2018 piedmont community board meeting · 10/18/2018 · plans. the transformation to medicaid...

2018 Piedmont

Community Board

Meeting

October 18, 2018

PIEDMONT COMMUNITY BOARD AGENDA October 18, 2018 Dinner (SERVED AT 6:00 p.m.)

SPEAKER PAGE PURPOSE 1. Call to Order- Matters of the

Public

Tregg Lindberg, Chair

1 Information

2. Opening Remarks


2 Information

3. Approval of July 19, 2018 Meeting Minutes


3 Action

4. Local CFAC Update

Jean Anderson 6 Information

5. Presentations

A. Community Relations Report

Reid Thornburg 7 Information

B. Annual Fiscal Year County Dashboard Report [July – June]

Reid Thornburg 8 Information

C. Quality Assurance Annual Performance Improvement Plan

Jill Queen 9 Information

D. Quality Management Annual Report

Jill Queen 10 Information

6. Community Updates Tregg Lindberg, Chair

11 Information

7. Closing Remarks


12 Information

Adjournment

PIEDMONT COMMUNITY BOARD MEMBERS

NAME PHONE EMAIL

Cabarrus County

Redella Hedrick (704) 791-8120 [email protected]

Betty Babb (704) 938-2744 [email protected]

Stephen M. Morris (704) 932-5126 [email protected]

Davidson County

Scott Craver (336) 474-2624 [email protected]

Keith Wingler (336) 787-3550 [email protected]

Steve Shell (336) 242-2000 [email protected]

Rowan County

Willi Beilfuss, Vice Chair (704) 279-4643 [email protected]

William McCubbins (704) 856-1812 [email protected]

Judy Klusman (704) 216-8180 [email protected]

Wilson Cherry (704) 467-5909 [email protected]

Stanly County

Dale Poplin (704) 982-1900 [email protected]

T. Scott Efird (980) 581-1798 [email protected]

Vacant

Union County

Tregg Lindberg, Chair (704) 200-3280 [email protected]

Michelle Lancaster (704) 283-3656 [email protected]

Vacant

CFAC Jean Anderson [email protected]

mailto:[email protected]














PIEDMONT AGENDA ITEM

MEETING DATE: October 18, 2018 AGENDA ITEM: 1

SUBJECT: Call to Order – Matters of the Public

BRIEF SUMMARY: The public may address the Piedmont Community Board.

REQUESTED ACTION: None

ATTACHMENTS: No

1



SUBJECT: Opening Remarks

BRIEF SUMMARY: Tregg Lindberg, Chair, will provide opening remarks.

REQUESTED ACTION: Information Only

ATTACHMENTS: No

2



SUBJECT: Approval of the July 19, 2018 Meeting Minutes

BRIEF SUMMARY: The minutes for the July 19, 2018 Piedmont Community Board Meeting are

attached for approval.

REQUESTED ACTION: Approve the minutes for the July 19, 2018 Piedmont Community Board

Meeting as presented.

ATTACHMENTS: Yes

3

Piedmont Community Board Meeting Minutes

July, 19, 2018

Members Present: Tregg Lindberg, Chair, Jean Anderson, Betty Babb, Willi Beilfuss, T. Scott Efird, Redella Hedrick, William McCubbins, Stephen Morris, Keith Wingler

Members Absent: Scott Craver, Judy Klusman, Michelle Lancaster, Dale Poplin, Steve Shelle

Staff Present: Reid Thornburg, LaKeisha McCormick, Ruth Michel

Guests: Beverly Morrow, Executive CFAC Chair

1. Call to Order –

Tregg Lindberg, Chair, called the meeting to order at 6:30 p.m.

Matters of the Public Any citizen may address the Community Board. No citizen addressed the Community Board.

2. Opening Remarks Opening remarks by Tregg Lindberg, Chair. Tregg Lindberg, Chair, welcomed Board Members and guests to the meeting.

3. Approval of the April 19, 2018 Meeting Minutes The minutes from the Thursday, April 19, 2018 Piedmont Community Board meeting were reviewed.

Jean Anderson motioned to approve the minutes as presented. Redella Hedrick seconded the motion. All in favor. Motion carried.

4. Annual Chair Election and Reinstatements A. Reid Thornburg, Senior Community Executive, reviewed the nominations for Chair. Scott Efird motioned to elect Tregg Lindberg to serve as Chair. Betty Babb seconded the motion. All in favor. Motion carried.

B. Reid Thornburg, Senior Community Executive, reviewed the nominations for Vice Chair.

Scott Efird motioned to elect Willi Beilfuss to serve as Vice Chair. Jean Anderson seconded the motion.

