AREA BOARD REGULAR MEETING Thursday, March …...2019/03/07 · Thursday, March 07, 2019 AREA BOARD...

Thursday, March 07, 2019 AREA BOARD REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 4:00-6:00 p.m.

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MEMBERS PRESENT: ☐Glenn Adams, Cumberland County Commissioner, JD, ☒Cynthia Binanay, Chair, MA, BSN, ☒Christopher Bostock, BSIM, ☒Heidi Carter, Durham County Commissioner, MPH, MS, ☒George Corvin, Vice-Chair, MD, ☒David Curro, BS, ☒Greg Ford, Wake County Commissioner, MA, ☒Lodies Gloston, MA, ☐David Hancock, MBA, MPAff, ☒Duane Holder, MPA, ☒D. Lee Jackson, BA, ☒Curtis Massey, JD, ☒Donald McDonald, MSW, ☒Lynne Nelson, BS, ☒Gino Pazzaglini, MSW LFACHE, ☐Pam Silberman, JD, DrPH, ☒Lascel Webley, Jr., MBA, MHA, and ☒McKinley Wooten, Jr., JD (via phone)

GUEST(S) PRESENT: Denise Foreman, Wake County Manager’s office; Yvonne French, NC DHHS DMH/DD/SAS (Department of Health and Human Services, Division of Mental Health, Developmental Disability and Substance Abuse Services) ALLIANCE STAFF PRESENT: Michael Bollini, Executive Vice-President/Chief Operating Officer; Denise Dirks, Administrative Assistant II; Joey Dorsett, Senior Vice-President/Chief Information Officer; Don Fowls, MD, Chief Medical Officer (interim); Doug Fuller, Director of Communications; Kelly Goodfellow, Executive Vice-President/Chief Financial Officer; Amanda Graham, Senior Vice-President/Operational Effectiveness; Veronica Ingram, Executive Assistant II; Beth Melcher, Executive Vice-President/Care Management; Sara Pacholke, Senior Vice-President/Financial Operations; Brian Perkins, Senior Vice-President/Strategy and Government Relations; Monica Portugal, Chief Compliance Officer; Robert Robinson, Chief Executive Officer; Sean Schreiber, Senior Vice-President/Provider Network and Evaluation; Sara Wilson, Director of Government Relations; Carol Wolff, General Counsel, and Doug Wright, Director of Community and Member Engagement 1. CALL TO ORDER: Chair Cynthia Binanay called the meeting to order at 4:05 p.m.

AGENDA ITEMS: DISCUSSION: 2. Announcements A. Mr. Robinson shared about the EQR (external quality review) visit that concluded today; this review is required by Federal and State

governments for all NC MCOs (managed care organizations) who have a contract to access Medicaid funding.

B. Mr. Robinson mentioned that the new NC OSA (Office of the State Auditor) report is public. Additional details may be found at http://www.ncauditor.net/EpsWeb/Reports/Performance/PER-2018-4445.pdf

C. Mr. Robinson reminded Board members that the annual Budget Retreat is Tuesday, March 19, 2019, at this location. He encouraged Board members to participate and to RSVP.

D. Mr. Robinson shared that NC DHHS asked NCACC (NC Association of County Commissioners) to develop recommendations for

the establishment of Tailored Plan regions. NCACC is convening a committee to provide input, which includes representation from NC MCOs. Glenn Adams will represent Alliance on this Committee.

E. Mr. Robinson shared that a meeting to discuss transition of the crisis facility in Fayetteville between the current provider and Alliance

staff will occur March 11, 2019.

F. Doug Fuller, Director of Communications, shared details of the agency’s new logo, email and website domains (Alliance Health/AllianceHealthPlan.org) as a result of the State’s Tailored Plan for NC MCOs.

3. Agenda Adjustments There were no adjustments to the agenda.

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http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2018-4445.pdf


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AGENDA ITEMS: DISCUSSION: 4. Public Comment There were no public comments. 5. Committee Reports A. Consumer and Family Advisory Committee – page 4

The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from Durham, Wake, Cumberland or Johnston Counties who receive mental health, intellectual/developmental disabilities or substance use/addiction services. This month’s report included draft minutes and supporting documents from the Cumberland, Durham, Wake, and Johnston subcommittee meetings, and the steering committee meeting. The committee reports were sent as part of the Board packet; Dave Curro, CFAC Chair, presented the report. He mentioned the recent CFAC retreat, where Dave Richard, Deputy Secretary for NC Medicaid at NC DHHS was a key presenter. Mr. Curro also mentioned additional Alliance staff who attended meetings and discussed additional involvement and outreach opportunities; he mentioned the April 1, 2019, statewide CFAC meeting and upcoming CFAC meetings. The CFAC report is attached to and made part of these minutes.

BOARD ACTION The Board received the report.

B. Finance Committee – page 38

The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Area Board. This month’s report included the draft minutes from the February meeting, the Summary of Savings/(Loss) by Funding Source, the Statement of Revenue and Expenses (budget to actual) report and ratios for the period ending January 31, 2019. Christopher Bostock, Committee Chair, presented the report. He mentioned that expenses exceeded revenues, due to reductions in State Single Stream funding. He also mentioned that all State mandated ratios were met. The Finance Committee is attached to and made part of these minutes.

BOARD ACTION The Board received the report.

6. Consent Agenda A. Draft Minutes from February 7, 2019, Board Meeting – page 48 B. Audit and Compliance Committee Report – page 54 C. By-Laws/Policy Committee Report – page 56 D. Executive Committee Report – page 82

The consent agenda was sent as part of the Board packet. There were no comments or discussion about the consent agenda. BOARD ACTION A motion was made by Mr. Webley to approve the consent agenda; motion seconded by Ms. Gloston. Motion passed unanimously.

7. Reappointment Recommendations – page 85

In accordance with the By-Laws of the Area Board, the terms of some Board members expire on March 31, 2019. The Board is requested to consider these members’ reappointment for an additional term and request official reappointment through the respective Boards of County Commissioners.

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AGENDA ITEMS: DISCUSSION: Chair Binanay shared that four members’ terms expire March 31, 2019: Curtis Massey, Donald McDonald, McKinley Wooten and herself. She stated that all members are willing to serve an additional term. She also shared that Mr. Massey’s current employment is being reviewed for potential or perceived conflict of interest; an update about Mr. Massey’s term will be shared at a future board meeting. BOARD ACTION A motion was made by Mr. Pazzaglini to request that the Wake Board of County Commissioners reappoints Donald McDonald to Alliance’s Board; motion seconded by Mr. Webley. Motion passed unanimously. A motion was made by Mr. Pazzaglini to request that the Wake Board of County Commissioners reappoints McKinley Wooten to Alliance’s Board; motion seconded by Mr. McDonald. Motion passed unanimously. A motion was made by Vice-Chair Corvin to request that the Durham Board of County Commissioners reappoints Cynthia Binanay to Alliance’s Board; motion seconded by Ms. Gloston. Motion passed unanimously.

8. Closed Session(s) BOARD ACTION A motion was made by Vice-Chair Corvin to enter closed session pursuant to NC § 143-318.11 (a) (3) and (a) (1) to consult with General Counsel regarding current litigation and to prevent the disclosure of information that is confidential and not a public record under NC § 122C-126.1; motion seconded by Ms. Gloston. Motion passed unanimously. The Board returned to open session.

9. Adjournment All business was completed; the meeting adjourned at 5:18 p.m.

Next Board Meeting Thursday, April 04, 2019

4:00 – 6:00 pm

3/7/2019 Robert Robinson, Chief Executive Officer Date Approved

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Alliance Health BOARD OF DIRECTORS

Agenda Action Form

ITEM: Consumer and Family Advisory Committee (CFAC) Report DATE OF BOARD MEETING: March 7, 2019 BACKGROUND: The Alliance Consumer and Family Advisory Committee, or CFAC, is made up of consumers and/or family members that live in Durham, Wake, or Cumberland Counties who receive mental health, intellectual/developmental disabilities and substance use/addiction services. CFAC is a self-governing committee that serves as an advisor to Alliance administration and Board of Directors. State statutes charge CFAC with the following responsibilities: Review, comment on and monitor the implementation of the local business plan Identify service gaps and underserved populations Make recommendations regarding the service array and monitor the development of additional

services Review and comment on the Alliance budget Participate in all quality improvement measures and performance indicators Submit findings and recommendations to the State Consumer and Family Advisory Committee

regarding ways to improve the delivery of mental health, intellectual/other developmental disabilities and substance use/addiction services.

The Alliance CFAC meets at 5:30pm on the first Monday in the months of February, April, June, August, October and December at the Alliance Corporate Office, 5200 West Paramount Parkway, in Morrisville. Sub-committee meetings are held in individual counties; the schedules for those meetings are available on our website. The Alliance CFAC tries to meet its statutory requirements by providing you with the minutes to our meetings, letters to the board, participation on committees, outreach to our communities, providing input to policies effecting consumers, and by providing the Board of Directors and the State CFAC with an Annual Report as agreed upon in our Relational Agreement describing our activities, concerns, and accomplishments. REQUEST FOR BOARD ACTION: Receive draft minutes from the Cumberland January 24th meeting, the Durham February 11th meeting, the Wake February 12th meeting, the Johnston February 19th, and the steering committee on February 4th and supporting documents. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Dave Curro, CFAC Chair; Doug Wright, Director of Community and Member Engagement

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Thursday, January 24, 2019 CFAC MEETING - REGULAR MEETING 711 Executive Place, Fayetteville, NC 28305 5:30 pm- 7:00 p.m.

Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 1 of 3

MEMBERS PRESENT: ☒Michael McGuire ☒Ellen Gibson, ☒Dorothy Johnson ☒Carrie Morrisy ☒Jackie Blue ☒Jamille Blue ☒Sharon Harris ☒Briana Harris ☒Shirley Francis ☒Tekeyon Lloyd ☒Tracey Glenn- Thomas ☒Renee Lloyd ☒Carson Lloyd Jr.

BOARD MEMBERS PRESENT: GUEST(S): ☐ C J Lewis ☒Vincent Francis, ☒ Kate Barrow STAFF PRESENT: ☒ Doug Wright, Director of Community and Member Engagement, ☒ Starlett Davis, Individual and Family Affairs Specialist, ☒ Terrasine Gardner, Member Engagement Manager

1. WELCOME AND INTRODUCTIONS: Michael welcomed everyone to the meeting. Introductions were made.

2. REVIEW OF THE MINUTES – Review of November 2018 Minutes. Minutes were accepted and approved. 3.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Public Comment Michael shared that the commercial from NAMI was outstanding.

Dorothy commented on the commercial. Michael brought that NC was becoming a transparent medical billing state and that we would be able to see exactly what we are being billed. Michael also congratulated Doug on his new position. Dorothy announced that NAMI received their recertification. Everyone congratulated her. Jackie announced that Pathway to Prosperity was having a community event at DSS from 10am-12pm. Information could be found on Cumberland County Website. Starlett Davis provided community events and resources.

See Doug, Terrasine, or Starlett for questions.

Ongoing

State/ MCO Updates Doug introduced Terrasine Gardner as his replacement. She is the Member Engagement Manager. She will be the point of contact after Starlett. Doug will still be involved. Terrasine introduced herself and gave information on herself. Everyone welcomed her. Doug gave information about the State CFAC meeting and 122C. It is about what CFAC is and what they will look like in regards to Medicaid transportation. He talked about having an opportunity to give feedback to the state. The retreat is coming up and it’s a good time to discuss this and give feedback. Branding Message. We have changed our name to Alliance Health. Our intention will be a tailored plan. We will manage behavioral health

See Doug, Terrasine, or Starlett for questions. Feedback will be obtained at CFAC Retreat.

Ongoing March 2, 2019

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: needs, physical health and pharmacy needs. We are making sure our name fits what we will be doing. It will be officially changed July1st. We are doing business now as Alliance Health. Community Health and Well Being- Changes in Community Relation. Doug went over the realignment of the new name and department. He went over the different changes, why they are happening, and who is a part of the department. This is due to the Medicaid transformation and the 1115 waiver. We speak about creating a culture of health. It means that communities believe people have the right to live in a healthy way and have the services they need and are used in a healthy way. It’s a community effort. Doug explained all of the departments. The group also talked about ILI and TCL as well as the environment of housing in Cumberland County. Doug also went over other positions in the department. This structure was effective January 1st. Alliance Complete Care was given out so everyone would have an understanding of the realignment of Alliance.

We are conducting business as Alliance Health. Official Name change July 1st. See Doug, Terrasine, or Starlett for questions. See Doug, Terrasine, or Starlett for questions.

July 1, 2019 Ongoing Ongoing

Upcoming Event CFAC Retreat- March 2, 2019 Agenda, Logistics, Etc. It will be at the new home office in Morrisville. The time is 9:45am to 2pm. Dave Curro invited Dave Richard, Director of Division Benefits or someone from his department will be there from the department. We will be doing team building and setting goals for the upcoming year. We will have lunch. Those that will commit to come need to contact Starlett to get logistics and how to get there. Starlett will reach out to get a count of who is coming and assist with getting carpool together.

CFAC Retreat will be March 2, 2019

March 2, 2019

Membership Discussion/ Community Outreach

Doug explained that Johnston County did a screening of Resilience. It’s a movie on adverse childhood events and how it effects a person’s life. It was a good turnout. Doug explained that many of the school officials that participated left with a lot of information to take back to the school. The film is available. The Generations Found and The Anonymous People movies are also available. Starlett explained that if there are any resources needed, please let her know. She also explained that we definitely need to support our members that are a part of other organizations. We can do that by going

Please let Starlett and Terrasine know if resources are needed or representation at different events.

Ongoing

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: to their meetings to support and also presenting on who and what CFAC is. Starlett also challenged the committee to bring one new person to the meetings each month. She explained that this is an open meeting and everyone is welcomes. However, we need more representation from the Substance Use population. Michael spoke about membership and obtaining more members,

Prep for next meeting We discussed the next meeting agenda items. Went over expectations, reminders, etc for the next meeting.

The members need to let Starlett know if they are coming to the retreat. Each member is to bring to a guest with them at the next meeting.

Ongoing

Appreciation Everyone gave their appreciation. N/A N/A

4. ADJOURNMENT: The meeting was adjourned at 7:15pm

Respectfully Submitted by: Starlett Davis Date Approved

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Monday, February 11, 2019 CFAC MEETING - REGULAR MEETING 1820 James Street, Durham NC 27701 5:30-730pm


MEMBERS PRESENT: ☒ Steve Hill, ☒ Tammy Shaw, ☐ Joe Kilsheimer, ☒ James Henry, ☐ Latasha Jordan ☒ Dave Curro, ☒ Trulia Miles, ☐ Brenda Solomon, ☐ Chris Dale, ☐ Dan Shaw BOARD MEMBERS PRESENT: GUEST(S): ☐ Susan Hertz, ☐ Tina Barnes, ☒ Vicky Bass, ☒ Jessica Larrison STAFF PRESENT: ☒ Doug Wright, Director of Community & Member Engagement, ☒ Terrasine Gardner, Member Engagement Manager, ☒ Ramona Branch, Individual & Family Engagement Specialist Call your Dial-In Number: (605) 472-5464 Enter your Access Code: 289674

1. WELCOME AND INTRODUCTIONS 2. REVIEW OF THE MINUTES – The minutes from the January 14, 2019, Consumer and Family Advisory Committee (CFAC) meeting were

reviewed; a motion was made by Dave Curro and seconded by Trula Miles to approve the minutes. Motion passed.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Public Comments Dave Curro mentioned that there was good attendance at the

CFAC Steering Committee meeting last Monday night.

Ongoing N/A

4. Interest in Membership/Outreach

Steve Hill asked the group to brainstorm ideas on how to recruit new members to the Durham CFAC subcommittee. Younger members are in need as well as all ages. Steve challenged the group by asking them to each bring (1) idea on how to recruit members and reach out to individuals.

