Jan 28, 2013

The Alleghany Highlands Community Services Board held its regular meeting on January 28, 2013 at 5:00 p.m. at the AHCS Administration Office.


PRESENT: Robert McCallister, Lisa Hicks, Nolan Nicely, Jr., Robert H. Johnson Jr., Connie Redman Back and Eleanor Payne.
Also present: Ingrid W. Barber, Executive Director; QuoVadis Washington-Brown, Director of Outpatient and Support Services; Angie Goodbar, Director of Intellectual Disabilities Services, Patty Flanagan, Fiscal & Reimbursement Supervisor; Nancy Curry, Quality Improvement Manager; Cara Major, Human Resources Manager; Adam Kenny, IT Manager and Gloria Humphries, Administrative Assistant and Clerk to the Board.


Absent: Charlesette Laws, Teresa Johnson and Karen Burns

Bob McCallister called the meeting to order at 5:41.m.

Bob McCallister welcome new board member Robert H. Johnson, Jr.
MOTION: That the Board approve the minutes of the November 15, 2012 regular meeting.
MOTION: Nolan Nicely
SECOND: Eleanor Payne
VOTE: Unanimous

Bob McCallister read thank you notes from Ida Sarafandi and Sally Putnam.

Recognition of Retirement
Bob McCallister and Cara Major presented a plaque of recognition to Ida Sarafandi for her 27 years of dedicated service to AHCS.
AHCS 2013 Strategic Plan slide show
2013 AHCS Strategic Plan
Ingrid gave a slideshow presentation of 2013 the Strategic Plan. She briefly discussed each goal.


Addition to the agenda
Bob announced that the new proposed AHCS Fee Schedule is being added to the agenda to be reviewed and accepted.


Mental Health & Substance Abuse
QuoVadis Washington-Brown provided the following report:

  • QuoVadis and the Mental Health and Substance Abuse staff continue to work on Same Day Access and community awareness about services.
  • QuoVadis reported that MH/SA staff worked on Same Day Access Office setups to enable staff that is on the collaborative documentation pilot to work more effectively with clients and prepare documentation prior to the client leaving their appointments.
  • QuoVadis participated in the following meetings:
  • QuoVadis attended the Greater Alleghany Health Advisory Meeting.
  • QuoVadis had a meeting with Golden Living Center staff regarding Emergency Services and crisis intervention.
  • QuoVadis visited the Veterans Administration Site for possibility of getting a contract to have Tele-psychiatry for veterans at the MH clinic.
  • QuoVadis attended the CPT 2013 Code Training: Changes to billing codes for psychiatrist and therapists. Psychiatrist will now have to determine the level of care provided during medication management visits.
  • QuoVadis provided a Stress Management workshop at Dabney Lancaster Community College.
  • QuoVadis attended the meeting with Catawba Regional Partnership partners at Mental Health America regarding development of information to be presented for a legislative breakfast regarding budget amendments to assist with additional child psychiatry time and funding for a mental health discharge planner for jails in Roanoke and Alleghany Co.
  • QuoVadis attended the Botetourt, Craig, and Alleghany Co. Re-entry meeting to discuss re-entry of inmates into the community.
  • QuoVadis attended a meeting with the Executive Director and Clinical Services Coordinator to discuss outpatient therapy services and recommendations to streamline services.
  • QuoVadis completed interviews for Administrative Supports Supervisor.
  • QuoVadis attended a meeting with A New Lease on Life Program partners to discuss fiscal year 2013 and the future of the grant.

Intellectual Disabilities

Angie Goodbar provided the following report:

• Angie reported that Intellectual Disability services have steadily embraced the new DOJ Settlement initiatives by staying abreast of milestones and being active participants of the accomplishments. The milestones and accomplishments include the completion of the core competency training for support coordinators, START (systematic, therapeutic, assessment, respite, treatment) Program, increase in waiver slots, National Core Indicators, discharges from the training centers to community based services, employment and housing initiatives.

• Angie stated that she has been involved in regional meetings about the planning and programing of the START crisis response system for individuals with intellectual disabilities. One individual in the area utilized the service which resulted in diverting hospitalization. The regional program also offers a six bed respite/crisis stabilization program in Christiansburg.

• Angie reported that The Department of Justice has contracted with National Core Indicators (NCI) to conduct interviews/ surveys with individuals and families in Virginia to determine what is working or not working with Medicaid waiver services. National Core Indicators are standard measures used across states to assess the outcomes of services provided to individuals and families. These indicators address key areas of concern including employment, rights, service planning, community inclusion, choice, health and safety. Sixteen individuals/families served by AHCS have been selected to participate in interviews. The interviews will be coordinated and conducted by DBHDS and the Partnership for People with Disabilities. AHCS Support Coordinators spent time with individuals and families explaining the interview process and purpose of NCI.

