Agenda - 05-17-2011- 5u - Laserfiche WebLink

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A$cc~+.,~.~-~ SUBJECT: OPC Area Program Update -April 2011 PURPOSE: To receive a report on the expansion of the 1915(b)(c) Medicaid waiver & the expected impact on the mental health, developmental disabilities & substance abuse service system in Orange, Person & Chatham Counties. BACKGROUND: On March 31, 2011 the Department of Health 8~ Human Services (DHHS) released an RFA for the expansion of the 1915(b)(c) Medicaid waiver, which will have significant impact on the organizational structure and governance of the existing system. HISTORICAL INFORMATION: House Bill 381, passed in October 2001, outlined a major transformation of the public mental health system. Guiding principles included: • Greater choice for consumers • No wrong door for admission to services • Services provided in the local communities • Greater involvement by both consumers and the provider community • State wide standardization and accountability • Focused shift to best practice and evidence-based treatment • Separation of management oversight from the provision of service In response to the new legislation OPC initiated divestiture of service programs in December 2003 and began its transition to a Local Management Entity (LME) with responsibility for: • screening, triage & referral for consumers entering the service system; • authorization of all state and/or locally funded services; • endorsement and monitoring of a comprehensive provider network; • customer service and community planning for our three county region. In 2007 the North Carolina General Assembly passed legislation that required that LMEs have a total population of 200,000+ or cover a geographic region of six or more counties. With a total population of 227,963 OPC is the fourth smallest LME in the state. As noted above LMEs were given responsibility for management of state and locally funded services, while management of Medicaid funded services was given to Value Options, a private for-profit vendor. This remained true until April 2005 when DHHS began operating a pilot project which allowed Medicaid funded services for mental health, developmental disabilities and substance abuse treatment to be provided on a capitation basis through a 1915(b)(c) combination waiver at PBH, the LME which covers Cabarrus, Davidson, Rowan, Stanly ~ Union counties. This pilot project has been successful and DHHS has made the decision to move forward with statewide expansion of the 1915(b)(c) waiver. What is a 1915(b)(c) Medicaid waiver? 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. 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 3