WV Health Care Authority
BEHAVIORAL HEALTH
CON STANDARDS MEETING
November 13, 2008 - 1:00 p.m. EST
Conference Reference #137202
Present:
Sonia Chambers, Health Care Authority
Sam Kapourales, Health Care Authority
Marianne Kapinos, General Counsel, Health Care Authority
Cindy Dellinger, Health Care Authority
Tim Adkins, CON, Health Care Authority
Shelia Kelly, CON, Health Care Authority
Russell Sickles, Job Squad, Inc.
Tina Maher, DHHR – Olmstead
Tanya Dillm-Page, CRC
Angie Wagner, CRC
John Russell, WV BHPA
Raymona Kinneberg, BJC, Inc.
Jim Carper, OHFLAC
Steve Wiseman, WV DD Council
Jim Thomas, Jackson & Kelly
Martha Morris, WV Consumer Advocate’s office
Chuck Johnson, Dinsmore & Shohl
Crystal Rader
By Phone:
Marilyn White, Health Care Authority
Jeff Pritchard, United Summit Center
Kathy Columbia, Board of Child Care
Eric Sams, Worthington Center
Nancy Vest, WVUH
Angela Slagger, WVUH
David Jarrett, CAMC
Sue Hage, DHHR
Rich Kylie, Community Health
Brad Shaw, Hillcrest in Wheeling
Ms. Marianne Kapinos: Our format to date has been to have the Certificate of Need division explain basically our current standards for Behavioral Health Services, and then we open it up to the people who are in attendance, not only in person but on the phone. And obviously, the purpose of the meeting is to determine people’s views on whether or not Behavioral Health Services should continue to remain subject to Certificate of Need review.
But, at first, if--Tim, would you just give us a brief overview of the current standards?
Mr. Tim Adkins: Sure. This is Tim Adkins. The Behavioral Health and Developmental Disability services, these standards address mental illness, alcoholism, substance abuse and developmental disabilities in children and adults. The standards do not address in-patient psychiatric services or ICFMR groups.
The standards are divided into five sections: children under 18, behavioral health service--this includes mental illness, emotional behavioral problems and also alcohol substance abuse--adult behavioral health service, adult substance abuse, senior Behavioral Health Services, seniors being 65 and over; and also developmental disabilities.
You have the standards in your hand, and they are quite lengthy, and each of the five groups have different--a different need methodology. And I’ll just real briefly go through some of those aspects.
Children in their adolescence their need methodology is based on care upon an estimate that 12 percents of youth under 18 will experience a mental health or addiction disorder, and the need methodology--also, applicant must demonstrate that an unmet need based upon that--the 12 percent factor.
I also say that, for children and adolescents, most of these services are eligible to go through the summary review process. And for this particular one, Sue Hage is the primary contact person with these services.
Adult Behavioral Health Services deals with the methodology with functional limitations based on prevalence of 10.6 percent OBHS. The Office of Behavioral Health Service estimates that 2.6 of this group will seek help. Alcohol and adult alcohol and substance abuse, this need methodology is based upon the estimate that 10 percent of the adult population has chemical dependency problems. Of that group, 12 percent will seek help. These services include low-intensity outpatient services, day treatment, long-term residential rehabilitation services and medically managed detox services.
Mental health services for the elderly is based upon the estimate that 25 percent of the elderly population may at some time need mental health services. Services may include residential, community-based and family support and education.
For the developmental disabilities there is the--the need methodology is based that of the population will have developmental disabilities. Here again, like Children's Services, the majority of developmental disability services, especially dealing with MRDD waiver services, are eligible to participate in the summary review process. And the director--or the contact person there is Pat Winston.
All the other aspects of the application dealing with quality, cost, financial feasibility, also dealing with that the project will not seriously impact other providers.
That’s all.
Ms. Marianne Kapinos: We also have a couple of other handouts, if you can just tell us what those are.
