HomeMy WebLinkAboutNovember_5_2013_Regular_MinutesIREDELL COUNTY BOARD OF COMMISSIONERS
REGULAR MINUTES
NOVEMBER 5. 2013
The Iredell County Board of Commissioners met on Tuesday, November 5, 2013, at 7:00
PM, in the Iredell County Government Center (Commissioners' Meeting Room), 200 South
Center Street, Statesville, NC.
Board Members Present
Chairman Steve Johnson
Vice Chairman Marvin Norman
David Boone
Renee Griffith
Ken Robertson
Staff present: County Manager Ron Smith, County Attorney Bill Pope, Finance Director
Susan G. Robertson, Planning Director Matthew Todd, Health Director Jane Murray, Executive
Assistant Retha Gaither, and Clerk to the Board Jean Moore.
CALL TO ORDER by Chairman Johnson
INVOCATION by Chairman Johnson
PLEDGE OF ALLEGIANCE
ADJUSTMENTS OF THE AGENDA: OTIO by Chairman Johnson to approve
the agenda as presented.
VOTING: Ayes — 5; Nays — 0.
APPOINTMENT BEFORE THE BOARD
Mr. David Swann Provides a Partners Behavioral Health Management Update and
Requests Approval of a Local Business Plan: Chief Clinical Officer Swann provided a brief
history on how local management entity business plans had evolved through the years. He said
that in 2001, legislation was passed requiring mental health programs to convert to managed-care
organizations and boards of commissioners were charged with approving the local business
plans. Swann said the first one occurred in 2004 followed by another in 2007. He said that in
2010 mental health entities were not required to draft plans due to new merger requirements.
Swann said that for 2013, the North Carolina Secretary for Health and Human Services was
requiring only limited information in the plan. He then summarized the plan as follows:
OVERVIEW
Per N.C. General Statute §122C-115.2, each Local Management Entity -Managed Care
Organization (LME -MCO) is required to provide detailed information about how it will meet
State standards, laws and rules for ensuring quality mental health, intellectual developmental
disabilities, and substance abuse services and outcome measures for evaluating program
effectiveness. Partners Behavioral Health Management's (Partners BHM) Local Business Plan
(LBP) will address key statewide and local initiatives.
The NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services
(DMUIDD/SAS) has developed and expressed commitment to the following statewide initiatives
that are addressed in this LBP:
A. Transition to Community Living
A Crisis Service Enhancement
C. Assertive Community Treatment Team ACTT/Supported Employment
D. Closer to Home Psychiatric Residential Treatment Facility (PRTF)
E. The Intellectual Developmental Disability (IDD) Waitlist
This LBP also includes Partners BHM's four local initiatives to improve or enhance the NC
Department of Health and Human Services (DHHS) performance indicators, needs/gaps, and/or
address any collaborative community planning process.
1
STATEWIDE INITIATIVES
A. Statewide Initiative: Transition to Community Living ITCL)
Issue: Ensuring consumers are transitioned safely and effectively into independent living in the
communityfrom an assisted living facility or long term psychiatric hospitalization.
Reason forAction: The Department of Justice (DO.I) settlement with the State of North Carolina
requires that Partners BHM transition consumers into independent living in the community after
being identified from one of the following ways:
1. Residing in Adult Care Home,
2. Pre Admission Screening and Resident Review PASARR process for diversion, or
3. State psychiatric hospitalization with unstable housing.
Measurable Goal(s) please specify if these are short term (< lyr.) or long term (> lyr.):
1. At least three consumers will be in the "Transitions/Request for Proposal to Move into
Housing" per month for FY 2013-2104. (Short term.)
2. In -Reach will be provided for at least 35% (231) of the 660 individuals in Priority 2
Population. (Long term)
3. Ensure that 90% of TCL consumers living in independent housing have been referred and
connected to appropriate community based services (i.e., ACTT, SE, CST) (Long term.)
Partners BHM's plan for addressing the initiative and achieving goals:
Partners BHM will:
L Reconcile the In -Reach list to determine consumer status.
2. Track all referrals to community based services.
3. Utilize a standardized and documented process that ensures all consumers' needs are
addressed, services and supports in place, prior to moving into independent living in
community.
4. Review all potential TCL consumers with medical director or designee.
5. Participate in the TCLIDOJ Forum to standardize processes.
B. Statewide Initiative: Crisis Services/ED Wait Times
Issue. Over -utilization of hospital Emergency Departments (ED) results in higher rates of
admission to inpatient psychiatric units.
Reason for Action: Several of the Partners BHM counties have historically higher rates of ED
use by persons with behavioral health needs compared to peers, as shown through the NC
DETECT report. Our eight -county area has a large number of inpatient psychiatric beds (237
community psychiatric hospital beds of the 1,788 statewide, more than 13016). Analysis has
shown many consumers use EDs for perceived ease of access and because they are not fully
aware of community based behavioral health services.
