Thursday, May 05, 2016
AREA BOARD REGULAR MEETING
4600 Emperor Boulevard, Durham, NC, 27703
4:00-6:00 p.m.
Page 1 of 4
MEMBERS PRESENT: ☒Ann Akland (via phone), ☒Cynthia Binanay, Vice-Chair, ☒Christopher Bostock, Chair, ☒George
Corvin, MD, ☒Kenneth Edge (via phone), ☒James Edgerton (via phone); ☒Lodies Gloston (via phone), ☒Phillip Golden, ☒John
Griffin, Ed.D, ☒Curtis Massey, ☐Rev. Michael Page, ☒George Quick, ☒Vicki Shore (via phone), ☒William Stanford, Jr.,
☒Caroline Sullivan, ☒Amelia Thorpe, ☐Lascel Webley, Jr., and ☒McKinley Wooten, Jr.
GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair; Dennis Farley, DMH
ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Tedra Anderson-Brown, MD, Medical Director; Hank Debnam, Cumberland Site
Director/Veterans Point of Contact; Joey Dorsett, CIO; Ashley Everette, Budget Analyst; Doug Fuller, Director of Communications; Kelly Goodfellow, CFO;
Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram, Executive Assistant; Geyer Longenecker, Quality Management Director;
Beth Melcher, Chief of Network Development and Evaluation; Ann Oshel, Chief Community Relations Officer; Sara Pacholke, Controller; Kelly Phillips,
Director of Budget and Financial Analysis; Monica Portugal, Chief Compliance Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Matthew Ruppel,
Director of Program Integrity; Sean Schreiber, Chief Clinical Officer; Doug Wright, Director of Consumer Affairs
1. CALL TO ORDER: Chairman Christopher Bostock called the meeting to order at 4:03 p.m.
AGENDA ITEMS: DISCUSSION:
2. Announcements A. FUTURE DEVELOPMENT WORKGROUP: This is a staff workgroup that meets monthly. Board members are invited to
attend this meeting. Chairman Bostock reminded Board members: the next meeting will be Tuesday, June 7 at 4:00 pm.
B. ANNUAL REPORT: Mr. Robinson provided an overview of the report; Board members received at the meeting.
C. MENTAL HEALTH AWARENESS MONTH: Mr. Robinson mentioned upcoming May events scheduled throughout
Alliance’s catchment area.
3. Agenda Adjustments Chairman Bostock mentioned an adjustment to the agenda: recommendation for reappointment of one Board member. There
were no other additional agenda adjustments.
4. Public Comment There were no public comments.
5. Committee Reports A. Consumer and Family Advisory Committee (5 minutes) – page 5
The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from
Durham, Wake, or Cumberland counties who receive mental health, intellectual/developmental disabilities or substance
use/addiction services. This month’s report included draft minutes from the April 4, 2016, meeting.
The committee reports were sent as part of the Board packet; Caroline Ambrose, CFAC Chair, presented the report. She noted
highlights from the April meeting which included a presentation of Alliance’s reinvestment plan and Medicaid
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AGENDA ITEMS: DISCUSSION:
reform/consolidation. Additionally, Ms. Ambrose expressed gratitude to Alliance on behalf of First in Families and the new
Cumberland chapter. The April CFAC meeting also addressed the importance of CFAC member’s participation and how their
input is impacts Alliance. CFAC has chosen to merge their Facebook page with Alliance’s. Mr. Robinson encouraged Board
members to visit Alliance’s Facebook and LinkedIn pages.
B. Finance Committee (10 minutes) – page 19
The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the
Area Board. This month’s report included draft minutes from the April meeting and a request to appoint a deputy finance officer
in accordance with GS 159-24 and 159-28.
George Quick presented the report on behalf of James Edgerton, Committee Chair. Mr. Quick mentioned that Alliance is in
very good shape financially and revenues continue to exceed expenditures. He mentioned that Alliance exceeds the State
required ratios with the exception of the medical loss ratio. As stated previously the medical expense ratio is being replaced by
the medical loss ratio. Alliance is at 84% and the ratio is 85%; As the medical loss ratio methodology and definition have
changed, Alliance is held harmless on this ratio through July 2017. Also, Mr. Quick mentioned the recommendation to appoint
Kelly Phillips, Director of Budget and Financial Analysis, as Deputy Finance Officer.
BOARD ACTION
A motion was made by Mr. George Quick to appoint Kelly Phillips as Deputy Finance Officer; seconded by Dr. John Griffin.
Motion passed unanimously.
6. Consent Agenda A. Draft Minutes from April 7, 2016, Board Meeting – page 28
B. Audit and Compliance Committee Report – page 33
C. Executive Committee Report – page 36
D. Human Rights Committee Report – page 52
E. Draft Minutes from Board Budget Retreat – page 75
Chairman Bostock mentioned that the consent agenda was sent as part of the Board packet; there were no questions or
discussion about the consent agenda.
BOARD ACTION
A motion was made by Mr. Phillip Golden to adopt the consent agenda; seconded by Dr. George Corvin. Motion passed
unanimously.
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4:00-6:00 p.m.
Page 3 of 4
AGENDA ITEMS: DISCUSSION:
7. FY17 Recommended
Budget (30 minutes) –
page 128
The recommended FY 2016-2017 budget was presented for consideration. Kelly Goodfellow, CFO, mentioned that this is
Alliance’s fifth budget and thanked members for attending the budget retreat. Kelly Phillips, Director of Budget and Financial
Analysis, provided an overview from the budget retreat regarding statute requirements, general fund, and FY17 budget revenues
and expenditures. She shared comparisons between FY16 budget and the FY17 recommended budget. Ms. Goodfellow
mentioned that FY17 Medicaid rates from the State are lower compared to FY16 rates; she stated that this is typical for managed
care as the expectation is to save money. The FY17 recommended budget presentation is attached to and made part of these
minutes.
BOARD ACTION
The Board received the recommended budget; no further action required at this time.
8. Review of Board
Officer Selection
Process (5 minutes) –
page 162
As stated in the by-laws officers of the Area Board shall be chosen for a one-year term at the final meeting of the fiscal year.
Chairman Bostock reviewed the process: according to Alliance by-laws officers may serve two consecutive (one year) terms.
Both he and Vice-Chair Binanay are finishing their first terms and are willing to serve an additional term.
Board members interested in serving as Chair or Vice-Chair for fiscal year 2016-2017 may forward names to Ms. Ingram (who
will compile a list) or come prepared to state their nomination at the June 2, 2016, meeting. Board members discussed not having
a nominating committee and instead having open nominations and then elections at the June meeting.
BOARD ACTION
The Board received the review; no further action required at this time.
New Agenda Item In accordance with NC General Statute 122C-118.1.d and Alliance by-laws, the initial terms of Alliance Board members were
staggered with each initial term being considered a full term. NC Senate Bill 191 allows members to be reappointed for two
additional three-year terms. John Griffin’s term expires on May 31, 2016. The matter brought before the Board today was to
recommend his reappointment. There were no questions or discussion about the recommendation.
BOARD ACTION
A motion was made by Mr. William Stanford to recommend John Griffin’s reappointment to the Cumberland Board of County
Commissioners; seconded by Commissioner Kenneth Edge. Motion passed unanimously.
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4:00-6:00 p.m.
Page 4 of 4
AGENDA ITEMS: DISCUSSION:
9. Updates Mr. Robinson mentioned that the implementation date for NC Innovations waiver was changed from July 1, 2016 to
November 1, 2016; this change will allow more time for implementation.
Mr. Robinson provided an update from recent meetings with NC legislators to discuss Medicaid Reform and budget cuts;
Dr. Michael Bollini mentioned a recent meeting with legislators and specifically Alliance’s good reputation among
providers.
Board discussed current IVC (involuntary commitment) rates at local hospitals.
10. Chairman’s Report There was no report.
11. Closed Session The Board entered closed session.
BOARD ACTION
A motion was made by Mr. McKinley Wooten to enter closed session pursuant to NC General Statute 143-318.11 (a) (6) to
consider the qualifications, competence, and performance of an employee and per NCGS 143-318.11 (1) to prevent disclosure
of information that is confidential and not a public record under NCGS 122C-126.1; seconded by Mr. William Stanford. Motion
passed unanimously.
The Board returned to open session.
BOARD ACTION
A motion was made by Ms. Lodies Gloston to approve the reduction in force for the Youth Opportunity Director and Youth
Opportunity Coordinator positions; seconded by Dr. George Corvin. Motion passed unanimously.
12. Adjournment With all business being completed the meeting adjourned at 6:07 p.m.
Next Board Meeting
Thursday, June 02, 2016
4:00 – 6:00
6/2/2016
Robert Robinson, Chief Executive Officer Date Approved
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(Back to agenda)
ITEM: Consumer and Family Advisory Committee (CFAC) Report
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
The Alliance Consumer and Family Advisory Committee, or CFAC, is made up of consumers and/or family
members that live in Durham, Wake, or Cumberland Counties who receive mental health,
intellectual/developmental disabilities and substance use/addiction services. CFAC is a self-governing
committee that serves as an advisor to Alliance administration and Board of Directors.
State statutes charge CFAC with the following responsibilities:
Review, comment on and monitor the implementation of the local business plan
Identify service gaps and underserved populations
Make recommendations regarding the service array and monitor the development of additional
services
Review and comment on the Alliance budget
Participate in all quality improvement measures and performance indicators
Submit findings and recommendations to the State Consumer and Family Advisory Committee
regarding ways to improve the delivery of mental health, intellectual/other developmental disabilities
and substance use/addiction services.
The Alliance CFAC meets at 5:30pm on the first Monday in the months of February, April, June, August,
October and December at the Alliance Corporate Office, 4600 Emperor Boulevard, Durham. Sub-
committee meetings are held in individual counties, the schedules for those meetings are available on our
website.
The Alliance CFAC tries to meet its statutory requirements by providing you with the minutes to our
meetings, letters to the board, participation on committees, outreach to our communities, providing input
to policies effecting consumers, and by providing the Board of Directors and the State CFAC with an
Annual Report as agreed upon in our Relational Agreement describing our activities, concerns, and
accomplishments. The Alliance CFAC is currently chaired by Caroline Ambrose while Israel Pattison
serves as vice-chair.
REQUEST FOR AREA BOARD ACTION:
The Alliance CFAC met as a whole on April 4th at the corporate office and by teleconference in Cumberland
County.
CEO RECOMMENDATION:
Receive the draft minutes.
RESOURCE PERSON(S):
Caroline Ambrose, CFAC Chair; Doug Wright, Director of Consumer Affairs
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
5A
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Monday, April 04, 2016 Consumer and Family Advisory Committee
Page 1 of 4
MEMBERS PRESENT: Israel Pattison, David Curro, Sharon OBrian, Carrie Ambrose, Allison Stutts, Steve Hill, Tammy Harrington, Dan Shaw, Kurtis Taylor, Latasha Jordan, Faye Griffin (telephonic), Jean Royster-Hill (telephonic), Brynda Saunders (telephonic) Cumberland County (teleconference) Lotta Fisher, Tracey Glen-Thomas, Dorothy Johnson GUEST(S) PRESENT: Marjorie Young, Leanna George (Johnston County CFAC), Bryce Coleman ( First in Families), Debby Torres (First in Families), Yancee Perez, Doug Wright, Rob Robinson, Kelly Goodfellow, CJ Lewis
1. WELCOME AND INTRODUCTIONS 2. REVIEW OF THE MINUTES - The minutes from the February 1st meeting were reviewed and approved.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
Rob Robinson, Kelly Goodfellow – reinvestment plan, Secretary’s announcement
Kelly spent some time reviewing the reinvestment plan for 2016 and 2017. She explained the impact state cuts had on the 2016 plan and the indicated impact the 2017 cut will have unless something changes. The cuts are included in legislation and to change that would take an action by the legislature. The presentation is attached. Rob Robinson spent some time discussing the new 1115 Waiver and its implications. He noted that the waiver is about the medical side of Medicaid, that any changes to the behavioral health side would happen 4 years after the implementation of the 1115 Waiver. That being said, the timeframe for changes to the MCO model would be anywhere from 5-7 years down the road. He also stated that knowing how the system as a whole is changing, Alliance’s goal would be to position itself to be a continuing part of the system long term. The Secretary put out a communication about MCO mergers, again partnering Alliance with Sandhills. The MCOs are to develop a plan to complete those mergers. The plan should be ready by the end of the summer, the actual mergers would take 1-2 years. Questions were ask about the viability of MCOs being a long term part
Continue to review the information around reinvestments, state cuts, the 1115 Waiver, and advocate as you deem appropriately.
Ongoing
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Monday, April 04, 2016 Consumer and Family Advisory Committee
Page 2 of 4
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: of the Medicaid system and Rob stated they had ask the same question to the Secretary. He appears committed to the model, therefore the additional mergers are needed to right size the MCOs. (4 total in the state)
First in Families Presentation
Debby Torres and Bryce Coleman gave an overview of who First in Families is and what they do to support families. Bryce spent some time talking about an initiative to support siblings of people with I/DD and encouraged members to let them know about a support group. The group’s information is available on Meet-Up.com. They left additional written materials and information for members.
Utilize resources and spread the word.
Ongoing
Subcommittees
Rules
Services
Communications
Wake
Durham
Cumberland – presenting Ellen Gibson for membership consideration
Area Board
Human Rights
Quality Management
Executive Leadership Team
Rules- Israel discuss the revision of by-laws, offered the opportunity for additional input. The goal is to present in June for a first reading, then vote in the changes at the next meeting. Services – Brynda noted the group has a meeting scheduled on Monday night. Communications – No meeting. Carrie encouraged members to think about a permanent chair for this committee. Wake – Israel gave a brief overview of minutes Durham – Steve talked about their meeting and gave a brief overview of the minutes. Cumberland – Did not have a meeting, had Mental Health First Aid Youth training instead. Decided to table the membership of Ellen Gibson until the next meeting so they could present additional information. Area Board – no report
Continue attending meetings and report back to the full committee.
Ongoing
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Monday, April 04, 2016 Consumer and Family Advisory Committee
Page 3 of 4
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Human Rights – no report Executive Leadership – Discussed the importance of gaining more participation, the value of that especially with the continued reform efforts underway.
State Updates/SWOT Analysis
CJ Lewis helped the committee through a SWOT analysis: Strengths Ears at the highest level – CEO attending Education on Community Increased diversity Strong core group of members Having a voice/being heard Weaknesses Lack of orientation Training Lack of participation Not enough input from families Too many acronyms Communication – to each other Time management Opportunities Community trainings, experts Ability to participate in legislative meetings, hearings, etc. Partnerships Outreach – community Challenges/Threats New members Transportation Legislation changes/Mergers
Review the information both locally and MCO wide through this process and make decisions about future needs and actions.
Members were also ask to fill out the self-
assessment form provided and return it to CJ Lewis.
