March 2016 Minutes

Thursday, March 03, 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, ☒Cynthia Binanay, Vice-Chair, ☒Christopher Bostock, Chair, ☐George Corvin,

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

☒Rev. Michael Page (entered at 4:15 via phone), ☒George Quick, ☒Vicki Shore (via phone), ☒William Stanford, Jr.,

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

GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair; Dennis Farley, DMH; Denise Foreman, Assistant to the Wake County Manager

ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Dr. Tedra Anderson-Brown, Medical Director; Margaret Brunson, Hospital

Relations Director; Hank Debnam, Cumberland Site Director/Veterans Point of Contact; Joey Dorsett, Chief Information Officer; Doug Fuller, Director of

Communications; Kelly Goodfellow, CFO; Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram, Executive Assistant; Susan

Know, Senior HR Analyst; Geyer Longenecker, Director of Quality Management; Beth Melcher, Chief of Network Development and Evaluation; Sara Pacholke,

Controller; Kate Peterson, Healthcare Network Project Manager; 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 Communications

1. CALL TO ORDER: Chairman Christopher Bostock called the meeting to order at 4:01 p.m.

AGENDA ITEMS: DISCUSSION:

2. Announcements A. FUTURE DEVELOPMENT WORKGROUP: Chairman Bostock reminded Board members of the next staff workgroup on

April 5, 2016, at 4:00 p.m. Board members are invited to attend this meeting and may contact Ms. Ingram to confirm their

attendance.

B. LEGISLATIVE LUNCHEON: Chairman Bostock reminded Board members that Alliance’s legislative luncheon is Friday,

March 18 from 12:00-2:00 p.m. at the corporate site.

C. BUDGET RETREAT: Additionally, Chairman Bostock reminded Board members of the annual Board budget retreat on

Tuesday, March 29 from 12:30-4:30 p.m. Additional details are forthcoming.

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 (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 February CFAC meeting.




4:00-6:00 p.m.

Page 2 of 4


The committee reports were sent earlier as part of the Board packet; Doug Wright, Director of Consumer Affairs, presented the

report. He provided an update from a recent meeting and announced an upcoming statewide CFAC meeting. Mr. Wright

mentioned an update on the recovery and self-determination training, plans to host a table at the upcoming NAMI walk, and

participation at the Board budget retreat later this month.

B. Finance Committee (10 minutes) – page 28

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.

George Quick presented the Finance Committee report. Mr. Quick noted that revenues exceeded expenditures and all State

required ratios were met except one. As stated previously the medical expense ratio is being replaced by the medical loss ratio.

Six of the eight NC MCOs currently do not meet the current medical expense ratio. Staff are working on implementing the new

definition requirements. Additionally, Mr. Quick reminded Board members of the upcoming budget retreat and reinvestment

plan. Mr. Robinson shared that the medical loss ratio methodology and definition have changed and MCOs are held harmless

through July 2017; steps are being taken to ensure Alliance meets this new requirement.

C. Policy Committee – page 35

Per Alliance Behavioral Healthcare Area Board Policy “Development of Policies and Procedures”, the Board is to review all

policies annually. The Board Policy Committee reviews a number of Policies each quarter in order to meet this requirement.

This month’s report included draft minutes from the February meeting.

Curtis Massey, Committee Chair, presented the report. He noted that the following policies are being recommended for approval

for without revision: Client Rights to Confidentiality; Client Rights to Dignity, Privacy, and Humane Care; Consumer Choice;

Coordination of Care for Special Health Care Populations; Advanced Directives and Advanced Instructions; Management of

Incidents Policy; Management of Investigation of Grievances; Consumer, Provider and Stakeholder Satisfaction; Selection

and Retention of Providers; Letters of Support; Rule Waiver Requests; Utilization Review Criteria; Utilization Review Process;

Appealing Clinical Utilization Management; Pre-Review Screening for Certification; Accessibility of Utilization

Review/Utilization Management Process; and Financial Eligibility.

Mr. Massey provided detailed information regarding the recommended revisions for three policies: Customer Services; Area

Board Conflict of Interest; and Provision of Services by Relatives/Legal Guardians.




4:00-6:00 p.m.

Page 3 of 4


BOARD ACTION

A motion was made by Mr. McKinley Wooten to approve the submitted policies; seconded by Dr. John Griffin. Motion passed

unanimously.

6. Consent Agenda A. Draft Minutes from February 4, 2016, Regular Board Meeting – page 67

B. Executive Committee Report – page 72

C. Network Development and Services Committee Report – page 81

D. Quality Management Committee Report – page 149

There were no comments or discussion about the consent agenda.

BOARD ACTION

A motion was made by Vice-Chair Cynthia Binanay to approve the consent agenda; seconded by Mr. William Stanford. Motion

passed unanimously.

7. Reinvestment Plan –

page 248

Kelly Goodfellow, CFO, and Sean Schreiber, Chief Clinical Officer, presented a detailed overview of Alliance’s reinvestment

plan. The overview included background behind the purpose for the plan and an outline of the two-year reinvestment strategy

through FY16 and into FY17. Mr. Schreiber provided a detailed review of eight focus areas. Ms. Goodfellow provided

information regarding funding, projections, management of the reinvestment plan and a sustainability plan.

Board members discussed the plan and requested to include it in the upcoming legislative luncheon on March 18, 2016. Also,

Board members mentioned that the reinvestment plan is an opportunity for NC Legislators to invest in public behavioral health

without increasing funding. The reinvestment plan is attached to and made part of these minutes.

BOARD ACTION

A motion was made by Commissioner Kenneth Edge to approve the reinvestment plan; seconded by Commissioner Caroline

Sullivan. Motion passed unanimously.

8. Updates A. 2015 NC DHHS Provider Satisfaction Survey Report – page 264

Geyer Longenecker, Quality Management Director, provided an update on the report. He reviewed Alliance’s performance

compared to the previous year and the statewide average for MCOs. Mr. Longenecker noted that for the second consecutive

year Alliance is top rated among NC MCOs in overall provider satisfaction. A copy of the report overview is attached to

and made part of these minutes.




4:00-6:00 p.m.

Page 4 of 4


B. Status of State’s Application for 1115 Waiver

Mr. Robinson provided an update from the March 1, 2016, Legislative Oversight Committee meeting. He mentioned that

most of the conversation was about moving toward a capitated model for physical care. Mr. Robinson shared that the

application will most likely change as the State is seeking feedback and most likely CMS (Centers for Medicare and

Medicaid Services) will may make recommendations: State officials are hosting twelve listening sessions across the state,

and there will be additional opportunities for public comment. The State’s waiver application is due to CMS by June 1,

2016.

BOARD ACTION

The Board received the updates. No additional action required.

9. Chairman’s Report Chairman Bostock reminded Board members that next month’s meeting will be held in Johnston County. Also, Chairman

Bostock invited Board members to attend the March 15, 2016, Executive Committee meeting and participate in the closed

session. The Executive Committee will evaluate the CEO and bring a recommendation to the Area Board at the April Area

Board meeting.

10. Adjournment With all business being completed the meeting adjourned at 5:47 p.m.

Next Board Meeting

Thursday, April 07, 2016

4:00 – 6:00

4/7/2016

Robert Robinson, Chief Executive Officer Date Approved

(Back to agenda)

ITEM: Consumer and Family Advisory Committee (CFAC) Report

DATE OF BOARD MEETING: March 3, 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 February 1st at the corporate office. The minutes

and supporting documents are attached for your review.

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

Monday, February 01, 2016 ALLIANCE CONSUMER AND FAMILY ADVISORY COMMITTEE

Page 1 of 5

MEMBERS PRESENT: Caroline Ambrose-Chairperson, Denise Wood, David Curro, Sharon O’Brian, Steve Hill, C.J. Lewis, Tammy Harrington, Dan Shaw, Lotta Fisher, Michael McGuire, Joe Kilsheimer, Israel Pattison, LaTasha Jordan VIA PHONE: Crystal Foreman, Faye Griffin, (Dorothy Johnson, John Bain, Tracey Glenn-Thomas, Jackie Blue- Fayetteville Office) GUEST(S) PRESENT: Marjorie Young, Doug Wright, Bonita Lawrence-McClure, Teri Kachur, Yancee Perez, Amanda Graham, Linda Losiniecki

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME

FRAME:

1. Welcome/Overview:

Introductions:

Welcome guest Marjorie Young Additional handouts included:

Sub-Committee Meeting Minutes from Durham, Wake, Board of Human Rights Committee

Consumer Empowerment Team Quarterly Update, Jan-March 2016

Strategic Plan Update CFAC: FY16 Strategic Plan Initiatives – Amanda Graham

What is Cultural Competence? – Bonita Lawrence-McClure

Re-Think Campaign Phase II – Doug Wright Meeting Minutes from 12-7-15: Approved as Written

2. Public Comment – Consumer/Family Challenges and Solutions:

Caroline opened with any comments:

Everyone had a great holiday.

Comments about the latest snow storm that hit the triangle area.

3. Sub-Committee Updates:

Rules No Meeting Services No Meeting Communications No Meeting Wake Dave gave a summary (Sub-Committee Minutes Handout):


Page 2 of 5


FRAME: Teri explained the upcoming Resource Fair, postponing the fair until Fall

(October), combining with Special Needs Awareness month.

Comments from Crystal on Housing needs/accessibility for ADA in the Wake County area.

CFAC Committee Charter is approved. Durham Steve gave a summary (Sub-Committee Minutes Handout):

Discussion on outreach to the communities, doing a Resource Fair and transportation needs

Yancee shared her discussion with Steve:

The Alliance website, where does administrative dollars go and how they are disbursed, advertising and where.

The ease of using the website, accessing and navigating.

There will be more discussion about the website at the next meeting. Cumberland Lotta gave a summary (Sub-Committee Minutes Handout):

Mental Health First Aid training for youth scheduled for February 25, 2016. All members welcome, register now.

Looking for suggestions and ideas for Cumberland outreach.

Gaps and needs list provided to Doug for review. Area Board Doug provided an update:

Met in closed session

Next meeting will be held at Wake office Human Rights Dan provided an update (Sub-Committee Minutes Handout):

Overview of grievance and incident data.

Discussion referrals to appropriate agencies, the appeals process within Alliance.

Looking for to recruit new members from CFAC and/or community.

Discussion on the 1115 Waiver implementation and MH/SA as part of the Medicaid system. Looking to share for more information as it comes available.


Page 3 of 5


FRAME: Quality Management No Update Executive Leadership Team Caroline provided an update:

Met on January 25, 2016

Discussed the sub-committee updates

NAMI Walk will take place on May 7, 2016:

Doug would like to see and encouraged members participate.

Suggestion to have CFAC to be an Exhibitor at the event. Cost for an Exhibitor table is $150. CFAC members would represent the Alliance CFAC.

Michael McGuire motioned to have a table and Dave Curro seconded the motion, all ayes.

Alliance puts together a team that will walk. Teams will raise money through sponsorship.

Discussion on Budget Retreat on March 29, 2016

Caroline would like collaboration with other CFAC members to develop a presentation for the Alliance Board.

Crystal Foreman and Dr. Michael McGuire volunteered and will assist.

Teri to get NAMI Walk information out to the CFAC members.

4. State Updates:

C.J. provided an update:

State CFAC meeting, February 10, 2016 at Dorthea Dix, Brown Building. Secretary Brajer and Dr. Quinn Cantrell will be speaking.

CFAC conference call February 17, 2016, link to call-in information available.

DWAC meeting on February 17, 2016

March 11 & 12, 2016 Autism Society hosting conference and exhibits for ACTT families and other professionals.

CFAC Collaborative meeting hosted by Smoky Mountain Center will be held on April 22, 2016 in Asheville, NC.

Additional information on the Crisis Solution Initiative can be found on their website: http://crisissolutoinsnc.org/

http://crisissolutoinsnc.org/


Page 4 of 5


FRAME:

5. Strategic Plan Update – Amanda Graham:

Amanda reviewed the goals of the Strategic Plan Update for CFAC (PowerPoint presentation/handout):

Discussion on Alliance’s Vision, Mission and Goals

Vision – To be a leader in transforming the delivery of whole person care in the public sector.

Mission – To improve the health and well-being of the people we serve by ensuring highly effective, community-based support and care.

Goals – There are 6 goals with objectives and initiatives within the goals.

Discussed the status and progress of the Strategic Initiatives and Goals. Doug followed up with the progress of Recovery and Self-Determination Trainings.

Next training at Wake on February 12, 2016 Doug discussed the white paper transformation plan for Alliance becoming a recovery oriented system of care.

Multi-year plan to fully implement.

CFAC will be part of developing some of the project plans. Discussion and Feedback from group:

What about hiring people with disabilities?

There are ways to work, but need to be cautious when collecting disability money.

How are the initiative teams represented?

Supervisors recommending staff from various departments.

New initiative participants are derived from an essay and the committee chairs evaluate essays and select the participants.

Future to have a “help wanted” section on the intranet.

Working a format with the recovery and transformation to include disabled individuals to participate on initiatives.

Will there be more expansion to have more providers?

Our network is full and closed.

Identify the need and support through Needs and Gaps survey.

Amanda will share with GO Team the hiring of people with disabilities, also include as part of the initiative teams.

6. Cultural Competency Orientation – Bonita Lawrence-McClure:

Bonita shared an overview (PowerPoint presentation/handout):

Group participation and feedback on cultural needs and expectations from MH/SA and I/DD consumers.


Page 5 of 5


FRAME: Group participation and feedback on the cultural reality of what is actually

occurring.

CFAC encouraged to do the Snapshot survey.

All providers will be required to have a Cultural Competency Plan.

Cultural Competency training:

Provider focus training – 2/23/16

Areas that CFAC members/consumers feel Alliance staff should be trained on, Doug will take any suggestions.

Discussion with interpreters being present at appointments for language barriers. There are language/translation services available for providers.

Alliance has a database of providers available who provide services for specific language speaking consumers. Contact Alliance’s Access line at (800) 510-9132.

7. Announcements:

Re-Think Campaign Phase II (handout): Doug gave an overview:

Doug Fuller and Doug Wright are looking for feedback on personal concerns, experiences or ideas that would help promote the Anti-Stigma campaign within Phase II.

8. Wrap Up & Adjourn: Meeting Adjourned at 7:30 p.m.

Strategic Plan Update CFAC:

FY16 Strategic Plan Initiatives

Our organizational Vision shapes the way

we conduct our business…

“To be a leader in transforming the delivery

of whole person care in the public sector”

Strategic Infrastructure

GO

ALS

MIS

SIO

N

To improve the health and well-being of the peoplewe serve by ensuring highly effective,community-based support and care

(1)

Have effective

relationships with a wide variety of

stakeholder groups

(2)

Be a data-

informed organization

(3)

Develop and effectively manage a

high quality provider network

(4)

Be a high-performing

and financially

sound organization

(5)

Attract and retain

a talented workforce

(6)

Be proactive in the

midst of a changing external

environment

Objectives

Initiatives

Working Towards Our Mission

(Goal 6)

Be proactive in the midst of

a changing external environment

6.1.

Anticipate and participate in

external environmental

change conversations

6.2.Plan for possible future alternatives

6.2.1.

Develop a strategy

for integrating care

6.2.2.

Prepare for potential

MCO consolidation

6.3.Stop, slow or

start other operational work as appropriate

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L

Progress

• 30 original initiatives

o 12 completed

o 9 active

o 9 pending

• 20 % active staff participation in initiatives

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L(Goal 1)

Have effective relationships with a wide variety of stakeholder groups

1.1.

Understand our key

stakeholders

1.2.

Be able to articulate and demonstrate our mission

1.2.1. Continue to

implement the Community Awareness Campaign

1.2.2.

Develop and implement

organizational branding campaign

1.3.Understand the collective impact of our partnership work, focusing on

key areas that produce results

Initiative Completions

• Goal 1: Have effective relationships with a

wide variety of stakeholder groups

o Foundational Recovery Knowledge training

completed

o Organizational Recovery Transformation Plan

completed

o Recovery Transformation Steering committee

forming

o Organizational Branding campaign completed

(Goal 2)

Be a data-informed organization

2.1.

Have reliable

data and systems

2.1.1Initiate a

data integrity

audit process

2.2.

Have easy access

to our data

2.3.

Know, understand

and use data

2.4.Communicate

our data effectively

2.4.1.Develop and implement

an enterprise-

level BI tool

2.5.Create a culture of

data ownership across the

organization

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L


• Goal 2: Be a data informed organization

o Recommendations for a data reporting process

completed

(Goal 3)

Develop and effectively manage a high quality provider network

3.1.

Have only quality providers in our

network

3.2.

Monitor provider performance

3.3.

Ensure a continuum of services that

matches the needs of the populations

we serve

3.3.2.Implement network development plan

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L


• Goal 3: Develop and effectively manage a high

quality provider network

o Network development plan 65% completed

o New process for evaluating rate structure

completed

(Goal 4)

Be a high performing andfinancially sound business

4.1.

Continuously improve business

operations

4.1.1.Measure and

evaluate organizational impact

of Community Relations activities

4.2.

Have effective financial

management

4.3.

Break down internal communication

barriers

4.3.2.Develop and launch

company intranet

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L

2015 Initiative Completions

• Goal 4: Be a high performing and financially

sound business

o Development and launch of intranet completed

o Recommendations for breaking down internal

communication barriers completed

o Internal Communication Plan being drafted with

input from staff

(Goal 5)

Attract and retain a talented workforce

5.1.

Manage our human resources

pipeline

5.2.

Manage staff performance

effectively

5.2.1.

Develop a reward and recognition program for

staff contributions

5.3.

Create an attractive, desired

work environment

5.3.2.

Create a healthy workforce initiative (to include wellness

initiatives)

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L

(Goal 6)

Be proactive in the midst of

a changing external environment

6.1.

Anticipate and participate in

external environmental

change conversations

6.2.Plan for possible future alternatives

6.2.1.

Develop a strategy

for integrating care

6.2.2.

Prepare for potential

MCO consolidation

6.3.Stop, slow or

start other operational work as appropriate

INIT

IAT

IVE

S O

BJE

CT

IVE

S

G

OA

L


• Goal 5: Attract and retain a talented workforce

o Cultural and Linguistic Competency Plan

completed

o Cultural and Linguistic Competency Committee

formed and operational

Questions and Comments?

oNext steps:

o Report status to Board in May

o Continue work on existing initiatives

o Identify and prioritize FY17 initiatives

(Back to agenda)

5B

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.

REQUEST FOR AREA BOARD ACTION: Accept the report.

CEO RECOMMENDATION: Accept the report.

RESOURCE PERSON(S):

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



Thursday, February 04, 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: Kenneth Edge, Amelia Thorpe

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 12/3/2015 meeting were reviewed; a motion was made by Vicki Shore and seconded by

George Quick.


FRAME:

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

of Net Position, Statement of Revenue and Expenses – Actual to Budget,

Senate Bill 208 Required Ratios, and DMA Contract Ratios

a) Statement of Net Position as of December 31, 2015

b) Statement of Revenue and Expenses – Actual to Budget as of

December 31, 2015 – Alliance currently has revenues exceeding

expenses of $21,811,000. The majority of this is related to Medicaid

and Medicaid risk reserve.

c) Senate Bill 208 Ratios - Alliance is currently meeting and exceeding

all required Senate Bill 208 ratios.

d) DMA Contract Ratios - Alliance is not currently meeting the

Medicaid Expense Ratio. The ratio requirement changed to only

calculate based on the current year (previously it was from the life of

the program) and the ratio benchmark was increased to 85% to align

with private sector’s benchmark (previously it was 80%). There is a

6 month grace period to allow time for service expenses to build up

during the year. MCO’s are still in discussion with DMA regarding

the way the ratio is calculated. MCO’s are proposing certain

administrative costs are included in the expense portion of the ratio

calculation (activities that contribute to the quality of care). The

private sector includes these costs in their calculation, however the

Sara Pacholke will

continue to update the

finance committee on

the results of

discussions with DMA

regarding how the

Medical Expense Ratio

is calculated.

Thursday, February 04, 2016 BOARD FINANCE COMMITTEE


Page 2 of 2


FRAME:

current DMA calculation excludes these costs. George Quick

requested that we include the current ratio calculation as well as the

proposed ratio calculation on the reports.

4. Kelly Goodfellow discussed the proposed budget amendment. There is a

proposed increase of $45,559,953. The majority of this is related to

Medicaid services, Medicaid risk reserve and Medicaid administration due to

a change in projections. In addition, a fund balance appropriation was

included to offset the state funding reductions. A motion from George

Quick was seconded by Vicki Shore to approve the budget amendment.

The Finance

Committee will

recommend that the

Board approve the

budget amendment.

4. ADJOURNMENT


Statement of Revenue and Expenses - Budget and Actual

1/31/2016

% Received/

Original Budget Current Period Year to Date Balance Expended

REVENUES

Local Grants $36,294,009.00 $4,916,408.55 $23,185,671.04 $13,108,337.96 63.88%

State & Federal Grants 47,181,727.00 6,201,976.97 26,110,739.10 21,070,987.90 55.34%

Medicaid Waiver Services 342,221,605.00 30,769,936.28 212,399,844.13 129,821,760.87 62.07%

In Kind 936,459.04 1,051,365.04

Total Revenue $425,697,341.00 42,824,780.84 262,747,619.31 164,001,086.73 61.72%

Administrative

Local Administration 364,086.00 49,442.93 231,486.14 132,599.86 63.58%

LME Administrative Grant 4,359,385.00 1,089,846.37 2,542,974.37 1,816,410.63 58.33%

Medicaid Waiver Administration 39,355,485.00 3,998,254.27 27,595,704.37 11,759,780.63 70.12%

Miscellanous Revenue 2,376.74 16,953.34

Total Administrative Revenue 44,078,956.00 5,139,920.31 30,387,118.22 13,708,791.12 68.94%

Total Revenues 469,776,297.00 47,964,701.15 293,134,737.53 177,709,877.85 62.40%

EXPENSES

Local Services 36,294,009.00 2,966,716.11 17,259,335.99 19,034,673.01 47.55%

State & Federal Services 47,181,727.00 4,153,355.29 31,558,923.75 15,622,803.25 66.89%

Medicaid Waiver Services 342,221,605.00 30,219,838.09 191,007,887.06 151,213,717.94 55.81%

In Kind Expenses 936,459.04 1,051,365.04

Total Service Expenses 425,697,341.00 38,276,368.53 240,877,511.84 185,871,194.20 56.58%

Administrative

Operational 6,063,955.00 402,558.03 3,252,653.90 2,811,301.10 53.64%

Salaries, Benefits, and Fringe 30,563,557.00 2,672,835.26 17,684,612.23 12,878,944.77 57.86%

Professional Services 7,451,444.00 634,389.17 3,530,395.66 3,921,048.34 47.38%

Total Administrative Expenses 44,078,956.00 3,709,782.46 24,467,661.79 19,611,294.21 55.51%

Total Expenses 469,776,297.00 41,986,150.99 265,345,173.63 205,482,488.41 56.48%

CHANGE IN NET POSITION 5,978,550.16 27,789,563.90


Senate Bill 208 Ratios

As of January 31, 2016

99.99%

86%

88%

90%

92%

94%

96%

98%

100%

102%

A U G - 1 5 S E P - 1 5 O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 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.

3.48

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

A U G - 1 5 S E P - 1 5 O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6

CURRENT RATIO

Bench Mark Alliance

Alliance Behavioral HealthcareDMA Ratios


97.87

0

20

40

60

80

100

120

AUG ‐1 5 S E P ‐1 5 OCT ‐1 5 NOV ‐15 DEC ‐15 J AN ‐1 6

DEFENSIVE INTERVALBench 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.

Alliance Behavioral HealthcareDMA Ratios


83.30%

70%

75%

80%

85%

90%

95%

JUL ‐1 5 AUG ‐1 5 S E P ‐1 5 OCT ‐1 5 NOV ‐15 DEC ‐15 J AN ‐1 6

MEDICAL EXPENSE RATIOBench 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.

83.49%

70%

75%

80%

85%

90%

95%

JUL ‐1 5 AUG ‐1 5 S E P ‐1 5 OCT ‐1 5 NOV ‐15 DEC ‐15 J AN ‐1 6

MEDICAL EXPENSE RATIOBench 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 Renenue. The benchmark is 85%. This is the ratio that is currently being negotiated with DMA.

5C

(Back to agenda)

ITEM: Policy Committee Report


BACKGROUND:

Per Alliance Behavioral Healthcare Area Board Policy “Development of Policies and Procedures”, the

Board is to review all policies annually. The Board Policy Committee reviews a number of Policies each

quarter in order to meet this requirement

Policies reviewed at the February 11, 2016 Policy Committee meeting and ready for Board approval

without revisions:

Policies reviewed with suggested revisions:

Coordination of Care for Special Health Care Populations

Provision of Services by Relatives-Legal Guardians

Area Board Conflict of Interest


Accept the report. Accept Board Policy Committee minutes from the February meeting as submitted. As

part of the annual review process approve the above listed policies for continued use. Approve the

recommended changes to the above listed policies.

CEO RECOMMENDATION:

Accept the report. Approve the reviewed policies for continued use and approve the proposed revised

policies.

RESOURCE PERSON(S):

Curtis Massey, Committee Chair; Monica Portugal, Chief Compliance Officer



Thursday, February 11, 2016

BOARD POLICY COMMITTEE - REGULAR MEETING

4600 Emperor Boulevard, Durham, NC 27703

4:00-6:00 p.m.


Page 1 of 5

APPOINTED MEMBERS PRESENT: ☒Lodies Gloston, B.A., M.A., ☒Phillip Golden, B.A., ☒Curtis Massey,

Committee Chair, B.A., J.D., ☐Vicki Shore, B.A., ☐

BOARD MEMBERS PRESENT:

GUESTS PRESENT: STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Carol Hammett, General Counsel; Asheena McMillan, Administrative Assistant


2. REVIEW OF THE MINUTES: The minutes from the November 12, 2016 meeting were reviewed; a motion was made by Ms. Gloston and

seconded by Mr. Golden to approve the minutes. Motion passed unanimously.


FRAME:

Announcements: None n/a n/a

Documents Provided: Minutes: 11/12/15; policies n/a n/a

Annual Review of

Policies:

The Committee reviewed Customer Services, Client Rights, Care

Coordination, Utilization Management, Provider Network and Quality

Management Policies.

Policies reviewed and considered for continued use without revisions:

Clients’ Rights

Clients’ Rights to Dignity, Privacy and Humane Care, CR-1

Motion was made by Mr. Golden and seconded by Ms. Gloston.

Motion carried.

Clients’ Rights to Confidentiality, CR-2


Motion carried.

Consumer Choice, CR-3


Policies will be

submitted to Board

Clerk for inclusion in the

March 3, 2016 Board

Packet.

February 22,

2016




4:00-6:00 p.m.


Page 2 of 5


FRAME:

Motion carried.

Advanced Directive/Advanced Instructions, CR-4

Motion was made by Ms. Gloston and seconded by Mr. Golden.

Motion carried.

Care Coordination

Coordination of Care for Special Health Care Populations, CC-1.

Question was posed whether population could be expanded. Ms.

Portugal clarified that the definition of Special Health Care and High

Risk Population is per contract with DMA. It was determined that

while DMA contract allows the population to be expanded, the

addition would impose an unfunded mandate to serve the expanded

population.


Motion carried.

Provider Network

Letters of Support, PN-2


Motion carried.

Rule Waiver Requests, PN-5


Motion carried.

Selection and Retention of Providers, PN-1

A Discussion took place regarding specific language in the policy

statement and provider financial disclosures.


Motion carried.




4:00-6:00 p.m.


Page 3 of 5


FRAME:

Quality Management

Consumer, Provider and Stakeholder Satisfaction, QM-1


Motion carried.

Management and Investigation of Grievances, QM-2


Motion carried.

Management of Incidents, QM-3


Motion carried.

Utilization Management

Accessibility of Utilization Review/Utilization Management

Process,UM-1


Motion carried.

Pre-Review Screening for Certification, UM-2


Motion carried.

Utilization Review Criteria, UM-3

Motion was made by Mr. Massey and seconded by Mr. Golden.

Motion carried.

Utilization Review Process, UM-4


Motion carried.




4:00-6:00 p.m.


Page 4 of 5


FRAME:

Appealing Utilization Management Decisions, UM-5


Motion carried.

Financial Eligibility, UM-6


Motion carried.

Policies reviewed with suggested revisions

Customer Services

Customer Services, CS-1

Revisions clarifying policy statement.


Motion carried.

Provider Network

Provision of Services by Relatives/Legal Guardians, PN-3

Removed definition and language referencing Employer of Record;

revised policy statement.

Motion to amend policy was made by Ms. Gloston and seconded by

Mr. Golden. Motion carried.

Other Policies for

Review and Revision

Governance

Area Board Conflict of Interest, G-1

Policy was revised to include the conflict of interest process proposed

by the Audit and Compliance Committee and approved by the Board

on December 3, 2015


Motion carried.

Policy will be submitted

to Board Clerk for

inclusion in the March 3,

2016 Board Packet.

February 22,

2016




4:00-6:00 p.m.


Page 5 of 5


FRAME:

Proposed New Policy Budget Transfers: Mr. Massey had question regarding current

authority. Ms. Portugal clarified the CEO’s and CFO’s current

authority and reiterated that policy was proposed by the Finance

Committee. Mr. Golden requested to not use the term “appropriations”

or to add a definition of the term.

Motion was made by Ms. Gloston and seconded by Mr. Golden to

refer policy back to Finance Committee with recommended

revisions/clarifications. Motion carried.

Policy will be referred

back to the Finance

Committee by Ms.

Portugal

February 22,

2016

Adjourned at 5:57pm

3. ADJOURNMENT: The meeting was adjourned at 5:57pm. Next meeting will be May 12, 2016, from 4:00 p.m. to 5:30 p.m.

AREA BOARD POLICIES & PROCEDURES

I. PURPOSE The purpose of this policy is to clearly define the standards and procedures for authorizing Medicaid and State funded services. II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to make timely and accurate utilization management determinations and notifications regarding requests for certification of treatment. Determinations and notifications shall be made in accordance with the requirements of the North Carolina Division of Mental Health/Developmental Disability/Substance Abuse Services (DMH/DD/SAS), the North Carolina Division of Medical Assistance (DMA) and the external accrediting body, URAC. III. PROCEDURES The Area Director shall develop procedures to implement the provisions of this policy.

TITLE: Utilization Review Process BOARD POLICY #: UM-4 LINES OF BUSINESS: Service Management RESPONSIBILITY: Area Board, Area Director

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

URAC STANDARDS: HUM, v. 7.0, Standards 10-12, 17-21, and 25-29.

APPROVAL DATE: 6/26/2012 LATEST REVISION DATE:

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to set forth the standards and criteria used by Alliance Behavioral Healthcare to determine the medical necessity of service requests submitted by network providers. II. DEFINITIONS Medical Necessity: 1. The procedure, product, or service is individualized, specific, and consistent with symptoms or

confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs; 2. The procedure, product, or service can be safely furnished, and no equally effective and more

conservative or less costly treatment is available statewide; and 3. The procedure, product, or service is furnished in a manner not primarily intended for the

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

III. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to implement objective clinical review criteria to govern all utilization management decisions regarding service authorization requests. These criteria have been developed by the North Carolina Division of Medical Assistance, and are documented in NC DMA Clinical Coverage Policies and the North Carolina Division of Mental Health/Developmental Disabilities/Substance Abuse Services and are documented in the MH/DD/SA Services Definition manual. The Alliance Clinical Advisory Council is authorized to approve clinical guidelines that can be used during the utilization review process. All Clinical Coverage Policies, Service Definitions and clinical guidelines that are used in the utilization management process shall be made available to providers and consumers. IV. PROCEDURES

The Area Director shall develop procedures to implement the provisions of this policy.

TITLE: Utilization Review Criteria BOARD POLICY #: UM-3 LINES OF BUSINESS: Service Management RESPONSIBILITY: Area Board, Area Director

REFERENCE(S):

URAC STANDARDS: HUM, v. 7.0, Standard 1


LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to ensure that Alliance Behavioral Healthcare (“Alliance”) complies with Federal and State laws, rules and regulations, contract requirements and national accreditation standards regarding the selection and retention of providers. II. POLICY STATEMENT It is the policy of Alliance to select and retain providers based on quality of care, quality of service, the service needs of the catchment area population and business needs of the organization. The goal of Alliance is to develop and maintain a sufficient network of high quality service providers that meets consumer and community needs within available resources and promotes efficiency and the economic viability of network providers. Selected providers must also meet the credentialing and re-credentialing requirements established by Alliance and the North Carolina Department of Health and Human Services. The North Carolina Medicaid 1915 b/c Waiver permits Alliance to operate a closed network by waiving the provider “freedom of choice” provision in the Social Security Act. The closed network is balanced by Alliance’s responsibility to ensure accessibility of services. In accordance with 42 CFR 438.214 and the terms and conditions of the Alliance contract with NCDHHS to operate a Prepaid Inpatient Health Plan, Alliance is required to implement provider selection and retention criteria that do not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. Criteria may include provider performance and other factors. Alliance shall not employ or contract with providers who are excluded from participation in Federal healthcare programs under either section 1128 or section 1128A of the Social Security Act or who have been terminated by the NC State Medicaid program for any reason. Alliance will establish a fair, impartial and consistent process for the enrollment and re-enrollment of mental health, intellectual/ developmental disability and/or substance abuse (“MH/I-DD/SA”) service providers in the Alliance Closed Network that complies with 42 CFR §438.207 and §438.214.