4

All in favor. Motion carried

5. Local CFAC Update

Jean Anderson, CFAC representative, provided the local CFAC updates to the Community Board.

6. Special Presentations A. Community Relations Report

Reid Thornburg, Senior Community Executive, presented the Community Relations Report.

B. Consumer and Family Advisory Committee Annual Report

Lakeisha McCormick presented the Consumer and Family Advisory Committee Annaual Report.

C. Client Rights Annual Report

Lakeisha McCormick reviewed the Client Rights Annual Report.

D. Guest Presentation

Tregg Lindberg, Chair, opened the floor for guests.

Beverly Morrow, CFAC Chair, provided updates on the Executive CFAC Board Committee.

7. Community Updates Tregg Lindberg, Chair, requested community updates from the Board.

Jean Anderson provided information on the next State CFAC meeting in Durham, NC.

8. Closing remarks Tregg Lindberg, Chair, provided closing remarks. Tregg Lindberg, Chair, updated the Community Board of the next meeting date.

Willi Beilfuss motioned to adjourn the meeting. Scott Efird seconded the motion.

All in favor. Motion carried.

Meeting adjourned at 7:31 p.m.

Community Board Clerk Date

5



SUBJECT: Local CFAC Update

BRIEF SUMMARY: Jean Anderson, CFAC Representative, will provide local CFAC updates.

REQUESTED ACTION: Information Only

ATTACHMENTS: No

6


MEETING DATE: October 18, 2018 AGENDA ITEM: 5.A.

SUBJECT: Community Relations Report

BRIEF SUMMARY: Reid Thornburg, Senior Community Executive, will review the Community

Relations Report.

REQUESTED ACTION: Information only

ATTACHMENTS: Appendix A

7


MEETING DATE: October 18, 2018 AGENDA ITEM: 5.B.

SUBJECT: Annual Fiscal Year County Dashboard Report [July – June]

BRIEF SUMMARY: Reid Thornburg, Senior Community Executive, will review the Annual Fiscal

Year County Dashboard Report [July – June].


ATTACHMENTS: Appendix B

8


MEETING DATE: October 18, 2018 AGENDA ITEM: 5.C.

SUBJECT: Quality Assurance Annual Performance Improvement Plan

BRIEF SUMMARY: Jill Queen, Quality Manager, will review the Quality Assurance Annual

Performance Improvement Plan.


ATTACHMENTS: Appendix C

9


MEETING DATE: October 18, 2018 AGENDA ITEM: 5.D.

SUBJECT: Quality Management Annual Report

BRIEF SUMMARY: Jill Queen, Quality Manager, will discuss the Quality Management Annual

Report.


ATTACHMENTS: Appendix D

10



SUBJECT: Community Updates

BRIEF SUMMARY: Tregg Lindberg, Chair, will request community updates from the Community

Board.


ATTACHMENTS: No

11



SUBJECT: Closing Remarks

BRIEF SUMMARY: Tregg Lindberg, Chair, will provide closing remarks.


ATTACHMENTS: No

12

APPENDIX A: Community Relations Report NOTES

13

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.

PIEDMONT COMMUNITY BOARD COMMUNITY RELATIONS REPORT

Reid ThornburgSenior Community ExecutiveOctober 18, 2018


Information provided in this presentation pertains only to the counties in the Cardinal Innovations Healthcare service area. This information is specific to the Cardinal Innovations service area and may not apply to other organizations, providers, stakeholders or individuals outside the Cardinal Innovations service area.

Presentation slides are brief, bullet-points of information and should not be used out of context.

Disclaimer

July 19, 2018

15


• Piedmont Local Community Initiatives of Interest Cabarrus County

Hispanic Community Outreach

Davidson County

Opioid Grant

Rowan County

Whole Person Whole Health

Stanly County

Night of Hope

Union County

UCPS Behavioral Health

October 18, 2018

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.October 18, 2018

• NC Medicaid Transformation

In August 2017 The North Carolina Department of Health and Human Services (DHHS) released a detailed proposed design for transforming the state Medicaid and NC Health Choice programs to managed care. When N.C. House Bill 403 passed, changes were set in motion that will transform North Carolina's Medicaid and NC Health Choice programs from a fee-for-service delivery model to managed care pre-paid health plans beginning in 2019 for Standard Plans and in 2021 for Tailored Plans. The transformation to Medicaid managed care is the most significant change to the NC Medicaid program in over 40 years and will impact an estimated 1.5 million individuals. North Carolina will integrate care for Medicaid enrollees by combining the responsibility for physical and behavioral healthcare at the plan level. The main goal of Medicaid reform is to help members achieve better health outcomes through coordination of physical and behavioral benefits.