Mr. Tim Adkins: Okay. The first handout is your map, and these--the map reflects the number of behavioral health facilities by county. And this was taken off of the OHFLAC website. Now this does--this may include--of course, this will include satellite offices and any place where there’s a behavioral health facility. And the last page--the last handout is a list of behavioral health facilities that are licensed through OHFLAC, and it was taken off of the website.
Ms. Marianne Kapinos: Thanks, Tim. These are also posted on the website--.
Mr. Tim Adkins: --On the website--.
Ms. Marianne Kapinos: --For those of you who are not here in person. I know we’ve had one person join us in person since we started, and that’s Chuck John Russellson. I’ll introduce you. You’re Chuck John Russellson with Dinsmore & Shohl.
And I’ve heard--are there any other people on the phone now? I thought I heard a couple new beeps.
It occurred to me while Tim was giving his overview that--I mean, we’ve had a number of these meetings, and I tend to forget. I mean--and a lot of the people that have attended one meeting have attended all of these meetings. But, there are awful lot of new faces here today, so I thought I should go back and explain why we are doing this.
We have been involved with a review of all the services that are currently under Certificate of Need review at the request of the legislature. There’s been actually a special subcommittee formed to study Certificate of Need. And one of the things that they are doing through the committee is looking at the list of services that we currently review and asking us to review them as well and to make recommendations as to which, if any, services should have Certificate of Need.
So, as a result of that, we’ve had pretty much a meeting on every service that we look at. But, I don’t know how many we’ve had so far, and we have a few more scheduled. But, obviously, this is one for behavioral health. And as I say, there are number of you that I don’t work with on a day-to-day basis, so you forgive if I’m not familiar with your names.
But, what we’ve been doing, the process has been, who we currently are, the history of why we’re here, and then throw it open for participation by the group to get your feedback on what you think about Certificate of Need review for this particular service.
Actually, I can just--and anybody that is--anybody’s that speaking, I would appreciate if--these meetings are being transcribed and they’re being--because they’re being recorded, and so it’s very difficult lots of times to [unintelligible], so the phone doesn’t always pick up your voice if you’re sitting over on the cheap seats.
So, actually, I can always depend on Phil Wright. He always has an opinion.
Mr. Phil Wright: Yeah--.
Ms. Marianne Kapinos: --I’ll start with you.
Mr. Phil Wright: Okay. Well, from the studies you’re using, [unintelligible].
Ms. Marianne Kapinos: Sort of the standards?
Mr. Phil Wright: Sort of the standards.
Ms. Marianne Kapinos: Yeah. They--.
Mr. Phil Wright: --You know, have they been updated?
Unidentified Man: Not since ’95.
Ms. Marianne Kapinos: The standards have not been. I don’t know about the studies.
Mr. Phil Wright: Or the studies. I mean, [unintelligible]--.
Ms. Marianne Kapinos: --The standards have not, no.
Mr. Phil Wright: Okay. What is the actual usage? Do you have--[unintelligible] children? I’m looking at the methodology for children and adolescence. It says you have records for 17,000 receiving publicly funded mental health services and addition services. But, what is it today currently in ’07, or do you have data ’06, wherever that data is?
Ms. Marianne Kapinos: Now, I have someone here that can offer me some assistance.
Ms. Raymona Kinneberg: Just in regard to Children's Services--.
Ms. Marianne Kapinos: --Would you identify yourself--?
Ms. Raymona Kinneberg: --This is Raymona Kinneberg. In regard to Children's Services, there’s very few applications for Certificate of Need for Children's Services anymore, because there was a law passed on subsequent to those standards which allows a waiver process for services to children, and that’s the normal route that people take. So, those standards are not as applicable as they used to be. That doesn’t mean they shouldn’t be updated. In point of fact, people do not go through CON for Children's Services. You go through a waiver--.
Unidentified Man: [--Unintelligible--.]
Unidentified Man: --Another. That’s one.
Mr. Tim Adkins: Summary [unintelligible]--MRDD [unintelligible] disables the same.
Ms. Marianne Kapinos: Parts of it.
Mr. Tim Adkins: Parts of it, it's eligible for summary review. But--.
Unidentified Man: --It just seems like there's a lot of--.