August, 2016
June, 2016
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Monday, April 04, 2016 Consumer and Family Advisory Committee
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AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Retain Members Complex system
Announcements
Facebook Page – Doug explained that we have been maintaining a CFAC Facebook page and have had limited success in getting members to participate and to get followers. Alliance has started a Facebook page for the organization and we are recommending putting a CFAC tab on that page, giving CFAC the ability to post information through Doug, always denoting that information is from CFAC, and to take advantage of Alliance’s promotional efforts in trying to drive traffic to its page. Through consensus, the group was fine with this change. NAMI Walk – Reminder the walk is on May 7th and CFAC has a table that you voted to man. Dave, Dan, and Sharon all said they would be there to man the table. Dave encouraged Wake members to participate. Nominating Committee – Carrie ask for volunteers to be a part of the nominating committee. They are to present a slate of officers at the next full CFAC meeting in June. Dave, Faye, and Sharon agreed to the task. Doug will get with them to set up an opportunity to review the task and support them in accomplishing it.
Doug to communicate with the Communications Department and assist with implementation of the group’s decision. People should show up and participate on May 7th. Doug will ensure that they have brochures and other information needed for the table. Doug will set up meeting, committee will prepare a slate of officers.
April, 2016
May 7th
June Board Meeting
5. ADJOURNMENT
The group adjourned at 7:30pm.
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Presentation to CFACApril 4, 2016
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• As we invest in developing quality services,
we continue to save
• Plan will address unmet needs
• Sustainable plan through fund balance and
service dollars
• Strong management oversight will allow us
to make adjustments as needed
Reinvestment Plan
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• Develop/expand community-based services
• Manage utilization of high-cost services
• Improve access to services
• Provider stability through rate increases
• Incentive evidence based practices
• Reduce ED admissions and wait times
• Integrated care activities
• Opiate/benzodiazepine misuse
Focus Areas
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FY16 Reinvestment
Description Original Plan Revised Plan
Bridge Funding $400,000
ICF Rate Increase 4,000,000 1,500,000
Crisis Facilities 11,000,000 11,000,000
NC START 620,000 472,000
Integrated Care 1,500,000 450,000
Network Plan 5,000,000 750,000
Expansion of Therapeutic Foster Care 186,000
Trauma Informed Therapeutic Foster Care 50,000
ICF Transitions with B3 funds 183,000
Technology Enabled Home 10,000
Short Term Stabilization PRTF 300,000
Outpatient Rates 1,000,000 250,000
Total $23,520,000 $15,151,000
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FY17 Reinvestment
Description Fully-FundedNon-Funded Investments
with $17M Reduction
FY17 Revised
Investment Plan
Enhanced Therapeutic Foster Care $905,000 X
ICF Transitions 1,000,000 X
Trauma Informed Therapeutic Foster Care 100,000 100,000
Expanded Integrated Care 750,000 750,000
Technology Enabled Home 25,000 X 25,000
Short Term Stabilization PRTF 900,000
First Responders Reimbursement 310,000 310,000
Mobile Crisis 800,000 X
BH Urgent Care 6,500,000 X
Child Facility Based Crisis 9,500,000 X
Peer Respite/Rapid Response 540,000 540,000
Peer Transition Teams 500,000 500,000
IDD Crisis Respite Facility 1,314,000 X
Intensive Wrap Around 360,000 360,000
Group Living Step Down 191,625 191,625
Additional Service Rate Increases 6,250,000 X
Total $29,945,625 $2,776,625
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• Six regions across state
• Three commercial MCOs and up to 12 PLEs
• Timeline
oDHHS to submit Waiver by June 1, 2016
oCMS approval anticipated January 1, 2018
oPHP (PLE and MCOs) “go-live” July 1, 2019
oLME/MCO system left as is until July 1, 2023
Medicaid Reform Plan
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Proposed Regions
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• Four specialty health regions for behavioral
health
• Alliance to merge with Sandhills to form
South Central Region
• LME/MCO implantation plans to be developed
and submitted by end of summer
Latest Developments
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Proposed Regions
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(Back to agenda)
ITEM: Finance Committee Report
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
The Finance Committee’s function is to review financial statements and recommend
policies/practices on fiscal matters to the Area Board. The Finance Committee meets monthly at
3:00 p.m. prior to the regular Area Board Meeting.
General Statute 159-24 requires that each local government or public authority shall appoint a
finance officer to hold office at the pleasure of the appointing board or official. 159-28 allows for
the appointment of a deputy finance officer for the purpose of pre-audit requirements.
REQUEST FOR AREA BOARD ACTION:
Accept the report. Appoint Kelly Phillips as Deputy Finance Office of Alliance Behavioral
Healthcare.
CEO RECOMMENDATION:
Accept the report. Appoint Kelly Phillips as Deputy Finance Office of Alliance Behavioral
Healthcare.
RESOURCE PERSON(S):
James Edgerton, Committee Chair; Robert Robinson, CEO; Kelly Goodfellow, CFO
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
5B
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Thursday, April 07, 2016 BOARD FINANCE COMMITTEE
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date.
Page 1 of 2
APPOINTED MEMBERS PRESENT: ☒ James Edgerton, Chair; ☐George Quick, MBA, ☒ John Griffin; ☒ Vicki Shore ☒ Chris Bostock BOARD MEMBERS PRESENT: Bill Stanford GUEST(S) PRESENT:
STAFF PRESENT: Rob Robinson, CEO; Kelly Goodfellow, CFO; Sara Pacholke, Controller
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – The minutes from the 2/4/2016 meeting were reviewed; a motion was made by Vicki Shore and seconded by John Griffin. The minutes from the 3/3/2016 meeting were reviewed; a motion was made by John Griffin and seconded by Vicki Shore.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME: 3. The monthly financial reports were discussed which includes the Statement
of Revenue and Expenses – Actual to Budget, Senate Bill 208 Required Ratios, and DMA Contract Ratios
a) Statement of Revenue and Expenses – Actual to Budget as of February 29, 2016 – Alliance currently has revenues exceeding expenses of $27,595,645. The majority of this is related to Medicaid and Medicaid risk reserve.
b) Senate Bill 208 Ratios - Alliance is currently meeting and exceeding all required Senate Bill 208 ratios.
c) DMA Contract Ratios – Alliance is currently meeting and exceeding the defensive interval ratio. Alliance is not currently meeting the Medicaid Expense Ratio. MCO’s are negotiating the contract terms with DMA to change the language to include a Medical Loss Ratio (MLR). This ratio includes certain administrative costs in the expense portion of the ratio calculation (activities that contribute to the direct quality of care). The private sector includes these costs in their calculation, however the current DMA calculation excludes these costs.
4. Rob Robinson and Kelly Goodfellow went over Alliance’s discussion with DMA regarding our Medicaid Rates for FY17. DMA presented Alliance with a 3% rate reduction and allowed us the option to respond.
Finance Committee Meeting 5/5/16 Page 3 of 10
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Thursday, April 07, 2016 BOARD FINANCE COMMITTEE
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
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
5. Sara Pacholke discussed that we would be presenting a motion next month to appoint Kelly Phillips, Director of Budget and Financial Analysis as the Deputy Finance Officer.
6. The Budget Transfer Policy was discussed. Jim Edgerton recommended adding language that specified that the transfers would be brought to the Finance Committee before the board. Rob explained that we are working on basic benefit packages that would be offered in each county.
4. ADJOURNMENT
Finance Committee Meeting 5/5/16 Page 2 of 10
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ASSETS
Current Assets
Cash and cash equivalents $60,290,370.58
Restricted cash 15,685,614.00
Short term investments 35,015,330.69
Due from other governments 8,221,092.02
Accounts receivable, net of allowance for uncollectible accounts 383,359.02
Sales tax refund receivable 71,277.68
Prepaid expenses 245,360.36
Total Current Assets 119,912,404.35
Noncurrent Assets
Restricted Cash 24,024,996.16
Other assets 106,321.66
Capital assets, net of accumulated depreciation 881,247.05
Net Pension Asset 1,862,066.00
Deferred Outflows of Resources 2,933,681.00
Total Other Assets 29,808,311.87
Total Assets $149,720,716.22
LIABILITIES
Current Liabilities
Accounts Payable and Other Current Liabilities 4,161,198.97
Claims and other service liabilities 30,282,094.97
Current portion of accrued vacation 489,279.15
Total Current Liabilities 34,932,573.09
Noncurrent Liabilities
Accrued Vacation 734,930.18
Deferred Inflows of Resources 4,538,308.00
Total Long-Term Liabilities 5,273,238.18
Total Liabilities 40,205,811.27
NET POSITION
Capital Assets at Beginning of Year 726,913.09
Restricted 33,523,126.09
Unrestricted 48,965,250.46
Net Revenue over Expenses:
Current Year Change in Net Position 26,299,615.31
Total Net Position 109,514,904.95
Total Liabilities and Net Position $149,720,716.22
Statement of Net Position - As of March 31, 2016
Finance Committee Meeting 5/5/16 Page 4 of 10
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Net Position as of June 30, 2015
Capital Assets at Beginning of Year $726,913.09
Restricted
Risk Reserve 17,837,513.24
State Services 62,500.00
Cumberland Services 5,186,805.07
Wake Services 10,436,307.78
Total Restricted 33,523,126.09
Unrestricted 48,965,250.46
Total Net Position as of June 30, 2015 83,215,289.64
Current Year Change in Net Position
Related to Risk Reserve 6,187,482.92
Related to Medicaid Services 20,471,560.54
Related to State and Federal Grant Services (8,021,901.74)
Related to Local Services 1,245,352.26
Related to Administration 6,417,121.33
Total Current Year Change in Net Position 26,299,615.31
TOTAL NET POSITION $109,514,904.95
Net Position: Detail - As of March 31, 2016
Finance Committee Meeting 5/5/16 Page 5 of 10
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% Received/Original Budget Current Period Year to Date Balance Expended
REVENUESLocal Grants $36,294,009.00 $2,078,931.75 $27,343,534.54 $8,950,474.46 75.34%State & Federal Grants 54,491,655.00 2,872,728.39 32,574,666.82 21,916,988.18 59.78%Medicaid Waiver Services 372,401,144.00 31,021,474.10 273,820,770.86 98,580,373.14 73.53%In Kind - - 1,051,365.04 -
Total Revenue 463,186,808.00 35,973,134.24 334,790,337.26 129,447,835.78 72.28%
AdministrativeLocal Administration 364,086.00 20,789.33 273,064.80 91,021.20 75.00%LME Administrative Grant 4,359,385.00 363,282.00 3,269,538.50 1,089,846.50 75.00%Medicaid Waiver Administration 47,325,972.00 4,028,865.93 35,574,618.27 11,751,353.73 75.17%Miscellanous Revenue 100,000.00 11,654.62 34,091.06 65,908.94 34.09%
Total Administrative Revenue 52,149,443.00 4,424,591.88 39,151,312.63 12,998,130.37 75.08%
Total Revenues 515,336,251.00 40,397,726.12 373,941,649.89 142,445,966.15 72.56%
EXPENSESLocal Services 36,294,009.00 2,295,054.06 26,207,474.85 10,086,534.15 72.21%State & Federal Services 54,491,655.00 3,952,338.88 40,596,568.56 13,895,086.44 74.50%Medicaid Waiver Services 372,401,144.00 30,728,526.86 247,161,727.40 125,239,416.60 66.37%In Kind Expenses - - 1,051,365.04 -
Total Service Expenses 463,186,808.00 36,975,919.80 315,017,135.85 149,221,037.19 68.01%
AdministrativeOperational 7,160,457.00 744,985.69 4,409,680.44 2,750,776.56 61.58%Salaries, Benefits, and Fringe 36,090,150.00 2,899,759.44 23,146,426.29 12,943,723.71 64.14%Professional Services 8,798,836.00 1,073,091.19 5,068,792.00 3,730,044.00 57.61%Miscellanous Expense 100,000.00 - - 100,000.00 0.00%
Total Administrative Expenses 52,149,443.00 4,717,836.32 32,624,898.73 19,424,544.27 62.56%
Total Expenses 515,336,251.00 41,693,756.12 347,642,034.58 168,645,581.46 67.46%
CHANGE IN NET POSITION ($1,296,030.00) $26,299,615.31
Statement of Revenue and Expenses (Budget and Actual) - As of March 31, 2016
Finance Committee Meeting 5/5/16 Page 6 of 10
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Senate Bill 208 Ratios - As of March 31, 2016
100.00%
86%
88%
90%
92%
94%
96%
98%
100%
102%
O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6 F E B - 1 6 M A R - 1 6
PERCENT PAID
Bench Mark Alliance
Percent Paid = Percent of clean claims paid within 30 days of receiving. The benchmark is 90%.
Current Ratio = Compares current assets to current liabilities. Liquidity ratio that measures an organization's ability to pay short term oblications. The benchmark is 1.0.
3.43
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6 F E B - 1 6 M A R - 1 6
CURRENT RATIO
Bench Mark Alliance
Finance Committee Meeting 5/5/16 Page 7 of 10
25 of 162
DMA Ratios - As of March 31, 2016
94.85
0
20
40
60
80
100
120
O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6 F E B - 1 6 M A R - 1 6
DEFENSIVE INTERVAL
Bench Mark Alliance
Defensive Interval = Current assets divided by average daily operating expenses. This rato shows how many days the
organization can continue to pay expenses if no additional cash comes in. The benchmark is 30 days.
Finance Committee Meeting 5/5/16 Page 8 of 10
26 of 162
DMA Ratios - As of March 31, 2016
83.68%
70%
75%
80%
85%
90%
95%
O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6 F E B - 1 6 M A R - 1 6
MEDICAL EXPENSE RATIO
Bench Mark MER
Medical Expense Ratio (MER) = Total Service Expenses divided by Total Medicaid Revenue less Risk Reserve Revenue. The
benchmark is 85%. This is the ratio requirement per our contract with DMA. MCO's are held harmless through July 2017.
83.76%
70%
75%
80%
85%
90%
95%
O C T - 1 5 N O V - 1 5 D E C - 1 5 J A N - 1 6 F E B - 1 6 M A R - 1 6
MEDICAL LOSS RATIO
Bench Mark MLR
Medical Loss Ratio (MLR) = Total Services Expenses plus Administrative Expenses that go towards directly improving
health outcomes divided by Total Medicaid Revenue less Risk Reserve Revenue. The benchmark is 85%. This is the ratio
that is currently being negotiated with DMA.
Finance Committee Meeting 5/5/16 Page 9 of 10
27 of 162
(Back to agenda)
ITEM: Draft Minutes from the April 7, 2016, Board Meeting
DATE OF BOARD MEETING: May 5, 2016
REQUEST FOR BOARD ACTION: Approve the draft minutes from the April 7, 2016, Board Meeting.
CEO RECOMMENDATION: Approve the minutes.
RESOURCE PERSON(S): Robert Robinson, CEO; Veronica Ingram, Executive Assistant
A.
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
6A
28 of 162
Thursday, April 07, 2016
AREA BOARD REGULAR MEETING
521 North Brightleaf Boulevard, Smithfield, NC 27577
4:00-6:00 p.m.