Measurable Goal(s) please speck if these are short term (< lyr.) or long term (> lyr.):
1. Use of Walk-in Crisis services will be increased by 20% during the calendar year over
the baseline period. (Short term.)
2. Successfully conduct Crisis Intervention Training (CIT) for law enforcement officers and
emergency personnel, certifying at least 50 individuals across the eight -county catchment
area. (Short term)
3. Delivery of Mobile Crisis services will be conducted in the community at least 51 % of the
time, instead of the ED. This goal will be measured on a monthly basis. (Long term.)
Partners BHM's plan for addressing issue and achieving goals:
L Develop and initiate a community awareness campaign to providers, stakeholders,
enrollees and the community at large identifying the non -emergency room options for
crisis management.
2. Customer Services staff will be trained on an ongoing basis to appropriately advise each
caller of the range of service options to match the consumer's level of clinical acuity.
3. Continue to build additional access to care through existing Walk-in Crisis Services in
all eight counties.
4. Utilize the Memphis Crisis Intervention Training (CIT) curriculum, a 40 -hour, one-week
course as a law-enforcement agency training tool. Establish performance-based
contracting with Mobile Crisis Management (MCMV providers to incentivize services
being provided in the community rather than in EDs.
5. Educate local hospital EDs of Partners BHM's expectations of community-based delivery
ofMCMservices.
6. Track all MCM responses and provide data analysis and reporting to workgroup of MCO
& MCMProviders to monitor gains.
C. Statewide Initiative: ACTT/Suonorted Emplovment
Issue: Need for ACTT and Supported Employment providers to demonstrate growth oriented
outcomes with consumers, (i. e., focus on community integration, transition and recovery).
Current ACTT research indicates that the focus is more on decreasing hospital length of stay
versus the number of visits. ACTT providers are expected to be the first line, if not sole,
provider of all the services needed. This will assure that consumers in crisis will be served
without additional visits to Emergency Departments and thus without additional costs to
Medicaid
Reason for Action: As a result of the DOJ settlement, the State of North Carolina determined
that the ACTT and Supported Employment service definitions needed to be modified and
represent the necessary supports for consumers moving into independent living in the
community. There is a need for enhanced quality providers, thus Tool for Measurement ofACT
(I'MACT), and a need for Supported Employment to be funded by Medicaid.
Measurable Goal(s) please sped if these are short term (< lyr.) or long term (> lyr.):
1. Maintain two Supported Employment Providers. (Long term)
2. Refer at least 10% of consumers involved with TCL/DOJ housing for Supported
Employment. (Long term)
3. Refer at least 5% of consumers initially identified for TCL/DOJ, but were successfully
diverted, for Supported Employment. (Long term.)
Partners BHMplan for addressing Issue and achieving goals:
1. Careful monitoring for medical necessity and adherence to service definitions.
2. Educate consumers in TCL on the benefits of Supported Employment.
3. Develop and implement provider training through multiple LME -MCO departments
(Provider Network, UM, Medical Director, Quality Management, Care Coordination,
System of Care).
D. Statewide Initiative: Closer to Home - PRTF
Issue: Ensure PRTF providers are outcome driven and family focused, including as
geographically optimal as feasible.
Reasons for Action: Historically, consumers from the Partners BHM catchment area have been
referred to PRTFs throughout North Carolina and several programs out of state. Partners BHM
has reviewed and is closely monitoring all PRTF providers within the network Partners BHM's
focus has been on: reducing the number of children placed in PRTF who did not meet medical
necessity; reducing the length of stay; and ensuring that consumers are placed, when possible,
within close proximity to their home. A caveat to out of state PRTF placements is that South
Carolina facilities are closer than several North Carolina facilities for some Partners BHM
enrollees, therefore making these facilities more conducive to family visits and family therapy.
Measurable Goal(s) please specify if these are short term (< lyr.) or long term (> lyr.):
1. 100% of PRTF providers in the Partners Behavioral Health Management network will be
outcome driven and family focused. (Long term)
2. 95% of PRTF placements will consider proximity to the consumer's family and natural
support system. (Long term.)
3. 100% of PRTF Initial Service Authorization Requests will be reviewed by the medical
director or designee. (Short term.)
W
Partners BHM's plan for addressing issue and achieving goals:
1. Continue to develop and offer training on the continuum of care, facilitated by multiple
departments within Partners BHM (Provider Network Utilization Management, Medical
Director, Quality Management, Care Coordination).
2. Close monitoring of provider outcomes:
• Use of therapeutic treatment interventions;
• Ensuring discharge/step down plans, and;
• Increase offamily engagement with treatment within the home community.