Unidentified Man: --[Unintelligible] have to just do a survey of utilization and find out.
Ms. Marianne Kapinos: Can you--?
Unidentified Man: [--Unintelligible--.]
Ms. Marianne Kapinos: --Just be sure you say who you are before you speak?
Unidentified Man: Sorry.
Ms. Marianne Kapinos: That’s okay. That doesn’t mean those standards are [unintelligible] date. But, in terms of the Children’s Services and a big portion of the MRDD services, their waiver process is in place for [unintelligible].
Mr. Phil Wright: --But, do you know how much 2007 [unintelligible]--?
Ms. Marianne Kapinos: --Is there somebody from the department that could--?
Mr. Phil Wright: --Do you collect that data--?
Ms. Marianne Kapinos: --Answer that? But, this agency does not.
Unidentified Man: But, is that an original application processes[unintelligible] time consuming and [unintelligible] the process [unintelligible]?
Ms. Marianne Kapinos: The buzzing has started again. Thank you.
Ms. Raymona Kinneberg: The department does--this is Raymona. The department does have some information on utilization in terms of [inaudible] MRDD and behavioral health community. Any of that information has been for the department. You have some on behavioral health [unintelligible] financial--.
Ms. Marianne Kapinos: --Right--.
Mr. Tim Adkins: --It's more financial.
Unidentified Man: The problem is breaking it down [unintelligible] methodology is different from the way they keep their data, so you just have to break the data down a little bit. That’s all.
Ms. Marianne Kapinos: Anybody here’s going to defend the current need methodology, given how old it is?
Ms. Raymona Kinneberg: No. They're [unintelligible] need of updating.
Unidentified Man: In need of updating.
Ms. Raymona Kinneberg: Even when they were adopted.
Ms. Marianne Kapinos: Well, there’s that as well.
Mr. Rich Kylie: This is Rich Kylie. The September 6th, 2006 memo that came out that clarified the six points that need to met in order for a need methodology, in order for CON to basically meet that criteria is still based on 49-730 of the West Virginia code. And so, you already have the standards. They’ve been looked at as recently as 2006 to allow for those to come in in order to reduce the outplacement of kids from the state. The volume of those kids that are still out of state are partly what was determining some of that need at one point.
Mr. Tim Adkins: That’s the summary of review process, right?
Ms. Marianne Kapinos: Right.
Mr. Rich Kylie: Right.
Mr. Russell Sickles: And can I ask a real basic question? Do--?
Ms. Marianne Kapinos: --Could you identify yourself?
Mr. Russell Sickles: My name’s Russell Sickles from Job Squad, Inc.
Ms. Marianne Kapinos: --Thank you--.
Mr. Russell Sickles: --Job Squad, a waiver provider. What is the rational for a Certificate of Need? Seems like a lot of the--and this is really based--you know, the life [unintelligible]. The, you know, standards to be met through other means. Seems to me Certificate of Need is really [unintelligible] choice and affecting in terms of that [unintelligible] interest, I guess.
And I’m really seeing a lot of families and individuals who don’t have tons of choice among services. And [unintelligible] the CON is a huge bearing to offering--to developing an array of choices. I’m not--does anybody know how many new providers have, you know, kind of a yearly [unintelligible] of new providers? It seems like that’s not happening very much. And I guess what’s the rational for the CON? Why’s it even--isn't there a--?
Ms. Marianne Kapinos: --Since our chairperson just arrived, I’m going to allow her to answer that.
Ms. Sonia Chambers: The--well--Certificate of Need, in general, I think, is designed to address many of the difficulties in healthcare economics. The economics of healthcare do not behave the same way that they do for--in manufacturing or a lot of other sectors. In healthcare instead of--I guess, [unintelligible]. Sorry, I’ve been in too many meetings on different topics today. Instead of the--if--with there being more providers [unintelligible] down, in healthcare it seems there are more providers [unintelligible] goes up.
And there are a number of, I think, reasons for that. I think that we often see if there are more imaging centers or providers of a certain service, instead of the same number [unintelligible] doing the same scans only for different entities, we see a much greater number of scans given or Behavioral Health Services rendered.
