Buena Vista County
Management Plan Annual Review
Fiscal year 2010
The purpose of this report is to summarize the activities of Fiscal Year 2010 relative to the Buena Vista County Management Plan in order to meet the requirements of IAC441—25.13(3).
Strategic Plan Goals and Objectives Progress Review:
Goal #1: The Buena Vista County MH/MR/DD service system will provide more individualized supports for people with disabilities to lead more fulfilled lives that offer choices and opportunities within the scope of a person’s needs and abilities.Objective 1: In keeping with the values and principles of choice, community and empowerment within the management plan, Buena Vista County will continue to foster a person-centered vs. system-driven service system through June of 2012.
ACTION STEPS
1. Buena Vista County will continue to co-sponsor trainings locally with various service providers to enhance learning opportunities for agency staff that will ultimately lead to better services for the consumers whom we serve.
2. Survey consumers annually to assess their perspective on the system.
3. The Buena Vista County Managed Care Advisory Board will be involved in opportunities to improve handicap accessibility ie; Santa’s Castle, within the community whenever possible.
4. The Buena Vista County Managed Care Advisory Board will promote consumer involvement in a variety of activities that increase both wellness and socialization within the community such as the March of Dimes walk or other formal events.
5. Buena Vista County Case Managers will continue to write plans that support the consumer’s dreams and visions for their future and advocate for progress. In situations where progress towards a consumer’s goal is stagnant from year to year, the Case Manager will work collectively with the team towards development of creative ideas that will lead to accomplishment.
6. Genesis Development and Buena Vista County Community Services will continue to facilitate monthly self-advocacy meetings (ACES-Advocacy/Choice/Empowerment/Support) to promote the consumers abilities to speak up for themselves and obtain what they want out of life.
7. Increase provider collaboration through quarterly advisory meetings to enhance services within the community, grant opportunities, and progress towards the indicators.
The Buena Vista County (BVC) Managed Care Advisory Board met on a regular basis during Fiscal Year 2010 to review policy and budget issues as well as assess progress towards our new Strategic Plan. The BVC Managed Care Advisory Board maintains an active role in steering and guiding our mental health system towards our vision of ensuring that persons with disabilities reside in and receive supports in the least restrictive setting based on their individual needs consistent with the principles of choice, community and empowerment. Representation on the BVC Managed Care Advisory Board consists of a consumer, family member, mental health providers, mental retardation service providers, vocational providers and case management. One of the outcomes of the regular meetings that has evolved over time is the strong cohesiveness of the members and the increased collaboration among the agencies. The solid partnerships that have developed throughout this process has served to strengthen the system as a whole for the benefit of all persons served within the county. To that end, the BVC Managed Care Advisory Board co-sponsored the fifth annual fall training opportunity on November 17, 2009 in which the Central Iowa Players (formerly known as the Stigma Busters) presented an afternoon of vignettes regarding the stigma surrounding mental illness and how each of us has "stigmatized" at one point or another. Fifty-three consumers, family members, direct care staff and individuals from the general public were in attendance at this event.
Buena Vista County Case Management was audited in April of 2010 by the Quality Assurance Division of the Department of Human Services and received a three-year accreditation with a 100% score. One of the focuses of the accreditation process is the consumer goals to ensure that maintenance goals are not the standard. The Case Managers were commended by the reviewers for the service plan goals as it was evident that they promote independence and are also stated in the consumer's own words whenever appropriate. Buena Vista County Community Services has maintained involvement with Genesis Development in hosting monthly self-advocacy meetings to promote the consumers’ ability to speak up for themselves and obtain what they want out of life.
Objective 2: Buena vista county will provide services and supports within the community of a person's choice by June of 2012.
ACTION STEPS
1. Increase independent living and housing opportunities that are community-based and integrated by exploring options for transitional apartments or houses that could be staffed based on individual need.
2. Research funding opportunities for community housing project listed above including county block grant if possible.
3. Access the Money Follows the Person Grant to transition individuals from the ICF/MR setting into the community.
4. Sustain the Lighthouse project to assist hospitalized individuals with returning to and maintaining community living.
One consumer moved from a 24-hour Home and Community Based waiver home into his own apartment into the community with supports during the past year. Several consumers with chronic mental illness were assisted with returning to their own homes with additional supports in order to prevent residential placement. There has been no progress to date in regards to the establishment of a transitional home or apartment within the community.