16


• Plans At-A-Glance

Depending on their diagnoses and/or level of need, all NC Medicaid enrollees will be enrolled in a Standard Plan or a BH I/DD Tailored Plan.

October 18, 2016


17


• Cardinal’s Transition Strategy and Commitment

The focus of Cardinal Innovations Healthcare is to prepare to evolve into a Tailored Plan which means that we will still largely be serving the same people who receive services from us today. We estimate 83 percent of those currently served are eligible for a Tailored Plan and 17 percent fall under the Standard Plan. Tailored Plans are designed to address persons who experience an enhanced level of service needs. Cardinal is, and will continue to be, focused on our members and their health and wellness.

The transition to a Tailored Plan will not affect our core mission at all. We are putting strategies in place to ensure our members are well-covered in the future of Medicaid. While there are still questions to be answered, we will work with our partners at the Department of Health and Human Services and with lawmakers to address questions or concerns as we move forward.

October 18, 2016


• Medicaid Transformation Resources

https://ncdhhs.gov/nc-medicaid-transformation

https://nciom.org/what-is-medicaid-transformation

https://i2icenter.org/category/medicaid-transformation

October 18, 2016

18


• School Health Advisory Council (SHAC) Each of the five counties that make up the Piedmont Territory host a SHAC

meeting that addresses the overall, integrated healthcare needs of students in the various school systems. Cardinal Innovations Healthcare is proud to be a part of each of these councils to provide a behavioral health perspective for effective intervention in the lives of young people who are exposed to a world of anxiety, pressure, stress, and trauma. Each SHAC has representation from school nurses, social workers, public health officials, social services staff, educators, and safety officials.

October 18, 2018


COMMUNITY

OPERATIONS

Community Engagement

Community Relations

Member Engagement

Questions

19

APPENDIX B: Annual Fiscal Year County Dashboard

Report [July – June] NOTES

Annual Fiscal Year County

Dashboard Report [July – June]

21

Cabarrus County Dashboards

FYTD June 2018

County Funded Program Descriptions

Community-based crisis intervention service available 24/7/365 to assist with mental health, substance use, and developmental disability needs. Trained crisis

staff offer direct, in-person intervention where individuals are located at the time of need.

Monarch DD Emerg Backup Provision of 24 hour per day availability of back up and relief staff in the case of emergency or crisis.

CRC Kannapolis MedsPrescription medications for non-Medicaid, uninsured, and indigent members admitted to the Crisis Recovery Center (CRC) who are in need of stabilization of

their mental/behavioral health symptomatology and/or related physical health issues.

CRC Union MedsPrescription medications for non-Medicaid, uninsured, and indigent members admitted to the Crisis Recovery Center (CRC) who are in need of stabilization of


CRC Union OpsFacility based crisis, short-term residential and non-hospital detox facility. The facility is equipped to address detoxification and acute psychiatric needs. The CRC

is able to admit involuntary patients.

Daymark Adv AccessCommunity-based treatment of individuals that assures 'the right treatment at the right time'. Individuals are seen expeditiously in times of stress to attempt to

minimize exacerbation of a crisis and limit the potential of a higher level of care being required.

Daymark Med AssistancePrescription medications for non-Medicaid, uninsured, and indigent members who are in need of prescription medications for the stabilization of their

mental/behavioral health symptomatology and/or related physical health issues.

Daymark Mobile Crisis

County Funded Program

CRC KannapolisFacility based crisis, short-term residential and non-hospital detox facility. The facility is equipped to address detoxification and acute psychiatric needs. The CRC

is able to admit involuntary patients.

County Funded Program Description

123


FYTD June 2018

Report data as of August 24, 2018. All graphs are county specific unless otherwise noted.

County Funded Programs*

CRC Kannapolis

CRC Kannapolis Meds

CRC Union Meds

CRC Union Ops

Daymark Adv Access

Daymark Med Assistance


Monarch DD Emerg Backup

Total:

*Please see the County Funded Program Descriptions (Pg. 1) for additional detail

FY Budget

Amount

99.0%

100.0%

100.0%

$1,674

$32,471

$137,200

$105,911

$1,674

FYTD

Expenses

$15,549$15,549

Cabarrus Funding

$63,889

$248,688

$137,200

$105,911

$63,889

$248,688

100.0%

% Spent

100.0%$32,471

$28,978$35,443

Please note that providers have up to 90 days to submit claims and that this will affect the number of members served and expense amounts on this report. The numbers for

the previous months will be updated each reporting period.