3. Modify number of PRTF providers to better reflect the needs of our network
4. Facilitate care reviews prior to PRTF placement to ensure community resources are
considered prior to placing a child outside of their home community.
5. Increase peer reviews and decrease the length of authorization periods.
6. Improve requirements for assessment forms and required documentation.
7. Increase review of current medications and medication changes by increasing
engagement of PRTF Medical Directors.
8. Assign Care Coordination staff to each PRTFfacility to participate in Child/Family
Team Meetings and assist with bringing consumers closer to home.
E. Statewide Initiative: Intellectual/Developmental Disabilities Waitlist
Issue. Ensure the accuracy of the Registry of Unmet Needs.
Reasons for Action: Three legacy LMEs (Crossroads, Mental Health Partners and Pathways)
merged in July 2012, resulting in approximately 1,100 individuals on the resulting Registry of
Unmet Needs. The process for screening and referral varied across the three legacy LMEs.
Measurable Goal(s) please sped if these are short term (< lyr.) or long term (> lyr.):
Validate the number of individuals on the Registry of Unmet Needs by October 1, 2014 to have
an accurate analysis of individuals for potential Innovations expansion slots. (Short term.)
Partners BHM's plan for addressing issue and achieving goals:
1. All individuals placed on the Registry of Unmet Needs prior to July 1, 2012 will be
screened for potential eligibility using a consistent tool and method.
2. Each individual will be screened using the I/DD Tracking Sheet, which includes all areas
reported on the quarterly waitlist report.
3. The individuals will have one of the following dispositions once screened: Remain on
Registry of Unmet Needs, Inactive, or Removed from Registry.
LOCAL INITIATIVES
A. Local Initiative: Providing Timely Engagement after Acute Care Services
Issue: Many consumers leaving Inpatient or Facility -Based Care (FBC) are not seen for
aftercare within seven days. This increases the risk of readmission to acute care services.
Reasons for Action: Over the past year of Community Systems Progress Reporting, Partners
BHM's data has trended downward in both "timely follow up from community hospitals" and
"timely follow up Crisis Services. " Providers report a variety of reasons why they are not able
to provide a billable service. Research suggests that recidivism rates are reduced substantially
by providing timely aftercare.
Measurable Goal(s) please sped if these are short term (< lyr.) or long term (> ]yr.):
1. By 2015, 60% of FBC and inpatient care discharges will receive a billed service by a
behavioral health provider within seven days of discharge. (Long term)
2. Providers will be contracted in each of the eight counties to provide engagement services
to consumers being discharged from completed acute care stays and will use alternative
service definitions for outreach as needed within the first 30 days. (Short term.)
Partners BHM's plan for addressing issue and achieving goals:
I. Assure that Care Coordinators are assigned and working closely with all local facilities
(Hospitals and FBC).
2. Care Coordinators will ensure referrals are made to local providers.
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3. Provider Network will recruit and contract with an adequate number of quality providers
to ensure accessibility.
4. Quality Management will ensure these codes are captured in the state reports for
services provided.
5. Providers will meet regularly with the MCO to review gains, problem solve, and
implement additional engagement strategies as needed to promote higher rates of timely
follow up.
B. Local Initiative. Assure Appropriate Use of Intensive In -Home and Therapeutic Foster
Care Services
Issue. There is a historic overutilization of Intensive In -Home (IIH) and Therapeutic Foster
Care (TFC) Services.
Reasons for Action: Prior to February 2013, children and adolescents had been receiving these
services beyond the recommended lengths of stay without concrete interventions supporting
continued stay criteria (i. e., no identified changes in consumer treatment symptoms and no
evidence of discharge planning). The purpose of this initiative is to ensure that each consumer
receives the right treatment for their symptoms, for the right amount of time, and appropriate
discharge planning is being carried out to support the consumer's success in least restrictive
services.
Measurable Goal(s) please specify if these are short term (< lyr.) or long term (> lyr.):
1. Ensure that individuals receiving Intensive In -Home and Therapeutic Foster Care
services meet medical necessity. (Short term.)
2. All Intensive In -Home and Therapeutic Foster Care providers will utilize evidenced
based practices. (Longterm.)
Partners BHM Plan for addressing issue and achieving goals:
1. Hold bi-annual collaborative meetings with local Department of Social Services and
Juvenile Justice staff.
2. Administer focus reviews of authorizations for IIH and TFC.
3. Conduct provider trainings on service definitions and medical necessity, utilizing staff in
various Partners BHM departments.
4. Improve assessment forms and required documentation.
5. Establish benchmarks that require peer reviews for Intensive In -Home and Therapeutic
Foster Care.
6. Adjust the number of IlHproviders to match our consumers' need while strengthening
clinical outcomes.
C. Local Initiative: Maintain Medical Loss Ratio
Issue: Assertive management of our medical loss ratio is imperative for our financial health and
performance as a MCO.