Page 1 of 4
MEMBERS PRESENT: ☒Ann Akland (via phone), ☒Cynthia Binanay, Vice-Chairwoman (via phone), ☒Christopher
Bostock, Chairman, ☒George Corvin, MD, ☒Kenneth Edge, ☒James Edgerton, ☒Lodies Gloston, ☒Phillip Golden (via
phone), ☒John Griffin, Ed.D, ☒Curtis Massey (via phone), ☒Rev. Michael Page (via phone), ☐George Quick, ☒Vicki Shore,
☒William Stanford, Jr., ☒Caroline Sullivan (via phone), ☒Amelia Thorpe, ☒Lascel Webley, Jr., and ☐McKinley Wooten, Jr.
GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair (via phone); Carol Beaumont, Johnston County Mental Health Board; Jeffrey Carver, Johnston Board
of County Commissioners; Rick Hester, Johnston County Manager; Terry Keene, Johnston County Mental Health Board; and Jason Phipps, Johnston County
Mental Health Board/Johnston CFAC Chair
ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Hank Debnam, Cumberland Site Director/Veterans Point of Contact; Joey Dorsett,
CIO; Kelly Goodfellow, CFO; Amanda Graham, Chief of Staff; Veronica Ingram, Executive Assistant; Janis Nutt, Johnston Site Director; Sara Pacholke,
Controller; Monica Portugal, Chief Compliance Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Sean Schreiber, Chief Clinical Officer; and Doug
Wright, Director of Consumer Affairs
1. CALL TO ORDER: Chairman Christopher Bostock called the meeting to order at 4:02 p.m.
AGENDA ITEMS: DISCUSSION:
2. Announcements A. INTRODUCTIONS: Chairman Bostock thanked Dr. Janis Nutt for hosting today’s meeting. Commissioner Jeffrey Carver
welcomed attendees to Johnston County.
B. MAKING A DIFFERENCE BREAKFAST: Mr. Robinson notified Board members that this year’s annual Making a
Difference Breakfast in Durham is on May 5, 2016, from 8:30-10:00 a.m. It is an opportunity to thank and honor
community partners involved with system of care. All Board members are invited to attend the breakfast.
C. UPCOMING MEETINGS WITH LEGISLATORS: Mr. Robinson mentioned upcoming meetings with NC legislators on
April 19, 2016; he invited Board members to contact him if they are able to attend.
D. FUTURE DEVELOPMENT WORKGROUP: Mr. Robinson reminded Board members that the next meeting will be Tuesday,
April 5 at 4:00 pm. This is a staff workgroup that meets monthly. Board members are invited to attend this meeting.
3. Agenda Adjustments There were no adjustments to the agenda.
4. Public Comment There were no public comments.
5. Committee Reports A. Consumer and Family Advisory Committee – page 5
The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from
Durham, Wake, or Cumberland counties who receive mental health, intellectual/developmental disabilities or substance
29 of 162
Thursday, April 07, 2016
AREA BOARD REGULAR MEETING
521 North Brightleaf Boulevard, Smithfield, NC 27577
4:00-6:00 p.m.
Page 2 of 4
AGENDA ITEMS: DISCUSSION:
use/addiction services. This month’s report included draft minutes from the Alliance CFAC’s June meeting, a recap of
snapshot surveys, a copy of alcohol awareness training, and the CFAC monthly board report summary.
The committee reports were sent as part of the Board packet; Caroline Ambrose, CFAC Chair, presented the report. Ms.
Ambrose mentioned a recent mental health first aid training for Cumberland CFAC subcommittee members and the
Cumberland community; new Consumer Relations Specialist, Starlett Davis; recent participation in Alliance’s annual Board
budget retreat; and a presentation on accessing I/DD services. Additionally, Ms. Ambrose mentioned development of a
strategic plan to meet legislative requirements and a recent demonstration of navigating Alliance’s website.
B. Finance Committee – page 48
The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to
the Area Board. This month’s report included draft minutes from the February meeting. James Edgerton, Finance Committee
Chair, presented the report. Mr. Edgerton noted that revenue exceeds expenditures; he mentioned Alliance’s excellent
performance on State mandated ratios and discussions being made on changes to two of the ratio definitions.
BOARD ACTION
The Board received the reports; no additional action required.
6. Consent Agenda A. Draft Minutes from March 3, 2016, Regular Board Meeting – page 57
B. Audit and Compliance Committee Report – page 62
C. County Commissioners Advisory Committee Report – page 70
D. Executive Committee Report – page 73
E. Network Development and Services Committee Report – page 76
F. Quality Management Committee Report – page 115
G. 457 and 401K Plan Provisions – page169
Chairman Bostock stated that the consent agenda was sent as part of the Board packet; there were no questions or discussion
about the consent agenda.
BOARD ACTION
A motion was made by Mr. William Stanford to accept the consent agenda; seconded by Ms. Lodies Gloston. Motion passed
unanimously.
30 of 162
Thursday, April 07, 2016
AREA BOARD REGULAR MEETING
521 North Brightleaf Boulevard, Smithfield, NC 27577
4:00-6:00 p.m.
Page 3 of 4
AGENDA ITEMS: DISCUSSION:
7. Training A. Data Analytics Roadmap – page 170
Alliance is committed to expanding and enhancing its current analytic capabilities to improve business reporting, quality of
care, the cost of care and member experience. Michael Bollini, Chief Strategy Officer, provided an overview of the progress
of the data analytics roadmap and noted changes in staff roles to implement this program. He shared about performance
metrics and characteristics of analytics delivery maturity; Dr. Bollini concluded with the overall benefit of the analytics
program: to provide data to best determine next steps, to provide aggregate data to providers, and to provide data regarding
social determinants and varying population demographics (for the catchment area and local communities).
Board members discussed applicable uses and requested a timeline for program implementation milestones. Dr. Bollini
mentioned that the data discovery milestone is August 2016 and that an update will be provided to the Board if requested.
The presentation of the data analytics roadmap is attached to and made part of these minutes.
B. Strategic Plan Goal #5: Attract and Retain a Talented Workforce – page 183
Al Ragland, Chief HR Officer, reviewed the following: Alliance’s performance management system and its alignment to
the strategic plan; training series for supervisors, management and executive leadership; employee development system with
nearly 9,000 hours of training within the past year; newly initiated wellness program and reward and recognition program;
ongoing internal communications plan; social committee activities (including annual All-Staff training); current staff
demographics, turnover and time to fill rates.
Mr. Robinson shared the positive impact from the activities that the social committee coordinates. He commended social
committee chair, Anita Hoggard, Training Specialist. Board members requested information regarding turnover rate with
other NC MCOs, state and county agencies. Mr. Ragland shared that for the information currently available, Alliance’s rates
are better. He will provide an update when additional information is available. Additionally, Board members requested
information regarding if future wellness programs could be used to impact insurance coverage (enrollment in wellness plan
could lower premium rates). Mr. Ragland shared that this is being pursued; he also stated that as Alliance is self-insured, it
has produced over 10% projected savings. The presentation of the strategic plan goal five update is attached to and made
part of these minutes.
BOARD ACTION
The Board received the trainings; no additional action required.
31 of 162
Thursday, April 07, 2016
AREA BOARD REGULAR MEETING
521 North Brightleaf Boulevard, Smithfield, NC 27577
4:00-6:00 p.m.
Page 4 of 4
AGENDA ITEMS: DISCUSSION:
8. Updates A. Senate Bill 208 – page 206
Kelly Goodfellow, CFO, presented an update on SB 208 audit performed by an external consultant (HMS) per legislative
guidelines/requirements. Ms. Goodfellow noted that Alliance received results from the September review of March-August
2015; she noted all findings were favorable. The data from all NC MCOs is also provided to NC DHHS Secretary, Rick
Brajer. The presentation of the Senate Bill 208 audit is attached to and made part of these minutes.
B. Medicaid Reform/Consolidation
Mr. Robinson reminded Board members of Secretary Brajer’s Medicaid reform plan. He mentioned the State’s 1115
innovations waiver application and how it moves physical healthcare to a capitated rate plan under which MCOs already
operate. The secretary’s plan includes three state-wide commercial managed care companies and up to twelve PLEs
(provider led entities). MCOs are left as is through July 1, 2023. The draft 1115 waiver is currently being vetted primarily
through a series of twelve listening sessions convened by the DHHS across the North Carolina.
Also, Mr. Robinson mentioned the March 17, 2016, meeting with Secretary Brajer and NC LME/MCO CEOs; at this
meeting Secretary Brajer shared his plan regarding MCO consolidation; this included his plan for a merger between
Alliance and Sandhills LME/MCOs.
9. Chairman’s Report Chairman Bostock reminded Board members that next month’s Board meeting is at Alliance’s corporate site.
10. Closed Session BOARD ACTION
A motion was made by Dr. George Corvin to enter closed session pursuant to per § 143-318.11 (a) (6) to consider the
qualifications, competence, and performance of an employee; seconded by Dr. John Griffin. Motion passed unanimously.
The Board returned to open session.
11. Adjournment With all business being completed the meeting adjourned at 6:30 p.m.
Next Board Meeting
Thursday, May 05, 2016
4:00 – 6:00
Robert Robinson, Chief Executive Officer Date Approved
32 of 162
(Back to agenda)
ITEM: Audit and Compliance Committee Report
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND: The purpose of the Audit and Compliance Committee is to put forth a meaningful effort to review
the adequacy of existing compliance systems and functions and to assist the Area Board in
fulfilling its oversight responsibilities.
This report includes draft minutes for the April 18, 2016 meeting.
REQUEST FOR AREA BOARD ACTION: Accept the report.
CEO RECOMMENDATION: Accept the report.
RESOURCE PERSON(S): Lascel Webley, Committee Chair; Monica Portugal, Chief Compliance Officer
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
6B
33 of 162
Monday, April 18, 2016
BOARD AUDIT AND COMPLIANCE COMMITTEE - SPECIAL MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 p.m.
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: ☐Curtis Massey, B.A., J.D., ☒George Quick, B.A., M.B.A., ☒Lascel
Webley, Jr., Committee Chair, B.S., M.B.A., M.H.A., ☒McKinley Wooten, Jr., B.A., J.D.,
BOARD MEMBERS PRESENT: None
GUEST(S) PRESENT: None
STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Ken Marsh, Medicaid Program Director
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – The minutes from the September 10, 2015, meeting and notes from November 19, 2015 and March 10, 2016
meetings were reviewed; a motion was made by Mr. Wooten and seconded by Mr. Quick to approve the minutes. Motion passed unanimously.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
3. Annual Conflict of
Interest Disclosures
All but three Board Members have turned in the annual disclosure form. So
far no conflict, which has not already been approved by the Board, has been
disclosed. Mr. Webley requested that meeting stipends are withheld,
according to the conflict of interest policy, until the forms have been
submitted.
Ms. Portugal will
request that the
stipends be withheld
By April 30,
2016
4. Independent Audit
Contract
The Committee reviewed a summary of the FY17 Contract and Scope of
Work between Alliance and the audit firm. There was a discussion regarding
the contract and whether Alliance should pursue other firm. Mr. Quick stated
the selected firm has expertise in areas other firms do not, including local
government. Many counties in the Alliance catchment area use the same
firm. Ms. Portugal explained that the firm’s most recent (2013) peer review
conducted through American Institute of CPAs resulted in a passing score.
The next system peer review is due in October of this year. Ms. Portugal
suggested to utilize the results of the review to evaluate the firm’s
performance and own internal controls. Also, all relationships between
Alliance and the firm were disclosed.
A motion was made by Mr. Wooten that Mr. Webley, as the Committee
Chair, be given the authority to sign the contract on behalf of the Committee.
The motion was seconded by Mr. Quick. Motion passed.
Ms. Portugal will
request the results of
the next peer review
October 2016
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Monday, April 18, 2016
BOARD AUDIT AND COMPLIANCE COMMITTEE - SPECIAL MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 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
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
Mr. Webley signed the contract.
5. Annual Risk
Assessment
Ms. Portugal provided an overview of the annual risk assessment and
requested feedback regarding the proposed methodology for FY17. Mr.
Wooten recommended that the Compliance Department continue recruitment
of the financial auditor position in order to gain additional expertise in
certain areas. The Committee agreed with the proposed methodology.
N/A N/A
6. EQRO Update As a follow up to the previous meeting, Mr. Marsh reported that Alliance has
submitted a formal request to DMA to designate the Continuous Quality
Improvement Committee as an “other structure” as allowed in Section 7.1 of
the DMA / Alliance Contract. Alliance is expecting an answer from DMA
sometime soon.
N/A N/A
7. Quarterly Reports
The Committee reviewed the quarterly Compliance dashboard for Quarters
1, 2, and 3 of FY16. Members asked questions related to the hotline,
overpayments and special investigations.
N/A N/A
8. ADJOURNMENT: next meeting will be May 11, 2016, from 4:00 p.m. to 5:30 p.m.
35 of 162
(Back to agenda)
ITEM: Executive Committee Report
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
The Executive Committee sets the agenda for Area Board meetings and acts in lieu of the Area
Board between meetings. Actions by the Executive Committee are reported to the full Area Board
at the next scheduled meeting. Draft minutes from the April 19, 2016, meeting and approved
minutes from the March 29, 2016, meeting are attached.
REQUEST FOR AREA BOARD ACTION: Accept the report.
CEO RECOMMENDATION: Accept the report.
RESOURCE PERSON(S): Christopher Bostock, Area Board Chair; Robert Robinson, CEO
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
6C
36 of 162
Tuesday, March 29, 2016
BOARD EXECUTIVE COMMITTEE MEETING - SPECIAL MEETING
4600 Emperor Boulevard, Durham, NC 27703
11:30 a.m. to 12:30 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 1
APPOINTED MEMBERS PRESENT: ☐Ann Akland, Services Committee Chair, B.S.; ☒Cynthia Binanay, Board
Vice-Chair, B.S.N, M.A.; ☒Christopher Bostock, Board Chair, B.S.I.M.; ☒George Corvin, Quality Management
Committee Chair, M.D. (entered at 11:47 a.m.); ☒James Edgerton, Finance Committee Chair, B.S.; ☒Lodies Gloston,
Human Rights Committee Chair, B.A., M.A.; ☒Curtis Massey, Policy Committee Chair, B.A., J.D. (via phone); ☒
William Stanford, Previous Board Chair, B.A., J.D.; and ☐Lascel Webley, Audit and Compliance Committee Chair,
B.S., M.B.A., M.H.A
BOARD MEMBERS PRESENT: None
GUEST(S): None
STAFF PRESENT: Veronica Ingram, Executive Assistant; Al Ragland, Chief HR Officer
1. WELCOME AND INTRODUCTIONS: Chairman Bostock reminded Committee members of the budget retreat occurring at 12:30 pm.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
2. Closed Session Committee entered closed session.
COMMITTEE ACTION:
A motion was made by Ms. Lodies Gloston to enter closed session pursuant to NC
General Statue 143-318.11(a) (6) to discuss the performance of a public official;
seconded by Mr. William Stanford. Motion passed unanimously.