In particular with behavioral health, the state views a number of advocates and legislators greatly expanded the number of services that were eligible for Medicaid reimbursement. And after that [unintelligible], the amount of the Medicaid budget devoted to those services went up exponentially. You saw a great--a much greater number of providers, and the total budget associated with behavioral health went though the ceiling.
The legislature and other policy makers decided that one of the ways to rank was to have Certificate of Need for Behavioral Health Services. And I understand that there is a tension between choice and [unintelligible] behind Certificate of Need.
Unidentified Man: I guess when behavioral health--people have budgets, and it doesn’t matter if there’s one provider or 20, that--there’s not going to be more money spent, see?
Ms. Sonia Chambers: But, that’s not true in the Medicaid program. Medicaid is an entitlement. And if it is provided--if it is determined that it’s a Medicaid eligible service, then Medicaid gets billed for it.
Unidentified Man: But there--.
Unidentified Man: [--Unintelligible.]
Ms. Sheila Kelly: This is Sheila Kelly. I think one of the problems that [unintelligible] may be having is that, whenever programs are one small piece of what is encompassed by the program description of behavioral health, waiver, yes, there's a finite number of clients, they've submitted [unintelligible] budgets, and therefore there’s only X number of dollars to be spent, although, within those X number of dollars, there’s considerable range, depending on what the provider can work out.
In the remainder of Behavioral Health Services, particularly in Behavioral Health Services that involve beds, children’s behavioral--children’s residential programs or not so much substance abuse, because nobody can make money in substance abuse [unintelligible] in other kinds of programs there’s a lot more applicability to the CON standards for some of those programs.
Unidentified Man: So, maybe for the waiver--for the home and community-based waiver, I imagine those costs [unintelligible] services, what I’m seeing that those costs, you know, a person has a budget--.
Ms. Shelia Kelly: --Yeah--.
Unidentified Man: --And--and the way [unintelligible], because people may not have been getting those services.
Ms. Sheila Kelly: But, they--this is Sheila Kelly again. The [unintelligible] much more than just providers. It also looks at the financial viability of providers, because we’ve had situations where people have come in to the provider marketplace and failed miserably, leaving clients stranded and floundering. So, there’s a quality control issue. There’s a “Are you fit to survive" issue. There’s other issues that we looked at other than finite number of dollars with finite numbers of [inaudible].
Ms. Raymona Kinneberg: And this is Raymona Kinneberg. There’s another issue with relation to the waiver program, and it’s one of the one’s that’s exempted out of CON. And all the--what the authority does there is to provide a mechanism for the department to provide assistance, and we can--what to approve within our [unintelligible] health plans, [unintelligible] got available, and then the healthcare authority determines it’s not reviewable based on the department recommendation. So, the waiver program is actually a slightly different process than the rest of the behavioral health applications.
Mr. John Russell: Let me jump in, too. This is John Russell. Just to add that the growth in the waiver program expenditures are--in our estimation, [unintelligible] number of approved slots, which now are near 4,000 people, whereas just a few years ago it was 2,800 people. So, the average cost per recipient isn’t necessarily increasing the number of recipients overall who are in that budget line in the Medicaid budget.
Ms. Marianne Kapinos: [Unintelligible.] That doesn’t mean that your [unintelligible]. It fits the purpose and should we have it for Behavioral Health Services is the question, but it really is a little different for the waiver programs, at least from the rest of the programs.
Unidentified Man: And I think--I mean, [unintelligible] quality. I think that’s another--I’ve seen that hinder quality as opposed to support quality. And so, I wonder, in the [unintelligible] cost, I mean, there are states I’m sure that don’t have CONs. And has there been a comparable study about quality and cost that we can refer to? Anybody know?
Mr. John Russell: [Unintelligible] John Russell, again. David Braticks [sp] does a very good study analyzing and comparing data. We had the recent report [unintelligible]. It’s a very reliable report [unintelligible].