TITLE: Selection and Retention of Providers BOARD POLICY #: PN-1 LINES OF BUSINESS: Provider Network RESPONSIBILITY: Area Board, Area Director

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

URAC STANDARDS: CORE, v. 3.0, Standard 4; N-NM, v. 7.0, Standards 1-3, 5-17; N-CR, v. 7.0, Standards 1-16


4/2/2015

LATEST REVIEW DATE:

4/2/2015

TITLE: Selection and Retention of Providers

LATEST REVISION DATE: 4/2/2015

PAGE: 2 of 2

III. PROCEDURES The Area Director shall develop procedures to implement this policy.


I. PURPOSE The purpose of this policy is to ensure that Alliance Behavioral Healthcare processes waiver of licensure rule requests made by contracted licensed facilities in a consistent manner. When recommending approval to waive a rule, Alliance must ensure the existence of safeguards to protect the consumers’ health and safety. II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to process all rule waiver requests submitted by licensed facilities in the Alliance Provider Network consistently and in compliance with the North Carolina Administrative Code. The Administrative Rule outlines that the decision to grant or deny the waiver request shall be based on the following:

a. The nature and extent of the request; b. The existence of safeguards to ensure that the health, safety, or welfare of the clients

residing in the facility will not be threatened; c. The determination that the waiver will not affect the health, safety, or welfare of

clients residing in the facility; d. The existence of good cause; and e. Documentation of LME-MCO governing body approval when requests are from an

LME-MCO contract agency. The Alliance Area Board has delegated authority to the Area Director to approve and deny requests to waive a rule as authorized by Department of Health of Human Services.

III. PROCEDURES The Area Director shall develop procedures to ensure a consistent approval process of rule waiver requests.

TITLE: Rule Waiver Requests BOARD POLICY #: PN-5 LINES OF BUSINESS: Provider Network, Compliance RESPONSIBILITY: Area Board, Area Director

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

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


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to ensure that Alliance Behavioral Healthcare complies with the provisions of the NC Medicaid 1915(c) Innovations Waiver as Alliance reviews and processes requests to employ relatives as providers. II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to process requests:

1. from Network Providers to employ relatives/legal guardians (who live in the home of the Innovations Waiver participant) to provide Innovations Waiver services to adult family members; and,

2. from individuals who wish to participate in Individual and Family Directed Supports. The process for handling such requests shall comply with the policy and regulatory provisions of the Innovations Waiver. III. PROCEDURES The Area Director shall develop procedures to implement this policy.

TITLE: Provision of Services by Relatives/Legal Guardians BOARD POLICY #: PN-3 LINES OF BUSINESS: Provider Network Management RESPONSIBILITY: Area Board, Area Director

REFERENCE(S): DHHS DMA Contract

URAC STANDARDS: CORE, v. 3.0, Standard 4


4/2/2015

LATEST REVIEW DATE:

4/2/2015

Deleted: <#>DEFINITIONS¶¶Employer of Record: The individual recorded by and registered with federal and state government agencies as the Employer for legal purposes in the Employer of Record Model of Individual and Family Directed Supports.¶¶

Deleted:

Formatted: Font: 12 pt

Formatted: List Paragraph, Numbered + Level: 1 +Numbering Style: 1, 2, 3, … + Start at: 1 + Alignment:Left + Aligned at: 0.25" + Indent at: 0.5"

Deleted: and Employers of Record

Deleted: their

Formatted: Font: 12 pt


I. PURPOSE The purpose of this policy is to set forth policy regarding the use of licensed and non-licensed staff in the utilization management process.

II. DEFINITIONS Certification – authorization for an individual to receive services from an Area Authority provider. III. POLICY STATEMENT Alliance Behavioral Healthcare shall employ licensed clinical staff as well as non-clinical, administrative personnel to perform the utilization management functions required to issue certifications. Alliance shall ensure that licensed clinical staff are available to provide oversight and follow-up of clinically related questions during initial screening activities.

IV. PROCEDURES The Area Director shall develop procedures to implement this policy.

TITLE: Pre-Review Screening for Certification BOARD POLICY #: UM-2 LINES OF BUSINESS: Service Access, Utilization Management RESPONSIBILITY: Area Board, Area Director

REFERENCE(S): N/A

URAC STANDARDS: HUM, v. 7.0, Standards 7-11


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to define and establish a uniform and consistent approach for handling incidents which occur in the operations of a facility or service. II. DEFINITIONS Incidents: Events that are inconsistent with the routine operations of a service or care of a consumer that are likely to lead to adverse effects. Level I Incident: Event that is inconsistent with the routine operation of a service or care of a consumer that is likely to lead to adverse effects but does not meet the definition of a Level II or III incident. Level II Incident: As described in Level I Incident above but results in a threat to a consumer’s health and safety or presents a threat to the health and safety of others due to the consumer’s behavior. This includes a client death due to natural causes or terminal illness. Level III Incident: Event that is inconsistent with the routine operation of a service or care of a consumer that is likely to lead to adverse effects and result in:

1. a death or permanent physical or psychological impairment to a consumer; 2. a death or permanent physical or psychological impairment caused by a consumer; 3. a threat to public safety caused by a consumer; 4. an amber or silver alert, or news media involvement 5. any allegation of rape or sexual assault of a consumer or by a consumer.

III. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to ensure consumer safety and quality of care within the Alliance Behavioral Healthcare Network. Alliance will require that Network Providers respond to all level I, II and III incidents according to 10A North Carolina Administrative Code 27G .0603 and .0604 and that Alliance Behavioral Healthcare responds to all level III incidents in accordance with 10A North Carolina Administrative Code 27G .0605.

TITLE: Management of Incidents BOARD POLICY #: QM-3 LINES OF BUSINESS: Quality Management RESPONSIBILITY: Area Board, Area Director

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

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


4/2/2015

LATEST REVIEW DATE:

4/2/2015

TITLE: Management of Incidents


PAGE: 2 of 2

IV. PROCEDURES The Area Director shall develop procedures to implement this policy.


I. PURPOSE The purpose of this policy is to establish a process for receiving, investigating, resolving and managing grievances in a consistent manner. II. DEFINITIONS Complainant: Enrollee/consumer, legally responsible person, or Providers, authorized in writing and acting on behalf of the enrollee/consumer filing the grievance. Does not include providers, stakeholders or other individuals not acting on behalf of a consumer. Grievance: an expression of dissatisfaction by an enrollee, their legal guardian, or Provider, authorized in writing and acting on behalf of the enrollee/consumer about any matter other than decisions regarding requests for Medicaid services. Provider: an individual, agency or organization that provides mental health, developmental disabilities and/or substance abuse services to consumers and families.

III. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to respond to grievances received concerning the provision of publicly funded services in the Alliance Behavioral Healthcare catchment area. It is also the policy of Alliance Behavioral Healthcare to use the information gleaned from grievance proceedings as part of Alliance’s quality improvement process. IV. PROCEDURES The Area Director shall develop procedures to implement this policy. The procedures shall comply with all relevant state and Federal statutes and requirements of all regulatory, funding or accrediting bodies.

TITLE: Management and Investigation of Grievances BOARD POLICY #: QM-2 LINES OF BUSINESS: Network Administration, Clients Rights, Quality Management RESPONSIBILITY: Area Board, Area Director

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

URAC STANDARDS: CORE, v. 3.0, Standard 35


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to provide guidance on the issuance of letters of support/acknowledgment for community based projects for persons with mental illness, intellectual/developmental disabilities and substance abuse disorders.

II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to support the development of community based MH/IDD/SA services. Pursuant to the development of these services, the Area Authority may, from time to time, be asked for a letter of support or acknowledgment for a specific project. Some of these requests may be precipitated by law or regulation which requires Area Authority involvement or knowledge of the project. Irrespective of the reason for the request, the decision to submit a letter of support/acknowledgement shall be based on the service needs of the residents of the catchment area as identified in the Area Authority’s comprehensive planning process.

III. PROCEDURES The Area Director shall develop procedures for the issuance of letters of support for the various types of projects that might arise. The guiding principle for these procedures shall be the identification of need as reflected in the Area Authority’s comprehensive plan.

TITLE: Letters of Support BOARD POLICY #: PN-2 LINES OF BUSINESS: Service Access/Provider Network RESPONSIBILITY: Area Board, Area Director


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


LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to establish financial eligibility criteria for individuals not eligible for Medicaid and who are seeking treatment in the Alliance Provider Network. Eligibility for non-Medicaid funded services is not an entitlement and is contingent upon availability of funding. II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to establish financial eligibility criteria for the use of state funds as payment for behavioral health services to a non-Medicaid eligible individual in the Alliance area. For an individual to receive state funded treatment services, the following basic criteria must be met:

1. there must be funding available to pay for such treatment; 2. the individual must be a resident of a county in the Alliance area; 3. there must be no other payer to cover the cost of care; and 4. the individual or minor individual’s parent or legal guardian are deemed financially eligible for

services. An individual meets financial eligibility if the household income is at or below 300% of the federal poverty level and they have no assets or third party funding or insurance available to pay for services. Residents of the Alliance counties are eligible for crisis assessment and crisis services through the Alliance Provider Network when no other payer source is available. Under this policy, acute inpatient psychiatric services that require prior authorization are not considered crisis services.

III. PROCEDURES The Area Director will develop procedures to implement this policy.

TITLE: Financial Eligibility BOARD POLICY #: UM-6 LINES OF BUSINESS: Service Management RESPONSIBILITY: Area Board, Area Director

REFERENCE(S): DHHS DMH Contract

URAC STANDARDS:


LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to establish the expectation that Alliance Behavioral Healthcare shall operate a comprehensive customer services program. II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare that its Customer Services Program will provide the following:

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

2. Crisis services authorization as needed; and 3. Information in response to questions and inquiries expressed through the Access and Information

Line. III. PROCEDURES The Area Director shall develop procedures to implement this policy.

TITLE: Customer Services BOARD POLICY #: CS-1 LINES OF BUSINESS: Access to Care, Customer Service RESPONSIBILITY: Area Board, Area Director


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


LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to ensure that Alliance Behavioral Healthcare carries out its responsibility for providing care coordination to eligible individuals and families within the Alliance catchment area and to define the process of identifying and referring individuals to Care Coordination. II. DEFINITIONS Care Coordination: A collaborative process that links individuals and families with special healthcare needs and high risk/high cost individuals to services and resources in an effort to optimize clinical outcomes, decrease unnecessary utilization of services and ensure delivery of quality care. Special Health Care and High Risk Populations: Adult enrollees who are severely and persistently mentally ill and meet Level of Care Utilization

System for Psychiatric Services (LOCUS) criteria Child enrollees who are severely emotionally disturbed and meet Child and Adolescent Level of

Care Utilization System (CALOCUS) criteria Children under 21 years of age with a mental health or substance use diagnosis who are currently, or

have been within the past thirty (30) days, in a facility (including a Youth Development Center and Youth Detention Center) operated by the Department of Public Safety, or Division of Adult Correction and Juvenile Justice for whom Alliance has received notification of discharge.

Enrollees with substance use diagnosis AND current ASAM PPC Level of III.7 or II.2-D or higher. Enrollees with co-occurring diagnoses (SA/MH/I/DD) Opioid Dependent: Individuals with an opioid dependence diagnosis AND who have reported to

have used drugs by injection within the past thirty days CCNC/MCO (Community Care of North Carolina/Managed Care Organization) Priority List Consumers who meet criteria for the Transitions to Community Living Initiative Individuals on the NC Innovations Waiver Individuals with an intellectual or developmental disability diagnosis who are currently, or have

been within the past thirty (30) days, in a facility operated by the Division of Adult Correction and Juvenile Justice for whom Alliance has received notification of discharge

TITLE: Coordination of Care for Special Health Care Populations BOARD POLICY #: CC-1 LINES OF BUSINESS: Care Coordination RESPONSIBILITY: Area Board, Area Director REFERENCE(S): G.S. 122C-115.4 URAC STANDARDS: CORE, v. 3.0, Standards 4, 26, 36 & 38APPROVAL DATE: 8/20/2012 LATEST REVISION DATE:

4/2/2015

LATEST REVIEW DATE:

4/2/2015

TITLE: Coordination of Care for Special Health Care Populations


PAGE: 2 of 2

III. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to provide Care Coordination to individuals that meet the Special Health Care and High Risk Populations criteria delineated in part II. Alliance shall develop protocols to identify individuals who are high risk or who have special health care needs and ensure that those individuals identified receive care coordination as appropriate. Alliance shall employ qualified professionals who shall be located in the geographic areas covered by Alliance Behavioral Healthcare to provide care coordination. IV. PROCEDURES The Area Director shall develop procedures to implement this policy.


I. PURPOSE Alliance Behavioral Healthcare endeavors to provide services to the community that are timely, high quality and effective. Alliance Behavioral Healthcare is committed to a process of continuous quality improvement and assessment of its relationships with its community partners. II. POLICY STATEMENT Alliance Behavioral Healthcare seeks to serve the community in a manner that is efficient, responsive, and effective. It is the policy of the Board to employ appropriate techniques to measure the extent to which the Board is meeting its objectives and the level of satisfaction among the Board’s many constituencies. The results of these measurements are to be used to promote improvement of consumers’, providers’ and other stakeholders’ satisfaction and to improve the quality of services and treatment outcomes.

III. PROCEDURES The Area Director shall develop procedures to implement this Policy.

TITLE: Consumer, Provider and Stakeholder Satisfaction BOARD POLICY #: QM-1 LINES OF BUSINESS: Service Access, Quality Management RESPONSIBILITY: Area Board, Area Director

REFERENCE(S): DHHS Contracts

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


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to advocate and support an individual’s right to make informed choices about service provision.

II. POLICY STATEMENT It is the policy of the Area Authority to promote and encourage choice when consumers seek services from Alliance Behavioral Healthcare. Alliance Behavioral Healthcare shall ensure that each consumer seeking services receives the following:

i. information necessary to make an informed choice about service; ii. information about the range of other services available; iii. information about their right to receive services in a way that is non-coercive and protects

their right to self-determination and; iv. for Medicaid funded services, consumers shall be provided with a choice of at least two

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

III. PROCEDURES

The Area Director shall develop procedures to implement this policy.

TITLE: Consumer Choice BOARD POLICY #: CR-3 LINES OF BUSINESS: Service Access RESPONSIBILITY: Area Board, Area Director

REFERENCE(S): 122C-141

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


LATEST REVIEW DATE:

4/2/2015


I. PURPOSE

The purpose of this policy is to ensure that clients’ rights are respected and protected by all providers in the Alliance Behavioral Healthcare Provider Network. II. POLICY STATEMENT

It is the policy of Alliance Behavioral Healthcare that every person served has a right to dignity, privacy and humane care that must be respected and protected. Providers in the Alliance Behavioral Healthcare Provider Network shall assure basic human rights to each client. All programs operated by providers shall comply with the clients’ rights standards set forth in G.S. 122C, Article 3. III. PROCEDURES


TITLE: Clients’ Rights to Dignity, Privacy and Humane Care BOARD POLICY #: CR-1 LINES OF BUSINESS: Clients Rights RESPONSIBILITY: Area Board, Area Director

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

URAC STANDARDS: CORE, v. 3.0, Standards 4, 15, 16, 37 & 38; N-NM, v. 7.0, Standards 9 & 17; HCC, v. 5.0, Standards 17, 18 & 21


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE

The purpose of this policy is to protect each client’s right to privacy and to safeguard the confidentiality of identifiable health information. II. POLICY STATEMENT

All clients of Alliance Behavioral Healthcare shall be assured that their right to privacy and the confidentiality of their identifiable health information will be safeguarded. No staff member, volunteer, student or other person associated with Alliance Behavioral Healthcare shall use or disclose any information except as provided by these policies and procedures as authorized by the General Statutes of the State of North Carolina 122C Parts 52-56, Client Right to Confidentiality, the Federal Regulations 42 CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records, and the Health Insurance Portability and Accountability Act (HIPAA) regulations in 45 CFR. Any violation of this policy shall be grounds for disciplinary action, including termination of employment or termination of other services with Alliance. III. PROCEDURES

The Area Director shall develop procedures to implement the provisions of this policy.

TITLE: Client’s Right to Confidentiality

BOARD POLICY #: CR-2 LINES OF BUSINESS: Client Rights

RESPONSIBILITY: Area Board, Area Director

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

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


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE The purpose of this policy is to establish standards and guidelines to prevent conflict of interest on the part of members of the Alliance Behavioral Healthcare (“Alliance”) Area Board of Directors (hereinafter “Board” or “Area Board”). The policy is intended to supplement, but not replace any applicable federal or state laws, rules and regulations governing conflict of interest. This policy is also intended to meet the requirements of the Division of Medical Assistance regarding conflict of interest under the Medicaid 1915 (b)/(c) waiver. II. POLICY STATEMENT It is the policy of Alliance to ensure that none of its Board members have conflicts of interest with any of the provider agencies with which Alliance has a contractual or a consumer referral relationship. Each Area Board member shall fulfill his or her responsibilities consistent with all Federal and State laws and regulations, Area Board and Area Authority policies, and Area Board By-Laws regarding avoidance of conflict of interest. This includes the avoidance of the perception of conflict of interest which might undermine the efforts of the Area Board to maintain public confidence and trust in the Area Authority. III. DEFINITIONS Provider agency: Agency, organization or individual that is contracted with Alliance to deliver publicly-funded mental health, intellectual/ developmental disability, substance abuse or other treatment, habilitation, rehabilitation, educational, training and/or recovery related services to consumers. Vendor: Company or other entity that provides goods and services needed to develop, maintain or operate the corporation.

TITLE: Area Board Conflict of Interest BOARD POLICY #: G-1 LINES OF BUSINESS: Area Board RESPONSIBILITY: Area Board, Area Director

REFERENCE(S): N.C.G.S. § 122C-118.1(b), N.C.G.S. § 14-234, 42 CFR 438.58

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


9/3/2015

LATEST REVIEW DATE:

9/3/2015

TITLE: Area Board Conflict of Interest


PAGE: 2 of 4

IV. RESTRICTIONS AND REPORTING To ensure accurate disclosure and consideration of potential conflicts of interest, the following relationship of Board members are defined as a Conflict of Interest and must be reported: A. Receiving reimbursement as consultant or employee from Alliance or being employed by Alliance

during the time they serve as board member. B. No member of the Area Board may be a ‘family member’, as defined in Section IV-E of this policy,

of any employee of Alliance Behavioral Healthcare.

C. Representing him or herself to be an independent agent of the Area Board representing any potential Area Board action or position. Further, pursuant to NCGS 122C -118.1, no person registered as a lobbyist under Chapter 120C of the General Statutes shall be appointed to or serve on the Area Board.

D. Having a financial investment, an ownership interest (whether by stock ownership, partnership, or

otherwise), any arrangement for the payment of any commissions, rewards, or any other financial or tangible consideration or benefit, board membership, or employment with any provider agencies with which Alliance has a current contractual or referral relationship, except that a member a Board of County Commissioners who is also a member of the Board of Directors of any nonprofit hospital due to his/her status as a County Commissioner shall not be prohibited from serving on the Area Board even if the nonprofit hospital is contracted with Alliance. Any such member must recuse themselves from any Area Board votes that may impact the nonprofit hospital, and must likewise recuse themselves from any hospital Board votes that may impact Alliance.

1. A list of the provider agencies with which Alliance has contractual or referral relationships shall be

available upon request and shall be provided to Board members annually when Board members complete updated disclosure statements.

E. Having a family member who has a financial investment, an ownership interest (whether by stock

ownership, partnership, or otherwise), any arrangement for the payment of any commissions, rewards, or any other financial or tangible consideration or benefit, board membership, or employment with any provider agencies with which Alliance has a contractual or referral relationship.

For purposes of this policy, “family members” include:

1. The Board member’s spouse; 2. The Board member’s parents, children, and siblings; 3. The Board member’s stepparents, stepchildren, stepbrothers, and stepsisters; 4. The Board member’s father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-

in-law, and sister-in-law; 5. The Board member’s grandparents and grandchildren; 6. A spouse of any of the Board member’s grandparents or grandchildren.

E. Serving on the Consumer and Family Advisory Committee, unless as a designated liaison and reflected in the bylaws.



PAGE: 3 of 4

F. Having any interest in an Alliance vendor as follows:

1. The Board member is a director, officer, partner, or direct or indirect owner of the beneficial interest in more than 5% of the equity in the vendor.

2. The Board member has a family member who is a director, officer, partner, or direct or indirect owner of the beneficial interest in more than 5% of the equity in the vendor.

G. Personally having, or having a family member who has, any interest in any mortgage, deed of trust,

note, or other financial interest in a vendor where the value of such interest equals more than 5% of the value of the assets of the vendor.

V. REQUIREMENTS Certain actions are required on the part of Board members for effective implementation of this policy: A. Board members must observe the highest moral and ethical standards in any dealings in which they

represent the Area Board.

B. Board members must disclose on an ongoing basis any conflict or the appearance of a conflict of interest and depending on the circumstances, may be prohibited from serving or restricted in voting based on the disclosure.

C. All Board members are required to update the information on the disclosure form whenever a potential conflict arises.

D. Board members who are aware of any violations by any board members of this policy are required to report them to the Area Board Chair. The Board Chair shall notify the Area Director of the reported violation.

A. B.

C.

VII. CONFLICT OF INTEREST DISCLOSURE AND RESOLUTION PROCESS

A. The Conflict of Interest (COI) Disclosure form will be distributed no later than the February Board meeting.

B. Board members are required to submit COI Disclosure forms by March 31 each fiscal year. C. Board members who do not submit COI Disclosure forms by the due date will have their

membership on the Board suspended to include eligibility for stipends and financial reimbursement until such time the form is submitted. Board members who do not fully comply with the provisions in this Policy may be subject to removal from the Board.

D. Compliance Officer and Legal Counsel review forms and make recommendation to the CEO. Recommendations may include prohibition from voting to resignation from the Board.

E. Compliance Officer and Legal Counsel notifies Audit & Compliance Committee (Committee) Chair of the conflict and the recommendation to remove/avoid the conflict prior to Committee meeting.

Deleted: VI. CONFLICT OF INTEREST DISCLOSURE ¶¶The following actions may be required as a result of a disclosure:¶¶If a Board member has an interest that violates Part IV D of this policy, the Board member may be required to resign from the Board. ¶¶If a Board member (or Board member’s Family Member) has an interest or conflict that is reportable under this policy, the Board will review the situation and determine what steps, if any, need to be taken to avoid conflict of interest. Such steps may include, for example, prohibiting the board member from participating in any decisions regarding the use of, or negotiations with, the relevant Vendor or Provider Agency.¶¶

Moved down [1]: Board members who do not fully comply with the provisions in this Policy may be subject to removal from the Board.¶

Moved down [2]: While conflict of interest issues are being reviewed, the Board member and subject of the potential conflict may be prohibited from serving or restricted from voting.¶

Moved down [3]: The Area Board shall make the final decision regarding the disposition of all conflict of interest issues.¶

Moved (insertion) [1]

Deleted: ¶



PAGE: 4 of 4

F. Committee Chair calls Board member with identified conflict to discuss conflict and

recommendation prior to the Committee meeting. Board member is offered the opportunity to remove the conflict prior to presenting to the Committee:

a. If Board member removes the conflict, a new disclosure form is filled out reflecting no conflict

b. If Board member does not remove conflict, it is presented to the Committee c. While conflict of interest issues are being reviewed, the Board member and subject of the

potential conflict may be prohibited from serving or restricted from voting. G. Committee hears the conflict and makes a final recommendation to the Board. The Committee

will invite the Board member to be present when the matter is considered by the Committee. H. Committee submits recommendation to the full Board as consent agenda item using Agenda

Action Form (AAF) and a separate document identifying the Board Member, his/her conflict, and proposed solution.

I. The Area Board shall make the final decision regarding the disposition of all conflict of interest issues.


Deleted: ¶


Deleted: ¶


I. PURPOSE To establish a clear process to ensure that consumers’ federal and state due process rights are protected in regards to service reductions, suspensions, termination and denials. II. POLICY STATEMENT Alliance Behavioral Healthcare shall utilize a formal written process with concrete timeframes to govern appeals of denial, suspension, termination or reduction of service based on medical necessity determinations for all services. In accordance with applicable Federal and State laws, rules and regulations, the process shall make a distinction between appeals filed concerning Medicaid, state-funded and locally-funded services, standard appeals, i.e., cases involving non-urgent care and expedited appeals, i.e. cases involving urgent care. The process shall clearly delineate the steps that may be taken by a consumer or the consumer’s legal representative, or a provider or facility rendering service when the appellant asserts their right to appeal, either in verbal or written form. Written directions on how to file an appeal shall be provided with the decision. The directions shall be written in a manner that meets the health, literacy and linguistic needs of the persons affected by the policy. III. PROCEDURES The Area Director shall develop procedures to implement this policy.

TITLE: Appealing Utilization Management Decisions BOARD POLICY #: UM-5

LINES OF BUSINESS: Service Access, Utilization Management


REFERENCE(S): 10A NCAC 27G .7004



4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE

The purpose of this policy is to ensure that Alliance Behavioral Healthcare complies with regulatory requirements surrounding Advanced Directives and Advanced Instructions for Mental Health Treatment. II. POLICY STATEMENT

It is the policy of Alliance Behavioral Healthcare to distribute written information regarding Advance Directives and Advanced Instructions for Mental Health Treatment policies to adult Enrollees, including a description of applicable State and Federal laws. Written information regarding Advance Directives and Advanced Instructions shall cover the following topics:

1. Enrollee rights under State law; 2. Alliance policies respecting the implementation of those rights, including a statement of any

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

3. Information on the Advance Directive and Instructions policies of Alliance; and 4. The Enrollee's right to file a grievance with the State Certification and Survey Agency or the

Division of MH/DD/SAS concerning any alleged noncompliance with the Advance Directive or Instructions laws.

In compliance with 42 CFR 438.6(i) and N C GS 122C Part 2, the written information provided to Enrollees shall reflect changes in State law as soon as possible, but no later than 90 days after the effective date of the change. III. PROCEDURES


TITLE: Advanced Directives/Advanced Instructions BOARD POLICY #: CR-4

LINES OF BUSINESS: Customer Services, Care Coordination


REFERENCE(S): G.S. 122C Article 3, Part 2; 42 CFR 438.6(i)

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


4/2/2015

LATEST REVIEW DATE:

4/2/2015


I. PURPOSE

The purpose of this policy is to ensure timely reviews of oral or written requests for service authorization. II. POLICY STATEMENT It is the policy of Alliance Behavioral Healthcare to ensure timely access to care. Utilization management personnel shall be available during regular business hours to process requests and to communicate with providers, consumers and other stakeholders. All communications and interactions with the affected parties shall be cordial and courteous.

III. PROCEDURES The Area Director shall develop procedures to implement this policy.

TITLE: Accessibility of Utilization Review/Utilization Management Process BOARD POLICY #: UM-1

LINES OF BUSINESS: Service Access/Utilization Management





LATEST REVIEW DATE:

4/2/2015

(Back to agenda)

ITEM: Draft Minutes from the February 4, 2016, Board Meeting


REQUEST FOR BOARD ACTION: Approve the draft minutes from the February 4, 2016, Board Meeting.

CEO RECOMMENDATION: Approve the minutes.

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

A.



6A



5000 Falls of Neuse Road, Raleigh, NC 27609

4:00-6:00 p.m.

Page 1 of 4

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

☐George Corvin, MD, ☒Kenneth Edge, ☒James Edgerton, ☒Lodies Gloston (entered at 4:40 pm), ☒Phillip Golden, ☒John Griffin,

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

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

GUEST(S) PRESENT: Carolyn Ambrose, CFAC Chair; Dennis Farley, DMH; Denise Foreman, Wake County Manager’s Office; Jessica Holmes, Wake Board of

County Commissioners; Scott Taylor, former Board member; James West, Chairman of Wake Board of County Commissioners

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

Director/Veterans Point of Contact, Joey Dorsett, CIO; Kelly Goodfellow, CFO; Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram,

Executive Assistant; Geyer Longenecker, QM Director; Ken Marsh, Medicaid Program Director; Beth Melcher, Chief of Network Development and Evaluation; Ann

Oshel, Chief Community Relations Officer; Monica Portugal, Chief Compliance Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Sean Schreiber, Chief

Clinical Officer; Doug Wright, Director of Consumer Affairs

1. CALL TO ORDER: Chairman Christopher Bostock called the meeting to order at 4:04 p.m.


2. Announcements A. Plaque for Scott Taylor: Chairman Bostock expressed appreciation to former Board member, Scott Taylor, and presented him with

a plaque to commemorate his service on the Board.

B. Upcoming March Events

1) Future Development Workgroup Meeting: Chairman Bostock reminded Board members that the next monthly staff workgroup

meeting is Tuesday, March 1, 2016, at 4:00 pm. Board members should contact Ms. Ingram to confirm attendance.

2) Chairman Bostock reminded Board members that Alliance’s legislative luncheon is Friday, March 18, 2016, from 12:00-2:00

p.m. Board members may RSVP with Ms. Ingram.

3) Also, Chairman Bostock reminded the Board that the annual Board Budget Retreat is Tuesday, March 29 from 12:30-4:30.

Additional details are forthcoming.

C. Compliance Form: Monica Portugal, Chief Compliance Officer, distributed annual compliance forms to Board members.

D. Additional Announcements:

1) Mr. Robinson mentioned that the 38th Annual Legislative Breakfast on Mental Health is Saturday, March 19 from 8:30-11:30

a.m. at the Friday Center in Chapel Hill. Alliance is sponsoring a table at this community event. Mr. Robinson shared that

Alliance will register interested Board members; they may contact Ms. Ingram for assistance.




4:00-6:00 p.m.

Page 2 of 4


2) Mr. Robinson mentioned an upcoming meeting with a Legislator; he invited Board members to attend if available and to contact

him for additional information. The meeting is scheduled for Wednesday, February 10 at 4:00 pm.

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 (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 November Cumberland subcommittee meeting, the January Durham and Wake

subcommittee meetings, and the December full CFAC meeting.

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

appreciation for CFAC members being able to attend the December NC Council Conference. She expressed appreciation for Alliance

staff’s participation in recent CFAC meetings. Commissioner Sullivan discussed having CFAC members participate in Wake County’s

transit plan discussions.

B. Finance Committee (10 minutes) – page 22

The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Area

Board. This month’s report included draft minutes from the December meeting.

Jim Edgerton, Finance Committee Chair, presented the report. He mentioned that revenues exceeded expenditures; all ratios are above

State mandated requirements except the medical expense ratio. Mr. Edgerton mentioned that the State recently increased this ratio; he

noted corrective actions that staff are coordinating with State officials.

Kelly Goodfellow, CFO, presented the request to amend the budget by an increase of $45 million from 469 million to 515 million. Ms.

Goodfellow provided detailed information which was also presented to and approved by the Finance Committee. Ms. Goodfellow shared

that the bulk of this change was due to an increase in covered lives.

BOARD ACTION

A motion was made by Mr. James Edgerton to approve the budget amendment; seconded by Mr. George Quick. Motion passed

unanimously.




4:00-6:00 p.m.

Page 3 of 4


6. Consent Agenda A. Draft Minutes from September 3, 2015, Regular Board Meeting – page 29

B. Executive Committee Report – page 37

C. Human Rights Committee Report – page 49

D. Network Development and Services Committee Report – page 73

E. Quality Management Committee Report – page 98

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. McKinley Wooten to approve the consent agenda; seconded by Mr. William Stanford. Motion passed

unanimously.

7. Recommendation for

Reappointment – page

140

In accordance with NC General Statute 122C-118.1.d and the By-Laws of the Alliance Board, the initial terms of Alliance Board

members were staggered with each initial term being considered a full term. Accordingly the initial terms of some members were

designated to end after one year, others after two, and others after three. NC Senate Bill 191 revised G.S. 122C-118.1.d to allow members

to be reappointed for two additional three-year terms. The terms of Board members Curtis Massey, Cynthia Binanay, and McKinley

Wooten, Jr., are set to expire on March 31, 2016.

There were no comments or discussion about the recommendations.

BOARD ACTION

A motion was made by Mr. William Stanford to recommend to the respective Board of County Commissioners the reappointment of

Cynthia Binanay, Curtis Massey and McKinley Wooten; seconded by Mr. Phillip Golden. Motion passed unanimously.

8. Training:

Innovations and

Resource Allocation –

page 141

Alliance is responsible for implementing and managing the Medicaid C (Innovations Waiver). Over the past several years, NC DMA

has been working to update the waiver and implement Resource Allocation, which is geared to improving how funds are utilized to

support individuals on the Innovations waiver, extend self-direction and freedom or choice.

Jarett Stone, I/DD Clinical Director, highlighted changes to the service array that will be available under the Innovations Waiver and

provided an overview of the Resource Allocation process and the impact of this process. The Innovations/Resource Allocation

presentation is attached to and made part of these minutes.

BOARD ACTION

The Board received the training; no further action required.




4:00-6:00 p.m.

Page 4 of 4


9. Updates: New

Programs/Initiatives A. New Programs/Initiatives

1) Ann Oshel, Chief Community Relations Officer, presented an update on the emergency para-medicine initiative; she mentioned

that a grant was received in Wake and Durham counties to reimburse EMS partners for alternative diversion to crisis facilities

instead of emergency departments. Ms. Oshel mentioned that discussion is underway to pursue this initiative in Cumberland

County.

2) Beth Melcher, Chief of Network Development and Evaluation, provided an update on the following programs/initiatives:

a) OASIS, first psychosis program associated with UNC-Chapel Hill, started seeing its first individuals late spring 2015. A

symposium is scheduled for February 18, 2016; if interested Board members may contact Dr. Melcher for additional

information.

b) The State posted a TBI (traumatic brain injury) Medicaid waiver application and identified Alliance as the first MCO to

implement this waiver once the application is approved by CMS. This could potentially be part of the Innovations Waiver.

c) CTI (critical time intervention) has been operating in Cumberland County. Another opportunity specifically for TCL

(transitions to community living) individuals who do not have a designated housing slot is being pursued.