None specified. N/A
3. Return to Open
Session
Committee returned to open session.
Chairman Bostock noted that the Area Board would hold a closed session during its
April 7, 2016, meeting. The Executive Committee would share input at that time.
None specified. N/A
4. ADJOURNMENT: the next Committee meeting will be April 19, 2016, at 4:00 p.m.
37 of 162
Tuesday, April 19, 2016
BOARD EXECUTIVE COMMITTEE MEETING - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 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, Services Committee Chair, B.S. (via phone); ☒Cynthia
Binanay, Board Vice-Chair, B.S.N, M.A. (via phone); ☒Christopher Bostock, Board Chair, B.S.I.M.; ☒George
Corvin, Quality Management Committee Chair, M.D. (via phone); ☒James Edgerton, Finance Committee Chair, B.S.;
☒Lodies Gloston, Human Rights Committee Chair, B.A., M.A.; ☒Curtis Massey, Policy Committee Chair, B.A., J.D.
(via phone); ☐William Stanford, Previous Board Chair, B.A., J.D.; and ☒Lascel Webley, Audit and Compliance
Committee Chair, B.S., M.B.A., M.H.A (via phone)
BOARD MEMBERS PRESENT: None
GUEST(S): None
STAFF PRESENT: Amanda Graham, Chief of Staff; Carol Hammett, General Counsel; Veronica Ingram, Executive Assistant; Rob Robinson, CEO
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – The minutes from the March 15, 2016, and March 29, 2016, Executive Committee meetings were reviewed; a
motion was made by Mr. Edgerton and seconded by Mr. Webley to approve the minutes. Motion passed unanimously.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
3. Updates a) NEXT FUTURE DEVELOPMENT WORKGROUP MEETING: Chairman
Bostock reminded Committee members that the next meeting for this staff work
group is Tuesday, May 3, 2016, at 4:00 p.m.
b) MEDICAID REFORM/CONSOLIDATION: Mr. Robinson provided an update
on the State’s 1115 waiver application. Additionally, he reviewed NC Council’s
recommendations regarding the 1115 waiver and noted that LME/MCO’s will
remain in current form for four years after implementation of the physical health
side.
a) Committee
members will
contact Ms.
Ingram to
confirm
attendance or
arrange a call-in
number.
b) None specified.
a) 5/3/2016
b) N/A
4. MHPA (Mental
Health Plans of
America)
Mr. Robinson reported that Alliance recently joined MHPA which is a trade
association for Health Plans treating the Medicaid population.
None specified. N/A
5. May 5, 2016, Area
Board Draft Agenda
Committee reviewed draft agenda and provided input. Ms. Ingram will
forward revised
agenda to staff
4/19/2016
38 of 162
Tuesday, April 19, 2016
BOARD EXECUTIVE COMMITTEE MEETING - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 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
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
6. Closed Session COMMITTEE ACTION:
A motion was made by Mr. Edgerton to enter closed session pursuant to NC
General Statute 143-318.11(a) (6) to consider the qualifications, competence, and
performance of an employee; seconded by Ms. Gloston. Motion passed
unanimously.
Committee returned to open session. Chairman Bostock will present the
Committee’s recommendation at the May 5, 2016, Area Board meeting.
None specified. N/A
5. ADJOURNMENT: the next Committee meeting will be May 17, 2016, at 4:00 p.m.
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REGISTRATION OPENS MAY 1, 2016!
50 of 162
Medicaid Health Plans of America 1150 18th Street NW, Suite 1010
Washington, DC 20036 www.mhpa.org
51 of 162
6D
(Back to agenda)
ITEM: Human Rights Committee Report
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
The Human Rights Committee shall include consumers and family members representing mental
health, developmental disabilities and substance abuse.
The Human Rights Committee functions include:
1) Reviewing and evaluating the Area Authority’s Client Rights policies at least annually and
recommending needed revisions to the Area Board.
2) Overseeing the protection of client rights and identifying and reporting to the Area Board
issues which negatively impact the rights of persons serviced.
3) Reporting to the full Area Board at least quarterly.
The Human Rights Committee shall meet at least quarterly.
The Human Rights Committee is required by statute and by your by-laws. The Committee meets
at least quarterly and reports to you by presenting the minutes of the meetings as well as through
Quality Management Reports reviewing grievances and incidents.
The Human Rights Committee is a Board Committee with at least 50% of its membership being
either consumers or family members that are not Board Members. All members and the chair are
appointed by the Chair of the Alliance Board of Directors. The Committee is currently chaired by
Ms. Lodies Gloston. Draft minutes and attachments for April 14, 2016, meeting are attached.
REQUEST FOR AREA BOARD ACTION:
Accept the report.
CEO RECOMMENDATION:
Accept the report.
RESOURCE PERSON(S):
Lodies Gloston, Committee Chair; Doug Wright, Director of Consumer Affairs; May Alexander,
QM Data Manager
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
52 of 162
Thursday, April 14, 2016
BOARD HUMAN RIGHTS COMMITTEE - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 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 5
APPOINTED MEMBERS PRESENT: ☒Marie Dodson, ☒Lodies Gloston, Board member/Committee Chair,
B.A., M.A., ☒Dan Shaw, ☒William Stanford, Board member, B.A., J.D., ☒Dr. Michael Teague, ☐Amelia Thorpe,
Board member, B.A., and ☐McKinley Wooten, Jr., Board member, B.A., J.D.
APPOINTED, NON-VOTING MEMBERS PRESENT:
BOARD MEMBERS PRESENT:
GUEST(S) PRESENT: STAFF PRESENT: Doug Wright, Yancee Pérez, Star Davis, Monica Portugal, May Alexander
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES - The minutes from the January 14, 2016, meeting were reviewed; a motion was made by Lodies Gloston and
seconded by Dan Shaw to approve the minutes. Motion passed.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
Grievances – May Alexander
May reviewed the number of complaints against Alliance in
FY16.
There are 47 complaints against Alliance so far this year. 46
of the complaints are LME/MCO functions and 1 is
categorized as Client Rights.
The 7 different sources the complaints came from:
Consumer, Parent/Guardian, Provider, Family Member,
Attorney, Consumer Advocate/Rep., & Other.
19 of 47 were External Stakeholder concerns, 26 were
Grievances, and 2 were Internal Employee Concerns.
May reviewed Client Rights and Confidentiality Concerns
in FY16.
There are 31 concerns regarding Clients Rights or
HIPPA/Confidentiality so far this fiscal year.
53 of 162
Thursday, April 14, 2016
BOARD HUMAN RIGHTS COMMITTEE - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 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 5
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
20 concerns were related to Clients Rights and 11 were
HIPAA/Confidentiality concerns. 6 of 31 concerns were
initiated by an Alliance employee.
Incidents – May Alexander
May spoke to the level three incident data (those that result
in physical or psychological damage). There are five
compliance categories that Alliance tracks each month.
It was mentioned that the area Alliance Providers struggle
most are in the area of verbal reporting to the proper agency
within a time frame of 24 hrs. and a written report within 72
hrs. There is a process that will be implemented by the
Corporate Compliance Committee in FY 17. That process
will include issuing warning letters and plans of correction.
Important note upon viewing the data presented by May;
each block is a month, and non-compliance is separated by
categories.
Information is collected about all level three incidents
abuse/neglect/exploitation and whether they were reported,
how many were reported, and whether they were reported
to the Department of Social Services or not. It was noted
that all sexual assaults are categorized as a level three.
May reviewed with the HRC the January and February data.
There was an increase in reports for the month of January
and February.
54 of 162
Thursday, April 14, 2016
BOARD HUMAN RIGHTS COMMITTEE - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date.
Page 3 of 5
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
Following was a report on the Level three incidents by
county. A noted abnormality was that there were no level
three incidents reported in Cumberland and Johnston
counties.
May mentioned that the reason some data doesn’t show as
of yet, is due to the fact that autopsies can take anywhere
from 12 months to even longer.
Compliance – Monica
Portugal
Monica Portugal, Chief Compliance Officer made a
presentation to the HRC giving an overview of the
Compliance Department.
Presentation began with exploring who is involved
• Each employee is committed – condition of
employment
• Every department serves a role
• Inter-departmental committees provide oversight
and reporting
• The Board is informed and governs the organization
• Oversight agencies monitor and enforce
How is compliance monitored
• Routine Monitoring
• Targeted Monitoring
• Grievance and Complaints Investigations
• Compliance Investigations
• Special Investigations
• Quality Assurance and Quality Improvement
• Clinical Reviews
55 of 162
Thursday, April 14, 2016
BOARD HUMAN RIGHTS COMMITTEE - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date.
Page 4 of 5
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
What does the compliance process look like
• Prevention:
• Information, Training, Obligations
• Detection:
• Monitoring/Investigation/Review
• Resolution and Mitigation:
• Findings presented to Corporate Compliance
Committee
• Actions and Sanctions
• Reconsiderations
Follow up from last meeting:
May, research the
opioid data included
with terminal illness
data
Potential Members
May reported that she looked into why opioid data was
included along with the terminal illness data. She
speculated that it may be something that was developed by
the state, and that death of natural causes are labeled as a
level two incident. The answer is still unclear.
Monica recommended contacting the DMH customer
service team to clarify.
Lodies introduced an individual interested in becoming a
member of the Human Rights Committee. The group
decided that it would be best for the potential member to be
present at the next meeting to introduce themselves and be
available to answer questions from the HRC members.
Lodies to contact potential member to
attend the next HRC meeting.
Next Meeting topic
Why people need
services, why people
leave services, and
There was discussion among the group concerning the
ability to only cover one topic from those proposed.
56 of 162
Thursday, April 14, 2016
BOARD HUMAN RIGHTS COMMITTEE - REGULAR MEETING
4600 Emperor Boulevard, Durham, NC 27703
4:00-6:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date.
Page 5 of 5
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME:
why people change
providers
Denials
Announcements There were no further announcements.
5. ADJOURNMENT: next meeting will be July 14, 2016 from 4:00 p.m. to 5:30 p.m.
57 of 162
Month # of Concerns
July 5
August 7
September 3
October 3
November 8
December 9
January 8
February 4
March
April
May
June
Nature of Issue July August September October November
Clients Rights 0 0 0 0 0
Confidentiality/HIPAA 0 0 0 0 0
LME/MCO Functions 5 7 3 3 8
# of Concerns - FY15
Summary of Concerns Against Alliance - FY16
47 complaints against Alliance in FY 2016
46 LME/MCO Functions. 1 Clients Rights
7 different sources (Consumer, Parent/Guardian, Provider, Family Member, Attorney,
Consumer Advocate/Rep., Other) submitted complaints.
19 of 47 were External Stakeholder concerns; 26 were Grievances; 2 were Internal
Employee Concerns
5
7
3 3
8
9
8
0
1
2
3
4
5
6
7
8
9
10
July August September October November December January
Number of Concerns Against Alliance by Month
# of Concerns Against Alliance by Nature of Issue
58 of 162
1
5
7
3 3
8
9 7
0
1
2
3
4
5
6
7
8
9
10
July August September October November December January
# of Concerns Against Alliance by Nature of Issue
Clients Rights Confidentiality/HIPAA
59 of 162
December January February March April May June
0 1 0
0 0 0
9 7 4
# of Concerns - FY15
4
January February March April May June
Number of Concerns Against Alliance by Month - FY16
# of Concerns Against Alliance by Nature of Issue - FY16
60 of 162
4
January February March April May June
# of Concerns Against Alliance by Nature of Issue - FY16
LME/MCO Functions
61 of 162
Yes No
March Appropriately Categorized 10 0
Notified Proper Agency 10 0
Reported Within Timeline 7 3
Effective Intervention and Protection 10 0
Report Accurate and Complete 10 0
Yes No
February Appropriately Categorized 9 2
Notified Proper Agency 6 5
Reported Within Timeline 9 2
Effective Intervention and Protection 6 5
Report Accurate and Complete 8 3
Yes No
January Appropriately Categorized 11 1
Notified Proper Agency 11 1
Reported Within Timeline 10 2
Effective Intervention and Protection 10 2
Report Accurate and Complete 10 2
Yes No
December Appropriately Categorized 9 0
Notified Proper Agency 8 1
Reported Within Timeline 8 1
Effective Intervention and Protection 9 0
Report Accurate and Complete 9 0
Yes No
November Appropriately Categorized 16 1
Notified Proper Agency 14 3
Reported Within Timeline 15 2
Effective Intervention and Protection 16 1
Report Accurate and Complete 15 2
Yes No
October Appropriately Categorized 14 1
Notified Proper Agency 15 0
Reported Within Timeline 12 3
Effective Intervention and Protection 13 2
Report Accurate and Complete 13 2
Yes No
September Appropriately Categorized 13 0
Incident Compliance for Level 3s - FY16
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Jan
uar
yD
ece
mb
erN
ove
mb
erO
cto
be
rSe
pte
mb
erA
ugu
stJu
ly
62 of 162
Notified Proper Agency 12 1
Reported Within Timeline 11 2
Effective Intervention and Protection 13 0
Report Accurate and Complete 13 0
Yes No
August Appropriately Categorized 11 1
Notified Proper Agency 12 0
Reported Within Timeline 9 3
Effective Intervention and Protection 12 0
Report Accurate and Complete 12 0
Yes No
July Appropriately Categorized 12 1
Notified Proper Agency 13 0
Reported Within Timeline 12 1
Effective Intervention and Protection 11 2
Report Accurate and Complete 12 1
July August September October
Appropriately Categorized 1 1 0 1
Notified Proper Agency 0 0 1 0
Reported Within Timeline 1 3 2 3
Effective Intervention and Protection 2 0 0 2
Report Accurate and Complete 1 0 0 2
Categories Receiving "No"s by Month
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Mar
chFe
bru
ary
Jan
uar
y
1
1
2
1
1
3
1
2
1
3
2
2
1
3
1
2
1
1
1
2
2
2
5
5
3
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Non-Compliance by Category by Month
63 of 162
Yes No % No
Appropriately Categorized 105 7 7%
Notified Proper Agency 101 11 11%
Reported Within Timeline 93 19 20%
Effective Intervention and Protection 100 12 12%
Report Accurate and Complete 102 10 10%
Combined Compliance for Level 3s - FY16
105 101 93 100
7%, 7 11%, 11 20%, 19 12%, 12
0
20
40
60
80
100
120
AppropriatelyCategorized
Notified Proper Agency Reported Within Timeline Effective Interventionand Protection
Report Accurate and
Combined Compliance for Level 3s - FY16
Yes No
0 1 2 3 4 5 6 7 8 9
July August September October November December January
64 of 162
2
2
2
1
1
1
32
1
2
1
3
2
2
1
2
1
3
1
1
2
1
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Level 3 Incident Compliance by Month - FY16
65 of 162
November December January February March April May
1 0 1 2 0
3 1 1 5 0
2 1 2 2 3
1 0 2 5 0
2 0 2 3 0
3
2
5
2
5
3
1
1
2
0 2 4 6 8 10 12 14 16 18
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Effective Intervention and Protection
Report Accurate and Complete
Appropriately Categorized
Notified Proper Agency
Reported Within Timeline
Yes No
2 1 2 2
5
3
Compliance by Category by Month - FY16
66 of 162
102
10%, 10
Report Accurate andComplete
10 11 12 13 14 15 16 17 18 19 20
January February March April May June
67 of 162
68 of 162
June
18 20
69 of 162
Client Rights CompliancePresentation to the Human Rights Committee
April 14, 2016
Monica Portugal, Chief Compliance Officer
70 of 162
71 of 162
Who Is Involved?