Ms. Sonia Chambers: John Russell, do you have access to that? Do you have it--?
Mr. John Russell: --[Unintelligible], I think.
Ms. Sonia Chambers: That’d be great. If you could, we’d be happy to have that.
Mr. John Russell: Sure.
Ms. Marianne Kapinos: I had just started with Phil Wright, because I knew he always has something to say. And then we--and you said--.
Unidentified Man: Just my last comment on that. It seems like I’m seeing a need for more smaller providers, smaller providers who can give individualized focus to individuals, and I think the current system [unintelligible] setup really hinders that.
Ms. Marianne Kapinos: And you did not give us opinion as to whether you thought it should continue to be reviewable.
Unidentified Man: Well, I’m not giving an opinion.
Unidentified Man: Not yet.
Ms. Tina Maher: I have just a question. This is Tina Maher, Olmstead Coordinator for DHHR. It’s kind of question of are the standards going to be cleaned up any, kind of get rid of some of the stuff that doesn’t--like, I’m looking on page 27 where it talks about the closure of Collin Anderson Center. That’s done, gone, probably get rid of that. I’m looking at where it says approximately 280 persons with developmental disabilities live in state and private nursing facilities. Right now it’s about 570 to 600. The minimum dataset that all nursing homes complete give that estimate on a quarterly basis, so that’d be an easy number to find.
Ms. Sonia Chambers: We have--this is Sonia Chambers. We have been waiting for the outcome of the adolescent behavioral health plan for the state before we update the standards.
Ms. Sonia Chambers: So, we have recognized for some time that those standards needed to be updated, and we had [unintelligible] time requested [unintelligible] input into how they ought to be updated and have been waiting for a--you know, the task force and the plan so that we can go back in and redo the standards.
What--at this point, because the legislature is looking at this whole issue, I think it makes sense to get through the legislative session to see what the position of the standard--the statute is, and, hopefully we’ll then have some recommendations from the--what's--see the name, exactly--The Comprehensive Behavioral Health Commission. We will have comprehensive recommendations from The Comprehensive Behavioral Health Commission, and [unintelligible] convene a task force to look at updating--.
Ms. Tina Maher: --Okay--.
Ms. Sonia Chambers: --These standards, among others.
Ms. Tina Maher: Okay. And then, the last thing I have on that is, on page 30, the definition of institution. I know most people [unintelligible] large congregate facility as an institution, but CMS actually defines it as four or more people, unrelated, living together. You can’t have less than four in an [unintelligible] facility, and that’s the definition they use.
Ms. Sonia Chambers: I’m sure that we will want you to participate [unintelligible].
Ms. Tina Maher: Yeah, we will [unintelligible].
Ms. Sonia Chambers: Yeah. We have--we know that they need to be updated--.
Ms. Tina Maher: --Okay.
Unidentified Man: [Unintelligible] reflect the current standard, and we are in favor of maintaining the standards. If there is an opportunity to adjust the standard, [unintelligible] had suggested we would [unintelligible] participate in that process. So, [unintelligible].
Ms. Sonia Chambers: If you’re in favor of--even though facilities are [unintelligible].
Unidentified Man: [Unintelligible] our operations are exempt. Not all of our members are comprehensive [unintelligible].
Ms. Sonia Chambers: Would your centers support being completely subject to it and not exempt?
Mr. Rich Kylie: No, the centers would not, based on the requirements of the Hartley requirement that came down that is still in place and will have to be acted on. And part of that was reviewed. And if you take a look at it, that was a 1997 WV 5953HXC, the CON determination that was made based on core services. This is Rich Kylie. I’m sorry.
The other thing that comes along with that is there’s some other contingencies that have occurred since then and since the beginning of this stuff. One is the ASO organization coming in and screening those things to reduce those kind of costs that are extraneous that were there and reviewing it.
The other is that the majority of the services provided by behavioral health centers directly are not cost-based. They’re fee-for-service based, so there’s a cost containment in there by itself, because the proliferation of agencies, there was a concern in the beginning, more so than the cost, in terms of raising rates by virtue of charging more for services because it seems to be a fixed fee for service that we’re receiving.