Brainstorm and write down ideas

Due March 2, 2019

5. LME/MCO updates NC Medicaid Managed Care PHP Contract Awards: Ramona and Doug went over the NC Medicaid Managed Care Prepaid Health Plan Contract Awards. Statewide PHP contracts were awarded to the following entities, which will offer Standard Plans in all regions in North Carolina: AmeriHealth Caritas North Carolina, Inc., Blue Cross Blue Shield of North Carolina, United Healthcare of North Carolina Inc., and WellCare of North Carolina, Inc. A fact sheet was handed out that entails detailed information. This fact sheet can be viewed on the DHHS website.

Ongoing- Prepare questions for CFAC retreat

March 2, 2019

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: https://files.nc.gov/ncdhhs/medicaid/Medicaid-Factsheets-PHP-2.4.19.pdf The group was asked to read over the information and prepare any questions or comments for the CFAC retreat that will host guest speaker Dave Richards from DHHS, who speak specifically on Medicaid transformation.

6. Steering Committee Dave Curro summarized the Steering Committee meeting that took place on February 4, 2019. The next meeting is a phone in meeting and it will take place on March 4, 2019 at 530pm.

Ongoing N/A

7. Needs and Gaps Steve Hill went over the Needs and Gaps which will be due by April 30, 2019. The group was asked to be come up with a list and prepare to discuss during the March 2 CFAC retreat as well as the next monthly meeting on March 11, 2019. The following things were mentioned during this meeting: transportation, child-care, IDD support services (gap), and housing.

Prepare lists and discuss

March 2 & 11 2019

8. Event Planning CFAC Retreat- March 2, 2019- This will take place at the new corporate office of Alliance Health. 5200 West Paramount Parkway, Suite 200 Morrisville NC, 27560 Ramona will be calling members to get an exact count for this event for catering purposes. Those that committed at this meeting were: Steve Hill, Dave Curro, Trula Miles, and Tammy and/or Dan Shaw. NAMI Walks CFAC table- 05.18.2019- Ramona asked who would be available to host the CFAC table during the 2019 NAMI Walks, it will be held at Dorthea Dix park. This item will be addressed during the next meeting in March.

Ramona will call members to get exact count for catering purposes, the week of February 18.

N/A

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 9. Announcements/

Opportunities 10th Annual North Carolina One Community Recovery Conference- Tammy and Trula both expressed interest in attending this event that will take place on March 13-15, 2019 in Greensboro and asked for assistance with funding. This will be brought to the CFAC Steering Committee for approval during the March 4, 2019 phone in meeting. Transportation will not be provided. State CFAC Advocacy Day 2019- The date has not been decided yet- but please plan to attend this year-more info will come once it becomes available.

Addressed during next Steering Committee meeting

March 4, 2019

1. ADJOURNMENT: the next meeting will be March 11, 2019, at 5:30 pm Respectfully Submitted by: Ramona Branch, Individual & Family Engagement Specialist 02.13.2019 Click here to enter text. Date Approved

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Tuesday, February 12, 2019 Wake CFAC Subcommittee meeting. 5000 Falls of Neuse Road Suite #310, Raleigh NC 27614 5:30 – 7:00 pm.

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MEMBERS PRESENT: ☒Carole Johnson, ☒ Megan Mason, ☐ Karen McKinnon, ☐ Connie King-Jerome, ☒ Israel Pattison, ☒ Annette Smith, ☒ Ben Smith, ☒ Wanda (Faye) Griffin, ☒Gregory Schweitzer. GUEST(S): STAFF PRESENT: ☒ Doug Wright, Director of Individual and Family Affairs, ☒ Terrasine Garner, Community Member and Engagement Manager, ☐ Stacy Guse, Individual and Family Affairs Specialist.

1. WELCOME AND INTRODUCTIONS

2. REVIEW OF THE MINUTES – The minutes from the January 8, 2019, Wake Consumer and Family Advisory Committee (CFAC) Subcommittee meeting were reviewed; a motion was made by Israel Pattison and seconded by Megan Mason to approve the minutes. Motion passed unanimously.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:

Public Comments LME/MCO Updates 2019

. Health Plan Changes – Doug discussed that with the continued cuts, the possibility of plan changes are imminent and that we will bring that to CFAC as soon as we are aware. Carlyle Johnson is requesting the Network Adequacy and Accessibility needs and gaps survey that will be coming available. This survey will be circulating soon and will need to be completed by April 30th. – Members were informed of the process discussed at the steering committee, a shorter one page document that could be easily filled out at events and possibly providers, etc. The survey will be available electronically as well and we are being ask to help get more responses from our members. The April 6th event would be a great place to get some responses. State CFAC Monday April 1, 2019 The Lusk Center 2501 Summit Ave Greensboro. You must register for attendance and lunch. Here is the link to register: https://www.eventbrite.com/e/statewide-cfac-meeting-2019-tickets-55663883173 Stacy created a sign-up sheet for those who will attend and who can carpool so we can coordinate. Several people signed up, Stacy will get with signed up to get them registered and arrange transportation.

Bring back information. Distribute surveys and encourage members to fill them out and return them. Use the showing of “Resilience” as an opportunity to get some feedback from members. Stacy to register members that want to attend and arrange for car-pooling.

3-12-19 4-6-19 3-12-19

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https://www.eventbrite.com/e/statewide-cfac-meeting-2019-tickets-55663883173

https://www.eventbrite.com/e/statewide-cfac-meeting-2019-tickets-55663883173


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Annual Event Planning Movie ordered - yes Date and location confirmed - April 6, 2019 11:00 am at RCNC 5245 Capital Blvd Stacy has confirmed location, time, and seating. Eventbrite link and will go live in March: https://resilience-wake.eventbrite.com The link is live and ready for distribution. Press Kit – Synopsis Wake Network of Care Food list will be presented March 12, 2019

Send link out and monitor registration. Develop flyer for distribution. Work with RCNC to find the best method to get people from their program registered.

3-1-19

Announcements-Opportunities

CFAC Retreat – March 2, 9:45 am – 2:00pm, Alliance’s new office. The purpose from health benefits and talk to use about tailored plans. Please contact Stacy Guse 919 651 8909 to let her know who will attend so we can plan accordingly. Several members committed to be at the CFAC retreat on March 2: Annette Smith, Carole Johnson, Faye Griffin. Greg Schweitzer, Israel Pattison all committed. Alliance Health will have manned tables at these two resource fairs: Imaginably Conference February 23, 2019 930am-5pm Brooks Avenue Church of Christ 700 Brooks Avenue Raleigh, NC 27607 https://thepowerofthedream.org/event/imaginability-conference/ Please see the website for more information and registration. Share and Care Cary: Friday, February 22, 2019 9:30 a.m.-12:30 p.m. | Herbert C. Young Community Center 101 Wilkinson Avenue Cary NC Stop by and see what your community has to offer! Persons with disabilities, parents and care providers are invited to this FREE event for a time of resource sharing and networking. Service animals are permitted. Community organizations and agencies that offer services for persons with disabilities will be on hand to share information about what they have to offer to the community.

Stacy to call and verify attendance for all Wake CFAC members for planning purposes. Members were made aware of opportunities to work tables at these two events, let Stacy know if you would like to attend and participate.

3-22-19 2-20-19

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https://resilience-wake.eventbrite.com/


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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Spent some time talking about tailored plans and how that may impact members. Concern about would someone’s doctor would change, etc. Discussed that the tailored plans will not start until 2021 and that chances are that most doctors would contract with the tailored plan, for physical health the network is open to any willing provider. Reviewed timelines for standard plans.

Monthly updates.

3-12-19

Training Medicaid Works in North Carolina – Doug reviewed the information about Medicaid and how it currently works and who it covers.

Informational N/A

3. ADJOURNMENT: the next meeting will be March 12, 2019, at 5:30 p.m. Respectfully Submitted by: February 12, 2019 Doug Wright. Date Approved

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Tuesday, February 19, 2019 CFAC MEETING - REGULAR MEETING 521 North Brightleaf Boulevard, Smithfield, NC 27577 5:30-7:00 p.m.


MEMBERS PRESENT: Dorothy Best, Albert Dixon, Jason Phipps, Cassandra Williams-Herbert, Leanna George, and Jerry Dodson

BOARD MEMBERS PRESENT: None GUEST(S): None STAFF PRESENT: Doug Wright, Director of Community and Member Engagement, Terrasine Gardner, Member Engagement Manager, Noah Swabe, Individual and Family Engagement Specialist


2. REVIEW OF THE MINUTES – The minutes from the January 15, 2019 Consumer and Family Advisory Committee (CFAC) meeting were reviewed; a motion was made by Leanna George and seconded by Jerry Dodson to approve the minutes. Motion passed.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Public Comment Albert noted the lack of transportation in Johnston County. Albert described

some personal challenges he has been facing in reference to transportation for out of county appointments.

Continue to look at alternate transportation and help support the needs and gap survey

Ongoing

4. LME/MCO Updates

Carlyle Johnson is currently working on the needs and gaps assessment. There was a low return rate for Johnston County last year. CFAC members want to assist in promoting the survey for a larger return this year. CFAC members will have the survey at local events and help disburse them in the community to increase exposure. Jason Phipps presented a copy of a 2009 Needs Assessment Survey which was put together by Johnston County CFAC. March 2, 2019: CFAC retreat will be held at the home office. All members were encouraged to attend, Doug requested an official head count by Monday, February 25, 2019 in order to plan accordingly. Doug and Terrasine reviewed the stipend process with CFAC members: Process in which checks are cut and disbursed. CFAC members discussed some of their challenges and frustrations with stipends and the process. The information on the stub (or lack thereof) makes it difficult to determine the meeting/event for which the stipend is given. At times, the length of time to receive the stipend was reported to be lengthy. Doug and Terrasine discussed possible solutions for the stipend process with the CFAC. Doug did explain EFT was also an option and that if members wanted EFT to touch base with Noah.

Doug or Terrasine will send CFAC members the needs and gap survey once it’s completed. Noah will forward the 2009 Johnston CFAC Needs Assessment to Doug and Carlyle. Members will inform Noah by 2/25/19 on attendance to CFAC retreat. Terrasine will follow up with finance to see if there is a way to make the check stubs for stipends more detailed.

February 25, 2019

5. State Updates Doug reviewed the awarded Standard Plans announced earlier this month by DHHS. Doug led a conversation about some of the changes to expect with the implementation of standard plans. Discussed Johnston County

Alliance Health will continue to update and inform CFAC

Ongoing

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: being in “Phase 1” of implementation and what members should expect in the coming months. The Statewide CFAC was brought up and CFAC members were encouraged to attend the meeting on April 1, 2019. Dorothy and Albert are riding together and requested Noah assist in getting them registered for the meeting.

members of changes regarding Medicaid transformation. Noah will register Dorothy and Albert for the Statewide CFAC meeting on April 1, 2019.

6. Upcoming and Future Community Events

Johnston County CFAC will have a table at the Clayton Crossings Special Needs Resource Fair hosted by the Johnston County chapter of the Autism Society. Leanna, Jason, Jerry, Cassandra, and Dorothy said they expected they would be able to attend the event and help man the table. Leanna asked about having a “one pager” on accessing I/DD services. Cups, pens, and candy will be given out at the table. The guardianship event is still in planning phases and possible dates are being reviewed.

Noah will reach out to Nancy Kent to secure the “one-pager” on I/DD services.

March 1, 2019

7. Sub-committee Updates

Cassandra updated the CFAC about SSStrong Day which has invited the Johnston County Child Collaborative to participate in lieu of their Mental Health Awareness Day event. Cassandra reports final details will be given at the next collaborative. Cassandra asked the CFAC to begin thinking of what they would want at the CFAC table during the event.

Begin brainstorming content and material to have for SSStrong Day.

March 19, 2019

8. Announcements Albert will be hosting an event on June 22, 2019 from 12:00pm to 2:00pm at the Smithfield Public Library on the role of Peer Support Specialists.

Continue to promote the event. Ongoing

9. ADJOURNMENT: the next meeting will be March 19, 2019 at 5:00 p.m. April 16, 2019 at 5:00 p.m.

May 21, 2019 at 5:00 p.m.

Respectfully Submitted by:

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Click here to enter text. Date Approved

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Monday, February 04, 2019 CFAC MEETING - REGULAR MEETING 4600 Emperor Boulevard, Durham, NC 27703 5:30 – 7:00 p.m.


MEMBERS PRESENT: Dave Curro, Carole Johnson, Connie King-Jerome, Jerry Dodson, Jason Phipps, Michael McGuire, Steve Hill, Cassandra Herbert, Tracy Glenn Thomas, Shirley Francis, Renee Lloyd, Tekeyyon Lloyd, Sharon Harris, Brianna Harris BOARD MEMBERS PRESENT: GUEST(S): CJ Lewis, Carlyle Johnson STAFF PRESENT: Doug Wright, Director of Community and Member Engagement, Terrasine Gardner, Member Engagement Manager, Starlett Davis, Stacy Guse, Ramona Branch, Noah Swabe Call your Dial-In Number: (605) 472-5464 Enter your Access Code: 289674

1. WELCOME AND INTRODUCTIONS 2. REVIEW OF THE MINUTES – The minutes from the January 7, 2019, Consumer and Family Advisory Committee (CFAC) meeting were

reviewed; a motion was made by Michael McGuire and seconded by Steve Hill to approve the minutes. Motion passed.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Public Comment

Individual/Family Challenges and Solutions

Doug went over the NC Medicaid Managed Care Prepaid Health Plan Contract Awards. Statewide PHP contracts were awarded to the following entities, which will offer Standard Plans in all regions in North Carolina: AmeriHealth Caritas North Carolina, Inc., Blue Cross Blue Shield of North Carolina, United Healthcare of North Carolina Inc., and WellCare of North Carolina, Inc. A fact sheet was handed out that entails detailed information. This fact sheet can be viewed on the DHHS website. https://files.nc.gov/ncdhhs/medicaid/Medicaid-Factsheets-PHP-2.4.19.pdf

Ongoing N/A

4. Carlyle Johnson - Network Adequacy and Accessibility Analysis

Carlyle Johnson went over information about the needs and gaps survey that will be coming available. This survey will be circulating and will need to be completed by April 30th.

Local CFACs to assist in getting community members to complete survey during community events

April 30, 2019

5. Steering Committee Role Doug went over a flow chart that was created that details Alliance CFAC communication. Dave Curro went over a handout that entails ideas for more structure for the CFAC Steering Committee meetings that

Ongoing N/A

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: ensures we are meeting statutory requirements while addressing the needs of our communities. The Steering Committee will help the County Subcommittees organize activities needed to address the following concerns: Manage Statutory Requirements Outreach Major Internal Events Communication These activities will be documented on a spreadsheet by your Individual & Family Engagement Specialist. In addition, 1-2 comments and/or questions will be expected from each County for the Area Board.

6. State Updates Doug went over the Consumer Caucus that took place at this year’s annual conference at Pinehurst. The focus this year was on Strengthening Consumer Voice in System Change. Doug also mentioned that there will be several community forums in the upcoming months that will focus primarily on the Medicaid transformation. CJ Lewis (SCFAC) (DHHS) was in attendance and asked that any question, comments, and concerns about tailored plans to be discussed at the local CFAC meeting and presented to the State CFAC meeting.

N/A N/A

7. Subcommittees • Wake • Durham • Cumberland • Johnston • Area Board • Human Rights

Consent Agenda Ongoing Ongoing

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: • Quality

Management

8. Announcements Imaginably Conference February 23, 2019 930am-5pm Brooks Avenue Church of Christ 700 Brooks Avenue Raleigh, NC 27607 https://thepowerofthedream.org/event/imaginability-conference/ Please see the website for more information, and registration.

N/A N/A

9. ADJOURNMENT: the next meeting will be March 4, 2019, at 5:30 p.m. (phone-in)

Respectfully Submitted by: Ramona Branch, Individual & Family Engagement Specialist 02.05.2019 Click here to enter text. Date Approved

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CE&E Update | February 2019

1

ANNOUNCEMENTS

1. Rutherford County LME/MCO Disengagement Plan: Rutherford County has announced

that on December 28, 2018, its government was notified by the North Carolina Department

of Health and Human Services (NC DHHS) Secretary Mandy Cohen, MD, MHP, that, in

accordance with NCGS § 122C-115(a3) and the county disengagement rules, NC DHHS is

approving Rutherford County's realignment with Partners Behavioral Health Management

(Partners) with an effective date of July 1, 2019. To learn more, visit the Partners Website:

https://www.partnersbhm.org.