• Each employee is committed – condition of
employment
• Every department serves a role
• Inter-departmental committees provide oversight and
reporting
• The Board is informed and governs the organization
• Oversight agencies monitor and enforce
72 of 162
How Do We Do It?
• Routine Monitoring
• Targeted Monitoring
• Grievance and Complaints Investigations
• Compliance Investigations
• Special Investigations
• Quality Assurance and Quality Improvement
• Clinical Reviews
73 of 162
Compliance Process
• Prevention:
• Information, Training, Obligations
• Detection:
• Monitoring/Investigation/Review
• Resolution and Mitigation:
• Findings presented to Corporate Compliance Committee
• Actions and Sanctions
• Reconsiderations
74 of 162
(Back to agenda)
6E
ITEM: Budget Retreat
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
Review and approve the Budget Retreat minutes.
REQUEST FOR AREA BOARD ACTION: Approve the minutes.
CEO RECOMMENDATION: Approve the minutes.
RESOURCE PERSON(S):
Robert Robinson, CEO; Kelly Goodfellow, CFO
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
75 of 162
Tuesday, March 29, 2016
AREA BOARD REGULAR MEETING: ANNUAL BUDGET RETREAT
4600 Emperor Boulevard, Durham, NC, 27703
12:30-4:00 p.m.
Page 1 of 2
MEMBERS PRESENT: ☒Ann Akland, ☒Cynthia Binanay, Vice-Chairwoman, ☒Christopher Bostock, Chairman,
☒George Corvin, MD, ☐Kenneth Edge, ☒James Edgerton, ☒Lodies Gloston, ☒Phillip Golden, ☐John Griffin, Ed.D,
☐Curtis Massey, ☒Rev. Michael Page (entered at 1:33 p.m.), ☒George Quick, ☐Vicki Shore, ☒William Stanford, Jr.,
☐Caroline Sullivan, ☐Amelia Thorpe, ☐Lascel Webley, Jr., and ☐McKinley Wooten, Jr.
GUEST(S) PRESENT: Caroline Ambrose, CFAC Chair
ALLIANCE STAFF PRESENT: Michael Bollini, Chief Strategy Officer; Dr. Tedra Anderson-Brown, Medical Director; Joey Dorsett, Chief
Information Officer; Cathy Eaton, Administrative Assistant for Finance Department; Ashley Everette, Budget Analyst; Kelly Goodfellow, CFO; Carol
Hammett, General Counsel; Veronica Ingram, Executive Assistant; Beth Melcher, Chief of Network Development and Evaluation; Ann Oshel, Chief
Community Relations Officer; Sara Pacholke, Controller; Kelly Phillips, Director of Budget and Financial Analysis; Monica Portugal, Chief Compliance
Officer; Al Ragland, Chief HR Officer; Rob Robinson, CEO; Sean Schreiber, Chief Clinical Officer; and Doug Wright, Director of Consumer Affairs
1. INTRODUCTIONS: Mr. Robinson welcomed attendees; attendees introduced themselves.
AGENDA
ITEMS: DISCUSSION:
2. Opening/
Approach to
Budgeting
Kelly Goodfellow, CFO, provided a brief overview of the agenda. She noted that the approach to budgeting included historical
experience, capitation rate setting (which impacts funding), strategic initiatives, stakeholder input, needs and gaps analysis, and
the legislative environment which all impact the pending budget. Additionally, Ms. Goodfellow provided an overview of the
administrative budget and upcoming events which could impact the budget.
3. CFAC
Perspective
Caroline Ambrose, CFAC Chair, provided an overview of Alliance CFAC; Ms. Ambrose’s presentation included CFAC
composition, involvement/influence in additional community stakeholder groups, informational sources, and opportunities to
share input though Alliance department and reports, specifically gaps in services and needs that CFAC members identified.
Additionally, Ms. Ambrose shared overall concerns of CFAC members and expressed gratitude for being a part of the budget
retreat.
4. Provider
Networks
Beth Melcher, Chief of Network Development and Evaluation, reminded Board members of elements of the reinvestment plan
and provided an overview on the following: service priorities, disparities in State benefit plan, and FY17 DHHS State
initiatives/goals for NC MCOs.
76 of 162
Tuesday, March 29, 2016
AREA BOARD REGULAR MEETING: ANNUAL BUDGET RETREAT
4600 Emperor Boulevard, Durham, NC, 27703
12:30-4:00 p.m.
Page 2 of 2
AGENDA
ITEMS: DISCUSSION:
Board members requested an update regarding housing and the DOJ settlement. Ms. Oshel provided an update with local
housing options; she noted that developing partnerships with landlords and potential master lease agreements are some of the
options Alliance is pursuing. Additionally, Board members requested information regarding how State funds originally
designated to specific counties are utilized.
5. Clinical
Review
Sean Schreiber, Chief Clinical Officer, reviewed information on spending data by funding type, population, and service utilized;
he also provided information regarding how care was managed.
Board members discussed emergency room usage and how crisis facilities and elements of Alliance’s reinvestment plans can
impact emergency room usage for behavioral health needs.
6. Financial
Review
Kelly Phillips, Director of Budget and Financial Analysis, provided an overview of the budget to date: noting Medicaid
revenue/expense, services budget, administration budget, the PMPM (per member per month) funding, and current expenditures
compared to last year. Ms. Phillips also presented an overview of projected FY17 budget impacts.
7. Board Input Board members discussed potential budget impacts: impact from the end of SAMSHA grant, second year of single stream
funding cuts, amount specified for the administrative budget, potential expenses related to consolidating MCOs, and investment
options per statute requirements.
8. Next Steps Ms. Phillips mentioned that a recommended budget will be presented at the May Board meeting; the public hearing and
approved budget will occur at the June Board meeting. The budget retreat presentations are attached to and made part of these
minutes.
9. Adjournment With all business being completed the meeting adjourned at 2:54 p.m.
77 of 162
FY17 Budget Retreat
March 29, 2016
78 of 162
• Approach to budgeting
• CFAC perspective
• Provider Networks review
• Clinical review
• Financial review
• Board input
• Next steps
Agenda Review
79 of 162
• Historical and YTD experience
• Capitation rate
o Trend and rate offer
• Strategic initiatives
oReinvestment Plan
• Stakeholder input
o Board, CFAC, County, etc.
• Legislative environment
Approach to Budgeting
80 of 162
• Administrative
o Staff need and projections
o Professional services
o Medicaid Reform
• Consultants, staffing impact, facility needs,
training and education, etc.
o MCO consolidation
Approach to Budgeting
81 of 162
Consumer and Family
Advisory Committee
82 of 162
AllianceCFAC
WakeSubcommittee
DurhamSubcommittee
CumberlandSubcommittee
Johnston CFACInterlocal
Agreement
Board of Directors
Who Are We?
83 of 162
• Peer Support Specialist
• Board Member, The Arc of the Triangle
• Board Member, Durham County Community
Living Program
• Wellness City Citizen
• NAMI Wake
• NAMI Durham
• NAMI Cumberland/Harnett/Lee
Scope of Influence
84 of 162
• Americans with Disabilities Act, Cumberland
• Special Olympics
• Advocacy and Leadership Committee,
NC Council on Developmental Disabilities
• State CFAC
• First in Families
• Homeless Veteran’s Council
• Alliance Human Rights Committee
Scope of Influence
85 of 162
• Snap Shop surveys
• Community outreach activities
o Resource fair, Anonymous People film showing
• Personal experience and experiences shared
with us by community members
• Advocacy groups
Sources of Information
86 of 162
1. In thinking in this very minute, what
suggestion would you make to have CFAC
be a more meaningful experience?
2. Name two goals that you would like CFAC
to accomplish in the next four months.
3. In thinking about your community at this
very moment, is there a gap in services or
a service that needs addressing?
Snap Shot Survey
87 of 162
4. Please note any areas of concern as it relates
to the cultural competence of Alliance or the
providers in our network.
5. In thinking about CFAC's "advisory" role, make
a suggestion that you think the Alliance Board
should take on or address.
Members encouraged to fill out a Snap Shot
Survey at each meeting attended and whenever
they have concerns or ideas they feel the need
to share
Snap Shot Survey
88 of 162
• Annual Report
• Monthly minutes and reports
• Gaps and Needs Analysis
• Budget retreat
• Participation on Global Quality Management
and Human Rights Committees
Communicating Our Concerns
89 of 162
• Affordable and accessible housing
• Transportation
• Employment
• Education
Note of interest: In every forum or avenue
utilized to gather input, these common themes
around healthy communities were repeated
often
Social Determinants of Health
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• Innovations slots
• Direct care workers
o Shortage of qualified workers having a major
impact on authorized services being utilized
• Assistive technology
• Crisis respite
• Case management
• Effective school inclusion
I/DD Service Gaps and Needs
91 of 162
• Peer-run respite
• Recovery centers
• Psychiatric appointments
o Especially for females preferring same gender
services
• Effective peer support
• Accessible services
• Crisis services for children in Cumberland
Mental Health Gaps and Needs
92 of 162
• Medical detoxification
• Social detoxification
• Expanded treatment options
o Most SUD consumers don’t have insurance,
not many options or at best long wait lists
• Recovery centers
• Youth services
SUD Gaps and Needs
93 of 162
• LGBTQ – appropriate services
• Deaf community – availability and access to
services
• Non-English speakers – availability and
access to services
• Transition-aged youth
• Veterans and families
Specialty Populations
94 of 162
• Medicaid expansion
• Collaborative/integrated services
• The “digital divide”
• Trust in the system
• Continued State funding cuts
• Stigma
Systemic Concerns
95 of 162
• Alliance benefit plans
o Currently every community has a different
benefit plan for State and indigent services
o This is not only confusing but reinforces the idea
of the “haves and have nots”
Systemic Concerns
96 of 162
Thanks for having us participate today.
We will leave you with a quote from the
Recovery and Self Determination trainings:
“You can never change things by fighting
the existing reality. To change something,
build a new model that makes the
existing model obsolete.”
-Buckminster Fuller
97 of 162
FY16 Community Needs
and Gaps Analysis
98 of 162
• Expand services to meet geographic access
and choice standards
• Develop a more uniform State benefit
package across the four-county Alliance
region
• Expand capacity for crisis, hospital diversion
and respite services for all ages/disabilities
Service Priorities
99 of 162
• Increase breadth, access and quality of
residential treatment and housing options
• Increase capacity to serve consumers with
co-occurring IDD/MI
• Develop and enhance the continuum of
care for individuals with substance use
disorders
Service Priorities
100 of 162
• Increase availability, tracking and oversight
of specialty services and evidence-based
practices
• Increase availability of transportation
resources
• Increase availability of employment
resources
Service Priorities
101 of 162
• Residential
• Substance use
• I/DD supported employment
• I/DD respite
• Psychological testing
Disparities in State Benefit Plan
102 of 162
• Recovery is possible
• Crisis Solutions Initiative
• Employment
• Housing options
• Integration of behavioral and physical
health service
• The Resilient Child and Family
• Opioid and prescription drug abuse
FY17 DHHS Initiatives
103 of 162
Population Trends
and Care Management
104 of 162
$322,951,801
$46,446,282
Medicaid vs. State Spending
Medicaid State
Total Spending Data
105 of 162
$142,180,916$180,770,884
Medicaid Spending by Age
Child Adult
Total Medicaid Spending:
$322,951,801
106 of 162
$5,211,575
$41,234,304
State Spending by Age
Child Adult
Total State Spending:
$46,446,282
107 of 162
$113,424,906
$48,739,080
$17,027,403
$62,896,855
$11,719,533
$69,095,742
$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
Child MH/SA Adult/MHSA Child InnovationsAdult Innovations Child Non-Innovations IDD
Adult Non-Innovations IDD
Medicaid Spending by Age and Diagnosis
Total Medicaid Spending:
$322,951,801
108 of 162
$5,734$2,774
$25,721
$52,988
$5,942
$49,318
Medicaid Spending Per ConsumerChild MH/SA Adult/MHSA
Child Innovations Adult Innovations
Child Non-Innovations IDD Adult Non-Innovations IDD
19780
17565
662 1187 1972 1401
0
5000
10000
15000
20000
25000
Medicaid Consumers
# of Medicaid Consumers Served by Age and Diagnosis
Child MH/SA
Adult/MHSA
Child Innovations
Adult Innovations
Child Non-Innovations IDD
Adult Non-Innovations IDD
Total Medicaid Spending:
$322,951,801
109 of 162
$3,882,373
$32,897,329
$1,329,502
$8,337,077
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
$35,000,000
Child MH/SA Adult/MHSA Child IDD Adult IDD
State Spending by Age and Diagnosis
Total State Spending:
$46,446,282
110 of 162
$2,333 $2,259$3,077
$8,739
State Spending Per Consumer
Child MH/SA Adult/MHSA Child IDD Adult IDD
1664
14561
432954
0
2000
4000
6000
8000
10000
12000
14000
16000
Child MH/SA Adult/MHSA Child IDD Adult IDD
# of State Consumers Served
Total State Spending:
$46,446,282
111 of 162
$9,293,146
$68,253,431
ICF Medicaid Spending by Age
Child Adult
• 79% of the total Non-Innovations Medicaid
Spending was on Child ICF services
• 99% of the total Non-Innovations Medicaid
Spending was on Adult ICF services
112 of 162
$13,410,779
$5,480,237
Inpatient Medicaid Spending by Age
Child Adult
• 9% of the Medicaid Spending was on
Child Inpatient services
• 3% of the Medicaid Spending was on
Adult Inpatient services
113 of 162
41%
20%
15%
24%
68%
16%
7%9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
1 to 7 8 to 11 12 TO 15 15+
Inpatient LOS in Days by Age
Child Adult
114 of 162
$468,372
$2,515,611
Medicaid Crisis Spending by Age
Child Adult
• 0.33% of the Medicaid Spending was on
Child Crisis services
• 1.39% of the Medicaid Spending was on
Adult Crisis services
115 of 162
$13,802,581
$12,374,652
$10,370,196
Non IDD Residential Medicaid Spending
PRTF TFC Group Homes
• 11% of the Non-Innovations Medicaid
Spending was on PRTF services
• 10% of the Non-Innovations Medicaid
Spending was on TFC services
• 8% of the Non-Innovations Medicaid
Spending was on Group Home Services
116 of 162
$2,710,429
$2,198,475
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
Adult Adult MH/SA Adult IDD
State Residential Spending
$6,725
$11,510
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
Adult Adult MH/SA Adult IDD
State Residential Spending Per Consumer
403
191
0
50
100
150
200
250
300
350
400
450
Adult Adult MH/SA Adult IDD
# of State Residential Consumers Served
• 8% of the State Spending was on Adult
MH/SA Residential services
• 26% of the State Spending was on Adult
IDD services
117 of 162
• Children with I/DD and behavioral health
issues
• TCLI
• Children with sexually reactive/aggressive
behavior
• Adults In ICFs
• Kids in Therapeutic Foster Care
Special Populations
118 of 162
• I/DD ED Care Coordinator
• Joint rounds
• Outlier management
• Specialty referrals
• Rapid case escalation
Care Management Approach
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FY16 Financial Review
120 of 162
• Financial performance through February ‘16
• PMPM review
• FY17 Budgetary Impacts
FY16 Financial Review
121 of 162
FY16
Actual Budget Variance
Service Revenue 292,279,102$ 463,286,808$ 171,007,706$
Medicaid 237,312,561 372,401,144 135,088,583
Non-Medicaid 54,966,541 90,885,664 35,919,123
Service Expense 278,136,357$ 463,286,808$ 185,150,451$
Medicaid 216,528,340 372,401,144 155,872,804
Non-Medicaid 61,608,017 90,885,664 29,277,647
Profit/(Loss) 14,142,745$ -$ 14,142,745$
Margin % 4.84% 4.84%
Admin Revenue 34,452,009$ 52,049,443$ 17,597,434$
Admin Expense 27,907,066 52,049,443 24,142,377
Profit/(Loss) 6,544,943$ -$ 6,544,943$
FY16 February Financial Performance
122 of 162
FY16 February PMPM to Budget
FY16
Category of Service Actual Budget Variance
Medicaid Lives 209,183 204,924 4,259
ACTT 4.32$ 5.31$ 0.99$
BH LT Residential 8.87 8.66 (0.21)
Community Support 0.85 1.38 0.53
Crisis Services 0.68 0.93 0.25
Day Treatment 1.16 2.84 1.68
ICF/MR 31.31 35.99 4.68
IIHS 12.12 14.50 2.38
Innovations 32.22 32.64 0.42
Inpatient 8.24 6.64 (1.60)
MST 2.13 1.84 (0.29)
Outpatient 14.03 14.71 0.68
PRTF 5.21 5.07 (0.14)
Psych Rehab 2.64 2.84 0.20
Unknown (IBNR) 1.63 - (1.63)
1915(b)(3) 3.98 2.72 (1.26)
Total 129.39$ 136.07$ 6.68$
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FY16 February PMPM to PY
Service FY15 FY16 Change
ACTT 3.68$ 4.32$ 17.3%
BH LT Residential 8.14 8.87 9.0%
Community Support 0.77 0.85 10.8%
Crisis Services 0.85 0.68 -20.0%
Day Treatment 1.56 1.16 -25.4%
ICF/MR 28.23 31.31 10.9%
IIHS 15.52 12.12 -21.9%
Innovations 26.98 32.22 19.4%
Inpatient 6.13 8.24 34.4%
MST 1.75 2.13 22.0%
Outpatient 12.06 14.03 16.3%
PRTF 4.55 5.21 14.5%
Psych Rehab 2.30 2.64 14.9%
IBNR 5.06 1.63 -67.7%
1915(b)(3) 0.94 3.98 321.2%
Total 118.51$ 129.39$ 9.2%
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• Medicaid lives
• State/Federal Block Grants
o TCLI funds
• County
o Specific services to address
• Grants – BECOMING, HUD
o BECOMING Ends 9/30/2016
• Legislative impacts – $17M reduction
FY17 Budgetary Impacts
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• Recommended Budget – May Board meeting
• Public Hearing – June Board meeting
• Approve Budget – June Board meeting
Next Steps
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(Back to agenda)
7
ITEM: FY17 Recommended Budget
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
The FY 2015-2016 Recommended Budget is being presented to the Board for consideration.