Objective 3: Buena vista county will increase socialization opportunities for consumers which will enhance their physical and mental well-being by June of 2012.
ACTION STEPS
1. Explore the need for a weekend/evening Drop-In Center through the distribution of surveys to all consumers in Buena Vista County.
2. Research possible grants for start-up costs and long-term sustainability.
3. Establish a Drop-In Center or the designation of a social coordinator who could plan regularly scheduled activities.
4. Explore the potential for agencies to partner together to manage activities if a Drop-In Center is not identified as a substantial need within the county.
A sub-committee was formed in the fall of 2009 to begin discussion on the initiation and development of a Drop-In Center in Buena Vista County. Shortly after the committee was formed, Plains Area Mental Health Center hired an a BVU intern, Chantel Croghan, who joined the subcommittee and was instrumental in developing a survey that would gauge the interest and need for a Drop-In Center or additional social opportunities within Buena Vista County. Chantel conducted focus groups at all local provider agencies to obtain input into the survey. There was very limited attendance at the focus groups however, eleven participants completed the needs assessment survey. At the April meeting, Chantel reported to the MC Advisory Board that there was unanimous support for a Drop-In Center in Buena Vista County with 91% of the participants indicating interest in increased social opportunities. The participants believed that a drop-in center would increase their quality of life and enhance opportunities for socializing with others.
Recommendations from the Needs Assessment were as follows:
*Begin with determining how many clients would be eligible to utilize the drop-in center or socialization group - appears that currently there is not enough interest start up a full drop-in center at this time
*Start with a gradual process through a socialization group then extending to a full drop-in center
*Ensure sustainability
*Research donors or funding to decrease the direct financial costs required of consumers
In July of 2010, the Managed Care Advisory Board made the decision to begin with socialization activities geared toward the CMI population before focusing on a Drop-In-Center. Some of the activities that were discussed were going to movies, restaurants, game night/movie. Due to the central location of Plains Area Mental Health Center, it was also decided to house the coordinator out of their office and that they would hire the individual on a part-time basis with an initial budget request of $13,000. Patrick Schmitz and Dawn Mentzer approached the Buena Vista County Board of Supervisors on 9/28/10 to request funding from the county. The funding was philosophically approved yet the Board recommended an application for a Community Foundation Grant first. Plains submitted the grant prior to the deadline but it was not received by the Community Foundation by the deadline therefore we plan to re-apply in the spring of 2011.
Documentation of Stakeholder Involvement
The composition of our managed care board remained unchanged with provider, community service staff, consumer representation and family representation. The Targeted Case Management Advisory Board met on three occasions during FY’10 and many of the representatives serve on both committees.
The Managed Care Advisory Board met on four occasions during Fiscal Year 2009 (7/21/09, 10/22/09, 1/28/10 and 4/29/10). (Minutes are attached as an appendix) Throughout these meetings, the CPC Administrator advised the board on legislative changes that impact the MH/DD system on a state and local level, the progress towards the goals of the managed care plan, quality assurance activities and we also planned our annual provider training. At each meeting, the BVC Managed Care Advisory Board was also provided with information regarding the status of the Buena Vista County MH/DD budget.
Actual Provider Network
The following chart contains the service providers who served Buena Vista County individuals during FY’10:
AGENCY / MI/CMI / MR/DDBuena Vista County Community Services / Targeted Case Management(CMI) / Targeted Case Management, County Service Monitoring
Integrated Health Systems/Glenwood / NA / ICF-MR Services
Cherokee Mental Health Institute / Inpatient/Outpatient
Medication Management / NA
Courage Homes - Sioux City / NA / ICF-MR Services
Faith Hope & Charity / NA / HCBS
Genesis Development / Work Activity; SCL;
Supported Employment;
Day Habilitation; Pre-Vocational / Work Activity; SCL;
Supported Employment;
Day Habilitation; Transportation; Pre-Vocational
Howard Center / NA / SCL
Ida Sheltered Industries / Work Activity/SCL / Work Activity/SCL
MidStep Services, Inc. / NA / ICF/MR
Oakshire House-Sioux City / NA / ICF-MR Services
Opportunity Living I,II& III - Lake City / NA / ICF-MR Services
Plains Area Mental Health Center / Outpatient/Psych/Med Management / NA
The Pride Group / RCF / NA
Regional Transit Authority / Transportation / Transportation
REM-Developmental Services / NA / Adult Day Care
Seasons Center for Community Mental Health / Outpatient, Medication Management, ADT, SCL, Evaluation / NA
Siouxland Mental Health Center / Medication Management / NA
Storm Lake Cab Company / Transportation / Transportation
Sunshine Services / Work Services / NA
Village Northwest / NA / ICF-MR Services/SCL/Day Habilitation/Work Activity/Supported Employment
New Hope Village / NA / HCBS - SCL and Pre-Vocational
Link Associates / NA / HCBS Transportation
Actual Expenditures/Scope of Services
Buena Vista County continues to provide Targeted Case Management Services and 100% County Case Management to persons with Chronic Mental Illness, Mental Retardation and Developmental Disabilities. The CPC Administrator is directly employed by Buena Vista County and is responsible for all aspects of the managed care process, budgeting and oversight of the case management program. Services are authorized by the CPC for eligible individuals in accordance with the managed care plan. The following matrix outlines the actual expenditures and scope of services that were provided during Fiscal Year 2010 by disability group:
Account Code / MentalIllness / Chronic
Mental Illness / Mental
Retardation / Dev.