2. The North Carolina General Assembly Committee meetings have begun to be posted on the

calendar. To keep track of the scheduled meetings, go to:

https://www.ncleg.gov/LegislativeCalendar.

UPCOMING EVENTS

• February 6th What’s Up Breakfast Networking- is designed to keep child-serving staff and

families up-to-date about resources and emerging services as well as an opportunity to

announce activities within agencies. The 8:30 – 10:30 a.m. format allows time for

networking/breakfast; program presentations and announcements. For information please

contact Chandrika Brown: [email protected] or Stephanie Jones:

[email protected] Location: Chatham County Library

Conference Room, 197 NC-87 Pittsboro, NC (brochure attached)

• February 13th SCFAC - The monthly State CFAC Meeting will be held on Wednesday,

February 13th at the Ashby Building on the Dorothea Dix Campus from 9:00 a.m. to 3:00

p.m. Where: 1987 Umstead Drive Ashby Bldg. Raleigh, NC 27603. To participate by

conference call, dial: 1-888-273-3658 and enter Access code: 2490768#. RSVP ahead of

time to Kate Barrow at [email protected].

• February 20th State to Local Conference Call- Find out what other CFACs are doing and

get updates from the State CFAC. The call begins promptly at 7:00 P.M and ends at 8:30

p.m. Local CFACs are encouraged to submit their agenda items to Kate Barrow no later

than Monday, February 11th. To participate in the monthly State to Local Conference Call,

dial 1-888-273-3658 and use Access code:490768#.

• March 13-15- NC One in Recovery Conference: Registration is now open! The NC 'One

Community in Recovery' Conference is an inspiring and informative event, designed to

foster the continuing growth of the North Carolina Recovery Movement, to teach participants

how to get recovery programming up and running in their own communities, to showcase

some of the most progressive recovery practices and to bring the community of providers

and individuals in recovery together as students and partners. This conference is also

designed to educate and motivate participants to apply principles of recovery in their

personal and professional lives. https://northwestahec.wfubmc.edu/courses-and-

events/55357/10th-annual-nc-one-community-in-recovery-conference-connecting-people-

raising-voices (brochure attached)

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https://www.partnersbhm.org/

https://www.ncleg.gov/LegislativeCalendar

mailto:[email protected]



https://northwestahec.wfubmc.edu/courses-and-events/55357/10th-annual-nc-one-community-in-recovery-conference-connecting-people-raising-voices




2

NEWS & UPDATES RESOURCES:

- DHHS Joint Communication Bulletins: https://www.ncdhhs.gov/divisions/mhddsas/joint-

communication-bulletins

- Medicaid Transformation: https://www.ncdhhs.gov/assistance/medicaid-transformation

More information NC Medicaid Managed Care Public notices, press releases, session laws

and submit a comment feedback is welcome and encouraged

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https://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins

https://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins

https://www.ncdhhs.gov/assistance/medicaid-transformation


3

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4

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Flow of Governance/Communicationfrom MCO to, Consumer Affairs Office, MCO-CFAC and Local CFAC's

Revised February 4th, 2019

Alliance HealthManaged Care Organization (MCO) Area Board

MHConsumers

I/DDConsumers

SASConsumers

MHConsumers

I/DDConsumers

SASConsumers

MHConsumers

I/DD Consumers

SASConsumers

MH Consumers

I/DD Consumers

SASConsum

Service Array ,Delivery and Gaps in services




Durham County NC Innovations

Registry of Unmet Needs

Wake County NC Innovations


Cumberland County NC Innovations


Johnston County NC Innovations


Just added the Registry of Unmet needs to show that each Registry of Unmet Needs, kept in each county and managed corporately

Johnston CFAC (Sub-Committee)Local Chair + 2 Others

Minimum 1 member from each population MH, I/DD and SUD

Cumberland CFAC (Sub-Committee)Local Chair + 2 Others


Durham CFAC (Sub-Committee)Local Chair + 2 Others


Wake CFAC (Sub-Committee)Local Chair + 2 Others


Alliance Health Managed Care Organization (MCO) - Management of Services

Local CFAC Charter

Local CFAC Charter

Local CFAC Charter

Local CFAC Charter

Johnston CountyMH/I-DD/SUD

Communities Served

Cumberland CountyMH/I-DD/SUD

Communities Served

Wake CountyMH/I-DD/SUD

Communities Served

Durham CountyMH/I-DD/SUD

Communities Served

Alliance Health CFAC - Steering CommitteeNC Statute 122C CFAC RequirementsAlliance CFAC By-lawsRelational Agreement

Individual and Family Affairs Liaison




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Flow of Governance/Communicationfrom MCO to, Consumer Affairs Office, MCO-CFAC and Local CFAC's

Revised February 4th, 2019

mers

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NC MedicaidNC Medicaid Managed CarePrepaid Health Plan Contract Awards

Fact Sheet

Today, the North Carolina Department of Health and Human Services (the Department) announced the entities who have received contracts to participate as Prepaid Health Plans (PHPs) in Medicaid Managed Care when the program launches in November 2019. PHPs were selected based on a thorough and fair evaluation of responses submitted to the Request for Proposal (RFP) released by the Department in August 2018.

BACKGROUND

In 2015, the NC General Assembly enacted Session Law 2015-245, directing the transition of Medicaid from a predominantly fee-for-service structure to managed care. In managed care, the Department will remain responsible for all aspects of the Medicaid and NC Health Choice programs. The Department will delegate the direct management of certain health services and financial risks to PHPs, which will contract with care providers to deliver services to their members.

From 2015 to 2018, extensive collaboration and feedback from stakeholders shaped a detailed program for Medicaid Managed Care that is innovative, consistent with North Carolina and federal laws, and responsive to the needs of the beneficiaries, as well as clinicians, hospitals and health plans. In October 2018, North Carolina received federal approval from the Center for Medicare & Medicaid Services (CMS) to transition to Medicaid managed care and make other changes related to Medicaid Transformation.

RFP EVALUATION PROCESS

This is the largest procurement in Department history. The selected PHPs will provide managed care services to most Medicaid and NC Health Choice beneficiaries. The RFP clearly communicated the Department’s requirements and defined the standards that PHPs must adhere to in contracting with the Department.

The Department selected PHPs, using a competitive procurement process, started with issuing an RFP for

Medicaid Managed Care Prepaid Health Plans on Aug. 9, 2018. The Department opened proposals from potential PHPs on Oct. 12, 2018. The Department’s Medicaid Procurement and Contracts section first reviewed proposals to determine that they were in the proper form and included all required documents, as described in the RFP.

An Evaluation Committee was formed, consisting of Department Medicaid employees. The Evaluation Committee first screened the proposals and determined if minimum qualifications outlined in the RFP were met. Then, over the next four months, the Evaluation Committee reviewed those proposals and developed an award recommendation based on the methodology described in the RFP.

The Department will submit the contracts to CMS for its approval.

SELECTED PREPAID HEALTH PLANS

Statewide PHP contracts were awarded to the following entities, which will offer Standard Plans in all regions in North Carolina:

• AmeriHealth Caritas North Carolina, Inc.

• Blue Cross and Blue Shield of North Carolina

• UnitedHealthcare of North Carolina, Inc.

• WellCare of North Carolina, Inc.

A regional PHP contract was awarded to Carolina Complete Health, a provider-led entity, which will offer plans in Regions 3 and 5 (see page 3 for information about regions).

AN IMPORTANT NOTE ON PHP SELECTION

The Evaluation Committee recommended the selection of four statewide PHPs and no regional PHPs. The Department accepted the committee’s recommended four statewide PHPs, and also selected one Provider-Led Entity in regions 3 and 5 to ensure consistency with the intent of S.L. 2015-245, the authorizing legislation for Medicaid managed care.

Three Provider-Led Entities responded to the RFP. Only two of these, however, submitted an offer for a regional contract award. Of these, only Carolina Complete Health’s total score achieved the threshold to meet overall expectations.

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https://files.nc.gov/ncdhhs/medicaid/SKM_22719020408390.pdf

https://files.nc.gov/ncdhhs/medicaid/SKM_22719020408390.pdf

All PHPs will be subject to rigorous oversight by the Department to ensure strong provider networks, a full range of benefits, accountability for quality and outcomes, a positive beneficiary experience and timely payments to providers, among other aspects of a successful managed care program.

TIMING OF MEDICAID MANAGED CARE LAUNCH

About 1.6 million Medicaid and NC Health Choice beneficiaries will enroll in a Standard Plan, which will provide integrated physical health, behavioral health and pharmaceutical services. To ease the transition to Medicaid Managed Care, Standard Plans will launch in two phases.

In Regions 2 and 4, Medicaid Managed Care will launch in November 2019:

• Region 2: Alleghany, Ashe, Davidson, Davie, Forsyth, Guilford, Randolph, Rockingham, Stokes, Surry, Watauga, Wilkes, and Yadkin counties.

• R egion 4: Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren, and Wilson counties.

In all other regions, Medicaid Managed Care will launch in February 2020:

• R egion 1: Avery, Buncombe, Burke, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, and Yancey counties.

• R egion 3: Alexander, Anson, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly, and Union counties.

• R egion 5: Bladen, Brunswick, Columbus, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Sampson, and Scotland counties.

• Region 6: Beaufort, Bertie, Camden, Carteret, Chowan, Craven, Currituck, Dare, Duplin,

Edgecombe, Gates, Greene, Halifax, Hertford, Hyde, Jones, Lenoir, Martin, Northampton, Onslow, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington, and Wayne counties.

IMPORTANT UPCOMING DATES

The Department will provide updates about the progress toward implementing Medicaid Managed Care.

• Health care providers will review which PHPs were awarded and hold contract discussions with the PHPs.

• The Department will work with the PHPs to prepare for the launch of NC Medicaid Managed Care, including system and operational readiness and compliance with contract provisions.

• NC Medicaid beneficiaries will begin receiving information in the mail about managed care, the health plan options available to them and how to enroll in the plan they want. Eligible beneficiaries will receive a welcome packet with information about selecting a PHP.

Below are important activities which will occur as the Department and the PHPs prepare for Medicaid managed care:

Summer 2019. Each PHP has contracted with many care providers as it builds its network to meet Department standards.

July 2019. Enrollment Broker must have its call center operational and relevant staff located in North Carolina.

July-September 2019. Managed care will start in two phases. For regions in Phase 1, this will be the window in which beneficiaries select a PHP.

September 2019. Beneficiaries who do not select a PHP will have one automatically assigned to them, based on the Department’s auto-assignment algorithm.

2

NC MEDICAID MANAGED CARE REGIONS

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September-October 2019. Beneficiaries will receive a welcome packet and identification care from their selected or assigned PHP. The PHP will receive transition of care information from the Department to support continuity of care and care management.

November 2019. NC Medicaid Managed Care Phase 1 will launch. Beneficiaries in Regions 2 and 4 will begin to receive services through their PHPs.

October-December 2019. For regions in Phase 2, this will be the window in which beneficiaries select a PHP.

February 2020. NC Medicaid Managed Care Phase 2 will launch. Beneficiaries in the remaining four Regions will begin receiving services through their PHPs.

MORE INFORMATION

For more information on North Carolina Medicaid Managed Care, visit the Medicaid Transformation website at ncdhhs.gov/medicaid-transformation.

State of North Carolina • Department of Health and Human Services • Division of Health Benefits (NC Medicaid)www.medicaid.ncdhhs.gov • NCDHHS is an equal opportunity employer and provider. 01/2019

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https://www.ncdhhs.gov/assistance/medicaid-transformation

https://www.medicaid.ncdhhs.gov

North Carolina Department of Health and Human Services Division of Mental Health, Developmental Disabilities, And

Substance Abuse Services

Local Management Entities/ Managed Care Organizations Administrative Functions Monitoring

Report November 2018

Prepared by:

Quality Management Section Division of Mental Health, Developmental Disabilities, and Substance Abuse

Services North Carolina Department of Health and Human Services 3004 Mail Services Center, Raleigh, NC 27699-3004

(919) [email protected]

Version: 01/08/18

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NCDHHS DMHDDSAS

NC DHHS LME/MCO Performance SummaryNovember 2018 Report

Meets Standards?12/20/2018

DMA Performance Measures Standard Allia

nce

Card

inal

Eastp

oin

teP

art

ners

Sandhills

Tri

lliu

m

Vaya

% of Community Inpatient Readmits assigned to Care Coord. 85% N Y Y Y Y Y YTotal % of Auth Requests Processed in Required Timeframes 95% Y Y Y Y Y Y Y

% Routine Auths Processed in 14 Days 95% Y Y Y Y Y Y Y% Expedited/Inpt Auths Processed in 3 Days 95% Y Y Y Y Y Y Y

% of Claims Processed within 30 Days 90% Y Y Y Y Y Y Y% of Complaints resolved in 30 days 90% Y Y Y Y Y Y Y

DMH Performance MeasuresTotal % of Auth Requests Processed in Required Timeframes 95% Y Y Y Y Y Y Y

% Routine Auths Processed in 14 Days 95% Y Y Y Y Y Y Y% Expedited/Inpt Auths Processed in 3 Days 95% Y Y Y Y Y Y Y

% of Claims Processed within 30 Days 90% Y Y Y Y Y Y Y% of Complaints resolved in 30 days 90% Y Y Y Y Y

Combined Performance Measures% of calls Abandoned <5% Y Y Y Y Y Y Y% Answered within 30 seconds 95% Y Y Y Y Y Y Y

Yellow Shading indicates the MCO did not meet the Standard for one or two consecutive months.

Pink Shading indicates the MCO did not meet the Standard for 3 or more consecutive months.

Gray Shading indicates not applicable this report period.

Page 1 of 7 of 85

NCDHHS DMHDDSAS

EXPLANATIONS% of Readmits assigned to Care Coordination - Alliance - (DMA) - In November 2018, not meeting this performance standard was due to a tranistion to a new electronic care management system. This issue has been resolved and should not reoccur. Number of Level 2 Critical Incident Reports Received -Alliance - (Combined) - Noted in December 2018, the spike in level 2 incidents submisisons that began in November 2018 and continued through December 2018 was related to one provider submitting mulitple months of late incidents. # of Complaints Resolved in 30 Days - Trillium - (DMA) - Noted in December 2018, two grievances were resolved outside of 30 days due to damage and issues from Hurricane Florence delaying responses from providers.

Note: When reviewing the data, please note that the highlighted outliers may be considered as a positive or negative indicator. The highlighted outlier indicates a value that is numerically distant from the other data points in the set of data.