REQUEST FOR AREA BOARD ACTION: Review the report.
CEO RECOMMENDATION: Review the report.
RESOURCE PERSON(S):
Robert Robinson, CEO; Kelly Goodfellow, CFO
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
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FY17 RECOMMENDED BUDGET MAY 5, 2016
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Alliance Behavioral Healthcare
Annual Budget FY 2016-2017
Board of Directors
Christopher Bostock, Chair
Cynthia Binanay, Vice Chair
Durham County Wake County
Cynthia Binanay Ann Akland
Phillip Golden George Corvin, MD
Curtis Massey James Edgerton
Commissioner Michael Page William Stanford, Jr.
George Quick Commissioner Caroline Sullivan
Amelia Thorpe McKinley Wooten, Jr.
Lascel Webley, Jr. (vacancy)
Cumberland County Johnston County
John Griffin, Ed. D Vicki Shore
Commissioner Kenneth Edge
Lodies Gloston
Christopher Bostock
Robert Robinson, CEO
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Table of Contents
Reader’s Guide ............................................................................................................................................ 5
Alliance Demographic Information ........................................................................................................... 7
Departmental Information ......................................................................................................................... 8
Clinical Operations ................................................................................................................................. 8
Business Operations ................................................................................................................................ 9
Provider Network and Evaluation ....................................................................................................... 11
Information Technology ....................................................................................................................... 12
Community Relations ........................................................................................................................... 13
Corporate Compliance ......................................................................................................................... 14
Strategic Operations ............................................................................................................................. 15
General Fund Revenues ........................................................................................................................... 18
General Fund Expenditures ..................................................................................................................... 20
Budget Comparison .................................................................................................................................. 22
Functional Organization Chart ............................................................................................................... 23
Draft Budget Ordinance ........................................................................................................................... 24
Budget and Amendment Process ............................................................................................................. 25
Budget Calendar ....................................................................................................................................... 26
Glossary of Terms ..................................................................................................................................... 26
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May 5, 2016 Alliance Board Members, On behalf of the entire organization I thank each of you for your expertise, guidance and support during the past year of continued organizational growth. We are pleased to share with you our FY17 budget proposal. With this budget we will maintain our ongoing effort to build North Carolina’s most fiscally-stable, clinically-sound behavioral health managed care organization. We are excited to have reached a point at which we can begin to implement a plan to strategically reinvest some of our savings into innovative, effective services and supports that fill identified gaps in our communities and help ensure effective pathways to recovery and self-determination for the individuals we serve. I told you in this letter last year that Alliance was in a strong position as we looked to the future of Medicaid reform in North Carolina, and our work over the past year, as well as the work that this budget will fund, will continue to enhance that position. We look forward to working closely with you all during this budget process. Best Regards,
Rob Robinson Chief Executive Officer
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Reader’s Guide FY 2016 - 2017 is the fifth annual budget presented for Alliance Behavioral Healthcare (Alliance). This section is provided to help the reader understand the budget by explaining how the document is organized. This document details the budget for fiscal year 2016 - 2017 for Alliance’s administrative and service operations covering Durham, Wake, Cumberland and Johnston counties. The budget year begins July 1, 2016 and ends June 30, 2017. The document will show how the funds are allocated and how they will be spent. Alliance Behavioral Healthcare LME/MCO will have one fund called the General Fund. The General Fund will account for all administrative and service operations and will be divided into functional areas for Administration, Medicaid Services, State Services, Local Services, and Grant Funds, when applicable. Revenues and Expenditures of the General Fund The categories of the revenue and expenditures are the same. They include the following: Administration Alliance Behavioral Healthcare is administratively funded through a combination of the Medicaid waiver, state LME allocation, and county administrative contribution. Alliance began the management of Medicaid services under a waiver according to Session Law 2011-264 House Bill 916 on February 1, 2013. These funds refer to the administration dollars allocated under a contract with the NC Division of Medical Assistance. The funds are allocated based on a per member per month basis. The members per month budgeted is based on historical experience and projections. The NC Division of Mental Health, Developmental disabilities, and Substance Abuse services (NC DMH) continue to allocate funds to administer state and federal block grant dollars for the purposes of serving the non-Medicaid population. Cumberland, Durham, and Wake counties allocate 1% of the county dollars in administrative support for the management of their dollars in serving consumers in their respective county. Miscellaneous This category is to account for any funds received during the fiscal year that do not fall into one of the above mentioned categories and are not significant enough to require their own category. The funds roll up into the Administrative budget. Medicaid Services Alliance Behavioral Healthcare began the management of Medicaid services under a waiver according to Session Law 2011-264 House Bill 916 on February 1, 2013. These funds refer to the dollars allocated under the contract with the NC Division of Medical Assistance to provide services to Medicaid enrollees of Durham, Wake, Cumberland, and Johnston counties. State Services These funds represent state allocated dollars for Durham, Wake, Cumberland, and Johnston communities to provide services for non-Medicaid citizens with mental health, intellectual/developmental disabilities and substance abuse needs. The funds include Federal Block Grant dollars as allocated from the NC DMH.
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Local Services These funds represent the Cumberland, Durham, and Wake county allocations to Alliance to provide services for citizens with mental health, intellectual/developmental disabilities, and substance abuse needs in their respective counties. Grants When applicable, grant funds are those that are specified for a particular project or program. Draft Budget Ordinance A draft budget ordinance is being included for informational purposes. Additional Information The basis of accounting and budgeting for Alliance Behavioral Healthcare is modified accrual per G.S. 159-26. This means that revenues are recorded in the time period in which they are measurable and available. Revenues are recognized when they are received in cash. Expenditures are recognized in the period when the services are received or liabilities are incurred. This document was prepared by Alliance Behavioral Healthcare Business Operations and is available online at www.alliancebhc.org. If further information is needed, please contact Kelly Phillips, Director of Budget & Financial Analysis, at 4600 Emperor Blvd, Durham, North Carolina 27703 or by email at [email protected].
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Alliance Demographic Information
Alliance Regional Population Data
Population* Medicaid Eligible
Medicaid Eligible %
of Population
Medicaid Served
Non-Medicaid
Served Total
Served
Cumberland 323,838 71,466 22.1% 10,859 2,952 13,811
Durham 300,952 49,278 16.4% 8,044 3,554 11,598
Johnston 185,660 36,796 19.8% 5,138 1,683 6,821
Wake 1,024,198 113,852 11.1% 15,637 8,645 24,282
Total 1,834,648 271,392 14.8% 39,678 16,834 56,512
* 2015 Statistics, US Census Bureau
Persons Served by Age and Disability Based on Claims Paid by Medicaid and IPRS
Child/Youth (ages 0-17) Mental Health SA I/DD Total
Cumberland 4,956 185 721 5,862
Durham 3,877 74 501 4,452
Johnston 2,367 35 374 2,776
Wake 7,955 152 1187 9,294
Total Child/Youth 19,155 446 2783 22,384
Adult (ages 18+) Mental Health SA I/DD Total
Cumberland 6,824 1495 799 9,118
Durham 5,552 1812 830 8,194
Johnston 3,517 869 341 4,727 Wake 11,496 3007 1973 16,476
Total Adult 27,389 7,183 3,943 38,515
Total Served 56,512 Providers: Credentialed Agencies 343 CABHAs 49 Hospitals 61 ED Only 100 LIP - Group 100 LIP - Solo 321 LP Only 5,113 PRTF 12
Total 6,099
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Departmental Information
Clinical Operations
Brief Description of Department and Units
The Clinical Operations Department is comprised of five units and receives clinical oversight from the Alliance Medical Director.
The Access and Information Center (the Alliance 24/7 call center) links consumers to a range of services in the community and ensures that callers in need of crisis services are provided with timely access and follow-up. In addition to screening and referral activities, the call center provides information to general healthcare providers, CCNCs and to crisis providers to help coordinate the care of consumers needing routine services or during an after-hours crisis. It handles general information requests for Alliance as well.
MH/SA and IDD Utilization Management (UM) are responsible for authorizing services and monitoring and managing consumers during an episode of care. Activities include monitoring utilization of services authorized, reviewing effectiveness of treatment interventions and making recommendations to improve the effectiveness of consumer treatment plans.
MH/SA and IDD Care Coordination are responsible for working with specific high-risk populations identified within the waiver contract and priority populations that have been identified by Alliance, including individuals with high ED utilization patterns. Care Coordination links consumers with both services and supports and helps eliminate barriers that allow consumers to live as successfully as possible within the community. MH/SA Care Coordination is extending their ability to better address the needs of individuals with serious and persistent mental illness with co-occurring physical health conditions
Eligibility and Enrollment staff process State-funded consumer enrollment requests and consumer demographic updates, assist the UM team with a number of administrative tasks and provide support to the MDs by scheduling URAC required post denial peer-to-peer conversations.
UM Appeals manually processes all adverse decision letters and manages the entire UM appeals process.
Accomplishments for FY16
Clinical Operations met all waiver performance standards for the year. Innovations spending was within budget targets. Significant increase in utilization of Multi Systemic Therapy (MST); MST moved to a case rate
model of reimbursement There has been a continued downward trend in Intensive In-Home utilization; met target utilization
goal for the end of the year and continues to trend downward. Improved care coordination functions that are managed within the Access Center primarily around
assisting families waiting for C Waiver slots and needing Medicaid covered behavioral health services. Average days between a call to Access and an appointment was 4 days.
Maintained low Psychiatric Residential Treatment Facility (PRTF) utilization. No children in true out of state facilities.
ED liaisons had a reported significant impact on both reducing consumer time in the ED and deferring consumers from inpatient care, with inpatient readmission rates low throughout the year.
Successfully implemented best practice integrated care models in all Alliance counties. Successfully filled all available Innovations slots, moved from ICFs to the community using Money
Follows the Person Funding and B3 services
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Implemented three evidenced based outpatient models of care with enhanced rates Added IDD/MHSA care coordinator to Wake CC Team, reduction in IDD wait times in EDs already
occurring Implemented NC START program for children, available to all Alliance counties Implemented a population health analytics tool
Summary of Goals and Objectives for FY17
Continue to meet and exceed all waiver contract requirements. Expand the use of case rates and other risk sharing payment arrangements Decrease ED readmissions by expanding ED liaisons to additional hospitals and increase the follow-
up scope of positions. Improve consumer adherence with antipsychotic medications Decrease services that require prior authorization and manage based on data review, including
outcome measures. Decrease number of consumers with stays beyond expected ranges for highly utilized services Develop and pilot an IDD Patient Centered Behavioral Health Home that is responsible for
managing total health of patient population. Maintain low consumer appeals rate. Increase number of consumers served through integrated healthcare teams. Increase intensive in-home and residential services alternatives. Expand use of general outpatient services. Increase use of Medication Assisted Treatment for substance abusers. Decrease average length of stay (ALOS) of children in Therapeutic Foster Care. Implement law enforcement division program in Cumberland for individuals arrested for low level
drug offenses. Decrease inappropriate Opiate and Benzodiazepine prescribing practices of both in-network and
primary care prescribers. Improve options and use of community based treatment for youth with problematic sexual behavior. Implement Resource Allocation Model under the Medicaid C Waiver.