Disability / Service Total
04382 / Consultation / $50,870.00 $68,159.40
$68174.40 / $50,870.00 $68,159.40
$68174.40
05373 / Public Education / $50,000.00 / $50,000.00
21374 / Case Management - T19 Match / $1439.84 / $12,851.38 / $780.94 / $15,072.16
31354 / Transportation (non-Sheriff)/Regional Transit / $1444.00 / $31,089.36 / $32,533.36
33345 / Ongoing Rent Subsidy / $586.73 / $586.73
42305 / Psychotherapeutic Tmt. Outpatient / $24,190.69 / $24,190.69
43384 / Evaluation / $7001.14 / $7001.14
50362 / Work Activity Services / $16,358.03 / $89,836.35 / $106,194.38
50367 / Adult Day Care / $1418.11 / $17,474.75 / $12,546.46 / $31,439.32
50368 / Supported Employment Services / $2634.62 / $27,170.60 / $29,805.22
63310 / Comm Supervised Apt Living (Comm. 1-5 Bed) / $30,663.90 / $30,663.90
63329 / Supported Community Living (Comm. 1-5 Bed) / $201,333.22 / $201,333.22
64314 / RCF (Comm. 6-15 Bed) / $18,571.35 / $18,571.35
65318 / ICF/MR (Comm. 16+ Beds) / $301,280.79 / $301,280.79
71319 / Inpatient (State MHI) / $37,599.69 / $2233.62 / $39,833.31
74353 / Sheriff Transportation / $2377.02 / $2377.02
74393 / Legal Representation (court costs/legal fees) / $2951.00 / $259.88 / $3210.88
74395 / Mental Health Advocates / $1824.23 / $1824.23
Total County / $176,813.77 / $75023.35 / $681,623.18 / $13,327.40 / $946,787.70
Number, type and resolution of appeals
There were no appeals filed during Fiscal Year 2010.
Quality assurance implementation, findings and impact on plan
Surveys were sent out in conjunction with the annual case management satisfaction surveys in January 2010. Consumers and family members expressed 100% satisfaction with the services provided in Buena Vista County while the provider satisfaction survey resulted in 89% satisfaction with Case Management Services. There were no unmet service needs identified by those who responded and all were very favorable regarding the service system that we have to offer in Buena Vista County.
Waiting List Information
Buena Vista County did not place any individual who was requesting services on a waiting list during FY’10.
Annual report prepared by:
Dawn Mentzer, Buena Vista/Carroll Counties CPC Administrator
Date
APPENDIX
Buena Vista County Managed Care Board Meeting
Minutes
4/29/10
3:00 p.m.
The Buena Vista County Managed Care Advisory Board met on this date at the Community Services Department in Storm Lake. The following Advisory Board members were present: , Tami Mills-Thomas, Dawn Mentzer, (Buena Vista County Community Services), Cindy Wiemold (Faith, Hope and Charity), Patrick Schmitz and Chantel Croghan (Plains Area Mental Health Center), Alicia Gatzemeyer (Case Manager), Susan Irwin (Vocational Rehabilitation), Pat Allen (family member), Sandy Pingel (Genesis Development) and Charleen Anderson (Mental Health Advocate). Members absent were Lynn Younie (Case Manager), Diane Mangold (Seasons Center), Paul Merten (Buena Vista County Supervisor), Lenny Young (consumer)
The following topics were discussed:
1. Drop-In Center - Subcommittee Update