Reasons for Action: To be good stewards of public dollars, regular financial monitoring must
occur to ensure that capitated Medicaid funds are appropriately utilized within the catchment
area to ensure all behavioral health needs are met. Partners BHM has a historically good
penetration rate. Our objective is to maintain this rate, continually evaluate utilization and
expand services as f ending allows.
Measurable Goal(s) please specify if these are short term (< lyr.) or long term (> lyr.): To
meet a Medical Loss Ratio Percentage of 92% to 98% on a monthly basis. (Long term.)
Partners BHM's plan for addressing issue and achieving goals:
• Monitor the Medical Expense Ratio and Defensive Interval tool and evaluate the results
on a monthly basis.
• Record the results and report to DMA and DMH, as well as internal management and
our Board per NC Session Law 2013-85.
• Take appropriate action when there is a variance above or below the stated benchmark
• Convene an interdepartmental Benefit Grid Team to review and adjust the benefit grids
as needed.
• Convene the Services Gaps and Analysis Team as necessary to look at areas of
underutilization for possible service expansion.
D. Local Initiative: Same Day Access to Outpatient and Psychiatric Treatment
Issue: Inability of consumers to access same day services.
Reasons for Action: To provide quick access to service for individuals in need of behavioral or
physical health support, including initial assessment for immediate service or to facilitate
referral for individuals who are not able to be served by Integrated Health Centers (IHCs). The
primary, but not exclusive, target population will be individuals or families displaying needs
involving mental health or substance use issues. Same Day Access is a shift in practice from just
"scheduling a client" to actually delivering a service.
Measurable Goal(s) please specify if these are short term (< Iyr.) or long term (> lyr.):
Develop Integrated Health Centers (IHCs) so all consumers will have access to same day
services within 30 minutes or 30 miles of where they reside (Long term)
Partners BHM's plan for addressing issue and achieving goals:
1. Through a Request for Information processor negotiation, Partners BHM will select a
provider to operate a central facility, which is accessible and known to the community,
for each county in our catchment area.
2. The IHC will emphasize Same Day Access as an over -arching service strategy. The
services to be provided at the beginning of the IHC project will include the following:
• Same Day Access to Care Walk-in Crisis and psychiatric aftercare for adults and
children.
• On-site prescriber capability, with psychiatry services available on call or by
video.
• Appropriate levels of nursing services to support the prescriber capacity.
• Licensed Outpatient capacity to perform initial assessments, including both MH
and SA expertise.
• Qualified Professional and support capacity to facilitate referral andplacement.
• Sufficient Outpatient capacity to provide some on-going therapy for urgent or
emergent service needs for children and adults with MH and/or SA needs.
Commissioner Robertson noted the plan listed a large number of psychiatric beds;
however, the sheriffs department had mentioned the lengthy driving and wait times to transport
patients, especially to the eastern part of the state. He asked if Partners had a large number of
beds or a shortage.
Swann said there were 237 beds, and some individuals had stated that Partners was
"over -bedded." He said the bed calculation could be misleading as many hospitals had licenses
for a certain number of beds; however, these same facilities might not have enough staff to care
for the patients.
Robertson said the deputies were detained for long periods of time in the transports. He
asked how many of the 237 beds were active.
Swann said that on a regular, or daily basis, about 60 beds would have to be removed
from the total. He said many hospitals had large bed capacities but didn't utilize all of them.
Swann said also that some clients might need a hospital specializing in a certain problem, and
this could cause lengthier travel times. He said patients with mental illnesses and other
significant medical complications were hard to place.
Robertson asked if some of the goals were being created to save money.
Swann said "appropriate levels of care" were needed. He said it had been found that
some patients had been receiving services that were inappropriate to their needs. Swann said the
care was primarily managed around the needs of the person.
Robertson asked if most of the patients were Medicaid or if they had private insurance.
Swann said Medicaid was primarily the revenue source. He said the indigent population
was receiving services from State and county funds.
Robertson said the information indicated there were 1,100 people on the unmet registry
of needs.
Swann said there was a "large wall" between the registry and the medical loss ratio. He
said the services for the registry, or the wait list, were specific to intellectual and developmental
disability services. Swann said that in North Carolina, Medicaid excluded that population. He
said the State issued a number of slots, and an amount of money was averaged over the slots.
Swann said people were brought into the slots, and the medical loss ratio was determined.
Robertson asked if all of the reorganizations were completed.
Swann said no. He said that in response to a State requirement, the ten managed care
organizations in North Carolina would form three or four healthcare agencies. Swann said
Iredell would be included in an entity (35 counties) extending from Rockingham County to
Cherokee County, and it would include Forsyth County but exclude Mecklenburg. He said this
proposal would be submitted to the Governor in January.
