AREA BOARD REGULAR MEETING Thursday, May 05 ......2016/05/05 · Thursday, May 05, 2016 AREA BOARD REGULAR MEETING 4600 Emperor Boulevard, Durham, NC, 27703 4:00-6:00 p.m. Page 3

Thursday, May 05, 2016

AREA BOARD REGULAR MEETING

4600 Emperor Boulevard, Durham, NC, 27703

4:00-6:00 p.m.

Page 1 of 4

MEMBERS PRESENT: ☒Ann Akland (via phone), ☒Cynthia Binanay, Vice-Chair, ☒Christopher Bostock, Chair, ☒George

Corvin, MD, ☒Kenneth Edge (via phone), ☒James Edgerton (via phone); ☒Lodies Gloston (via phone), ☒Phillip Golden, ☒John

Griffin, Ed.D, ☒Curtis Massey, ☐Rev. Michael Page, ☒George Quick, ☒Vicki Shore (via phone), ☒William Stanford, Jr.,

☒Caroline Sullivan, ☒Amelia Thorpe, ☐Lascel Webley, Jr., and ☒McKinley Wooten, Jr.

GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair; Dennis Farley, DMH

ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Tedra Anderson-Brown, MD, Medical Director; Hank Debnam, Cumberland Site

Director/Veterans Point of Contact; Joey Dorsett, CIO; Ashley Everette, Budget Analyst; Doug Fuller, Director of Communications; Kelly Goodfellow, CFO;

Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram, Executive Assistant; Geyer Longenecker, Quality Management Director;

Beth Melcher, Chief of Network Development and Evaluation; Ann Oshel, Chief Community Relations Officer; Sara Pacholke, Controller; Kelly Phillips,

Director of Budget and Financial Analysis; Monica Portugal, Chief Compliance Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Matthew Ruppel,

Director of Program Integrity; Sean Schreiber, Chief Clinical Officer; Doug Wright, Director of Consumer Affairs

1. CALL TO ORDER: Chairman Christopher Bostock called the meeting to order at 4:03 p.m.

AGENDA ITEMS: DISCUSSION:

2. Announcements A. FUTURE DEVELOPMENT WORKGROUP: This is a staff workgroup that meets monthly. Board members are invited to

attend this meeting. Chairman Bostock reminded Board members: the next meeting will be Tuesday, June 7 at 4:00 pm.

B. ANNUAL REPORT: Mr. Robinson provided an overview of the report; Board members received at the meeting.

C. MENTAL HEALTH AWARENESS MONTH: Mr. Robinson mentioned upcoming May events scheduled throughout

Alliance’s catchment area.

3. Agenda Adjustments Chairman Bostock mentioned an adjustment to the agenda: recommendation for reappointment of one Board member. There

were no other additional agenda adjustments.

4. Public Comment There were no public comments.

5. Committee Reports A. Consumer and Family Advisory Committee (5 minutes) – page 5

The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from

Durham, Wake, or Cumberland counties who receive mental health, intellectual/developmental disabilities or substance

use/addiction services. This month’s report included draft minutes from the April 4, 2016, meeting.

The committee reports were sent as part of the Board packet; Caroline Ambrose, CFAC Chair, presented the report. She noted

highlights from the April meeting which included a presentation of Alliance’s reinvestment plan and Medicaid

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4:00-6:00 p.m.

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reform/consolidation. Additionally, Ms. Ambrose expressed gratitude to Alliance on behalf of First in Families and the new

Cumberland chapter. The April CFAC meeting also addressed the importance of CFAC member’s participation and how their

input is impacts Alliance. CFAC has chosen to merge their Facebook page with Alliance’s. Mr. Robinson encouraged Board

members to visit Alliance’s Facebook and LinkedIn pages.

B. Finance Committee (10 minutes) – page 19

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 April meeting and a request to appoint a deputy finance officer

in accordance with GS 159-24 and 159-28.

George Quick presented the report on behalf of James Edgerton, Committee Chair. Mr. Quick mentioned that Alliance is in

very good shape financially and revenues continue to exceed expenditures. He mentioned that Alliance exceeds the State

required ratios with the exception of the medical loss ratio. As stated previously the medical expense ratio is being replaced by

the medical loss ratio. Alliance is at 84% and the ratio is 85%; As the medical loss ratio methodology and definition have

changed, Alliance is held harmless on this ratio through July 2017. Also, Mr. Quick mentioned the recommendation to appoint

Kelly Phillips, Director of Budget and Financial Analysis, as Deputy Finance Officer.

BOARD ACTION

A motion was made by Mr. George Quick to appoint Kelly Phillips as Deputy Finance Officer; seconded by Dr. John Griffin.

Motion passed unanimously.

6. Consent Agenda A. Draft Minutes from April 7, 2016, Board Meeting – page 28

B. Audit and Compliance Committee Report – page 33

C. Executive Committee Report – page 36

D. Human Rights Committee Report – page 52

E. Draft Minutes from Board Budget Retreat – page 75

Chairman Bostock mentioned that the consent agenda was sent as part of the Board packet; there were no questions or

discussion about the consent agenda.

BOARD ACTION

A motion was made by Mr. Phillip Golden to adopt the consent agenda; seconded by Dr. George Corvin. Motion passed

unanimously.

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4:00-6:00 p.m.

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7. FY17 Recommended

Budget (30 minutes) –

page 128

The recommended FY 2016-2017 budget was presented for consideration. Kelly Goodfellow, CFO, mentioned that this is

Alliance’s fifth budget and thanked members for attending the budget retreat. Kelly Phillips, Director of Budget and Financial

Analysis, provided an overview from the budget retreat regarding statute requirements, general fund, and FY17 budget revenues

and expenditures. She shared comparisons between FY16 budget and the FY17 recommended budget. Ms. Goodfellow

mentioned that FY17 Medicaid rates from the State are lower compared to FY16 rates; she stated that this is typical for managed

care as the expectation is to save money. The FY17 recommended budget presentation is attached to and made part of these

minutes.

BOARD ACTION

The Board received the recommended budget; no further action required at this time.

8. Review of Board

Officer Selection

Process (5 minutes) –

page 162

As stated in the by-laws officers of the Area Board shall be chosen for a one-year term at the final meeting of the fiscal year.

Chairman Bostock reviewed the process: according to Alliance by-laws officers may serve two consecutive (one year) terms.

Both he and Vice-Chair Binanay are finishing their first terms and are willing to serve an additional term.

Board members interested in serving as Chair or Vice-Chair for fiscal year 2016-2017 may forward names to Ms. Ingram (who

will compile a list) or come prepared to state their nomination at the June 2, 2016, meeting. Board members discussed not having

a nominating committee and instead having open nominations and then elections at the June meeting.

BOARD ACTION

The Board received the review; no further action required at this time.

New Agenda Item In accordance with NC General Statute 122C-118.1.d and Alliance by-laws, the initial terms of Alliance Board members were

staggered with each initial term being considered a full term. NC Senate Bill 191 allows members to be reappointed for two

additional three-year terms. John Griffin’s term expires on May 31, 2016. The matter brought before the Board today was to

recommend his reappointment. There were no questions or discussion about the recommendation.

BOARD ACTION

A motion was made by Mr. William Stanford to recommend John Griffin’s reappointment to the Cumberland Board of County

Commissioners; seconded by Commissioner Kenneth Edge. Motion passed unanimously.

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9. Updates Mr. Robinson mentioned that the implementation date for NC Innovations waiver was changed from July 1, 2016 to

November 1, 2016; this change will allow more time for implementation.

Mr. Robinson provided an update from recent meetings with NC legislators to discuss Medicaid Reform and budget cuts;

Dr. Michael Bollini mentioned a recent meeting with legislators and specifically Alliance’s good reputation among

providers.

Board discussed current IVC (involuntary commitment) rates at local hospitals.

10. Chairman’s Report There was no report.

11. Closed Session The Board entered closed session.

BOARD ACTION

A motion was made by Mr. McKinley Wooten to enter closed session pursuant to NC General Statute 143-318.11 (a) (6) to

consider the qualifications, competence, and performance of an employee and per NCGS 143-318.11 (1) to prevent disclosure

of information that is confidential and not a public record under NCGS 122C-126.1; seconded by Mr. William Stanford. Motion

passed unanimously.

The Board returned to open session.

BOARD ACTION

A motion was made by Ms. Lodies Gloston to approve the reduction in force for the Youth Opportunity Director and Youth

Opportunity Coordinator positions; seconded by Dr. George Corvin. Motion passed unanimously.

12. Adjournment With all business being completed the meeting adjourned at 6:07 p.m.

Next Board Meeting

Thursday, June 02, 2016

4:00 – 6:00

6/2/2016

Robert Robinson, Chief Executive Officer Date Approved

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(Back to agenda)

ITEM: Consumer and Family Advisory Committee (CFAC) Report

DATE OF BOARD MEETING: May 5, 2016

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, 4600 Emperor Boulevard, Durham. 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. The Alliance CFAC is currently chaired by Caroline Ambrose while Israel Pattison

serves as vice-chair.

REQUEST FOR AREA BOARD ACTION:

The Alliance CFAC met as a whole on April 4th at the corporate office and by teleconference in Cumberland

County.

CEO RECOMMENDATION:

Receive the draft minutes.

RESOURCE PERSON(S):

Caroline Ambrose, CFAC Chair; Doug Wright, Director of Consumer Affairs

Alliance Behavioral Healthcare

BOARD OF DIRECTORS Agenda Action Form

5A

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Monday, April 04, 2016 Consumer and Family Advisory Committee

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MEMBERS PRESENT: Israel Pattison, David Curro, Sharon OBrian, Carrie Ambrose, Allison Stutts, Steve Hill, Tammy Harrington, Dan Shaw, Kurtis Taylor, Latasha Jordan, Faye Griffin (telephonic), Jean Royster-Hill (telephonic), Brynda Saunders (telephonic) Cumberland County (teleconference) Lotta Fisher, Tracey Glen-Thomas, Dorothy Johnson GUEST(S) PRESENT: Marjorie Young, Leanna George (Johnston County CFAC), Bryce Coleman ( First in Families), Debby Torres (First in Families), Yancee Perez, Doug Wright, Rob Robinson, Kelly Goodfellow, CJ Lewis

1. WELCOME AND INTRODUCTIONS 2. REVIEW OF THE MINUTES - The minutes from the February 1st meeting were reviewed and approved.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:

Rob Robinson, Kelly Goodfellow – reinvestment plan, Secretary’s announcement

Kelly spent some time reviewing the reinvestment plan for 2016 and 2017. She explained the impact state cuts had on the 2016 plan and the indicated impact the 2017 cut will have unless something changes. The cuts are included in legislation and to change that would take an action by the legislature. The presentation is attached. Rob Robinson spent some time discussing the new 1115 Waiver and its implications. He noted that the waiver is about the medical side of Medicaid, that any changes to the behavioral health side would happen 4 years after the implementation of the 1115 Waiver. That being said, the timeframe for changes to the MCO model would be anywhere from 5-7 years down the road. He also stated that knowing how the system as a whole is changing, Alliance’s goal would be to position itself to be a continuing part of the system long term. The Secretary put out a communication about MCO mergers, again partnering Alliance with Sandhills. The MCOs are to develop a plan to complete those mergers. The plan should be ready by the end of the summer, the actual mergers would take 1-2 years. Questions were ask about the viability of MCOs being a long term part

Continue to review the information around reinvestments, state cuts, the 1115 Waiver, and advocate as you deem appropriately.

Ongoing

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: of the Medicaid system and Rob stated they had ask the same question to the Secretary. He appears committed to the model, therefore the additional mergers are needed to right size the MCOs. (4 total in the state)

First in Families Presentation

Debby Torres and Bryce Coleman gave an overview of who First in Families is and what they do to support families. Bryce spent some time talking about an initiative to support siblings of people with I/DD and encouraged members to let them know about a support group. The group’s information is available on Meet-Up.com. They left additional written materials and information for members.

Utilize resources and spread the word.

Ongoing

Subcommittees

Rules

Services

Communications

Wake

Durham

Cumberland – presenting Ellen Gibson for membership consideration

Area Board

Human Rights

Quality Management

Executive Leadership Team

Rules- Israel discuss the revision of by-laws, offered the opportunity for additional input. The goal is to present in June for a first reading, then vote in the changes at the next meeting. Services – Brynda noted the group has a meeting scheduled on Monday night. Communications – No meeting. Carrie encouraged members to think about a permanent chair for this committee. Wake – Israel gave a brief overview of minutes Durham – Steve talked about their meeting and gave a brief overview of the minutes. Cumberland – Did not have a meeting, had Mental Health First Aid Youth training instead. Decided to table the membership of Ellen Gibson until the next meeting so they could present additional information. Area Board – no report

Continue attending meetings and report back to the full committee.

Ongoing

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Human Rights – no report Executive Leadership – Discussed the importance of gaining more participation, the value of that especially with the continued reform efforts underway.

State Updates/SWOT Analysis

CJ Lewis helped the committee through a SWOT analysis: Strengths Ears at the highest level – CEO attending Education on Community Increased diversity Strong core group of members Having a voice/being heard Weaknesses Lack of orientation Training Lack of participation Not enough input from families Too many acronyms Communication – to each other Time management Opportunities Community trainings, experts Ability to participate in legislative meetings, hearings, etc. Partnerships Outreach – community Challenges/Threats New members Transportation Legislation changes/Mergers

Review the information both locally and MCO wide through this process and make decisions about future needs and actions.

Members were also ask to fill out the self-

assessment form provided and return it to CJ Lewis.

August, 2016

June, 2016

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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Retain Members Complex system

Announcements

Facebook Page – Doug explained that we have been maintaining a CFAC Facebook page and have had limited success in getting members to participate and to get followers. Alliance has started a Facebook page for the organization and we are recommending putting a CFAC tab on that page, giving CFAC the ability to post information through Doug, always denoting that information is from CFAC, and to take advantage of Alliance’s promotional efforts in trying to drive traffic to its page. Through consensus, the group was fine with this change. NAMI Walk – Reminder the walk is on May 7th and CFAC has a table that you voted to man. Dave, Dan, and Sharon all said they would be there to man the table. Dave encouraged Wake members to participate. Nominating Committee – Carrie ask for volunteers to be a part of the nominating committee. They are to present a slate of officers at the next full CFAC meeting in June. Dave, Faye, and Sharon agreed to the task. Doug will get with them to set up an opportunity to review the task and support them in accomplishing it.