B. Medicaid Reform

Mr. Robinson provided an update regarding Medicaid reform; noting the State’s deadline to submit an application for 1115 Waiver

by July 1, 2016. He mentioned a recent meeting with Dee Jones, Division of Health Benefits COO; Jamal Jones, DHHS, and Julia

Lerche, DHHS. The meeting served as an introduction to MCOs and the Division of Health Benefits.

BOARD ACTION

The Board received the updates; no further action required.

10. Chairman’s Report Chairman Bostock surrendered the floor to Alliance Board member and Wake County Commissioner, Caroline Sullivan. She introduced

two of her colleagues: Chairman James West and Commissioner Jessica Holmes.

11. Adjournment With all business being completed the meeting adjourned at 5:13 p.m.

Next Board Meeting


4:00 – 6:00

Robert Robinson, Chief Executive Officer Date Approved

(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. Attached are the draft minutes from the February 16, 2016, meeting.



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



6B

Tuesday, February 16, 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.; ☒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. (via phone); ☒James Edgerton, Finance Committee Chair, B.S. (via phone); ☒Lodies

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

☒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

BOARD MEMBERS PRESENT: None

GUEST(S): None

STAFF PRESENT: Kelly Goodfellow, CFO; Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram, Executive

Assistant; Rob Robinson, CEO; Sean Schreiber, Chief Clinical Officer


2. REVIEW OF THE MINUTES – The minutes from the January 19, 2016, Executive Committee meeting were reviewed; a motion was made by

Mr. Stanford and seconded by Ms. Gloston to approve the minutes. Motion passed unanimously.


FRAME:

3. Updates a) NEXT FUTURE DEVELOPMENT WORKGROUP:

Chairman Bostock reminded Committee members of the next

meeting: Tuesday, March 1, 2016, at 4:00 p.m.

b) MARCH 18, 2016, ALLIANCE LEGISLATIVE

LUNCHEON: Chairman Bostock reminded Committee

members to confirm attendance with Ms. Ingram.

c) MARCH 19, 2016, 38TH ANNUAL LEGISLATIVE

BREAKFAST AT UNC FRIDAY CENTER: Chairman

Bostock advised Committee members of this community

event. Alliance will register Board members interested in

attending.

d) NC LEGISLATURE: Mr. Robinson mentioned previous and

potential upcoming meetings with NC Legislators.

a) Committee members will confirm

attendance with Ms. Ingram.

b) Committee members will confirm

attendance with Ms. Ingram. Ms.

Ingram will send guest list to

Committee members.

c) Committee members will confirm

attendance with Ms. Ingram.

d) As meetings are scheduled Mr.

Robinson will update Board

members and confirm if one or

two members can attend.

a) 3/1/2016

b) 3/11/2016

c) Before

3/1/2016

d) None

specified.

Tuesday, February 16, 2016

BOARD EXECUTIVE COMMITTEE MEETING - REGULAR MEETING


4:00-6:00 p.m.


Page 2 of 2


FRAME:

4. Alliance

Reinvestment Plan

Mr. Robinson introduced Ms. Goodfellow and Mr. Schreiber; he

provided background behind developing the reinvestment plan.

The reinvestment plan was developed as requested by

stakeholders in response to the FY16 and 17 State single stream

budget cuts.

Chairman Bostock provided additional background information

from his meeting with NC Legislators. As a result of this meeting

Chairman Bostock was encouraged to share information

regarding the impact of funding cuts on expanding services.

Mr. Edgerton requested additional information regarding how

fund balance spent on services will be sustained. Committee

discussed presenting this information (with a sustainability plan)

to the Board Finance and Network Development and Services

Committees.

Chairman Bostock encouraged Board members to utilize the

points demonstrated in the reinvestment plan during discussions

with NC Legislators. The reinvestment plan is attached to and

made part of these minutes.

Staff will present reinvestment

sustainability plan to the March

Board Finance Committee.

3/3/2016

5. April 7, 2016,

Board Meeting in

Johnston County

Committee discussed the plan to hold the April Board meeting in

Johnston County and potentially holding a reception prior to the

meeting. Committee discussed the impact on Committees

meeting the same day.

Ms. Ingram will add topic to March

Executive Committee meeting.

3/15/2016

6. March 3, 2016,

Area Board Draft

Agenda

Committee reviewed proposed agenda and provided input. Ms. Ingram will forward agenda to

staff.

2/17/2016

7. ADJOURNMENT: the next Committee meeting will be March 15, 2016, at 4:00 p.m.

The Alliance Vision: To be a leader in transforming the delivery of whole person care in the public sector

Reinvestment Plan

This summary of the Alliance Behavioral Healthcare Reinvestment Plan is offered in response to the

requests of numerous key stakeholders to better understand the impact of State budget cuts.

Background

Session Law 2015-241 directs the DMH/DD/SAS to reduce its allocation for single stream funding to North

Carolina’s LME-MCOs, while requiring that the LME-MCOs maintain the same level of service provided in

FY15. These reductions equate to $110M across the LME-MCO system in FY16 and another $152M in

FY17. Because Alliance expends its State funding each year to meet the needs of the citizens we serve, we

do not accumulate a State fund balance. Subsequently we are forced to tap into our Medicaid fund balance

to maintain these services. It is important to note that the intent of the Medicaid fund balance is to provide the

financing necessary to build a stronger, more effective service delivery system. These are dollars that

Alliance saves by making sure that people get the right service, in the right amount, at the right time.

Alliance and the other LME/MCOs utilize the Medicaid fund balance dollars in a number of ways. Maintaining

provider cash flow and stability is key to a viable service system. As with any business, the fund balance is

also used to pay for unanticipated expenses as well as infrastructure enhancements like IT upgrades and

capital purchases and improvements. Perhaps the most exciting and critical way that the dollars are spent is

to fund the substantial implementation costs of important programs intended to fill gaps in the service

system, enhancing the effectiveness and quality of care and community-based supports and consumer

accessibility to care.

Alliance Net Position as of June 30, 2015

Investment in capital assets $726,913

Restricted:

Risk Reserve 17,837,513

County funds 15,623,113

State funds 62,500

Total Restricted 33,523,126

Unrestricted Fund Balance:

Medicaid funding (service and admin) 48,965,248

State funds 0

Total Net Position $83,215,288


FY16 Reinvestment

ICF Rate Increase $1,500,000

Crisis Facilities 11,000,000

NC START 472,000

Integrated Care 450,000

Network Development 750,000

Enhanced Therapeutic Foster Care 186,000

Trauma informed Therapeutic Foster Care 50,000

ICF Transitions with B3 funds 183,000

Technology Enabled Homes 10,000

Short Term PRTF beds 300,000

Outpatient Rate Increases 250,000

Total Reinvestment $15,151,000

Planned FY17 Reinvestment

(“X” denotes inability to implement should the budgeted reduction occur)

FY17

(fully funded) FY17

(with reduction) Proposed

Implementation Date

Enhanced Therapeutic Foster Care $905,000 X 7/1/2016

ICF Transitions 1,000,000 X 7/1/2016

Trauma Informed Therapeutic Foster Care 100,000 7/1/2016

Expanded Integrated Care 750,000 7/1/2016

Technology Enabled Home 25,000 7/1/2016

Short Term Stabilization PRTF 900,000 X 7/1/2016

First Responders Reimbursement 310,000 7/1/2016

Mobile Crisis 800,000 X 7/1/2016

BH Urgent Care 6,500,000 X 8/1/2016

Child Facility Based Crisis 9,500,000 X 9/1/2016

Peer Respite/Rapid Response 540,000 9/1/2016

Peer Transition Teams 500,000 9/1/2016

IDD Crisis Respite Facility 1,314,000 X 9/1/2016

Intensive Wrap Around 360,000 9/1/2016

Group Living Step Down 191,625 9/1/2016

Additional service rate increases 6,250,000 X 7/1/2016

Total $29,945,625


Funding Projections

No Reductions Less $152M

FY15 Fund Balance, Medicaid Unrestricted (service portion) $42,790,734 $42,790,734

Alliance portion of $110M reduction (11,066,104) (11,066,104)

FY15 Fund Balance after $110M reduction (service funds only) 31,684,630 31,684,630

FY16 original Reinvestment Plan (15,151,000) (15,151,000)

Balance of FY15 funds 16,533,630 16,533,630

Beginning FY16 Fund Balance 16,533,630 16,533,630

FY16 projected Medicaid savings as of December 2015 25,065,011 25,065,011

FY17 projected budgeted reduction (17,000,000)

FY17 projected Medicaid savings 20,000,000 20,000,000

FY17 Reinvestment Plan (29,945,625) (29,945,625)

Projected FY17 ending Fund Balance $31,653,016 14,653,016

FY16 Medicaid budget $372,401,144

Fund balance as percentage of budget 8.50% 3.93%

Total Actual and Proposed Reinvestment (with no reductions) - $45,096,625

Investment Activity Description Outcome

Crisis Facilities 24/7 crisis and evaluation center able to address needs of walk-in consumers

and individuals brought by law enforcement and EMS on involuntary

Reduce the use of Emergency Departments

Child NC START Specialized assessment and support team to address needs of children with

intellectual and developmental disabilities. Provides assessments, develops

extensive behavior plans and trains and supports families and community

caregivers to implement plans.

Reduce crisis, ED utilization, and the need

for higher levels of care.

Network Development Address services needs identifies in service gaps analysis Improve service access and choice and

address gaps in service continuum

Enhanced Therapeutic Foster Care Provide extra support and staffing to children with high needs living in

therapeutic foster homes. Alternative to locked residential treatment

Further reduce locked residential treatment

utilization and decrease child inpatient

LOS. Of initial group of children receiving

this service, none had inpatient or ED

admissions.

Trauma Informed Therapeutic

Foster Care

Offer trauma specific training to Therapeutic Foster Care parents and provider

agency staff. Training will focus on skills needed to treat children who exhibit

aggressive behavior and have histories of abuse and neglect.

Reduce LOS in foster care, improve

unification, decrease placement disruptions.

ICF Transitions with B3 funds Transition 10-20 consumers out of Intermediate Care Facilities (ICF), which are

institutions, to community setting using an array of support services that are

available as a result of Medicaid savings. The transition will open capacity

within the ICF system to accept consumers in need of this level of care.

Reduce ICF spending and create capacity

within existing CON beds

Technology Enabled Homes Outfit a group home for adults with IDD with an array of independence

enabling technology and safety monitoring devices and cover related monthly

expenses. Consumers and families learn to use technology in the supported

home and then technology devices are installed in community residences.

Reduce spending related to direct care

staffing and expand opportunities for

community living.

Short Term PRTF beds Specialized assessment and evaluation program in secure residential facilities

for children. Programs provide a 30 day intensive stabilization, transition and

evaluation service that develops a treatment plan to be implemented in the

community. Frequently used by children taken into emergency custody by DSS

who have challenging behaviors.

Decrease locked residential utilization and

decrease length of stay

Expanded Integrated Care Expand programs that provide whole person care in either primary care offices

specialty psychiatric provider offices. Expansion will include development of a

model to address the total care needs of individuals with IDD and poorly treated

chronic health conditions.

Expand access to behavioral health

services, create further capacity within

existing specialty care network. Aligns

with state health reform objectives.

Reinvestment Programs

Page 1 of 3



First Responders Reimbursement Provide payments to EMS for evaluating consumers with behavioral health

crises in the community and pay for ED diversion to local crisis facilities.

Currently EMS only receives reimbursement for services if they bring a patient

to an ED.

Decrease ED utilization, expand state pilot

Mobile Crisis 24/7 crisis response team with psychiatric access available on the mobile crisis

team. Capacity to serve all age/ disability groups including dually diagnosed

MH/IDD. Provide 24/7 response to crisis situations to divert individuals from

emergency departments and support individuals to remain in the community.

Improve community crisis services,

decrease ED utilization and cost

BH Urgent Care Outpatient behavioral health services that allow for consumers to walk-in and

receive same day access to Comprehensive clinical assessment (CCA) and

psychiatric evaluation, triage, counseling and medications for urgent and

routine needs. Follow-up services are also provided in these settings. available

on the same day, walk-in basis. Extended hours available

Improve non-emergency level access to

same day services and decrease use of

emergency departments

Child Facility Based Crisis 24/7 crisis and evaluation center specifically targeted to the needs of youth.

Walk-in access as well as accepting youth on involuntary commitment status.

Includes 10-16 bed stabilization unit.

Decrease child inpatient utilization and

extended ED stays

Peer Respite/Rapid Response Peer respite offer a supportive alternative or step-down from more intensive

levels of care such as emergency departments and crisis centers. Peer respite

offers a therapuetic foster care setting as an alternative to crisis or inpatient

level of care. Rapid Response uses specially trained and supervsied therpaeutic

foster parents to provide crisis servcie for children who require an out of home

placment and can be managed in a nonsecure setting.

Expand alternatives to higher levels of care,

reduce spending

Peer Transition Teams Support transition between levels of care, including transportation, to connect

indiviudals to service.

Decrease long ED stays and reduce ED

readmission

IDD Crisis Respite Facility Provide access to facility based crisis services for individuals with IDD and

significant behavior problems.

Decrease both ED and Inpatient lengths of

stay

Page 2 of 3



Intensive Wrap Around Coordination to high risk, multiple system involved youth. The service would

be used to divert children from psychiatric facilities by providing the children

and families highly coordinated community based care. The intensive

coordination helps maintain school and oftentimes foster care or therapeutic

foster care services

Decrease overall residential spending

Group Living Step Down Package of individual and peer supports to help transition consumers currently

residing in group homes.

Expand community living options and offer

existing adult group home capacity to assist

with inpatient step-down

Additional service rate increases Evaluation of current rates and increases in the areas of outpatient, residential,

PRTF, and PSR

Stabilize provider network and improve

quality

Page 3 of 3

(Back to agenda)

ITEM: Network Development and Services Committee Report


BACKGROUND:

The committee reviews progress on the agency’s network development plan and progress on

service development. The committee reports to the Area Board and provides guidance and

feedback on development of the needs and gaps assessment to meet state and agency requirements.

This month’s report includes draft minutes and materials from the February 10, 2016, meeting.



RESOURCE PERSON(S): Ann Akland, Committee Chair; Beth Melcher, Chief of Network Development and Evaluation



6C

Wednesday, February 10, 2016

BOARD NETWORK DEVELOPMENT & SERVICES COMMITTEE - RECESSED MEETING 4600 Emperor Boulevard, Durham, NC 27703 4:00-5:00 p.m.

Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 1 of 2

APPOINTED MEMBERS PRESENT: ☒Ann Akland, Committee Chair, B.S., ☒Cynthia Binanay, B.S.N., M.A., ☒George Corvin, M.D., ☒William Stanford, B.A., J.D., ☒Amelia Thorpe, B.A.

BOARD MEMBERS PRESENT: Chris Bostock GUEST(S) PRESENT: None STAFF PRESENT: Beth Melcher; Carlyle Johnson; Ann Oshel


2. REVIEW OF THE MINUTES – The minutes from the December 9, 2015, meeting were reviewed; a motion was made by Ms. Binanay and

seconded by Dr. Corvin to approve the minutes. Motion passed unanimously.


FRAME: 3. Network Development

Plan Update Reviewed progress on plan. 11 initiatives are complete. Remainder are in process and on track.

Continue work on initiatives.

Report on progress next meeting

Needs and Gaps Assessment Survey Results

Reviewed overall timeline for developing and submitting needs and gaps analysis to the state. Also reviewed and discussed preliminary survey results. Substantial increase in number of responses received compared to last year. Also reviewed preliminary issues/needs identified

Carlyle will complete analysis and draft report by early March and committee will review

March meeting to review draft report

Regional Housing Plan

Ann Oshel reviewed why the report was developed and the thinking behind it. Focus is on housing as a healthcare strategy. Considerable concerns around violations to Fair Housing law and Ann outlined actions Alliance has taken with those who are not providing reasonable accommodation and training options Alliance is offering. Ann also review strategies to advance housing opportunities

Implement activities and strategies in the housing plan

Ongoing

Next meeting Members requested presentation on activities associated with PSR programs as well as review of the needs and gaps analysis report

Wednesday, February 10, 2016

BOARD NETWORK DEVELOPMENT & SERVICES COMMITTEE - RECESSED MEETING 4600 Emperor Boulevard, Durham, NC 27703 4:00-5:00 p.m.

Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 2 of 2


FRAME: 4. ADJOURNMENT: next meeting will be March 9, 2016, from 4:00 p.m. to 5:00 p.m.

FY16 Network Development Plan Update 2‐10‐16

Status Summary # of Initiatives Completed 11Almost complete 1In progress 26Grand Total 38

NDP Objective Project Status / Updates % Complete

Expand services to meet geographic access and choice standards

Expand Medicaid (b)(3) Individual Support (Cumberland, Johnston)

Completed; selected providers in all counties through RFP process. 100%

Expand Opioid Treatment availability for Medicaid (Cumberland) and State‐funded consumers (Cumberland, Durham, Johnston and Wake). Develop Medication Assisted Treatment programs in all counties

Developed modified services definition and contract scope of work for Medication‐Assisted Treatment with Buprenorphine. Cost model developed and approved by Rate Setting and Budget & Finance committees, with UM Committee review pending. The modifier will increase options for provision of evidence‐based medication assisted treatment for SA and enable tracking of EBP use. 75%

Add State‐funded PSR services in Cumberland County.

Completed; added contract for state‐funded PSR in Cumberland County 100%

Add State‐funded SACOT in Durham County

Completed; added contract for state‐funded SACOT in Durham County 100%

Develop a more uniform State benefit package across the four‐county Alliance area

Develop a more uniform State benefit package across the four‐county Alliance area

In process of reviewing Alliance benefit plan for state‐funded services to identify county‐specific variation and develop recommendations for addressing disparities. Results will be included in 2016 Community Needs 90%

NDP Objective Project Status / Updates % Complete Assessment and will be discussed with Alliance Board in FY17 budget preparation process.

Expand capacity for crisis, hospital diversion and respite services for all ages/disabilities

Assure the availability of high quality, accessible and effective Mobile Crisis services in all counties and increase capacity

Reviewed mobile crisis data and potential model options. Margaret Brunson is preparing Request for Proposals (RFP) that will reflect recommendations for service models and scope of mobile crisis coverage. 50%

Expand access to and capacity of walk‐in crisis centers (Behavioral Health Urgent Care Centers), including evening hours (Tier II Same Day Access)

Completed inventory of Same Day Access providers and developed survey regarding service accessibility and barriers to SDA implementation. Survey completed and additional review of Monarch’s Same Day Access model is in process. Obtained funding for expansion of Same Day Access to include evenings. Further analysis will assist with identifying challenges, opportunities and cost model assumptions for further development. 65%

Expand/Enhance Capacity of Facility Based Crisis

*Completed RFP process for Durham Crisis services and selected provider. *Posted RFP for additional Wake crisis facility and vendor, Monarch, has been selected. Implementation plans are being developed and Monarch is exploring potential facility locations. 57%

Provide education to urgent care and primary care practices about Alliance and crisis response resources and how to access them, including Open Access, mobile crisis, facility based crisis

Obtained information from CCNC to identify priority practices for training. Met with CCNC to develop joint training information, and setting up primary care/behavioral health provider meetings. Establishing new position within Clinical Operations for Director of Care Integration. Purchased software to run routine reports on primary care practices with high number of behavioral health consumers. Integrated Care Director has been hired and started Feb. 2. CMT has been implemented with initial focus on notification for consumers who did not fill antipsychotic medication prescriptions and notifying PCPs 58%

NDP Objective Project Status / Updates % Complete about potential opioid abuse issues. Part of communication strategy will be to education primary care physicians about non‐ED crisis services available to their patients.

Implement Advanced Practice Paramedics program in Durham

Coordinated training program for Durham CIT‐certified EMS paramedics to receive additional on‐line training. Both Wake and Durham EMS have completed webinar training. We received allocation letters for Wake and Durham to be reimbursed for alternative drop off destinations. 75%

Develop capacity for IDD Crisis Respite

Working with provider, New Hope, to identify and implement service model for short‐term (30‐45 days) PRTF for children with autism. New Hope is evaluating models from other states. 60%

Review outcomes for rapid response crisis diversion services for children and adolescents

Review of Wake rapid response has been completed. We will re‐evaluate after we obtain more accurate and specific data. Workgroup has been convened and is working through issues related to 131D licensure rules and crisis beds. 80%

Implement Critical Time Intervention (CTI) in Cumberland

Completed selection of provider through RFP and have implemented services in Cumberland. 100%

Increase breadth, access and quality of residential options

Evaluate transitional living outcomes and capacity and determine need for expansion

Project initiated and assigned to Tamara Smith. Project Advisory Team convened and project charter and data analysis have been completed. 33%

Develop Comprehensive Assessment for youth with complex needs prior to referral to residential services

Identified provider, reviewed list of standard measures that will be required in assessment, and requested rate proposal from provider. Contract pending with UNC to provide this service, with services expected to begin in January‐February 2016. 90%


Complete residential continuum study‐ Add recommendations from study

TAC report completed; Alliance will hire director of housing and this position will implement specific project plan to address housing gaps. TAC report was presented to Alliance Board Services Committee on 11/18. 90%

Increase capacity to serve dually diagnosed (IDD/MI) consumers

Implement pilot Youth Villages Choices model for dually diagnosed (IDD/MI) youth

Identified three CHOICES consumers through Care Coordination, and referrals are in process for initial pilot implementation. Meeting with Pinnacle to explore Therapeutic Foster Care option. 80%

Evaluate increased funding support for NC START

Funding has been identified for adolescent START program, based on proposal submitted by Easter Seals UCP. Contract is pending, NC START has hired clinical team lead, and in‐home supports team lead, with plan to begin services in mid‐January. 100%

Offer dual diagnosis (IDD/MI) training for Mobile Crisis teams Completed training. 100% Offer training on IDD/MI dual diagnosis issues to large behavioral health practices Completed training 100%

Develop plan to address service gaps between enhanced benefit and outpatient services and to address need for case management

Develop alternative service definition for Medicaid‐funded outpatient treatment

Working with consultant, Partners MCO and providers to develop proposed alternative service definition. Draft completed and submitted to DMA. 58%

Develop service definition to fill service gap between ACTT and CST

Working with consultant, Partners MCO and providers to develop proposed alternative service definition. Working on cost model and revision of service definition. 58%

Increase availability, tracking and oversight of specialty services and evidence‐based practices

Increase number of evidence based practices meeting fidelity for substance abuse providers

Working with SA providers through SA Treatment Provider Collaborative, and developed contract to provide individualized provider consultations on EBPs. Requested proposals from SA providers and selected six providers who will received individualized on‐site consultations. 62%

NDP Objective Project Status / Updates % Complete Consultation has been completed with Cape Fear and written recommendations are being prepared.

Contract for EBP models for IIH and require independent fidelity reviews

Meeting monthly with IIH providers to implement change in contract requiring family‐oriented EBPs. Multiple meetings and workgroups with providers, developers and implementation resources to refine implementation plans. Developing cost models for training and long‐term sustainability of EBPs, in collaboration with providers and EBP developers. Developing contract scopes of work for IIH EBPs for addition to Medicaid contracts effective 7/1/16. 80%

Develop process for development and implementation of evidence‐based practices with external fidelity verification Completed. 100% Promote EBPs for PSR programs including peer led programs, recovery oriented programs, and for dually diagnosed (MH/IDD)

Gathering information about PSR services, EBP models and will prepare written recommendations. 55%

Provide Training and Consultation for Providers to promote improved quality and implementation of evidence based practices

Peer Support training was held on November 20 and is scheduled for December 14 for both providers and Alliance staff. Completed DBT training 11/2‐11/6. Working with Behavioral Tech and providers regarding DBT sustainability planning. Providing SE Collaborative to promote evidence‐based MH/SA IPS model supported employment services. 60%


ID high cost/high need populations and match with EBP

Implement pilots for Youth Villages Intercept model, Kidspeace TFC and Mentor Family Centered Treatment model for high needs youth Pilots all launched effective July 1. 100% Implement First Episode Psychosis Program in Wake County Completed implementation. 100%

Improve access to services for non‐English speaking consumers

Conduct survey of providers with identified services for non‐English speaking consumers. Clarify service availability and capacity for more robust bilingual/bicultural program emphasis.

Worked with Alliance Cultural Competency committee to develop provider survey and have posted on website for provider input. Results will be included in 2016 Community Needs Assessment. 85%

Increased capacity to serve TBI population Participate in TBI HRSA grant

Screening for TBI through Call Center and collecting data for state analysis. Working with Brain Injury Association of NC and neuroresource facilitator to develop TBI‐specific trainings for provider community. *Met with new TBI Specialists at DMH (Scott Pokorny and Travis Williams). Will begin reviewing data through TBI Grant Steering Committee. *DHHS has announced plans for a TBI waiver that will be piloted with Alliance in the first year of the waiver. There are 49 slots attached to the waiver for Alliance. 55%


Expand integrated behavioral health/medical care

Conduct Inventory of current integrated care initiatives (e.g., Turning Point, Lincoln, UNC WakeBrook; Johnston Public Health, exploring Duke/CBC co‐location and reverse co‐location; FHR Dartmouth In‐Shape, Southlight) Completed inventory. 100%

Implement integrated healthcare pilots

Developed charters and project plans for each pilot. Hired consultant to evaluate pilots. Contracts pending for new initiatives with Carolina Outreach, Family Preservation and Easter Seals UCP. 60%

Conduct evaluation of current integrated behavioral health/medical care initiatives and development of recommendations for further expansion

Hired consultant to evaluate pilot projects. Evaluation in process. 40%

Increase availability of resources for transportation

Review transportation initiatives in other states, inventory provider and stakeholders efforts and develop recommendations

Pending further discussions about project objectives and timeframes. 0%

Increase availability of resources for employment

Increase number of persons receiving MH/SA SE/LTVS

Conducted RFP for SE/LTVS services in Cumberland, selected vendor and in the process of expanding services in Cumberland. Meeting regularly with SE/LTVS providers through collaborative. *NC is now working with several other states and federal government through Vision Quest and Office of Disability and Employment Policy (ODEP) to look at sustainability of IPS at a statewide level. Alliance is participating in this planning process. 67%

NDP Objective Project Status / Updates % Complete *We are looking at feasibility of aligning b3 rate and service definition with state rate and service definition. * Project planning with SPMO on increasing TCLI numbers and IPS SE.

Evaluate impact of MH/SA SE‐LTVS

QM will be scheduling brainstorming meeting to begin project. 5%

Explore models and supports for consumer‐run businesses

Pending further discussions about project objectives and timeframes. 0%

FY16 Community Needs and Gaps Assessment

Alliance Board Services CommitteeFebruary 10, 2016

Report Schedule

Task Timeframe

Consumer access and choice review (geomapping) Mid‐February

Administer surveys: consumer, family, stakeholders, providers, staff

Jan. 1‐31

Request stakeholder / focus group feedback December 1‐January 31

Analysis of survey results Feb 1‐15

Draft report March 1

Final report submitted April 1

Community Input

• CFAC and APAC input

• Distributed surveys by e‐mail and website

• Contacted community groups that publicized survey via web pages, e‐mail and meetings

• Identified recent surveys, needs assessments, and other documentation of service needs

• Requested feedback from consumer, stakeholder and provider groups (e.g., group discussions of needs and gaps resulting in collective response)

Survey Questions

• Separate questions for IDD, Child MH/SA, & Adult MH/SA

• Added section on TBI

• Ratings of access to services

• Services that were needed but not available

• Barriers to accessing care

• Underserved populations

• Housing needs and gaps

• Employment needs and gaps

Survey Responses

• 573 responses, including over 50 hard copy responses

Response Group Number of Responses

Consumer and Family 126

Provider 242

Stakeholder 72

Staff 133

TOTAL 573

Survey Responses by County

County Consumers & Families

Providers Stakeholders

Cumberland 54 64 27

Durham 13 74 17

Johnston 7 69 7

Wake 42 150 25

*Note: providers and stakeholders may serve multiple counties

Access Priorities: IDD

• Institutional care (ICF‐IID)

• Inpatient psychiatric treatment for dually diagnosed

• Crisis services

• Services to support development and implementation of behavior plans

• Residential options

• Also noted: modifications to assist with independent functioning; vocational & educational services (C&F # 1, 3)

Access Priorities: Child MH/SA

• Relief for primary caretakers (e.g., respite)

• Outpatient opioid treatment for adolescents

• Services for youth engaged in sexual harm

• Services for transition‐age youth (ages 16‐21)

• Therapeutic secure residential treatment

Access Priorities: Adult MH/SA

• Relief for primary caretakers (e.g., respite)

• Short‐term residential treatment for substance use disorders

• Services for geriatric community

• Short‐term daily structured programs (e.g., partial hospitalization)

• Training on skills to promote recovery

• Also noted: Community‐based intensive treatment; vocational & educational services (C&F # 1 & 2)

Access Priorities: TBI

• Meaningful structured daily activities

• Development and implementation of behavior plans

• Residential options

• Modifications to assist with independent functioning

• Institutional care (ICF‐IID)

Additional Information

• Input from community workgroups, committees, collaboratives (e.g., SOC, crisis collaboratives)

• Alliance staff committee input (e.g., UM, Compliance)

• Survey analysis: service gaps and underserved populations for each population group

• Housing, Employment and Transportation gaps

• Geographic access and choice analysis

• Updates on Network Development Plan and DHHS initiatives

Discussion


Regional Housing Plan

2

Background and Overview

Access to safe, quality and affordable housing – and the supports necessary to maintain

that housing – constitute one of the most basic and powerful social determinants of

health. In particular, for individuals and families trapped in a cycle of crisis and housing

instability due to poverty, mental illness, addictions or chronic health issues, housing

can entirely dictate their health and health trajectory. For these populations, housing is

a precursor of health. Supportive housing, an evidence based practice that combines

permanent affordable housing with comprehensive and flexible support services, is

increasingly recognized as a cost-effective health intervention for homeless and other

extremely vulnerable populations.

Housing is the Best Medicine: Supportive Housing and the Social Determinants of Health

Corporation for Supportive Housing, July 2014

Alliance Behavioral Healthcare is pleased to submit our Regional Housing Plan to

increase quality, affordable housing capacity and options for persons with behavioral

health issues living in our catchment area. Alliance serves four counties – Wake,

Durham, Cumberland and Johnston – which include the most populated county in North

Carolina as well as a rural but quickly-growing county. The demographics of our

communities present great opportunities and significant challenges for meeting the

needs of persons who are homeless, precariously housed or returning from institutional

settings. Affordable housing and the critical and ongoing supports required to

successfully maintain housing are complex, complicated and costly but yield a high

return on investment.

Stemming from our original days as an LME and our evolution to an LME-MCO, Alliance

has always regarded housing as a healthcare strategy. Research on cost savings and

cost avoidance for crisis services alone when someone is stably housed are

indisputable, as are the improved life outcomes when a person has a place to call

home. Alliance practices the philosophy of Housing First – that housing is a basic

human right and a prerequisite for successful engagement and retention in treatment.

Persons, especially those with histories of homelessness with SPMI, are more receptive

to intensive and integrated interventions after they are in their own housing.

As outlined in our Housing Plan, we have already made a sizable investment in

developing our continuum of housing options in order to maximize everyone’s potential

to live in the least restrictive environment possible, in housing of their choice and with

the appropriate level of supports and services to help them be successful in maintaining

independent living. While this first phase of our Housing Plan focuses on adults with

mental illness and permanent supportive housing efforts, Alliance contracted with the

3

Technical Assistance Collaborative (TAC) between March and June of 2015 to conduct

a comprehensive analysis of our housing and residential continuum across the age

span and across disability types. In subsequent revisions to the Housing Plan we will

outline strategies and recommendations to address housing needs for the IDD and

young adult populations.

While this Housing Plan will explore opportunities to revamp services that support

housing stability and enhance relationships with developers and funders, Alliance has

already experienced significant success related to housing efforts. In FY16 the Durham

Housing Authority committed 75 Section 8 Housing Choice vouchers to Alliance. We

administer Shelter Plus Care vouchers in a HUD-funded supportive housing program

known as Durham DASH with a 97% retention rate of participants in the program. In

addition, we employ four Housing Specialists located in each of our communities who

not only administer our rental assistance program but serve in leadership roles with

community housing efforts. At the Senior Management level, multiple departments

support the implementation of the TCL Initiative and we have convened an internal TCL

Steering Committee which meets monthly to review progress and problem solve

barriers. To further explore and implement the recommendations from the TAC Report

and the MCO Housing Plan, Alliance will soon begin recruiting a Director of Housing to

be embedded within the Community Relations Department. The full TAC Report can be

found at http://www.alliancebhc.org/wp-content/uploads/filebase/TAC-Housing-

Report.pdf.

Housing has been rated as a priority need in Alliance’s Gaps and Needs Assessment

dated March 2015. Stakeholder surveys revealed that the highest priorities related to:

Affordable housing

Housing in safe neighborhoods

Rental subsidies

Housing availability for individuals with legal histories including sex offenders

Housing for substance abuse and SPMI population, and

A burdensome application process and waiting list for housing vouchers.

Solutions to address each of these priorities are well underway with high levels of

community engagement to collectively identify further improvements. Alliance’s Board of

Directors has shown significant interest and support for our housing efforts particularly

around permanent supportive housing.

Alliance’s Housing Plan was developed in consultation with TAC, City of Raleigh

Community Development and Neighborhoods, Wake County Human Services

Department of Housing and Transportation, City of Durham Community Development,

http://www.alliancebhc.org/wp-content/uploads/filebase/TAC-Housing-Report.pdf

http://www.alliancebhc.org/wp-content/uploads/filebase/TAC-Housing-Report.pdf

4

City of Durham Housing Authority, Cumberland County Continuum of Care Committee,

county governments, the Wake Directors Group and the Durham Directors Group, as

well as multiple landlords and developers including DHIC, CASA and Mills Construction

Company. It has been posted on our website for public review. In addition, we have

reviewed the Consolidated Plans for each city/county required by HUD for CDBG,

HOME and ESG funding and the Analysis of Impediments to Fair Housing Choice

required by HUD for CDBG funding.