Commissioner Griffith said it was understood that even if services could be provided for
the 1,100 people, this could not occur until the State provided 1,100 more slots.
Swann said correct.
Griffith said the ability, or the services to care for the people, existed.
Swann said, "I would say that we do not have the resources. Every one of those slots has
a range with the maximum being at $135,000. You can see what you could get into so the State
has authorized a certain number of slots in each budget. We are told how many slots we have
based on our population. We then pull people off the wait list and enroll them in the services."
OTIO by Commissioner Griffith to approve the local business plan as stipulated in
the joint resolution.
VOTING: Ayes — 5; Nays — 0.
JOINT RESOLUTION
OF
THE BOARDS OF COUNTY COMMISSIONERS
OF
BURKE, CATAWBA, CLEVELAND, GASTON, IREDELL, LINCOLN, SURRY AND
YADKIN COUNTIES
APPROVING AND ADOPTING
PARTNERS BEHAVIORAL HEALTH MANAGEMENT'S LOCAL BUSINESS PLAN
2013-2016
WHEREAS, Partners Behavioral Health Management ("Partners BHM") was
established by joint agreement between the Commissioners of Burke, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Surry and Yadkin counties on July 1, 2012, by merging the former
Mental Health Partners, Crossroads Behavioral Healthcare, and Pathways Local Management
Entity (LME) Area Authorities; and
WHEREAS, North Carolina General Statute § 122C-115.2 requires each Local
Management Entity -Managed Care Organization (LME -MCO), including Partners BHM,
periodically to provide a Local Business Plan (LBP) detailing information about how each LME -
MCO will meet State standards, laws and rules for ensuring quality mental health, intellectual
developmental disabilities, and substance abuse services and outcome measures for evaluating
program effectiveness, including state and local initiatives; and
WHEREAS, on October 17, 2013, the Board of Directors of Partners BHM thoroughly
discussed and approved the attached "Partners Behavioral Health Management Local Business
Plan 2013-2016;" and
WHEREAS, North Carolina General Statute § 122C-115.2 requires Partners BHM's
LBP be approved by the eight Boards of County Commissioners in Partners BHM's catchment
area before submitting that LBP to the Secretary of the North Carolina Department of Health and
Human Services for certification.
NOW THEREFORE, BE IT JOINTLY RESOLVED that the Boards of County
Commissioners of Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin
counties hereby approve and adopt the attached "Partners Behavioral Health Management Local
Business Plan 2013-2016," in compliance with North Carolina General Statute § 122C-115.2.
ADOPTED AND RATIFIED in eight counterparts by the Boards of County
Commissioners of Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin.
PUBLIC HEARINGS
Chairman Johnson declared the meeting to be in a public hearing.
Consideration of Proposed Text and Map Amendments to the 2030 Horizon Plan:
Planning Director Matthew Todd briefed the board about this matter, and a copy of the staff
report is as follows:
E3CNATIQNI OF THE; REQUEST
When the 2030 Horizon Plan was adopted in September 2009, procedures were set forth
for updates and amendments to be able to be made to the plan. The plan calls for
updates to take place at least every five years, or as other situations such as changes in
the economy, projected growth, and other issues may trigger an earlier update. The
plan also addresses amendments that should not take place more than once a year.
Plan amendments may be approved if the Board of Commissioners makes specific
findings that:
■ The proposed amendment is beneficial to the county or addresses issues not
foreseen during the planning process;
• The proposed amendment is compatible with the surrounding area, and the
goals and policies of this plan;
■ The proposed amendment will address and mitigate impacts on transportation,
services, and facilities;
■ The proposed amendment will have minimal effect on service provision,
including adequacy or availability of facilities and services, and is compatible
with existing and planned service provision;
• The proposed amendment is consistent with the logical expansion of the three
county growth areas;
• Strict adherence to the plan would result in a situation neither intended nor in
keeping with other goals and policies of this plan; and
• The proposed plan amendment will promote the public welfare and will be
consistent with the goals and policies of this plan.
The following update and amendment to the 2030 Horizon Plan is being presented for
review and approval. The proposed changes include updates to the information in the
plan and amendments to three of the four future land use maps.
aPDr 01
Text
Within the text of the document, many demographic numbers were used to develop
the goals and strategies of the plan. Since the adoption of the plan, many changes
have occurred in the economy, thus affecting the demographic information provided
in the document. The Planning staff has reviewed and updated the demographic
numbers to make sure that changes are addressed and growth trends are accurately
reflected within the document.
Goals
U
Since the adoption of the plan, the Planning staff has accomplished several of the
goals in the plan and is continuously working on other goals. We have developed and
maintain a tracking system to keep up with the status of the goals.
AMENDMENTS
The Planning staff has reviewed the future land use maps and has made suggestions for
amendments to four areas. Maps of these areas are included at the end of the plan.