Doug to communicate with the Communications Department and assist with implementation of the group’s decision. People should show up and participate on May 7th. Doug will ensure that they have brochures and other information needed for the table. Doug will set up meeting, committee will prepare a slate of officers.

April, 2016

May 7th

June Board Meeting

5. ADJOURNMENT

The group adjourned at 7:30pm.

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Presentation to CFACApril 4, 2016

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• As we invest in developing quality services,

we continue to save

• Plan will address unmet needs

• Sustainable plan through fund balance and

service dollars

• Strong management oversight will allow us

to make adjustments as needed

Reinvestment Plan

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• Develop/expand community-based services

• Manage utilization of high-cost services

• Improve access to services

• Provider stability through rate increases

• Incentive evidence based practices

• Reduce ED admissions and wait times

• Integrated care activities

• Opiate/benzodiazepine misuse

Focus Areas

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FY16 Reinvestment

Description Original Plan Revised Plan

Bridge Funding $400,000

ICF Rate Increase 4,000,000 1,500,000

Crisis Facilities 11,000,000 11,000,000

NC START 620,000 472,000

Integrated Care 1,500,000 450,000

Network Plan 5,000,000 750,000

Expansion of Therapeutic Foster Care 186,000

Trauma Informed Therapeutic Foster Care 50,000

ICF Transitions with B3 funds 183,000

Technology Enabled Home 10,000

Short Term Stabilization PRTF 300,000

Outpatient Rates 1,000,000 250,000

Total $23,520,000 $15,151,000

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FY17 Reinvestment

Description Fully-FundedNon-Funded Investments

with $17M Reduction

FY17 Revised

Investment Plan

Enhanced Therapeutic Foster Care $905,000 X

ICF Transitions 1,000,000 X

Trauma Informed Therapeutic Foster Care 100,000 100,000

Expanded Integrated Care 750,000 750,000

Technology Enabled Home 25,000 X 25,000

Short Term Stabilization PRTF 900,000

First Responders Reimbursement 310,000 310,000

Mobile Crisis 800,000 X

BH Urgent Care 6,500,000 X

Child Facility Based Crisis 9,500,000 X

Peer Respite/Rapid Response 540,000 540,000

Peer Transition Teams 500,000 500,000

IDD Crisis Respite Facility 1,314,000 X

Intensive Wrap Around 360,000 360,000

Group Living Step Down 191,625 191,625

Additional Service Rate Increases 6,250,000 X

Total $29,945,625 $2,776,625

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• Six regions across state

• Three commercial MCOs and up to 12 PLEs

• Timeline

oDHHS to submit Waiver by June 1, 2016

oCMS approval anticipated January 1, 2018

oPHP (PLE and MCOs) “go-live” July 1, 2019

oLME/MCO system left as is until July 1, 2023

Medicaid Reform Plan

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Proposed Regions

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• Four specialty health regions for behavioral

health

• Alliance to merge with Sandhills to form

South Central Region

• LME/MCO implantation plans to be developed

and submitted by end of summer

Latest Developments

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Proposed Regions

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(Back to agenda)

ITEM: Finance Committee Report


BACKGROUND:

The Finance Committee’s function is to review financial statements and recommend

policies/practices on fiscal matters to the Area Board. The Finance Committee meets monthly at

3:00 p.m. prior to the regular Area Board Meeting.

General Statute 159-24 requires that each local government or public authority shall appoint a

finance officer to hold office at the pleasure of the appointing board or official. 159-28 allows for

the appointment of a deputy finance officer for the purpose of pre-audit requirements.


Accept the report. Appoint Kelly Phillips as Deputy Finance Office of Alliance Behavioral

Healthcare.

CEO RECOMMENDATION:

Accept the report. Appoint Kelly Phillips as Deputy Finance Office of Alliance Behavioral

Healthcare.

RESOURCE PERSON(S):

James Edgerton, Committee Chair; Robert Robinson, CEO; Kelly Goodfellow, CFO



5B

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Thursday, April 07, 2016 BOARD FINANCE COMMITTEE

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

Page 1 of 2

APPOINTED MEMBERS PRESENT: ☒ James Edgerton, Chair; ☐George Quick, MBA, ☒ John Griffin; ☒ Vicki Shore ☒ Chris Bostock BOARD MEMBERS PRESENT: Bill Stanford GUEST(S) PRESENT:

STAFF PRESENT: Rob Robinson, CEO; Kelly Goodfellow, CFO; Sara Pacholke, Controller

1. WELCOME AND INTRODUCTIONS

2. REVIEW OF THE MINUTES – The minutes from the 2/4/2016 meeting were reviewed; a motion was made by Vicki Shore and seconded by John Griffin. The minutes from the 3/3/2016 meeting were reviewed; a motion was made by John Griffin and seconded by Vicki Shore.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME

FRAME: 3. The monthly financial reports were discussed which includes the Statement

of Revenue and Expenses – Actual to Budget, Senate Bill 208 Required Ratios, and DMA Contract Ratios

a) Statement of Revenue and Expenses – Actual to Budget as of February 29, 2016 – Alliance currently has revenues exceeding expenses of $27,595,645. The majority of this is related to Medicaid and Medicaid risk reserve.

b) Senate Bill 208 Ratios - Alliance is currently meeting and exceeding all required Senate Bill 208 ratios.

c) DMA Contract Ratios – Alliance is currently meeting and exceeding the defensive interval ratio. Alliance is not currently meeting the Medicaid Expense Ratio. MCO’s are negotiating the contract terms with DMA to change the language to include a Medical Loss Ratio (MLR). This ratio includes certain administrative costs in the expense portion of the ratio calculation (activities that contribute to the direct quality of care). The private sector includes these costs in their calculation, however the current DMA calculation excludes these costs.

4. Rob Robinson and Kelly Goodfellow went over Alliance’s discussion with DMA regarding our Medicaid Rates for FY17. DMA presented Alliance with a 3% rate reduction and allowed us the option to respond.

Finance Committee Meeting 5/5/16 Page 3 of 10

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Thursday, April 07, 2016 BOARD FINANCE COMMITTEE


Page 2 of 2


FRAME:

5. Sara Pacholke discussed that we would be presenting a motion next month to appoint Kelly Phillips, Director of Budget and Financial Analysis as the Deputy Finance Officer.

6. The Budget Transfer Policy was discussed. Jim Edgerton recommended adding language that specified that the transfers would be brought to the Finance Committee before the board. Rob explained that we are working on basic benefit packages that would be offered in each county.

4. ADJOURNMENT


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ASSETS

Current Assets

Cash and cash equivalents $60,290,370.58

Restricted cash 15,685,614.00

Short term investments 35,015,330.69

Due from other governments 8,221,092.02

Accounts receivable, net of allowance for uncollectible accounts 383,359.02

Sales tax refund receivable 71,277.68

Prepaid expenses 245,360.36

Total Current Assets 119,912,404.35

Noncurrent Assets

Restricted Cash 24,024,996.16

Other assets 106,321.66

Capital assets, net of accumulated depreciation 881,247.05

Net Pension Asset 1,862,066.00

Deferred Outflows of Resources 2,933,681.00

Total Other Assets 29,808,311.87

Total Assets $149,720,716.22

LIABILITIES

Current Liabilities

Accounts Payable and Other Current Liabilities 4,161,198.97

Claims and other service liabilities 30,282,094.97

Current portion of accrued vacation 489,279.15

Total Current Liabilities 34,932,573.09

Noncurrent Liabilities

Accrued Vacation 734,930.18

Deferred Inflows of Resources 4,538,308.00

Total Long-Term Liabilities 5,273,238.18

Total Liabilities 40,205,811.27

NET POSITION

Capital Assets at Beginning of Year 726,913.09

Restricted 33,523,126.09

Unrestricted 48,965,250.46

Net Revenue over Expenses:

Current Year Change in Net Position 26,299,615.31

Total Net Position 109,514,904.95

Total Liabilities and Net Position $149,720,716.22

Statement of Net Position - As of March 31, 2016


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Net Position as of June 30, 2015

Capital Assets at Beginning of Year $726,913.09

Restricted

Risk Reserve 17,837,513.24

State Services 62,500.00

Cumberland Services 5,186,805.07

Wake Services 10,436,307.78

Total Restricted 33,523,126.09

Unrestricted 48,965,250.46

Total Net Position as of June 30, 2015 83,215,289.64

Current Year Change in Net Position

Related to Risk Reserve 6,187,482.92

Related to Medicaid Services 20,471,560.54

Related to State and Federal Grant Services (8,021,901.74)

Related to Local Services 1,245,352.26

Related to Administration 6,417,121.33

Total Current Year Change in Net Position 26,299,615.31

TOTAL NET POSITION $109,514,904.95

Net Position: Detail - As of March 31, 2016


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% Received/Original Budget Current Period Year to Date Balance Expended

REVENUESLocal Grants $36,294,009.00 $2,078,931.75 $27,343,534.54 $8,950,474.46 75.34%State & Federal Grants 54,491,655.00 2,872,728.39 32,574,666.82 21,916,988.18 59.78%Medicaid Waiver Services 372,401,144.00 31,021,474.10 273,820,770.86 98,580,373.14 73.53%In Kind - - 1,051,365.04 -

Total Revenue 463,186,808.00 35,973,134.24 334,790,337.26 129,447,835.78 72.28%

AdministrativeLocal Administration 364,086.00 20,789.33 273,064.80 91,021.20 75.00%LME Administrative Grant 4,359,385.00 363,282.00 3,269,538.50 1,089,846.50 75.00%Medicaid Waiver Administration 47,325,972.00 4,028,865.93 35,574,618.27 11,751,353.73 75.17%Miscellanous Revenue 100,000.00 11,654.62 34,091.06 65,908.94 34.09%

Total Administrative Revenue 52,149,443.00 4,424,591.88 39,151,312.63 12,998,130.37 75.08%

Total Revenues 515,336,251.00 40,397,726.12 373,941,649.89 142,445,966.15 72.56%

EXPENSESLocal Services 36,294,009.00 2,295,054.06 26,207,474.85 10,086,534.15 72.21%State & Federal Services 54,491,655.00 3,952,338.88 40,596,568.56 13,895,086.44 74.50%Medicaid Waiver Services 372,401,144.00 30,728,526.86 247,161,727.40 125,239,416.60 66.37%In Kind Expenses - - 1,051,365.04 -

Total Service Expenses 463,186,808.00 36,975,919.80 315,017,135.85 149,221,037.19 68.01%

AdministrativeOperational 7,160,457.00 744,985.69 4,409,680.44 2,750,776.56 61.58%Salaries, Benefits, and Fringe 36,090,150.00 2,899,759.44 23,146,426.29 12,943,723.71 64.14%Professional Services 8,798,836.00 1,073,091.19 5,068,792.00 3,730,044.00 57.61%Miscellanous Expense 100,000.00 - - 100,000.00 0.00%

Total Administrative Expenses 52,149,443.00 4,717,836.32 32,624,898.73 19,424,544.27 62.56%

Total Expenses 515,336,251.00 41,693,756.12 347,642,034.58 168,645,581.46 67.46%

CHANGE IN NET POSITION ($1,296,030.00) $26,299,615.31

Statement of Revenue and Expenses (Budget and Actual) - As of March 31, 2016


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Senate Bill 208 Ratios - As of March 31, 2016

100.00%

86%

88%

90%

92%

94%

96%

98%

100%

102%

O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6 F E B - 1 6 M A R - 1 6

PERCENT PAID

Bench Mark Alliance

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

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

3.43

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00


CURRENT RATIO

Bench Mark Alliance


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DMA Ratios - As of March 31, 2016

94.85

0

20

40

60

80

100

120


DEFENSIVE INTERVAL

Bench Mark Alliance

Defensive Interval = Current assets divided by average daily operating expenses. This rato shows how many days the

organization can continue to pay expenses if no additional cash comes in. The benchmark is 30 days.


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DMA Ratios - As of March 31, 2016

83.68%

70%

75%

80%

85%

90%

95%


MEDICAL EXPENSE RATIO

Bench Mark MER

Medical Expense Ratio (MER) = Total Service Expenses divided by Total Medicaid Revenue less Risk Reserve Revenue. The

benchmark is 85%. This is the ratio requirement per our contract with DMA. MCO's are held harmless through July 2017.

83.76%

70%

75%

80%

85%

90%

95%


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 less Risk Reserve Revenue. The benchmark is 85%. This is the ratio

that is currently being negotiated with DMA.


27 of 162

(Back to agenda)

ITEM: Draft Minutes from the April 7, 2016, Board Meeting


REQUEST FOR BOARD ACTION: Approve the draft minutes from the April 7, 2016, Board Meeting.

CEO RECOMMENDATION: Approve the minutes.

RESOURCE PERSON(S): Robert Robinson, CEO; Veronica Ingram, Executive Assistant

A.



6A

28 of 162

Thursday, April 07, 2016


521 North Brightleaf Boulevard, Smithfield, NC 27577

4:00-6:00 p.m.

Page 1 of 4

MEMBERS PRESENT: ☒Ann Akland (via phone), ☒Cynthia Binanay, Vice-Chairwoman (via phone), ☒Christopher

Bostock, Chairman, ☒George Corvin, MD, ☒Kenneth Edge, ☒James Edgerton, ☒Lodies Gloston, ☒Phillip Golden (via

phone), ☒John Griffin, Ed.D, ☒Curtis Massey (via phone), ☒Rev. Michael Page (via phone), ☐George Quick, ☒Vicki Shore,

☒William Stanford, Jr., ☒Caroline Sullivan (via phone), ☒Amelia Thorpe, ☒Lascel Webley, Jr., and ☐McKinley Wooten, Jr.

GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair (via phone); Carol Beaumont, Johnston County Mental Health Board; Jeffrey Carver, Johnston Board

of County Commissioners; Rick Hester, Johnston County Manager; Terry Keene, Johnston County Mental Health Board; and Jason Phipps, Johnston County

Mental Health Board/Johnston CFAC Chair

ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Hank Debnam, Cumberland Site Director/Veterans Point of Contact; Joey Dorsett,

CIO; Kelly Goodfellow, CFO; Amanda Graham, Chief of Staff; Veronica Ingram, Executive Assistant; Janis Nutt, Johnston Site Director; Sara Pacholke,

Controller; Monica Portugal, Chief Compliance Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Sean Schreiber, Chief Clinical Officer; and Doug

Wright, Director of Consumer Affairs

1. CALL TO ORDER: Chairman Christopher Bostock called the meeting to order at 4:02 p.m.


2. Announcements A. INTRODUCTIONS: Chairman Bostock thanked Dr. Janis Nutt for hosting today’s meeting. Commissioner Jeffrey Carver

welcomed attendees to Johnston County.

B. MAKING A DIFFERENCE BREAKFAST: Mr. Robinson notified Board members that this year’s annual Making a

Difference Breakfast in Durham is on May 5, 2016, from 8:30-10:00 a.m. It is an opportunity to thank and honor

community partners involved with system of care. All Board members are invited to attend the breakfast.

C. UPCOMING MEETINGS WITH LEGISLATORS: Mr. Robinson mentioned upcoming meetings with NC legislators on

April 19, 2016; he invited Board members to contact him if they are able to attend.

D. FUTURE DEVELOPMENT WORKGROUP: Mr. Robinson reminded Board members that the next meeting will be Tuesday,

April 5 at 4:00 pm. This is a staff workgroup that meets monthly. Board members are invited to attend this meeting.

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

4. Public Comment There were no public comments.

5. Committee Reports A. Consumer and Family Advisory Committee – page 5

The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from

Durham, Wake, or Cumberland counties who receive mental health, intellectual/developmental disabilities or substance

29 of 162




4:00-6:00 p.m.

Page 2 of 4


use/addiction services. This month’s report included draft minutes from the Alliance CFAC’s June meeting, a recap of

snapshot surveys, a copy of alcohol awareness training, and the CFAC monthly board report summary.

The committee reports were sent as part of the Board packet; Caroline Ambrose, CFAC Chair, presented the report. Ms.

Ambrose mentioned a recent mental health first aid training for Cumberland CFAC subcommittee members and the

Cumberland community; new Consumer Relations Specialist, Starlett Davis; recent participation in Alliance’s annual Board

budget retreat; and a presentation on accessing I/DD services. Additionally, Ms. Ambrose mentioned development of a

strategic plan to meet legislative requirements and a recent demonstration of navigating Alliance’s website.

B. Finance Committee – page 48

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 February meeting. James Edgerton, Finance Committee

Chair, presented the report. Mr. Edgerton noted that revenue exceeds expenditures; he mentioned Alliance’s excellent

performance on State mandated ratios and discussions being made on changes to two of the ratio definitions.

BOARD ACTION

The Board received the reports; no additional action required.

6. Consent Agenda A. Draft Minutes from March 3, 2016, Regular Board Meeting – page 57

B. Audit and Compliance Committee Report – page 62

C. County Commissioners Advisory Committee Report – page 70

D. Executive Committee Report – page 73

E. Network Development and Services Committee Report – page 76

F. Quality Management Committee Report – page 115

G. 457 and 401K Plan Provisions – page169

Chairman Bostock stated that the consent agenda was sent as part of the Board packet; there were no questions or discussion

about the consent agenda.

BOARD ACTION

A motion was made by Mr. William Stanford to accept the consent agenda; seconded by Ms. Lodies Gloston. Motion passed

unanimously.

30 of 162




4:00-6:00 p.m.

Page 3 of 4


7. Training A. Data Analytics Roadmap – page 170

Alliance is committed to expanding and enhancing its current analytic capabilities to improve business reporting, quality of

care, the cost of care and member experience. Michael Bollini, Chief Strategy Officer, provided an overview of the progress

of the data analytics roadmap and noted changes in staff roles to implement this program. He shared about performance

metrics and characteristics of analytics delivery maturity; Dr. Bollini concluded with the overall benefit of the analytics

program: to provide data to best determine next steps, to provide aggregate data to providers, and to provide data regarding

social determinants and varying population demographics (for the catchment area and local communities).

Board members discussed applicable uses and requested a timeline for program implementation milestones. Dr. Bollini

mentioned that the data discovery milestone is August 2016 and that an update will be provided to the Board if requested.

The presentation of the data analytics roadmap is attached to and made part of these minutes.

B. Strategic Plan Goal #5: Attract and Retain a Talented Workforce – page 183

Al Ragland, Chief HR Officer, reviewed the following: Alliance’s performance management system and its alignment to

the strategic plan; training series for supervisors, management and executive leadership; employee development system with

nearly 9,000 hours of training within the past year; newly initiated wellness program and reward and recognition program;

ongoing internal communications plan; social committee activities (including annual All-Staff training); current staff

demographics, turnover and time to fill rates.

Mr. Robinson shared the positive impact from the activities that the social committee coordinates. He commended social

committee chair, Anita Hoggard, Training Specialist. Board members requested information regarding turnover rate with

other NC MCOs, state and county agencies. Mr. Ragland shared that for the information currently available, Alliance’s rates

are better. He will provide an update when additional information is available. Additionally, Board members requested

information regarding if future wellness programs could be used to impact insurance coverage (enrollment in wellness plan

could lower premium rates). Mr. Ragland shared that this is being pursued; he also stated that as Alliance is self-insured, it

has produced over 10% projected savings. The presentation of the strategic plan goal five update is attached to and made

part of these minutes.

BOARD ACTION

The Board received the trainings; no additional action required.

31 of 162




4:00-6:00 p.m.

Page 4 of 4


8. Updates A. Senate Bill 208 – page 206

Kelly Goodfellow, CFO, presented an update on SB 208 audit performed by an external consultant (HMS) per legislative

guidelines/requirements. Ms. Goodfellow noted that Alliance received results from the September review of March-August

2015; she noted all findings were favorable. The data from all NC MCOs is also provided to NC DHHS Secretary, Rick

Brajer. The presentation of the Senate Bill 208 audit is attached to and made part of these minutes.

B. Medicaid Reform/Consolidation

Mr. Robinson reminded Board members of Secretary Brajer’s Medicaid reform plan. He mentioned the State’s 1115

innovations waiver application and how it moves physical healthcare to a capitated rate plan under which MCOs already

operate. The secretary’s plan includes three state-wide commercial managed care companies and up to twelve PLEs

(provider led entities). MCOs are left as is through July 1, 2023. The draft 1115 waiver is currently being vetted primarily

through a series of twelve listening sessions convened by the DHHS across the North Carolina.

Also, Mr. Robinson mentioned the March 17, 2016, meeting with Secretary Brajer and NC LME/MCO CEOs; at this

meeting Secretary Brajer shared his plan regarding MCO consolidation; this included his plan for a merger between

Alliance and Sandhills LME/MCOs.

9. Chairman’s Report Chairman Bostock reminded Board members that next month’s Board meeting is at Alliance’s corporate site.

10. Closed Session BOARD ACTION

A motion was made by Dr. George Corvin to enter closed session pursuant to per § 143-318.11 (a) (6) to consider the

qualifications, competence, and performance of an employee; seconded by Dr. John Griffin. Motion passed unanimously.

The Board returned to open session.


Next Board Meeting


4:00 – 6:00

Robert Robinson, Chief Executive Officer Date Approved

32 of 162

(Back to agenda)

ITEM: Audit and Compliance Committee Report


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 Area Board in

fulfilling its oversight responsibilities.

This report includes draft minutes for the April 18, 2016 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



6B

33 of 162

Monday, April 18, 2016

BOARD AUDIT AND COMPLIANCE COMMITTEE - SPECIAL MEETING

4600 Emperor Boulevard, Durham, NC 27703

4:00-6:00 p.m.


Page 1 of 2

APPOINTED MEMBERS PRESENT: ☐Curtis Massey, B.A., J.D., ☒George Quick, B.A., M.B.A., ☒Lascel

Webley, Jr., Committee Chair, B.S., M.B.A., M.H.A., ☒McKinley Wooten, Jr., B.A., J.D.,

BOARD MEMBERS PRESENT: None

GUEST(S) PRESENT: None

STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Ken Marsh, Medicaid Program Director


2. REVIEW OF THE MINUTES – The minutes from the September 10, 2015, meeting and notes from November 19, 2015 and March 10, 2016

meetings were reviewed; a motion was made by Mr. Wooten and seconded by Mr. Quick to approve the minutes. Motion passed unanimously.


FRAME:

3. Annual Conflict of

Interest Disclosures

All but three Board Members have turned in the annual disclosure form. So

far no conflict, which has not already been approved by the Board, has been

disclosed. Mr. Webley requested that meeting stipends are withheld,

according to the conflict of interest policy, until the forms have been

submitted.

Ms. Portugal will

request that the

stipends be withheld

By April 30,

2016

4. Independent Audit

Contract

The Committee reviewed a summary of the FY17 Contract and Scope of

Work between Alliance and the audit firm. There was a discussion regarding

the contract and whether Alliance should pursue other firm. Mr. Quick stated

the selected firm has expertise in areas other firms do not, including local

government. Many counties in the Alliance catchment area use the same

firm. Ms. Portugal explained that the firm’s most recent (2013) peer review

conducted through American Institute of CPAs resulted in a passing score.

The next system peer review is due in October of this year. Ms. Portugal

suggested to utilize the results of the review to evaluate the firm’s

performance and own internal controls. Also, all relationships between

Alliance and the firm were disclosed.

A motion was made by Mr. Wooten that Mr. Webley, as the Committee

Chair, be given the authority to sign the contract on behalf of the Committee.

The motion was seconded by Mr. Quick. Motion passed.

Ms. Portugal will

request the results of

the next peer review

October 2016

34 of 162

Monday, April 18, 2016

BOARD AUDIT AND COMPLIANCE COMMITTEE - SPECIAL MEETING


4:00-6:00 p.m.


Page 2 of 2


FRAME:

Mr. Webley signed the contract.

5. Annual Risk

Assessment

Ms. Portugal provided an overview of the annual risk assessment and

requested feedback regarding the proposed methodology for FY17. Mr.

Wooten recommended that the Compliance Department continue recruitment

of the financial auditor position in order to gain additional expertise in

certain areas. The Committee agreed with the proposed methodology.

N/A N/A

6. EQRO Update As a follow up to the previous meeting, Mr. Marsh reported that Alliance has

submitted a formal request to DMA to designate the Continuous Quality

Improvement Committee as an “other structure” as allowed in Section 7.1 of

the DMA / Alliance Contract. Alliance is expecting an answer from DMA

sometime soon.

N/A N/A

7. Quarterly Reports

The Committee reviewed the quarterly Compliance dashboard for Quarters

1, 2, and 3 of FY16. Members asked questions related to the hotline,

overpayments and special investigations.

N/A N/A

8. ADJOURNMENT: next meeting will be May 11, 2016, from 4:00 p.m. to 5:30 p.m.

35 of 162

(Back to agenda)

ITEM: Executive Committee Report


BACKGROUND:

The Executive Committee sets the agenda for Area Board meetings and acts in lieu of the Area

Board between meetings. Actions by the Executive Committee are reported to the full Area Board

at the next scheduled meeting. Draft minutes from the April 19, 2016, meeting and approved

minutes from the March 29, 2016, meeting are attached.

REQUEST FOR AREA BOARD ACTION: Accept the report.

CEO RECOMMENDATION: Accept the report.

RESOURCE PERSON(S): Christopher Bostock, Area Board Chair; Robert Robinson, CEO



6C

36 of 162

Tuesday, March 29, 2016

BOARD EXECUTIVE COMMITTEE MEETING - SPECIAL MEETING


11:30 a.m. to 12:30 p.m.


Page 1 of 1

APPOINTED MEMBERS PRESENT: ☐Ann Akland, Services Committee Chair, B.S.; ☒Cynthia Binanay, Board

Vice-Chair, B.S.N, M.A.; ☒Christopher Bostock, Board Chair, B.S.I.M.; ☒George Corvin, Quality Management

Committee Chair, M.D. (entered at 11:47 a.m.); ☒James Edgerton, Finance Committee Chair, B.S.; ☒Lodies Gloston,

Human Rights Committee Chair, B.A., M.A.; ☒Curtis Massey, Policy Committee Chair, B.A., J.D. (via phone); ☒

William Stanford, Previous Board Chair, B.A., J.D.; and ☐Lascel Webley, Audit and Compliance Committee Chair,

B.S., M.B.A., M.H.A


GUEST(S): None

STAFF PRESENT: Veronica Ingram, Executive Assistant; Al Ragland, Chief HR Officer

1. WELCOME AND INTRODUCTIONS: Chairman Bostock reminded Committee members of the budget retreat occurring at 12:30 pm.


FRAME:

2. Closed Session Committee entered closed session.

COMMITTEE ACTION:

A motion was made by Ms. Lodies Gloston to enter closed session pursuant to NC

General Statue 143-318.11(a) (6) to discuss the performance of a public official;

seconded by Mr. William Stanford. Motion passed unanimously.

None specified. N/A

3. Return to Open

Session

Committee returned to open session.

Chairman Bostock noted that the Area Board would hold a closed session during its

April 7, 2016, meeting. The Executive Committee would share input at that time.

None specified. N/A

4. ADJOURNMENT: the next Committee meeting will be April 19, 2016, at 4:00 p.m.

37 of 162

Tuesday, April 19, 2016

BOARD EXECUTIVE COMMITTEE MEETING - REGULAR MEETING


4:00-6:00 p.m.


Page 1 of 2

APPOINTED MEMBERS PRESENT: ☒Ann Akland, Services Committee Chair, B.S. (via phone); ☒Cynthia

Binanay, Board Vice-Chair, B.S.N, M.A. (via phone); ☒Christopher Bostock, Board Chair, B.S.I.M.; ☒George

Corvin, Quality Management Committee Chair, M.D. (via phone); ☒James Edgerton, Finance Committee Chair, B.S.;

☒Lodies Gloston, Human Rights Committee Chair, B.A., M.A.; ☒Curtis Massey, Policy Committee Chair, B.A., J.D.

