Public Hearing Date: 03/30/2009 in Humboldt County and 03/31/2009 in Pocahontas County
The Strategic Planning committees are responsible for developing the three-year strategic plan for Humboldt and Pocahontas Counties. These committees are comprised of consumers, family members, providers, and concerned citizens. The strategic plan describes the county’s vision for its mental health, mental retardation, and developmental disabilities system for the ensuing three fiscal years. The plan lists goals and objectives that are guided by the system principles of choice, empowerment, and community. These goals and objectives reflect the system which the Humboldt/Pocahontas Counties plan to have in place in three years, the steps which will be taken to develop the system, and how progress toward implementation will be measured.
Humboldt County Members and Affiliations
Don Anderson Designated Lead Staff/Family Member
Dawn Anderson Consumer
Greg Stoebe Humboldt County Magistrate/Family Member
Alice Warner Pocahontas, Humboldt, and Wright County Advocate
Humboldt/Pocahontas County Community Services staff shall meet with the planning/advisory board at a minimum of three (3) times during a fiscal year to review progress toward goals in the strategic plan or to modify goals and objectives listed in the strategic action plan.
This plan has been based on trend and annual report information, evaluation results, surveys, observations. Input was provided by consumers, families, providers, and other stakeholders.
Transportation- need for flexibility, affordability, and evening and weekend transportation
The need to develop day services that lead to integration and/or employment opportunities.
Need for transitional/crisis beds
Need to educate the public regarding opportunities and struggles within the MH/DD System.
Need to develop individualized funding of supports while controlling costs and maintaining accountability.
Humboldt/Pocahontas County Community Services staff shall meet periodically with service providers to discuss needs or changes in best practice in order to aid in meeting the goals listed in this strategic action plan, and to address planning to assist in dealing with other needs identified.
Humboldt/Pocahontas County will evaluate this information prior to reviewing the next year’s plan of action. Goals may be modified based on the information received. Progress of current goals will be measured to ensure that time lines are being met.
Weaknesses in services or in the managed care process will be addressed, and corrective action will be taken. If needed, a team will be sent out to evaluate the situation and make recommendations that will correct or eliminate the inadequacy.
Records will be kept on the number of appeals that were requested in a year and will be documented in the annual report. Appeal statistics will allow Humboldt/Pocahontas County to analyze what may be lacking in our plan. Consideration to fund and/or provide for these services will be given when reviewing the following year’s plan.
4x64- 318 Intermediate Care Facility For The Mentally Retarded (ICF/MR License) 6-15 Beds
4x64- 399 Other 6-15 Beds..
4x65- 310 Community Supervised Apartment Living Arrangement (CSALA) 16 and over Beds
4x65- 314 Residential Care Facility (RCF License) 16 and over Beds
4x65- 315 Residential Care Facility For The Mentally Retarded (RCF/MR License) 16 and over Beds
4x65- 316 Residential Care Facility For The Mentally Ill (RCF/PMI License) 16 and over Beds
4x65- 317 Nursing Facility (ICF, SNF or ICF/PMI License) 16 and over Beds
4x65- 318 Intermediate Care Facility For The Mentally Retarded (ICF/MR License)
4x65- 399 Other 16 and over Beds..
4x71- 319 Inpatient/State Mental Health Institutes
4x71- 399 Other
4x72- 319 Inpatient/State Hospital Schools
4x72- 399 Other.
4x73- 319 Inpatient/Community Hospital
4x73- 399 Other
4x74- 300 Diagnostic Evaluations Related To Commitment.
4x74- 353 Sheriff Transportation
4x74- 393 Legal Representation for Commitment
4x74- 395 Mental Health Advocates
4x74- 399 Other
RATIONALE FOR SERVICES SELECTED: It is believed that the above listed service by diagnostic category will meet a vast majority of consumer needs for those persons Humboldt/Pocahontas County are financially responsible for.
Access to services may be restricted in both Humboldt County and Pocahontas County in FY2010 due to shortages in MH/DD funds
This restriction is in place due to an anticipated short fall of funds in Fiscal Year 2010. New consumers requesting services may be placed on a waiting list. It is hoped that proactive reductions in services that exceed current level of need will provide funds to limit this restriction.
Access to services or levels of service may be restricted due to pursuance of least restrictive settings
Some consumers may require emergency services until stabilized or until a provider can be located that is able to provide the supports necessary to allow them to live in a less restrictive community setting. As it is the desire of Humboldt/Pocahontas County that persons live in the least restrictive setting possible this may restrict access to more restrictive placements or cause the county to seek a change in a placement to a less restrictive setting.