West Memorial Highway
This section of W. Memorial Highway has some existing commercial zoning that is not
classified as commercial in the 2030 Horizon Plan. There are existing businesses located
in areas designated for residential uses. The Union Grove Fire Department owns
property just west of the intersection of W. Memorial Highway and Howards Bridge Road
and has obtained zoning permits for the fire department. Based on the factors
mentioned above, the Planning staff is recommending a Rural Commercial node at the
intersection of Howards Bridge Road and W. Memorial Highway, as well as extending
the existing Rural Commercial area to the node.
Highway 70/Salisbury Highway
The north side of the intersection of Highway 70 and Salisbury Highway is identified in
the Horizon Plan as Medium -Density Residential. However, the current zoning in this
area is M-2 (Heavy Manufacturing). A large majority of the property is already being
used for industrial purposes. The surrounding properties to the north are identified as
Employment Center-Industrial/Office/Flex in the plan (See the map titled Hwy
70/Salisbury Hwy). Therefore, the staff feels that changing the designation to
Employment Center-Industrial/Office/Flex will bring the future land use in line with the
existing zoning and uses.
Amity Hill Road
In March 2012, the Planning staff proposed a review of the area identified on the
Southern Statesville Area map as part of a rezoning request for L & M Construction. The
City of Statesville has annexed areas on the north and south side of Amity Hill Road near
the interchange. These areas are proposed for commercial uses. The City of Statesville
has expressed some concern regarding aesthetics and outside storage for this area
due to conditions placed on the commercial uses for the Larkin project. The City
requested that we consider a designation for the commercial areas that would be
consistent with the approved commercial areas in their jurisdiction. The Town of
Troutman was also consulted about this area, but had no objections to the
recommended changes. Based on the City of Statesville's comments, the Planning
staff is recommending adding a Rural Commercial designation along Amity Hill Road,
removing the Corridor Commercial along the interstate and replacing it with Medium -
Density Residential.
Southern Troutman
The Town of Troutman amended their Land Use Plan in March of 2012 by changing the
areas identified on the Southern Troutman Area map from residential to industrial. This
area is within their USA boundary. Since coordinating future land uses within the USA
boundaries has been a major part of the Horizon Plan from its inception, this change is
being proposed to make the Horizon Plan match the Town's Land Use Plan.
BOARD COMMENTS
PLANNING BOARD ACTION: On October 2, 2013, the Planning Board voted 8-0 to
recommend approval of the text and map amendments to the 2030 Horizon Plan.
Mr. Todd mentioned that much of the data used in Table 10, pertaining to employment
and wages by industry in 2006, was incorrect.
Commissioner Boone and Commissioner Robertson indicated they had both noted some
of the discrepancies in Table 10 (page 56).
Todd said the document contained about 50 action items, and a few years ago a tracking
system was created to let the public and staff members know what had been accomplished.
9
Commissioner Boone referred to GM -FLU Policy 1.3: Coordinate Infrastructure
Improvements and Extension of Extraterritorial Jurisdiction. He said the policy read as follows:
"The county will develop and adopt a common policy for extension of extraterritorial jurisdiction
(ETJ) that will require municipalities to meet specific criteria before approving requests for ETJ
expansion." Boone asked what steps had taken place regarding this item.
Todd said this was put in place within a year or two of the Land Development Code. He
said there was a specific step-by-step process that was built off this strategy.
Commissioner Boone asked if anything had occurred regarding the periodic inspection of
septic systems.
Todd said no.
Boone referred to page 70 and asked the definition for flowserve as it applied to
environmental brownfield sites.
Todd said he was unfamiliar with the term.
Boone said that under transportation, two issues were mentioned with one being to take
steps to ensure that right of ways would be available for future projects and the other was to take
steps to ensure road connectivity between adjacent subdivisions to avoid traffic congestion. He
asked if anything had occurred on these two items.
Todd said that for subdivisions, language had been added to the zoning ordinance to
encourage connectivity of new developed subdivisions.
Boone said there were numerous roads in the county that could be connected at little cost
and they would relieve traffic on the main arteries.
Todd said language had been added but with the slowdown in development not much
"had come into play yet."
Commissioner Boone noted a few errors in the plan as follows:
Paee 20: The document mentions a future interchange for Brawley School Road and
Interstate 77. This has already occurred.
Page 62: The document mentions seven historic districts in Statesville and Mooresville,
but later, the information indicates there are four districts in Statesville and one in Mooresville.
Page 72: The document indicates that Coddle Creek Elementary and Cloverleaf
Elementary Schools would be built. These two schools have already been built.
Page 73: The document indicates there are 36 schools in the Iredell-Statesville and
Mooresville Graded School Districts; however, when adding all of them up that are listed, there
are actually 37.