(via phone); ☐William Stanford, Previous Board Chair, B.A., J.D.; and ☒Lascel Webley, Audit and Compliance

Committee Chair, B.S., M.B.A., M.H.A (via phone)


GUEST(S): None

STAFF PRESENT: Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram, Executive Assistant; Rob Robinson, CEO


2. REVIEW OF THE MINUTES – The minutes from the March 15, 2016, and March 29, 2016, Executive Committee meetings were reviewed; a

motion was made by Mr. Edgerton and seconded by Mr. Webley to approve the minutes. Motion passed unanimously.


FRAME:

3. Updates a) NEXT FUTURE DEVELOPMENT WORKGROUP MEETING: Chairman

Bostock reminded Committee members that the next meeting for this staff work

group is Tuesday, May 3, 2016, at 4:00 p.m.

b) MEDICAID REFORM/CONSOLIDATION: Mr. Robinson provided an update

on the State’s 1115 waiver application. Additionally, he reviewed NC Council’s

recommendations regarding the 1115 waiver and noted that LME/MCO’s will

remain in current form for four years after implementation of the physical health

side.

a) Committee

members will

contact Ms.

Ingram to

confirm

attendance or

arrange a call-in

number.

b) None specified.

a) 5/3/2016

b) N/A

4. MHPA (Mental

Health Plans of

America)

Mr. Robinson reported that Alliance recently joined MHPA which is a trade

association for Health Plans treating the Medicaid population.

None specified. N/A

5. May 5, 2016, Area

Board Draft Agenda

Committee reviewed draft agenda and provided input. Ms. Ingram will

forward revised

agenda to staff

4/19/2016

38 of 162

Tuesday, April 19, 2016

BOARD EXECUTIVE COMMITTEE MEETING - REGULAR MEETING


4:00-6:00 p.m.


Page 2 of 2


FRAME:

6. Closed Session COMMITTEE ACTION:

A motion was made by Mr. Edgerton to enter closed session pursuant to NC

General Statute 143-318.11(a) (6) to consider the qualifications, competence, and

performance of an employee; seconded by Ms. Gloston. Motion passed

unanimously.

Committee returned to open session. Chairman Bostock will present the

Committee’s recommendation at the May 5, 2016, Area Board meeting.

None specified. N/A

5. ADJOURNMENT: the next Committee meeting will be May 17, 2016, at 4:00 p.m.

39 of 162

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REGISTRATION OPENS MAY 1, 2016!

50 of 162

https://healthcrowd.com/

http://www.medtronic.com/us-en/index.html?cmpid=mdt_com_orcl_us_home_f52_plc_home&utm_source=mdt_com_orcl_us_home&utm_medium=f5_redirect&utm_campaign=PLC_Launch_2015

http://www.centene.com/

https://www.express-scripts.com/index.html

https://www.mtm-inc.net/

Medicaid Health Plans of America 1150 18th Street NW, Suite 1010

Washington, DC 20036 www.mhpa.org

51 of 162

http://www.mhpa.org/

http://www.alliancebhc.org/

https://www.trilliumhealth.org/

https://www.facebook.com/Medicaid-Health-Plans-of-America-MHPA-94254724141/

http://www.marchforbabies.org/team/Medicaid

6D

(Back to agenda)

ITEM: Human Rights Committee Report


BACKGROUND:

The Human Rights Committee shall include consumers and family members representing mental

health, developmental disabilities and substance abuse.

The Human Rights Committee functions include:

1) Reviewing and evaluating the Area Authority’s Client Rights policies at least annually and

recommending needed revisions to the Area Board.

2) Overseeing the protection of client rights and identifying and reporting to the Area Board

issues which negatively impact the rights of persons serviced.

3) Reporting to the full Area Board at least quarterly.

The Human Rights Committee shall meet at least quarterly.

The Human Rights Committee is required by statute and by your by-laws. The Committee meets

at least quarterly and reports to you by presenting the minutes of the meetings as well as through

Quality Management Reports reviewing grievances and incidents.

The Human Rights Committee is a Board Committee with at least 50% of its membership being

either consumers or family members that are not Board Members. All members and the chair are

appointed by the Chair of the Alliance Board of Directors. The Committee is currently chaired by

Ms. Lodies Gloston. Draft minutes and attachments for April 14, 2016, meeting are attached.


Accept the report.

CEO RECOMMENDATION:

Accept the report.

RESOURCE PERSON(S):

Lodies Gloston, Committee Chair; Doug Wright, Director of Consumer Affairs; May Alexander,

QM Data Manager



52 of 162


BOARD HUMAN RIGHTS COMMITTEE - REGULAR MEETING


4:00-6:00 p.m.


Page 1 of 5

APPOINTED MEMBERS PRESENT: ☒Marie Dodson, ☒Lodies Gloston, Board member/Committee Chair,

B.A., M.A., ☒Dan Shaw, ☒William Stanford, Board member, B.A., J.D., ☒Dr. Michael Teague, ☐Amelia Thorpe,

Board member, B.A., and ☐McKinley Wooten, Jr., Board member, B.A., J.D.

APPOINTED, NON-VOTING MEMBERS PRESENT:

BOARD MEMBERS PRESENT:

GUEST(S) PRESENT: STAFF PRESENT: Doug Wright, Yancee Pérez, Star Davis, Monica Portugal, May Alexander


2. REVIEW OF THE MINUTES - The minutes from the January 14, 2016, meeting were reviewed; a motion was made by Lodies Gloston and

seconded by Dan Shaw to approve the minutes. Motion passed.


FRAME:

Grievances – May Alexander

May reviewed the number of complaints against Alliance in

FY16.

There are 47 complaints against Alliance so far this year. 46

of the complaints are LME/MCO functions and 1 is

categorized as Client Rights.

The 7 different sources the complaints came from:

Consumer, Parent/Guardian, Provider, Family Member,

Attorney, Consumer Advocate/Rep., & Other.

19 of 47 were External Stakeholder concerns, 26 were

Grievances, and 2 were Internal Employee Concerns.

May reviewed Client Rights and Confidentiality Concerns

in FY16.

There are 31 concerns regarding Clients Rights or

HIPPA/Confidentiality so far this fiscal year.

53 of 162




4:00-6:00 p.m.


Page 2 of 5


FRAME:

20 concerns were related to Clients Rights and 11 were

HIPAA/Confidentiality concerns. 6 of 31 concerns were

initiated by an Alliance employee.

Incidents – May Alexander

May spoke to the level three incident data (those that result

in physical or psychological damage). There are five

compliance categories that Alliance tracks each month.

It was mentioned that the area Alliance Providers struggle

most are in the area of verbal reporting to the proper agency

within a time frame of 24 hrs. and a written report within 72

hrs. There is a process that will be implemented by the

Corporate Compliance Committee in FY 17. That process

will include issuing warning letters and plans of correction.

Important note upon viewing the data presented by May;

each block is a month, and non-compliance is separated by

categories.

Information is collected about all level three incidents

abuse/neglect/exploitation and whether they were reported,

how many were reported, and whether they were reported

to the Department of Social Services or not. It was noted

that all sexual assaults are categorized as a level three.

May reviewed with the HRC the January and February data.

There was an increase in reports for the month of January

and February.

54 of 162




4:00-6:00 p.m.


Page 3 of 5


FRAME:

Following was a report on the Level three incidents by

county. A noted abnormality was that there were no level

three incidents reported in Cumberland and Johnston

counties.

May mentioned that the reason some data doesn’t show as

of yet, is due to the fact that autopsies can take anywhere

from 12 months to even longer.

Compliance – Monica

Portugal

Monica Portugal, Chief Compliance Officer made a

presentation to the HRC giving an overview of the

Compliance Department.

Presentation began with exploring who is involved

• Each employee is committed – condition of

employment

• Every department serves a role

• Inter-departmental committees provide oversight

and reporting

• The Board is informed and governs the organization

• Oversight agencies monitor and enforce

How is compliance monitored

• Routine Monitoring

• Targeted Monitoring

• Grievance and Complaints Investigations

• Compliance Investigations

• Special Investigations

• Quality Assurance and Quality Improvement

• Clinical Reviews

55 of 162




4:00-6:00 p.m.


Page 4 of 5


FRAME:

What does the compliance process look like

• Prevention:

• Information, Training, Obligations

• Detection:

• Monitoring/Investigation/Review

• Resolution and Mitigation:

• Findings presented to Corporate Compliance

Committee

• Actions and Sanctions

• Reconsiderations

Follow up from last meeting:

May, research the

opioid data included

with terminal illness

data

Potential Members

May reported that she looked into why opioid data was

included along with the terminal illness data. She

speculated that it may be something that was developed by

the state, and that death of natural causes are labeled as a

level two incident. The answer is still unclear.

Monica recommended contacting the DMH customer

service team to clarify.

Lodies introduced an individual interested in becoming a

member of the Human Rights Committee. The group

decided that it would be best for the potential member to be

present at the next meeting to introduce themselves and be

available to answer questions from the HRC members.

Lodies to contact potential member to

attend the next HRC meeting.

Next Meeting topic

Why people need

services, why people

leave services, and

There was discussion among the group concerning the

ability to only cover one topic from those proposed.

56 of 162




4:00-6:00 p.m.


Page 5 of 5


FRAME:

why people change

providers

Denials

Announcements There were no further announcements.

5. ADJOURNMENT: next meeting will be July 14, 2016 from 4:00 p.m. to 5:30 p.m.

57 of 162

Month # of Concerns

July 5

August 7

September 3

October 3

November 8

December 9

January 8

February 4

March

April

May

June

Nature of Issue July August September October November

Clients Rights 0 0 0 0 0

Confidentiality/HIPAA 0 0 0 0 0

LME/MCO Functions 5 7 3 3 8

# of Concerns - FY15

Summary of Concerns Against Alliance - FY16

47 complaints against Alliance in FY 2016

46 LME/MCO Functions. 1 Clients Rights

7 different sources (Consumer, Parent/Guardian, Provider, Family Member, Attorney,

Consumer Advocate/Rep., Other) submitted complaints.

19 of 47 were External Stakeholder concerns; 26 were Grievances; 2 were Internal

Employee Concerns

5

7

3 3

8

9

8

0

1

2

3

4

5

6

7

8

9

10

July August September October November December January

Number of Concerns Against Alliance by Month

# of Concerns Against Alliance by Nature of Issue

58 of 162

1

5

7

3 3

8

9 7

0

1

2

3

4

5

6

7

8

9

10


# of Concerns Against Alliance by Nature of Issue

Clients Rights Confidentiality/HIPAA

59 of 162

December January February March April May June

0 1 0

0 0 0

9 7 4

# of Concerns - FY15

4

January February March April May June

Number of Concerns Against Alliance by Month - FY16

# of Concerns Against Alliance by Nature of Issue - FY16

60 of 162

4


# of Concerns Against Alliance by Nature of Issue - FY16

LME/MCO Functions

61 of 162

Yes No

March Appropriately Categorized 10 0

Notified Proper Agency 10 0

Reported Within Timeline 7 3

Effective Intervention and Protection 10 0

Report Accurate and Complete 10 0

Yes No

February Appropriately Categorized 9 2





Yes No

January Appropriately Categorized 11 1





Yes No

December Appropriately Categorized 9 0





Yes No

November Appropriately Categorized 16 1





Yes No

October Appropriately Categorized 14 1





Yes No

September Appropriately Categorized 13 0

Incident Compliance for Level 3s - FY16

Reported Within Timeline

Effective Intervention and Protection

Report Accurate and Complete

Appropriately Categorized

Notified Proper Agency





























Jan

uar

yD

ece

mb

erN

ove

mb

erO

cto

be

rSe

pte

mb

erA

ugu

stJu

ly

62 of 162





Yes No

August Appropriately Categorized 11 1





Yes No

July Appropriately Categorized 12 1





July August September October

Appropriately Categorized 1 1 0 1

Notified Proper Agency 0 0 1 0

Reported Within Timeline 1 3 2 3

Effective Intervention and Protection 2 0 0 2

Report Accurate and Complete 1 0 0 2

Categories Receiving "No"s by Month














Mar

chFe

bru

ary

Jan

uar

y

1

1

2

1

1

3

1

2

1

3

2

2

1

3

1

2

1

1

1

2

2

2

5

5

3






Non-Compliance by Category by Month

63 of 162

Yes No % No

Appropriately Categorized 105 7 7%

Notified Proper Agency 101 11 11%

Reported Within Timeline 93 19 20%

Effective Intervention and Protection 100 12 12%

Report Accurate and Complete 102 10 10%

Combined Compliance for Level 3s - FY16

105 101 93 100

7%, 7 11%, 11 20%, 19 12%, 12

0

20

40

60

80

100

120

AppropriatelyCategorized

Notified Proper Agency Reported Within Timeline Effective Interventionand Protection

Report Accurate and

Combined Compliance for Level 3s - FY16

Yes No

0 1 2 3 4 5 6 7 8 9


64 of 162

2

2

2

1

1

1

32

1

2

1

3

2

2

1

2

1

3

1

1

2

1


































Level 3 Incident Compliance by Month - FY16

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November December January February March April May

1 0 1 2 0

3 1 1 5 0

2 1 2 2 3

1 0 2 5 0

2 0 2 3 0

3

2

5

2

5

3

1

1

2

0 2 4 6 8 10 12 14 16 18














Yes No

2 1 2 2

5

3

Compliance by Category by Month - FY16

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102

10%, 10

Report Accurate andComplete

10 11 12 13 14 15 16 17 18 19 20


67 of 162

68 of 162

June

18 20

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Client Rights CompliancePresentation to the Human Rights Committee

April 14, 2016

Monica Portugal, Chief Compliance Officer

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71 of 162

Who Is Involved?

• Each employee is committed – condition of

employment

• Every department serves a role

• Inter-departmental committees provide oversight and

reporting

• The Board is informed and governs the organization

• Oversight agencies monitor and enforce

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How Do We Do It?

• Routine Monitoring

• Targeted Monitoring

• Grievance and Complaints Investigations

• Compliance Investigations

• Special Investigations

• Quality Assurance and Quality Improvement

• Clinical Reviews

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Compliance Process

• Prevention:

• Information, Training, Obligations

• Detection:

• Monitoring/Investigation/Review

• Resolution and Mitigation:

• Findings presented to Corporate Compliance Committee

• Actions and Sanctions

• Reconsiderations

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(Back to agenda)

6E

ITEM: Budget Retreat


BACKGROUND:

Review and approve the Budget Retreat minutes.