Current levels of services may be reduced in anticipation of or due to shortages in funds.
This restriction is in place due to an anticipated short fall of funds in Fiscal Year 2010. Consumers currently receiving services who are requesting additional services may be placed on a waiting list. It is hoped that proactive reductions in services that exceed current level of assessed need will provide funds to limit this restriction.
Service Access or levels may be restricted due to lack of progress.
Persons who have not made significant progress towards their identified outcomes
may have their funds restricted until an alternative provider can be located or
adjustments to their identified outcomes can be made. ICPs will be monitored to
assure goals are measurable and have accurate time frames for achievement.
quarterly progress will be monitored to assure progress is being made. If
progress is not being made, needs will be reassessed and the individuals service will be adjusted accordingly
Service Access or levels may be restricted due to negotiations in rates
At times services or increases in levels of services may be inaccessible due to the negotiation process between Humboldt/Pocahontas County and a service provider. Humboldt County has become a member of the County Rate Information System to assist in the negotiation process.
Humboldt and Pocahontas Counties will make every attempt to maintain eligibility guidelines and service availability as outlined in its plan. Our ability to do so is contingent on the Iowa Legislature’s appropriating sufficient funds to maintain current eligibility and services to meet projected increases in the number of new consumers and increasing service costs. If sufficient funding is not approved, waiting lists will have to be implemented.
In the event of the creation of a waiting list for funding in one or both counties, consumers placed on the waiting list will be notified. The notification will include the estimated length of time the person may have to wait before funding will be available. Those consumers will be informed that the county is unable to provide the requested services because of inadequate funding.
Consumers on the waiting list will be contacted at least semi-annually and advised of their current status, and any adjustment to the expected time on the list. When funding becomes available, Humboldt/Pocahontas County will determine which individuals will enter the system in accordance with the date placed on the waiting list.
Other possible policies that may be implemented due to full encumbrance of MH/DD funds are as follows:
Should MH/DD funding become fully encumbered and it is anticipated that funds will be fully encumbered into the following fiscal year, service rates and service levels will be frozen to avoid continued service reductions and increasing the wait period for services. As MH/DD funds become unencumbered rates will be evaluated based on cost and rates will be increased to cost or prorated by availability of funding.
The county may eliminate non-mandated diagnostic criteria to reduce expenditure levels. Such changes in county policy will require approval at the state level and will primarily affect persons with developmental disabilities.
Funding will be terminated for persons in ICF/MR facilities who are eligible for Nursing Home level of care. Funding will remain in place for 90 days to allow the County Social Worker or Case manager to secure placement in an ICF or SNF. Persons who are in an ICF or SNF will not be eligible for county MH/DD funds.
County MH/DD funds will not be utilized to fund day programming or vocational programming for person over the age of 65 who live in an RCF, as they are eligible for the Elderly Waiver Program.
MI/CMI clients should be encouraged to access the 23:59 crisis bed prior to commitment.
Persons enrolled under the HCBS/MR Waiver who are requesting S.E. will be required to utilize S.E. under the HCBS/MR Waiver.
EARLY INTERVENTION PLAN:
Indicators/Triggers: When budgeting for a fiscal year, if it is anticipated that the current budgeted level of services will exceed anticipated revenues and use the remainder of any fund balances, it will be assumed that that the following fiscal year may have shortages in funds.
What to Do: In such a case, levels of service will be reviewed and reduced where possible. Increases in levels of service will be monitored and may be placed on a waiting list. Health and Safety will become a priority over Quality of Life in order to acquire less costly placements. These measures may open up funds to new consumer requests in the years ahead and may also eliminate the need for further reductions in levels of service or the use of waiting lists.
Access Points have been identified where people can go to enter the MH/MR/DD system. The following are designated access points:
Berryhill Center for Mental Health
DHS Case Management
Humboldt County Case Management
Humboldt/Pocahontas County Community Services
Humboldt/Pocahontas County Department of Human Services
Humboldt/Pocahontas County Clerk of Court
Division of Vocational Rehabilitation Services
GOALS AND OBJECTIVES
Humboldt/Pocahontas Counties have developed a three year strategic action plan that is guided by the core values of choice, empowerment, and community.
Issue: Funding availability can not be accurately predicted because of state and federal policies and Medicaid uncertainties. To ensure that the greatest number of people are able to receive appropriate supports, we must be able to adapt to funding changes.
To establish a system of resource and infrastructure management to accommodate demands on the capacity of the system.
To evaluate and implement a case rate system of payment.