100.0%

81.8%

100.0%

100.0%

$640,825 $634,360

NOTE: County “Maintenance of Effort” funds targeting local behavioral health needs may be managed by Cardinal Innovations or by the county. Data shown here only represents county funds managed by Cardinal Innovations. Some counties manage all of their "Maintenance of Effort" funding.

NOTE: Cardinal Innovations will be making payments to each county to cover programs that did not utilize/spend their funding for FY1718.

224


FYTD June 2018

Registry of Unmet NeedsNumber of Members Served All Age and All Diagnosis

Number of Members Served by Age and Diagnosis

646695

758 789 791 812 806858 881 875

925

790

98 99 94 98 101 89 98 111 98 95 102 94

5 5 4 5 5 5 8 7 5 4 3 30

100

200

300

400

500

600

700

800

900

1000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Child Members Served by DiagnosisAges 3 through 17

MH IDD SUD

9601009

916 953 936853

965 945 947877 881 836

340 352 351 349 349 345 350 355 353 343 345 339399 426 389 404 411 413 445 444 458 450 430 387

0

200

400

600

800

1000

1200

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Adult Members Served by DiagnosisAges 18 and over

MH IDD SUD

129 130

134

130 129 130 129

144

141143

145 144

120

125

130

135

140

145

150

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y

Innovations Registry of Unmet Needs

NOTE: Innovations slots and funding are allocated by the state. MCOs have no ability to fund or expand the number of Innovations slots.

1606 1704 1674 1742 1727 16651771 1803 1828 1752 1806

1626

438 451 445 447 450 434 448 466 451 438 447 433

404 431 393 409 416 418 453 451 463 454 433 390

0

500

1000

1500

2000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

All Members Served Ages 3 and over

All Diagnosis

MH IDD SUD

NOTE: This is a distinct count of members served. Members with multiple diagnosis will only be counted once. The sum of the previous graph will not be equal to the total in this graph.

325


FYTD June 2018

Service Category Definitions

Community

Psych Rehab

Residential

PRTF

Emergency Department

Service to help adults with psychiatric disabilities manage their illness and their lives with as little professional intervention as possible.

Hospital emergency department.

Intermediate Care Facility for individuals with Intellectual Disabilities.

Intensive In-Home Services - services provided in the person's home by a small team with at least one Licensed Professional.

Outpatient ED

Partial Hosp/Day Tx

Mandated service categories effective 7/1/2013.

IIHS

Definition

Additional supports for Medicaid recipients such as Community Guide and Individual Support.

Assertive Community Treatment Team - services received in the community that address functional areas of the identified population.

A short-term service for acutely mentally ill children or adults designed to prevent hospitalizations or to serve as a step down for those leaving an

inpatient facility.

Crisis Services

A long-term residential program for people with behavioral health needs.

Services that are provided in the community.

Community based mental health and substance abuse rehabilitation services and interventions.

Services received in a crisis or emergency situation such as Mobile Crisis and Facility-based crisis.

ICF

Group settings that serve people across all disability groups.

Psychiatric Residential Treatment Facilities provide residential care to persons under the age of 21 who need 24-hour supervision and specialized

interventions.

Inpatient

MST

Outpatient

Innovations

Service Category

1915 (b)(3) Services

Services provided in a hospital Emergency Department on an outpatient basis.

BH Long Term Residential

Community Support

Medicaid Waiver for individuals with Intellectual Disabilities.

Hospital-based psychiatric care.

Multisystemic Therapy is a family and community-based therapy for juveniles.

Services received in the community including evaluation, therapy, and psychiatric care.

ACTT

426


FYTD June 2018

Members Served and Expenses by Service Category

Members Served is based on Member's County of Medicaid Eligibility not on the Provider's physical

location.

Expenses by Service Categories is based on the Total Paid Amount.

*Please see the Service Category Definitions (Pg. 4) for additional detail

17

20

22

34

35

28

60

65

108

147

226

443

294

424

425

4188

9

20

35

38

39

46

61

73

117

173

236

280

288

383

481

4218

0 1000 2000 3000 4000 5000

MST

Community Support

PRTF (Psychiatric ResidentialTreatment Facility)


Psych Rehab

Partial Hosp/Day Tx

ICF

ACTT (Assertive CommunityTreatment Team)

IIHS

Crisis Services

Innovations

Outpatient ED


Inpatient


Outpatient

Distinct Members Served - Medicaid Funding

Jul'17-Jun'18 Jul'16-Jun'17

$119,212

$69,047

$1,059,298

$884,436

$200,183

$458,841

$7,772,345

$735,119

$960,650

$108,962

$11,020,480

$62,395

$1,663,744

$2,087,579

$477,359

$3,364,175

$91,495

$68,679

$1,976,725

$1,229,078

$197,838

$594,590

$8,403,329

$782,103

$1,002,065

$165,173

$12,169,452

$35,474

$1,514,733

$2,566,376

$529,499

$3,591,183

$0 $4,000,000 $8,000,000 $12,000,000

MST

Community Support

PRTF (Psychiatric Residential Treatment Facility)