REQUEST FOR AREA BOARD ACTION: Approve the minutes.

CEO RECOMMENDATION: Approve the minutes.

RESOURCE PERSON(S):

Robert Robinson, CEO; Kelly Goodfellow, CFO



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AREA BOARD REGULAR MEETING: ANNUAL BUDGET RETREAT


12:30-4:00 p.m.

Page 1 of 2

MEMBERS PRESENT: ☒Ann Akland, ☒Cynthia Binanay, Vice-Chairwoman, ☒Christopher Bostock, Chairman,

☒George Corvin, MD, ☐Kenneth Edge, ☒James Edgerton, ☒Lodies Gloston, ☒Phillip Golden, ☐John Griffin, Ed.D,

☐Curtis Massey, ☒Rev. Michael Page (entered at 1:33 p.m.), ☒George Quick, ☐Vicki Shore, ☒William Stanford, Jr.,

☐Caroline Sullivan, ☐Amelia Thorpe, ☐Lascel Webley, Jr., and ☐McKinley Wooten, Jr.

GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair

ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Dr. Tedra Anderson-Brown, Medical Director; Joey Dorsett, Chief

Information Officer; Cathy Eaton, Administrative Assistant for Finance Department; Ashley Everette, Budget Analyst; Kelly Goodfellow, CFO; Carol

Hammett, General Counsel; Veronica Ingram, Executive Assistant; Beth Melcher, Chief of Network Development and Evaluation; Ann Oshel, Chief

Community Relations Officer; Sara Pacholke, Controller; Kelly Phillips, Director of Budget and Financial Analysis; Monica Portugal, Chief Compliance

Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Sean Schreiber, Chief Clinical Officer; and Doug Wright, Director of Consumer Affairs

1. INTRODUCTIONS: Mr. Robinson welcomed attendees; attendees introduced themselves.

AGENDA

ITEMS: DISCUSSION:

2. Opening/

Approach to

Budgeting

Kelly Goodfellow, CFO, provided a brief overview of the agenda. She noted that the approach to budgeting included historical

experience, capitation rate setting (which impacts funding), strategic initiatives, stakeholder input, needs and gaps analysis, and

the legislative environment which all impact the pending budget. Additionally, Ms. Goodfellow provided an overview of the

administrative budget and upcoming events which could impact the budget.

3. CFAC

Perspective

Caroline Ambrose, CFAC Chair, provided an overview of Alliance CFAC; Ms. Ambrose’s presentation included CFAC

composition, involvement/influence in additional community stakeholder groups, informational sources, and opportunities to

share input though Alliance department and reports, specifically gaps in services and needs that CFAC members identified.

Additionally, Ms. Ambrose shared overall concerns of CFAC members and expressed gratitude for being a part of the budget

retreat.

4. Provider

Networks

Beth Melcher, Chief of Network Development and Evaluation, reminded Board members of elements of the reinvestment plan

and provided an overview on the following: service priorities, disparities in State benefit plan, and FY17 DHHS State

initiatives/goals for NC MCOs.

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AREA BOARD REGULAR MEETING: ANNUAL BUDGET RETREAT


12:30-4:00 p.m.

Page 2 of 2

AGENDA

ITEMS: DISCUSSION:

Board members requested an update regarding housing and the DOJ settlement. Ms. Oshel provided an update with local

housing options; she noted that developing partnerships with landlords and potential master lease agreements are some of the

options Alliance is pursuing. Additionally, Board members requested information regarding how State funds originally

designated to specific counties are utilized.

5. Clinical

Review

Sean Schreiber, Chief Clinical Officer, reviewed information on spending data by funding type, population, and service utilized;

he also provided information regarding how care was managed.

Board members discussed emergency room usage and how crisis facilities and elements of Alliance’s reinvestment plans can

impact emergency room usage for behavioral health needs.

6. Financial

Review

Kelly Phillips, Director of Budget and Financial Analysis, provided an overview of the budget to date: noting Medicaid

revenue/expense, services budget, administration budget, the PMPM (per member per month) funding, and current expenditures

compared to last year. Ms. Phillips also presented an overview of projected FY17 budget impacts.

7. Board Input Board members discussed potential budget impacts: impact from the end of SAMSHA grant, second year of single stream

funding cuts, amount specified for the administrative budget, potential expenses related to consolidating MCOs, and investment

options per statute requirements.

8. Next Steps Ms. Phillips mentioned that a recommended budget will be presented at the May Board meeting; the public hearing and

approved budget will occur at the June Board meeting. The budget retreat presentations are attached to and made part of these

minutes.


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FY17 Budget Retreat

March 29, 2016

78 of 162

• Approach to budgeting

• CFAC perspective

• Provider Networks review

• Clinical review

• Financial review

• Board input

• Next steps

Agenda Review

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• Historical and YTD experience

• Capitation rate

o Trend and rate offer

• Strategic initiatives

oReinvestment Plan

• Stakeholder input

o Board, CFAC, County, etc.

• Legislative environment

Approach to Budgeting

80 of 162

• Administrative

o Staff need and projections

o Professional services

o Medicaid Reform

• Consultants, staffing impact, facility needs,

training and education, etc.

o MCO consolidation

Approach to Budgeting

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Consumer and Family

Advisory Committee

82 of 162

AllianceCFAC

WakeSubcommittee

DurhamSubcommittee

CumberlandSubcommittee

Johnston CFACInterlocal

Agreement

Board of Directors

Who Are We?

83 of 162

• Peer Support Specialist

• Board Member, The Arc of the Triangle

• Board Member, Durham County Community

Living Program

• Wellness City Citizen

• NAMI Wake

• NAMI Durham

• NAMI Cumberland/Harnett/Lee

Scope of Influence

84 of 162

• Americans with Disabilities Act, Cumberland

• Special Olympics

• Advocacy and Leadership Committee,

NC Council on Developmental Disabilities

• State CFAC

• First in Families

• Homeless Veteran’s Council

• Alliance Human Rights Committee

Scope of Influence

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• Snap Shop surveys

• Community outreach activities

o Resource fair, Anonymous People film showing

• Personal experience and experiences shared

with us by community members

• Advocacy groups

Sources of Information

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1. In thinking in this very minute, what

suggestion would you make to have CFAC

be a more meaningful experience?

2. Name two goals that you would like CFAC

to accomplish in the next four months.

3. In thinking about your community at this

very moment, is there a gap in services or

a service that needs addressing?

Snap Shot Survey

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4. Please note any areas of concern as it relates

to the cultural competence of Alliance or the

providers in our network.

5. In thinking about CFAC's "advisory" role, make

a suggestion that you think the Alliance Board

should take on or address.

Members encouraged to fill out a Snap Shot

Survey at each meeting attended and whenever

they have concerns or ideas they feel the need

to share

Snap Shot Survey

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• Annual Report

• Monthly minutes and reports

• Gaps and Needs Analysis

• Budget retreat

• Participation on Global Quality Management

and Human Rights Committees

Communicating Our Concerns

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• Affordable and accessible housing

• Transportation

• Employment

• Education

Note of interest: In every forum or avenue

utilized to gather input, these common themes

around healthy communities were repeated

often

Social Determinants of Health

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• Innovations slots

• Direct care workers

o Shortage of qualified workers having a major

impact on authorized services being utilized

• Assistive technology

• Crisis respite

• Case management

• Effective school inclusion

I/DD Service Gaps and Needs

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• Peer-run respite

• Recovery centers

• Psychiatric appointments

o Especially for females preferring same gender

services

• Effective peer support

• Accessible services

• Crisis services for children in Cumberland

Mental Health Gaps and Needs

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• Medical detoxification

• Social detoxification

• Expanded treatment options

o Most SUD consumers don’t have insurance,

not many options or at best long wait lists

• Recovery centers

• Youth services

SUD Gaps and Needs

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• LGBTQ – appropriate services

• Deaf community – availability and access to

services

• Non-English speakers – availability and

access to services

• Transition-aged youth

• Veterans and families

Specialty Populations

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• Medicaid expansion

• Collaborative/integrated services

• The “digital divide”

• Trust in the system

• Continued State funding cuts

• Stigma

Systemic Concerns

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• Alliance benefit plans

o Currently every community has a different

benefit plan for State and indigent services

o This is not only confusing but reinforces the idea

of the “haves and have nots”

Systemic Concerns

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Thanks for having us participate today.

We will leave you with a quote from the

Recovery and Self Determination trainings:

“You can never change things by fighting

the existing reality. To change something,

build a new model that makes the

existing model obsolete.”

-Buckminster Fuller

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FY16 Community Needs

and Gaps Analysis

98 of 162

• Expand services to meet geographic access

and choice standards

• Develop a more uniform State benefit

package across the four-county Alliance

region

• Expand capacity for crisis, hospital diversion

and respite services for all ages/disabilities

Service Priorities

99 of 162

• Increase breadth, access and quality of

residential treatment and housing options

• Increase capacity to serve consumers with

co-occurring IDD/MI

• Develop and enhance the continuum of

care for individuals with substance use

disorders

Service Priorities

100 of 162

• Increase availability, tracking and oversight

of specialty services and evidence-based

practices

• Increase availability of transportation

resources

• Increase availability of employment

resources

Service Priorities

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• Residential

• Substance use

• I/DD supported employment

• I/DD respite

• Psychological testing

Disparities in State Benefit Plan

102 of 162

• Recovery is possible

• Crisis Solutions Initiative

• Employment

• Housing options

• Integration of behavioral and physical

health service

• The Resilient Child and Family

• Opioid and prescription drug abuse

FY17 DHHS Initiatives

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Population Trends

and Care Management

104 of 162

$322,951,801

$46,446,282

Medicaid vs. State Spending

Medicaid State

Total Spending Data

105 of 162

$142,180,916$180,770,884

Medicaid Spending by Age

Child Adult

Total Medicaid Spending:

$322,951,801

106 of 162

$5,211,575

$41,234,304

State Spending by Age

Child Adult

Total State Spending:

$46,446,282

107 of 162

$113,424,906

$48,739,080

$17,027,403

$62,896,855

$11,719,533

$69,095,742

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

Child MH/SA Adult/MHSA Child InnovationsAdult Innovations Child Non-Innovations IDD

Adult Non-Innovations IDD

Medicaid Spending by Age and Diagnosis


$322,951,801

108 of 162

$5,734$2,774

$25,721

$52,988

$5,942

$49,318

Medicaid Spending Per ConsumerChild MH/SA Adult/MHSA

Child Innovations Adult Innovations

Child Non-Innovations IDD Adult Non-Innovations IDD

19780

17565

662 1187 1972 1401

0

5000

10000

15000

20000

25000

Medicaid Consumers

# of Medicaid Consumers Served by Age and Diagnosis

Child MH/SA

Adult/MHSA

Child Innovations

Adult Innovations

Child Non-Innovations IDD

Adult Non-Innovations IDD


$322,951,801

109 of 162

$3,882,373

$32,897,329

$1,329,502

$8,337,077

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

Child MH/SA Adult/MHSA Child IDD Adult IDD

State Spending by Age and Diagnosis


$46,446,282

110 of 162

$2,333 $2,259$3,077

$8,739

State Spending Per Consumer


1664

14561

432954

0

2000

4000

6000

8000

10000

12000

14000

16000


# of State Consumers Served


$46,446,282

111 of 162

$9,293,146

$68,253,431

ICF Medicaid Spending by Age

Child Adult

• 79% of the total Non-Innovations Medicaid

Spending was on Child ICF services

• 99% of the total Non-Innovations Medicaid

Spending was on Adult ICF services

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$13,410,779

$5,480,237

Inpatient Medicaid Spending by Age

Child Adult

• 9% of the Medicaid Spending was on

Child Inpatient services

• 3% of the Medicaid Spending was on

Adult Inpatient services

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41%

20%

15%

24%

68%

16%

7%9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

1 to 7 8 to 11 12 TO 15 15+

Inpatient LOS in Days by Age

Child Adult

114 of 162

$468,372

$2,515,611

Medicaid Crisis Spending by Age

Child Adult

• 0.33% of the Medicaid Spending was on

Child Crisis services

• 1.39% of the Medicaid Spending was on

Adult Crisis services

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$13,802,581

$12,374,652

$10,370,196

Non IDD Residential Medicaid Spending

PRTF TFC Group Homes

• 11% of the Non-Innovations Medicaid

Spending was on PRTF services


Spending was on TFC services


Spending was on Group Home Services

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$2,710,429

$2,198,475

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

Adult Adult MH/SA Adult IDD

State Residential Spending

$6,725

$11,510

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000


State Residential Spending Per Consumer

403

191

0

50

100

150

200

250

300

350

400

450


# of State Residential Consumers Served

• 8% of the State Spending was on Adult

MH/SA Residential services

• 26% of the State Spending was on Adult

IDD services

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• Children with I/DD and behavioral health

issues

• TCLI

• Children with sexually reactive/aggressive

behavior

• Adults In ICFs

• Kids in Therapeutic Foster Care

Special Populations

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• I/DD ED Care Coordinator

• Joint rounds

• Outlier management

• Specialty referrals

• Rapid case escalation

Care Management Approach

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FY16 Financial Review

120 of 162

• Financial performance through February ‘16

• PMPM review

• FY17 Budgetary Impacts

FY16 Financial Review

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FY16

Actual Budget Variance

Service Revenue 292,279,102$ 463,286,808$ 171,007,706$

Medicaid 237,312,561 372,401,144 135,088,583

Non-Medicaid 54,966,541 90,885,664 35,919,123

Service Expense 278,136,357$ 463,286,808$ 185,150,451$

Medicaid 216,528,340 372,401,144 155,872,804

Non-Medicaid 61,608,017 90,885,664 29,277,647

Profit/(Loss) 14,142,745$ -$ 14,142,745$

Margin % 4.84% 4.84%

Admin Revenue 34,452,009$ 52,049,443$ 17,597,434$

Admin Expense 27,907,066 52,049,443 24,142,377

Profit/(Loss) 6,544,943$ -$ 6,544,943$

FY16 February Financial Performance

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FY16 February PMPM to Budget

FY16

Category of Service Actual Budget Variance

Medicaid Lives 209,183 204,924 4,259

ACTT 4.32$ 5.31$ 0.99$

BH LT Residential 8.87 8.66 (0.21)

Community Support 0.85 1.38 0.53

Crisis Services 0.68 0.93 0.25

Day Treatment 1.16 2.84 1.68

ICF/MR 31.31 35.99 4.68

IIHS 12.12 14.50 2.38

Innovations 32.22 32.64 0.42

Inpatient 8.24 6.64 (1.60)

MST 2.13 1.84 (0.29)

Outpatient 14.03 14.71 0.68

PRTF 5.21 5.07 (0.14)

Psych Rehab 2.64 2.84 0.20

Unknown (IBNR) 1.63 - (1.63)

1915(b)(3) 3.98 2.72 (1.26)

Total 129.39$ 136.07$ 6.68$

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FY16 February PMPM to PY

Service FY15 FY16 Change

ACTT 3.68$ 4.32$ 17.3%

BH LT Residential 8.14 8.87 9.0%

Community Support 0.77 0.85 10.8%

Crisis Services 0.85 0.68 -20.0%

Day Treatment 1.56 1.16 -25.4%

ICF/MR 28.23 31.31 10.9%

IIHS 15.52 12.12 -21.9%

Innovations 26.98 32.22 19.4%

Inpatient 6.13 8.24 34.4%

MST 1.75 2.13 22.0%

Outpatient 12.06 14.03 16.3%

PRTF 4.55 5.21 14.5%

Psych Rehab 2.30 2.64 14.9%

IBNR 5.06 1.63 -67.7%

1915(b)(3) 0.94 3.98 321.2%

Total 118.51$ 129.39$ 9.2%

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• Medicaid lives

• State/Federal Block Grants

o TCLI funds

• County

o Specific services to address

• Grants – BECOMING, HUD

o BECOMING Ends 9/30/2016

• Legislative impacts – $17M reduction

FY17 Budgetary Impacts

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• Recommended Budget – May Board meeting

• Public Hearing – June Board meeting

• Approve Budget – June Board meeting

Next Steps

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(Back to agenda)

7

ITEM: FY17 Recommended Budget


BACKGROUND:

The FY 2015-2016 Recommended Budget is being presented to the Board for consideration.