Page 2 of 7 of 85

NCDHHS DMHDDSAS

LME/MCO Monthly Monitoring Report November 2018 Report

Medicaid and State Combined 12/20/2018

LME-MCO: Alliance Cardinal Eastpointe Partners Sandhills Trillium Vaya NC Total

Monitoring Area Standard Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 STD DEV

Call Center

Total Number of Calls (re: services for consumers) 4,536 4,916 2,683 2,613 2,280 1,896 3,181 22,105

# of Calls Abandoned 48 87 44 15 62 17 29 302

% of calls Abandoned <5% 1.1% 1.8% 1.6% 0.6% 2.7% 0.9% 0.9% 1.4%

Avg Speed to Answer Calls (seconds) o 6.0 5.0 4.0 7.0 6.0 5.0 9.0 6.0 1.51

# of Calls Answered within 30 seconds 4,430 4,817 2,679 2,587 2,218 1874 3,144 21,749

% Answered within 30 seconds 95% 97.7% 98.0% 99.9% 99.0% 97.3% 98.8% 98.8% 98.4%

IDD Wait List

Number of Persons on the IDD Waitlist (snapshot on 1st of Month) 3,472 3,348 555 1,370 1,769 1,119 1,369 13,002

# of Persons on Registry of Unmet Needs for Innovations Waiver 3,436 3,270 548 1,323 1,627 1,119 1,353 12,676

% of Persons waiting who are on the Reg. of Unmet Needs o 99% 98% 99% 97% 92% 100% 99% 97% 2%

# of Persons waiting for residential services - 330 7 102 39 0 57 535

% of Persons waiting for residential services o 0% 10% 1% 7% 2% 0% 4% 4% 4%

# of Persons waiting for ADVP - 271 - 6 103 - - 380

% of Persons waiting for ADVP o 0% 8% 0% 0% 6% 0% 0% 3% 3%

# of Persons waiting for vocational services - 1 - 2 - 0 - 3

% of Persons waiting for vocational services o 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0% 0%

Service Status of Persons on the Waiting List

# of Persons on Waitlist receiving B3 Services 421 884 44 216 607 585 273 3,030

% of Persons on Waitlist receiving B3 Services o 12% 26% 8% 16% 34% 52% 20% 23% 14%

# of Persons on Waitlist receiving State Services 562 591 139 421 264 188 232 2,397

% of Persons on Waitlist receiving State Services o 16% 18% 25% 31% 15% 17% 17% 18% 5%

# of Persons on Waitlist receiving State and/or B3 services (undup) 819 1,315 183 526 871 672 387 4,773

% of Persons on Waitlist receiving State and/or B3 Services o 24% 39% 33% 38% 49% 60% 28% 37% 12%

# of Persons on Waitlist not receiving any LME/MCO funded svcs 2,653 2,033 372 844 898 447 982 8,229

% of Persons on Waitlist not receiving any LME/MCO funded svcs o 76% 61% 67% 62% 51% 40% 72% 63% 12%

Incidents

Number of Level 2 Critical Incident Reports received 356 289 51 169 174 222 346 1,607

Number of Level 3 Critical Incident Reports received 26 57 12 20 26 26 33 200

Transitions to Community Living Initiative1

Individuals in In-reach 1,106 1,807 655 687 565 979 780 6,579

Number of individuals in Transition Planning process 64 94 47 27 12 39 6 289

Number of Individuals Housed - Total 300 701 221 327 255 297 289 2,390

Claim/Encounter Processing in NCTracks DMH- % of Claims $ Value Denied by Date of Service FY16 <5% 1.5% 11.0% 3.9% 0.8% 9.4% 6.1% 3.5% 5.3% 4%

DMH- % of Claims $ Value Denied by Date of Service FY17 <5% 4.7% 5.2% 1.3% 4.1% 7.8% 4.6% 4.5% 4.7% 2%

DMH- % of Claims $ Value Denied by Date of Service FY18 <5% 2.0% 4.0% 1.0% 1.0% 3.0% 2.0% 4.0% 3.0% 1%

DMH- % of Claims $ Value Denied by Date of Service FY19 YTD <5% 2.0% 1.0% 1.0% 2.0% 1.0% 3.0% 2.0% 2.0% 1%

Note: All Level 3 Critical Incidents are reviewed by the LME/MCO to ensure Providers conduct internal investigation.Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3

consecutive months.

Blue highlights indicate possible outliers (>1.5 Std Dev

above or below the LME/MCO Avg).

1 Please be aware that September 2018 data is used in this section.

Page 3 of 7 of 85

NCDMHDDSAS

MCO Monthly Monitoring Report November 2018 Report

Medicaid Only 12/20/2018

LME/MCO:

Monitoring Area Standard Alliance Cardinal Eastpointe Partners Sandhills Trillium Vaya Statewide STD DEV

Persons Served Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

Unduplicated Count of Medicaid Members 222,433 427,485 153,527 140,513 173,115 207,658 157,275 1,482,006

# Persons Receiving MH Services 11,448 21,357 5,809 8,563 8,290 9,330 8,873 73,670

% of Members Receiving MH Services o 5.1% 5.0% 3.8% 6.1% 4.8% 4.5% 5.6% 5.0% 0.7%

# Persons Receiving SA Services 1,137 3,050 1,311 1,432 1,582 1,543 1,501 11,556

% of Members Receiving SA Services o 0.5% 0.7% 0.9% 1.0% 0.9% 0.7% 1.0% 0.8% 0.2%

# Persons Receiving DD Services 2,550 6,566 1,318 2,343 1,939 2,856 2,123 19,695

% of Members Receiving DD Services o 1.1% 1.5% 0.9% 1.7% 1.1% 1.4% 1.3% 1.3% 0.3%

Unduplicated # that received MH/DD/SA Services 14,781 28,518 7,714 11,468 11,811 12,235 12,130 98,657

% of Members Receiving MH/DD/SA Services o 6.6% 6.7% 5.0% 8.2% 6.8% 5.9% 7.7% 6.7% 1.0%

Community Psychiatric Hospitalization Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

# of MH Admissions to Community Psychiatric Inpatient 124 434 143 80 110 226 192 1,309

Rate of MH Admissions per 1,000 Medicaid Members o 0.56 1.02 0.93 0.57 0.64 1.09 1.22 0.88 0.25

# of MH Admissions that were Readmissions within 30 days 18 16 27 8 10 31 31 141

% of MH Admissions that were Readmissions within 30 days o 14.5% 3.7% 18.9% 10.0% 9.1% 13.7% 16.1% 10.8% 4.7%

# of MH Inpatient Discharges 194 318 146 89 122 241 208 1,318

MH Inpt Average Length of Stay (days) o 10.8 8.9 6.8 5.4 4.7 6.9 7.4 7.7 1.91

# of SA Admissions to Community Psychiatric Inpatient 1 35 9 5 22 8 15 95

Rate of SA Admissions per 1,000 Medicaid Members o 0.00 0.08 0.06 0.04 0.13 0.04 0.10 0.06 0.04

# of SA Admissions that were Readmissions within 30 days 0 1 0 1 3 0 2 7

% of SA Admissions that were Readmissions within 30 days o 0% 3% 0% 20% 14% 0% 13% 7% 7.7%

# of SA Inpatient Discharges 2 24 7 5 25 7 15 85

SA Inpt Average Length of Stay (days) o 7.0 6.9 5.7 7.4 5.5 4.0 4.1 5.7 1.27

Care Coordination Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

# of MH and SA Readmits assigned to a Care Coordinator 15 16 27 9 13 27 33 140

% of Readmits assigned to Care Coordination 85.0% 83.3% 94.1% 100.0% 100.0% 100.0% 87.1% 100.0% 94.6%

Emergency Dept Utilization (3 month lag) Aug-18 Aug-18 Aug-18 Aug-18 Aug-18 Aug-18 Aug-18 Aug-18

# of ED Admits for persons with MHDDSA diagnoses 294 1034 287 305 341 380 423 3,064

Rate of ED Admits per 1,000 Medicaid Members o 1.32 2.28 1.83 2.07 2.00 1.75 2.62 2.1 0.38

# of ED Admits for persons who are active consumers 96 580 98 179 127 202 173 1,455

% of ED Admits that were for active consumers o 33% 56% 34% 59% 37% 53% 41% 47% 10.2%

# of ED Admits which were readmissions within 30 days 40 230 44 65 60 18 73 530

% of ED Admissions Readmitted within 30 days o 14% 22% 15% 21% 18% 5% 17% 17.3% 5.4%

Authorization Requests Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

Total Number of Auth Requests Received 4,290 6,236 2,387 3,304 2,593 2,402 2,659 23,871

# Standard Auth. Request Decisions 3,714 5,070 1,829 3,149 2,138 1,493 1,990 19,383

# Standard Auth Requests Processed in 14 Days 3,710 5,050 1,829 3,138 2,138 1,493 1,990 19,348

% Processed in 14 Days 95.0% 99.9% 99.6% 100.0% 99.7% 100.0% 100.0% 100.0% 99.8% 0.2%

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 576 1,166 558 155 455 909 669 4,488

# Expedited and Inpatient Auth Requests Processed in 3 Days 574 1,164 558 155 455 905 669 4,480

% Processed in 3 Days 95.0% 99.7% 99.8% 100.0% 100.0% 100.0% 99.6% 100.0% 99.8% 0.2%

Total % of Auth Requests Processed in Required Timeframes 95.0% 99.9% 99.6% 100.0% 99.7% 100.0% 99.8% 100.0% 99.8% 0.1%

Page 4 of 7 of 85

NCDMHDDSAS

MCO Monthly Monitoring Report November 2018 Report

Medicaid Only 12/20/2018

LME/MCO:

Monitoring Area Standard Alliance Cardinal Eastpointe Partners Sandhills Trillium Vaya Statewide STD DEV

# of Auth Requests Denied for Clinical Reasons 68 212 99 169 33 8 46 635

% of Total Auth Requests Denied for Clinical Reasons o 1.6% 3.4% 4.1% 5.1% 1.3% 0.3% 1.7% 2.7% 1.6%

# of Administrative Denials 32 1 23 39 - 44 18 157

% of Total Auth Requests Denied for Admin Reasons o 0.7% 0.0% 1.0% 1.2% 0.0% 1.8% 0.7% 0.7% 0.6%

Total # of Auth Requests Denied 100 213 122 208 33 52 64 792

% of Total Auth Requests Approved o 97.7% 96.6% 94.9% 93.7% 98.7% 97.8% 97.6% 96.7% 1.7%

Number of Consumer Authorization Appeals received 6 54 9 23 4 9 21 126

Rate of Consumer Auth. Appeals per 1,000 persons svd o 0.4 1.9 1.2 2.0 0.3 0.7 1.7 1.3 0.65

Number of Authorizations overturned due to Consumer Appeals - 21 1(partial) - 1 1 3 26

Claims 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15

Total # Clean Claim Received during Month (detail lines) 111,016 212,729 60,417 78,883 59,270 102,931 105,315 730,561

Rate of Claims Rcpt per Person Served o 7.5 7.5 7.8 6.9 5.0 8.4 8.7 7.4 1.12

# Paid 103,760 200,804 52,058 70,427 57,809 96,616 91,071 672,545

# Denied 7,255 11,925 8,359 8,454 1,461 6,313 14,135 57,902

# Pended or in Process 1 0 - 2 - 2 109 114

Percent Denied o 6.5% 5.6% 13.8% 10.7% 2.5% 6.1% 13.4% 7.9% 4.0%

# Paid or Denied within 30 Days 109,747 212,710 59,167 78,883 59,270 102,929 102,525 725,231

Percent Processed within 30 Days 90.0% 98.9% 100.0% 97.9% 100.0% 100.0% 100.0% 97.4% 99.5% 1.0%

Avg # days for Processing (from Receipt to Payment ) o 8 8 9 9 9 7 9 8.4 0.75

Number of Provider claim Appeals received 23 2 0 0 0 0 36 61

Rate of Provider Claim appeals per 1,000 persons served o 1.6 0.1 0.0 0.0 0.0 0.0 3.0 0.6 1.08

Number of claim denials overturned due to Provider Appeals 23 0 0 0 0 0 4 27

Complaints/Grievances Oct-18 Oct-18 Oct-18 Oct-18 Oct-18 Oct-18 Oct-18 Oct-18

Total number of complaints received (1 month prior) 60 45 10 7 19 11 19 171

Rate of Complaints per 1,000 Persons Served o 3.11 1.39 1.00 0.53 1.41 0.64 1.27 1.7 0.80

# Consumer complaints against provider 24 29 3 2 10 10 13 91

% Consumer complaints against provider o 40% 64% 30% 29% 53% 91% 68% 53% 21.0%

# Consumer complaints against LME/MCO 3 16 2 4 6 1 4 36

% Consumer complaints against LME/MCO o 5% 36% 20% 57% 32% 9% 21% 21% 16.4%

# Provider complaints against LME/MCO 1 0 - 1 - - 2 4

% Provider complaints against LME/MCO o 2% 0% 0% 14% 0% 0% 11% 2% 5.6%

# of Other Types of Complaints 32 0 5 - 3 - - 40

# of Complaints Resolved in 30 Days 59 45 10 7 19 11 19 170

Percent of Complaints resolved in 30 days 90.0% 98.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.4%

Program Integrity--Fraud, Waste and Abuse Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

Number of Provider fraud and abuse cases under investigation by

LME/MCO-New8 24 10 4 5 10 5 66

Number of Provider fraud and abuse cases under investigation by

LME/MCO-Ongoing from previous month33 50 10 62 5 3 113 276

Number of Enrollee fraud and abuse cases investigated by LME/MCO 0 0 0 0 0 0 1 1

Number of Cases Referred to DMA Program Integrity 1 0 0 0 1 0 0 2

Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3

consecutive months.



Page 5 of 7 of 85

NCDMHDDSAS


State/Federal Block Grant Only 12/20/2018

LME/MCO:

Monitoring Areas Standard Alliance Cardinal Eastpointe Partners Sandhills Trillium Vaya Statewide STD DEV

Persons Served Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

Estimated number of Uninsured in Catchment Area 167,581 311,096 84,198 93,680 113,741 137,401 114,321 1,022,018

# Persons Receiving MH Services 2,541 3,476 1,404 1,708 1,903 2,361 2,193 15,586

% of Uninsured Receiving MH Services o 1.5% 1.1% 1.7% 1.8% 1.7% 1.7% 1.9% 1.5% 0.24%

# Persons Receiving SA Services 1,029 2,094 669 1,230 772 1,831 1,351 8,976

% of Uninsured Receiving SA Services o 0.6% 0.7% 0.8% 1.3% 0.7% 1.3% 1.2% 0.9% 0.30%

# Persons Receiving DD Services 614 830 436 411 543 423 227 3,484

% of Uninsured Receiving DD Services o 0.4% 0.3% 0.5% 0.4% 0.5% 0.3% 0.2% 0.3% 0.11%

Unduplicated # Persons Receiving MH/DD/SA Services 4,102 6,045 2,311 3,131 3,218 3,907 3,673 26,387

% of Uninsured Receiving MH/DD/SA Services o 2.4% 1.9% 2.7% 3.3% 2.8% 2.8% 3.2% 2.6% 0.43%

Community Psychiatric Hospitalization (1) Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

# of MH Admissions to Community Psychiatric Inpatient 95 306 35 78 99 171 138 922

Rate of MH Admissions per 1,000 Uninsured o 0.57 0.98 0.42 0.83 0.87 1.24 1.21 0.90 0.28

# of MH Admissions that were Readmissions within 30 days 4 12 1 9 6 9 24 65

% of MH Admissions that were Readmissions within 30 days o 4% 4% 3% 12% 6% 5% 17% 7.0% 4.87%

# of MH Inpatient Discharges 138 174 42 81 112 186 136 869

MH Inpt Average Length of Stay (days) o 8.0 7.3 6.0 5.5 3.1 6.8 6.3 6.4 1.46

# of SA Admissions to Community Psychiatric Inpatient 11 45 7 18 23 26 29 159

Rate of SA Admissions per 1,000 Uninsured o 0.07 0.14 0.08 0.19 0.20 0.19 0.25 0.16 0.06

# of SA Admissions that were Readmissions within 30 days 1 2 0 2 0 1 2 8

% of SA Admissions that were Readmissions within 30 days o 9% 4% 0% 11% 0% 4% 7% 5% 4.0%

# of SA Inpatient Discharges 16 28 10 21 25 24 31 155

SA Inpt Average Length of Stay (days) o 6.5 7.3 4.4 4.3 4.1 5.9 5.3 5.5 1.13

Authorizations Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18 Nov-18

Total Number of Auth Requests Received 1,119 2,422 592 1,863 1,161 625 792 8,574

# Standard Auth. Request Decisions 831 1,492 403 1,605 746 214 245 5,536

# Standard Auth Requests Processed in 14 Days 831 1,482 403 1,604 746 214 245 5,525

% Processed in 14 Days 95.0% 100.0% 99.3% 100.0% 99.9% 100.0% 100.0% 100.0% 99.8% 0.00

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 288 930 189 258 415 411 547 3,038

# Expedited and Inpatient Auth Requests Processed in 3 Days 287 924 189 258 415 411 547 3,031

% Processed in 3 Days 95.0% 99.7% 99.4% 100.0% 100.0% 100.0% 100.0% 100.0% 99.8% 0.00

Total % of Auth Requests Processed in Required Timeframes 95.0% 99.9% 99.3% 100.0% 99.9% 100.0% 100.0% 100.0% 99.8% 0.00

# of Auth Requests Denied for Clinical Reasons 12 20 11 9 6 1 7 66

% of Total Auth Requests Denied for Clinical Reasons o 1.1% 0.8% 1.9% 0.5% 0.5% 0.2% 0.9% 0.8% 0.5%

# of Administrative Denials - 5 10 13 - 8 2 38

% of Total Auth Requests Denied for Admin Reasons o 0.0% 0.2% 1.7% 0.7% 0.0% 1.3% 0.3% 0.4% 0.6%

Total # of Auth Requests Denied 12 25 21 22 6 9 9 104

% of Total Auth Requests Approved o 99% 99% 96% 99% 99% 99% 99% 99% 0.9%

Number of Consumer Authorization Appeals received - 1 - 3 - - - 4

Rate of Consumer Auth. Appeals per 1,000 persons svd o 0.0 0.2 0.0 1.0 0.0 0.0 0.0 0.2 0.33

Number of Authorizations overturned due to Consumer Appeals - 1 - - - - - 1

Page 6 of 7 of 85

mailto:Beyonce@19

NCDMHDDSAS


State/Federal Block Grant Only 12/20/2018

LME/MCO:

Monitoring Areas Standard Alliance Cardinal Eastpointe Partners Sandhills Trillium Vaya Statewide STD DEV

Claims 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15 10/16 - 11/15

Total # Clean Claim Received during Month (header) 29,702 37,786 12,773 20,769 8,211 22,468 22,384 154,093

Rate of Claims Rcpt per Person Served o 7.24 6.25 5.53 6.63 2.55 5.75 6.09 5.84 1.40

# Paid 27,010 34,124 11,612 18,557 8,066 20,343 17,555 137,267

# Denied 2,692 3,662 1,161 2,212 145 2,125 4,828 16,825

# Pended or in Process 0 - - - 1 1

Percent Denied o 9.1% 9.7% 9.1% #VALUE! 1.8% 9.5% 21.6% 10.9% #VALUE!