Explore other case rate systems of payment currently being used by counties by 10/1/09
Began using case rate system on paper by 12/1/09
Collect information about actual expenses vs. case rate by 12/1/09.
Implement actual case rate system based upon consumer’s level of functioning and need for services by 1/1/10.
All persons will be assessed with the exception of outpatient mental health services or supports that are court ordered.
LOCUS and ICAP will be used to make assessment to determine level of need.
Adjust case rates at least annually beginning on 7/1/10.
Projected Costs: FY10: 0$; FY11 and FY12: To be determinedObjective 2:
To advocate for the continuation of Medicaid as an entitlement program that provides significant funding for the system, but to advocate for the revision of Medicaid to offer more individualized, flexible, cost effective supports to Medicaid eligible consumers. Action Steps:
Ongoing Monitoring of Medicaid changes.
Ongoing Monitoring of state changes in Medicaid Plan and Waivers.
Maintain ongoing communication with legislators and stakeholders.
Projected Costs: FY 10: 0$; FY 11 and FY12: To be determined Objective 3:
To accommodate for growth in the number of consumers accessing services. Action Steps:
Determine annually the number of consumers transitioning from the children’s system.
Predict as accurately as possible the number of other new consumers coming into the system on an annual basis.
Projected costs: FY 10: $60,000 in Humboldt County and $50,000in Pocahontas County FY11 and FY12: Additional money each year based upon consumers accessing services ISSUE: Current employment services do not promote our goal of increased self-sufficiency. Employment services should be redesigned to fit this value. Current employment services are often used as a service to fill a person’s day, and without regard for the cost-benefit ratio of cost of services to income earned. Many of these individuals may benefit from other services or supports. Supports and services should offer choices and opportunities within the scope of a person’s needs and abilities
Align employment services more closely with our mission, vision, and values. Objective 1:
Humboldt and Pocahontas County will offer educational, training, and employment services that promote our goal of increased self-sufficiency. Action Steps:
By 7/1/09 Develop an advisory group of various stakeholders including representation from consumers, employment providers, case management, and other service providers to explore methods of defining those who “can progress toward working competitively”, and defining the value of other life enhancing activities for those who can not work competitively.
By 9/1/09, the advisory group along with additional members (as identified) will assist in developing an array of services that meet our vision of employment.
By 9/1/09, the advisory group will look at exploring non-conventional, non-traditional employment possibilities. The advisory group will also assist in designing services or supports that are meaningful and life enhancing for people considered not to be competitively employable, with an emphasis the overall personal development of individuals.
Financial assistance for Supported Employment will continue to be provided in order to increase opportunities for community-based employment.
By 10/1/09, providers will pursue enclave or other job-related opportunities such as volunteer positions.
Beginning 7/1/09, to continue working with our network providers and Division of Vocational Rehabilitation Services to allow for maximum efficiency and effectiveness for our providers, to ensure continuity and purpose of employment services are carried out, and funding options are maximized for services when appropriate.
Additional growth of services will be encouraged on an ongoing basis as necessary to add choice, capacity, and varying needs of our consumers.
System outcomes and provider outcomes will be reviewed and adjusted accordingly, on a quarterly basis.
Projected Costs: After initial administrative costs, costs will be identified after determining service needs and providers.
ISSUE: Because of the current lack of Psychiatrists and mental health professionals in our rural area, many individuals are having difficulty in accessing timely and readily available services.
Humboldt and Pocahontas Counties will remain open to current and future innovations/opportunities to improve services. Objective: Humboldt and Pocahontas Counties will continue to seek outside opportunities to enhance its support system Action Steps:
Beginning on 7/1/09 there will be ongoing communication with the Berryhill Center for Mental Health to establish and maintain tele-psychiatry sites in each county.
Identify and secure tele-psychiatry sites in both counties, by 9/1/09.
Tele-psychiatry sites will be established in both Humboldt and Pocahontas Counties by 07/1/10
Grant opportunities will be reviewed with the advisory Board, which meets quarterly.
Beginning on 7/1/09, Humboldt and Pocahontas Counties will keep up to date on technological advances that will enhance the system, and implement them whenever possible.
Cost: To be determined
ON-GOING SUPPORT GOAL
Information about the Humboldt/Pocahontas County MH/DD System will continue to be readily accessible.
Objective: Provide Ongoing Community Education
Update annually and distribute brochures.
Maintain information on the County Web Sites about the Humboldt/Pocahontas County MH/DD System and related information.
Distribute the Humboldt/Pocahontas County Managed Care Plan in formats accessible to all populations.