This Plan is divided into four sections:

Current Community-Based Housing Initiatives

Need for Improved Access and Capacity to Quality Affordable Permanent

Supportive Housing

Wrapraround Services/Supports and Sustainable Housing, and

Crisis Planning.

Each section includes a description of our current efforts as well as opportunities to

increase housing capacity and collaboration. Links to references are included. As a next

step to begin implementing these recommendations Alliance will develop a detailed

project plan outlining priority goals, tasks and timeframes. This detailed project plan will

be submitted by February 15, 2016. Given the significant housing challenges for the

TCL Initiative, a short-term project plan focused on this population is included with this

Plan. We have convened an internal Housing Committee that will review progress on

both project plans. It is our hope that the recommendations outlined in this Plan can

inform the statewide housing plan.

Current Community Based Housing Initiatives

Independent Living Initiative

The Independent Living Initiative (ILI) is a foundational part of our mission as an LME-

MCO to provide whole person care for our members in times of need due to housing

crises. Alliance provides financial assistance directly to landlords and vendors in the

form of emergency eviction prevention and utility payments, security deposits, and first

month’s and ongoing rent payments for targeted vulnerable populations. Housing

Specialists in each county contact landlords directly to facilitate the approval and

payment process and to provide education about Alliance’s resources for housing.

Applications are reviewed bi-monthly by a Housing Triage Committee made up of

community stakeholders who are knowledgeable of multiple resources. This Committee

uses a risk assessment scoring tool to identify barriers to housing stability for each

applicant and prioritizes applicants with the highest level of need. Each applicant’s

5

previous housing, credit and criminal history are considered by the tool, as well as each

applicant’s potential for increased income through education and employment. While

the vast majority of funds are used to maintain permanent housing, funds can also be

utilized for bridge housing situations, such as boarding rooms or Oxford Houses, until a

sustainable housing plan is developed.

Alliance is piloting an online housing database for the Independent Living Initiative

which will streamline the application process for providers. The database will go from

application to payment with safeguards to reduce errors and will allow Alliance’s IT

Department to easily capture demographic data about persons served. This will inform

Alliance about how to be more flexible with rental assistance to best fit the needs of our

applicants and collaborate within the continuum of care.

Alliance has provided rental and/or utility assistance to almost 450 landlords or utility

companies. The graphs below provide a snapshot of FY15 ILI data.

6

Beginning in FY16 as a component of the ILI Program, Alliance has implemented the

Restoring Hope Initiative, which is a 4-12 month longer-term rental assistance program

targeting the highest users of crisis services, jails, residential settings or hospitals who

are homeless or precariously housed. Alliance will track several key performance

indicators such as community tenure, reduction in crisis services, engagement and

retention in services and re-arrests to assess the impact of longer term rental

assistance coupled with community supports on a high risk healthcare population.

7

Transitions to Community Living

Despite recent progress, the implementation of the TCL initiative has been very

challenging, particularly in Wake County. Alliance currently employs six Transition

Coordinators, three In-Reach Certified Peer Support Specialists and a Supervisor. This

fiscal year we will add five additional Transition Coordinators, six In-Reach Peer

Support Specialists and another Supervisor.

Currently we have fully transitioned:

28 people in Wake with another 30 in process of transitioning

12 in Cumberland with another seven in transition

Four in Durham with another four in transition, and

10 in Johnston with another nine in transition.

A tool called the Quality of Life survey has been utilized to evaluate the success rate for

those housed. It is administered prior to move in, 11 months post-transition, and 24

months post-transition. The most recent results of these surveys for data gathered

across North Carolina can be found at http://www2.ncdhhs.gov/tcli/quality.html.

With success being roughly defined as maintaining tenancy in supported housing

without return to an adult care home or other supervised setting as a permanent

residence, we can report the following results:

19 transitioned individuals have remained in supported housing for two+ years

11 people have been successful in supportive housing for one-two years

13 individuals have been successful in supportive housing for six months

Eight persons have lost their housing slots

o Four are deceased

o Two moved out-of-state

o One chose to live with family

o One moved into their own home without the subsidy.

This fiscal year Alliance’s goal is to transition 82 more people. To date we have fully

transitioned nine. Alliance has developed a short-term, six-month project plan to

accelerate the progress for increasing the number of those fully transitioned by June 30,

2016.

Some of the biggest barriers we have encountered are the same barriers to housing any

person who has limited financial means and is experiencing a mental illness would

encounter. Over the past year Alliance has met regularly with DHHS to proactively

problem solve, provide updates, and strategize regarding barriers to successfully

http://www2.ncdhhs.gov/tcli/quality.html

8

transitioning the required number of persons under the Settlement. These conversations

have been very constructive in increasing the subsidy in Wake County and rebranding

the subsidy to reduce negative connotations, but have not significantly increased the

housing numbers in Wake.

In a competitive rental market landlords are reluctant to rent to a person with bad credit

and/or a criminal record. The stigma of mental illness persists – every landlord we have

met with has experienced major issues on their property and the subsidy is not

competitive compared to other voucher-based programs. In Wake, the affordable

housing inventory simply does not exist to the capacity to honor housing choice.

Landlords and developers understand the extra support services and longer-term

monitoring that accompany a person moving into housing and find it reassuring that

they know who to call in a crisis and that the person is receiving the help they need to

be successful in housing.

The single largest barrier seems to be the subsidy payment. Over 120 landlords have

refused the subsidy payment in Wake County alone. While the State has piloted an

increased subsidy in Wake County it still has not yielded a significant increase in the

number of landlords. A more detailed account of barriers and solutions submitted to

DHHS can be found at http://www.alliancebhc.org/wp-content/uploads/filebase/TCL-

Barriers-and-Solutions.pdf. In Durham, Cumberland and Johnston counties there is a

larger supply of ready housing inventory including vacant targeted units, and we are

confident that we can quickly honor the requests of persons choosing to live in those

communities.

Partnering with Landlords and Developers

Alliance has worked to build support for the TCL Initiative and the ILI Program among

landlords and housing providers by hosting a series of landlord appreciation events

across our region. This summer over 60 community stakeholders attended the breakfast

in Wake County, including service providers, landlords, State and local government

representatives, and members of the faith community. More than 15 landlords

participated in Durham and Cumberland, and all renewed their commitment to working

with Alliance to increase private landlord housing inventory. Many of these landlords

own multiple properties. These events not only provided an opportunity to thank

landlords for their commitment and to encourage recruitment of fellow landlords, but

also to engage in an honest dialogue about system/service improvements from their

perspective. Overwhelmingly, landlords cited the lack of provider monitoring and case

management as a primary reason for eviction and withdrawal from special needs

housing.

On November 24 the City of Raleigh Department of Community Development facilitated

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a roundtable discussion with developers to explore barriers and solutions to increase

not only the inventory of affordable housing, but to increase the number of units

designated to persons with behavioral health issues. Generally speaking, there was a

genuine willingness from developers to strengthen the partnership with Alliance. While

the themes of stigma, service supports, improved communication with providers and

landlords, and the chaos of the mental health system were discussed throughout our

region with housing partners, there are unique considerations for developers in Wake

County that make substantially increasing the number of affordable units more complex

and complicated. Many of these considerations are outside the scope of an MCO but

we have made a commitment to continue the dialogue to explore both short- and long-

term solutions.

Providing Housing Education to Our Consumers

Alliance’s Ready to Rent Program© is a housing readiness workshop that provides

education, guidance and resources to help families and individuals develop the skills

necessary to break the cycle of homelessness, achieve stability in all aspects of family

life and realize their potential for self-sufficiency. The Ready to Rent© program is

required for any tenant in Alliance’s Supportive Housing programs and is a major

reason that we have a 97% retention rate in housing even when services become less

intense. The workshop spans two hours per week for six weeks, totaling 12 hours, and

teaches participants to:

Identify barriers and challenges

Prioritize housing needs

Identify resources to overcome barriers

Increase understanding of credit and finances

Determine money goals

Create a spending plan

Consider ways to increase income and decrease spending

Choose a money management system

Increase feelings of self determination

Choose housing that meets your needs

Understand fair housing laws

Understand rental and lease agreements

Make a plan to keep your home safe

Understand landlord tenant law

Communicate and get along with landlord and neighbors

Understand how to end a rental relationship successfully

Understand reality and consequences of eviction

Understand how to recover deposits.

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After completing the full 12 hours participants receive a Ready to Rent© diploma which

is recognized by housing providers as proof of their achievement and their commitment

to change behaviors that led to residential instability. Alliance is a licensed site in

Durham and is in the process of completing the certification for our other sites. We will

offer this training free of charge to all tenants in the supportive housing programs and

TCL Initiative.

Voucher and Subsidized Housing

The DASH Supportive Housing Program was established as a permanent housing

response to the critical needs of the most vulnerable chronically-homeless individuals

and families in the Durham community. Funded by the HUD Continuum of Care

Program, DASH provides permanent housing assistance, in connection with supportive

services, to homeless people with disabilities and their families. The program provides a

minimum of 12 housing units per year to 30 adults and children. DASH strives to meet

academic, social, vocational, and physical and behavioral healthcare needs through

integrating housing, treatment, and community support services. To impact positive

change in participant’s lives, DASH provides of a full range of comprehensive and

coordinated treatment and services including care coordination, medication

management, life skills training, tenancy and budgeting training, behavioral health

counseling, transportation and vocational training.

The DASH supportive housing program has implemented key components of the

Housing First approach to helping people become housed and connected to

mainstream services as quickly as possible. DASH has no programmatic preconditions

such as demonstration of sobriety, completion of alcohol or drug treatment, or

agreement to comply with a treatment regimen upon entry into the program.

Additionally, DASH prioritizes people who have the highest service needs as evidenced

by the VI-SPDAT (Vulnerability Index-Service Prioritization Decision Assistance Tool).

Those scoring the highest on the VI-SPDAT participate in a Care Review (community

planning process) each month to help them access identified permanent housing

options and other needed services based on their individualized needs, including food

and nutrition, Medicaid funding, primary care connections, and behavioral health

services. Monthly meetings are held to review progress of action plan developed during

care review to ensure accountability through the transition phase.

Based on the success of DASH and the Care Review process which provides

wraparound planning for housing stability, in FY16 the Durham Housing Authority

designated 75 Section 8 Housing Choice vouchers to Alliance. All targeted units have

been prioritized for the TCL population.

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At the time this document was published, there were at least 192 affordable properties

in the Alliance region listed in SocialServe, the identified database of available

properties designated in the Department of Justice settlement:

105 in Wake County

34 in Durham County

34 in Cumberland County

19 in Johnston County.

Additionally, a number of occupied or vacant Targeted Housing Program units are

located in the Alliance region

305 in Wake County (in 44 properties)

124 in Durham County (in 13 properties)

180 in Cumberland County (in 24 properties)

67 in Johnston County.

Alliance also maintains a strong partnership with Shelter Plus Care and HUD-VASH

programs in all of our communities. Using county funding we contract for three Case

Managers to support persons in the Shelter Plus Care program in Wake County.

Accessing Housing for High-Users of Public Services

It is nearly impossible for high users of public services who are homeless or unstably

housed to change patterns of utilization of crisis services, most notably emergency

departments, or of incarceration without being able to address their temporary or

permanent housing needs. One of the major obstacles to securing permanent housing

in these situations is a lack of flexible, readily-accessible housing. Arranging for private

landlord/tenant relationships is difficult and often includes barriers such as lack of

income, poor credit histories and/or criminal backgrounds.

Alliance is exploring creative financing strategies for landlords to overcome these

barriers, and is continually building capacity for temporary, or bridge, housing. Alliance

contracts with transitional living programs in Wake, Durham and Cumberland counties.

While short in duration, these programs are consistently at capacity and not always able

to accommodate time sensitive discharge dates. Alliance contracts for a current total of

33 beds, although Wake will expand by another 15 beds in the next couple of months.

There are currently 18 beds in Durham; six in Cumberland and nine in Wake. For

persons facing eviction upon discharge Alliance is able to access ILI funds to pay back

rent and maintain housing.

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Next Steps:

Alliance will begin recruitment for Director of Housing by January 31, 2016.

Alliance will maintain four Housing Specialists as the local points of contacts for

landlords and housing stakeholders.

Alliance will explore opportunities to apply and/or partner for Continuum of Care

funds in all four counties to increase supported housing capacity for persons we

serve using best practice approaches.

Alliance will continue advocacy for affordable and permanent supportive housing

utilizing outcome and cost model data to local stakeholders, County

Commissioners, its Board of Directors, and other advocates.

Alliance will expand the Ready to Rent© curriculum in all four sites. This training

will be free to tenants and head of households and will be fully implemented by

April 1, 2016.

Following the model with Durham Housing Authority, Alliance will work with Public

Housing Authorities in Wake, Cumberland and Johnston to explore possibility of

designated Section 8 Housing Choice vouchers

Alliance will continue to increase the pool of engaged landlords and developers

through formal and informal roundtable discussions, education, mental health

training and appreciation activities.

Alliance will continue to provide regular feedback to NCHFA, DHHS and Social

Serve regarding improvements for housing locater services

In Wake County Alliance will expedite targeted recruitment efforts in the areas

most persons have expressed a desire to live to increase the number of private

landlords as part of the TCL Initiative.

In partnership with DHHS and Wake County, Alliance will convene housing

meetings with potential developers and landlords to determine strategies and

incentives to increase housing inventory.

Alliance will continue to hold monthly meetings with TCL partners to update

housing progress and problem solve barriers.

Next Steps Contingent on Funding:

In partnership with DHHS and other stakeholders, Alliance will explore financing

incentives for landlords that include holding fees to designate a certain number of

temporary or permanent rental units for persons we serve. This will expedite the

move-in period for another person when designated unit becomes vacant.

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Need for Improved Access and Capacity to Quality Affordable

Permanent Supportive Housing

Supportive housing is a combination of affordable housing and supportive services

designed to help vulnerable individuals and families use stable housing as a platform for

health, recovery, and personal growth (Corporation for Supportive Housing, 2013). The

supportive housing model consists of three components – housing, supportive services

and property/housing management, and includes five dimensions of quality – tenant-

centered, accessible, coordinated, integrated and sustainable.

Across Alliance’s four communities there is a lack of both accessibility to affordable

housing, for which a tenant pays no more than 30% of their income, and a systematic

way to meet potential needs/preferences within the system using a housing choice

approach. Based on the graph above, a person or family with a low or fixed income

would find it impossible to secure housing based on fair market rental rates. While

Alliance has made some impact on the capacity and prioritization of affordable housing

for persons with disabilities, the largest gap in affordable housing with the most urgent

need is in Wake County.

As required by HUD, each city/county recipient of CDBG, HOME and ESG funds must

develop a Consolidated Plan that outlines local intentions to expand affordable housing

opportunities and removing barriers to increase access to housing. For the purposes of

Alliance’s Housing Plan, these Consolidated Plans, which include a thorough needs

assessment and current affordable housing inventory, serve as our gap analysis.

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The Plans will also serve as the conduit to developing mutually-reinforcing activities

between housing partners and Alliance to increase the number of designated affordable

housing units.

Since affordable housing is the greatest challenge in Wake County, we have provided a

more detailed account of that housing market to illustrate the complexity and

competition of increasing the affordable housing inventory. Also, due to considerations

around transportation and convenience to amenities and public services, most persons

transitioning as part of TCL express a desire to live in Raleigh or Cary. While embarking

on an aggressive plan to increase the number of available affordable units in Raleigh to

340 per year or 1700 units over the next five years, the City has only expanded capacity

by 137 units per year over the last five years. That, combined with a 3.1% vacancy rate

(less than half of the national average of 6.72%), makes it extremely challenging to find

quality affordable housing within the City limits – much less housing that is dedicated to

the mental health population with landlords accepting subsidies or vouchers.

Raleigh has approximately 70,605 rental units, of which approximately 45% are

occupied by low to moderate income households paying more than 30% of income

towards housing expenses. Approximately 23% of those households were paying more

than 50% of income for housing expenses. Renter households with incomes at or below

50% of the area median income account for 82% of all cost-burdened households.

Also in the realm of affordable housing, the City of Raleigh Public Housing Authority

serves over 1400 households. While there is a waiting list, the Raleigh Housing

Authority does give priority to persons with behavioral health issues. All stakeholders

recognize the unintended consequences from a serious lack of affordable housing – in

2014 over 1170 persons were homeless in the Point of Time count, most likely an

underreported number. Consideration that it can take up to two years to arrange

financing and to construct new housing, increasing the housing inventory can be a

lengthy process, particularly during tough economic times. The City of Raleigh has been

a huge supporter of not only creating affordable housing but of ensuring that housing is

designated for vulnerable populations. They have pledged to work with developers

through their upcoming RFP process to increase the percentage of units set aside for

persons with the TCL Initiative. This could include both one- and two-bedroom units. As

the City of Raleigh 2016-2020 Consolidated Plan points out, the barriers to affordable

housing are not always financial. Page 81 of that document includes a listing of the

“Negative Effects of Public Policies on Affordable Housing and Residential Investment.”

The City of Raleigh Consolidated Plan 2016-2020 can be found at https://www.raleigh

nc.gov/content/HousingNeighborhoods/Documents/ConsolidatedPlan.pdf. While the shortage of affordable housing units is still significant in Cumberland County

and the City of Fayetteville, Alliance has been more successful in engaging private

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landlords to accept subsidy payments for the TCL population. This is partly due to the

fair market rental rate there being the lowest in the Alliance region, alleviating the

financial gap for landlords between the subsidy payment and the fair market rate, and

partly due to a high vacancy rate in the private rental market. In Fayetteville over 1440

households are served by the Public Housing Authority. Over 100 people are on the

Section 8 waiting list and over 600 applicants are on the waitlist for public housing, with

more than half waiting for one bedroom units. Alliance has met with the City of

Fayetteville Community Development and the Cumberland County Office of Community

Development to advance strategies designed to engage developers and the Public

Housing Authority, which has a broader relationship with private landlords than do the

City and County. We have also explored potential funding opportunities within the CoC.

The Cumberland County Community Development 2015-2020 Consolidated Plan can

be found at http://www.co.cumberland.nc.us/community_dev/downloads/2015/2015-

2020_consolidated_plan_2015_action_plan_draft_3.pdf.

As in Cumberland, there is still a significant shortage of affordable housing in Durham,

but Alliance has been more successful in engaging landlords to accept vouchers and

subsidies based on our long-standing history as an active housing partner. There are

more rental units available in Durham County, resulting in a less competitive

marketplace than Wake County/Raleigh. In Durham over 2200 households are served

by the Durham Housing Authority, and approximately 700 people are on the wait list for

Housing Choice vouchers. However, Durham Housing Authority has dedicated 75

Section 8 Housing Choice vouchers to Alliance and efforts are mainly focused on

increasing the pool of private landlords. The City of Durham 2015-2020 Five Year

Consolidated Plan can be found at http://durhamnc.gov/DocumentCenter/View/7614.

In Johnston County there are four public housing agencies – Smithfield Housing

Authority, Selma Housing Authority, Benson Housing Authority and Johnston County

Housing Assistance Payments Program (HAPP), which administers Section 8 vouchers.

Collectively there are 1176 households served by the four agencies with HAPP serving

the most households and 1168 on the waiting list including 934 for Section 8. In addition

to the capacity for affordable housing options there is also a need for better and more

centralized access to information on all available subsidized housing inventory. Alliance

maintains a Vendor Profile database of all landlords/properties that have participated in

the ILI Program and TCLI. We are exploring enhancements to this database that allow

for tracking of recruitment efforts and improved matching of landlords and potential

tenants. TAC has shared several ideas for tracking this type of data which will allow for

real-time and efficient tracking of landlords and their preference for populations served.

Along with this there remains the need for more intensive work with landlords to

encourage them to accept subsidies and people who may not meet a property’s

http://www.co.cumberland.nc.us/community_dev/downloads/2015/2015-2020_consolidated_plan_2015_action_plan_draft_3.pdf

http://www.co.cumberland.nc.us/community_dev/downloads/2015/2015-2020_consolidated_plan_2015_action_plan_draft_3.pdf

http://durhamnc.gov/DocumentCenter/View/7614

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screening requirements for credit history and criminal backgrounds. Refusals by

landlords of reasonable accommodations remains an issue with TCL and are routinely

reported to DHHS staff for follow up.

Alliance hosts a mandatory Fair Housing training for all providers to assist in tenant

advocacy and to increase awareness of the process for reasonable accommodations

and reasonable modifications as outlined in the 2008 Updated Edition, Fair Housing for

Tenants with Disabilities. In addition, Wake County’s 2015 Analysis of Impediments to

Fair Housing Choice determined that “fair housing education and outreach efforts may

not satisfy need,” and identified five priority action steps, primarily including:

Educating elected officials and department staff

Targeting outreach and education especially to landlords renting a small number

of units, and

Conducting paired real estate testing in the local market and publishing the results

as a means of public education and deterrence against future discrimination

against landlords.

Alliance will fully support and assist in the education and outreach efforts in all of our

communities.

Alliance adheres to the values and principles of System of Care as a “way of doing

business” which is largely rooted in collaborative frameworks to bring about system

change. A System of Care approach also works to remove barriers, fragmentation and

siloed systems. By the very nature of funding and regulations, the housing and

behavioral health systems lend themselves to a more categorical and fragmented

relationship. Achieving collective results with mutually-reinforcing activities is critical to

both short-term and long-term progress. Our local Housing Specialists, TCLI staff, and

members of Senior Management and Executive Leadership all participate in local and

statewide housing collaboratives. Much of our participation with local CoCs is in

leadership roles. We also participate in various coalitions to end homelessness and

have engaged in conversations with the Triangle J Council of Governments to

collaborate on a possible Housing Summit or a series of facilitated conversations to

develop a regional “master plan” to maximize resources and opportunities. All of our

local governments and stakeholders have committed to regular meetings to review the

MCO Housing Plan and establish more local goals.

Next Steps:

To ensure individuals are in the least restrictive setting as possible and to promote

community integration, Alliance will establish a process to facilitate informed

choice of housing and service options for all individuals.

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Alliance will actively support local and state efforts to assist in Fair Housing

outreach and education activities for landlords, developers, tenants and other

stakeholders.

While Alliance has developed successful relationships with many local housing

entities, we will review the array of housing providers across the four counties and

identify where there are any additional relationships that could be established, re-

established or enhanced.

Following Durham Housing Authority’s commitment of 75 Section 8 Housing

Choice vouchers, Alliance will strengthen the partnerships with other local Public

Housing Agencies (PHA’s) to specifically set aside Section 8 vouchers for

consumers served by Alliance. In exchange for designated vouchers, Alliance will

consider incentives such as rent guarantee or subsidy or service related such as

case management.

Alliance will work with HUD-assisted housing developments to consider a

preference or priority for Alliance consumers. Durham has 20 HUD-assisted

properties, Wake has 32, Johnston has 15 and Cumberland has 24.

Given that all four communities are recipients of HOME funds for tenant- or

project-based assistance, Alliance will explore potential partnerships to create

more affordable housing targeted to persons with behavioral health conditions. In

2014, Fayetteville received $618,000, Durham $814,000, Wake county $540,000

and Raleigh $1,073,000.

In partnership with developers, NCHFA, local governments and DHHS will explore

the policy barriers related to affordable housing.


In partnership with DHHS, NCHFA and local stakeholders, Alliance will explore

establishing contingency funds for landlords accepting vouchers and subsidies for

home modifications required by HUD inspection standards or for damages to the

property. This may also include the rehab of older units.

Alliance will consider contracting directly with HUD certified inspectors in order to

streamline and expedite the inspection process for voucher and subsidized units.

This will also allow continuity in the process for landlords and relationship building.

Alliance will explore further consulting contracts with TAC and Corporation for

Supportive Housing to inform our housing continuum, best practices, data

collection and other financing strategies for developers including Social Impact

Investing.

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Wrapraround Services/Supports and Sustainable Housing

According to Dr. Kelly Duran of Belleville Hospital in New York, “the most appropriate

question may not be how we can afford to pay for social determinants of health as a

health intervention, but whether, we can afford not to pay for social determinants of

health as a health intervention.”

Comprehensive planning, strong community supports, and an array of treatment

services designed to promote housing stability and integration is critical to long-term

housing success. In addition, quality providers who understand how to access housing

resources, offer tenancy supports, and engage landlords as partners are equally critical

to the success and expansion of housing options. Alliance will convene a Housing

Learning Collaborative for providers to increase the education and proficiency of

providing treatment that also supports housing success. Landlords and developers will

also be invited to attend to facilitate shared problem solving and collective wisdom.

Whole Person Care

Alliance’s philosophy, services and supports all promote whole person care. Nowhere

is this more evident than in our Care Review process, which has received national

attention and praise. Through our System of Care efforts all four communities host

both child and adult Care Review teams. Care Review is a community planning

process with the person/family present to develop their own action goals based on

the principles of recovery and self-determination. Team members from the

community represent each of the 12 life domain areas with the primary purpose to

eliminate barriers to accessing needed services and supports.

In Durham and Wake counties, Care Review teams are specifically targeting persons

who are homeless or have housing needs. These teams meet in the shelters and/or

target systems such as crisis facilities and jails where housing plays a major role in

successful discharge planning. One of the major benefits of these specialized teams

is the ability to work in tandem with housing programs and providers to match the

appropriate level of care along a continuum of housing options to support successful

transitions. Alliance has plans to expand these specialized housing Care Review

teams into all four counties.

A Care Review meeting can improve timely access to and increased engagement in

services, resources and supports for an individual and/or family. It can provide an

opportunity for comprehensive planning, generating new ideas, and addressing any

system barriers than may be present. The Care Review meeting is where technical

assistance can be offered to professionals who are providing supports and

interventions to an individual and/or family.

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The Care Review team will develop an Action Plan during the meeting and this

document will include agreed-upon action steps that should take place after the

meeting. The Action Plan should address multiple life domains, address more than

one option for a person, and include services/supports and resources outside the

scope of paid services/treatments. The Plan will be agreed upon by all team

members and accountability for executing the plan will be the responsibility of those

identified during the meeting and in developing the plan. The individual/family will

receive a copy of the Action Plan at the close of the meeting, and the plan will dictate

subsequent follow up.

Service Delivery and Wraparound Supports

Permanent supportive housing provides an essential foundation for the delivery of

services that lead to improved outcomes, medication compliance and engagement in

services. As with the importance of matching housing options with preferences, there

cannot be a “one size fits all” approach to service delivery. Alliance is in various

stages of implementing a range of evidence based and evidence informed models

that directly correlate with housing success. Alliance is continually working to provide

as many options for tenancy support to individuals in permanent housing as possible.

Case Management Services

One of the most critical service components to successfully maintaining housing is

case management. Alliance utilizes Wake County funds to contract with Triangle

Family Services to employ three full-time Case Managers to support program

recipients in the Wake Rental Assistance Housing Program (RAHP), which is also

inclusive of Shelter Plus Care voucher recipients. Triangle Family Services Case

Managers provide assertive engagement for recipients to assist them in linking to

other community supports and provide ongoing case management to assist SPC

recipients in maintaining adequate living capacity.

Tenancy Support Team

Tenancy Support Team (TST) is a service provided to individuals participating in the

TCL Initiative. TST utilizes a three-member team to work to increase and restore an

individual’s ability to live successfully in the community by maintaining tenancy,

managing their illness and recovery, and reestablishing his or her community roles

related to comprehensive life domains. Alliance has selected two providers to offer

TST services throughout our region – Easter Seals/UCP and B and D, which will be

fully operational in early January.

While this model has great potential, it is currently limited to the TCL population, is

not billable to Medicaid, and at a $13.40 reimbursement rate may not have a cost

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benefit to providers. Alliance will continue to cost model the service for sustainability,

seek feedback from stakeholders regarding the utility of this service, and consider

expanding the TST to other populations served in supportive housing.

FUSE Model

Frequent Users System Engagement (FUSE) is an initiative launched by the

Corporation for Supportive Housing to help communities identify and engage super-

high users of public systems and place them in supportive housing to break the

repeated cycle of costly crisis services, shelters and the criminal justice system.

The model represents an opportunity to transform the homeless, health and criminal

justice systems to increase housing stability and reduce emergency department use

and jail recidivism. The model promotes the use of data to target and track tenants

based on their use of systems. Alliance and several partners from Wake County

Government recently traveled to Charlotte to meet with the members of MeckFuse,

which has fully implemented the FUSE model with promising success. We have also

contacted other communities across the country to inquire about their target

populations, data tracking, and lessons learned. Based on the highly-collaborative

partnerships with our public systems, a documented history of utilizing a scattered

site approach with engaged landlords and data sharing protocols in place, making

Alliance well-poised to replicate this model in all four communities using Wake

County as a pilot site. There is flexibility in the Community Support Team service

definition to apply the staffing requirements to develop a FUSE team.

Critical Time Intervention

Alliance was one of four recipients funded to implement Critical Time Intervention, an

evidence based practice designed for vulnerable populations transitioning from

homelessness or institutional settings. It is a three-phase, nine-month intensive case

management service utilizing a three-person team. A draft State-funded service

definition has been developed that will be cost modeled during the pilot phase.

Alliance has also submitted an in lieu of service definition to DMA for Medicaid

reimbursement. After grant funds have ended and with the approval of the service

definitions, Alliance will consider expanding the service to other counties to assist in

successful transitions for persons with complex needs. Alliance will also submit a

proposal for the latest DHHS funding opportunity to expand this service to the TCL

population.

Transportation

Transportation has consistently been rated in Alliance’s Gap and Needs Analysis as

a high need. Barriers to public transportation have been noted, as well as concerns

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about accessing Medicaid transportation. In each county there are plans to tie

affordable housing into potential mass transit and bus stops, and to improve Medicaid

transportation services.

Durham County has seen a concerted effort to improve transit efficiency and

consumer education and support. A workgroup of transit officials, behavioral health

providers, and representatives of consumer groups was formed to better understand

the transportation barriers for people with behavioral health needs. The team

analyzed transportation funded by Medicaid in the county and found that 28% of

Medicaid-funded transports are used for behavioral health appointments. The bulk of

these trips (85%) are made on para-transit providers, although a few individuals

receive fixed-route bus passes through the program. The passes must be picked up

at Department of Social Services, and this constitutes a barrier for many recipients.

In addition, a survey of 427 Durham County behavioral health recipients and service

providers ranked transportation barriers second overall out of 17 barriers, with service

providers ranking transportation as the top barrier and patients ranking it third. Based

on these identified needs, the workgroup applied for a transportation planning grant

and was awarded a Design Challenge Grant from the National Center for Mobility

Management. Grant funds of $25,000 are allowing the workgroup to receive technical

assistance to design innovative solutions to healthcare-related transportation

challenges in the area of access to behavioral health treatment over a six-month

period. The team will work with fixed route (DATA Bus) and demand response (DATA

Access, Lincoln Community Health Center, Red Cross) to optimize efficient ridership

on all systems and develop a travel trainer program to educate and assist transit

awareness. Lessons learned as part of this design grant will be shared with providers

and partners in other counties.

Improved transportation was also cited in Wake County’s Analysis of Impediments to

Fairy Housing Choice, which stated that “the public transportation system in Wake

County, which serves members of the protected classes, is fragmented and does not

adequately connect RCAP’s (Racially Concentrated Area of Poverty) to higher

opportunity areas.” Six priority action steps were identified, including connecting

areas with affordable housing to the region’s major employment centers, coordinating

future transportation routes with affordable housing developments, and acquiring

parcels in the vicinity of transit-oriented developments for the specific purpose of

creating affordable housing.

Maximizing Medicaid Funding for Supportive Housing

The US Department of Health and Human Services Office of the Assistant Secretary for

Planning and Evaluation (ASPE) recently published a series of reports on the use of

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Medicaid funds to pay for supportive housing. These reports indicate that Medicaid can

cover and pay for many of the services in supportive housing including case

management, service coordination and rehabilitative services. Achieving some of the

optimal benefits will be a little more challenging in North Carolina, as the state has not

opted into Medicaid expansion, nor is there a reimbursable service definition for

targeted case management. However, opportunities still exist under current waivers to

advocate with DMA on the benefits and outcomes of supportive housing.

ASPE has identified five steps to increasing Medicaid coverage of Supportive Housing

Services:

Conduct a crosswalk of supportive housing services and those covered by

Medicaid

Make the business case for supportive housing

Ccreate a Medicaid supportive housing services benefit

Measure and reinvest savings, and

Educate, engage and partner.

Alliance would be very interested in partnering with DHHS to convene a committee to

further examine these five steps and how we might improve Medicaid coverage for

supportive housing services.

Next Steps:

Alliance will form a Housing Learning Collaborative with providers and housing

stakeholders to increase education on topics including Housing First philosophy,

developing sustainable housing plans, evidence based practice models related to

housing, and Fair Housing by March 1, 2016.

Alliance will continue to require all providers – not just agency representatives –

as well as internal staff to complete mandatory Fair Housing training.

Alliance will expand housing Care Review teams into each county by April 1,

2016.

Alliance will work with crisis and criminal justice partners to develop a formalized

process for early identification of persons with housing needs to promote

successful transitions and reduce recidivism. These individuals could also be

considered “at-risk” for placement in an adult care facility.

Alliance will continue to consult with TAC and the Corporation for Supportive

Housing on best practice models for supportive housing, aligning services to

match housing needs/preferences and maximizing Medicaid funding for

supportive housing services.

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Alliance will cost model the Tenancy Support Team service and consider

expanding to other populations and the submission of an “in lieu of” request to

DMA.

In partnership with Wake County and housing stakeholders, Alliance will

implement the FUSE supportive housing model targeting the high users of

shelters, crisis services and the jail.