# Paid or Denied within 30 Days 29,281 37,786 12,773 20,769 8,211 22,468 21,457 152,745

Percent Processed within 30 Days 90.0% 98.6% 100.0% 100.0% 100.0% 100.0% 100.0% 95.9% 99.1% 0.01

Avg # days for Processing (from Receipt to Payment ) o 9.0 8.4 10.8 8.6 9.0 7.1 8.5 8.8 1.01

Complaints Oct-18 Oct-18 Oct-18 Oct-18 Oct-18 Oct-18 Oct-18 Oct-18

Total number of complaints received (1 month prior) 8 12 2 2 - 3 - 27

Rate of Complaints per 1,000 Persons Served o 1.33 1.59 0.78 0.55 - 0.59 - 1.02 0.56

# Consumer complaints against provider 2 10 - 1 - 1 - 14

% Consumer complaints against provider o 25% 83% 0% 50% 33% 52% 27.7%

# Consumer complaints against LME/MCO - 0 - 1 - - - 1

% Consumer complaints against LME/MCO o 0% 0% 0% 50% 0% 4% 20.0%

# Provider complaints against LME/MCO - 0 1 - - - - 1

% Provider complaints against LME/MCO o 0% 0% 50% 0% 0% 4% 20.0%

# of Other Types of Complaints 6 2 1 - - 2 - 11

# of Complaints Resolved in 30 Days 8 12 2 2 - 3 - 27

Percent of Complaints resolved in 30 days 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% -

Yellow Highlights indicate the MCO did not meet the Standard

(1) Community Psychiatric Hospitalization includes 3-Way Contract funded beds, which are not distributed evenly across LME-MCO catchment areas, and may impact utilzation rates.

Pink Highlights indicate the MCO did not meet the Standard for 3

consecutive months.



Page 7 of 7 of 85

mailto:Beyonce@19

Save the date!STATEWIDE

CONSUMER & FAMILY ADVISORY COMMITTEE

MEETINGMonday, April 1, 2019

9 a.m. to 3 p.m.Sign-in begins at 8:30 a.m.Lunch provided to registered guests.

Location: The Lusk Center2501 Summit Ave.Greensboro, NC

(Across from Hospice and Palliative Care)

Special Guests: Dave Richard, DHHSKathy Nichols, DHHS

Victoria Whitt, Sandhills Center

Hosted by the

CFAC

Registration is required no later than March 25.To register, go to:

https://statewidecfacmeeting.eventbrite.com For more information, contact Sandra Dunlap at

[email protected] or call (336) 389-6219.

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5B

(Back to agenda)


Agenda Action Form

ITEM: Finance Committee Report DATE OF BOARD MEETING: March 7, 2019 BACKGROUND: The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Board. The Finance Committee meets monthly at 3:00 p.m. prior to the regular Board Meeting. This month’s report includes the draft minutes from the February 7, 2019, meeting, the Summary of Savings/(Loss) by Funding Source, the Statement of Revenue and Expenses (budget to actual) report and ratios for the period ending January 31, 2019 and recommendations to the Board to approve all presented contracts over $250,000. REQUEST FOR BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Christopher Bostock, Committee Chair; Kelly Goodfellow, Executive Vice-President/Chief Financial Officer

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Next Meeting: Thursday, April 4, 2019 from 3:00-4:00 Alliance Health

5200 W. Paramount Parkway Morrisville, NC 27560

Finance Committee Meeting Thursday, March 7, 2019

3:00-4:00 pm

AGENDA

1. Review of the Minutes – February 7, 2019

2. Monthly Financial Reports as of January 31, 2019

a. Summary of Savings/(Loss) by Funding Sourceb. Statement of Revenue and Expenses (Budget & Actual)c. Senate Bill 208 Ratiosd. DMA Contractual Ratios

3. Approval of Contract(s)

4. Adjournment

Finance Committee Meeting 3/7/19 Meeting Packet Page 1 of 9 of 85

Thursday, February 07, 2019 BOARD FINANCE COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 2:30-4:00 p.m.


APPOINTED MEMBERS PRESENT: ☒Cynthia Binanay, MA, Board Chair, ☒Chris Bostock, BSIM (Committee Chair), ☐Gino Pazzaglini, MSW, ☒ Lascel Webley, MBA, MHA ☐ David Hancock

BOARD MEMBERS PRESENT: n/a GUEST(S) PRESENT: Mary Hutchings, Wake County Internal Audit STAFF PRESENT: Robert Robinson, CEO (LCAS); Kelly Goodfellow, Executive Vice-President/Chief Financial Officer; Sara Pacholke, Senior Vice-President/Financial Operations (BS, CPA), Sean Schreiber, SVP-Provider Network and Evaluation


2. REVIEW OF THE MINUTES – The minutes from the December 6, 2018, meeting were reviewed; a motion was made by Chair Cynthia Binanay and

seconded by Mr. Lascel Webley to approve the minutes. Motion passed unanimously.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Monthly Financial

Reports The monthly financial reports were discussed which includes the Statement of Net Position, Summary of Savings/(Loss) by Funding Source, the Statement of Revenue and Expenses, Senate Bill 208 Required Ratios, and DMA Contract Ratios as of December 31, 2018. Ms. Sara Pacholke discussed the monthly reports.

• Total assets of $173M with $113.7M being current. A large portion are unspendable due to being comprised of the required risk reserve, investments, or accounts receivable.

• Total Liabilities of $68.3M with $59.8M being current • Total net position is $104.7M, which is a decrease of $8.1M from 6/30/18. • As of 12/31/18, we have a loss of $8.1M and need $11.8M from fund

balance to offset legislative reductions. The loss will continue to grow during FY19 due to legislative cuts.

a) We are meeting all SB208 and DMA contract ratios.

4. Approval of Contracts Ms. Sara Pacholke went over three current informal IFB’s that Alliance has outstanding related to the Child facility based crisis building in Fuquay-Varina:

• IFB 19-004 Phase A – Interior Demolition & Asbestos Abatement. Total estimated cost is $334,468, which includes a 5% construction contingency.

o A motion was made by Chair Cynthia Binanay and seconded by Mr. Lascel Webley to recommend to the Board to authorize the CEO to enter into a contract for interior demolition and abatement for the child facility based crisis building in Fuquay-Varina for an amount not to exceed $335,000. Motion passed unanimously.

• IFB 19-005 Phase B – Roof Replacement. Total estimated cost is $272,347, which includes a 5% construction contingency.

Bring recommendations to the Board. Obtain answer regarding reason for roof cost.

2/7/19 Board Meeting When meeting minutes are sent out.

Finance Committee Meeting 3/7/19

Meeting Packet Page 2 of 9 of 85



AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: o Mr. Lascel Webley asked if the roof cost was due to the asbestos or

the size. Ms. Sara Pacholke will follow up with the Facilities Director with an answer.

o A motion was made by Chair Cynthia Binanay and seconded by Mr. Lascel Webley to recommend to the Board to authorize the CEO to enter into a contract for roof replacement for the child facility based crisis building in Fuquay-Varina for an amount not to exceed $273,000. Motion passed unanimously.

• IFB 19-006 Phase C – Pavement Repair. Total estimated cost is $193,910, which includes a 5% construction contingency.

o A motion was made by Chair Cynthia Binanay and seconded by Mr. Lascel Webley to recommend to the Board to authorize the CEO to enter into a contract for pavement repair for the child facility based crisis building in Fuquay-Varina for an amount not to exceed $194,000. Motion passed unanimously.

5. Quarterly Updates Ms. Kelly Goodfellow went over the quarterly updates.

• Reinvestment plan – we have spent approximately $872,000 year to date. As the Durham Recovery Response building construction wraps up and the child facility building construction starts this amount will increase.

• Solvency standards – still waiting on write up from the State for the first quarter requirement. The next quarterly solvency standard review is coming up.

• PMPM & Eligible lives – the state has recouped additional amounts in February. We are still working with the State to resolve the issue.

Non-Medicaid – We show a variance of budgeted State dollars to projected spending of $5.5M. Majority of this is due to allocations received mid-way through the year. We are attempting to spend, but might not due to when we received the allocation letters. Areas that are over or under spending were discussed as well as proposed transfers within non-Medicaid, State and Federal funding.

6. Budget Transfer Request

Based on the non-Medicaid report as of 12/31/18, recommended transfers were presented. The net impact to the budget is zero. This moves budgeted amounts between Federal and State line items. A motion was made by Chair Cynthia Binanay and seconded by Mr. Lascel Webley to recommend to the board in accordance with Board policy BO-19, Budget Transfers, to approve the following transfers within the non-Medicaid budget related to State and Federal funding:

• Increase Assertive Community Treatment Team (ACTT) by $315,000 • Increase Personal Assistance by $410,000

Bring recommendation to the Board.

2/7/19 Board meeting





AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: • Decrease Residential Services/Supervised Living by $700,000 • Decrease Placeholder for rate increases by $850,000 • Increase Adult Developmental Vocational Program (ADVP) by $1,000,000 • Decrease Intensive in Home (IIH) by $100,000 • Decrease Multi Systemic Therapy (MST) by $75,000

The motion passed unanimously. 7. Budget Retreat The budget retreat will be held on March 19th at 12:30. Ms. Kelly Goodfellow

reminded the Committee that the goal of the budget retreat is to provide the Board with information so that they can approve the recommended budget. The planned discussion topics for the upcoming budget retreat are:

• Financial review • Medicaid services - spending, budget, and strategy • Non-Medicaid services – budget and changes for FY20

Tailored Plan – this will be a large focus of the retreat

8. Wake Adult Crisis Building

It was discussed that alternative funding options were exhausted so the recommendation is to sell the building. We previously had an interested buyer who has seen the building twice. A motion was made by Mr. Lascel Webley and seconded by Chair Cynthia Binanay to recommend to the Board to authorize the CEO to take the necessary actions to market and sell the property. The motion passed unanimously.

Bring recommendation to the Board.

2/7/19 Board meeting

9. Closed Session The Finance Committee held a closed session pursuant to NC General Statute 143-318-11 (a) 1. A motion was made by Chair Cynthia Binanay and seconded by Mr. Lascel Webley to close the meeting pursuant to NC General Statute 143-318.11 (a) 1 to prevent the disclosure of information that is privileged or confidential pursuant to the law of this State or of the United States, or not considered a public record within the meaning of Chapter 132 of General Statutes. The motion passed unanimously. All guests were asked to leave. The Committee returned to open session.

4. ADJOURNMENT: next meeting will be March 7, 2019, from 3:00 p.m. to 4:00 p.m.





Respectfully Submitted by: Click here to enter text. Date Approved



Fund Balance Revenue Expense Savings/(Loss)

Medicaid Waiver Services -$ 222,504,332$ 223,659,488$ (1,155,156)$

Federal & State Grants 13,355,030 21,738,420 35,093,450 (0)

Local Grants - 18,114,235 18,117,252 (3,017)

Administrative - 33,873,424 34,169,882 (296,458)

Total 13,355,030$ 296,230,411$ 311,040,072$ (1,454,631)$

Less Amount from Fund Balance (13,355,030)$

Net Savings/(Loss) (14,809,661)$

June 30, 2018 Change January 31, 2019

Investment in Fixed Assets 4,409,429 283,810 4,693,239

Restricted - Risk Reserve 43,027,793 4,998,773 48,026,566

Restricted - Other 5,856,438 1,203,393 7,059,831

Committed

Legislative Reductions 25,141,196 (13,355,030) 11,786,166

Intergovernmental Transfer 3,007,817 (1,754,560) 1,253,257

Reinvestment 18,769,500 (1,152,089) 17,617,411

Total Committed 46,918,513 (16,261,679) 30,656,834

Unrestricted 12,723,765 (5,033,958) 7,689,807

Total Fund Balance 112,935,938 (14,809,661) 98,126,277

Summary of Savings/(Loss) by Funding Source as of January 31, 2019

Fund Balance as of January 31, 2019



% Received/

Budget Current Period Year to Date Balance Expended

REVENUES

Local Grants $37,931,390.00 $3,257,553.36 $18,114,235.29 $19,817,154.71 47.76%

State & Federal Grants 77,881,018.00 3,572,760.81 21,738,419.58 56,142,598.42 27.91%

Medicaid Waiver Services 379,107,645.00 30,241,558.83 222,504,331.81 156,603,313.19 58.69%

Total Revenue $494,920,053.00 37,071,873.00 262,356,986.68 232,563,066.32 53.01%

Administrative

Local Administration 369,054.00 33,273.33 232,916.04 136,137.96 63.11%

LME Administrative Grant 4,359,385.00 363,283.00 2,542,981.08 1,816,403.92 58.33%

Medicaid Waiver Administration 55,780,727.00 4,128,211.95 30,348,771.59 25,431,955.41 54.41%

Miscellanous Revenue 885,000.00 107,721.21 748,755.20 136,244.80 84.61%

Total Administrative Revenue 61,394,166.00 4,632,489.49 33,873,423.91 27,520,742.09 55.17%

Total Revenues $556,314,219.00 41,704,362.49 296,230,410.59 260,083,808.41 53.25%

EXPENSES

Local Services 37,931,390.00 3,257,553.36 18,117,252.27 19,814,137.73 47.76%

State & Federal Services 77,881,018.00 5,088,247.93 35,093,449.77 42,787,568.23 45.06%

Medicaid Waiver Services 379,107,645.00 33,970,935.36 223,659,487.79 155,448,157.21 59.00%

Total Service Expenses 494,920,053.00 42,316,736.65 276,870,189.83 218,049,863.17 55.94%

Administrative

Operational 7,832,123.51 1,090,596.71 5,455,378.24 2,376,745.27 69.65%

Salaries, Benefits, and Fringe 44,912,299.33 4,217,940.75 26,164,853.07 18,747,446.26 58.26%

Professional Services 7,764,743.16 715,418.60 2,549,650.38 5,215,092.78 32.84%

Miscellanous Expense 885,000.00 - - 885,000.00 0.00%

Total Administrative Expenses 61,394,166.00 6,023,956.06 34,169,881.69 27,224,284.31 55.66%

Total Expenses 556,314,219.00 48,340,692.71 311,040,071.52 245,274,147.48 55.91%

CHANGE IN NET POSITION ($6,636,330.22) ($14,809,660.93)

Statement of Revenue and Expenses (Budget and Actual) - As of January 31, 2019



Senate Bill 208 Ratios - As of January 31, 2019

100.00% 100.00% 99.98% 100.00% 100.00% 99.98%

86%

88%

90%

92%

94%

96%

98%

100%

102%

A U G - 1 8 S E P - 1 8 O C T - 1 8 N O V - 1 8 D E C - 1 8 J A N - 1 9

PERCENT PAID

Bench Mark Alliance

Percent Paid = Percent of clean claims paid within 30 days of receiving. The requirement is 90% or greater.

