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Partners welcomes Rutherford County!

July 1st, 2019 – Partners will serve as Rutherford County’s

Managed Care Organization.

Behavioral Health Services (MH / I/DD / SUD), previously

managed by Vaya Health, will be managed by Partners.

Vaya and Partners are working together for a successful

and seamless transition.

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➢ We are here today to share information about Partners’

Intellectual and Developmental Disability services and

systems, and to answer your questions and address

your concerns about the transition.

➢ Question cards

➢ Restroom locations

➢ Today’s meeting includes an informational session

followed by an opportunity to chat specifically to your

individual needs in the lobby

Partners’ I/DD CC Organizational Structure

Three main units within our I/DD CC Department:

➢ Southern Region – Cleveland, Gaston, Lincoln and

Rutherford counties

➢ Northern Region – Burke, Catawba, Iredell, Surry,

and Yadkin counties

➢ I/DD CC Systems – All nine counties

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Southern Region – Rutherford Expansion

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I/DD Clinical Director

I/DD CC Manager

I/DD CC Supervisor

7- 8

I/DD CC’s

26-30 Individuals

I/DD CC Supervisor

7-8

I/DD CC’s

26-30 Individuals

I/DD CC Supervisor

7-8

I/DD CC’s

26-30 Individuals

I/DD CC Supervisor

(new)

7-8 (4 new)

I/DD CC’s

26-30 Individuals

Service Array

➢NC Innovations – Medicaid Waiver

➢ IPRS – Limited State Dollars

➢B3 – Medicaid (non-Innovations)

➢Medicaid - In Lieu of Service (Long Term

Community Supports)

➢ Intermediate Care Facilities for Individuals

with Intellectual Disabilities (ICF-IID)

➢Specialty Programs

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Roles and Responsibilities – NC Innovations

➢ Coordinate all Medicaid-funded services

➢ Refer to Community Navigator for non-Medicaid

needs

➢ Educate about available services

➢ Write Individual Support Plans as the team requests

➢ Submit Service Authorization Requests

➢ Monitor services as outlined in the plan

➢ Monitor for health and safety

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IPRS, B3 Medicaid, In Lieu Of, Other

➢Provider is “Clinical Home”

➢Care Coordinator assigned to each individual,

as a “go-to” person for questions or concerns

➢Community-based care coordination as needed

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I/DD Systems Unit – Organizational Structure

I/DD Systems Manager

I/DD Program Supports

Supervisor

Program Supports

Coordinator (1)

Registry & Referral

Specialist (2)

Olmstead Specialists (2)

I/DD Monitoring Supervisor

I/DD Monitoring

Specialists (5)

I/DD Assessment Supervisor

I/DD Assessment

Specialists (5)

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I/DD Systems Unit – Program Supports

➢Program Support Specialist

• State Reporting

• National Core Indicator

Survey

• Multiple Committees

• NC Innovations Slot

Management

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➢ Registry and Referral Specialists

• Intake

• Registry of Unmet Needs (RUN)

• B-3 Service Referrals (I/DD Respite / I/DD

Community Guide)

• Care Coordination for individuals on RUN or

receiving non-Innovations I/DD Services

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➢ Olmstead Specialists

• Statewide Specialty Programs (Care Coordination)

o Murdoch Center, J Iverson RI/DDle, etc.

o Money Follows the Person (discharges to the

community from institutional care)

o Intermediate Care Facilities for Individuals with

Intellectual and Developmental Disabilities (ICF

IID)

I/DD Systems – Assessment Specialists

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The SIS® identifies the amount of support a person needs throughout their day-to-day activities. This is determined by reviewing seven different “Life Domains” and the amount of support that is needed for the person to be successful in each of these areas, as well as any exceptional medical and behavioral items.

What is Success?

Success is when a person has the same opportunities and quality of life as anyone else of their same age in

their community.

The SIS® reflects a new way of thinking about assessment.

The focus is on the support needs of the person, not their deficits.

The SIS® is comprehensive. It evaluates the pattern and intensity of needed supports in seven Life Domains (common to ALL persons), in protection and advocacy activities, and in exceptional medical and behavioral support needs.

The SIS® involves the individual as a vital source of information.

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The SIS® will be completed by a trained interviewer.

The SIS® interview takes two to three hours to

complete.