Ms. Sonia Chambers: John Russell, do you want to add anything else?
Mr. John Russell: No, nothing at this point.
Ms. Sonia Chambers: Okay. I’m sure you have an opinion.
Unidentified Man: [Unintelligible.]
Ms. Sonia Chambers: Go ahead, Steve.
Mr. Steve Wiseman: Yeah. Steve Wiseman of the WV DD Council. I appreciate that--I know that the [unintelligible] is going to be updated [unintelligible].
Ms. Sonia Chambers: Can everybody on the phone hear Steve?
Unidentified Man: Not well.
Ms. Sonia Chambers: Can you--would you step up to the microphone? Yeah, because Steve's way over here.
Mr. Steve Wiseman: Thank you. Steve Wiseman with WV Disabilities Council. No, I don’t have a lot to say, except I think the points were well made.
I think that Russell Sickles made a good observation, that the concern about any undue burden on small, maybe sometimes more nimble, providers being able to get on board, the [unintelligible] Rich Kylie was talking about with regards to fee-for-service, at least at this point, and other kinds of strategies that are getting brought in right now for individual budgeting that is also cost containing
So, I think there’s some [unintelligible] wasn't necessarily all in place [unintelligible]. I think that they [unintelligible] John Russell [unintelligible] still viable, and, for the most part, I like them myself, maybe because I [unintelligible]. But, that probably doesn’t have anything to do with the development [unintelligible] part of it.
But, I think that at least we can [unintelligible] and get them more timely. I also would think, which I did back then, and that was the exempt service [unintelligible] that are not facility based and not services [unintelligible] setting and community based [unintelligible] development of community-based [unintelligible] facility based.
Ms. Sonia Chambers: Okay.
Unidentified Man: Just kind of a [unintelligible] do you think the [unintelligible] judgment thing that was addressed earlier. I have a question. Really, if you redo the [unintelligible], these standards apply really to behavioral health facilities and the outpatient services. Some of the trends we’re seeing in [unintelligible] hospital [unintelligible] to take [unintelligible] large part. And I don’t think there’s a need to adjust the way we [unintelligible], but you might want to be careful when you do those [unintelligible]. But, the way the [unintelligible] system of care was originated, it [unintelligible] different [unintelligible], and I don’t know if that’s changed since then.
Ms. Sonia Chambers: [Unintelligible] on this side of the room?
Ms. Sonia Chambers: We've got a number of people [unintelligible].
Ms. Sonia Chambers: Okay. Okay. How about anybody on the phone?
Unidentified Man: No.
Mr. Rich Kylie: I don’t know about anybody else, but this sounds like the World War II paratroopers all hitting their crickets at the same time on this end.
Ms. Sonia Chambers: I wasn’t sure how to describe it, but that’s--.
Mr. Rich Kylie: --Best I can do.
Ms. Sonia Chambers: Okay.
Ms. Sonia Chambers: I think someone’s laid their phone down and left.
Ms. Sonia Chambers: Or they don’t hear [unintelligible]. Anybody else on the phone like to [unintelligible]?
Mr. Brad Shaw: This is Brad Shaw. I’m calling from Hillcrest in Wheeling. And I have a quick question on the waiver program. And we have a project we’re going to get started here, building a 36-bed child-adolescent psychiatric unit. And was wondering what the process would be to see if that project would qualify for the waiver program.
Ms. Sonia Chambers: I think to answer--I think everybody’s unofficial opinion was, "I don’t think so."
Mr. Brad Shaw: I’m sorry, say that again?
Ms. Sonia Chambers: Well--.
Ms. Sonia Chambers: --You have to put something in writing and in a letter specifying about what you would like to do.
Mr. Brad Shaw: And who do we send that to?
Ms. Sonia Chambers: Dayle Stepp.
Mr. Brad Shaw: Dayle Stepp, okay. And ask him if it would qualify for that waiver program?
Ms. Sonia Chambers: Are you talking about the summary review--?
Unidentified Man: --Yeah, for Children's Services--.