Mr. Todd then reviewed the proposed changes to the maps.
Ray Anderson, a property owner near the concrete plant on Highway 70, asked what
type of zoning would occur on his land.
Mr. Todd said the zoning was not going to change. He said the land use plan would
match the use of the property.
Mr. Anderson said he had received a letter stating the zoning would be changed. He said
his property was currently zoned for residential uses, but the letter indicated it would be zoned
for commercial and office use.
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Mr. Todd asked to see the letter but Mr. Anderson said he did not have it with him. Todd
again said the county was not changing the zoning. He said the land use plan indicated the area
would be industrial, employment center, and industrial flex.
Anderson asked the definition for industrial flex.
Todd said a person could request an industrial type zoning for either light or heavy
district.
No one else desired to speak, and Chairman Johnson adjourned the hearing.
OTIO by Commissioner Robertson to approve the text and map amendments to the
2030 Horizon Plan based on the findings being consistent with the 2030 Horizon Plan and to also
include the corrections submitted by Commissioner Boone.
VOTING: Ayes — 5; Nays — 0.
ADMINISTRATIVE MATTERS
Request from the Planning Department for Approval of the Plat Review Officer's
List: Planning Director Matthew Todd said that due to staffing changes, the plat review officer
list needed to be amended for Iredell County as well as for three municipalities.
OTIO by Commissioner Griffith to approve the amended plat review officer list.
VOTING: Ayes — 5; Nays — 0.
PLAT REVIEW OFFICER'S LIST
IREDELL COUNTY:
TOWN OF MOORESVILLE:
CITY OF STATESVILLE:
William Allison
Rebecca M. Harper
Matthew Todd
John Lowman
Timothy D. Brown
Craig Culbertson
Maureen Gable
David Currier
Sherry Ashley
Elaine Anthony
Erika Martin
Request from the Health Department for Approval of Additions to the Clinical
Services Fee Schedule: Health Director Jane Murray requested approval of new fees and
Current Terminology Procedure (CTP) codes. She said most of the fees were for laboratory
tests.
OTIO by Commissioner Griffith to approve the additions to the Clinical Services Fee
Schedule.
VOTING: Ayes — 5; Nays — 0.
CPT Code
Description
Fee
81003 PC
Auto U/A without micro
$5
81015 PC
Urine Micro
$10
81025 PC
Pregnancy Test
$20
82172 PC
Apolipoprotein B
$27
82651 PC
Dihydrotestosterone
$32
82785 PC
Aller IgE
$10
11
83695 PC
Lipoprotein a
$11
83701 PC
BHL, LDLGGE/HDLGGE
$37
83825 PC
Mercury Blood or Urine
$28
84156 PC
Total Protein urine
$11
84402 PC
Free Testosterone
$19
84432 PC
Thyroglobulin
$8
84540 PC
Urea Nitrogen —Urine
$10
Alrgy PC
Allergy Panel (region 2
$188
86003 PC
Allergy test single antigen
$10
86317 PC
Rabies titer
$42
86480 PC
Quantiferon TB gold
$72
86800 PC
Thyroglobulin Antibodies
$8
90686
Quadrivalent Flu Vaccine
$15
Request from the Health Department for Approval of an Addition to the
Environmental Health Fee Schedule: Health Director Jane Murray requested the addition of a
limited food service establishment (LFSE) charge to the fee schedule. She said the $75 fee had
previously been collected, but a portion was retained by the State. Mrs. Murray said the State
was now allowing the counties to retain the $75.00, and the fee needed to be added to the
schedule.
OTIO by Vice Chairman Norman to approve the addition of the LFSE fee to the
environmental health fee schedule.
VOTING: Ayes — 5; Nays — 0.
Request from the Health Department for Approval to Write -Off Uncollected Patient
Accounts in the Amount of $39,566.32: Health Director Jane Murray requested permission to
write-off $39,566.32 in uncollected accounts. She said the accounts had not experienced any
activity since June 30, 2010, and the private -pay clients were sent 30, 60, and 90 day past due
letters. Murray said the debts had been submitted to the NC Debt Setoff Program. She said the
Medicaid write-offs were primarily due to the invoicing for services that were not covered, or the
patient's benefit maximum had been reached.
Commissioner Griffith asked about the Medicaid debts. She asked if anything was being
done to better monitor what services were being covered.
Murray said the staff members could verify if a patient had Medicaid; however, they
couldn't determine if a service such as a physical had been provided. She said patients were
asked when they last had a physical exam or dental procedure, but many times the patient could
not recall the date. She acknowledged that the Medicaid debt of $19,507.02 was a concern and
indicated the staff tried "to stay on top of this."
Commissioner Boone stated that when he was on the board of health, Mrs. Griffith's
question had been asked many times.