REQUEST FOR AREA BOARD ACTION: Review the report.

CEO RECOMMENDATION: Review the report.

RESOURCE PERSON(S):

Robert Robinson, CEO; Kelly Goodfellow, CFO



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FY17 RECOMMENDED BUDGET MAY 5, 2016

129 of 162

2 | F Y 1 7 R e c o m m e n d e d B u d g e t


Annual Budget FY 2016-2017

Board of Directors

Christopher Bostock, Chair

Cynthia Binanay, Vice Chair

Durham County Wake County

Cynthia Binanay Ann Akland

Phillip Golden George Corvin, MD

Curtis Massey James Edgerton

Commissioner Michael Page William Stanford, Jr.

George Quick Commissioner Caroline Sullivan

Amelia Thorpe McKinley Wooten, Jr.

Lascel Webley, Jr. (vacancy)

Cumberland County Johnston County

John Griffin, Ed. D Vicki Shore

Commissioner Kenneth Edge

Lodies Gloston

Christopher Bostock

Robert Robinson, CEO

130 of 162


Table of Contents

Reader’s Guide ............................................................................................................................................ 5

Alliance Demographic Information ........................................................................................................... 7

Departmental Information ......................................................................................................................... 8

Clinical Operations ................................................................................................................................. 8

Business Operations ................................................................................................................................ 9

Provider Network and Evaluation ....................................................................................................... 11

Information Technology ....................................................................................................................... 12

Community Relations ........................................................................................................................... 13

Corporate Compliance ......................................................................................................................... 14

Strategic Operations ............................................................................................................................. 15

General Fund Revenues ........................................................................................................................... 18

General Fund Expenditures ..................................................................................................................... 20

Budget Comparison .................................................................................................................................. 22

Functional Organization Chart ............................................................................................................... 23

Draft Budget Ordinance ........................................................................................................................... 24

Budget and Amendment Process ............................................................................................................. 25

Budget Calendar ....................................................................................................................................... 26

Glossary of Terms ..................................................................................................................................... 26

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May 5, 2016 Alliance Board Members, On behalf of the entire organization I thank each of you for your expertise, guidance and support during the past year of continued organizational growth. We are pleased to share with you our FY17 budget proposal. With this budget we will maintain our ongoing effort to build North Carolina’s most fiscally-stable, clinically-sound behavioral health managed care organization. We are excited to have reached a point at which we can begin to implement a plan to strategically reinvest some of our savings into innovative, effective services and supports that fill identified gaps in our communities and help ensure effective pathways to recovery and self-determination for the individuals we serve. I told you in this letter last year that Alliance was in a strong position as we looked to the future of Medicaid reform in North Carolina, and our work over the past year, as well as the work that this budget will fund, will continue to enhance that position. We look forward to working closely with you all during this budget process. Best Regards,

Rob Robinson Chief Executive Officer

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Reader’s Guide FY 2016 - 2017 is the fifth annual budget presented for Alliance Behavioral Healthcare (Alliance). This section is provided to help the reader understand the budget by explaining how the document is organized. This document details the budget for fiscal year 2016 - 2017 for Alliance’s administrative and service operations covering Durham, Wake, Cumberland and Johnston counties. The budget year begins July 1, 2016 and ends June 30, 2017. The document will show how the funds are allocated and how they will be spent. Alliance Behavioral Healthcare LME/MCO will have one fund called the General Fund. The General Fund will account for all administrative and service operations and will be divided into functional areas for Administration, Medicaid Services, State Services, Local Services, and Grant Funds, when applicable. Revenues and Expenditures of the General Fund The categories of the revenue and expenditures are the same. They include the following: Administration Alliance Behavioral Healthcare is administratively funded through a combination of the Medicaid waiver, state LME allocation, and county administrative contribution. Alliance began the management of Medicaid services under a waiver according to Session Law 2011-264 House Bill 916 on February 1, 2013. These funds refer to the administration dollars allocated under a contract with the NC Division of Medical Assistance. The funds are allocated based on a per member per month basis. The members per month budgeted is based on historical experience and projections. The NC Division of Mental Health, Developmental disabilities, and Substance Abuse services (NC DMH) continue to allocate funds to administer state and federal block grant dollars for the purposes of serving the non-Medicaid population. Cumberland, Durham, and Wake counties allocate 1% of the county dollars in administrative support for the management of their dollars in serving consumers in their respective county. Miscellaneous This category is to account for any funds received during the fiscal year that do not fall into one of the above mentioned categories and are not significant enough to require their own category. The funds roll up into the Administrative budget. Medicaid Services Alliance Behavioral Healthcare began the management of Medicaid services under a waiver according to Session Law 2011-264 House Bill 916 on February 1, 2013. These funds refer to the dollars allocated under the contract with the NC Division of Medical Assistance to provide services to Medicaid enrollees of Durham, Wake, Cumberland, and Johnston counties. State Services These funds represent state allocated dollars for Durham, Wake, Cumberland, and Johnston communities to provide services for non-Medicaid citizens with mental health, intellectual/developmental disabilities and substance abuse needs. The funds include Federal Block Grant dollars as allocated from the NC DMH.

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Local Services These funds represent the Cumberland, Durham, and Wake county allocations to Alliance to provide services for citizens with mental health, intellectual/developmental disabilities, and substance abuse needs in their respective counties. Grants When applicable, grant funds are those that are specified for a particular project or program. Draft Budget Ordinance A draft budget ordinance is being included for informational purposes. Additional Information The basis of accounting and budgeting for Alliance Behavioral Healthcare is modified accrual per G.S. 159-26. This means that revenues are recorded in the time period in which they are measurable and available. Revenues are recognized when they are received in cash. Expenditures are recognized in the period when the services are received or liabilities are incurred. This document was prepared by Alliance Behavioral Healthcare Business Operations and is available online at www.alliancebhc.org. If further information is needed, please contact Kelly Phillips, Director of Budget & Financial Analysis, at 4600 Emperor Blvd, Durham, North Carolina 27703 or by email at [email protected].

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Alliance Demographic Information

Alliance Regional Population Data

Population* Medicaid Eligible

Medicaid Eligible %

of Population

Medicaid Served

Non-Medicaid

Served Total

Served

Cumberland 323,838 71,466 22.1% 10,859 2,952 13,811

Durham 300,952 49,278 16.4% 8,044 3,554 11,598

Johnston 185,660 36,796 19.8% 5,138 1,683 6,821

Wake 1,024,198 113,852 11.1% 15,637 8,645 24,282

Total 1,834,648 271,392 14.8% 39,678 16,834 56,512

* 2015 Statistics, US Census Bureau

Persons Served by Age and Disability Based on Claims Paid by Medicaid and IPRS

Child/Youth (ages 0-17) Mental Health SA I/DD Total

Cumberland 4,956 185 721 5,862

Durham 3,877 74 501 4,452

Johnston 2,367 35 374 2,776

Wake 7,955 152 1187 9,294

Total Child/Youth 19,155 446 2783 22,384

Adult (ages 18+) Mental Health SA I/DD Total

Cumberland 6,824 1495 799 9,118

Durham 5,552 1812 830 8,194

Johnston 3,517 869 341 4,727 Wake 11,496 3007 1973 16,476

Total Adult 27,389 7,183 3,943 38,515

Total Served 56,512 Providers: Credentialed Agencies 343 CABHAs 49 Hospitals 61 ED Only 100 LIP - Group 100 LIP - Solo 321 LP Only 5,113 PRTF 12

Total 6,099

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Departmental Information

Clinical Operations

Brief Description of Department and Units

The Clinical Operations Department is comprised of five units and receives clinical oversight from the Alliance Medical Director.

The Access and Information Center (the Alliance 24/7 call center) links consumers to a range of services in the community and ensures that callers in need of crisis services are provided with timely access and follow-up. In addition to screening and referral activities, the call center provides information to general healthcare providers, CCNCs and to crisis providers to help coordinate the care of consumers needing routine services or during an after-hours crisis. It handles general information requests for Alliance as well.

MH/SA and IDD Utilization Management (UM) are responsible for authorizing services and monitoring and managing consumers during an episode of care. Activities include monitoring utilization of services authorized, reviewing effectiveness of treatment interventions and making recommendations to improve the effectiveness of consumer treatment plans.

MH/SA and IDD Care Coordination are responsible for working with specific high-risk populations identified within the waiver contract and priority populations that have been identified by Alliance, including individuals with high ED utilization patterns. Care Coordination links consumers with both services and supports and helps eliminate barriers that allow consumers to live as successfully as possible within the community. MH/SA Care Coordination is extending their ability to better address the needs of individuals with serious and persistent mental illness with co-occurring physical health conditions

Eligibility and Enrollment staff process State-funded consumer enrollment requests and consumer demographic updates, assist the UM team with a number of administrative tasks and provide support to the MDs by scheduling URAC required post denial peer-to-peer conversations.

UM Appeals manually processes all adverse decision letters and manages the entire UM appeals process.

Accomplishments for FY16

Clinical Operations met all waiver performance standards for the year. Innovations spending was within budget targets. Significant increase in utilization of Multi Systemic Therapy (MST); MST moved to a case rate

model of reimbursement There has been a continued downward trend in Intensive In-Home utilization; met target utilization

goal for the end of the year and continues to trend downward. Improved care coordination functions that are managed within the Access Center primarily around

assisting families waiting for C Waiver slots and needing Medicaid covered behavioral health services. Average days between a call to Access and an appointment was 4 days.

Maintained low Psychiatric Residential Treatment Facility (PRTF) utilization. No children in true out of state facilities.

ED liaisons had a reported significant impact on both reducing consumer time in the ED and deferring consumers from inpatient care, with inpatient readmission rates low throughout the year.

Successfully implemented best practice integrated care models in all Alliance counties. Successfully filled all available Innovations slots, moved from ICFs to the community using Money

Follows the Person Funding and B3 services

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Implemented three evidenced based outpatient models of care with enhanced rates Added IDD/MHSA care coordinator to Wake CC Team, reduction in IDD wait times in EDs already

occurring Implemented NC START program for children, available to all Alliance counties Implemented a population health analytics tool

Summary of Goals and Objectives for FY17

Continue to meet and exceed all waiver contract requirements. Expand the use of case rates and other risk sharing payment arrangements Decrease ED readmissions by expanding ED liaisons to additional hospitals and increase the follow-

up scope of positions. Improve consumer adherence with antipsychotic medications Decrease services that require prior authorization and manage based on data review, including

outcome measures. Decrease number of consumers with stays beyond expected ranges for highly utilized services Develop and pilot an IDD Patient Centered Behavioral Health Home that is responsible for

managing total health of patient population. Maintain low consumer appeals rate. Increase number of consumers served through integrated healthcare teams. Increase intensive in-home and residential services alternatives. Expand use of general outpatient services. Increase use of Medication Assisted Treatment for substance abusers. Decrease average length of stay (ALOS) of children in Therapeutic Foster Care. Implement law enforcement division program in Cumberland for individuals arrested for low level

drug offenses. Decrease inappropriate Opiate and Benzodiazepine prescribing practices of both in-network and

primary care prescribers. Improve options and use of community based treatment for youth with problematic sexual behavior. Implement Resource Allocation Model under the Medicaid C Waiver.

Business Operations


The Business Operations Department is responsible for the oversight and management of Alliance’s financial accountability relating to budgeting, claims, auditing and financial analysis. It includes: Finance and Accounting - responsible for the agency's financial transactions, financial reporting,

adherence to Generally Accepted Accounting Principles (GAAP), ensuring adequate and effective internal controls, etc.

Claims Processing - responsible for the monitoring and review of all claims processing for all funding sources, analysis of paid and denied claims, special ED claim review, etc.

Budget and Financial Analysis - responsible for the development and monitoring of the Alliance budget and analyzing budget to actual at both the administrative and service level. The staff in this unit are also responsible for the review and analysis of Medicaid dollars to include Per Member Per Month (PMPM) spending by category of service and aid, budget vs. actual, individual provider or service trends, etc. Responsibility also includes rate setting for programs, services, and providers.

Facility Management - responsible for the oversight of all Alliance leased locations in coordination with landlord and management of Alliance vehicles.