Ms. Sonia Chambers: --For Children's Services?
Mr. Brad Shaw: Yeah. Yeah, the waiver program for Children's Services. Yeah.
Ms. Sonia Chambers: Okay. I think--.
Ms. Sonia Chambers: I don’t think it would, but just ask questions.
Mr. Brad Shaw: Okay--.
Ms. Sonia Chambers: --You’re also welcome to call the CON division and to talk with them about that before you send the letter.
Mr. Brad Shaw: Call--I’m sorry, you broke up there. Call who?
Ms. Sonia Chambers: You can call and talk to Tim Adkins about it.
Mr. Brad Shaw: Tim Adkins?
Ms. Sonia Chambers: Yeah. His name is Tim Adkins, and he’s an analyst in our Certificate of Need division.
Mr. Brad Shaw: Okay. What’s his number?
Ms. Sonia Chambers: 558-7000
Mr. Brad Shaw: Okay. I’ll try that. Thank you very much.
Ms. Sonia Chambers: Anybody else on the phone?
Unidentified Man: See if Sue Hage is on there?
Ms. Sonia Chambers: Sue, are you on the phone?
Ms. Sue Hage: Yes, I am. And I think it’s my phone that’s making all the noise. Not the clicking noise, but the other first noise.
Ms. Sonia Chambers: All right. Anybody else who’s on the phone want to make any comments?
Ms. Sonia Chambers: We will accept written comments. We will accept those up till 30 days from today, and you can mail those to the Healthcare Authority, 100 Dee drive, Charleston, West Virginia 25311, or you can e-mail, or fax. And put those to Dayle Stepp’s attention, please.
All right. Any other comments?
Mr. Rich Kylie: This is Rich Kylie, again. Thanks for letting us participate.
Ms. Sonia Chambers: You are more than welcome. Happy to have you.
Unidentified Man: May I [unintelligible] with the matter of counting how many support [unintelligible]?
Ms. Sonia Chambers: No. I think the process is that, you know, the legislature has been looking at Certificate of Need generally, and then has asked the agency to give recommendations to the legislature about which services ought to remain reviewable or not. If you made any recommendations, we wanted to hear from people involved, what they thought. And I think we will, obviously, take the results of these meetings, discuss it amongst ourselves, discuss it with the department and provide some recommendations to the legislature. As you well know, the legislature will do with that recommendation as they wish.
Unidentified Man: So, the waiver, is there any effort to reach out to families at all, or I guess it was just an invite [unintelligible] they would come here, maybe? I don’t know if there’s any--are there any family members of people who are actually utilizing? We all seem to be providing, but I don’t know if there’s anybody on the receiving end of services. I mean, that’s an important perspective that--I don't know if there’s any effort to reach out to [unintelligible] planning process [unintelligible], is that correct?
Ms. Shelia Kelly: Yes. This is Shelia Kelly. With the Comprehensive Behavioral Health Commission, there were consumer representatives on the working subcommittees. There’s a consumer representative on the actual commission or on the Advisory Board. I don’t remember which.
Again, the Comprehensive Behavioral Health Commission focused pretty much exclusively on mental health and substance abuse issues, because the Developmental Disabilities community basically asked it to be--asked to be opted out of that process. When it was appropriate, we tried to include DD advocates and consumers in that process. But, generally speaking, it was a mental health substance--or it is a mental health substance abuse kind of process.
Mr. Rich Kylie: This is Rich Kylie again. You also have APS quality councils that are available if they want to do some more outreach to those groups to find out what their interests are. That includes the DD, SA, NMI.
Ms. Sonia Chambers: Great. Thank you for that suggestion.
Ms. Sue Hage: And this is Sue Hage. And the children side, through the system of care, we have the FAS, which is the Family Advocate and Support process. And we’re developing parent coordinators to work closely with families and--in an attempt to get them involved and to get their concerns, what they see is working and not working.
Ms. Sonia Chambers: All right. Well, if there’s nothing else for the meeting today, I appreciate everybody’s time and effort. Thank you very much.