4. If state policy limits care to specific disability categories, what would happen to existing clients who no longer qualify for services?

Current clients, who may not qualify for services under a reformed system, would transition out of treatment based on periodic utilization reviews. No one would be inappropriately removed from services, and there would be no impact at all on persons with mental retardation.

5. How do access issues differ for MH, MR, and SA clients?

The CSB system is the preferred provider for state funds directed to the community. CSBs make the decisions on delivering or purchasing services, and MH, MR, and SA access to services varies across the system. MR access is largely determined by waiver eligibility and match. Lack of Medicaid coverage is an issue with SA access.

6. What impact on access will result from the 1999-parity law, SB 430?

After lunch, the Committee continued the discussion on resource management. The Committee agreed upon the following areas of interest for consideration:

1. Privatizing and contracting more services;
2. In view of the capital outlay plan that centralizes facilities’ services, determining the impact on the staff;
3. Reviewing staffing needs for appropriate balance and support;
4. Reviewing qualifications and training of staff;
5. Availability of private providers for MH and MR acute care services in Virginia;
6. Rapid stabilization of acute care clients;
7. Economic development prospects and/or alternative state utilization of facility properties;
8. Projected number of MH and MR clients identified who could transition to community services if resources were available;
9. Regional transitional living centers;
10. Regional MR facilities; and
11. Should publicly funded providers be in competition with the private sector?

The Committee will meet again on June 4, 1999 at Northwestern Community Services in Front Royal, Virginia. The topic will be on access to care.

The meeting was adjourned at 2:30 P.M.