Agenda - 05-10-2011 - 2 - Laserfiche WebLink

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6 The number of LMEs in the state has been reduced over the years from 41 to 23. Given the current economic climate, LMEs have been encouraged to continue consolidation efforts in order to create efficiencies and savings. OPC is the fourth smallest LME in the state based on the population of our three counties (227,963), so with the recent release of the RFA and related legislation, it is no longer an option for OPC to remain "as is". The minimum population threshold for LMEs will be increased to 300,000 by 7/1/12 and 500,000 by 7/1/13, and the number of LMEs in the state will be reduced to 8-10. While we are very proud of OPC and its accomplishments over the last 40+ years, we recognize that we will need to change, and we have tried to be thoughtful and proactive in considering our future options. 4. Will OPC still exist? Yes, although we may look a little different in the future. We are currently in discussions with PBH about what the local presence in the OPC community will look like. OPC will most definitely still exist and will be available to respond to the needs of the local community, although our internal structure may look different than it does currently. 5. What is a waiver? A waiver is an agreement between the state and Center for Medicaid Services in Washington to be released from certain Medicaid rules. In 1965, amendments to the Social Security Act (SSA) established the Medicaid program. Under the Medicaid program each state establishes its own eligibility standards, benefits packages, payment rates, and program administration. There are two major types of serviced delivery systems in Medicaid; fee for service and managed care. States wishing to operate managed care service delivery systems must apply for a waiver of certain Medicaid rules. The Social Security Act authorizes multiple waiver and demonstration authorities which allows for flexibility at the state level. Under Section 1915 (b) of the SSA, waivers are granted which allow states to implement managed care delivery systems and restrict consumer choice of providers. These specific waivers often target individuals with mental health and substance abuse issues, although some services are available for people with intellectual/developmental disabilities (I/DD). Under Section 1915(c) of the SSA, waivers exist to provide a continuum of services in the community to individuals who are disabled. Presently North Carolina operates a 1915 (c) waiver for individuals with I/DD referred to as the CAP-MR/DD program. States may choose to simultaneously operate 1915 (b) and (c) waivers.