There needs to be at least two respondents present

during the entire SIS® interview.

◦ Someone from the school system is preferred for

SIS-C®.

The person being interviewed is encouraged to

participate as much as they can. We understand that

this is a long interview and the person may not want

to be involved during the entire process.

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The SIS® is an interview, not a test.

The person being interviewed and the SIS®

interviewer must meet to complete the interview.

Every question must be asked and scored.

The Adult SIS® has 86 questions.

The SIS®-C contains 94 questions.

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The POM will be completed by a Council on Quality and

Leadership (CQL) trained interviewer.

The POM can take 2 to 3 hours to complete. This divided

between the person and their support/staff.

The interviewer will first spend time talking to the person about

their life.

Then the interviewer will talk to the support/staff about how

they help the person.

Although having a POM interview is not required, it helps in

identifying the person’s priorities, makes planning more person-

centered, and is focused on the person playing a vital role in their

lives.

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I/DD Systems Unit – Monitoring Specialists

Assist Care Coordinators with face-to-face monitoring

in Residential and AFL settings

Monitor for Home and Community Based Standards

Maintains a residential vacancy listing from providers

Assist residential providers with brainstorming

challenging situations

Monitor Health and Safety

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I/DD Systems Unit – Monitoring Specialists

➢ Regular concerns

➢ Immediate concerns

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I/DD Systems Unit – Monitoring SpecialistsHOME AND COMMUNITY BASED STANDARDS

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➢ Review service requests and individualized plans in

order to approve➢ The right service – based on medical necessity

➢ The right amount of service – based on what is happening

➢ At the right time – based on current need

➢ Provide recommendations when appropriate➢ May recommend a variety of treatment options that might

work better

➢ May recommend ideas the individual or team haven’t

considered before

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➢ Works with providers and care coordinators

➢ To obtain additional information to support service

request approvals

➢ To ensure quality of care provided to individuals

➢ To monitor use of services approved for

effectiveness and need to continue or change

➢ Provides Appeal Rights

➢ When requested services, amounts of services, or

length of services do not meet medical necessity

and are either partially approved or denied, you

have the right to appeal the decision

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Adaptive Behavioral Treatment (ABT) for Autism➢ This service may address significant deficits or

significant behavioral issues due to Autism Spectrum Disorders.

➢ This service may be approved for children 21 years old or younger that have Medicaid AND have a written diagnosis by the appropriate professional of Autism Spectrum Disorder with significant deficits or behaviors.

➢ This service is reviewed and approved or denied by a specialty / multidisciplinary Utilization Management Team.

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➢ This service uses evidenced based practices, for

example, Applied Behavioral Analysis.

➢ There are service exclusions that apply when the

individual is receiving other services that already

include similar treatment.

➢ ABT providers are available in Burke, Catawba,

Cleveland, Gaston, Iredell, and Lincoln counties.

➢ Work continues to expand providers in other

counties.

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Our MissionThe Innovations Stakeholders Committee is a group of consumers, families, providers, and those in the community with a vested interest in I/DD services. The group assists in managing service delivery for these disabilities and those with co-occurring disorders.

➢ Members of NC Innovations Stakeholders are individuals, family members and others either receiving or providing NC Innovations Waiver Services.

➢ This committee is the local NC Innovations committee that feeds information to the State Innovations Committees and NC Medicaid.

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Our MissionPartners Behavioral Health Management’s CFAC will lead efforts to create a community where people with disabilities are valued and treated with dignity. Where stigma, accompanying attitudes, discrimination, and other barriers are eliminated.

Members of CFAC:

➢ Attend and participate in regular meetings

➢ Represent mental health, substance use, and intellectual and developmental disabilities in Partners’ service area

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Our Mission

The Human Rights Committee (HRC) is a standing

committee of the Partners Behavioral Health

Management’s Board of Directors. The Committee’s

mission is to protect the human rights of individuals

served by providers in the Partners’ Network in the

delivery of MH, I/DD, and SU services.

To learn more please visit:

http://www.partnersbhm.org/human-rights-committee/

➢ Visit Our Rutherford County Web Page:

https://www.partnersbhm.org/welcome-rutherford-

county/#FAQ

➢ Contact Us:

• By email: Rutherford_Questions@partnersbhm.org

• By phone: 704-884-2505

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