Current Ratio = Compares current assets to current liabilities. Liquidity ratio that measures an organization's ability to pay short term oblications. The requirement is 1.0 or greater.

2.45

2.14 2.15

1.97 1.921.86

0.00

0.50

1.00

1.50

2.00

2.50

3.00


CURRENT RATIO

Bench Mark Alliance



DMA Ratios - As of January 31, 2019

58.2260.16

52.16 52.15

59.50

54.97

0

10

20

30

40

50

60

70


DEFENSIVE INTERVAL

Bench Mark Alliance

Defensive Interval = Cash + Current Investments divided by average daily operating expenses. This rato shows how manydays the organization can continue to pay expenses if no additional cash comes in. The requirement is 30 days or greater.

93.23%

94.67%93.70%

95.14%

90.20%

91.88%

75%

80%

85%

90%

95%

100%


MEDICAL LOSS RATIO

Bench Mark MLR

Medical Loss Ratio (MLR) = Total Services Expenses plus Administrative Expenses that go towards directly improving health outcomes divided by Total Medicaid Revenue. The requirement is 85% or greater cumulative for the rating period (7/1/17-6/30/18).


Meeting Packet Page 9 of 9

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6A

(Back to agenda)


Agenda Action Form

ITEM: Draft Minutes from the February 7, 2019, Board Meeting DATE OF BOARD MEETING: March 7, 2019 REQUEST FOR BOARD ACTION: Approve the draft minutes from the February 7, 2019, meeting.

CEO RECOMMENDATION: Approve the minutes. RESOURCE PERSON(S): Robert Robinson, CEO; Veronica Ingram, Executive Assistant II

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Thursday, February 07, 2019 AREA BOARD REGULAR MEETING 4600 Emperor Boulevard, Durham, NC, 27703 4:00-6:00 p.m.

Page 1 of 5

MEMBERS PRESENT: ☒Glenn Adams, Cumberland County Commissioner, JD (via phone; exited at 5:02 pm), ☒Cynthia Binanay, Chair, MA, BSN, ☒Christopher Bostock, BSIM (via phone after 5:53 pm), ☒Tony Braswell, Johnston County Commissioner, ☐Heidi Carter, Durham County Commissioner, MPH, MS, ☐George Corvin, Vice-Chair, MD, ☒David Curro, BS, ☒Greg Ford, Wake County Commissioner, MA, ☒Lodies Gloston, MA (entered at 4:14 pm), ☒David Hancock, MBA, MPAff (entered at 4:12 pm), ☒Duane Holder, MPA, ☒D. Lee Jackson, BA, ☒Curtis Massey, JD (entered at 5:33 pm), ☐Donald McDonald, MSW, ☒Lynne Nelson, BS, ☐Gino Pazzaglini, MSW LFACHE, ☒Pam Silberman, JD, DrPH, ☒Lascel Webley, Jr., MBA, MHA, and ☒McKinley Wooten, Jr., JD

GUEST(S) PRESENT: Dorothy Best, Johnston CFAC; Janet Conner-Knox, A Caring Heart, LLC; Albert Dixon, Johnston CFAC; Jerry Dobson, Johnston CFAC; Yvonne French, NC DMH (Department of Health and Human Services/Department of Mental Health, Developmental Disabilities and Substance Abuse Services); Cassandra Herbert, Johnston CFAC; Mary Hutchings, Wake County Finance Department; Marilyn Pearson, Director of Johnston County Public Health Department; Jason Phipps, Johnston CFAC; and Steve Strickland, Assistant Director of Johnston County Public Health Department ALLIANCE STAFF PRESENT: Brandon Alexander, Communications and Marketing Specialist II; Lori Caviness, Community Relations Manager; Terrasine Gardner, Community Relations Manager; Kelly Goodfellow, Executive Vice-President/Chief Finance Officer; Veronica Ingram, Executive Assistant II; Beth Melcher, Executive Vice-President/Care Management; Ann Oshel, Senior Vice-President/Community Relations; Sara Pacholke, Senior Vice-President/Financial Operations; Brian Perkins, Senior Vice-President/Strategy and Government Relations; Monica Portugal, Chief Compliance Officer; Robert Robinson, Chief Executive Officer; Sean Schreiber, Senior Vice-President/Provider Network and Evaluation; Sara Wilson, Government Relations Director; Carol Wolff, General Counsel; and Doug Wright, Director of Community and Member Engagement 1. CALL TO ORDER: Chair Cynthia Binanay called the meeting to order at 4:05 p.m.

AGENDA ITEMS: DISCUSSION: 2. Oath of Office Veronica Ingram, notary public, administered the oath of office to new Board member and Johnston County Commissioner, Tony

Braswell. 3. Announcements Commissioner Braswell introduced himself and Johnston County staff, Dr. Marilyn Pearson and Mr. Strickland. The following Johnston

CFAC representatives were present and introduced themselves: Dorothy Best, Albert Dixon, Jerry Dobson, Cassandra Herbert, and Jason Phipps. Mr. Robinson reminded attendees of Alliance’s name change. The change is due to NC Medicaid Transformation and Alliance’s changing role to be responsible for whole person care for individuals specified by the NC General Assembly via the Tailored Plans. He also reminded Board members of the upcoming Board budget retreat, which is scheduled for March 19, 2019. Ms. Wolff announced that on February 4, 2019, the Town of Fuquay-Varina unanimously approved Alliance’s rezoning request for Alliance’s child crisis facility located at 400 W Ransom Street, Fuquay-Varina. Such approval however was made subject to a Release and Waiver of claims against the Town for the prior Board of Adjustment action as well as the prior zoning issues. Ms. Wolff clarified that the new zoning approval would make prior zoning issues moot, and that the Board of Adjustment appeal period ran out back in January. Therefore, the Release was a formality that the Town requested.

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Page 2 of 5

AGENDA ITEMS: DISCUSSION: BOARD ACTION: A motion was made by Ms. Nelson to certify that the board release and waive all claims associated with the prior Board of Adjustment action as well as the prior zoning issues. Motion seconded by Mr. Jackson. Motion passed unanimously.

4. Agenda Adjustments There were no adjustments to the agenda. 5. Public Comment There were no public comments. 6. Committee Reports A. Consumer and Family Advisory Committee – page 3

The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from Durham, Wake, Cumberland and Johnston Counties who receive mental health, intellectual/developmental disabilities or substance use/addiction services. This month’s report included draft subcommittee minutes and supporting documents from the Steering Committee and the Durham, Wake and Johnston Committees. Dave Curro, CFAC Chair, presented the report, which included an update from the recent Steering Committee meeting, a review of Alliance KPIs (key performance indicators), and reports from Alliance staff. He also mentioned Johnston CFAC’s showing of the movie, “Resilience,” input from attendees and Mark Botts’ (UNC School of Government) presentation at the State CFAC meeting. The CFAC annual retreat is in March 2019; Mr. Curro invited Board members to the annual retreat and encouraged County Commissioners to attend a local CFAC meeting. The CFAC report is attached to and made part of these minutes. BOARD ACTION The Board received the report.

B. Finance Committee – page 49 The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Area Board. This month’s report included draft minutes from the December 6, 2018, meeting, the Statement of Net Position, budget to actual report and ratios for the period ending December 31, 2018, and recommendations to the Board to approve all presented contracts over $250,000. Christopher Bostock, Committee Chair, presented the report. Mr. Bostock mentioned that expenses exceeded revenue due to continued reduction in State Single Stream funding. All State mandated ratios were met. Mr. Bostock presented the Finance Committee’s recommendations on a budget transfer and contracts for the Board to approve. Ms. Goodfellow provided background on the proposed budget transfer. The Finance Committee report is attached to and made part of these minutes.

Proposed Budget Transfers as of 12.31 BOARD ACTION A motion was made by Mr. Bostock to approve the proposed transfers within the non-Medicaid budget related to State and Federal funding as presented; motion seconded by Ms. Gloston. Motion passed unanimously. A motion was made by Mr. Bostock to authorize the CEO to enter a contract for asbestos removal (at 400 W. Ransom Street,

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Page 3 of 5

AGENDA ITEMS: DISCUSSION: Fuquay-Varina) not to exceed $335,000; motion seconded by Ms. Nelson. Motion passed unanimously. A motion was made by Commissioner Ford to authorize the CEO to enter a contract for roof repair (at 400 W. Ransom Street, Fuquay-Varina) not to exceed $273,000; motion seconded by Ms. Gloston. Motion passed unanimously. A motion was made by Mr. Bostock to authorize the CEO to enter a contract for pavement repair (at 400 W. Ransom Street, Fuquay-Varina) not to exceed $194,000; motion seconded by Ms. Nelson. Motion passed unanimously.

7. Consent Agenda A. Draft Minutes from December 6, 2018, Board Meeting – page 58 B. Audit and Compliance Committee Report – page 63 C. County Commissioners Advisory Board Report – page 71 D. Executive Committee Report – page 74 E. Human Rights Committee Report – page 78 F. Network Development and Services Committee Report – page 108 The consent agenda was sent as part of the Board packet. There were no comments or discussion about the consent agenda. BOARD ACTION A motion was made by Mr. Webley to approve the consent agenda; motion seconded by Commissioner Ford. Motion passed unanimously.

8. Training/ Presentation: Complete Care Model

Alliance is implementing a population health model called Alliance Complete Care to more effectively support and manage the populations we serve, achieve better health outcomes, and prepare for the transition to a Tailored Plan in NC Medicaid reform. Beth Melcher, Executive Vice-President/Care Management, presented the model, which utilizes data analytics to risk stratify populations and takes a comprehensive care approach to incorporate effective interventions, engagement and self-management strategies, physical health, and social determinants of health (SDoH). The model envisions creating multi-disciplinary teams responsible for implementing this population management model. Dr. Melcher shared background for developing this model and action taken to implement the model. She shared how this process will increase efficiency, how the organization has undergone reorganization to best reflect this initiative and the benefit this process will provide for the people Alliance serves. Board members discussed the State’s SDoH pilot and how it relates to the work currently performed by Alliance to address SDoH. BOARD ACTION The Board accepted the training/presentation.

9. Annual Compliance Report – page 112

The Alliance compliance program is designed to deter and mitigate risk to the organization through prevention, detection and remediation activities. It is intended that the scope of all compliance activities promotes integrity, ensures objectivity, fosters trust and supports the stated values of Alliance Behavioral Healthcare. In accordance with contractual obligations and federal regulations, Alliance shall have an effective compliance program with reasonable oversight by the governing board; understanding the scope and operations of the compliance program. The Board approved Corporate Compliance Plan states that a report of compliance efforts will be presented annually to the Alliance Behavioral Healthcare Area Board.

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AGENDA ITEMS: DISCUSSION: Monica Portugal, Chief Compliance Officer, presented the report. Ms. Portugal mentioned elements of the Compliance Program, effectiveness of the program and training provided to staff and providers. She also provided a quantitative overview of incidents, network fraud/abuse reports, privacy/security, and elements of internal audit and monitoring. BOARD ACTION The Board accepted the report.

10. Sale of Property Located at 3309 Durham Drive, Raleigh – page 113

On September 21, 2016, Alliance purchased the property located at 3309 Durham Drive in Raleigh for the purpose of opening an additional adult crisis facility. Due to financial constraints and inability to sustain the services long term, the project did not proceed as planned. After due consideration of alternative options, it is recommended that Alliance cancel the plans for the crisis facility at this location and sell the property. The Board was therefore requested to authorize the CEO to take the necessary actions to market and sell the property. The final offer will be brought back to the Board for approval at a later date. Kelly Goodfellow, Executive Vice-President/Chief Financial Officer, presented the proposal. She mentioned that Alliance purchased this property in 2013 with the intent to use it as an adult crisis facility. With funding reductions, feasibility of the project was compromised. Alliance researched other avenues, including potential partnerships. BOARD ACTION A motion was made by Mr. Webley to authorize the CEO to market the property located at 3309 Durham Drive, Raleigh, NC (the final offer will be brought to the Board for approval); motion seconded by Mr. Bostock. Motion passed unanimously.

11. Legislative Priorities – page 114

Brian Perkins, Senior Vice-President/Strategy and Government Relations, and Sara Wilson, Director of Government Relations, presented an overview of the legislative priorities. Board members requested stating the agency’s support of Medicaid Expansion without requiring work requirements. The legislative priorities are attached to and made part of these minutes. BOARD ACTION A motion was made by Mr. Wooten to approve the 2019 legislative priorities with the recommended amendment; motion seconded by Commissioner Ford. Motion passed unanimously. Ms. Wilson reviewed the State’s Standard Plan, which was awarded February 5, 2019. Additional details of this Plan can be found at https://files.nc.gov/ncdhhs/medicaid/Medicaid-Factsheets-PHP-2.4.19.pdf. Ms. Wilson also reviewed the implementation timelines. BOARD ACTION The Board accepted the report. Mr. Robinson reviewed key elements of the audit conducted by the State, “Medicaid Capitation Rate Setting”; he also reviewed the agency’s perspective about the findings in this report. Mr. Perkins shared that this report was primarily focused on the Department’s (NC Department of Health and Human Services) management of NC MCOs (managed care organizations). BOARD ACTION

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https://files.nc.gov/ncdhhs/medicaid/Medicaid-Factsheets-PHP-2.4.19.pdf


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AGENDA ITEMS: DISCUSSION: The Board accepted the report.

12. Chair’s Report Chair Binanay reminded Board members that the next meeting is Thursday, March 7, 2019, at Alliance’s office at 5200 West Paramount Parkway in Morrisville, NC.

13. Closed Session(s) BOARD ACTION A motion was made by Commissioner Ford to enter closed session pursuant to NC § 143-318.11 (a) (3) and (a) (1) to consult with General Counsel regarding current litigation and to prevent the disclosure of information that is confidential and not a public record under NC § 122C-126.1; motion seconded by Mr. Wooten. Motion passed unanimously. The Board returned to open session.

14. Adjournment All business was completed; the meeting adjourned at 7:09 p.m.

Next Board Meeting Thursday, March 07, 2019

4:00 – 6:00 pm

Robert Robinson, Chief Executive Officer Date Approved

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(Back to agenda)

6B

ITEM: Audit and Compliance Committee Report DATE OF BOARD MEETING: March 7, 2019 BACKGROUND: The purpose of the Audit and Compliance Committee is to put forth a meaningful effort to review the adequacy of existing compliance systems and functions and to assist the Board in fulfilling its oversight responsibilities. This Committee report includes minutes from its February special meeting. REQUEST FOR AREA BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Lascel Webley, Committee Chair; Monica Portugal, Chief Compliance Officer

Alliance Behavioral Healthcare BOARD OF DIRECTORS

Agenda Action Form

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Monday, February 11, 2019

BOARD AUDIT AND COMPLIANCE COMMITTEE - SPECIAL MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 4:00-5:30 p.m.


APPOINTED MEMBERS PRESENT: ☒Christopher Bostock, BSIM, (phone) ☒ Duane Holder, MPA, (phone) ☒ Lascel Webley, Jr., MBA, MHA Committee Chair (phone)

BOARD MEMBERS PRESENT: Cynthia Binanay, MA, BSN, Chair; George Corvin, MD, Vice-Chair (phone) GUEST(S) PRESENT: None STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Joshua Knight, Internal Auditor


2. REVIEW OF THE MINUTES – No minutes were reviewed during this meeting.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Internal Audit Action Plan Committee reviewed and discussed corrective action plan submitted by department

management in response to an internal audit. Discussion took place to determine if action steps are of sufficient scope and appropriate to address the findings. Committee discussed next steps and expectation of improved results from the follow-up audit.