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Implemented a formal procurement program to increase control and security of procurement cards. Hired an Accounting Manager which allows for greater segregation of duties and oversight. Revised our Vendor Maintenance procedure and incorporated an IRS Tax Identification Number

Verification program to improve accuracy of vendor information. Formed a new committee specifically designed to review our Medicaid Per Member Per Month

(PMPM) by category of service on a monthly basis. The Committee has allowed for some very informative discussions as well as provided an opportunity to compare financial data with clinical data.

Implemented a new IBNR model to improve the accuracy of estimating our outstanding claims liability.

Implemented a web based employee expense reimbursement which improves the efficiency and accuracy of the reimbursement process.

Improved department efficiencies by combining Reimbursement and Analysis team with the Budget and Analysis team.

Revised the reimbursement and rate setting process which allowed for efficiency in approving rates and greater communication among departments.

Formalized administrative budget reports, as well as budget to actual reports, for reporting to the Chiefs to allow for budget ownership and flexibility of spending.

Alliance claims staff continues to provide weekly claims training for providers to ensure updated knowledge of systems and claim information is shared will all providers. Provider survey satisfaction noted that Alliance claims rated as one of the best in claims training, accurate information given to provider, and claims processed in a timely and accurate manner.

The HMS audit for March 2015 through August 2015 resulted in high scores of 99.96% in timeliness of provider payment, 99.81% in claims processing accuracy, and 99.96% in financial accuracy.


Review the need for additional positions in all areas to increase support and improve efficiencies such as a Grant Accountant who can focus on federal funding requirements.

Implement changes to our billing software which will improve the interface between the billing software and accounting software.

Upgrade our accounting software to a newer version which will give team members access to more efficient software

Identify budget software that works in conjunction with the accounting software Review the need for building modifications, relocation of site staff, and complete a review of all

facility needs including a 3-5 facility plan Continue to enhance our reporting and analysis of our services especially in the area of Medicaid

drilling down to the population level, Medicaid eligible lives, and category of service. Enhance training and development so that staff are fully trained and have the tools they need to do

their job. We will focus on building a unified team with the help of updated procedures and process flows, mutual understanding of work, cross departmental training and most importantly adhering to our mission and values.

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Provider Network and Evaluation


The Provider Network and Evaluation Department is responsible for the continuous review and evaluation of the provider network for quality of services, adherence to contract requirements, standards of care and performance, while ensuring a full array of providers is available to meet the needs of our service recipients. It also is responsible to ensure the quality of all Alliance services and processes through quality management activities and evaluating the quality of services provided by Alliance. The Department is comprised of two sections: Provider Network Operations has three components:

o Networks is responsible for managing the communication and dissemination of information to the community of providers, identifying and recruiting new providers, and for providing or arranging for technical assistance for currently enrolled providers.

o Credentialing assures that all providers in the Alliance network meet agency, State, Federal and accreditation requirements and that credentialing information is reviewed and tracked for continuous and timely review.

o Contracts is responsible for the timely development and distribution of all contracts, amendments, and extensions and ensures coordination of administrative activities including official correspondence with providers, provider education and liaison, and administration of provider contracts.

Quality Management is responsible for creating a culture of continuous quality improvement across the agency and assuring quality within the agency, across the provider network, and with contracted vendors. Quality Management has three components:

o Quality Assurance develops reports for Alliance management, committees and the state; investigates and resolves incidents and complaints and analyzes data from NC-TOPPS, IRIS and other sources.

o Quality Review oversees our Quality Improvement Projects (QIPs); performs quality reviews to identify opportunities for improvement; conducts in-depth analyses of provider programs; and develops quality management standards and training for our providers.

o Provider Monitoring completes on-site monitoring reviews to determine provider compliance with rules and regulations; conducts post-payment reviews to identify inappropriate payments to providers; and completes focused reviews to investigate other compliance issues. Data Analysis manages data, creates reports, and offers analysis of data to support decision making.


Establishment of provider collaboratives to provide technical assistance and improve quality. Expansion of Continuous Quality Improvement (CQI) processes throughout the agency. Implementation of multiple evidence based practice service models. Development of multiple new evidence based service definitions to fill service gaps. Improved processes and relationships with our hospital partners. Implementation of contract tracking software to improve accuracy and efficiency.


Improve and streamline business process for implementing new services. Implement credentialing software. Improve relationships with and contract management of hospitals/health systems. Improve capacity for risk and trends analysis.

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Address provider network needs and gaps as specified in network development plan. Focus provider collaborative efforts on implementation of evidence based practices. Enhance provider performance measure reporting. Streamline reports generation. Increase number of provider contracts for evidence based practices. Identify and implement a process for monitoring evidence based practices. Improve communication processes with Providers.

Information Technology


The IT department is comprised of three distinct teams:

Application Development and Quality Assurance - Responsible for all internal application development, including SharePoint and the corporate Intranet. Manages all quality assurance and user acceptance testing and documentation to support corporate audits.

Informatics/Business Intelligence Development - Responsible for extracting, organizing, cataloging and defining all key data elements that support Alliance. BI also is responsible for report and dashboard development to support the information needs of the company.

IT Infrastructure and Support - Installs and supports all business data and voice networks within the Alliance sites. They are responsible for maintaining network and data security, HIPAA compliancy, email security, network and server performance and administration.


Deployed Enterprise Vault Email Archiving system. Deployed Netwrix Password management system. Deployed Commvault File Archiving and Unitrends Backup systems. Relocated hardware, network and communication systems to new Call Center location. Migrated SharePoint and Existing Shared Drives to New Storage Solution. Developed Corporate Intranet to Provide Efficient Enterprise Communications. Selected Care Management Technologies and MicroStrategy Business Intelligence Solutions to

provide enterprise class reporting solutions. Developed Independent Living Initiative application and provider portal to streamline the process of

evaluating and approving the application. Implemented agile approach to software development. Implemented New ICD-10 Codes in AlphaMCS, Back Office Systems and Providers to meet

conversion date of October 1, 2015. Fully implemented Team Foundation Server in department to effectively monitor application

development and testing.


Continue to improve quick response and reduce resolution time on KACE support tickets. Enhance disaster recovery solution and relocate to secondary colocation facility. Upgrade corporate PC's to Windows 10. Develop Accounts Receivable reconciliation application to track all claims activity submissions and

messaging.

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Develop DOJ Application and provider portal for Supported Employment Initiative. Implement MicroStrategy as an enterprise wide reporting solution for Alliance. Develop and begin implementation of Alliance IT Strategic Plan. Enhance Credentialing Workflow within AlphaMCS Application. Develop Provider Search and Resource Availability Tracking Application. Develop improved process for requesting and tracking AlphaMCS enhancements.

Community Relations


Community Relations is one of the most varied and diverse departments within Alliance. Recognizing that a local and visible presence is essential to building and sustaining partnerships critical to meeting organizational outcomes, the Community Relations teams take an innovative approach to improving the systems that support the effectiveness of services. Teams are continually assessing system and service gaps from multiple vantage points including co-location within other systems, outreach activities to stakeholders and advocates, and hosting community collaborative and workgroups. Utilizing a System of Care (SOC) framework, Community Relations focuses on the strengths and vulnerabilities of complex public systems, treatment of the “whole person,” and system transformation to improve policy, shared funding, collaboration and best practices. Recognizing that social determinants of health (i.e. homelessness, poverty/inequality and lack of education/employment) are key drivers of health care costs, Community Relations often plays a tangential role to the MCO functions - improving the environments in which people live increases engagement and retention in services, overall health and wellness, and more meaningful and productive lives that promote recovery. Accomplishments for FY16

Implemented short-term rental assistance program (ILI) in each community. Developed a standardized Alliance overview presentation training to over 500 community partners

and stakeholders. Each community has highly successful Crisis Intervention Training (CIT) training programs with

designated CIT Coordinators. Implemented Care Review in each community. Developed crisis reduction plans for each community. Won two national Excellence in Communication and Community Outreach Awards for

BECOMING. Funding renewed for two HUD-funded supportive housing programs in Durham. Wake and Durham Community Collaborative completed strategic plans outlining SOC priorities.


Hire a Director of Housing and Director of Community Relations. Study the need for additional personnel to target key areas across the 4 counties (i.e. System of Care

Manager). Promote cross-departmental collaboration to improve person and service outcomes. Assist in the development of models of care for special and high-risk populations.

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Assist in the development of comprehensive community supports to increase community tenure and quality of life for high-risk adolescents and adults.

Expand Assertive Engagement to special populations across the four communities. Identify activities of Community Relations (i.e. housing, Care Review) and develop key

performance indicators to show the impact and return on investment. Develop pilot programs in partnership with other internal departments to study the quality and

effectiveness of programs targeting high risk populations (i.e. IIH, ED diversion, etc.).

Corporate Compliance


The Alliance Corporate Compliance Department focuses on the prevention, detection and correction of identified violations of federal and state laws and regulations, and fraud control and unethical conduct, and encourages an environment where employees can report compliance concerns without fear of retaliation. It includes thirteen employees and is responsible for internal and external compliance to include policies and procedures, accreditation compliance, compliance training, internal audits and monitoring, claims audits, hotline reporting, investigation and correction of non-compliance, remediation, HIPAA privacy and security, medical records, public records, Network fraud and abuse investigations, provider actions and sanctions, and provider dispute resolution. Accomplishments for FY16

Opened 114 fraud and abuse investigations, closed 87 investigations, and referred 10 full investigations to DMA Program Integrity for determination of credible allegation of fraud.

Identified over $147,000 in overpayments as a result of fraud, waste and abuse investigations. Conducted internal audits of three major Alliance functions. Continued the implementation process for policy and procedure management, third party risk

management, contract management, incident management, and HIPAA breaches. Monitored all sites for HIPAA Privacy compliance. Contracted with external vendor to conduct

Security Risk Assessment. Implemented a Compliance Page on the Alliance Intranet, containing resources, training materials,

information about internal compliance and program integrity, etc. Issued 48 notice of action letters in response to Network compliance issues referred to the

Compliance Committee. Identified over $1 million in overpayments through the Corporate Compliance Committee process. Managed 29 requests for reconsideration of actions against providers. Audited 3% of adjudicated claims weekly. Audited inpatient and ED claims weekly. Conducted internal investigations and developed remediation plans where applicable, monitored

corrective action plans to ensure successful implementation. Conducted new hire orientation ongoing, annual compliance training to all employees and the Board

of Directors, providers and published informational materials related to compliance, fraud and abuse to a variety of stakeholder groups.

Conducted targeted HIPAA training to clinical departments. Conducted targeted Program Integrity training to several internal departments.

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Our goal is to embed compliance, fraud control, and business ethics into Alliance day-to-day business through the use of infrastructures and tools designed to help achieve compliance with Federal, State, and local laws and regulations, and accreditation standards. The infrastructure and tools of focus for FY17:

o Continue/finalize the implementation of C360 to increase efficiencies, improve employee training and track internal compliance as well as Business Associate compliance.

o Improve process to assess the impact of regulatory changes on Alliance operations, including review and revision to policies and procedures, manuals and training to ensure compliance with applicable changes.

o Contract with vendor for fraud detection data mining purposes to enhance our current methods and increase effectiveness of fraud detection efforts.

o Provide specialized training to department staff to promote professional growth and to achieve nationally recognized certifications in the areas of fraud examination and internal audits.

o Adjust positions within the department in order to continue to meet the needs of Alliance. o Add positions in areas where current staffing is inadequate and to meet the increased demands

of our department. An annual work plan developed as a result of an annual risk assessment drives all compliance

operations. Items selected for the work plan pose significant risk (legal, financial, reputation) to Alliance. The plan is finalized at the beginning of each fiscal year and has therefore not yet been developed for FY17. Below are a few anticipated areas of focus:

o Increased staff training with focus on HIPAA, confidentiality, policies and procedures, and regulatory and accreditation requirements.

o Expand the internal audit plan and increase compliance monitoring with timely resolution and implementation of risk mitigation plans.

o Monitor implementation of identified strategies to correct HIPAA security deficiencies and audit for compliance.

o Provide compliance training and resources to providers. o Expand focused and ad hoc claims audits to identify overpayments, underpayments and other

irregularities or compliance issues. o Prepare for and achieve URAC reaccreditation o Conduct fraud and abuse investigations to detect and deter fraud and abuse in the Alliance

Network. Prioritize areas of highest risk. o Provide assistance, input and compliance oversight of Alliance pilots and other efforts.

Strategic Operations


The Strategic Operations Department is housed under Administration and provides support and connectivity to the entire organization, serving as a change agent and a cross departmental liaison to all Alliance departments. The Chief of Staff leads the 11 staff members who make up the department, which is comprised of 4 distinct units, below:

The Strategic Project Management team (SPMO) is maturing into an internal consulting group, including a director and 3 project managers. They have engaged in a number of high priority projects including the ICD-10 transition, analysis and reengineering of the DOJ/TCLI processes, strategic plan initiatives, encounter data enhancements, and implementation of integrated care pilots. All of the projects have centered on cross departmental workflows and increasing efficient use of resources while meeting contractual requirements. The SPMO has also offered intensive 6 month training to Alliance staff in Project management skills and is embarking on a 6 month training on

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Process Improvement, enhancing skill building across the company and modeling a culture of cross functional collaboration.

The Alliance Communications Unit, which consists of the Director of Communications and a Communications Specialist, has oversight of all internal and external organizational communications to multiple stakeholders within a four-county audience of nearly two million people. This broad scope of work includes all organizational advertising/marketing development and production, oversight of organizational branding efforts, content maintenance of a robust and complex website and social media program, a leadership role in organizational internal communications, and provision of communications support and technical assistance for the entire organization.

The Medicaid Program Director (MPD) is responsible for ensuring compliance with the DMH and Medicaid Waivers contracts, all external reviews (EQRO, Mercer, and TCLI) and projects related to same, and is a liaison between Alliance and DHHS staff. As a team of one, the MPD participates in multiple cross functional work groups to ensure collaboration and compliance.

Cumberland and Johnston sites - The Cumberland site director oversees the facilities and two administrative staff at the Cumberland site and is also the Military Veterans Point of Contact (MVPOC) for the entire Alliance catchment area, as established by statute. The MVPOC is required to serve as a care coordination liaison for veterans and their families who quality for services, and to educate staff and other stakeholders about the special needs of veterans. The Chief of Staff serves as the executive liaison to the Johnston site director.