Alliance will continue to explore the expansion of evidence based practices such

as Critical Time Intervention that have strong correlations to positive housing

outcomes.

Crisis Planning

Being prepared to respond to emergency situations – be it a psychiatric crisis that

jeopardizes housing stability, a natural or weather-related disaster that causes stress

and anxiety for the tenant, or an emergency closure of a facility that will abruptly

displace multiple people – is critical to housing maintenance. Alliance has convened a

Safety Committee that is responsible for communicating procedures and needed

information during a crisis, for continually reviews policies, procedures and events to

improve our response, and for monitoring and implementation of our internal Business

Continuity Disaster Plan. We have developed coordinated responses with each of our

public Emergency Management Partners.

Moreover, Alliance has had extensive conversations with property managers and

landlords regarding crisis response to a tenant and have begun outreach efforts with

properties regarding our Access number, Mobile Crisis services and Crisis Intervention

Teams, and has adopted the following crisis procedures to respond to a natural disaster

or weather-related event:

Purpose

To safeguard the well-being of those individuals residing in supportive housing in the

Alliance catchment (Cumberland, Durham, Johnston, and Wake Counties).

Procedure for Addressing Crisis Situations

Upon notification to Alliance Behavioral Healthcare of a crisis (weather, situational,

compromise of housing/habitability), the information shall be communicated via

phone and by a follow-up email to:

24

o Chief Community Relations Officer (Ann Oshel – (919) 651-8855 –

[email protected])

o Director of MHSA Care Coordination (Nave Sands – (919) 651-8417 –

[email protected])

o Transitions to Community Living (TCL) Supervisor of site where the

individual’s home is located (Tinya Ramirez – (919) 651-8749 –

[email protected])

o The Housing Specialist of site where the individual’s home is located

o Others to be contacted by the Transitions to Community Living Supervisor/

Housing Specialist of site where home is located

Alliance Care Coordination Supervisors from other sites if residents are

from their counties

DSS or other LME/MCO’s where applicable.

The TCL Supervisor/Housing Specialist at the site where the individual’s home is

located will take the lead role to assure that all residents are safe in their current

home or safely transferred to appropriate placements in the case of damage to the

home making it uninhabitable.

TCL Supervisor/Housing Specialist will communicate with the Chief Community

Relations Officer and the Director of MHSA Care Coordination to:

o Confirm that the plan of action to check-in with individuals has been started.

o Ascertain the names of the residents and if applicable, their guardians if this

information has not been provided previously.

TCL Supervisor/Housing Specialist will:

o Identify licensed staff (assigned TCL or MHSA Care Coordinator) who can

contact the guardians of the residents to explain the role of the LME/MCO.

o Identify and deploy the appropriate staff member who can contact the

individual or the individual’s guardian to conduct a safety check and ensure

basic needs are met

If basic needs (food, water, shelter, warmth, alternative light/heat

sources, emergency numbers/contacts, reliable source of

communication, etc.) are not met, available resources and options will

be reviewed and provided where applicable.

o In the case that the individual’s home has become uninhabitable or tenancy

has been compromised and where there are no readily available options (i.e.

family, friend, natural supports, monies for temporary living arrangements),

supervisors will identify staff who can contact facilities to identify empty beds

mailto:[email protected]



25

and to communicate this to the guardians/individuals to make consumer

guided choices.

o Contact other Alliance MHSA Care Coordination sites for assistance if needed.

TCL Supervisor/Housing Specialist will provide updates via email to all those

identified in #1 on a regular basis.

If there is lack of response from any guardians the staff member attempting contact

will discuss this with the appropriate supervisor. If continued concern for safety is

determined, designated staff will contact the Adult Protective Services staff for

assistance.

TCL Supervisor/Housing Specialist or designee will:

o Provide daily reports, as applicable

o Participate in a debrief Conference Call with all those individuals in #1, as

applicable

o Submit completed safety check forms on each individual contacted or where

contact was attempted.

TCL Supervisor/Housing Specialist will communicate with the designated Care

Coordinator to monitor consumer to assure that all behavioral health services,

medical services, and tenancy support services (where applicable) are active during

and post crisis and that noted services remain in place where a new placement is

the end result.

o Service providers involved will be contacted via phone and follow up email in

order to provide regular updates and maintain open communication during and

post crisis.

o Monitoring will continue to ensure safety post crisis with a follow up check on

business day following the resolution of the crisis. This will be documented and

reported to all those listed above.

TCL Supervisor/Housing Specialist will provide a written report to MHSA care

Coordination director outlining the steps taken and the end result by case.

The TCL utilizes The Adverse Weather Emergency Check-In form, which can be found

at http://www.alliancebhc.org/wp-content/uploads/filebase/Adverse-Weather-

Emergency-Check-In.pdf, and the Cold Weather Emergency Check-In form, which can

be found at http://www.alliancebhc.org/wp-content/uploads/filebase/Cold-Weather-

Emergency-Check-In.pdf.

In accordance with the DHHS Operational Guide for a Coordinated Response to the Sudden Closure of a Residential Care Facility, which can be found at

http://www.alliancebhc.org/wp-content/uploads/filebase/Adverse-Weather-Emergency-Check-In.pdf

http://www.alliancebhc.org/wp-content/uploads/filebase/Adverse-Weather-Emergency-Check-In.pdf

http://www.alliancebhc.org/wp-content/uploads/filebase/Cold-Weather-Emergency-Check-In.pdf

http://www.alliancebhc.org/wp-content/uploads/filebase/Cold-Weather-Emergency-Check-In.pdf

26

https://ncdhhs.s3.amazonaws.com/s3fs-public/documents/files/acrf_operational_guide.pdf, Alliance has developed procedures for emergency closures, which can be found at http://www.alliancebhc.org/wp-content/uploads/filebase/Emergency-Closing-of-Adult-Residentials.pdf.

Plan Summary

Increasing the capacity of affordable housing designated for persons with behavioral

health issues and creating a System of Care culture and approach accompanied by the

treatment services and supports critical to maintaining housing is multi-pronged and

multi-faceted. Some strategies will yield quick returns while others will be longer-term

and more costly. To meet the goals of expanding access to supportive housing and

creating opportunities for people with disabilities to live in the communities of their

choice requires broad and diverse partnerships including private and philanthropic

partners, creative financing strategies such as Social Impact Investing, and an

expanded Medicaid reimbursable service array.

Alliance is firmly committed to the success of TCLI as well as to promoting housing as a

healthcare strategy. The recommendations and next steps outlined in this plan are

intended to address both the urgency of expanding housing options in rural and urban

communities as well as structurally improving the system designed to offer housing

supports.

https://ncdhhs.s3.amazonaws.com/s3fs-public/documents/files/acrf_operational_guide.pdf

https://ncdhhs.s3.amazonaws.com/s3fs-public/documents/files/acrf_operational_guide.pdf

http://www.alliancebhc.org/wp-content/uploads/filebase/Emergency-Closing-of-Adult-Residentials.pdf

http://www.alliancebhc.org/wp-content/uploads/filebase/Emergency-Closing-of-Adult-Residentials.pdf

Housing is a Healthcare Strategy: Overview of MCO Housing Plan

Presentation to the Services CommitteeFebruary 10, 2016

“Access to safe, quality and affordable housing –and the supports necessary to maintain that

housing – constitute one of the most basic and powerful social determinants of health.

In particular, for individuals and families trapped in a cycle of crisis and housing instability due to

poverty, mental illness, addictions or chronic health issues, housing can entirely dictate

their health and health trajectory.”

World Health Organization, 2008

Housing is a Healthcare Strategy

• Opportunity at the federal and state level to advance the issues of housing and healthcare

• Opportunity to educate and promote Fair Housing laws for persons with psychiatric disabilities

• Continued challenges across the state and our region to increase affordable housing inventory

Why We Wrote the Report

• Continued challenges across the state and our region to meet the required housing slots for DOJ Settlement

• Because DHHS told us we had to

Why We Wrote the Report

• Title VIII of the 1968 Civil Rights Act also known as the Fair Housing Act

• Seven federally protected classes:o Raceo Coloro Religiono National origino Sexo Disabilityo Presence of children

Fair Housing

• American with Disabilities Act 1990

• Olmstead vs L.C. 1999 ruling that requires states to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs

Fair Housing

• Federal and state laws that forbids landlords and property managers to discriminate against a person with a disability

• Reasonable accommodation allows for the change in rule, practice or policy

o Criminal record

o Credit history

o Repair or modification to the apartment

Reasonable Accommodation

• Landlords can deny a reasonable accommodation request if it presents an “undue burden” or “fundamental alteration”

o Over 120 landlords have denied reasonable accommodation requests in Wake County

Reasonable Accommodation

• Current community-based housing initiatives

• Need for improved access and capacity to quality affordable Permanent Supportive Housing

• Wraparound services/supports and sustainable housing

• Crisis planning

Sections of the Report

• Independent Living Initiative

• Transitions to Community Living Initiative

• Ready to Rent training

• Voucher and subsidized housingo Section 8 Housing Choice Vouchers

o Shelter Plus Care (Durham)

Current Housing Initiatives

• Recruit Director of Housing

• Expand Ready to Rent in all counties

• Exploring further partnerships with Public Housing Authorities

• Included housing allocation in Savings Reinvestment Plan

o Rehab units to meet HUD codes

o Vacancy/loss payments

Short Term Strategies

• Reviewed Affordable Housing Consolidated Plans and Analysis of Impediments to Fair Housing in each county

• City of Raleigh provided bonus points to developers partnering with Alliance as part of QAP application

• Extensive waiting lists for Section 8 housing in all our counties

Improved Access and Capacity

Fair Market Rental Rates

• Fair Housing outreach and education

• Increase number of designated units with landlords, developers, funders and property managers

• Exploring Master Leasing agreements (Wake pilot for TCLI)

• Exploring financial incentives to developerso Social Impact Investing


• Care Review

• Array of services aligned to correlate with housing stability

• Maximizing Medicaid funds to pay for supportive housing

Wraparound Services and Supports

• Convene a Housing Learning Collaborative

• Train providers on supportive housing

• Explore expansion of key treatment services that support housing tenure

• Continued consultation with TAC and Corporation for Supportive Housing


• Every community struggles with demand/supply of affordable housing

• Housing is a very complicated and expensive world

o What should be the role of a managed care company, i.e. United Healthcare Affordable Housing Investment Program?

• Our treatment and payment systems are not aligned with housing stability/community tenure

Our Housing Challenges

• Not very stakeholder embraces the Housing First philosophy

• Policies that promote the integration of housing and healthcare

• Creating and funding a continuum of housing and support services

• Leveraging federal, state and local (private and public) dollars to incentive and finance housing

Our Housing Challenges

• Educate elected officials that housing is a healthcare strategy

• Take the DOJ housing strategies to scale for other populations

• Continue education and advocacy for Fair Housing

• Recruit landlords to increase housing inventory

• Advocate for increasing designated vouchers and incentives for persons with BH issues

Advancing the Issue

6D

(Back to agenda)

ITEM: Global Quality Management Committee Report


BACKGROUND:

The Global QMC is the standing committee that is granted authority for Quality Management by

the MCO. The Global QMC reports to the MCO Board of Directors which derives from General

Statute 122C-117. The Quality Management Committee serves as the Board’s monitoring and

evaluation committee charged with the review of statistical data and provider monitoring reports.

The goal of the committee is to ensure quality and effectiveness of services and to identify and

address opportunities to improve LME/MCO operations and local service system with input from

consumers, providers, family members, and other stakeholders.

The Alliance Board of Directors Chairperson appoints the committee consisting of five voting

members whereof three are Board members and two are members of the Consumer and Family

Advisory Committee (CFAC). Other non-voting members include at least one MCO employee

and one provider representative. In FY 2016, a new CFAC member joined the committee—Amelia

Thorpe. The MCO employees typically assigned are the Director of the Quality Management

(QM) Department who has the responsibility for overall operation of the Quality Management

Program; the MCO Medical Director, who has ultimate responsibility of oversight of quality

management; the Quality Review Manager, who staffs the committee; the Quality Management

Data Manager; and other staff as designated.

The Global QMC meets at least quarterly each fiscal year and provides ongoing reporting to the

Alliance Board. The Global QMC approves the MCO’s annual Quality Improvement Projects,

monitors progress in meeting Quality Improvement goals, and provides guidance to staff on QM

priorities and projects. Further, the Committee evaluates the effectiveness of the QM Program and

reviews and updates the QM Plan annually.

The draft minutes and materials from the February meeting are attached (a quorum was not

present). The committee did not meet in January. At the meeting, the committee received reports

on provider monitoring, as required by our contract, and an update on crisis, inpatient, and

Emergency Department data and performance. The committee also received a brief update on our

Corrective Action Plan in response to the EQR visit in November, which required approval by the

committee. Since there was not a quorum, committee members were asked to review the materials

and come prepared in March to vote on approval. The committee reviewed and discussed key

performance data in the “Dashboard” report. QM staff highlighted the strengths and areas in need

of improvement, along with the action plans to improve performance. Lastly, the committee

received a brief update on Quality Improvement Projects. QM is managing 7 active and 3 QIPs



6D

(Back to agenda)

that are closing. All QIPs are making progress, with exceptions for the Care Coordination (IDD),

Mystery Shopper (IDD), and Access to Care. These projects are initiating new interventions and

will re-evaluate performance after implementation of interventions.


Accept the report.

CEO RECOMMENDATION:

Accept the report.

RESOURCE PERSON(S):

George Corvin, Committee Chair; Geyer Longenecker, Quality Management Director; Tina

Howard, Quality Review Manager

Thursday, February 04, 2016 GLOBAL QUALITY MANAGEMENT COMMITTEE

Page 1 of 5

VOTING MEMBERS PRESENT: ☐ Ann Akland, BS (Area Board); ☐ George Corvin, MD, Chair (Area Board); ☐ Phillip Golden, BA (Area Board); ☐ Joe

Kilsheimer, MBA (CFAC); ☐ Amelia Thorpe (CFAC); ☒ Lascel Webley, Jr., MBA, MHA (Area Board)

NON-VOTING MEMBERS PRESENT: ☒ Tim Ferreira, BA (Provider Representative, I/DD); ☐ Nicole Novello Olsen, MSM (Provider Representative, MH/SA)

STAFF PRESENT: ☐ May Alexander, MS, LMFT, Quality Management Data Manager; ☒ Tina Howard, MA, Quality Review Manager; ☒ Geyer Longenecker,

JD, Quality Management Director; ☒ Alison Rieber, LCSW, Network Evaluator Supervisor; ☒ Tedra Anderson-Brown, Medical Director; ☒ Doug Wright,

Director of Consumer Affairs; ☒ Sandra Ellis, Administrative Assistant/Scribe

GUEST(S) PRESENT: ☐ WELCOME AND INTRODUCTIONS

Neither Chair nor Co-Chair were in attendance. No actions was taken because the quorum was not met.

REVIEW OF THE MINUTES: December 3, 2015 minutes were not reviewed or acted upon. Will be reviewed at the March 3, 2016 meeting.

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: OLD BUSINESS: 2015 EQR REVIEW (Geyer) (Submitted by the Carolinas Center for Medical Excellence External Quality Review)

Unable to vote as a quorum was not present.

Reviewed EQR #11, Quality Management evaluation, the final compliance action report but no vote was taken. A couple of pages were drafted for the committee to look at next month for a vote.

The QM Department has drafted the following assessment of its FY 2015 goals. The assessment was presented in February 2016 (no vote) to the CQI Committee and Global Quality Management Committee for review and approval, and added to its FY 2015 QM Program Assessment.

The majority of the goals were met, such as providers included in the Credentialing Committee. There are some policy issues which need to be addressed prior to having providers on the CQI Committee or the QIP Project Advisory Teams. This is under consideration.

The few performance measures which were out of line have been corrected. We are now down to two this year.

Review for a vote. March 3, 2016 Meeting


Page 2 of 5

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: NEW BUSINESS: Monitoring Report (Alison Rieber):

Alison gave an in-depth overview on Monitoring Reporting. The last information was shared with the committee in October 2015.

There is a routine monitoring tool used for every provider every two years. This monitoring has been expanded to include therapeutic foster care and agencies, not sites, are monitored.

Reciprocity agreements were a big push last year but monitoring cannot be postponed as it is required every two years beginning in 2013. The Routine Monitoring Process states that providers will be monitored every two years.

Since monitoring first began in 2013, the evaluation team has completed routine monitoring for all provider agencies except those providing primarily therapeutic foster care and hospitals providing outpatient services. Monitoring of providers of therapeutic foster care will begin in April 2016.

The monitoring supervisor will work with Alliance’s Hospital Relations Director to understand the hospital contracts and arrange monitoring of hospitals providing outpatient services.

Alliance began monitoring LIPs in October 2014 and monitored ninety-six LIP practices by January 2016. However, 130 LIP practices with current billing have not yet been monitored. These routine reviews cannot be completed within the two-year time frame beginning in March 2014, when the tools were revised and the new Routine Monitoring Process began.

Approximately 67% of these LIP practices are billing Alliance for five or fewer consumers over a period of three months.

In FY 2015, Alliance was fourth in LME/MCOs in number of reviews completed. In the first two quarters of FY 2016, Alliance was second in the number of routine reviews completed.


Page 3 of 5

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Performance Standards Compliance Dashboard – FY 2015 – FY 2016: (Geyer)

Since the Routine Review Monitoring Process was resumed in March 2014, Alliance has increased the number of routine reviews/month from 10.25 to 17.5. This has been accomplished by hiring additional evaluators. The team has gained two positions since March 2014. Will be adding one more position for a total of twelve positions.

Increasing scheduling efficiency in monitoring of small agencies.

Geyer spoke to the NC DHHS LME/MCO Performance Summaries for September, October and November 2015. These are summary reports of LME/MCO performance that are routinely sent.

Alliance has made a real effort to comply with the routine basic reports from the State and takes these reports very seriously in making sure we are meeting goals.

Areas out of compliance include Care Coordination initial contact, the finance report, NCTOPPS, CDW submissions, and Access to Care. QM staff met with Care Coordinators Team Leads to address compliance, which resulted in improved performance.

The CDW submissions have been a point of focus for 1 ½ years. The status of CDW submissions on one element was out of compliance but Alliance has already made progress on that number.

The reason the finance report was deemed incomplete is because staff indicated no claims were submitted for Path MOE instead of entering a zero. That has been corrected.

NC-TOPPS is an ongoing issue due to timeliness. Actions taken during Q1 FY2016 included removing two closed agencies from the online database and hiring a new NC-TOPPS staff member dedicated to the task.


Page 4 of 5

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Crisis/Hospital/ED Report (Tina)

An analysis on recent innovations information and is being done to see why it was not completed. Driving the numbers would be a lot of times within forty-five days claims have not been filed.

Alliance is making progress and we can be proud of the submission report; waiting for information of Access to Care Report.

Presented an update from this time last year. Of the noted challenges for last year, some improvements has been made in intensive services for juveniles and an expansion of peer services.

This year’s presentation included inpatient data and progress on key Process and Performance Indicators.

Of note, there was a slight improvement in crisis calls returned to the QM tester within an hour in the 2nd Quarter of FY 16. A new intervention of referring to Compliance was added in 2015.

Cumberland crisis services expanded hours and there is a planned expansion of another crisis facility and inpatient services in Wake County.

Continued challenges include: improving Mobile Crisis, complete transition of new provider in Durham, and continuing to expand hours in Cumberland.

QIP Updates (Tina)

First several slides were a summary.

Quality Improvement Projects; met EQRO standards of meeting

We are on target for all QIPs, with the exception of Access to Care, Care Coordination (IDD), and Mystery Shopper (IDD).

Committee members are encouraged to review slides in more detail and send questions/concerns to Tina.


Page 5 of 5

AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:

UPCOMING MEETINGS: Dates and locations are same as Board, topics are tentative

March 3, 2016 (location: Corporate) – Performance Standards Dashboard, Clinical Guideline Reviews, Other Topics – TBD April 2016 (not meeting – Spring Break) May 5, 2016 (location: Corporate) – QIP Proposals & Updates, other topics – TBD – will keep committee updated during the next couple months when not meeting. June 2, 2016 (location: Corporate) – Vote on QIP Proposals, Performance Standards Dashboard, other topics – QM program evaluation is due by the end of August

ADJOURNMENT: The committee adjourned at 3:30pm

December 22, 2015 2015 EQR Review Corrective Action Plan Item 11 Comment: “The Quality Program Evaluation should include appropriate measure results trended over time (if applicable), any barriers identified for not meeting specific goals or objectives, recommended interventions, and any program changes needed.” Response: The QM Department has drafted the following assessment of its FY 2015 goals. The assessment will be presented in February 2016 to the CQI Committee and Global Quality Management Committee for review and approval, and added to its FY 2015 QM Program Assessment. FY 2015 Quality Management Goals Assessment Goal 1: Meet 100% of performance measures. Description: The QM Department is committed to ensuring that Alliance meets all performance measures established in Alliance's contracts with the DMA and DMH. These measures cover the range of Alliance's activities, including performance by Alliance's Clinical, Utilization Management, Call Center and QM Departments. Performance: During FY 2015, Alliance met 80.3% (196 of 244) of its contractual performance measures. These included: LME-MCO monthly report: 155 of 156 99.4% Performance Submission quarterly report: 8 of 14 57.1% Access to Care quarterly report: 3 of 36 8.3% Innovations reports: 26 of 30 87.7% NC-TOPPS report: 4 of 8 50.0% Result: Alliance did not meet its goal for FY 2015, and will include this goal in its FY 2016 work plan. Barriers: Alliance identified the following barriers during FY 2015:

LME-MCO report: Alliance did not meet all performance standards for Care Coordination assignment. QM Department staff determined that the assignment process complicated and does not make assignments by default.

Performance Submission report: Alliance has not meet all Consumer Data Warehouse submission requirements because of: a lack of resources at the state to implement requested corrections; and the need for additional Alliance staffing to oversee data integrity.

Access to Care: Alliance has identified issues in staff training, IT system configuration, and data integrity.

NC-TOPPS: Alliance has identified a number of providers who have consistently not met NC-TOPPS reporting requirements.

Interventions:

LME-MCO report: Alliance has implemented changes in its Care Coordination assignment process to assure assignment in all cases.

Performance Submission report: Alliance has submitted formal Compliance Action Plans to the state, and created inter-departmental work groups to implement the plans.

Access to Care: Alliance has implemented new criteria develop by the state, which is expected to set new Access to Care performance measures based on actual LME-MCO performance rather than historic standards.

NC-TOPPS: Alliance has implemented a compliance program requiring Plans of Correction from non-compliant providers. Those providers who receive three POCs in a year are referred to the Compliance Department for additional review and action.

Goal 2: Establish QM reporting in 100% of Alliance committees. Description: Description: Alliance is committed to a QM program that is data-driven. The QM Department will review the activities and data requirements of the Global QM Committee, CQI Committee, and various Alliance subcommittee. The QM Department will facilitate the development of relevant reporting, including the creation of "dashboards" to assess fundamental performance, and the development of reports required by contract or accreditation. Performance: During FY 2015, the QM Department worked with the nine internal CQI Committees and the board’s Global Quality Committee to assess current reporting, and identify and develop additional reporting. Dashboard reports were created for all committees. Result: Alliance meet its goal for FY 2015. Goal 3: Review 100% of Alliance committee reports to identify new QM risk factors. Description: The QM Department will review all reports created by the various Alliance committees, identify areas of risk or non-performance, and facilitate the mitigation of these issues. Performance: All CQI subcommittees met regularly in FY 2015. Committee leaders were asked to provide reports to the CQI Committee at its monthly meetings. However, subcommittees did actually report only 50% of the time, ranging from 100% for the UM Committee to 20% for the IT Committee. Result: Alliance did not meet its goal for FY 2015, and will include this goal in its FY 2016 work plan. Barriers: The CQI subcommittees have not been formally charged with identifying and reporting on quality issues. In addition, the reporting process has not been formally documented. Interventions:

The QM Department will facilitate the creation of new committee charters specifying the reporting requirement for each subcommittee.

A reporting form will be developed and implemented.

Subcommittee agendas will include reviewing quality issues and completing the reporting form.

Subcommittee reports will be included on the CQI Committee agenda. Goal 4: Create a rapid QM response program and train 100% of department heads on its use. Description: The QM Department has identified the need for a quick and user-friendly way for Alliance departments to request QM assistance. QM staff will develop on online request form for QM assistance and associated training materials. QM staff will train 100% of department heads on how to access the system and submit a request for QM review. Performance: The QM Department created a form for requesting a rapid quality review. The form was placed on the shared server where it could be accessed by all staff. The QM Department informed all staff of the rapid review process via a series of all-Alliance emails. Result: Alliance meet its goal for FY 2015. Goal 5: Review HEDIS standards and implement relevant performance measures. Description: Developed by the NCQA, the HEDIS program is a set of performance measures that allow MCOs to better evaluate their performance against national standards. The QM Department will review the HEDIS measures, identify the measures that are relevant to Alliance's behavioral health activities, and facilitate the creation of reports on those HEDIS measures. Performance: The QM Department reviewed the latest HEDIS reporting standards. The QM Department then reviewed current state-required performance measures and confirmed that the state measures are HEDIS-based. The QM Department concluded that Alliance is meeting relevant HEDIS reporting requirements via its current state-mandated reporting. Result: Alliance meet its goal for FY 2015. Goal 6: Develop provider QM education and inform 100% of providers. Description: Continuous quality improvement is the responsibility of all stakeholders in Alliance, including providers. The QM Department will create guides, templates and training materials to help providers create effective QM programs. The QM Department will inform 100% of providers about the availability of these materials. Performance: The QM Department developed an “Introduction to Quality Management” training program aimed at providers. The program was presented at the June 2015 All-Provider meeting. The presentation was posted on the Alliance website, and providers were notified about its availability. Result: Alliance meet its goal for FY 2015. Goal 7: Evaluate the establishment of provider outcomes.

Description: The establishment of provider outcomes is the next great step in improving the effectiveness and efficiency of patient care. The QM Department will evaluate current methods for establishing outcomes; and assess the relevancy of those methods to Alliance. Performance: During FY 2015, Alliance completed the following activities:

The QM Department completed a literature review of current performance measures used to evaluate behavioral health providers.

The QM Department contributed to the development of three pilot programs to evaluated extended Intensive In-Home services offered by providers KidsPeace, Youth Villages and Mentor. QM staff reviewed existing performance measures, and developed uniform measures to allow a comparison of the three programs.

The QM Department implemented a process for evaluating provider compliance with clinical practice guidelines. The process identifies two or more essential requirements and tracks provider compliance. The analysis will be used to develop general provider training, and to identify specific providers for focused training. The QM Department has started its reviews with clinical practice guidelines for ADHD in children and schizophrenia in adults.

Result: Alliance meet its goal for FY 2015.

NC DHHS LME/MCO Performance SummaryNovember 2015 Report

Meets Standards?1/15/2016

DMA Performance Measures Standard Allia

nce

Card

inal

Cente

rPoin

tE

astp

oin

teP

art

ners

Sandhills

Sm

oky

Mounta

inTri

lliu

m

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

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

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

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



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

Yellow Highlights indicate the MCO did not meet the Standard for one or two consecutive months.

Pink Highlights indicate the MCO did not meet the Standard for 3 or more consecutive months.

Count %Number of Standards Not Met: 0 0%

Number of Standards Not Met for 2 or more Months (pinks): 0 0%Number of LME/MCOs with 2 or more Standards Not Met: 0 0%

EXPLANATIONSAll LME-MCOs met all performance measures with standards.

Page 1 of 6

LME/MCO Monthly Monitoring Report November 2015 Report

Medicaid and State Combined 1/15/2016

Monitoring Area Standard Alliance Cardinal Center-

Point

Eastpointe Partners Sandhills Smoky

Mountain

Trillium NC Total STD

DEV

Call Center

Total Number of Calls (re: services for consumers) 5,110 4,715 2,973 4,518 3,376 2810 4,681 2,052 28,183

# of Calls Abandoned 77 57 45 102 83 41 127 35 532

% of calls Abandoned <5% 1.5% 1.2% 1.5% 2.3% 2.5% 1.5% 2.7% 1.7% 1.9%

Avg Speed to Answer Calls (seconds) o 7.0 5.0 5.2 4.0 8.0 5.0 6.0 4.0 5.7 1.32

# of Calls Answered within 30 seconds 5,033 4,658 2,866 4,452 3,263 2,769 4551 2,017 27,592

% Answered within 30 seconds 95% 98.5% 98.8% 96.4% 98.5% 96.7% 98.5% 97.2% 98.3% 97.9%

IDD Wait List

Number of Persons on the IDD Waitlist (snapshot on 1st of Month) 2,191 1,904 1,264 786 939 1,305 1,244 823 9,633

# of Persons on Registry of Unmet Needs for Innovations Waiver 2,146 1,830 1,263 786 900 1,183 1,072 669 9,180

% of Persons waiting who are on the Reg. of Unmet Needs o 98% 96% 100% 100% 96% 91% 86% 81% 95% 6%

# of Persons waiting for residential services - 56 - - 27 46 67 23 196

% of Persons waiting for residential services o 0% 3% 0% 0% 3% 4% 5% 3% 2% 2%

# of Persons waiting for ADVP 14 79 1 - 3 76 - 35 173

% of Persons waiting for ADVP o 1% 4% 0% 0% 0% 6% 0% 4% 2% 2%

# of Persons waiting for vocational services - 2 2 - 4 - 37 7 45

% of Persons waiting for vocational services o 0% 0% 0% 0% 0% 0% 3% 1% 0% 1%

Service Status of Persons on the Waiting List

# of Persons on Waitlist receiving B3 Services 286 577 243 67 113 263 246 78 1,795

% of Persons on Waitlist receiving B3 Services o 13% 30% 19% 9% 12% 20% 20% 9% 19% 7%

# of Persons on Waitlist receiving State Services 628 204 339 238 233 158 770 322 2,570

% of Persons on Waitlist receiving State Services o 29% 11% 27% 30% 25% 12% 62% 39% 27% 15%

# of Persons on Waitlist receiving State and/or B3 services (undup) 688 717 506 305 248 421 833 337 3,718

% of Persons on Waitlist receiving State and/or B3 Services o 31% 38% 40% 39% 26% 32% 67% 41% 39% 11%

# of Persons on Waitlist not receiving any LME/MCO funded svcs 1,503 1,187 758 481 691 884 411 486 5,915

% of Persons on Waitlist not receiving any LME/MCO funded svcs o 69% 62% 60% 61% 74% 68% 33% 59% 61% 11%

Incidents

Number of Level 2 Critical Incident Reports received 166 220 45 69 142 166 164 79 972

Number of Level 3 Critical Incident Reports received * 17 21 2 7 9 14 16 11 86

* All Level 3 Critical Incidents are reviewed by the LME/MCO to ensure Providers conduct internal investigation.

Department of Justice SettlementIndividuals in In-reach 468 834 224 371 353 320 633 600 3,803

Number of individuals in Transition Planning process 65 44 15 24 38 16 31 38 271

Number of Individuals Housed - Total 53 112 53 67 53 83 79 119 619

Claim/Encounter Processing in NCTracksDMH- % of Claims $ Value Denied by Date of Service FY15 YTD <10% 5% 28% 10% 7% 2% 26% 12% 9% 13% 9%

DMH- % of Claims $ Value Denied by Date of Service FY16 YTD <10% 16% 33% 22% 36% 4% 30% 15% 6% 19% 11%

Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3 consecutive months. Blue highlights indicate possible outliers.