Management will implement the Action Plan; Compliance will conduct follow-up audit; results will be reported to this Committee.

Follow-up audit will be conducted in 6-12 months

4. Other Committee Chair introduced new conflict of interest disclosed by Board Member. A summary of the conflict was presented to the Committee. Board Chair Binanay requested that the matter be presented to the Executive Committee.

Conflict of Interest will be brought to Executive Committee.

Next Executive Committee meeting

5. ADJOURNMENT: next meeting will be February 27, 2019, from 4:00 p.m. to 6:00 p.m.

Respectfully Submitted by: Monica Portugal Date Approved

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6C

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Agenda Action Form

ITEM: Policy Committee Report DATE OF BOARD MEETING: March 7, 2019 BACKGROUND: Per Alliance Behavioral Healthcare Board Policy “Development of Policies and Procedures,” the Board is to review all policies annually. The Board Policy Committee reviews a number of Policies each quarter in order to meet this requirement. Policies reviewed at the December 13, 2018, Policy Committee meeting and ready for Board approval without revisions: CC1 Coordination of Care for Special Health Care Population CR1 Clients Rights to Dignity Privacy and Humane Care; CR2 Clients Right to Confidentiality; CR4 Advanced Directives Advanced Instructions CS1 Customer Services PN1 Selection and Retention of Providers; PN2 Letters of Support; PN3 Provision of Services by Relatives-Legal Guardians QM1 Consumer, Provider and Stakeholder Satisfaction; QM2 Management and Investigation of Grievances; QM3 Management of Incidents UM1 Accessibility of UR-UM Process; UM2 Pre-Review Screening for Certification; UM4 Utilization Review Process; UM5 Appealing Clinical Utilization Management Decisions Policies reviewed with recommended revisions: CR3 Consumer Choice; PN5 Rule Waiver Requests; UM3 Utilization Review Criteria; Policies reviewed and recommended to repeal: None REQUEST FOR BOARD ACTION: Accept the report. Accept Board Policy Committee minutes from the December meeting as submitted. As part of the annual review process approve the above listed policies for continued use. Approve the recommended changes to the above listed policies. CEO RECOMMENDATION: Accept the report. Approve the reviewed policies for continued use and approve the proposed revised policies. RESOURCE PERSON(S): Lodies Gloston, Committee Chair; Monica Portugal, Chief Compliance Officer

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Thursday, December 13, 2018 BOARD POLICY COMMITTEE - REGULAR MEETING 4600 Emperor Boulevard, Durham, NC 27703 4:00-6:00 p.m.


APPOINTED MEMBERS PRESENT: ☒Dave Curro, BS, ☒Lodies Gloston, MA (Committee Chair), (via teleconference) ☒Curtis Massey, JD (via teleconference) BOARD MEMBERS PRESENT: GUESTS PRESENT: STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Carol Wolff, General Counsel, Kathy Dempsey, Compliance Analyst 1. WELCOME AND INTRODUCTIONS 2. REVIEW OF THE MINUTES: The minutes from the November 8, 2018, meeting were reviewed; a motion was made by Mr. Dave Curro and seconded by Mr.

Dave Curro to approve the minutes. Motion passed unanimously.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 1. Care Coordination

Policies CC1 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

2. Client Rights Policies CR1 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

CR-2 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

CR-3 A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as revised. Motion passed unanimously.

CR4 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

In policy CR3, the bullets will be changed from Roman numerals to Arabic numerals before being presented to the Board of Directors for approval.

3. Customer Services Policies CS1 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

4. Provider Network Policies PN1 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. PN2- A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: PN3 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. PN5 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as revised. Motion passed unanimously.

In policy PN5, the bullets will be changed from letters to Arabic numerals before being presented to the Board of Directors for approval.

5. Quality Management Policies

QM1 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. QM2 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. QM3 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as revised. Motion passed unanimously.

6. Utilization Management Policies

UM1 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. UM2 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. UM3 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as revised. Motion passed unanimously. UM4 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously. UM5 - A motion was made by Mr. Dave Curro and seconded by Mr. Curtis Massey to approve the policy as presented. Motion passed unanimously.

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 7. Other A proposal was made to change “DMA” to “NC Medicaid” as non-substantive

throughout all policies where it may appear in existing policies. A motion was made by Mr. Curtis Massey and seconded by Mr. Dave Curro to approve. Motion passed unanimously.

Policies will be updated accordingly.

ADJOURNMENT: next meeting will be March 14, 2019, from 4:00 p.m. to 5:30 p.m. Adjourned 4:27 p.m. Respectfully Submitted by: Kathy Dempsey Date Approved

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POLICIES & PROCEDURES

I. PURPOSE

The purpose of this policy is to advocate and support an individual’s right to make informed choices

about service provision.

II. POLICY STATEMENT

It is the policy of the Area Authority to promote and encourage choice when consumers members seek

services from Alliance Behavioral Healthcare. Alliance Behavioral Healthcare shall ensure that each

consumer member seeking services receives the following:

i.1. information necessary to make an informed choice about service;

ii.2. information about the range of other services available and;

iii.3. information about their right to receive services in a way that is non-coercive and protects

their right to self-determination.

For Medicaid funded services, consumers members shall be provided with a choice of at least two

provider agencies from which they may elect to receive services. (May not apply to some

highly specialized services)

III. PROCEDURES

The Chief Executive Officer shall develop procedures to implement this policy.

TITLE: Consumer Member Choice

BOARD POLICY #: CR-3

LINES OF BUSINESS: Service Access

RESPONSIBILITY: Board of Directors, Chief Executive Officer

REFERENCE(S): 122C-141

URAC STANDARDS: CORE, v. 3.0, Standards 4, 12 & 39; N-NM, v. 7.0, Standard 6

APPROVAL DATE: 6/7/2012

LATEST REVISION

DATE: 3/1/2018

LATEST REVIEW

DATE: 3/1/2018

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I. PURPOSE

The purpose of this policy is to ensure that Alliance Behavioral Healthcare (Alliance) processes waiver

of licensure rule requests made by contracted licensed facilities in a consistent manner. When

recommending approval to waive a rule, Alliance must ensure the existence of safeguards to protect the

consumers’ health and safety.


It is the policy of Alliance Behavioral Healthcare to process all rule waiver requests submitted by

licensed facilities in the Alliance Provider Network consistently and in compliance with the North

Carolina Administrative Code. The Administrative Rule outlines that the decision to grant or deny the

waiver request shall be based on the following:

a.1. The nature and extent of the request;

b.2.The existence of safeguards to ensure that the health, safety, or welfare of the clients

residing in the facility will not be threatened;

c.3. The determination that the waiver will not affect the health, safety, or welfare of

clients residing in the facility;

d.4.The existence of good cause; and

e.5. Documentation of LME-MCO governing body approval when requests are from an

LME-MCO contract agency.

The Alliance Board of Directors has delegated authority to the Chief Executive Officer to approve and

deny requests to waive a rule as authorized by Department of Health of Human Services.

III. PROCEDURES

The Chief Executive Officer shall develop procedures to ensure a consistent approval process of rule

waiver requests.

TITLE: Rule Waiver Requests

BOARD POLICY #: PN-5

LINES OF BUSINESS: Provider Network, Compliance


REFERENCE(S): 10A NCAC 27G .0813

URAC STANDARDS: CORE, v. 3.0, Standards 4 & 27


LATEST REVISION

DATE: 4/2/2015

LATEST REVIEW

DATE: 3/1/2018

Formatted: Numbered + Level: 3 + Numbering Style:

1, 2, 3, … + Start at: 1 + Alignment: Left + Aligned at:

1" + Indent at: 1.25"

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I. PURPOSE

The purpose of this policy is to set forth the standards and criteria used by Alliance Behavioral Healthcare

to determine the medical necessity of service requests submitted by network providers.

II. DEFINITIONS

Medical Necessity:

1. The procedure, product, or service is individualized, specific, and consistent with symptoms or

confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs;

2. The procedure, product, or service can be safely furnished, and no equally effective and more

conservative or less costly treatment is available statewide; and

3. The procedure, product, or service is furnished in a manner not primarily intended for the

convenience of the recipient, the recipient’s caretaker, or the provider.

III. POLICY STATEMENT

It is the policy of Alliance Behavioral Healthcare to implement objective clinical review criteria to

govern all utilization management decisions regarding service authorization requests. These criteria

have been developed by the North Carolina Division of Medical Assistance Medicaid, and are

documented in NC DMA Medicaid Clinical Coverage Policies and the North Carolina Division of

Mental Health/Developmental Disabilities/Substance Abuse Services and are documented in the

MH/DD/SA Services Definition manual. The Alliance Clinical Advisory Council is authorized to

approve clinical guidelines that can be used during the utilization review process. All Clinical Coverage

Policies, Service Definitions and clinical guidelines that are used in the utilization management process

shall be made available to providers and consumers.

IV. PROCEDURES

The Chief Executive Officer shall develop procedures to implement the provisions of this policy.

TITLE: Utilization Review Criteria

BOARD POLICY #: UM-3

LINES OF BUSINESS: Service Management


REFERENCE(S):

URAC STANDARDS: HUM, v. 7.3, Standard 1


LATEST REVISION

DATE: 9/1/2016

LATEST REVIEW

DATE: 3/1/2018

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I. PURPOSE

The purpose of this policy is to ensure that Alliance Behavioral Healthcare (Alliance) carries out its

responsibility for providing care coordination to eligible individuals and families within the Alliance

catchment area and to define the process of identifying and referring individuals to Care Coordination.

II. DEFINITIONS

Care Coordination: A collaborative process that links individuals and families with special healthcare

needs and high risk/high cost individuals to services and resources in an effort to optimize clinical

outcomes, decrease unnecessary utilization of services, and ensure delivery of quality care.

Special Health Care and High Risk Populations:

Adult enrollees who are severely and persistently mentally ill and meet Level of Care Utilization

System for Psychiatric Services (LOCUS) criteria

Child enrollees who are severely emotionally disturbed and meet Child and Adolescent Level of

Care Utilization System (CALOCUS) criteria

Children under 21 years of age with a mental health or substance use diagnosis who are currently, or

have been within the past thirty (30) days, in a facility (including a Youth Development Center and

Youth Detention Center) operated by the Department of Public Safety, or Division of Adult

Correction and Juvenile Justice for whom Alliance has received notification of discharge.

Enrollees with substance use diagnosis and current ASAM PPC Level of III.7 or II.2-D or higher.

Enrollees with co-occurring diagnoses (SA/MH/I/DD)

Opioid Dependent: Individuals with an opioid dependence diagnosis and who have reported to have

used drugs by injection within the past thirty days

CCNC/MCO (Community Care of North Carolina/Managed Care Organization) Priority List

Consumers who meet criteria for the Transitions to Community Living Initiative

Individuals on the NC Innovations Waiver

Individuals with an intellectual or developmental disability diagnosis who are currently, or have

been within the past thirty (30) days, in a facility operated by the Division of Adult Correction and

Juvenile Justice for whom Alliance has received notification of discharge

TITLE: Coordination of Care for Special Health Care Populations

BOARD POLICY #: CC-1

LINES OF BUSINESS: Care Coordination


REFERENCE(S): G.S. 122C-115.4

URAC STANDARDS: CORE, v. 3.0, Standards 4, 26, 36 & 38


LATEST REVISION

DATE: 4/2/2015

LATEST REVIEW

DATE: 3/1/2018

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TITLE: Coordination of Care for Special Health Care

Populations

LATEST REVISION

DATE: 4/2/2015

PAGE:

2 of 2


It is the policy of Alliance Behavioral Healthcare to provide Care Coordination to individuals that meet

the Special Health Care and High Risk Populations criteria delineated in part II. Alliance shall develop

protocols to identify individuals who are high risk or who have special health care needs and ensure that

those individuals identified receive care coordination as appropriate. Alliance shall employ qualified

professionals who shall be located in the geographic areas covered by Alliance Behavioral Healthcare to

provide care coordination.

IV. PROCEDURES


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I. PURPOSE

The purpose of this policy is to ensure that clients’ members’ rights are respected and protected by all

providers in the Alliance Behavioral Healthcare Provider Network.


It is the policy of Alliance Behavioral Healthcare that every person served has a right to dignity, privacy

and humane care that must be respected and protected. Providers in the Alliance Behavioral Healthcare

Provider Network shall assure basic human rights to each clientmember. All programs operated by

providers shall comply with the clients’ rights standards set forth in G.S. 122C, Article 3.

III. PROCEDURES


TITLE: Clients’ Members’ Rights to Dignity, Privacy and Humane Care


LINES OF BUSINESS: Clients Human Rights


REFERENCE(S): G.S. 122C Article 3

URAC STANDARDS: CORE, v. 3.0, Standards 4, 15, 16, 37 & 38; N-NM, v. 7.0, Standards 9 &

17; HCC, v. 5.0, Standards 17, 18 & 21


LATEST REVISION

DATE: 4/2/2015

LATEST REVIEW

DATE: 3/1/2018

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I. PURPOSE

The purpose of this policy is to protect each client’s member’s right to privacy and to safeguard the

confidentiality of identifiable health information.


All clients members of Alliance Behavioral Healthcare shall be assured that their right to privacy and the

confidentiality of their identifiable health information will be safeguarded. No staff member, volunteer,

student or other person associated with Alliance Behavioral Healthcare shall use or disclose any

information except as provided by these policies and procedures as authorized by the General Statutes of

the State of North Carolina 122C Parts 52-56, Client Right to Confidentiality, the Federal Regulations 42

CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records, and the Health Insurance

Portability and Accountability Act (HIPAA) regulations in 45 CFR. Any violation of this policy shall be

grounds for disciplinary action, including termination of employment or termination of other services

with Alliance.

III. PROCEDURES


TITLE: Client’s Member’s Right to Confidentiality


LINES OF BUSINESS: Client Human Rights


REFERENCE(S): GS 122C-52-56, 45 CFR Part160 and 164, 42 CFR Part 2

URAC STANDARDS: CORE, v. 3.0, Standards 4, 13, 15, 16, 37; N-NM 9


LATEST REVISION

DATE: 4/2/2015

LATEST REVIEW

DATE: 3/1/2018

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I. PURPOSE

The purpose of this policy is to ensure that Alliance Behavioral Healthcare (Alliance) complies with

regulatory requirements surrounding Advanced Directives and Advanced Instructions for Mental Health

Treatment.


It is the policy of Alliance Behavioral Healthcare to distribute written information regarding Advance

Directives and Advanced Instructions for Mental Health Treatment policies to adult EnrolleesMembers,

including a description of applicable State and Federal laws. Written information regarding Advance

Directives and Advanced Instructions shall cover the following topics:

1. Enrollee Member rights under State law;

2. Alliance policies respecting the implementation of those rights, including a statement of any

limitation regarding the implementation of Advance Directives and Instructions as a matter of

conscience;

3. Information on the Advance Directive and Instructions policies of Alliance; and

4. The Enrollee's Member's right to file a grievance with the State Certification and Survey Agency

or the Division of MH/IDD/SA Services concerning any alleged noncompliance with the

Advance Directive or Instructions laws.

In compliance with 42 CFR 438.3(j) and N C GS 122C Article 3, Part 2, the written information

provided to Enrollees Members shall reflect changes in State law as soon as possible, but no later than

90 days after the effective date of the change.

III. PROCEDURES


TITLE: Advanced Directives/Advanced Instructions


LINES OF BUSINESS: Customer Services, Care Coordination


REFERENCE(S): G.S. 122C Article 3, Part 2; 42 CFR 438.3(j)

URAC STANDARDS: CORE, v. 3.0, Standards 4, 35, 37 & 38


LATEST REVISION

DATE: 3/2/2017

LATEST REVIEW

DATE: 3/1/2018

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I. PURPOSE

The purpose of this policy is to establish the expectation that Alliance Behavioral Healthcare shall

operate a comprehensive customer services program.


It is the policy of Alliance Behavioral Healthcare that its Customer Services Program will provide the

following:

1. 24/7/365 access to services by providing screening, triage and referral through the Access and

Information Line;

2. Crisis services authorization as needed; and

3. Information in response to questions and inquiries expressed through the Access and Information

Line.