Business Operations
Brief Description of Department and Units
The Business Operations Department is responsible for the oversight and management of Alliance’s financial accountability relating to budgeting, claims, auditing and financial analysis. It includes: Finance and Accounting - responsible for the agency's financial transactions, financial reporting,
adherence to Generally Accepted Accounting Principles (GAAP), ensuring adequate and effective internal controls, etc.
Claims Processing - responsible for the monitoring and review of all claims processing for all funding sources, analysis of paid and denied claims, special ED claim review, etc.
Budget and Financial Analysis - responsible for the development and monitoring of the Alliance budget and analyzing budget to actual at both the administrative and service level. The staff in this unit are also responsible for the review and analysis of Medicaid dollars to include Per Member Per Month (PMPM) spending by category of service and aid, budget vs. actual, individual provider or service trends, etc. Responsibility also includes rate setting for programs, services, and providers.
Facility Management - responsible for the oversight of all Alliance leased locations in coordination with landlord and management of Alliance vehicles.
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Accomplishments for FY16
Implemented a formal procurement program to increase control and security of procurement cards. Hired an Accounting Manager which allows for greater segregation of duties and oversight. Revised our Vendor Maintenance procedure and incorporated an IRS Tax Identification Number
Verification program to improve accuracy of vendor information. Formed a new committee specifically designed to review our Medicaid Per Member Per Month
(PMPM) by category of service on a monthly basis. The Committee has allowed for some very informative discussions as well as provided an opportunity to compare financial data with clinical data.
Implemented a new IBNR model to improve the accuracy of estimating our outstanding claims liability.
Implemented a web based employee expense reimbursement which improves the efficiency and accuracy of the reimbursement process.
Improved department efficiencies by combining Reimbursement and Analysis team with the Budget and Analysis team.
Revised the reimbursement and rate setting process which allowed for efficiency in approving rates and greater communication among departments.
Formalized administrative budget reports, as well as budget to actual reports, for reporting to the Chiefs to allow for budget ownership and flexibility of spending.
Alliance claims staff continues to provide weekly claims training for providers to ensure updated knowledge of systems and claim information is shared will all providers. Provider survey satisfaction noted that Alliance claims rated as one of the best in claims training, accurate information given to provider, and claims processed in a timely and accurate manner.
The HMS audit for March 2015 through August 2015 resulted in high scores of 99.96% in timeliness of provider payment, 99.81% in claims processing accuracy, and 99.96% in financial accuracy.
Summary of Goals and Objectives for FY17
Review the need for additional positions in all areas to increase support and improve efficiencies such as a Grant Accountant who can focus on federal funding requirements.
Implement changes to our billing software which will improve the interface between the billing software and accounting software.
Upgrade our accounting software to a newer version which will give team members access to more efficient software
Identify budget software that works in conjunction with the accounting software Review the need for building modifications, relocation of site staff, and complete a review of all
facility needs including a 3-5 facility plan Continue to enhance our reporting and analysis of our services especially in the area of Medicaid
drilling down to the population level, Medicaid eligible lives, and category of service. Enhance training and development so that staff are fully trained and have the tools they need to do
their job. We will focus on building a unified team with the help of updated procedures and process flows, mutual understanding of work, cross departmental training and most importantly adhering to our mission and values.
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Provider Network and Evaluation
Brief Description of Department and Units
The Provider Network and Evaluation Department is responsible for the continuous review and evaluation of the provider network for quality of services, adherence to contract requirements, standards of care and performance, while ensuring a full array of providers is available to meet the needs of our service recipients. It also is responsible to ensure the quality of all Alliance services and processes through quality management activities and evaluating the quality of services provided by Alliance. The Department is comprised of two sections: Provider Network Operations has three components:
o Networks is responsible for managing the communication and dissemination of information to the community of providers, identifying and recruiting new providers, and for providing or arranging for technical assistance for currently enrolled providers.
o Credentialing assures that all providers in the Alliance network meet agency, State, Federal and accreditation requirements and that credentialing information is reviewed and tracked for continuous and timely review.
o Contracts is responsible for the timely development and distribution of all contracts, amendments, and extensions and ensures coordination of administrative activities including official correspondence with providers, provider education and liaison, and administration of provider contracts.
Quality Management is responsible for creating a culture of continuous quality improvement across the agency and assuring quality within the agency, across the provider network, and with contracted vendors. Quality Management has three components:
o Quality Assurance develops reports for Alliance management, committees and the state; investigates and resolves incidents and complaints and analyzes data from NC-TOPPS, IRIS and other sources.
o Quality Review oversees our Quality Improvement Projects (QIPs); performs quality reviews to identify opportunities for improvement; conducts in-depth analyses of provider programs; and develops quality management standards and training for our providers.
o Provider Monitoring completes on-site monitoring reviews to determine provider compliance with rules and regulations; conducts post-payment reviews to identify inappropriate payments to providers; and completes focused reviews to investigate other compliance issues. Data Analysis manages data, creates reports, and offers analysis of data to support decision making.
Accomplishments for FY16
Establishment of provider collaboratives to provide technical assistance and improve quality. Expansion of Continuous Quality Improvement (CQI) processes throughout the agency. Implementation of multiple evidence based practice service models. Development of multiple new evidence based service definitions to fill service gaps. Improved processes and relationships with our hospital partners. Implementation of contract tracking software to improve accuracy and efficiency.
Summary of Goals and Objectives for FY17
Improve and streamline business process for implementing new services. Implement credentialing software. Improve relationships with and contract management of hospitals/health systems. Improve capacity for risk and trends analysis.
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Address provider network needs and gaps as specified in network development plan. Focus provider collaborative efforts on implementation of evidence based practices. Enhance provider performance measure reporting. Streamline reports generation. Increase number of provider contracts for evidence based practices. Identify and implement a process for monitoring evidence based practices. Improve communication processes with Providers.
Information Technology
Brief Description of Department and Units
The IT department is comprised of three distinct teams:
Application Development and Quality Assurance - Responsible for all internal application development, including SharePoint and the corporate Intranet. Manages all quality assurance and user acceptance testing and documentation to support corporate audits.
Informatics/Business Intelligence Development - Responsible for extracting, organizing, cataloging and defining all key data elements that support Alliance. BI also is responsible for report and dashboard development to support the information needs of the company.
IT Infrastructure and Support - Installs and supports all business data and voice networks within the Alliance sites. They are responsible for maintaining network and data security, HIPAA compliancy, email security, network and server performance and administration.
Accomplishments for FY16
Deployed Enterprise Vault Email Archiving system. Deployed Netwrix Password management system. Deployed Commvault File Archiving and Unitrends Backup systems. Relocated hardware, network and communication systems to new Call Center location. Migrated SharePoint and Existing Shared Drives to New Storage Solution. Developed Corporate Intranet to Provide Efficient Enterprise Communications. Selected Care Management Technologies and MicroStrategy Business Intelligence Solutions to
provide enterprise class reporting solutions. Developed Independent Living Initiative application and provider portal to streamline the process of
evaluating and approving the application. Implemented agile approach to software development. Implemented New ICD-10 Codes in AlphaMCS, Back Office Systems and Providers to meet
conversion date of October 1, 2015. Fully implemented Team Foundation Server in department to effectively monitor application
development and testing.
Summary of Goals and Objectives for FY17
Continue to improve quick response and reduce resolution time on KACE support tickets. Enhance disaster recovery solution and relocate to secondary colocation facility. Upgrade corporate PC's to Windows 10. Develop Accounts Receivable reconciliation application to track all claims activity submissions and
messaging.
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Develop DOJ Application and provider portal for Supported Employment Initiative. Implement MicroStrategy as an enterprise wide reporting solution for Alliance. Develop and begin implementation of Alliance IT Strategic Plan. Enhance Credentialing Workflow within AlphaMCS Application. Develop Provider Search and Resource Availability Tracking Application. Develop improved process for requesting and tracking AlphaMCS enhancements.
Community Relations
Brief Description of Department and Units
Community Relations is one of the most varied and diverse departments within Alliance. Recognizing that a local and visible presence is essential to building and sustaining partnerships critical to meeting organizational outcomes, the Community Relations teams take an innovative approach to improving the systems that support the effectiveness of services. Teams are continually assessing system and service gaps from multiple vantage points including co-location within other systems, outreach activities to stakeholders and advocates, and hosting community collaborative and workgroups. Utilizing a System of Care (SOC) framework, Community Relations focuses on the strengths and vulnerabilities of complex public systems, treatment of the “whole person,” and system transformation to improve policy, shared funding, collaboration and best practices. Recognizing that social determinants of health (i.e. homelessness, poverty/inequality and lack of education/employment) are key drivers of health care costs, Community Relations often plays a tangential role to the MCO functions - improving the environments in which people live increases engagement and retention in services, overall health and wellness, and more meaningful and productive lives that promote recovery. Accomplishments for FY16
Implemented short-term rental assistance program (ILI) in each community. Developed a standardized Alliance overview presentation training to over 500 community partners
and stakeholders. Each community has highly successful Crisis Intervention Training (CIT) training programs with
designated CIT Coordinators. Implemented Care Review in each community. Developed crisis reduction plans for each community. Won two national Excellence in Communication and Community Outreach Awards for
BECOMING. Funding renewed for two HUD-funded supportive housing programs in Durham. Wake and Durham Community Collaborative completed strategic plans outlining SOC priorities.
Summary of Goals and Objectives for FY17
Hire a Director of Housing and Director of Community Relations. Study the need for additional personnel to target key areas across the 4 counties (i.e. System of Care
Manager). Promote cross-departmental collaboration to improve person and service outcomes. Assist in the development of models of care for special and high-risk populations.
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Assist in the development of comprehensive community supports to increase community tenure and quality of life for high-risk adolescents and adults.
Expand Assertive Engagement to special populations across the four communities. Identify activities of Community Relations (i.e. housing, Care Review) and develop key
performance indicators to show the impact and return on investment. Develop pilot programs in partnership with other internal departments to study the quality and
effectiveness of programs targeting high risk populations (i.e. IIH, ED diversion, etc.).
Corporate Compliance
Brief Description of Department and Units
The Alliance Corporate Compliance Department focuses on the prevention, detection and correction of identified violations of federal and state laws and regulations, and fraud control and unethical conduct, and encourages an environment where employees can report compliance concerns without fear of retaliation. It includes thirteen employees and is responsible for internal and external compliance to include policies and procedures, accreditation compliance, compliance training, internal audits and monitoring, claims audits, hotline reporting, investigation and correction of non-compliance, remediation, HIPAA privacy and security, medical records, public records, Network fraud and abuse investigations, provider actions and sanctions, and provider dispute resolution. Accomplishments for FY16
Opened 114 fraud and abuse investigations, closed 87 investigations, and referred 10 full investigations to DMA Program Integrity for determination of credible allegation of fraud.
Identified over $147,000 in overpayments as a result of fraud, waste and abuse investigations. Conducted internal audits of three major Alliance functions. Continued the implementation process for policy and procedure management, third party risk
management, contract management, incident management, and HIPAA breaches. Monitored all sites for HIPAA Privacy compliance. Contracted with external vendor to conduct
Security Risk Assessment. Implemented a Compliance Page on the Alliance Intranet, containing resources, training materials,
information about internal compliance and program integrity, etc. Issued 48 notice of action letters in response to Network compliance issues referred to the
Compliance Committee. Identified over $1 million in overpayments through the Corporate Compliance Committee process. Managed 29 requests for reconsideration of actions against providers. Audited 3% of adjudicated claims weekly. Audited inpatient and ED claims weekly. Conducted internal investigations and developed remediation plans where applicable, monitored
corrective action plans to ensure successful implementation. Conducted new hire orientation ongoing, annual compliance training to all employees and the Board
of Directors, providers and published informational materials related to compliance, fraud and abuse to a variety of stakeholder groups.
Conducted targeted HIPAA training to clinical departments. Conducted targeted Program Integrity training to several internal departments.
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Summary of Goals and Objectives for FY17
Our goal is to embed compliance, fraud control, and business ethics into Alliance day-to-day business through the use of infrastructures and tools designed to help achieve compliance with Federal, State, and local laws and regulations, and accreditation standards. The infrastructure and tools of focus for FY17:
o Continue/finalize the implementation of C360 to increase efficiencies, improve employee training and track internal compliance as well as Business Associate compliance.
o Improve process to assess the impact of regulatory changes on Alliance operations, including review and revision to policies and procedures, manuals and training to ensure compliance with applicable changes.
o Contract with vendor for fraud detection data mining purposes to enhance our current methods and increase effectiveness of fraud detection efforts.
o Provide specialized training to department staff to promote professional growth and to achieve nationally recognized certifications in the areas of fraud examination and internal audits.
o Adjust positions within the department in order to continue to meet the needs of Alliance. o Add positions in areas where current staffing is inadequate and to meet the increased demands
of our department. An annual work plan developed as a result of an annual risk assessment drives all compliance
operations. Items selected for the work plan pose significant risk (legal, financial, reputation) to Alliance. The plan is finalized at the beginning of each fiscal year and has therefore not yet been developed for FY17. Below are a few anticipated areas of focus:
o Increased staff training with focus on HIPAA, confidentiality, policies and procedures, and regulatory and accreditation requirements.
o Expand the internal audit plan and increase compliance monitoring with timely resolution and implementation of risk mitigation plans.
o Monitor implementation of identified strategies to correct HIPAA security deficiencies and audit for compliance.
o Provide compliance training and resources to providers. o Expand focused and ad hoc claims audits to identify overpayments, underpayments and other
irregularities or compliance issues. o Prepare for and achieve URAC reaccreditation o Conduct fraud and abuse investigations to detect and deter fraud and abuse in the Alliance
Network. Prioritize areas of highest risk. o Provide assistance, input and compliance oversight of Alliance pilots and other efforts.
Strategic Operations
Brief Description of Department and Units
The Strategic Operations Department is housed under Administration and provides support and connectivity to the entire organization, serving as a change agent and a cross departmental liaison to all Alliance departments. The Chief of Staff leads the 11 staff members who make up the department, which is comprised of 4 distinct units, below:
The Strategic Project Management team (SPMO) is maturing into an internal consulting group, including a director and 3 project managers. They have engaged in a number of high priority projects including the ICD-10 transition, analysis and reengineering of the DOJ/TCLI processes, strategic plan initiatives, encounter data enhancements, and implementation of integrated care pilots. All of the projects have centered on cross departmental workflows and increasing efficient use of resources while meeting contractual requirements. The SPMO has also offered intensive 6 month training to Alliance staff in Project management skills and is embarking on a 6 month training on
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Process Improvement, enhancing skill building across the company and modeling a culture of cross functional collaboration.
The Alliance Communications Unit, which consists of the Director of Communications and a Communications Specialist, has oversight of all internal and external organizational communications to multiple stakeholders within a four-county audience of nearly two million people. This broad scope of work includes all organizational advertising/marketing development and production, oversight of organizational branding efforts, content maintenance of a robust and complex website and social media program, a leadership role in organizational internal communications, and provision of communications support and technical assistance for the entire organization.