Page 2 of 6

MCO Monthly Monitoring Report November 2015 Report 1/15/2016

Medicaid Only LME/MCO:

Monitoring AreaStandard

Alliance Cardinal Center-

Point


Mountain

Trillium Statewide STD

DEV

Persons Served Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

Unduplicated Count of Medicaid Members 211,215 323,222 76,785 189,601 139,232 171,615 154,574 171,203 1,437,447

# Persons Receiving MH Services 13,268 13,596 3,053 8,171 7,327 6,848 9,354 8,743 70,360

% of Members Receiving MH Services o 6.3% 4.2% 4.0% 4.3% 5.3% 4.0% 6.1% 5.1% 4.9% 0.9%

# Persons Receiving SA Services 1,102 1,529 147 1,190 1,054 598 842 1,383 7,845

% of Members Receiving SA Services o 0.5% 0.5% 0.2% 0.6% 0.8% 0.3% 0.5% 0.8% 0.5% 0.2%

# Persons Receiving DD Services 2,852 3,912 1,060 1,419 1,822 1,344 2,035 1,717 16,161

% of Members Receiving DD Services o 1.4% 1.2% 1.4% 0.7% 1.3% 0.8% 1.3% 1.0% 1.1% 0.2%

Unduplicated # that received MH/DD/SA Services 16,616 19,037 4,188 10,038 9,843 8,790 11,783 10,819 91,114

% of Members Receiving MH/DD/SA Services o 7.9% 5.9% 5.5% 5.3% 7.1% 5.1% 7.6% 6.3% 6.3% 1.0%

Community Psychiatric Hospitalization Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

# of MH Admissions to Community Psychiatric Inpatient 149 292 75 161 128 85 174 146 1,210

Rate of MH Admissions per 1,000 Medicaid Members o 0.71 0.90 0.98 0.85 0.92 0.50 1.13 0.85 0.84 0.18

# of MH Admissions that were Readmissions within 30 days 20 19 9 12 18 7 19 15 119

% of MH Admissions that were Readmissions within 30 days o 13.4% 6.5% 12.0% 7.5% 14.1% 8.2% 10.9% 10.3% 9.8% 2.6%

# of MH Inpatient Discharges 174 215 56 176 70 113 204 175 1,183

MH Inpt Average Length of Stay (days) o 6.10 9.00 5.90 7.00 6.50 3.60 9.85 10.54 7.8 2.17

# of SA Admissions to Community Psychiatric Inpatient 0 19 2 19 7 13 7 5 72

Rate of SA Admissions per 1,000 Medicaid Members o - 0.06 0.03 0.10 0.05 0.08 0.05 0.03 0.05 0.03

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

% of SA Admissions that were Readmissions within 30 days o 10.5% 0.0% 15.8% 28.6% 0.0% 0.0% 0.0% 10% 10.3%

# of SA Inpatient Discharges 0 19 2 21 6 13 7 4 72

SA Inpt Average Length of Stay (days) o - 4.5 3.5 5.1 5.6 2.8 4.9 4.5 4.5 1.68

Care Coordination Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

# of MH and SA Readmits assigned to a Care Coordinator 18 20 9 15 20 7 19 15 123

% of Readmits assigned to Care Coordination 85.0% 90.0% 95.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.6%

Emergency Dept Utilization (3 month lag) Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015

# of ED Admits for persons with MHDDSA diagnoses 251 641 126 379 257 291 383 317 2,645

Rate of ED Admits per 1,000 Medicaid Members o 1.22 1.79 1.64 1.97 1.74 1.70 2.42 1.72 1.8 0.31

# of ED Admits for persons who are active consumers 71 337 61 123 135 92 110 136 1,065

% of ED Admits that were for active consumers o 28.3% 52.6% 48.4% 32.5% 52.5% 31.6% 28.7% 42.9% 40% 9.9%

# of ED Admits which were readmissions within 30 days 22 106 23 67 35 46 56 21 376

% of ED Admissions Readmitted within 30 days o 8.8% 16.5% 18.3% 17.7% 13.6% 15.8% 14.6% 6.6% 14.2% 3.9%

Authorization Requests Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

Total Number of Auth Requests Received 3,051 4,384 1,470 2,051 4,263 2,302 2,995 2,534 23,050

# Standard Auth. Request Decisions 2,633 3,602 1,300 1,473 4,102 1,916 2341 1,665 19,032

# Standard Auth Requests Processed in 14 Days 2,625 3,600 1,299 1,466 4,099 1,916 2341 1,664 19,010

% Processed in 14 Days 95.0% 99.7% 99.9% 99.9% 99.5% 99.9% 100.0% 100.0% 99.9% 99.9% 0.2%

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 418 782 170 578 161 386 654 869 4,018

# Expedited and Inpatient Auth Requests Processed in 3 Days 418 782 170 572 161 386 654 856 3,999

% Processed in 3 Days 95.0% 100.0% 100.0% 100.0% 99.0% 100.0% 100.0% 100.0% 98.5% 99.5% 0.4%

Total % of Auth Requests Processed in Required Timeframes 95.0% 99.7% 100.0% 99.9% 99.4% 99.9% 100.0% 100.0% 99.4% 99.8% 0.2%

Page 3 of 6

MCO Monthly Monitoring Report November 2015 Report 1/15/2016




Point


Mountain


DEV

# of Auth Requests Denied for Clinical Reasons 55 103 36 234 291 109 51 112 991

% of Total Auth Requests Denied for Clinical Reasons o 1.8% 2.3% 2.4% 11.4% 6.8% 4.7% 1.7% 4.4% 4.3% 3.1%

# of Administrative Denials 20 - 91 - 52 1 10 350 524

% of Total Auth Requests Denied for Admin Reasons o 0.7% 0.0% 6.2% 0.0% 1.2% 0.0% 0.3% 13.8% 2.3% 4.6%

Total # of Auth Requests Denied 75 103 127 234 343 110 61 462 1,515

% of Total Auth Requests Approved o 97.5% 97.7% 91.4% 88.6% 92.0% 95.2% 98.0% 81.8% 93.4% 5.3%

Number of Consumer Authorization Appeals received 8 17 7 25 19 16 3 1 96

Rate of Consumer Auth. Appeals per 1,000 persons svd o 0.5 0.9 1.7 2.5 1.9 1.8 0.3 0.1 1.1 0.83

Number of Authorizations overturned due to Consumer Appeals 1 5 - 5 5 5 1 - 22

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

Total # Clean Claim Received during Month (detail lines) 92,431 316,678 65,942 133,673 61,971 47,792 65,535 68,672 852,694

Rate of Claims Rcpt per Person Served o 5.6 16.6 15.7 13.3 6.3 5.4 5.6 6.3 9.4 4.64

# Paid 85,877 268,165 59,615 117,920 55,385 45,944 54,685 64,689 752,280

# Denied 6,551 48,287 6,253 15,753 6,445 1,848 10,848 3,964 99,949

# Pended or in Process 3 226 74 - 141 - 2 19 465

Percent Denied o 7.1% 15.3% 9.5% 11.8% 10.4% 3.9% 16.6% 5.8% 11.7% 4.2%

# Paid or Denied within 30 Days 91,342 316,452 65,810 133,635 61,971 47,787 64,486 68,652 850,135

Percent Processed within 30 Days 90.0% 98.8% 99.9% 99.8% 100.0% 100.0% 100.0% 98.4% 100.0% 99.6% 0.6%

Avg # days for Processing (from Receipt to Payment ) o 8.0 8.3 9.0 11.6 9.0 8.7 14.5 7.2 9.5 2.21

Number of Provider claim Appeals received 2 11 0 0 0 0 10 0 23

Rate of Provider Claim appeals per 1,000 persons served o 0.1 0.6 - 0.8 0.3 0.34

Number of claim denials overturned due to Provider Appeals 0 1 0 0 0 0 3 0 4

Complaints/Grievances Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Total number of complaints received (1 month prior) 51 58 15 5 23 22 29 16 219

Rate of Complaints per 1,000 Persons Served o 2.8 2.6 3.2 0.4 1.9 1.9 2.1 1.2 2.4 0.83

# Consumer complaints against provider 23 42 10 4 18 12 22 14 145

% Consumer complaints against provider o 45.1% 72.4% 66.7% 80.0% 78.3% 54.5% 75.9% 87.5% 66% 13.2%

# Consumer complaints against LME/MCO 2 15 4 - 5 3 5 2 36

% Consumer complaints against LME/MCO o 3.9% 25.9% 26.7% 0.0% 21.7% 13.6% 17.2% 12.5% 16% 9.1%

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

% Provider complaints against LME/MCO o 0.0% 0.0% 0.0% 0.0% 0.0% 4.5% 0.0% 0.0% 0% 1.5%

# of Other Types of Complaints 26 1 1 1 - 6 2 - 37

# of Complaints Resolved in 30 Days 51 58 15 5 23 22 28 16 218

Percent of Complaints resolved in 30 days 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.6% 100.0% 99.5%

Program Integrity--Fraud, Waste and Abuse Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

Number of Provider fraud and abuse cases under investigation by LME/MCO-New 9 5 6 23 12 36

872

Number of Provider fraud and abuse cases under investigation by LME/MCO-

Ongoing from previous month14 17 15 30 59 7

751

218

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

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


Page 4 of 6

LME/MCO Monthly Monitoring Report November 2015 Report 1/15/2016

State/Federal Block Grant Only LME/MCO:

Monitoring AreasStandard


Point


Mountain


DEV

Persons Served Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

Estimated number of Uninsured in Catchment Area 242,665 368,759 75,722 127,820 135,125 169,370 167,109 184,151 1,470,721

# Persons Receiving MH Services 3,615 2,274 916 1,701 1,518 1,362 2,390 2,173 15,949

% of Uninsured Receiving MH Services o 1.5% 0.6% 1.2% 1.3% 1.1% 0.8% 1.4% 1.2% 1.1% 0.28%

# Persons Receiving SA Services 1,053 1,050 272 572 658 500 820 1,659 6,584

% of Uninsured Receiving SA Services o 0.4% 0.3% 0.4% 0.4% 0.5% 0.3% 0.5% 0.9% 0.4% 0.18%

# Persons Receiving DD Services 809 839 255 559 504 446 607 694 4,713

% of Uninsured Receiving DD Services o 0.3% 0.2% 0.3% 0.4% 0.4% 0.3% 0.4% 0.4% 0.3% 0.06%

Unduplicated # Persons Receiving MH/DD/SA Services 5,338 4,163 1,406 2,660 2,595 2,308 3,696 3,914 26,080

% of Uninsured Receiving MH/DD/SA Services o 2.2% 1.1% 1.9% 2.1% 1.9% 1.4% 2.2% 2.1% 1.8% 0.38%

Community Psychiatric Hospitalization (1) Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

# of MH Admissions to Community Psychiatric Inpatient 78 189 84 64 203 38 114 82 852

Rate of MH Admissions per 1,000 Uninsured o 0.32 0.51 1.11 0.50 1.50 0.22 0.68 0.45 0.58 0.40

# of MH Admissions that were Readmissions within 30 days 4 4 10 5 11 1 10 9 54

% of MH Admissions that were Readmissions within 30 days o 5.1% 2.1% 11.9% 7.8% 5.4% 2.6% 8.8% 11.0% 6.3% 3.40%

# of MH Inpatient Discharges 73 97 62 69 108 43 119 103 674

MH Inpt Average Length of Stay (days) o 5.2 7.0 5.1 5.8 5.1 5.8 7.7 7.4 6.3 1.00

# of SA Admissions to Community Psychiatric Inpatient 0 6 13 16 20 16 13 5 89

Rate of SA Admissions per 1,000 Uninsured o - 0.02 0.17 0.13 0.15 0.09 0.08 0.03 0.06 0.06

# of SA Admissions that were Readmissions within 30 days 0 1 1 3 1 1 1 0 8

% of SA Admissions that were Readmissions within 30 days o 16.7% 7.7% 18.8% 5.0% 6.3% 7.7% 0.0% 9% 6.1%

# of SA Inpatient Discharges 0 8 8 17 15 20 14 9 91

SA Inpt Average Length of Stay (days) o - 6.3 4.8 5.2 3.9 3.6 5.6 7.3 5.0 2.07

Authorizations Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015 Nov 2015

Total Number of Auth Requests Received 824 1,225 623 314 895 1,054 673 511 6,119

# Standard Auth. Request Decisions 676 687 417 261 853 737 410 280 4,321

# Standard Auth Requests Processed in 14 Days 676 687 416 260 853 737 410 280 4,319

% Processed in 14 Days 95.0% 100.0% 100.0% 99.8% 99.6% 100.0% 100.0% 100.0% 100.0% 100.0% 0.00

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 148 538 206 53 42 317 263 231 1,798

# Expedited and Inpatient Auth Requests Processed in 3 Days 147 538 206 52 42 317 262 230 1,794

% Processed in 3 Days 95.0% 99.3% 100.0% 100.0% 98.1% 100.0% 100.0% 99.6% 99.6% 99.8% 0.01

Total % of Auth Requests Processed in Required Timeframes 95.0% 99.9% 100.0% 99.8% 99.4% 100.0% 100.0% 99.9% 99.8% 99.9% 0.00

# of Auth Requests Denied for Clinical Reasons 4 1 10 44 20 18 8 6 111

% of Total Auth Requests Denied for Clinical Reasons o 0.5% 0.1% 1.6% 14.0% 2.2% 1.7% 1.2% 1.2% 1.8% 4.3%

# of Administrative Denials - 2 - 9 - 3 77 91

% of Total Auth Requests Denied for Admin Reasons o 0.0% 0.0% 0.3% 0.0% 1.0% 0.0% 0.4% 15.1% 1.5% 4.9%

Total # of Auth Requests Denied 4 1 12 44 29 18 11 83 202

% of Total Auth Requests Approved o 99.5% 99.9% 98.1% 86.0% 96.8% 98.3% 98.4% 83.8% 97% 6.0%

Number of Consumer Authorization Appeals received 2 - - 2 1 3 0 1 9

Rate of Consumer Auth. Appeals per 1,000 persons svd o 0.4 - 0.8 0.4 1.3 0.3 0.3 0.42

Number of Authorizations overturned due to Consumer Appeals 1 - - - 1 - - - 2

NOTE: State/Federal Block Grant funds are not an entitlement and are not distributed on a per capita basis, and funding level may impact performance on some measures. Page 5 of 6

LME/MCO Monthly Monitoring Report November 2015 Report 1/15/2016




Point


Mountain


DEV

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

Total # Clean Claim Received during Month (header) 20,625 52,166 10,787 26,910 30,106 6,323 19,173 20,526 186,616

Rate of Claims Rcpt per Person Served o 3.9 12.5 7.7 10.1 11.6 2.7 5.2 5.2 7.16 3.45

# Paid 18,207 45,121 9,602 23,455 27,262 6,010 16,161 19,177 164,995

# Denied 2,418 7,045 1,185 3,455 2,844 313 2,985 1,344 21,589

# Pended or in Process 0 - - - - 27.0 5 32

Percent Denied o 11.7% 13.5% 11.0% 12.8% 9.4% 5.0% 15.6% 6.5% 11.6% 3.3%

# Paid or Denied within 30 Days 20,405 52,166 10,765 26,876 30,106 6,323 18,551 20,521 185,713

Percent Processed within 30 Days 90.0% 98.9% 100.0% 99.8% 99.9% 100.0% 100.0% 96.8% 100.0% 99.5% 0.01


Complaints Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Total number of complaints received (1 month prior) 13 15 2 19 3 3 10 7 72

Rate of Complaints per 1,000 Persons Served o 2.2 2.9 1.1 6.3 0.9 0.8 2.3 1.5 2.76 1.68

# Consumer complaints against provider 2 10 2 6 - 1 5 2 28

% Consumer complaints against provider o 15% 67% 100% 32% 0% 33% 50% 29% 39% 29.3%

# Consumer complaints against LME/MCO - - - 2 - - 2 3 7

% Consumer complaints against LME/MCO o 0% 0% 0% 11% 0% 0% 20% 43% 10% 14.5%

# Provider complaints against LME/MCO - - - 4 - - - 1 5

% Provider complaints against LME/MCO o 0% 0% 0% 21% 0% 0% 0% 14% 7% 7.8%

# of Other Types of Complaints 11 5 7 3 2 3 1 32

# of Complaints Resolved in 30 Days 13 15 2 19 3 3 10 7 72

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



Page 1 of 6

NC DHHS LME/MCO Performance SummaryOctober 2015 Report


DMA Performance Measures Standard Alli

ance

Car

dina

lC

ente

rPoi

ntE

astp

oint

eP

artn

ers

San

dhill

sS

mok

y M

ount

ain

Trill

ium

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











EXPLANATIONSAlliance: 80% of Inpatient Readmits Assigned to Care Coordination. Per Alliance, "October's percentage was affected by 3 members who did not have a care coordinator assigned. 1 of the 3 did not meet criteria for care coordination per the definitions. The other 2 have been assigned a care coordinator as of 11/5/15."

Page 2 of 6

LME/MCO Monthly Monitoring Report October 2015 ReportMedicaid and State Combined 12/22/2015

Monitoring Area Standard Alliance Cardinal Center- Point

Eastpointe Partners Sandhills Smoky Mountain

Trillium NC Total STD DEV

Call Center Total Number of Calls (re: services for consumers) 5,888 5,647 3,415 5,285 3,686 2810 4,921 2,655 31,652

# of Calls Abandoned 73 87 58 109 47 41 129 61 544% of calls Abandoned <5% 1.2% 1.5% 1.7% 2.1% 1.3% 1.5% 2.6% 2.3% 1.7%Avg Speed to Answer Calls (seconds) o 7.0 5.0 5.3 4.0 9.0 5.0 6.0 4.0 5.9 1.56

# of Calls Answered within 30 seconds 5,815 5,559 3,342 5,199 3,532 2,769 4786 2,594 31,002% Answered within 30 seconds 95% 98.8% 98.4% 97.9% 98.4% 95.8% 98.5% 97.3% 97.7% 97.9%IDD Wait ListNumber of Persons on the IDD Waitlist (snapshot on 1st of Month) 2,169 1,892 1,263 802 930 1,305 1,256 798 9,617

# of Persons on Registry of Unmet Needs for Innovations Waiver 2,122 1,821 1,262 802 891 1,183 1,060 654 9,141 % of Persons waiting who are on the Reg. of Unmet Needs o 98% 96% 100% 100% 96% 91% 84% 82% 95% 7%

# of Persons waiting for residential services - 55 - - 28 46 63 23 192 % of Persons waiting for residential services o 0% 3% 0% 0% 3% 4% 5% 3% 2% 2%

# of Persons waiting for ADVP 10 80 - - 6 76 - 27 172 % of Persons waiting for ADVP o 0% 4% 0% 0% 1% 6% 0% 3% 2% 2%

# of Persons waiting for vocational services - 2 1 - 20 - 32 7 55 % of Persons waiting for vocational services o 0% 0% 0% 0% 2% 0% 3% 1% 1% 1%

Service Status of Persons on the Waiting List# of Persons on Waitlist receiving B3 Services 296 565 246 66 114 263 244 75 1,794


# of Persons on Waitlist receiving State Services 640 203 341 252 269 158 768 320 2,631 % of Persons on Waitlist receiving State Services o 30% 11% 27% 31% 29% 12% 61% 40% 27% 15%

# of Persons on Waitlist receiving State and/or B3 services (undup) 696 704 510 318 257 421 831 334 3,737 % of Persons on Waitlist receiving State and/or B3 Services o 32% 37% 40% 40% 28% 32% 66% 42% 39% 11%

# of Persons on Waitlist not receiving any LME/MCO funded svcs 1,473 1,188 753 484 673 884 425 464 5,880 % of Persons on Waitlist not receiving any LME/MCO funded svcs o 68% 63% 60% 60% 72% 68% 34% 58% 61% 11%

Incidents Number of Level 2 Critical Incident Reports received 181 258 51 127 162 166 196 97 1,141 Number of Level 3 Critical Incident Reports received * 15 17 3 2 11 14 17 6 79 * All Level 3 Critical Incidents are reviewed by the LME/MCO to ensure Providers conduct internal investigation.

Department of Justice SettlementIndividuals in In-reach 471 829 224 358 352 312 621 594 3,761 Number of individuals in Transition Planning process 59 41 15 20 42 16 35 35 263 Number of Individuals Housed - Total 53 101 52 66 51 78 74 118 593




Page 3 of 6

MCO Monthly Monitoring Report October 2015 Report 12/22/2015



Alliance Cardinal Center- Point


Trillium Statewide STD DEV

Persons Served Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Unduplicated Count of Medicaid Members 207,143 342,247 77,735 190,302 137,979 165,340 154,594 169,929 1,445,269# Persons Receiving MH Services 13,168 14,577 2,778 8,906 7,861 8,868 8,347 8,169 72,674


# Persons Receiving SA Services 1,059 1,013 138 1,249 749 979 834 1,282 7,303 % of Members Receiving SA Services o 0.5% 0.3% 0.2% 0.7% 0.5% 0.6% 0.5% 0.8% 0.5% 0.2%

# Persons Receiving DD Services 2,848 4,017 860 1,623 2,004 1,928 2,128 1,687 17,095 % of Members Receiving DD Services o 1.4% 1.2% 1.1% 0.9% 1.5% 1.2% 1.4% 1.0% 1.2% 0.2%

Unduplicated # that received MH/DD/SA Services 16,494 19,607 3,733 10,960 10,184 11,775 11,035 10,165 93,953% of Members Receiving MH/DD/SA Services o 8.0% 5.7% 4.8% 5.8% 7.4% 7.1% 7.1% 6.0% 6.5% 1.0%

Community Psychiatric Hospitalization Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

# of MH Admissions to Community Psychiatric Inpatient 166 341 87 144 162 150 184 187 1,421Rate of MH Admissions per 1,000 Medicaid Members o 0.80 1.00 1.12 0.76 1.17 0.91 1.19 1.10 0.98 0.16

# of MH Admissions that were Readmissions within 30 days 15 20 10 12 20 15 19 23 134% of MH Admissions that were Readmissions within 30 days o 9.0% 5.9% 11.5% 8.3% 12.3% 10.0% 10.3% 12.3% 9.4% 2.1%

# of MH Inpatient Discharges 168 221 55 161 80 144 180 211 1,220MH Inpt Average Length of Stay (days) o 6.30 9.30 5.80 6.00 5.80 4.30 10.61 7.38 7.3 1.94

# of SA Admissions to Community Psychiatric Inpatient 0 19 5 11 7 19 2 4 67Rate of SA Admissions per 1,000 Medicaid Members o - 0.06 0.06 0.06 0.05 0.11 0.01 0.02 0.05 0.03

# of SA Admissions that were Readmissions within 30 days 0 3 0 4 0 3 0 1 11% of SA Admissions that were Readmissions within 30 days o 0.0% 15.8% 0.0% 36.4% 0.0% 15.8% 0.0% 25.0% 16% 13.1%

# of SA Inpatient Discharges 0 23 7 14 6 20 1 5 76SA Inpt Average Length of Stay (days) o - 3.8 3.0 4.0 3.4 3.6 8.0 6.3 3.9 2.21

Care Coordination Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

# of MH and SA Readmits assigned to a Care Coordinator 12 22 10 16 20 18 19 24 141% of Readmits assigned to Care Coordination 85.0% 80.0% 95.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.2%Emergency Dept Utilization (3 month lag) Jul 2015 Jul 2015 Jul 2015 Jul 2015 Jul 2015 Jul 2015 Jul 2015 Jul 2015 Jul 2015

# of ED Admits for persons with MHDDSA diagnoses 280 726 244 389 264 276 329 315 2,823Rate of ED Admits per 1,000 Medicaid Members o 1.34 2.01 3.20 2.01 1.78 1.63 2.07 1.77 2.0 0.51

# of ED Admits for persons who are active consumers 82 395 140 120 137 85 104 171 1,234% of ED Admits that were for active consumers o 29.3% 54.4% 57.0% 30.8% 51.9% 30.8% 31.6% 54.3% 44% 12.0%

# of ED Admits which were readmissions within 30 days 33 125 58 61 37 39 41 43 437% of ED Admissions Readmitted within 30 days o 11.8% 17.2% 24.0% 15.7% 14.0% 14.1% 12.5% 13.7% 15.5% 3.6%

Authorization Requests Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Total Number of Auth Requests Received 3,596 4,663 1,489 2,410 4,374 2,702 3,501 2,858 25,593# Standard Auth. Request Decisions 3,118 3,786 1,282 1,899 4,144 2,240 2763 1,791 21,023

# Standard Auth Requests Processed in 14 Days 3,107 3,786 1,278 1,888 4,144 2,240 2761 1,790 20,994% Processed in 14 Days 95.0% 99.6% 100.0% 99.7% 99.4% 100.0% 100.0% 99.9% 99.9% 99.9% 0.2%

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 478 877 207 511 230 462 738 1,067 4,570# Expedited and Inpatient Auth Requests Processed in 3 Days 477 875 204 499 230 462 737 1,059 4,543

% Processed in 3 Days 95.0% 99.8% 99.8% 98.6% 97.7% 100.0% 100.0% 99.9% 99.3% 99.4% 0.8%Total % of Auth Requests Processed in Required Timeframes 95.0% 99.7% 100.0% 99.5% 99.0% 100.0% 100.0% 99.9% 99.7% 99.8% 0.3%

Page 4 of 6

MCO Monthly Monitoring Report October 2015 Report 12/22/2015






# of Auth Requests Denied for Clinical Reasons 68 115 47 234 236 127 90 110 1,027% of Total Auth Requests Denied for Clinical Reasons o 1.9% 2.5% 3.2% 9.7% 5.4% 4.7% 2.6% 3.8% 4.0% 2.4%

# of Administrative Denials 52 - 97 - 50 - 13 367 579% of Total Auth Requests Denied for Admin Reasons o 1.4% 0.0% 6.5% 0.0% 1.1% 0.0% 0.4% 12.8% 2.3% 4.3%

Total # of Auth Requests Denied 120 115 144 234 286 127 103 477 1,606% of Total Auth Requests Approved o 96.7% 97.5% 90.3% 90.3% 93.5% 95.3% 97.1% 83.3% 93.7% 4.5%Number of Consumer Authorization Appeals received 19 25 7 31 21 12 17 10 142Rate of Consumer Auth. Appeals per 1,000 persons svd o 1.2 1.3 1.9 2.8 2.1 1.0 1.5 1.0 1.5 0.59 Number of Authorizations overturned due to Consumer Appeals 1 2 1 5 1 2 4 - 16Claims 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15

Total # Clean Claim Received during Month (detail lines) 91,471 303,706 63,603 139,809 62,222 49,851 79,774 128,493 918,929Rate of Claims Rcpt per Person Served o 5.5 15.5 17.0 12.8 6.1 4.2 7.2 12.6 9.8 4.61

# Paid 84,035 260,433 56,963 117,698 55,163 47,792 68,554 117,003 807,641# Denied 7,429 43,124 5,199 22,111 6,884 2,059 11,123 10,552 108,481# Pended or in Process 7 149 1 - 175 - 97 938 1,367

Percent Denied o 8.1% 14.2% 8.2% 15.8% 11.1% 4.1% 14.0% 8.3% 11.8% 3.7%

# Paid or Denied within 30 Days 90,514 303,557 62,171 139,146 62,222 49,848 76,318 127,558 911,334Percent Processed within 30 Days 90.0% 99.0% 100.0% 97.7% 99.5% 100.0% 100.0% 95.7% 99.3% 98.8% 1.5%


Number of Provider claim Appeals received 3 5 0 0 0 0 9 0 17Rate of Provider Claim appeals per 1,000 persons served o 0.2 0.3 - - - - 0.8 - 0.2 0.27 Number of claim denials overturned due to Provider Appeals 1 0 0 0 0 0 3 0 4Complaints/Grievances Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015Total number of complaints received (1 month prior) 57 36 18 6 11 17 29 22 196Rate of Complaints per 1,000 Persons Served o 3.2 1.5 4.1 0.5 0.9 1.4 2.1 1.5 2.1 1.12

# Consumer complaints against provider 23 30 15 3 9 14 15 15 124 % Consumer complaints against provider o 40.4% 83.3% 83.3% 50.0% 81.8% 82.4% 51.7% 68.2% 63% 16.7%

# Consumer complaints against LME/MCO 3 6 3 1 - - 10 7 30 % Consumer complaints against LME/MCO o 5.3% 16.7% 16.7% 16.7% 0.0% 0.0% 34.5% 31.8% 15% 12.3%

# Provider complaints against LME/MCO - - - - - 2 - - 2 % Provider complaints against LME/MCO o 0.0% 0.0% 0.0% 0.0% 0.0% 11.8% 0.0% 0.0% 1% 3.9%

# of Other Types of Complaints 31 - - 2 2 1 4 - 40 # of Complaints Resolved in 30 Days 56 36 18 6 10 17 29 21 193

Percent of Complaints resolved in 30 days 90.0% 98.2% 100.0% 100.0% 100.0% 90.9% 100.0% 100.0% 95.5% 98.5%Program Integrity--Fraud, Waste and Abuse Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Number of Provider fraud and abuse cases under investigation by LME/MCO-New

1 6 5 35 11 3 13 5 79Number of Provider fraud and abuse cases under investigation by LME/MCO-Ongoing from previous month

13 20 11 31 49 6 76 3 209Number of Enrollee fraud and abuse cases investigated by LME/MCO

0 0 0 0 0 0 0 0 0Number of Cases Referred to DMA Program Integrity 0 1 0 1 0 0 0 2 4Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3 consecutive months. Blue highlights indicate possible outliers.


LME/MCO Monthly Monitoring Report October 2015 Report 12/22/2015






Persons Served Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Estimated number of Uninsured in Catchment Area 242,665 368,759 75,722 127,820 135,125 169,370 167,109 184,151 1,470,721 # Persons Receiving MH Services 3,617 2,568 856 1,813 1,800 2,183 2,175 1,985 16,997


# Persons Receiving SA Services 946 1,004 219 625 748 749 738 1,546 6,575 % of Uninsured Receiving SA Services o 0.4% 0.3% 0.3% 0.5% 0.6% 0.4% 0.4% 0.8% 0.4% 0.17%

# Persons Receiving DD Services 790 792 176 636 525 619 656 596 4,790 % of Uninsured Receiving DD Services o 0.3% 0.2% 0.2% 0.5% 0.4% 0.4% 0.4% 0.3% 0.3% 0.09%

Unduplicated # Persons Receiving MH/DD/SA Services 5,230 4,364 1,217 2,877 2,961 3,551 3,509 3,624 27,333 % of Uninsured Receiving MH/DD/SA Services o 2.2% 1.2% 1.6% 2.3% 2.2% 2.1% 2.1% 2.0% 1.9% 0.34%Community Psychiatric Hospitalization (1) Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

# of MH Admissions to Community Psychiatric Inpatient 72 191 101 53 193 42 106 94 852 Rate of MH Admissions per 1,000 Uninsured o 0.30 0.52 1.33 0.41 1.43 0.25 0.63 0.51 0.58 0.43

# of MH Admissions that were Readmissions within 30 days 5 0 8 0 10 1 6 2 32 % of MH Admissions that were Readmissions within 30 days o 6.9% 0.0% 7.9% 0.0% 5.2% 2.4% 5.7% 2.1% 3.8% 2.87%

# of MH Inpatient Discharges 62 49 71 46 87 43 107 95 560 MH Inpt Average Length of Stay (days) o 5.3 7.9 4.9 4.2 4.6 4.8 7.4 6.6 5.9 1.31

# of SA Admissions to Community Psychiatric Inpatient 1 10 11 14 25 30 14 8 113 Rate of SA Admissions per 1,000 Uninsured o 0.00 0.03 0.15 0.11 0.19 0.18 0.08 0.04 0.08 0.06

# of SA Admissions that were Readmissions within 30 days 0 0 1 0 1 1 2 1 6 % of SA Admissions that were Readmissions within 30 days o 0.0% 0.0% 9.1% 0.0% 4.0% 3.3% 14.3% 12.5% 5% 5.4%

# of SA Inpatient Discharges 1 6 15 10 19 29 15 7 102 SA Inpt Average Length of Stay (days) o 7.0 4.0 4.9 3.4 4.2 3.5 5.6 7.3 4.5 1.41

Authorizations Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015 Oct 2015

Total Number of Auth Requests Received 1,043 1,289 589 595 972 1,115 712 539 6,854 # Standard Auth. Request Decisions 879 713 387 532 926 795 422 269 4,923

# Standard Auth Requests Processed in 14 Days 879 713 387 531 925 795 422 268 4,920 % Processed in 14 Days 95.0% 100.0% 100.0% 100.0% 99.8% 99.9% 100.0% 100.0% 99.6% 99.9% 0.00

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 164 576 202 63 46 320 290 270 1,931 # Expedited and Inpatient Auth Requests Processed in 3 Days 164 574 202 63 46 320 290 268 1,927

% Processed in 3 Days 95.0% 100.0% 99.7% 100.0% 100.0% 100.0% 100.0% 100.0% 99.3% 99.8% 0.00 Total % of Auth Requests Processed in Required Timeframes 95.0% 100.0% 99.8% 100.0% 99.8% 99.9% 100.0% 100.0% 99.4% 99.9% 0.00

# of Auth Requests Denied for Clinical Reasons 7 5 11 56 28 14 2 3 126 % of Total Auth Requests Denied for Clinical Reasons o 0.7% 0.4% 1.9% 9.4% 2.9% 1.3% 0.3% 0.6% 1.8% 2.9%

# of Administrative Denials - - 1 - 14 - 4 97 116 % of Total Auth Requests Denied for Admin Reasons o 0.0% 0.0% 0.2% 0.0% 1.4% 0.0% 0.6% 18.0% 1.7% 5.9%

Total # of Auth Requests Denied 7 5 12 56 42 14 6 100 242 % of Total Auth Requests Approved o 99.3% 99.6% 98.0% 90.6% 95.7% 98.7% 99.2% 81.4% 96% 5.9%Number of Consumer Authorization Appeals received - - - 2 5 1 0 - 8 Rate of Consumer Auth. Appeals per 1,000 persons svd o 0.7 1.7 0.3 0.3 0.59 Number of Authorizations overturned due to Consumer Appeals - - - - 1 - - - 1


LME/MCO Monthly Monitoring Report October 2015 Report 12/22/2015






Claims 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15 9/16 - 10/15

Total # Clean Claim Received during Month (header) 20,760 49,900 13,055 26,110 27,311 4,310 20,527 31,892 193,865 Rate of Claims Rcpt per Person Served o 4.0 11.4 10.7 9.1 9.2 1.2 5.8 8.8 7.09 3.31

# Paid 18,500 43,690 12,402 22,674 24,345 4,049 16,824 28,864 171,348 # Denied 2,260 6,210 653 3,436 2,966 261 3,650 2,828 22,264 # Pended or in Process 0 - - - - 53.0 200 253

Percent Denied o 10.9% 12.4% 5.0% 13.2% 10.9% 6.1% 17.8% 8.9% 11.5% 3.8%# Paid or Denied within 30 Days 20,532 49,900 12,922 26,060 27,311 4,308 20,124 31,693 192,850


Avg # days for Processing (from Receipt to Payment ) o 8.0 13.6 8.7 9.5 9.0 9.6 9.0 7.0 9.6 1.81 Complaints Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015Total number of complaints received (1 month prior) 17 17 1 25 11 5 11 14 101 Rate of Complaints per 1,000 Persons Served o 2.8 3.5 0.6 8.2 3.6 1.4 2.4 2.9 3.70 2.12

# Consumer complaints against provider 7 8 1 3 3 2 6 3 33 % Consumer complaints against provider o 41% 47% 100% 12% 27% 40% 55% 21% 33% 25.2%

# Consumer complaints against LME/MCO - - - 2 2 - 3 5 12 % Consumer complaints against LME/MCO o 0% 0% 0% 8% 18% 0% 27% 36% 12% 13.3%

# Provider complaints against LME/MCO - 2 - 4 - 2 - 3 11 % Provider complaints against LME/MCO o 0% 12% 0% 16% 0% 40% 0% 21% 11% 13.5%

# of Other Types of Complaints 10 7 - 16 6 1 2 3 45 # of Complaints Resolved in 30 Days 17 17 1 25 11 5 11 14 101

Percent of Complaints resolved in 30 days 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% - Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3 consecutive months. Blue highlights indicate possible outliers.