• Angie reported that beginning March 2013, Support Coordinators will be required to provide enhanced case management to individuals that meet criteria. Support Coordinators will now be required to meet with individuals once every 30 days and every other month the contact must be in the home if the individual meets enhanced case management criteria. The enhanced case management criteria are as follows:
     - Receive services from providers having conditional or provisional licenses;
     - Have more intensive behavioral or medical needs as defined by the Supports Intensity Scale (“SIS”) category representing the highest level of risk to individuals;
     - Have interruption of service greater than 30 days
     - Encounter the crisis system for a serious crisis or for multiple less serious crises within a three-month period;
     - Have transitioned from a training center within the previous 12 months; or
     - Reside in congregate setting of 5 or more individuals

• Angie reported that the DOJ Settlement has made available Individual and Family Support Funds for individuals on the waiver wait list. Families will be provided funding to access short-term person/ family –centered resources, supports, and services. AHCS Support Coordinators will be responsible for helping families apply for these funds which will be made available early spring of this year.

• Angie reported that to provide improved quality of care and housing, AHCS has converted Merryfield Residence, a waiver group home to an Intermediate Care Facility (ICF). Merryfield is an eight bed facility.

• Angie, Director of ID and Linda Mack, Day Support Supervisor attended a presentation given by Adam Sass from DBHDS to explore employment opportunities for individuals with intellectual disabilities. ID staff also visited Henrico CSB to observe their Day Support and Supported Employment Programs.

• Angie reported that planning is underway to celebrate ID Awareness month in March. AHCS Intellectual Disability Services will be supporting the ARC campaign of the “New Virginia Way”. Governor McDonnell and the Virginia General Assembly have taken action to help Virginia transition to a community-based system of support for all people with intellectual and developmental disabilities (ID/DD). This transition will help the Commonwealth protect civil rights, achieve sustainability and serve more people with ID/DD in a better way. This transition will promote integrated services that maximize natural supports and result in real lives. It all comes down to “A Life like Yours”, a home, a job and a life in the community.


Quality Improvement
Nancy Curry provided the following report:

UR and HER

• Nancy reported that on January 15, 2013, the Office of Inspector General (OIG) conducted an audit of DAP (Discharge Assistance Program) funding and service plans. This audit was for five DAP consumers. This was a financial audit of the funding and how it is being utilized. They requested copies of client records for services purchased with DAP funds.

• Nancy created and distributed monthly UR reports to Executive Director and Directors: training, incomplete visits, unapproved visits, >90 days no activity.

• Nancy submitted quarterly reports to the Leadership team for review. Quarterly reports include: Incident Report, Human Rights Report, and Medication Error Report. A summary for the year 2012 was completed and detailed reports were provided for Directors to review.

• Nancy is working with Adam to create an incident reporting database within Credible. This will expedite reporting by staff and stream line the process.


• Nancy will facilitate quarterly Safety Committee Meeting on 1/24. The quarterly and annual incident reports will be reviewed to look for trends, identify any safety concerns, etc.

• Nancy will facilitate the Merryfield quarterly safety committee meeting on 1/24. Per requirements for ICF/MR we must have a safety committee specific for Merryfield.

• Nancy attended a called meeting of the Local Human Rights committee with Angie Goodbar to request affiliation for the ICF/MR.

• Nancy reported that DBHDS is implementing a new electronic web based application - the Computerized Human Rights Information System (CHRIS). AHCS will be in the first phase of implementation scheduled for February with training being held on 1/24.


• Nancy reported that AHCS has three Psychiatrists who are currently in the credentialing process to be added to AHCS as a provider. .

Staff Development

• Nancy reported that AHCS has 151 staff enrolled in Elevate.

Nancy is facilitating a workgroup to develop and implement new staff orientation. A draft outline has been developed. Members of the workgroup are HR Manager, and the IT manager.

Nancy assisted in training psychiatrists on the new CPT code documentation requirements.

Policy and Procedures

• Nancy will facilitate a workgroup comprised of Psychiatric Services Supervisor, consulting RN for Merryfield and RN Instructor for Med class to create/standardize agency wide medication management policies, forms, error reporting, etc.


Same Day Access:
- Nancy met with Psychiatric services staff to draft a medication management note for Credible. This form makes it easier to comply with collaborative documentation. A word document draft of the layout was developed from which the IT manager created the Credible form. This new form was implemented and has been working well for the psychiatrists. The form was also made to be compliant with the changes to the CPT codes


• Nancy attended CPT Code training offered in Roanoke by DMAS.