The Medicaid Program Director (MPD) is responsible for ensuring compliance with the DMH and Medicaid Waivers contracts, all external reviews (EQRO, Mercer, and TCLI) and projects related to same, and is a liaison between Alliance and DHHS staff. As a team of one, the MPD participates in multiple cross functional work groups to ensure collaboration and compliance.
Cumberland and Johnston sites - The Cumberland site director oversees the facilities and two administrative staff at the Cumberland site and is also the Military Veterans Point of Contact (MVPOC) for the entire Alliance catchment area, as established by statute. The MVPOC is required to serve as a care coordination liaison for veterans and their families who quality for services, and to educate staff and other stakeholders about the special needs of veterans. The Chief of Staff serves as the executive liaison to the Johnston site director.
Accomplishments for FY16
103 staff members attended the Project Management 101 classes conducted across all of Alliance’s offices and 25 students completed the 6 month project management class curriculum.
83 staff members attended the Business Process Improvement introduction classes across all Alliance office locations with 27 students that have registered for the BPR curriculum over the upcoming months.
The Process Reengineering project for TCL/DOJ team helped in preparation for the DOJ audit and streamlined the end to end process including Supportive Employment and Tenancy Supports while clarifying roles and responsibilities for staff and providers.
SPMO led the successful ICD10 conversion project which went live without issues on Oct 10th. The SPMO has successfully managed 25 projects so far sponsored by 16 distinct Alliance
departments. Organizational branding campaign in multiple media developed and executed, resulting in 8%
increase in brand awareness, 10+% increase in web traffic, and significant positive stakeholder feedback.
SEO (Search Engine Optimization) analysis completed, including numerous website enhancements creating easier navigation, improved site search capacity and search engine search results, overall better user experience, and enhanced analytic capacity.
Created social media plan and user guidelines and implemented polished organizational Facebook and LinkedIn presence; worked with key units across organization on using social media and email automation to meet their business goals.
Completed production of high-quality Annual Report six weeks sooner than in 2015; made changes to core brochures to reflect changes in WakeBrook branding; ensure adequate supply of all materials
Hired Communications Specialist with knowledge of public system and MCO experience. MVPOC successfully completed Mental Health First Aid training and is partnering with Community
relations staff to serve communities. Progress made on implementation of Alliance's Military Veterans Plan. Strategic Plan implementation: of 30 original initiatives,12 initiatives completed, 8 are in progress
and on target, 10 are pending with a 22% cross departmental staff participation in the work.
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Summary of Goals and Objectives for FY17
Recruit and hire additional Project Manager for SPMO. Identify funding for additional administrative support staff person. Focus on training and certification preparation for additional Project Management team. Funding for additional consultation and support from Zelos to ensure successful implementation of
the Strategic Plan and other projects of high importance. Funding for ongoing consultation to improve business process reengineering projects Plan, manage and communicate strategic plan initiatives and other high impact cross departmental
projects. Develop the SPMO into an internal consulting team. Increase skill mastery if project management principles and process reengineering methodologies
across Alliance. Assist in identifying and addressing Business Process Re-engineering opportunities, aligning with
strategic goals, to provide maximum effectiveness and efficiency, potentially utilizing external resources/consultants.
Assist Executive Leadership Team with evaluation and research analysis for strategic opportunities. Develop and implement next stage of organizational branding based on outcome of
consolidation/service area expansion. Continue to build social media/email automation program to meet identified business goals. Provide technical assistance in the creation of an organizational internal communications plan. Investigate a plan to increase organizational awareness of the importance of health literacy. Expand Alliance’s role as a leader in the state on Veteran’s issues by ongoing implementation of the
Military Veterans Plan. Improve Alliance's performance on newly created Annual External review from previous EQRO and
Mercer scores by 12%.
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General Fund Revenues FY2016-2017 Recommended Budget
Total General Fund Revenues: $492,082,711
County Administrative funds $ 364,086
LME Administrative funds 4,359,385
Medicaid Administrative funds 44,701,760
Medicaid Services & Reserves 351,149,760
Alliance
Federal $ 5,563,857
Durham
State $ 11,066,741
Federal 2,093,427
County 6,594,828
Wake
State $ 17,614,466
Federal 5,256,417
County 24,947,181
Cumberland
State $ 7,131,287
Federal 1,305,339
County 4,752,000
Johnston
State $ 4,293,829
Federal 385,124
Grants $ 403,224
Miscellaneous $ 100,000
TOTAL $ 492,082,711
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General Fund Revenues FY2016-2017 Recommended Budget
Total General Fund Revenues: $492,082,711
County7.38%
Administration10.06%
Medicaid Services71.36%
State Services11.20%
County Administration Medicaid Services State Services
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General Fund Expenditures FY2016-2017 Recommended Budget
Total General Fund Expenditures: $492,082,711
Administrative $ 49,425,231
Medicaid Services 351,149,760
State Services 54,710,487
Local Services 36,294,009
Grants 403,224
TOTAL $ 492,082,711
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General Fund Expenditures
FY2016-2017 Recommended Budget Total General Fund Expenditures: $492,082,711
Administrative10.06%
Services89.94%
Administrative Services
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Budget Comparison
Budgeted Revenue Budgeted Expenditures FY16 FY17 FY16 FY17
Administrative $ 52,049,443 $ 49,425,231 Administrative $ 52,049,443 $ 49,425,231
Medicaid Services $ 372,401,144 $ 351,149,760 Medicaid Services 372,401,144 351,149,760
Alliance
State & Federal Services
54,088,431 54,710,487
Federal $ 5,563,857 $ 5,563,857 Local Services 36,294,009 36,294,009
Durham Grants 403,224 403,224
State $ 11,066,741 $ 11,066,741 Miscellaneous 100,000 100,000
Federal 2,093,427 2,093,427 County 6,594,828 6,594,828
Wake - State $ 16,992,410 $ 17,614,466 Federal 5,256,417 5,256,417 County 24,947,181 24,947,181
Cumberland - State $ 7,131,287 $ 7,131,287 Federal 1,305,339 1,305,339 County 4,752,000 4,752,000
Johnston - State $ 4,293,829 $ 4,293,829 Federal 385,124 385,124
Grants 403,224 403,224 Miscellaneous 100,000 100,000
TOTAL $ 515,336,251 $ 492,082,711 $ 515,336,251 $ 492,082,711
Administrative funding decreased by $2,624,412 and Medicaid service funding decreased by $21,251,384. The decrease is due to the reduction of our PMPM as well as the recognition of retro-active Medicaid payments in FY16 but not in FY17.
The state dollars for Wake were more by $622,056. This is due to an increase in the state inpatient bed contract with one of the local hospitals.
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Functional Organization Chart
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Draft Budget Ordinance
ANNUAL BUDGET ORDINANCE ALLIANCE BEHAVIORAL HEALTHCARE
FY 2016 - 2017
WHEREAS, the proposed budget and budget message for FY 2016 - 2017 was submitted to the Alliance Behavioral Healthcare Area Board on May 5, 2016 by the Budget Officer; was filed with the Executive Secretary to the Board;
WHERESAS, on June 2, 2016, the Alliance Behavioral Healthcare Area Board held a public hearing pursuant to NC G.S. 159-12 prior to adopting the proposed budget;
BE IT ORDAINED by the Alliance Behavioral Healthcare Area Board that for the purpose of financing the operations of Alliance Behavioral Healthcare, for the fiscal year beginning July 1, 2016 and ending June 30, 2017, there is hereby appropriated funds the following by function:
DRAFT
Section 1: General Fund Appropriations Administration $ 49,425,231 Medicaid Services $ 351,149,760 State Services $ 54,710,387 Local Services $ 36,294,009 Grants $ 403,224 TOTAL $ 492,082,711
Section 2: General Fund Revenue Administration $ 49,425,231 Medicaid Services $ 351,149,760 State Services $ 54,710,387 Local Services $ 36,294,009 Grants $ 403,224TOTAL $ 492,082,711 Section 3: Authorities A. The LME/MCO Board authorizes the Budget Officer to transfer within an appropriation up to $100,000 cumulatively without report to the Board. B. The LME/MCO Board authorizes the Budget Officer to transfer up to $100,000 between appropriations with a report to the Board at the subsequent meeting. C. The CEO may enter into the following within budgeted funds:
1. Form and execute grant agreements within budgeted appropriations; 2. Execute leases for normal and routine business; 3. Enter into consultant, professional, maintenance, provider, or other service agreements; 4. Approve renewals for of contracts and leases; 5. Purchase of apparatus, supplies, materials or equipment and construction or repair work; 6. Reject any and all bids and re-advertise to receive bids.
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Budget and Amendment Process Overview The purpose of the budget and amendment process is to ensure that public dollars are spent in the manner as intended and in an effort to meet the needs of the citizens in relation to mental health, intellectual/developmental disabilities, and substance abuse needs. Through the budget, Alliance Behavioral Healthcare aims to fulfill its mission as granted by NC G.S. 122-C. Governing Statutes Alliance Behavioral Healthcare abides by the North Carolina Local Government Budget and Fiscal Control Act. It is the legal framework in which all government agencies must conduct their budgetary processes. NC G.S. 159 provides the legislation which includes several key dates such as:
159-10 - By April 30, Departments must submit requests to the Budget Officer 159-11(b) - By June 1, the Recommended Budget must be submitted the Board 159-12(b) - A public hearing must be held 159-13(a) - From 10 days after submitting to the Board, but by July 1, a balanced budget
must be adopted Budget Process FY 2016-2017 is the fifth recommended budget representing Alliance Behavioral Healthcare as a multi-county Area Authority. The budget represents services for Cumberland, Durham, Johnston and Wake counties. The administrative budget for this fiscal year was driven by our Per Member Per Month (PMPM) rate, FY17 projected costs, FTE positions, Department of Health and Human Services contract requirements, and costs related to the operating the Medicaid waiver. The Medicaid service budget was created based on historical experience and projections into the next fiscal year. Alliance will review the need for a budget amendment in the first quarter of FY17 if the projection of lives has changed based on payments received. The State and Local services budget was developed by gathering service information for each area based on the claims trends and information from staff. The FY17 allocations and benefit packages were reviewed and staff worked together to ensure all services were appropriately planned to be consistent with current services. Amendment Process The budget ordinance is approved at a function/appropriation level. The Budget Officer is authorized to transfer budget amounts within an appropriation up to $100,000 cumulatively without reporting to the Board. The Budget Officer is authorized to transfer budget amounts between functions up to $100,000 with an official report of such transfer being noted at the next regular Board meeting. Per G.S. 159-15, the governing board may amend the budget ordinance at any time after the ordinance's adoption in any manner, so long as the ordinance, as amended, continues to satisfy the requirements of G.S. 159-8 and 159-13.
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Budget Calendar
Thursday, May 5, 2016 FY 2016-2017 recommended budget presented at LME/MCO Board meeting By Friday, May 13, 2016 Notice of June 2, 2016 Public Hearing published Thursday, June 2, 2016 Public Hearing By Friday, June 24, 2016 LME/MCO Board adoption of FY 2016-2017 Budget Ordinance Friday, July 1, 2016 Budget is available in the General Ledger system
Glossary of Terms LME Per G.S. 122C-3(20b), Local Management Entity or LME means an area authority,
county program, or consolidated human services agency. It is a collective term that refers to functional responsibilities rather than governance structure.
MCO Managed Care Organization; LMEs that have adopted the financial risk and service review functions of the 1915(b) and 1915(c) waivers. LME-MCOs carry out the function of an LME and also act as health plans that provide health care in return for a predetermined monthly fee and coordinate care through a defined network of providers, physicians and hospitals.
Medicaid Waiver
States can submit applications to the federal Centers for Medicare and Medicaid Services, asking to be exempt from certain requirements. If granted a “1915(b)” waiver, a state can limit the number of providers allowed to serve consumers, easing the state’s administrative burden and saving money. If granted a “1915(c)” waiver, a state can offer more services focused on helping an intellectually or developmentally disabled consumer continue living in his or her home, rather than a group home.
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FY17 Recommended Budget
May 5, 2016
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•G.S. Requirements o Budget Message 159-11(b)
o Balanced Budget 159-8
o Presented before June 1 159-11(b)
o Public Hearing 159-12(b)
• General Fund
• Revenues & Expenditures of General Fund
FY17 Recommended Budget
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• Nine departments
• Successful FY16
o IT
o Other key successes
• Goals moving into FY17
FY17 Departmental Information
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• Total Revenue: $486m
o $23.0m less than FY16
o Medicaid down $21.0m and State up $622k
o Administrative down $2.6m
• Medicaid: $351.1m
• State (IPRS): $54.7m
• County: $36.7m
• Administrative: $49.4m
FY17 Budgeted Revenues
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Administrative
• 10% of total expenditures
• Personnel costs account for 76.5% of total
administrative costs
• Other key costs
o Infrastructure needs
o Professional services
o Training and education
FY17 Budgeted Expenditures
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Services
• 90% of total expenditures
o 71% Medicaid-funded, 11% State, 7% County
• Approach to budget
o Medicaid – history, capitation, new services
o State/Federal Block Grants – allocations,
service needs
o County – level funding, service needs
o Grants – BECOMING, other new opportunities
FY17 Budgeted Expenditures
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• Public hearing
• Potential changes
o State funds
o Medicaid lives impacting budget
o County dollars
• Approval of budget in June
Next Steps
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(Back to agenda)
ITEM: Review of Board Officers Selection Process
DATE OF BOARD MEETING: May 5, 2016
BACKGROUND:
As stated in the by-laws officers of the Area Board, Article II, Section D:
1. The officers of the Area Board shall be chosen for a one-year term at the final meeting of the
fiscal year in which the Area Board is serving, and shall be as follows:
a. Chairperson, and
b. Vice-Chairperson.
2. With the exception of the position of Executive Secretary (which shall be filled by the Area
Director/CEO), no officer shall serve in a particular office for more than two consecutive
terms.
3. Each Area Board member shall be eligible to serve as an officer.
4. Duties of officers shall be as follows:
a. Chairperson – this officer shall preside at all meetings and generally perform the duties of
a presiding officer. The Chairperson shall appoint all Area Board committees.
b. Vice Chairperson – this officer shall be familiar with the duties of the Chairperson and be
prepared to serve or preside at any meeting on any occasion where the Chairperson is
unable to perform his/her duties.
Chairman Bostock will review the process for determining next year’s officers. The election of
Board officers will occur at the June Board meeting. Board officer terms are concurrent with
Alliance’s fiscal year.
REQUEST FOR AREA BOARD ACTION:
Review the process for determining Board officers in preparation to vote for Board officers at the
June 2, 2016, Board meeting.
CEO RECOMMENDATION:
Review the process for determining Board officers in preparation to vote for Board officers at the
June 2, 2016, Board meeting.
RESOURCE PERSON(S):
Christopher Bostock, Area Board Chairman; Robert Robinson, CEO
Alliance Behavioral Healthcare
BOARD OF DIRECTORS Agenda Action Form
8
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