Page 1 of 6

NC DHHS LME/MCO Performance SummarySeptember 2015 Report


DMA Performance Measures Standard Alli

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











EXPLANATIONSAll LME-MCOs met all standards this month.

Page 2 of 6

LME/MCO Monthly Monitoring Report September 2015 ReportMedicaid and State Combined 11/13/2015

Monitoring Area Standard Alliance Cardinal Center- Point


Trillium NC Total STD DEV

Call Center Total Number of Calls (re: services for consumers) 5,859 5,497 3,675 5,157 3,728 2915 4,977 2,890 31,808

# of Calls Abandoned 70 100 68 109 89 75 104 40 615% of calls Abandoned <5% 1.2% 1.8% 1.9% 2.1% 2.4% 2.6% 2.1% 1.4% 1.9%Avg Speed to Answer Calls (seconds) o 7.0 5.0 4.4 4.0 8.0 5.0 6.0 4.0 5.6 1.37

# of Calls Answered within 30 seconds 5,789 5,397 3,560 5,059 3,590 2,840 4867 2,850 31,102% Answered within 30 seconds 95% 98.8% 98.2% 96.9% 98.1% 96.3% 97.4% 97.8% 98.6% 97.8%IDD Wait ListNumber of Persons on the IDD Waitlist (snapshot on 1st of Month) 2,121 1,891 1,247 788 926 1,251 1,243 756 9,467

# of Persons on Registry of Unmet Needs for Innovations Waiver 2,085 1,821 1,246 788 885 1,151 1,062 628 9,038 % of Persons waiting who are on the Reg. of Unmet Needs o 98% 96% 100% 100% 96% 92% 85% 83% 95% 6%

# of Persons waiting for residential services - 55 2 - 26 29 56 22 168 % of Persons waiting for residential services o 0% 3% 0% 0% 3% 2% 5% 3% 2% 2%

# of Persons waiting for ADVP - 80 - - 5 63 - 22 148 % of Persons waiting for ADVP o 0% 4% 0% 0% 1% 5% 0% 3% 2% 2%

# of Persons waiting for vocational services - 2 3 - 18 8 29 5 60 % of Persons waiting for vocational services o 0% 0% 0% 0% 2% 1% 2% 1% 1% 1%

Service Status of Persons on the Waiting List# of Persons on Waitlist receiving B3 Services 288 572 229 61 102 295 240 67 1,787


# of Persons on Waitlist receiving State Services 657 206 340 247 230 158 765 310 2,603 % of Persons on Waitlist receiving State Services o 31% 11% 27% 31% 25% 13% 62% 41% 27% 15%

# of Persons on Waitlist receiving State and/or B3 services (undup) 696 709 495 308 332 453 830 332 3,823 % of Persons on Waitlist receiving State and/or B3 Services o 33% 37% 40% 39% 36% 36% 67% 44% 40% 10%

# of Persons on Waitlist not receiving any LME/MCO funded svcs 1,425 1,182 752 480 594 798 413 424 5,644 % of Persons on Waitlist not receiving any LME/MCO funded svcs o 67% 63% 60% 61% 64% 64% 33% 56% 60% 10%

Incidents Number of Level 2 Critical Incident Reports received 171 231 58 80 150 109 189 108 988 Number of Level 3 Critical Incident Reports received * 13 12 4 6 18 9 17 10 79 * All Level 3 Critical Incidents are reviewed by the LME/MCO to ensure Provider conduct internal investigation.

Department of Justice SettlementIndividuals in In-reach 480 812 231 325 354 309 613 598 3,722 Number of individuals in Transition Planning process 49 46 14 16 38 23 35 34 255 Number of Individuals Housed - Total 53 99 50 66 49 76 71 116 580




Page 3 of 6

MCO Monthly Monitoring Report September 2015 Report 11/13/2015






Persons Served Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

Unduplicated Count of Medicaid Members 205,456 344,400 76,290 189,440 136,743 169,415 155,164 170,131 1,447,039# Persons Receiving MH Services 11,183 15,421 2,706 8,259 7,409 7,173 9,173 9,474 70,798


# Persons Receiving SA Services 851 1,630 229 1,125 1,423 783 1,377 1,440 8,858 % of Members Receiving SA Services o 0.4% 0.5% 0.3% 0.6% 1.0% 0.5% 0.9% 0.8% 0.6% 0.2%

# Persons Receiving DD Services 2,388 3,892 881 1,143 1,765 1,306 1,809 1,637 14,821 % of Members Receiving DD Services o 1.2% 1.1% 1.2% 0.6% 1.3% 0.8% 1.2% 1.0% 1.0% 0.2%

Unduplicated # that received MH/DD/SA Services 13,905 20,943 3,735 10,108 10,163 9,262 12,069 11,302 91,487% of Members Receiving MH/DD/SA Services o 6.8% 6.1% 4.9% 5.3% 7.4% 5.5% 7.8% 6.6% 6.3% 1.0%

Community Psychiatric Hospitalization Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

# of MH Admissions to Community Psychiatric Inpatient 142 336 85 103 175 66 185 173 1,265Rate of MH Admissions per 1,000 Medicaid Members o 0.69 0.98 1.11 0.54 1.28 0.39 1.19 1.02 0.87 0.30

# of MH Admissions that were Readmissions within 30 days 14 19 8 6 21 6 23 17 114% of MH Admissions that were Readmissions within 30 days o 9.9% 5.7% 9.4% 5.8% 12.0% 9.1% 12.4% 9.8% 9.0% 2.3%

# of MH Inpatient Discharges 161 266 60 138 77 92 164 196 1,154MH Inpt Average Length of Stay (days) o 6.40 9.10 6.10 6.00 5.80 4.70 10.59 11.15 8.2 2.28

# of SA Admissions to Community Psychiatric Inpatient 2 24 6 9 14 12 8 4 79Rate of SA Admissions per 1,000 Medicaid Members o 0.01 0.07 0.08 0.05 0.10 0.07 0.05 0.02 0.05 0.03

# of SA Admissions that were Readmissions within 30 days 0 0 0 0 3 1 1 1 6% of SA Admissions that were Readmissions within 30 days o 0.0% 0.0% 0.0% 0.0% 21.4% 8.3% 12.5% 25.0% 8% 9.6%

# of SA Inpatient Discharges 2 31 6 9 8 14 8 4 82SA Inpt Average Length of Stay (days) o 4.5 5.2 4.7 4.0 5.5 4.0 6.6 5.3 5.0 0.82

Care Coordination Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

# of MH and SA Readmits assigned to a Care Coordinator 13 19 8 6 24 7 24 18 119% of Readmits assigned to Care Coordination 85.0% 92.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.2%Emergency Dept Utilization (3 month lag) June 2015 June 2015 June 2015 June 2015 June 2015 June 2015 June 2015 June 2015 June 2015

# of ED Admits for persons with MHDDSA diagnoses 278 738 141 378 228 293 362 341 2,759Rate of ED Admits per 1,000 Medicaid Members o 1.4 2.1 1.8 2.0 1.7 1.7 2.3 2.0 1.9 0.28

# of ED Admits for persons who are active consumers% of ED Admits that were for active consumers o

# of ED Admits which were readmissions within 30 days 29 129 24 71 19 45 47 49 413% of ED Admissions Readmitted within 30 days o 10.4% 17.5% 17.0% 18.8% 8.3% 15.4% 13.0% 14.4% 15.0% 3.4%

Authorization Requests Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

Total Number of Auth Requests Received 3,139 3,539 1,287 2,472 4,505 2,828 3,440 2,804 24,014# Standard Auth. Request Decisions 2,705 2,881 1,089 2,013 4,281 2,352 2704 1,892 19,917

# Standard Auth Requests Processed in 14 Days 2,698 2,879 1,086 2,012 4,280 2,352 2700 1,889 19,896% Processed in 14 Days 95.0% 99.7% 99.9% 99.7% 100.0% 100.0% 100.0% 99.9% 99.8% 99.9% 0.1%

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 434 658 198 459 224 476 736 912 4,097# Expedited and Inpatient Auth Requests Processed in 3 Days 434 658 197 446 224 476 733 903 4,071

% Processed in 3 Days 95.0% 100.0% 100.0% 99.5% 97.2% 100.0% 100.0% 99.6% 99.0% 99.4% 1.0%Total % of Auth Requests Processed in Required Timeframes 95.0% 99.8% 99.9% 99.7% 99.4% 100.0% 100.0% 99.8% 99.6% 99.8% 0.2%

Method Under Revision

Page 4 of 6

MCO Monthly Monitoring Report September 2015 Report 11/13/2015






# of Auth Requests Denied for Clinical Reasons 48 153 38 247 219 110 77 105 997% of Total Auth Requests Denied for Clinical Reasons o 1.5% 4.3% 3.0% 10.0% 4.9% 3.9% 2.2% 3.7% 4.2% 2.4%

# of Administrative Denials 91 - 16 - 55 - 6 330 498% of Total Auth Requests Denied for Admin Reasons o 2.9% 0.0% 1.2% 0.0% 1.2% 0.0% 0.2% 11.8% 2.1% 3.8%

Total # of Auth Requests Denied 139 153 54 247 274 110 83 435 1,495% of Total Auth Requests Approved o 95.6% 95.7% 95.8% 90.0% 93.9% 96.1% 97.6% 84.5% 93.8% 4.1%Number of Consumer Authorization Appeals received 18 35 1 15 22 16 22 8 137Rate of Consumer Auth. Appeals per 1,000 persons svd o 1.3 1.7 0.3 1.5 2.2 1.7 1.8 0.7 1.5 0.58 Number of Authorizations overturned due to Consumer Appeals 2 3 1 3 3 8 5 1 26Claims 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15

Total # Clean Claim Received during Month (detail lines) 97,623 357,457 70,150 159,608 74,964 51,900 88,664 138,758 1,039,124Rate of Claims Rcpt per Person Served o 7.0 17.1 18.8 15.8 7.4 5.6 7.3 12.3 11.4 4.90

# Paid 90,240 311,971 63,416 142,410 68,310 50,131 75,373 124,635 926,486# Denied 7,383 45,473 6,734 17,197 6,262 1,769 13,284 12,889 110,991# Pended or in Process - 13 - 1 392 - 7 1,234 1,647

Percent Denied o 7.6% 12.7% 9.6% 10.8% 8.4% 3.4% 15.0% 9.4% 10.7% 3.2%

# Paid or Denied within 30 Days 96,508 357,444 70,023 158,718 74,965 51,893 86,359 137,527 1,033,437Percent Processed within 30 Days 90.0% 98.9% 100.0% 99.8% 99.4% 100.0% 100.0% 97.4% 99.1% 99.4% 0.9%


Number of Provider claim Appeals received 23 19 0 4 0 0 14 0 60Rate of Provider Claim appeals per 1,000 persons served o 1.7 0.9 - 0.4 1.2 0.7 0.58 Number of claim denials overturned due to Provider Appeals 21 0 0 0 0 0 5 0 26Complaints/Grievances Aug 2015 Aug 2015 Aug 2015 Aug-15 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015Total number of complaints received (1 month prior) 60 46 13 11 16 15 28 28 217Rate of Complaints per 1,000 Persons Served o 3.5 2.0 2.8 1.0 1.3 1.3 2.1 2.0 2.4 0.79

# Consumer complaints against provider 24 36 11 7 11 9 17 15 130 % Consumer complaints against provider o 40.0% 78.3% 84.6% 63.6% 68.8% 60.0% 60.7% 53.6% 60% 13.0%

# Consumer complaints against LME/MCO 1 10 2 - 5 2 6 13 39 % Consumer complaints against LME/MCO o 1.7% 21.7% 15.4% 0.0% 31.3% 13.3% 21.4% 46.4% 18% 14.2%

# Provider complaints against LME/MCO 3 - - - - 1 - - 4 % Provider complaints against LME/MCO o 5.0% 0.0% 0.0% 0.0% 0.0% 6.7% 0.0% 0.0% 2% 2.6%

# of Other Types of Complaints 32 - - 4 - 3 5 - 44 # of Complaints Resolved in 30 Days 60 46 13 11 16 15 27 28 216

Percent of Complaints resolved in 30 days 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.4% 100.0% 99.5%Program Integrity--Fraud, Waste and Abuse Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

Number of Provider fraud and abuse cases under investigation by LME/MCO-New

4 8 5 34 18 3 4 4 80Number of Provider fraud and abuse cases under investigation by LME/MCO-Ongoing from previous month

14 22 4 36 65 9 84 6 240Number of Enrollee fraud and abuse cases investigated by LME/MCO

0 0 0 0 0 0 0 0 0Number of Cases Referred to DMA Program Integrity 0 0 0 3 0 1 0 0 4Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3 consecutive months. Blue highlights indicate possible outliers.


LME/MCO Monthly Monitoring Report September 2015 Report 11/13/2015






Persons Served Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

Estimated number of Uninsured in Catchment Area 242,665 368,759 75,722 127,820 135,125 169,370 167,109 184,151 1,470,721 # Persons Receiving MH Services 2,899 2,474 837 1,686 1,359 2,064 2,579 2,265 16,163


# Persons Receiving SA Services 787 1,129 428 559 675 687 908 1,687 6,860 % of Uninsured Receiving SA Services o 0.3% 0.3% 0.6% 0.4% 0.5% 0.4% 0.5% 0.9% 0.5% 0.18%

# Persons Receiving DD Services 723 706 188 597 456 544 548 615 4,377 % of Uninsured Receiving DD Services o 0.3% 0.2% 0.2% 0.5% 0.3% 0.3% 0.3% 0.3% 0.3% 0.07%

Unduplicated # Persons Receiving MH/DD/SA Services 4,303 4,309 1,412 2,660 2,413 3,295 3,928 3,979 26,299 % of Uninsured Receiving MH/DD/SA Services o 1.8% 1.2% 1.9% 2.1% 1.8% 1.9% 2.4% 2.2% 1.8% 0.33%Community Psychiatric Hospitalization (1) Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

# of MH Admissions to Community Psychiatric Inpatient 85 162 89 20 221 24 97 47 745 Rate of MH Admissions per 1,000 Uninsured o 0.35 0.44 1.18 0.16 1.64 0.14 0.58 0.26 0.51 0.50

# of MH Admissions that were Readmissions within 30 days 2 4 4 1 13 0 12 3 39 % of MH Admissions that were Readmissions within 30 days o 2.4% 2.5% 4.5% 5.0% 5.9% 0.0% 12.4% 6.4% 5.2% 3.46%

# of MH Inpatient Discharges 92 70 58 20 113 32 90 44 519 MH Inpt Average Length of Stay (days) o 5.3 7.6 5.9 2.4 5.2 4.3 6.9 7.6 5.9 1.65

# of SA Admissions to Community Psychiatric Inpatient 2 5 10 2 10 6 14 8 57 Rate of SA Admissions per 1,000 Uninsured o 0.01 0.01 0.13 0.02 0.07 0.04 0.08 0.04 0.04 0.04

# of SA Admissions that were Readmissions within 30 days 0 0 2 1 1 0 4 0 8 % of SA Admissions that were Readmissions within 30 days o 0.0% 0.0% 20.0% 50.0% 10.0% 0.0% 28.6% 0.0% 14% 17.1%

# of SA Inpatient Discharges 1 4 18 8 6 8 14 9 68 SA Inpt Average Length of Stay (days) o 5.0 6.5 5.7 2.0 5.3 4.2 5.7 7.3 5.3 1.50

(1) Community Psychiatric Hospitalization includes 3-Way Contract funded beds, which are not distributed evenly across LME-MCO catchment areas, and may impact utilzation rates.Authorizations Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015 Sep 2015

Total Number of Auth Requests Received 916 1,029 534 454 945 1,240 684 494 6,296 # Standard Auth. Request Decisions 748 705 335 377 902 942 435 270 4,714

# Standard Auth Requests Processed in 14 Days 748 702 335 375 902 942 435 270 4,709 % Processed in 14 Days 95.0% 100.0% 99.6% 100.0% 99.5% 100.0% 100.0% 100.0% 100.0% 99.9% 0.00

# Auth Requests requiring Expedited Decisions, inclusive of Inpatient 168 324 199 77 43 298 249 224 1,582 # Expedited and Inpatient Auth Requests Processed in 3 Days 168 320 199 74 43 298 249 222 1,573

% Processed in 3 Days 95.0% 100.0% 98.8% 100.0% 96.1% 100.0% 100.0% 100.0% 99.1% 99.4% 0.01 Total % of Auth Requests Processed in Required Timeframes 95.0% 100.0% 99.3% 100.0% 98.9% 100.0% 100.0% 100.0% 99.6% 99.8% 0.00

# of Auth Requests Denied for Clinical Reasons 9 6 5 64 20 6 4 6 120 % of Total Auth Requests Denied for Clinical Reasons o 1.0% 0.6% 0.9% 14.1% 2.1% 0.5% 0.6% 1.2% 1.9% 4.4%

# of Administrative Denials 2 - 33 - 9 - 0 92 136 % of Total Auth Requests Denied for Admin Reasons o 0.2% 0.0% 6.2% 0.0% 1.0% 0.0% 0.0% 18.6% 2.2% 6.1%

Total # of Auth Requests Denied 11 6 38 64 29 6 4 98 256 % of Total Auth Requests Approved o 98.8% 99.4% 92.9% 85.9% 96.9% 99.5% 99.4% 80.2% 96% 6.9%Number of Consumer Authorization Appeals received - - - 1 5 - 0 - 6 Rate of Consumer Auth. Appeals per 1,000 persons svd o 0.4 2.1 0.2 0.85 Number of Authorizations overturned due to Consumer Appeals - - - - - - 1 - 1


LME/MCO Monthly Monitoring Report September 2015 Report 11/13/2015






Claims 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15 8/16 - 9/15

Total # Clean Claim Received during Month (header) 23,349 58,206 19,813 34,529 31,544 4,407 23,161 45,797 240,806 Rate of Claims Rcpt per Person Served o 5.4 13.5 14.0 13.0 13.1 1.3 5.9 11.5 9.16 4.49

# Paid 19,760 51,944 18,793 27,178 29,077 4,200 19,564 40,540 211,056 # Denied 3,589 6,262 1,020 7,351 2,467 207 3,597 4,950 29,443 # Pended or in Process 0 - - - - - - 307 307

Percent Denied o 15.4% 10.8% 5.1% 21.3% 7.8% 4.7% 15.5% 10.9% 12.2% 5.3%# Paid or Denied within 30 Days 23,114 58,206 19,780 33,695 31,544 4,395 22,698 45,490 238,922


Avg # days for Processing (from Receipt to Payment ) o 9.0 8.4 7.8 5.0 8.9 9.8 8.8 7.0 8.2 1.40 Complaints Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015 Aug 2015Total number of complaints received (1 month prior) 14 14 6 17 5 1 6 13 76 Rate of Complaints per 1,000 Persons Served o 2.3 2.8 3.1 5.5 1.6 0.3 1.3 2.8 2.89 1.45

# Consumer complaints against provider 2 7 3 2 1 1 4 7 27 % Consumer complaints against provider o 14% 50% 50% 12% 20% 100% 67% 54% 36% 28.0%

# Consumer complaints against LME/MCO - 1 3 2 1 - 1 1 9 % Consumer complaints against LME/MCO o 0% 7% 50% 12% 20% 0% 17% 8% 12% 15.1%

# Provider complaints against LME/MCO 1 1 5 - - - 3 10 % Provider complaints against LME/MCO o 7% 7% 0% 29% 0% 0% 0% 23% 13% 10.9%

# of Other Types of Complaints 11 5 - 8 3 - 1 2 30 # of Complaints Resolved in 30 Days 14 14 6 17 5 1 6 13 76

Percent of Complaints resolved in 30 days 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% - Yellow Highlights indicate the MCO did not meet the Standard Pink Highlights indicate the MCO did not meet the Standard for 3 consecutive months. Blue highlights indicate possible outliers.

February 4, 2016 From: Geyer Longenecker To: Global QM Committee Re: Care Coordination assignment compliance update Issue: During October 2015, Alliance did not meet the state’s standard of 85% for assigning inpatient readmissions to care coordination. Analysis: During October 2015, Alliance assigned 12 of 15 readmissions (80%). An analysis of the three cases where no assignment was made found:

In one case, Alliance had no documentation of hospital liaison/care coordination involvement.

In two cases, Alliance had documentation of involvement by the hospital liaison but no proper documentation of assignment.

QM staff conducted a review of Care Coordination procedures and assignment reporting practices and determined that:

State criteria for assigning care coordination is inconsistent with Alliance’s criteria. While the state counts assignments in all readmission cases, Alliance does not assign care coordination in every case. For example, care coordination is assigned when a consumer has three readmissions in one year.

Procedures state that the Care Coordination manager is responsible for making assignment decision. Actions: On January 7, QM staff met with Care Coordination team leads. All agreed that:

Alliance will continue to use its internal criteria for Care Coordination assignment

The Care Coordination manager will document all assignment decisions.

QM will count as assigned those cases where there is proper review and documentation of the Care Coordination manager’s review and decision, even when there is no actual assignment.

QM and Care Coordination leadership will meet again on January 28 to review progress. Results: Care coordination assignment met the state’s standard in November (90%) and December (100%).

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

Pat McCrory Richard O. Brajer

Governor Secretary DHHS

Courtney M. Cantrell, PhD

Division Director

www.ncdhhs.gov • www.ncdhhs.gov/mhddsas/

Tel 919-733-7011 • Fax 919-508-0951

Location: 306 N. Wilmington St. • Bath Building • Raleigh, NC 27601

Mailing Address: 3001 Mail Service Center • Raleigh, NC 27699-3001

An Equal Opportunity / Affirmative Action Employer

December 31, 2015

MEMORANDUM

TO: Rob Robinson, CEO

FROM: Courtney Cantrell

RE: First Quarter SFY 2016 Compliance with Reporting Requirements in the DHHS-LME

Performance Contract

The DHHS-LME Performance Contract requires LME-MCOs to submit reports and data in accordance

with contractual requirements1. The purpose of this memorandum is to provide information on your LME-

MCO’s compliance with these requirements (timeliness, completeness, accuracy) in the first quarter of

SFY 2015-16. Monitoring of the fiscal requirements helps to ensure essential data integrity and provides

reliable information needed for Federal reporting and for the oversight of specific program spending.

The direct outcome of the report reviews and the follow-up actions taken by LME-MCOs for Complaints,

SAJJ, TBI, Work First, NC-TOPPS, CDW and NCSNAP result in improvements in program access for

individuals served and their families. These reports also directly impact increases in the accountability

and effectiveness of LME-MCO and provider systems associated with improved client identification,

participation, quality of care and service outcomes.

LME-MCOs routinely review their individual results within their quality management committees for

quality assurance and improvement, as well as with their area boards and CFACs. CEOs have used these

reports for LME-MCO self-monitoring, and these reports have been instrumental in the adoption and

implementation of local improvement projects to enhance LME-MCO performance.

1 A schedule of reports is posted on the DMHDDSAS website’s Performance Contracts page at:

http://www2.ncdhhs.gov/mhddsas/statspublications/Contracts/Performancecontracts/fy14/lmeperformancerequirements6-14.pdf.

http://www.ncdhhs.gov/

http://www2.ncdhhs.gov/mhddsas/statspublications/Contracts/Performancecontracts/fy14/lmeperformancerequirements6-14.pdf

Alliance Behavioral Healthcare Report Submission Requirement

SFY 2016 1st Qtr

Monthly Financial Reports

Substance Abuse/Juvenile Justice Initiative Quarterly Report

Work First Initiative Quarterly Reports

Traumatic Brain Injury (TBI) Services Quarterly Report

Quarterly Complaints Report

System of Care Report N/A

SAPTBG Compliance Report N/A

National Core Indicators (NCI) Consents, Pre-Surveys, and Mail Surveys N/A

Percent of Report Submissions Met 80%

Statewide - Percent of Report Submissions Met 95%

= Report met requirements for being timely and complete/accurate

Data Submission Requirement SFY 2016

1st Qtr

Client Data Warehouse (CDW) - Screening Record

Client Data Warehouse (CDW) - ICD-9 Diagnosis

Client Data Warehouse (CDW) - Unknown Data (Admissions)

Client Data Warehouse (CDW) - Unknown Data (Discharges)

Client Data Warehouse (CDW) - Identifying and Demographic Records

Client Data Warehouse (CDW) - Drug of Choice

Client Data Warehouse (CDW) - Episode Completion Record (SA Clients)

NC Treatment Outcomes and Program Performance System (Update)

NC Support Needs Assessment Profile (NC-SNAP)

Percent of Data Submissions Met 78%

Statewide - Percent of Data Submissions Met 90%

= ≥ 90% of records were timely and/or complete

Your LME-MCO met 80 percent of the five report submission requirements and 78 percent of the nine

data submission requirements measured for the first quarter. Your LME-MCO liaison will contact you or

designated staff to discuss any issues you are encountering in meeting the Division’s expectations.

Statewide the LME-MCOs met 95 percent of the five report submission requirements and 90 percent of

the nine data submission/report requirements measured for the first quarter of SFY 2015-16.

A two page mini-report is enclosed that provides additional information for each measure as well as graphs

displaying performance trends for the two categories of measures over the most recent nine quarters for

your LME-MCO and the state.

If you have questions, please contact your LME-MCO liaison. He or she will assist in getting answers to

questions and/or having errors corrected.

CC: Dale Armstrong

Dave Richard

Sandy Terrell

Kathy Nichols

Mabel McGlothlen

Requirement TimelyAccurate & Complete

Other Criteria

Standard Met

% of LMEs that Met Standard

Reports

1. Monthly Financial Reports No No 75%

2. Substance Abuse/Juvenile Justice Initiative Quarterly Report Yes Yes 100%

3. Work First Initiative Quarterly Reports Yes Yes 100%

4. Traumatic Brain Injury (TBI) Services Quarterly Report Yes Yes 100%

5. Quarterly Complaints Report Yes Yes 100%

17. System of Care Report N/A N/A N/A N/A

18. SAPTBG Compliance Report (Other Criteria: Met Synar Requirement N/A N/A N/A N/A N/A

19. National Core Indicators (NCI) Consents, Pre-Surveys, and Mail Surveys N/A N/A N/A N/A

Overall Percentage of Reports Met 80% 80% N/A 80% 95%

Data≥ 90% of records are timely

and/or completeAll data

items ≥ 90%

6. Client Data Warehouse (CDW) - Screening Record 100% 88%

8. Client Data Warehouse (CDW) - Diagnosis Record 96% 100%

9. Client Data Warehouse (CDW) - Unknown Data (Admissions) 98% Met 100%

10. Client Data Warehouse (CDW) - Unknown Data (Discharges) 100% Met 100%

11. Client Data Warehouse (CDW) - Identifying and Demographic Records 98% 100%

12. Client Data Warehouse (CDW) - Drug of Choice 97% 88%

13. Client Data Warehouse (CDW) - Episode Completion Record (SA Clients) 81% 63%

15. NC Treatment Outcomes and Program Performance System (Update) 85% 93% 75%

16. NC Support Needs Assessment Profile (NC-SNAP) 91% 100%

Overall Percentage of Data Met 85% 95% 100% 78% 90%

SFY 2016 First Quarter LME-MCO Compliance with Reports & Data Requirements


This chart shows the LME-MCO's performance and the percent of all LME-MCOs that met the standard on submitting reports and data to the Division of MH/DD/SAS during the report quarter at the top of the chart, as required by the NC DHHS - LME-MCO Performance Contract. Percentages less than 90% and items that did not meet timeliness, accuracy, completeness, and other criteria are shaded red. Reporting requirements can be found at: http://www2.ncdhhs.gov/mhddsas/statspublications/contracts.

If LME-MCO staff have questions about any of the individual requirements or believe that information contained in this chart is in error, they should contact their LME-MCO liaison within 30 days of the report date. The LME-MCO liaison will assist in getting answers to questions and/or having errors corrected. The Division will send the LME-MCO a revised report if corrections are necessary due to Division errors.

Report Date: 11/30/2015 Page 1

10

0%

10

0%

80

%

10

0%

40

%

10

0%

10

0%

10

0%

80

%

95

%

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%

86

%

89

%

80

%

95

%

98

%

99

%

95

%

S F Y1 4 - Q 1 S F Y1 4 - Q 2 S F Y1 4 - Q 3 S F Y1 4 - Q 4 S F Y1 5 - Q 1 S F Y1 5 - Q 2 S F Y1 5 - Q 3 S F Y1 5 - Q 4 S F Y1 6 - Q 1

% R

EP

OR

T S

UB

MIS

SIO

NS

ME

AS

UR

ES

ME

T

ALLIANCE BEHAVIORAL HEALTHCARE REPORT SUBMISSION Alliance Behavioral Healthcare Statewide LME-MCO Trend

56

%

56

%

67

%

56

%

67

%

67

%

67

%

67

%

78

%84

%

81

%

78

% 81

%

81

%

81

% 85

% 88

% 90

%

S F Y1 4 - Q 1 S F Y1 4 - Q 2 S F Y1 4 - Q 3 S F Y1 4 - Q 4 S F Y1 5 - Q 1 S F Y1 5 - Q 2 S F Y1 5 - Q 3 S F Y1 5 - Q 4 S F Y1 6 - Q 1

% D

AT

A S

UB

MIS

SIO

N M

EA

SU

RE

S M

ET

ALLIANCE BEHAVIORAL HEALTHCARE DATA SUBMISSIONAlliance Behavioral Healthcare Statewide LME-MCO Trend

These graphs show Alliance Behavioral Healthcare’s overall performance compared with the state average (timeliness, completeness, accuracy) on submitting reports and data to the Division of MH/DD/SAS over the most recent 9 quarters as required by the DHHS - LME-MCO Performance Contract. Reporting requirements can be found at: http://www2.ncdhhs.gov/mhddsas/statspublications/contracts. The first set of graphs shows the percentage of report submission measures that were met, and the second set of graphs shows the percentage of data submission measures that were met.

Report Date: 11/30/2015 Page 2

February 4, 2016 From: Geyer Longenecker To: Global QM Committee Re: NC-TOPPS compliance update Issue: In its Q1 FY2016 Performance Summary report, DMA notes that Alliance’s timely NC-TOPPS submission rate of 84.29% did not meet the state’s standard of 90%. Actions Taken During Q1 FY2016:

Two agencies were removed from our network (Healthcore Resources and A United Community); both had NC-TOPPS compliance issues.

A new NC-TOPPS staff member started in August (Schuyler Moreno) – first time since May 2015 there was a staff dedicated to the process.

Actions Take During Q2 FY 2016:

400% increase in Plans of Corrections from 2 to 8.

Process modified to issue POCs to specific sites, and not just to the individual provider.

Withdrawal of Family Legacy will likely positively impact our compliance rate. Results: The Q2 FY 2016 NC-TOPPS timeliness compliance rate was 84.29%. Compliance increased each month: October: 76.29% November: 85.42% December: 91.16% Suggested Interventions: Increase communications with providers; send warning letters to providers who have had less than 90% compliance for two of the past three months. Further modify the POC process to target agencies as well as specific sites. For example, a site may be out of compliance for only one month, but the overall agency as a whole may be out of compliance for several months in a row. We need to issue POCs to the agency where compliance is a systemic issue.

February 4, 2016 From: Geyer Longenecker To: Global QM Committee Re: Finance compliance update Issue: In its Q1 FY2016 Performance Summary report, DMA notes that Alliance’s Monthly Financial Reports were not submitted in a complete/timely fashion. Analysis: DMA confirms that the report was submitted on time, but it was not being complete. Specifically, there was no data reported for Path MOE. Finance explains that no claims are submitted for Path MOE, and that the report was left blank to indicate this. Action: Going forward, Alliance will enter a zero in the Path MOE section of the report.

February 4, 2016 From: Geyer Longenecker To: Global QM Committee Re: CDW compliance update Issue: In its Q1 FY2016 Performance Summary report, DMA notes that one element of Alliance’s CDW submissions during Q1 FY2016 did not meet the state’s standard of 90%:

CDW REPORT

Q1 FY 2016

% Complete of the various required

elements for report

Unknown Mandatory New Fields Report 98% - 100%

Unknown Mandatory New Discharge Fields Report 98% – 100%

Unknown Mandatory Fields Report 96% - 100%

Screening Compliance Report Discontinued

Missing Substance Abuse Report 96%

Missing Identifying And Demographic Report 98%

Missing Activity for SA only Admissions Report 62%

Missing Diagnosis Report 96%

Analysis: The IT Department has discovered that the stored procedure Alpha created to process SA admission reports is not working in all cases. After speaking with Alpha, IT has decided that the best option is to manually handle the SA reports through AlphaMCS.

Provider MonitoringProvider Network Evaluation Unit

2/4/16

Routine Monitoring

• The Routine Monitoring Process and Tools were developed by a DHHS/LME-MCO/Provider workgroup to ensure consistent regulatory compliance measures to monitor providers across the state.

• Monitoring using the Gold Star Monitoring process and tools was conducted from April through December 2013. Monitoring was discontinued till March 2014 to allow for development and roll out of new streamlined Routine Monitoring tools. In October 2015, post payment reviews were expanded to include therapeutic foster care.

• The Routine Monitoring Process states that providers will be monitored every 2 years.

Routine Tool

• Routine Monitoring typically consists of a routine tool and post-payment review tools.

• For providers of only residential or opioid treatment services, which are monitored annually by DHSR, only the post-payment review tool is done.

• Providers contracted with multiple MCOs have raised the concern about duplication of monitoring efforts. Legal has been working on reciprocity agreements in which we can accept each other’s routine monitoring tools. However, each MCO is required to conduct their own post payment reviews.

