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AG 2001 03 26
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AG 2001 03 26
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Last modified
3/25/2002 4:51:10 PM
Creation date
11/27/2017 11:45:14 AM
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Meeting Minutes
Doc Type
Agenda
Meeting Minutes - Date
3/26/2001
Board
Board of Commissioners
Meeting Type
Regular
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TO: Secretary Carmen Hooker Buell <br />FROM: Dan Coughlin <br /> <br />Secretary Buell: <br /> <br />Congratulations on your recent appointment Your reputation precedes you and the public MH/DD/SA <br />sector, comers, & advocates are heartened and excited to have you at the helm. <br /> <br />By way of introduction, I am Dan Cough/in, Area Director of the Piedmoat Behavioral Healthcare, the <br />largest multi-county and third largest overall Area Program in the state. <br /> <br />I am new to the system baying come here in July from New York State where I worked in the public <br />MH/DD/SA system for over 25 years in roles ranging from direct clinical care and supecvision to public - <br />administration and policy making. I also spent time as the chief administrator of the behavioral health <br />division of a large hospital system in central New York and as an executive with ValueOpt/ons, a mt/omi <br />behavioral health managed care company (that you may know from your days in Massachusetts). My <br />perspectives herein, therefore, come more from my experiences outside of North Carolina than from inside. <br /> <br />Regarding the PCG Report, System Reform, and the Legislative Oversight Committee: <br /> <br />Division of Mll/DD/SA <br /> <br />· The Division of MIt/DD/SA sorely needs a strong, visionary leader with national standing who <br /> can manage and who is an expert in the field, knowing both national clinical and systems trends as <br /> well as health care policy and financing <br /> o The discussion around mb-directors for each disability should be deferred until well after <br /> a new DivisiOn Director is in place and the Division has been strengthened and stabilized <br />· Aligning the state Medicaid Plan with the Division of MH/DD/SA Plan is critical & consideration <br /> should be given to "carving out" the MHIDD/SA Medicaid piece <br />· The state MH/DD/SA Medicaid plan, as it exists, is a Byzantine fee-for-service system that lacks <br /> flexibility and falls to well support "special" populations such as SPMI adults & SED cinldren. <br /> The Medicaid plan should take advantage of the "Rehab Option" and/or Medicaid waivers. Local <br /> Area Programs should be supported and encouraged to write 1915B waivers that provide <br /> flexibility and ereative service provision <br />· The current structure of the system is designed on an acute care model which cannot adequately <br /> address modem community based models incorporating psychiatric rehabilitation, consumer <br /> empowerment, self-help and peer initiatives <br />· At the policy level, the slate needs to develop an overall vision and direction for the system that <br /> clearly and concretely defines populations to be served, concomitant benefits plans, and the <br /> financial structures to support both. There are particular needs surrounding "indigent care", SPMI, <br /> Homeless MI, MUSA (co morbidity), Forensic, & SED populations. <br /> <br />Local Services and Restructuring Governance <br /> <br />· First off, until the system is reformed at the state level (as above), to address changing governance <br /> at the local level is a case of putting the can before the horse <br />· Next, the existing governance model (Public Authorities) is probably the strongest model in <br /> existence clue to: <br /> o its hybrid character that weds public accountability with the independence and flexibility <br /> of a private organization. It's a tried and true model all over the counu*y (airports, <br /> hospitals, transportation, etc) <br /> its having a policy making, citizen board comprised of a mix of consumers, advocates, <br /> and public officials (County Commissioners) <br />· Critics of the existing Area Programs believe they are too many and too small; that, especially <br /> small, single county programs should consolidate. I agree <br /> <br /> <br />
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