III. PROCEDURES


TITLE: Customer Services

BOARD POLICY #: CS-1

LINES OF BUSINESS: Access to Care, Customer Service



URAC STANDARDS: CORE, v. 3.0, Standards 4, 6-9 & 34; HCC, v. 5.0, Standards 9 & 13-15


LATEST REVISION

DATE: 3/3/2016

LATEST REVIEW

DATE: 3/1/2018

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I. PURPOSE

The purpose of this policy is to ensure that Alliance Behavioral Healthcare (“Alliance”) complies with

Federal and State laws, rules and regulations, contract requirements and national accreditation standards

regarding the selection and retention of providers.


It is the policy of Alliance to select and retain providers based on quality of care, quality of service, the

service needs of the catchment area population and business needs of the organization. The goal of

Alliance is to develop and maintain a sufficient network of high quality service providers that meets

consumer and community needs within available resources and promotes efficiency and the economic

viability of network providers. Selected providers must also meet the credentialing and re-credentialing

requirements established by Alliance and the North Carolina Department of Health and Human Services.

The North Carolina Medicaid 1915 b/c Waiver permits Alliance to operate a closed network by waiving

the provider “freedom of choice” provision in the Social Security Act. The closed network is balanced

by Alliance’s responsibility to ensure accessibility of services.

In accordance with 42 CFR 438.214 and the terms and conditions of the Alliance contract with

NCDHHS to operate a Prepaid Inpatient Health Plan, Alliance is required to implement provider

selection and retention criteria that do not discriminate against particular providers that serve high-risk

populations or specialize in conditions that require costly treatment. Criteria may include provider

performance and other factors. Alliance shall not employ or contract with providers who are excluded

from participation in Federal healthcare programs under either section 1128 or section 1128A of the

Social Security Act or who have been terminated by the NC State Medicaid program for any reason.

Alliance will establish a fair, impartial and consistent process for the enrollment and re-enrollment of

mental health, intellectual/ developmental disability and/or substance abuse (“MH/I-DD/SA”) service

providers in the Alliance Closed Network that complies with 42 CFR §438.207 and §438.214.

TITLE: Selection and Retention of Providers


LINES OF BUSINESS: Provider Network


REFERENCE(S): 42 CFR §438.207, 42 CFR §438.214, DMA NC Medicaid Contract

URAC STANDARDS: CORE, v. 3.0, Standard 4; N-NM, v. 7.0, Standards 1-3, 5-17; N-CR, v.

7.0, Standards 1-16


LATEST REVISION

DATE: 3/2/2017

LATEST REVIEW

DATE: 3/1/2018

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TITLE: Selection and Retention of Providers

LATEST REVISION

DATE: 3/2/2017

PAGE:

2 of 2

III. PROCEDURES


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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to provide guidance on the issuance of letters of support/acknowledgment

for community based projects for persons with mental illness, intellectual/developmental disabilities,

and substance abuse disorders.


It is the policy of Alliance Behavioral Healthcare to support the development of community based

MH/IDD/SA services. Pursuant to the development of these services, the Area Authority may, from

time to time, be asked for a letter of support or acknowledgment for a specific project. Some of these

requests may be precipitated by law or regulation which requires Area Authority involvement or

knowledge of the project. Irrespective of the reason for the request, the decision to submit a letter of

support/acknowledgement shall be based on the service needs of the residents of the catchment area as

identified in the Area Authority’s comprehensive planning process.

III. PROCEDURES

The Chief Executive Officer shall develop procedures for the issuance of letters of support for the

various types of projects that might arise. The guiding principle for these procedures shall be the

identification of need as reflected in the Area Authority’s comprehensive plan.

TITLE: Letters of Support


LINES OF BUSINESS: Service Access/Provider Network



URAC STANDARDS: CORE, v. 3.0, Standard 4; N-NM, v. 7.0, Standard 2


LATEST REVISION

DATE:

LATEST REVIEW

DATE: 3/1/2018

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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to ensure that Alliance Behavioral Healthcare (Alliance) complies with the

provisions of the NC Medicaid 1915(c) Innovations Waiver as Alliance reviews and processes requests

to employ relatives as providers.


It is the policy of Alliance Behavioral Healthcare to process requests:

1. From Network Providers to employ relatives/legal guardians (who live in the home of the

Innovations Waiver participant) to provide Innovations Waiver services to adult family

members; and,

2. From individuals who wish to participate in Individual and Family Directed Supports.

The process for handling such requests shall comply with the policy and regulatory provisions of the

Innovations Waiver.

III. PROCEDURES


TITLE: Provision of Services by Relatives/Legal Guardians


LINES OF BUSINESS: Provider Network Management


REFERENCE(S): DHHS DMANC Medicaid Contract

URAC STANDARDS: CORE, v. 3.0, Standard 4


LATEST REVISION

DATE: 3/3/2016

LATEST REVIEW

DATE: 3/1/2018

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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to establish a process for receiving, investigating, resolving, and managing

member grievances in a consistent manner.

II. DEFINITIONS

Complainant: Enrollee/consumerMember, legally responsible person, or Providers, authorized in

writing and acting on behalf of the enrollee/consumer member filing the grievance. Does not include

providers, stakeholders or other individuals not acting on behalf of a consumermember.

Grievance: an expression of dissatisfaction by an enrolleemember, their legal guardian, or Provider,

authorized in writing and acting on behalf of the enrollee/consumermember about any matter other than

decisions regarding requests for Medicaid services.

Provider: an individual, agency or organization that provides mental health, developmental disabilities

and/or substance abuse services to consumermembers and families.


It is the policy of Alliance Behavioral Healthcare (Alliance) to respond to grievances received

concerning the provision of publicly funded services in the Alliance Behavioral Healthcare catchment

area. It is also the policy of Alliance Behavioral Healthcare to use the information gleaned from

grievance proceedings as part of Alliance’s quality improvement process.

IV. PROCEDURES

The Chief Executive Officer shall develop procedures to implement this policy. The procedures shall

comply with all relevant state and Federal statutes and requirements of all regulatory, funding or

accrediting bodies.

TITLE: Management and Investigation of Member Grievances

BOARD POLICY #: QM-2

LINES OF BUSINESS: Network Administration, Clients Rights, Quality Management


REFERENCE(S): 10A NCAC 27G. 7002, 7003

URAC STANDARDS: CORE, v. 3.0, Standard 35


LATEST REVISION

DATE: 4/2/2015

LATEST REVIEW

DATE: 3/1/2018

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TITLE: Management of Incidents

LATEST REVISION

DATE: 4/2/2015

PAGE:

2 of 2

IV. PROCEDURES


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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to define and establish a uniform and consistent approach for handling

incidents which occur in the operations of a facility or service.

II. DEFINITIONS

Incidents: Events that are inconsistent with the routine operations of a service or care of a

consumermember that are likely to lead to adverse effects.

Level I Incident: Event that is inconsistent with the routine operation of a service or care of a

consumermember that is likely to lead to adverse effects but does not meet the definition of a Level II or

III incident.

Level II Incident: As described in Level I Incident above but results in a threat to a consumermember’s

health and safety or presents a threat to the health and safety of others due to the consumermember’s

behavior. This includes a client death due to natural causes or terminal illness.

Level III Incident: Event that is inconsistent with the routine operation of a service or care of a

consumermember that is likely to lead to adverse effects and result in:

1. A death or permanent physical or psychological impairment to a consumermember;

2. A death or permanent physical or psychological impairment caused by a consumermember;

3. A threat to public safety caused by a consumermember;

4. An amber or silver alert, or news media involvement

5. Any allegation of rape or sexual assault of a consumermember or by a consumermember.


It is the policy of Alliance Behavioral Healthcare (Alliance) to ensure consumermember safety and

quality of care within the Alliance Behavioral Healthcare Network. Alliance will require that Network

Providers respond to all level I, II and III incidents according to 10A North Carolina Administrative

Code 27G .0603 and .0604 and that Alliance Behavioral Healthcare responds to all level III incidents in

accordance with 10A North Carolina Administrative Code 27G .0605.


BOARD POLICY #: QM-3

LINES OF BUSINESS: Quality Management


REFERENCE(S): 10A NCAC 27G .0603-.0605

URAC STANDARDS: CORE, v. 3.0, Standards 4, 24 & 38


LATEST REVISION

DATE: 4/2/2015

LATEST REVIEW

DATE: 3/1/2018

Commented [WNK1]: Do we need this section? Could be

say under the policy statement – that “Alliance will process

all grievances according to the guidelines established by

DHHS”

The reason I’m asking is that these definitions are

incomplete and the full definitions of what each level of

incident is takes up many pages.

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LATEST REVISION

DATE: 4/2/2015

PAGE:

2 of 2

IV. PROCEDURES


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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to ensure timely reviews of oral or written requests for service

authorization.


It is the policy of Alliance Behavioral Healthcare to ensure timely access to care. Utilization

management personnel shall be available during regular business hours to process requests and to

communicate with providers, consumers and other stakeholders. All communications and interactions

with the affected parties shall be cordial and courteous.

III. PROCEDURES


TITLE: Accessibility of Utilization Review/Utilization Management Process


LINES OF BUSINESS: Service Access/Utilization Management



URAC STANDARDS: HUM, v. 7.3, Standards 2-4


LATEST REVISION

DATE: 9/1/2016

LATEST REVIEW

DATE: 3/1/2018

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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to set forth policy regarding the use of licensed and non-licensed staff in

the utilization management process.

II. DEFINITIONS

Certification – authorization for an individual to receive services from an Area Authority provider.


Alliance Behavioral Healthcare (Alliance) shall employ licensed clinical staff as well as non-clinical,

administrative personnel to perform the utilization management functions required to issue

certifications. Alliance shall ensure that licensed clinical staff are available to provide oversight and

follow-up of clinically related questions during initial screening activities.

IV. PROCEDURES


TITLE: Pre-Review Screening for Certification


LINES OF BUSINESS: Service Access, Utilization Management


REFERENCE(S): N/A

URAC STANDARDS: HUM, v. 7.3, Standards 7-11


LATEST REVISION

DATE: 9/1/2016

LATEST REVIEW

DATE: 3/1/2018

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BOARD OF DIRECTORS


I. PURPOSE

The purpose of this policy is to clearly define the standards and procedures for authorizing Medicaid and

State funded services.


It is the policy of Alliance Behavioral Healthcare to make timely and accurate utilization management

determinations and notifications regarding requests for certification of treatment. Determinations and

notifications shall be made in accordance with the requirements of the North Carolina Division of

Mental Health/Intellectual and Developmental Disability/Substance Abuse Services, the North Carolina

Division of Medical Assistance Medicaid and the external accrediting body, URAC.

III. PROCEDURES


TITLE: Utilization Review Process


LINES OF BUSINESS: Service Management



URAC STANDARDS: HUM, v. 7.3, Standards 10-12, 17-21, and 25-29.


LATEST REVISION

DATE: 3/2/2017

LATEST REVIEW

DATE: 3/1/2018

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6D

(Back to agenda)


Agenda Action Form

ITEM: Executive Committee Report DATE OF BOARD MEETING: March 7, 2019 BACKGROUND: The Executive Committee sets the agenda for Board meetings and acts in lieu of the Board between meetings. Actions by the Executive Committee are reported to the full Board at the next scheduled meeting. Attached are the draft minutes from the February 19, 2019, meeting. REQUEST FOR BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Cynthia Binanay, Board Chair; Robert Robinson, CEO

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Tuesday, February 19, 2019 BOARD EXECUTIVE COMMITTEE REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 4:00-6:00 p.m.


APPOINTED MEMBERS PRESENT: ☒Cynthia Binanay, MA (Board Chair); ☒Christopher Bostock, BSIM (Previous Board Chair, Finance Committee Chair) (via phone); ☒George Corvin, MD (Board Vice-Chair); ☒Dave Curro, BS (Quality Management Committee Chair); ☒Lodies Gloston, MA (Policy Committee Chair) (via phone; entered at 4:22 pm); ☒Donald McDonald, MSW (Network Development and Services Committee Chair); ☒Lascel Webley, Jr., MBA, MHA (Audit and Compliance Committee Chair) (via phone); and ☒McKinley Wooten, Jr., JD (Human Rights Committee Chair) (via phone)

APPOINTED, NON-VOTING BOARD MEMBERS PRESENT: Gino Pazzaglini BOARD MEMBERS PRESENT: None GUEST(S): None STAFF PRESENT: Denise Dirks, Administrative Assistant II, Veronica Ingram, Executive Assistant II; Monica Portugal, Chief Compliance Officer; Robert Robinson, CEO; and Carol Wolff, General Counsel


2. REVIEW OF THE MINUTES – The minutes from the January 15, 2019, Executive Committee meeting were reviewed; a motion was made by Mr. Dave Curro and seconded by Mr. Donald McDonald to approve the minutes. Motion passed unanimously.


3. Updates a) LEGISLATIVE UPDATE: Mr. Robinson mentioned upcoming meetings with NC legislators. He also reported that Alliance is collaborating with other LME/MCOs CEO’s and their lobbyists to develop legislative strategies and coordinate additional meetings with legislators.

b) BOARD MEMBER TERMS: Chair Binanay mentioned four members whose Board terms expire March 31, 2019: Cynthia Binanay, Donald McDonald, Curtis Massey, and McKinley Wooten. Committee members discussed a potential/perceived conflict of interest for one member.

c) MEDICAID TRANSFORMATION: Mr. Robinson mentioned internal progress on a project plan to implement the State’s Tailored Plan, which Alliance is preparing to demonstrate readiness to operate.

d) CAPE FEAR: Mr. Robinson mentioned a recent conversation with the Cumberland County

Manager regarding facility space for the crisis services RFP (request for proposal).

e) STAFF FUTURES WORKGROUP MEETINGS: Chair Binanay reminded Board members about this meeting and quorum requirements per NC Open Meetings Law.

f) THE CASE FOR INCLUSION 2019 REPORT: Mr. Curro mentioned this report

(http://caseforinclusion.org/index.php/data/state-scorecards), which was released by the United Cerebral Palsy and the ANCOR Foundation to examine how well state programs meet the needs

a) None specified. b) Appointment

recommendations will be added to the agenda for the March Board meeting.

c) Topic will be covered at the March 7 Board meeting.

d) None specified. e) None specified. f) None specified.

a) N/A b) 3/7/19 c) 3/7/19 d) N/A e) N/A f) N/A

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https://pacidnc.us19.list-manage.com/track/click?u=2cf18f045ebdaf7b0b12c1b2a&id=dd9c8d2047&e=e5f5ab7d11

Tuesday, February 19, 2019 BOARD EXECUTIVE COMMITTEE REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 4:00-6:00 p.m.



of individuals with intellectual and developmental disabilities. Committee members discussed this report and potential next steps.

4. March 7, 2019, Area Board Draft Agenda

The Committee reviewed the draft agenda and provided input. Chair Binanay shared that tours of the new home office will occur before the Board meeting and Board Committee meetings. Ms. Ingram provided an overview of the tour schedule.

Ms. Ingram will forward the agenda to staff.

2/20/19

5. ADJOURNMENT: the next Committee meeting will be March 19, 2019, at 4:00 p.m.

Respectfully Submitted by: Name, Title Date Approved

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7

(Back to agenda)


Agenda Action Form

ITEM: Recommendation for Reappointment to Alliance’s Area Board

DATE OF BOARD MEETING: March 7, 2019

BACKGROUND: In accordance with the By-Laws of the Area Board, the terms of some Board members expire on March 31, 2019. The Board is requested to consider these members’ reappointment for an additional term and request official reappointment through their respective counties’ Boards of County Commissioners.

REQUEST FOR BOARD ACTION: The Board is requested to recommend to the respective Board of County Commissioners the reappointment of members whose terms expire March 31, 2019.

CEO RECOMMENDATION: The Board is requested to recommend to the respective Board of County Commissioners the reappointment of members whose terms expire March 31, 2019.

RESOURCE PERSON(S): Cynthia Binanay, Board Chair; and Robert Robinson, CEO

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