• As the reciprocity agreements have not been finalized, but providers have expressed concerns about duplication of effort, we have conducted only the post payment review for providers whose corporate site is outside our catchment area.

Routine Monitoring • The routine tool has the following sections:

• There are a number of post-payment tools. Tools are based on the type of service, such as Innovations, Residential, PTRF etc.

• Providers must score 85% on each subsection of the routine tool or post-payment tools to pass that section. Plans of correction are required when providers do not pass or if systemic issues are identified. Recoupment is required for claims found out of compliance on the post payment tools.

Agency Routine Review LIP Routine Review

Rights Notification Rights Notification

Incidents, Restrictive Interventions and Complaints Care Coordination/Service Availability

Coordination of Care/Crisis Services Storage of Records

Medication Review (when applicable)

Review Scores FY 2015, FY 2016 Q1 and 2

12

89

2321

1011

4

7

1 1 1

12

8

19

31

65

41

0

10

20

30

40

50

60

70

20 30% 30 - 40% 40 -50% 50 - 60% 60 -70% 70 -80% 80 - 85% 85 -90% 90 -95% 95 -99% 100%

Nu

mb

er o

f P

rovi

der

s

Provider Scores

LIP Agencies

Review Results FY 2015 and first half 2016• Agencies: 12.8% scored below 85% overall

• LIPs: 77.1% scored less than 85% overall

87.5% scored less than 85% on routine sub tool

37.5% scored less than 85% on post-payment review

90.6% required a Plan of Correction

• Common issues include: • Incorrect or missing rights notification information • Lack of care coordination• Failure to provide 24 hour coverage for crisis services• Lack of written policy regarding privacy, records storage as required by HIPAA• Documentation issues such as missing elements in CCAs and treatment plans

Actions taken to assist LIPs

• Alliance’s Provider Monitoring webpage updated to provide information regarding monitoring and links to resources.

• Specific PowerPoint trainings on the LIP routine tool and POC process and expectations developed and added to webpage.

• Monitoring staff provide considerable technical assistance including:• Sending copies of the tools with monitoring announcements

• Informing them about the available information on the website

• Sending copies of regulatory requirements such as Clinical Coverage Policy, APSM 45-2

• Individual technical assistance by phone and email.

Alliance completion of Routine Reviews-Agencies

• The Routine Monitoring Process states that providers will be monitored every 2 years.

• Alliance monitored 67 agencies in 2013 and 41 agencies in March through June 2014. These results were previously reported to Global Quality Management.

• Since monitoring first began in 2013, the evaluation team has completed routine monitoring for all provider agencies except those providing primarily therapeutic foster care and hospitals providing outpatient services. • Monitoring of providers of therapeutic foster care will begin in April.• The monitoring supervisor will work with Alliance’s Hospital Relations Director to

understand the hospital contracts and arrange monitoring of hospitals providing outpatient services.

• Completed re-monitoring for 22 of the 67 agencies monitored in 2013.

Alliance Completion of Routine Reviews - LIPs

• Alliance began monitoring LIPs in October 2014. We had monitored 96 LIP practices by January 2016.

• However, 130 LIP practices with current billing have not yet been monitored. These routine reviews cannot be completed within the 2 year time frame beginning in March 2014, when the tools were revised and the new Routine Monitoring Process began.

• Approximately 67% of these LIP practices are billing Alliance for 5 or fewer consumers over a period of 3 months.

Number of Reviews Completed

4154

128

51

0

20

40

60

80

100

120

140

160

180

FY 2015 7/15 - 12/15

Number of Reviews

Agencies

LIP

Completion of Reviews: Strategies

• In FY 2015, Alliance was 4th in LME/MCO in number of reviews completed. In the first two quarters of FY 2016, Alliance was 2nd in the number of routine reviews completed.

• Since the Routine Review Monitoring Process was resumed in March 2014, we have increased the number of routine reviews/month from 10.25 to 17.5. This has been accomplished by:• Hiring additional evaluators. The team has gained 2 positions since March

2014. We are in the process of adding 1 more position, for a total of 12 positions.

• Increasing scheduling efficiency in monitoring of small agencies.

169

285

101

124

122

60

161

369

189

106

42

61

38

89

104

123

90

0 50 100 150 200 250 300 350 400

Alliance

Cardinal

CenterPoint

Coastal Care

ECBH

Eastpointe

Partners

Sandhills

Smoky Mountain

Trillium

Number of Reviews

LME/

MC

O

Number of Reviews by MCO

FY 16 (6 mos)

FY 15

10.25

14.08

17.5

0

2

4

6

8

10

12

14

16

18

20

3/14 -6/14 FY 2015 7/15 - 12/15

Reviews/mo

Completion of Reviews: Barriers and Strategies

• The failure rate of LIP providers is the largest barrier to completing reviews of all providers within 2 years.

• Monitoring efficiency is dependent upon Evaluator availability. Technical assistance to LIPs, reviewing POCs and implementation of POCs requires considerable time and decreases the number of new reviews which can be completed.

• Compliance is overseeing a workgroup, which includes evaluators which will develop sample rights and release of information materials which may be used by providers.

Overview of Crisis ServicesPresentation to

Global Quality Management CommitteeFebruary 4, 2016

National Core Crisis Services

• 23 hour crisis stabilization/observation chairs

• Short term crisis residential services and crisis

stabilization

• Mobile crisis services

• 24/7 crisis lines

National Core Crisis Services

• Warm lines

• Psychiatric advance directives

• Peer crisis services

SAMHSA, 2014

Challenges Raised Last Year

• Promotion of Psychiatric advance directives

• Limited Peer crisis services

• Quality of Mobile Crisis Services

• Overuse of Cumberland ED

• Juveniles staying longer than 23 hours in crisis

and assessment

What has changed in last year?

Cumberland

• Community Mental Health Center @ Cape

Fear – licensed to accept IVC

• Pilot programs using EBPs for high risk youth

Durham

• New crisis facility provider, using recovery-

focused programming

• Loss of child CEO beds


Johnston

• Alliance has additional data to better

understand strengths/challenges in the

county


Wake

• Provider identified for new, additional crisis

facility in Wake County

• Planned expansion of Tier II (Open Access)

after normal business hours in Raleigh

• Expansion of 12 inpatient beds on WakeBrook

campus nearly complete

• Piloted Rapid Response service for children

Crisis and Assessment

Centers

Number of

Chairs/Beds

Provider23 Hour

Chair

Facility

Based

Crisis

Alcohol

and Drug

Detox

Unit

Inpatient

Community Mental Health

Center at Cape Fear Valley

(Roxie Avenue Center)

8 11 - 24

Durham Center Access

(DCA)10 16 -

-

Mental Health Division

Johnston Co. Health Dept.- - - -

UNC Health Care

at WakeBrook (CAS)*12 16 16 16

*An additional 12 inpatient beds planned for early in 2016.

Contract HospitalsContracted 3-

Way Beds

Total Inpatient

Beds

Cape Fear Valley Hospital 10 24*

Duke University Health 4 41

Johnston Health 5 20

UNC-Wakebrook 5 16

Total 24 101

Psychiatric Inpatient Beds

*Cape Fear Valley Behavioral Health Care has 32 licensed beds, however, they are currently using 24.

Current Status of Crisis System

Crisis Services UtilizationCumberland

3630

34

24

39 3640 41

58

4246

6357

75

66 67 66 6875

68 65 65

121

93

114

100107 108

9197

108

97

88

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV

Cumberland/Cape Fear CES, FBC & INPT Admissions Jan-Nov 2015

# Cape Fear CES # FBC Admissions # Inpt Admissions

*Provider Submitted Monthly Reports; No December reports received.

Crisis Services Utilization

Durham

Data Source: Provider Submitted Monthly Reports; Note: provider stopped admitting children and youth to Observation Chairs in October 2015 due to transition to new provider.

134

104

150167

143

114123

134

111126

101105

0

50

100

150

200

250

300

0

50

100

150

200

250

300

Jan Feb Mar Apr May Jun Jul Aug Sep Oct* Nov Dec

# Presenting to DCA and # Admitted to 23-Hour Observation Chairs, Jan-Dec 2015

# youth presenting at DCA # adults presenting to DCA

Crisis Services UtilizationJohnston

*Provider Submitted Monthly Reports

July Aug Sept Oct Nov Dec

Youth

Adults 44 55 46 50 36 28

44

55

4650

3628

Johnston Public HealthWalk-In Assessments

July-Dec 2015

Cannot break down by month due to HIPAA concerns

0

20

40

60

80

100

120

140

160

180

July Aug Sept Oct Nov Dec

144 140 148122 118

99

20 2127

3321

22

Johnston Memorial (ED)"Holding Beds" Admits

July-Dec 2015

Adults Youth

When an individual is in crisis and seeking services, he/she may walk-in to Johnston Public Health or go to the Emergency Department (ED). Johnston Public Health served an average of 43 adults/month and a total of 21 youth in the later part of 2015. The ED has psychiatric beds in a separate area, which they refer to as “holding beds”. Adults stay, on average, 20 hours (children stay for 33 hours) in these beds. An average of 129 adults and 24 children stayed in these beds from July - December 2015.

Crisis Services Utilization

Wake

*Provider Submitted Monthly Reports

261

201

243224

239257

272 278

237

277

235

283

0

50

100

150

200

250

300

350

400

450

500

0

50

100

150

200

250

300

350

400

450

500

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

# Admissions to WakeBrook CAS Jan-Dec 2015 and # Admitted to 23-Hr Observation Chairs

# youth presenting at CAS # adults presenting to CAS

Crisis Services UtilizationWake

(# Monthly Admissions FBC, ADU & INPT Jan-Oct ‘15)

30

3751

34 32

45

55 60

4944

84

67

86 8791

9793

84 82 82

3934

40

38 49

41

5237

2835

0

20

40

60

80

100

120

Jan Feb Mar Apr May Jun Jul Aug Sep Oct

FBC ADU INPT Linear (FBC) Linear (ADU) Linear (INPT)

*Provider Submitted Monthly Reports, no data since Oct. 2015.

ALOSFBC: 10.4 days

ADU: 5 daysINPT: 12 days

Key Process Indicators

Improve quality of Mobile Crisis services:

• Provider Networks is re-evaluating Mobile Crisis as part

of their analysis and development of the crisis system

• Concerns with individual providers have been forwarded

to Compliance

• Expanding use of EMS Community Paramedic Program

to Durham

Key Process Indicators

Improve response to First Responder tests

o There was a slight improvement in calls returned within an

hour in the 2nd Quarter of FY 16

o 7 agencies were referred to Compliance because of poor

performance, 5 received POCs and 2 received warning

letters, 4 successfully completed POCs including follow up

calls

o 1 agency is on probation due to poor performance and

unsuccessfully completing POC

Baseline from FY15

July-Sept 2015 Oct-Dec 2015 Goal

Calls Returned Within 1 Hour 33% 39% 50% 95%Calls Answered Within 30 Seconds

92% 88% 92% 100%

Reduction in ED Admission Rates

Key Performance Indicators

45.83 46.91 45.3847.39

46.5748.30

44.72

23.80

15.46 15.2216.94

20.3322.52

20.98

26.28 25.7822.27

19.3323.88

28.66 26.38

23.22 21.3320.08 19.35

21.5323.05

21.57

0.00

10.00

20.00

30.00

40.00

50.00

FY13 Q4 FY14 Q1 FY14 Q2 FY14 Q3* FY14 Q4* FY15 Q1* FY15 Q2*

Rate of Admissions to EDs

Cumberland Durham Johnston Wake

*Data is calculated using latest (2014) certified population estimates from NCOSBM.

The rate increased in Cumberland, Johnston, and Durham Counties.

Data source: Self-report by provider

Reduction in % of time that WakeBrook CAS is on diversion (closed)

Key Performance Indicators

0%

10%

20%

30%

40%

50%

60%

0:00

48:00

96:00

144:00

192:00

240:00

288:00

336:00

384:00

432:00

WakeBrook CAS Closures

Back Door (IVC) Closed-# of Hours Front Door Closed-# of Hours

Back Door (IVC) Closed-% of total operating hours Front Door Closed-% of total operating hours

Hrs closed% (of operating

hrs) closed

Reductions did not meet benchmark. As part of Crisis Services QIP, a new intervention of expanding Tier II (Open Access) after hours will be implemented by end of fiscal year.

Reduce LOS in InpatientKey Performance Indicators

% on IVC at admission Q1 Q2 Q3 Above/Below Avg Notes

Cape Fear Valley (Cumberland) 30% 27% 23% Below

Duke University Hospital (Durham) 62% 58% 60% Above

Johnston Memorial (Johnston) 75% 67% 65% Above

UNC-WakeBrook IPU (Wake) 100% 100% 100%

Above Identified as

outlier

Avg LOS (days) Q1 Q2 Q3 Above/Below Avg Notes

Cape Fear Valley (Cumberland) 6.16 5.12 4.99 Below

Duke University Hospital (Durham) 5.67 7.16 8.23 Above

Johnston Memorial (Johnston) 5.06 4.33 5.55 Below

UNC-WakeBrook IPU (Wake) 11.95 11.32 11.53 Above

Identified as

outlier

% of disharges with LOS >7 days* Q1 Q2 Q3 Above/Below Avg Notes

Cape Fear Valley (Cumberland) 23% 19% 18% Below

Duke University Hospital (Durham) 22% 34% 27% Above

Johnston Memorial (Johnston) 14% 10% 20% Below

UNC-WakeBrook IPU (Wake) 65% 62% 56% Above

WakeBrook had the highest percent on IVC at admission (100%), one of only two hospitals in the state with 100% across all three quarters. WakeBrook also had the longest lengths of stay (LOS) in the state across all three quarters.

Source: NCDHHS, DMHDDSAS, 3-Way Contract Psychiatric Inpatient Report (SFY 15, Q1-Q3)

Strengths in the Crisis Continuum

• Crisis Intervention Teams in each community

• Crisis Collaboratives in Durham, Wake and

Cumberland addressing system improvements

• Nationally certified Mental Health First Aid

trainers for Children and Adults

• Greater emphasis on an integrated primary

care approach

• Veterans’ Treatment Court (Cumberland)

Strengths in the Crisis Continuum

• Care Coordination

• Increased emergency housing options

• Implement EMS Community Paramedicine

Program (Durham and Wake)

• Low rate of admissions to Emergency Dept.

(Wake and Durham)

Crisis System Challenges

• Increase utilization of Durham facility

• Reduce number of consumers who use Mobile

Crisis services more than 3 times/year

• Increase options for children/youth in crisis and

prevent crises


• Reduce use of ED in Cumberland County

186.97

80.77

98.25

85.50

193.24

110.09

0.0010.0020.0030.0040.0050.0060.0070.0080.0090.00

100.00110.00120.00130.00140.00150.00160.00170.00180.00190.00200.00210.00

Cumberland* Durham* Johnston* Wake* Guilford Mecklenburg

State Avg Rate*: 150.24

Cumberland's rate is more than twice the rates in Wake and Durham Counties

Rate of Admissions to ED Primarily for Behavioral Health (Cal Yr 2014)

Source: NCDHHS, NCDMHDDASA, ED Amissions Report, FY 15 Q2, data from NCDETECT. Rate based on 10,000 population.*Increased rate from FY 14 (Jul 2013-Jun 2014)


What are we doing to address challenges?

• Further examining LOS at WakeBrook (QM recently

completed study of longest LOS at all facilities,

discussing findings/recommendations with clinical &

UM Committee)

• Expanding Tier II (after hours) and adding another

Tier IV in Wake to divert from CAS & ED

• Requiring Mobile Crisis contractors to refer

individuals who contact them 3 times/year to Care

Coordination and adhere to other best practices


What are we doing to address challenges?

• Durham: Transition to new provider complete,

utilization expected to increase

• Expand capacity and hours, along with accepting

individuals on IVC, at Roxie (Cape Fear,

Cumberland County)

• Expand pilots of services for high risk youth to

counties outside of Cumberland

• Evaluate and establish CEO (crisis observation)

and FBC (facility-based crisis) rates

FY 16

Quality Improvement Projects

Presentation to the CQI Leadership Team (1/27/16) &

Global Quality Management Committee (2/4/16)

FY 16 Quality Improvement Projects

Summary:

o 7 FY 16 QIPs

o Wrapping up 3 FY 15 QIPs

Successes:

o FY 15 Mystery Shopper QIP – Recommending closure of UM MHSA Call Monitoring because benchmark met (91% of calls adhered to Alliance procedures)

o FY 16 – First Responder QIP – Improvement in satisfactory calls following Compliance actions

o FY 16 – Crisis Services QIP – Expansion of Tier II (after hours) and new Tier IV in Wake County moving forward, promising initial results from Cumberland pilots


Red Flags:

o Delays in FY 15 QIPs – still no NCDETECT data (from the state) for ED QIP, waiting for IRR study for UM IDD, IIH data not available until late 2016 due to start of EBP models (July 2016)

o Continue UM IDD Call Monitoring (FY 15 Mystery Shopper QIP) because benchmarks not met

o Continue IDD Care Coordination QIP because benchmark not met, recommend new interventions

o No improvement in Access to Care performance, creating new interventions, adding providers to Project Advisory Team

Detailed Results for QIPs


Reduce use of Crisis Services in Wake and Cumberland Counties*

Goals:

o Reduce ED admissions of youth in best practice pilot programs (FCT and Enhanced TFC) in Cumberland County

o Increase # of providers offering Same Day Access (Tier II) after regular business hours

o Reduce percentage of time that WakeBrook CAS in Wake County is on diversion by 2% (source: self-report)

*Continuation from FY 15 ED Reduction QIP, revised goals

FY 16 Quality Improvement ProjectsInterventions (Cumberland):

o Family Centered Treatment (FCT) and Enhanced Therapeutic Foster Care (TFC) pilots

Interventions (Wake):

o Increase # of providers offering Same Day Access (Tier II) after regular business hours

Update:

o Promising results from Cumberland pilots (no ED/Crisis/Inpatient admissions of experimental groups)

o Wake: Monarch moving to new Tier II facility in February, will open after-hours by end of fiscal year

o Wake: Monarch awarded contract for additional Tier IV

FY 16 Quality Improvement ProjectsImprove Person-Centered Plans*

Goals:

o 85% of quality elements are met or partially met

o at least 55% of health and safety quality elements are met or partially met

Interventions:

o Feedback letters sent to providers

o Training on person-centered elements of planning and crisis plan

o Review of plans for individuals in Transitions to Community Living Initiative

o Additional technical assistance to providers

o Notice from UM informing providers that authorization requests without comprehensive crisis plan are considered incomplete

*Continuation from FY 15 Mystery Shopper QIP

FY 16 Quality Improvement ProjectsImprove Person-Centered Plans

Update:

o Held training in Dec 2015 for 49 participants, representing 11 providers

o Provided technical assistance to 4 providers (2 additional providers in late Jan)

o Another training scheduled for March 2016

Results:

o Next review scheduled for May for authorizations in April (after 2nd round of training)


First Responder* – test crisis lines of providers

Goals: 100% of calls answered within 30 seconds and 95% of providers return calls in 1 (follow up) hour

Interventions:

o Providers assigned to “Tiers” based on last FY’s performance (some called more frequently, others less)

o Written feedback to all providers after calls

o Refer to Compliance for providers who continue to score “unsatisfactory”, issue POC if poor performance continues

o Compare test results with actual data of consumers, open to enhanced services, using crisis services

*Continuation from FY 15 QIP

FY 16 Quality Improvement ProjectsUpdate:

o Continued calls on quarterly basis according to Tier

o 7 providers referred to Compliance, 5 POCs and 2 Warning Letters issued

Results:

o All POCs successfully closed (and successful tests) except for one

o The agency that did not successfully close POC is now on probation for 6 months

Baseline from FY15 July-Sept 2015 Oct-Dec 2015 Goal

Calls Returned Within 1 Hour 33% 39% 50% 95%

Calls Answered Within 30 Seconds

92% 88% 92% 100%

FY 16 Quality Improvement ProjectsIntensive In-Home* – Improve quality of IIH services

Goals: Reduce use of crisis services, reduce behavioral health interference with daily activities, and decrease severity of mental health symptoms.

Interventions:

o IIH providers to implement specific, family-focused EBP with external fidelity monitoring

o Training and technical assistance to providers

Update:

o EBP models selected, providers will not implement models until July 2016, collect post-intervention data in late 2016

*Continuation from FY 15 QIP

FY 16 Quality Improvement ProjectsCare Coordination* – Improve Care Coordination Services

Goals:

o MH/SA: Increase adherence to procedures (CC contact within 2 business days)

o I/DD: Reduce # of authorization requests denied/reduced due to lack of justification

Interventions:

o MH/SA: Training on Care Coordination expectations, change in procedures

o I/DD: Training/coaching of Care Coordination staff, UM training IDD Supervisors on Service Definitions, workgroup to improve ISPs

*Continuation from FY 15 QIP, due to delay in data and interventions

FY 16 Quality Improvement ProjectsCare Coordination

Results:

o MH/SA: Collected new baseline data for 2/01/2015 – 4/30/2015.

o Baseline: 43%

o Post-Intervention: 86%

o I/DD: Reduce % of authorization requests denied/reduced due to lack of justification

o Baseline: 78%

o Post-Intervention: 82%

o Recommendation: Consider new interventions, PAT to meet


Access to Care* – Improve initiation in services

Goals:

o Increase consumer initiation in services based on need:

Timeframe Revised Baseline(FY15Q3)

Goals State Goal

Emergent (within 2.25hours)

83% 97% 97%

Urgent (within 48 hours) 52% 62% 82%

Routine (within 14 days) 53% 63% 75%

*Continued from FY 15 due to changes in data parameters by state

FY 16 Quality Improvement ProjectsAccess to Care

Interventions:

o Addressed technical issues of aggregating accurate data

o Identified more accurate methods of collecting valid data sources for Emergent & Urgent appointments

o Training of Call Center staff to address inconsistencies in data entry

o Break data down by provider, county, and funding source to identify root causes and in December 2015 started reminder calls to routine consumers.

FY 16 Quality Improvement ProjectsResults*:

Overall

By Funding Source

Timeframe Baseline(FY15Q3)

FY 15, Q4:

Apr-Jun 2015

FY 16, Q1:

Jul-Sept 2015Goals

Emergent (within 2.25hours)

83% 71% 72% 97%

Urgent (within 48 hours) 52% 49% 48% 62%

Routine (within 14 days) 53% 47% 47% 63%

*Provider data incomplete, only 50% of data is populated, working with Call Center to improve data collection.

Timeframe

Medicaid Non-Medicaid

FY 15, Q3 FY 15, Q4 FY 16, Q1 FY 15, Q3 FY 15, Q4 FY 16, Q1

Emergent 76% 79% 67% 87% 68% 75%

Urgent 55% 53% 51% 50% 46% 47%

Routine 53% 52% 52% 53% 43% 41%


Reduce Errors in Grievance Module

Description:

Alliance staff enter grievances and complaints in the Grievance Module of Alpha. In FY 15, QM staff noted a 69% rate of errors of all the data entered. QIP will focus on reducing errors in most important 16 fields.

Goal:

o Reduce the grievance data entry error rate by 10%.


Reduce Errors in Grievance Module

Interventions:

o Revised initial interventions of Dept Supervisors providing oversight and second-level review of all complaints entered into system because it was too cumbersome.

o New Interventions: simplified definition of grievance, provided training to all staff, Grievance Specialists assume responsibility of entering most fields except for critical 5 fields.

o Waiting for Alpha to upgrade Grievance module to streamline and improve ease of use (estimated for February 2016).

o Post-Intervention data to be analyzed at end of January.

FY 15 QIPs – Closing Out

Conduct follow-up reviews:

• Mystery Shopper – UM call monitoring (see subsequent slides for results)

• Inter-Rater Reliability –I/DD-waiting for final IRR study• ED QIP – Waiting for NCDETECT data from the state


Mystery Shopper – Review of UM (I/DD & MH/SA) calls

Goals:

o 85% of calls follow Alliance greeting protocol

Interventions:

o Staff training and coaching (including re-training on Alliance’s procedures for greeting callers)

o Reminder cards created for each UM Staff person with greeting protocol

FY 15 Quality Improvement ProjectsMystery Shopper – Review of UM (I/DD & MH/SA) calls

Results

o Goal Met for MH/SA, but not for I/DD

Recommendations:

o Refer to Senior Compliance Analyst, individual coaching for Care Manager with least % met.

Care Mgt Team Data Measure N # Met % Met Goal

I/DD Baseline (10/14) 82 11 13% 85%

I/DD Post-Intervention (7/15) 87 38 44% 85%

I/DD Post-Intervention (10/15) 165 80 49% 85%

MH/SA Baseline (10/14) 291 41 14% 85%

MH/SA Post-Intervention (7/15) 306 252 82% 85%

MH/SA Post-Intervention (10/15) 306 279 91% 85%

(Back to agenda)

7

ITEM: Reinvestment Plan


BACKGROUND:

The reinvestment plan outlines Alliance’s two-year reinvestment strategy through FY16 and into

FY17. The recent changes in legislation, mandating a state reduction to fund balances as well as

changes to Medicaid for both physical and behavioral health, place Alliance in a unique situation.

Alliance is poised to handle changes in Medicaid through efficient operations, constantly

improving technology/analytics, and dedication to the consumers we serve. As time progresses,

Alliance will be required to adapt to new partners, reduced capitated rates to achieve desired waiver

results, and an increase in consumers due to population growth. Due to the environment constantly

changing this document will remain fluid and modified as needed over time. This initial roadmap

outlines how we plan to strategically reinvest our projected savings over the next two years to

continue to provide administrative support and services to meet the challenging issues facing our

consumers and community

REQUEST FOR AREA BOARD ACTION: Accept the training.

CEO RECOMMENDATION: Accept the training.

RESOURCE PERSON(S):

Robert Robinson, CEO; Kelly Goodfellow, CFO; Beth Melcher, Chief of Network Development

and Evaluation; Sean Schreiber, Chief Clinical Officer



Reinvestment Plan

Presentation to the Board of Directors

March 4, 2016

• Purpose of the reinvestment plan

• Review programs and services

• Sustainability in future years

• Management oversight

Reinvestment Plan Discussion

• 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

• Rate increase projections

• Previous experience with start up and

operational costs

• Provider submitted budgets

o Crisis facility, ICF rate increase, NC START

• Research and collaborative discussions

Funding Amounts

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

FY17 Reinvestment

Description Fully-FundedEnhanced Therapeutic Foster Care $905,000

ICF Transitions 1,000,000

Trauma Informed Therapeutic Foster Care 100,000

Expanded Integrated Care 750,000

Technology Enabled Home 25,000


First Responders Reimbursement 310,000

Mobile Crisis 800,000

BH Urgent Care 6,500,000

Child Facility Based Crisis 9,500,000

Peer Respite/Rapid Response 540,000

Peer Transition Teams 500,000

IDD Crisis Respite Facility 1,314,000

Intensive Wrap Around 360,000

Group Living Step Down 191,625

Additional Service Rate Increases 6,250,000

Total $29,945,625

• Impact is to both fund balance and annual

service dollars

• Shows gradual increase in savings due to

investments

• Gradual increase in service impact

• Impact of FY17 legislative reduction

• Future ability to invest

Sustainability Plan

Projections (without $17M Reduction)

FY16 YE FY17 YE FY18 YE FY19 YE

Beginning Fund Balance $42,750,734 $38,506,042 $27,255,417 $21,010,417

Legislative Reductions (11,066,104)

Available Fund Balance 31,684,630 38,506,042 27,255,417 21,010,417

Carryover from FY16 Investments (3,650,000) (650,000) (650,000)

Investments (12,151,000) (22,945,625) (10,085,000) (9,085,000)

Balance of FB 19,533,630 11,910,417 16,520,417 11,275,417

Service (Claims) Impact (3,500,000) (6,655,000) (20,510,000) (20,510,000)

Annual Savings 22,472,412 22,000,000 25,000,000 30,000,000

Ending Fund Balance 38,506,042 27,255,417 21,010,417 20,765,417

Medicaid Budget (Projected) 372,401,144 391,021,201 410,572,261 431,100,874

FB as a Percentage of Budget 10.34% 6.97% 5.12% 4.82%

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


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

Projections (with $17M Reduction)

FY16 YE FY17 YE FY18 YE FY19 YE

Beginning Fund Balance $42,750,734 $38,506,042 $28,424,417 $26,234,417

Legislative Reductions (11,066,104) (17,000,000)

Available Fund Balance 31,684,630 21,506,042 28,424,417 26,234,417

Carryover from FY16 Investments (3,650,000) (650,000) (650,000)

Investments (12,151,000) (2,776,625) (10,585,000) (10,585,000)

Balance of FB 19,533,630 15,079,417 17,189,417 14,999,417

Service (Claims) Impact (3,500,000) (6,655,000) (10,955,000) (10,955,000)

Annual Savings 22,472,412 20,000,000 20,000,000 20,000,000

Ending Fund Balance 38,506,042 28,424,417 26,234,417 24,044,417

Medicaid Budget (Projected) 372,401,144 391,021,201 410,572,261 431,100,874

FB as a Percentage of Budget 10.34% 7.27% 6.39% 5.58%

• Reports

o Monthly financials, PMPM trend reports, DMA

reporting template

• Committees

• Budget and Finance, CQI, Board Finance, UM

• Project plan

• Executive Leadership responsibility

• External oversight – audits, reviews, monitoring

Management

• 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

Summary

2015 Provider SurveyReview and Analysis

March 3, 2016

2015 Provider Survey

Survey Details

• Three-weeks from Aug. 24 – Sep. 18, 2015

• Total of 532 Alliance providers invited

• Total of 260 surveys collected

• Response rate of 48.9%; state = 45.0%

• 75.8% are Medicaid providers for 6-plus years

• 62.3% are Provider Agencies

• 36.5% are LIPs

• 1.2% Community Hospitals


Access

Appeals

Topic 2014 2015 Change State Difference

LME/MCO staff is easily accessible for information, referrals, and scheduling of appointments.

73.1 82.3 9.2 77.9 4.4

LME/MCO staff are referring consumers whose clinical needs match the service(s) my practice/agency provides.

60.8 72.7 11.9 64.6 8.1


My agency is satisfied with the appeals process for denial, reduction, or suspension of service(s).

46.8 59.2 12.4 50.3 8.9

2015 Provider SurveyAuthorizations

Claims

Communications


When I speak with staff about claims issues I am given consistent and accurate information.

77.2 76.9 -0.3 74.3 2.6

Claims processed in timely and accurate manner. 87.7 93.1 5.4 87.2 5.9

Topic 2014 2015 Change 2015 Difference

LME/MCOs website has been a useful tool for helping find tools and materials.

74.9 82.7 7.8 75.0 7.7


Authorizations for treatment and services are made within the required timeframes.

88.3 90.4 2.1 82.4 8.0

Denials for treatment and services are explained. 74.3 79.2 4.9 70.9 8.3The authorizations issued are accurate. 86.0 91.5 5.5 82.9 8.6

2015 Provider SurveyCompliance

Provider NetworksTopic 2014 2015 Change 2015 Difference

Provider Network meetings are informative and helpful.

64.3 63.1 -1.2 62.1 1.0

Provider Network keeps providers informed of changes that affect my local Provider Network.

77.8 75.8 -2.0 77.9 -2.1

Provider Network staff are knowledgeable and answer questions consistently and accurately.

70.2 74.2 4.0 71.9 2.3

How would you rate your overall satisfaction with Provider Network?

79.5 81.5 2.0 77.2 4.3


The LME/MCO staff conducts fair and thorough investigations.

55.0 65.8 10.8 65.5 0.3

After the audit or investigation, LME/MCO requests for corrective action plans and other supporting materials are fair and reasonable.

50.3 67.3 17.0 68.8 -1.5

2015 Provider SurveyStakeholders

Training


Claims trainings meet my needs. 71.3 71.6 0.3 69.2 2.4

Information Technology trainings are informative and meet my agency's needs.

63.2 64.2 1.0 65.0 -0.8

Trainings are informative and meet our needs as a provider/agency.

71.9 71.5 -0.4 70.4 1.1


Customer Service is responsive to local community stakeholders.

58.5 68.8 10.3 62.5 6.3

Our interests as a network provider are being adequately addressed in the local Provider Council.

50.9 56.5 5.6 52.2 4.3


Overall

Summary• Alliance was at or above state average for 20 of 23 elements (87%).

• Alliance had the highest score in 13 of 23 elements (57%).

• “North Carolina providers are, overall, still satisfied with the LMEs/MCOs, and at a slightly higher rate than in 2014.”

• “Of all plans, providers still seemed the most satisfied with Alliance.”


LME/MCO staff responds quickly to provider needs.

74.9 74.6 -0.3 72.9 1.7

Technical assistance and information provided by staff is accurate and helpful.

82.5 81.2 -1.3 76.6 4.6

Please rate your overall satisfaction with the LME/MCO.

84.2 85.0 0.8 79.2 5.8


More Training and Education?

Quality Management/Reporting: Performance/outcomes, NC-TOPPs

Clinical Coverage Policies: PCP training, clinical practice guidelines info

Provider Monitoring: Training, technical assistance for LIPs

2014 2015 Difference State Difference

Quality Management/Reporting 40.4 43.1 2.7 33.9 9.2Clinical Coverage Policies 37.4 41.2 3.8 35.7 5.5

Provider Monitoring 34.5 35.4 0.9 33.7 1.7Audit/Reimbursement 36.3 30.8 -5.5 29.3 1.5

Claims Processing 26.3 21.9 -4.4 21.8 0.1Enrollment 17.5 19.6 2.1 16.7 2.9

Information Technology 22.2 16.2 -6.0 14.2 2.0Appeals 17.5 14.6 -2.9 16.8 -2.2

Payment Policy 12.3 8.5 -3.8 9.4 -0.9