103 staff members attended the Project Management 101 classes conducted across all of Alliance’s offices and 25 students completed the 6 month project management class curriculum.

83 staff members attended the Business Process Improvement introduction classes across all Alliance office locations with 27 students that have registered for the BPR curriculum over the upcoming months.

The Process Reengineering project for TCL/DOJ team helped in preparation for the DOJ audit and streamlined the end to end process including Supportive Employment and Tenancy Supports while clarifying roles and responsibilities for staff and providers.

SPMO led the successful ICD10 conversion project which went live without issues on Oct 10th. The SPMO has successfully managed 25 projects so far sponsored by 16 distinct Alliance

departments. Organizational branding campaign in multiple media developed and executed, resulting in 8%

increase in brand awareness, 10+% increase in web traffic, and significant positive stakeholder feedback.

SEO (Search Engine Optimization) analysis completed, including numerous website enhancements creating easier navigation, improved site search capacity and search engine search results, overall better user experience, and enhanced analytic capacity.

Created social media plan and user guidelines and implemented polished organizational Facebook and LinkedIn presence; worked with key units across organization on using social media and email automation to meet their business goals.

Completed production of high-quality Annual Report six weeks sooner than in 2015; made changes to core brochures to reflect changes in WakeBrook branding; ensure adequate supply of all materials

Hired Communications Specialist with knowledge of public system and MCO experience. MVPOC successfully completed Mental Health First Aid training and is partnering with Community

relations staff to serve communities. Progress made on implementation of Alliance's Military Veterans Plan. Strategic Plan implementation: of 30 original initiatives,12 initiatives completed, 8 are in progress

and on target, 10 are pending with a 22% cross departmental staff participation in the work.

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Recruit and hire additional Project Manager for SPMO. Identify funding for additional administrative support staff person. Focus on training and certification preparation for additional Project Management team. Funding for additional consultation and support from Zelos to ensure successful implementation of

the Strategic Plan and other projects of high importance. Funding for ongoing consultation to improve business process reengineering projects Plan, manage and communicate strategic plan initiatives and other high impact cross departmental

projects. Develop the SPMO into an internal consulting team. Increase skill mastery if project management principles and process reengineering methodologies

across Alliance. Assist in identifying and addressing Business Process Re-engineering opportunities, aligning with

strategic goals, to provide maximum effectiveness and efficiency, potentially utilizing external resources/consultants.

Assist Executive Leadership Team with evaluation and research analysis for strategic opportunities. Develop and implement next stage of organizational branding based on outcome of

consolidation/service area expansion. Continue to build social media/email automation program to meet identified business goals. Provide technical assistance in the creation of an organizational internal communications plan. Investigate a plan to increase organizational awareness of the importance of health literacy. Expand Alliance’s role as a leader in the state on Veteran’s issues by ongoing implementation of the

Military Veterans Plan. Improve Alliance's performance on newly created Annual External review from previous EQRO and

Mercer scores by 12%.

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General Fund Revenues FY2016-2017 Recommended Budget

Total General Fund Revenues: $492,082,711

County Administrative funds $ 364,086

LME Administrative funds 4,359,385

Medicaid Administrative funds 44,701,760

Medicaid Services & Reserves 351,149,760

Alliance

Federal $ 5,563,857

Durham

State $ 11,066,741

Federal 2,093,427

County 6,594,828

Wake

State $ 17,614,466

Federal 5,256,417

County 24,947,181

Cumberland

State $ 7,131,287

Federal 1,305,339

County 4,752,000

Johnston

State $ 4,293,829

Federal 385,124

Grants $ 403,224

Miscellaneous $ 100,000

TOTAL $ 492,082,711

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General Fund Revenues FY2016-2017 Recommended Budget

Total General Fund Revenues: $492,082,711

County7.38%

Administration10.06%

Medicaid Services71.36%

State Services11.20%

County Administration Medicaid Services State Services

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General Fund Expenditures FY2016-2017 Recommended Budget

Total General Fund Expenditures: $492,082,711

Administrative $ 49,425,231

Medicaid Services 351,149,760

State Services 54,710,487

Local Services 36,294,009

Grants 403,224

TOTAL $ 492,082,711

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General Fund Expenditures

FY2016-2017 Recommended Budget Total General Fund Expenditures: $492,082,711

Administrative10.06%

Services89.94%

Administrative Services

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Budget Comparison

Budgeted Revenue Budgeted Expenditures FY16 FY17 FY16 FY17

Administrative $ 52,049,443 $ 49,425,231 Administrative $ 52,049,443 $ 49,425,231

Medicaid Services $ 372,401,144 $ 351,149,760 Medicaid Services 372,401,144 351,149,760

Alliance

State & Federal Services

54,088,431 54,710,487

Federal $ 5,563,857 $ 5,563,857 Local Services 36,294,009 36,294,009

Durham Grants 403,224 403,224

State $ 11,066,741 $ 11,066,741 Miscellaneous 100,000 100,000

Federal 2,093,427 2,093,427 County 6,594,828 6,594,828

Wake - State $ 16,992,410 $ 17,614,466 Federal 5,256,417 5,256,417 County 24,947,181 24,947,181

Cumberland - State $ 7,131,287 $ 7,131,287 Federal 1,305,339 1,305,339 County 4,752,000 4,752,000

Johnston - State $ 4,293,829 $ 4,293,829 Federal 385,124 385,124

Grants 403,224 403,224 Miscellaneous 100,000 100,000

TOTAL $ 515,336,251 $ 492,082,711 $ 515,336,251 $ 492,082,711

Administrative funding decreased by $2,624,412 and Medicaid service funding decreased by $21,251,384. The decrease is due to the reduction of our PMPM as well as the recognition of retro-active Medicaid payments in FY16 but not in FY17.

The state dollars for Wake were more by $622,056. This is due to an increase in the state inpatient bed contract with one of the local hospitals.

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Functional Organization Chart

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Draft Budget Ordinance

ANNUAL BUDGET ORDINANCE ALLIANCE BEHAVIORAL HEALTHCARE

FY 2016 - 2017

WHEREAS, the proposed budget and budget message for FY 2016 - 2017 was submitted to the Alliance Behavioral Healthcare Area Board on May 5, 2016 by the Budget Officer; was filed with the Executive Secretary to the Board;

WHERESAS, on June 2, 2016, the Alliance Behavioral Healthcare Area Board held a public hearing pursuant to NC G.S. 159-12 prior to adopting the proposed budget;

BE IT ORDAINED by the Alliance Behavioral Healthcare Area Board that for the purpose of financing the operations of Alliance Behavioral Healthcare, for the fiscal year beginning July 1, 2016 and ending June 30, 2017, there is hereby appropriated funds the following by function:

DRAFT

Section 1: General Fund Appropriations Administration $ 49,425,231 Medicaid Services $ 351,149,760 State Services $ 54,710,387 Local Services $ 36,294,009 Grants $ 403,224 TOTAL $ 492,082,711

Section 2: General Fund Revenue Administration $ 49,425,231 Medicaid Services $ 351,149,760 State Services $ 54,710,387 Local Services $ 36,294,009 Grants $ 403,224TOTAL $ 492,082,711 Section 3: Authorities A. The LME/MCO Board authorizes the Budget Officer to transfer within an appropriation up to $100,000 cumulatively without report to the Board. B. The LME/MCO Board authorizes the Budget Officer to transfer up to $100,000 between appropriations with a report to the Board at the subsequent meeting. C. The CEO may enter into the following within budgeted funds:

1. Form and execute grant agreements within budgeted appropriations; 2. Execute leases for normal and routine business; 3. Enter into consultant, professional, maintenance, provider, or other service agreements; 4. Approve renewals for of contracts and leases; 5. Purchase of apparatus, supplies, materials or equipment and construction or repair work; 6. Reject any and all bids and re-advertise to receive bids.

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Budget and Amendment Process Overview The purpose of the budget and amendment process is to ensure that public dollars are spent in the manner as intended and in an effort to meet the needs of the citizens in relation to mental health, intellectual/developmental disabilities, and substance abuse needs. Through the budget, Alliance Behavioral Healthcare aims to fulfill its mission as granted by NC G.S. 122-C. Governing Statutes Alliance Behavioral Healthcare abides by the North Carolina Local Government Budget and Fiscal Control Act. It is the legal framework in which all government agencies must conduct their budgetary processes. NC G.S. 159 provides the legislation which includes several key dates such as:

159-10 - By April 30, Departments must submit requests to the Budget Officer 159-11(b) - By June 1, the Recommended Budget must be submitted the Board 159-12(b) - A public hearing must be held 159-13(a) - From 10 days after submitting to the Board, but by July 1, a balanced budget

must be adopted Budget Process FY 2016-2017 is the fifth recommended budget representing Alliance Behavioral Healthcare as a multi-county Area Authority. The budget represents services for Cumberland, Durham, Johnston and Wake counties. The administrative budget for this fiscal year was driven by our Per Member Per Month (PMPM) rate, FY17 projected costs, FTE positions, Department of Health and Human Services contract requirements, and costs related to the operating the Medicaid waiver. The Medicaid service budget was created based on historical experience and projections into the next fiscal year. Alliance will review the need for a budget amendment in the first quarter of FY17 if the projection of lives has changed based on payments received. The State and Local services budget was developed by gathering service information for each area based on the claims trends and information from staff. The FY17 allocations and benefit packages were reviewed and staff worked together to ensure all services were appropriately planned to be consistent with current services. Amendment Process The budget ordinance is approved at a function/appropriation level. The Budget Officer is authorized to transfer budget amounts within an appropriation up to $100,000 cumulatively without reporting to the Board. The Budget Officer is authorized to transfer budget amounts between functions up to $100,000 with an official report of such transfer being noted at the next regular Board meeting. Per G.S. 159-15, the governing board may amend the budget ordinance at any time after the ordinance's adoption in any manner, so long as the ordinance, as amended, continues to satisfy the requirements of G.S. 159-8 and 159-13.

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Budget Calendar

Thursday, May 5, 2016 FY 2016-2017 recommended budget presented at LME/MCO Board meeting By Friday, May 13, 2016 Notice of June 2, 2016 Public Hearing published Thursday, June 2, 2016 Public Hearing By Friday, June 24, 2016 LME/MCO Board adoption of FY 2016-2017 Budget Ordinance Friday, July 1, 2016 Budget is available in the General Ledger system

Glossary of Terms LME Per G.S. 122C-3(20b), Local Management Entity or LME means an area authority,

county program, or consolidated human services agency. It is a collective term that refers to functional responsibilities rather than governance structure.

MCO Managed Care Organization; LMEs that have adopted the financial risk and service review functions of the 1915(b) and 1915(c) waivers. LME-MCOs carry out the function of an LME and also act as health plans that provide health care in return for a predetermined monthly fee and coordinate care through a defined network of providers, physicians and hospitals.

Medicaid Waiver

States can submit applications to the federal Centers for Medicare and Medicaid Services, asking to be exempt from certain requirements. If granted a “1915(b)” waiver, a state can limit the number of providers allowed to serve consumers, easing the state’s administrative burden and saving money. If granted a “1915(c)” waiver, a state can offer more services focused on helping an intellectually or developmentally disabled consumer continue living in his or her home, rather than a group home.

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FY17 Recommended Budget

May 5, 2016

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•G.S. Requirements o Budget Message 159-11(b)

o Balanced Budget 159-8

o Presented before June 1 159-11(b)

o Public Hearing 159-12(b)

• General Fund

• Revenues & Expenditures of General Fund

FY17 Recommended Budget

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• Nine departments

• Successful FY16

o IT

o Other key successes

• Goals moving into FY17

FY17 Departmental Information

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• Total Revenue: $486m

o $23.0m less than FY16

o Medicaid down $21.0m and State up $622k

o Administrative down $2.6m

• Medicaid: $351.1m

• State (IPRS): $54.7m

• County: $36.7m

• Administrative: $49.4m

FY17 Budgeted Revenues

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Administrative

• 10% of total expenditures

• Personnel costs account for 76.5% of total

administrative costs

• Other key costs

o Infrastructure needs

o Professional services

o Training and education

FY17 Budgeted Expenditures

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Services

• 90% of total expenditures

o 71% Medicaid-funded, 11% State, 7% County

• Approach to budget

o Medicaid – history, capitation, new services

o State/Federal Block Grants – allocations,

service needs

o County – level funding, service needs

o Grants – BECOMING, other new opportunities

FY17 Budgeted Expenditures

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• Public hearing

• Potential changes

o State funds

o Medicaid lives impacting budget

o County dollars

• Approval of budget in June

Next Steps

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(Back to agenda)

ITEM: Review of Board Officers Selection Process


BACKGROUND:

As stated in the by-laws officers of the Area Board, Article II, Section D:

1. The officers of the Area Board shall be chosen for a one-year term at the final meeting of the

fiscal year in which the Area Board is serving, and shall be as follows:

a. Chairperson, and

b. Vice-Chairperson.

2. With the exception of the position of Executive Secretary (which shall be filled by the Area

Director/CEO), no officer shall serve in a particular office for more than two consecutive

terms.

3. Each Area Board member shall be eligible to serve as an officer.

4. Duties of officers shall be as follows:

a. Chairperson – this officer shall preside at all meetings and generally perform the duties of

a presiding officer. The Chairperson shall appoint all Area Board committees.

b. Vice Chairperson – this officer shall be familiar with the duties of the Chairperson and be

prepared to serve or preside at any meeting on any occasion where the Chairperson is

unable to perform his/her duties.

Chairman Bostock will review the process for determining next year’s officers. The election of

Board officers will occur at the June Board meeting. Board officer terms are concurrent with

Alliance’s fiscal year.


Review the process for determining Board officers in preparation to vote for Board officers at the

June 2, 2016, Board meeting.

CEO RECOMMENDATION:

Review the process for determining Board officers in preparation to vote for Board officers at the

June 2, 2016, Board meeting.

RESOURCE PERSON(S):

Christopher Bostock, Area Board Chairman; Robert Robinson, CEO



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Documents

AREA BOARD REGULAR MEETING Thursday, May 05 ......2016/05/05 · Thursday, May 05, 2016 AREA BOARD REGULAR MEETING 4600 Emperor Boulevard, Durham, NC, 27703 4:00-6:00 p.m. Page 3