• Nancy attended the VA Credible Users Group meeting on 12/14 in Charlottesville.

• Nancy and the IT Manager will attend the National Credible Users Group Convention in March.

IT Manager Report

Adam Kenny reported the following:

Help Desk
• Adam reported that 29 documented “help desk” requests have been opened and resolved.
• Adam reported that help desk software will be installed soon to keep better track of the issues.
• Adam reported that he completed approximately 150 visit change requests.

• Adam created new form for MH Open Access / Collaborative Documentation.

• Adam created new forms for Merryfield ICF.

• Adam created new incident reporting form.

• Adam completed 2013 CPT code changes and form modifications.

Hardware and Networking
• Adam reported that all 155 users have been migrated to the new email system and all agency computers have been reconfigured to use the new mail server.

• Adam reported that all locations have been switched to Shentel with the exception of Mental Health and Lifeskills.

• Adam reported that PKI certificates to encrypt email between employees and state hospitals and discharge centers have been purchased.

• Adam stated that he has started configuring mail groups for the mail server.

• Adam attended monthly DMC meetings in Richmond.

• Adam will be attending the credible conference in March.

• Adam has started registering doctors for Medicaid incentive.

• Adam is working on creating tutorials for the new mail server

Human Resources

Cara Major provided the following report:

• Cara reported the 2012 fiscal year turnover rate was 24%.

• Cara reported the 2013 fiscal year turnover rate from July 2012-January 2013 for the entire agency is 18.7%.

Loss Report
• Cara reported that there was one vehicle incident with no damage or injury and one worker’s comp claim.

• Cara reported that advertising is being done with local papers (Roanoke, Lynchburg, Lexington, and Stanton), monster.com, Shentel Cable, Lumos Internet and the Roanoke paper.

• Cara reported that the Administrative Support Supervisor position has been filled.

• Cara provided an update on the open positions.

General Updates
• Cara thanked everyone who attended the agency Christmas lunches in December.

• Cara reported that the 2012 CARE Spirit Award was presented to Linda Mack.

• Cara reported that 30th Anniversary Committee has provided articles to be printed in the local paper each month providing history of the agency and information about the services.

• Cara stated that the Employee Breakfast was held December 3rd and next one is March 12, 2013.

• Cara stated that the Agency Supervisors Meeting will be held January 30, 2013.

• Cara conducted exit interviews with Mental Health Employees that resigned.

• Cara provided a copy of the VEC Report.

• Cara completed the VRS Modernization Webinars and BB&T Webinar regarding Health Care Reform Compliance.

• Cara will be attending the VACSB HR Committee meeting, SHRM PHR Course and monthly BB&T Webinars.

Budget Reports
Patty Flanagan provided the budget report.
• Patty provided the balance in the regular checking and foundation account and the consolidated year to date totals for the agency for the month of December 2012.

• Patty provided the MH/SA and ID fund balance reports.

Ingrid Barber provided the following report:
• Ingrid gave a reminder of the Chamber dinner March 2, 2013. Social hour is 5:30pm and dinner at 6:00pm.

Old Business
• Ingrid provided a copy of the form 990 by Robinson, Farmer and Cox and stated that this will need to be approved by the Board.

MOTION: That the Board approve the form 990 of the FY 2012 audit by Robinson, Farmer
And Cox.
MOTION: Nolan Nicely
SECOND: Robert Johnson
VOTE: Unanimous
TIME: 6:59pm

New Business

• Ingrid provided a hand out of the AHCS updated fee schedule to be approved by the board.

MOTION: That the Board approve the new AHCS Fee Schedule.
MOTION: Eleanor Payne
SECOND: Connie Redman Black
VOTE: Unanimous
TIME: 7:02pm

• Ingrid provided a copy of the VACSB 2012 Annual Report.

• Ingrid provided a handout of the Governor’s Proposed Budget Amendments FY 2012-

• Ingrid provided a handout of information regarding the Officer of Inspector General
Audit, Discharge Assistance Plans, Extraordinary Barriers List, State Hospitals Census
and the updated waiting list for waiver services.

• Ingrid provided a handout about the Affordable Care Act Medicaid Expansion.

• Ingrid provided a copy of the 2014 local funding request letters written to Covington City
Council and Alleghany Board of Supervisors

• Ingrid provided a handout of the VACSB budget update, public hearing and legislative


The next scheduled Board Meeting will be on Monday, March 18, 2013 at 5:30 pm. at the
Administration office building - 205 East Hawthorne Street, Covington, VA.

MOTION: That the January 28, 2013 regular meeting of the Alleghany Highlands Community Services Board be adjourned.
MOTION: Nolan Nicely
SECOND: Lisa Hicks
VOTE: Unanimous
TIME: 7:20