Murray said the health department rebilled Medicaid if a denial occurred, but if the
patient was over his or her cap, or had already received the service, that Medicaid wouldn't pay
twice.
Commissioner Robertson asked what happened if a patient returned for services after his
or her unpaid debt had been sent to the debt setoff program.
Murray said that if the patient came back within two years, his or her account would
reveal the debt amount and any payment plans. She said the patient would have to pay at least
50%, and if no payment plan existed, the full charge (100%) would have to be paid.
OTIO by Commissioner Boone to approve the write-off of the uncollected accounts
in the amount of $39,566.32.
VOTING: Ayes — 5; Nays — 0.
12
Write -Off Request
SUBPROGRAM
PRIVATE
PAY
MEDICAID
TOTAL
Child Health
$373.61
$577.00
$950.61
Dental Health
$9,339.71
$1,364.00
$10,703.71
Women's Preventive Health Services
$6,492.98
$9,615.00
$16,107.98
Immunizations
594.00
$618.00
$1,212.00
Maternal Health
2,921.00
$6,570.02
$9,491.02
Miscellaneous
263.00
$225.00
$488.00
Epidemiology
75.00
$538.00
$613.00
Total
$20,059.30
$19,507.02
L
$39,566.32
Request for Approval of the October 15, 2013 Minutes: OTIO by Commissioner
Boone to approve the minutes as presented.
VOTING: Ayes - 5; Nays — 0.
ANNOUNCEMENT OF VACANCIES OCCURRING ON BOARDS & COMM]
Charlotte Regional Transportation Planning Organization (3 announcements)
APPOINTMENTS TO BOARDS AND COMMISSIONS
Personnel Advisory Committee (1 appointment): Vice Chairman Norman nominated
Robert David Bennett.
OTIO by Chairman Johnson to close the nominations and to appoint Bennett by
acclamation.
VOTING: Ayes — 5; Nays — 0.
Local Emergency Planning Committee (3 appointments): Vice Chairman Norman
nominated Robert Childers, Paula Guiton, and Robert David Bennett.
OTIO by Chairman Johnson to close the nominations and to appoint Childers,
Guiton, and Bennett by acclamation.
VOTING: Ayes — 5; Nays — 0.
UNFINISHED BUSINESS
Retirement of Clerk to the Board Jean Moore: Chairman Johnson advised that Mrs.
Moore would be retiring effective December 2, 2013, after 30 years of employment with the
county and over 35 years of service in the local government retirement system. He requested the
scheduling of a reception for Moore at 5 PM, on November 19, 2013.
Commissioner Boone said it would be appropriate to invite former commissioners who
had served while Mrs. Moore was the clerk.
COUNTY MANAGER'S REPORT: County Manager Smith said the central
permitting, development services, and building standards software transition was finished and
smoothly working.
CLOSED SESSION: OTIO by Chairman Johnson at 8:10 PM, to enter in closed
session pursuant to G.S. 143-318.11 (a) (4) - Economic Development.
VOTING: Ayes — 5; Nays — 0.
(RETURN TO OPEN SESSION AT 8:32 PM)
13
CALL FOR A PUBLIC HEARING IN REGARDS TO PROJECT CUPID:
OTION� by Commissioner Griffith to call for a public hearing on Tuesday,
November 19, 2013, at 7:00 PM, regarding an economic development incentive ranging between
$252,200.00 and $485,000.00, over a five-year period, for an undisclosed company based on an
investment ranging between $13 million and $25 million in Iredell County.
VOTING: Ayes — 5; Nays — 0.
CALL FOR A PUBLIC HEARING IN REGARDS TO PROJECT TOOL:
OTIO by Chairman Johnson to call for a public hearing on Tuesday, November 19, 2013, at
7:00 PM, regarding an economic development incentive of $44,135.00, over a five-year period,
for an undisclosed company based on a $2,275,000.00 investment in Iredell County.
VOTING: Ayes — 5; Nays — 0.
CLARIFICATION ON THE NUMBER OF JOBS BEING CREATED BY NGK
CERAMICS: Economic Developer Robby Carney said the board previously approved an
incentive for Project Repeat/NGK Ceramics with 28 new full-time jobs. He said the company
might create 28 jobs, but for the incentive agreement, NGK was requesting that only 18 be listed.
OTIO by Vice Chairman Norman to approve NGK's request to list only 18 new jobs
in the incentive agreement.
VOTING: Ayes — 5; Nays — 0.
ADJOURNMENT: OTIO by Chairman Johnson to adjourn the meeting. (NEXT
MEETING: Friday, November 8, 2013, beginning at 8:30 AM, for a Fall Planning Session at
Little Joe's Enrichment Center, 117 Grannis Lane, Troutman, NC)
VOTING: Ayes — 5; Nays — 0.
Approval:
14
,a�, 14rfu-- -
Clerk t the Board