Psych Rehab

Partial Hosp/Day Tx

ICF

ACTT (Assertive Community Treatment Team)

IIHS

Crisis Services

Innovations

Outpatient ED


Inpatient


Outpatient

Expenses by Service Category - Medicaid Funding


527


FYTD June 2018


Members Served is based on member's County of Residence not on the Provider's physical

location.



0

0

0

9

17

100

156

146

426

906

0

2

6

12

28

87

162

175

450

984

0 200 400 600 800 1000 1200

Community Support

Partial Hosp/Day Tx

Community Support

Psych Rehab


Inpatient

Residential

Community

Crisis Services

Outpatient

Distinct Members Served - State Funding


$0

$0

$0

$46,977

$148,708

$563,221

$1,085,862

$623,440

$48,003

$150,450

$0

$926

$4,125

$46,526

$103,028

$517,941

$1,150,618

$751,702

$38,814

$321,644

$0 $500,000 $1,000,000 $1,500,000

Community Support

Partial Hosp/Day Tx

Community Support

Psych Rehab


Inpatient

Residential

Community

Crisis Services

Outpatient

Expenses by Service Category - State Funding


628


FYTD June 2018

Expenses by Facility Based Crisis & Mobile Crisis Services are based on the total Adjudicated

Amount.

Medicaid Member served for Facility Based Crisis & Mobile Crisis Services are based on member's

County of Residence not on the Provider's physical location.

Members Served and Expense Amounts - Facility Based Crisis & Mobile Crisis Management Services

Medicaid Member served for Facility Based Crisis & Mobile Crisis Services are based on the

Consumers Eligibility. Expenses by Facility Based Crisis & Mobile Crisis Services are based on the total Adjudicated

Amount.

50

115

63

128

0

20

40

60

80

100

120

140

Facility Based Crisis Mobile Crisis Management

Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid


252

210

282

205

0

50

100

150

200

250

300


Distinct Members Receiving FBC & MCM Crisis ServicesState


$89,750

$19,213

$145,074

$24,437

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000


Expenses by FBC & MCM Crisis ServiceMedicaid


$496,130

$33,511

$554,724

$32,823

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000


Expenses by FBC & MCM Crisis ServiceState


729


FYTD June 2018

Entity Type Definitions

Hospital Non-contracted Hospitals for which we reimburse Emergency Department services and Inpatient services.

Physician's Group of HospitalsA group of physicians, contracting or non-contracting, associated with hospitals but not employed by the facility. Considered non-contracting

unless otherwise specified.

Inpatient Hospital providing contracted behavioral health Inpatient and Emergency Department services.

Comprehensive Community

Clinics

Agency based entities providing a number of services, including assessment, enrollment, Outpatient and Psychiatric services, and serve at least

two disabilities. They are designated points of entry that ensure easy access for members.

Inpatient/Outpatient Hospital providing contracted behavioral health Emergency Department and Outpatient services.

Residential Facility located in-catchment but affiliated with another MCO/LME with local Quality Management mandated site visits and limited

oversight required.Senate Bill 163

Other Other entity not elsewhere defined.

County Agency Public health agency.

Neuro Behavioral Center State

Institution

State run medical and nursing care facility for individuals with severe or moderate developmental disability (IDD) and medical conditions of a

serious or chronic nature requiring 24 hour care.

ICFMR State Institution Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) - State run Intermediate Care Facility serving IDD Adults and children.

ADATC State InstitutionAlcohol Drug Abuse Treatment Center (ADATC) State Institution-A state run SUD Adult facility which provides medical detox and medically

monitored residential treatment.

Agencies provide one or more enhanced clinical/therapeutic/rehabilitative/habilitative service to MH, SUD, IDD, or multiple diagnosis groups.

LIPLicensed Independent Practitioner (LIP) - Individual Clinicians, Therapists, Psychiatrists, Psychologists, etc. that are individually contracted with

the MCO. They provide outpatient services such as therapy, psychiatric care, assessment and testing.

Psych State Institution State run Psychiatric care facility for children and adults.

Mandated Entity types effective 11/1/2017.

Entity Type Definition

Agency

LIP GroupLicensed Independent Practitioner (LIP) Groups are a group of clinicians, Therapists, Psychiatrists, Psychologists, etc. providing outpatient services

such as therapy, psychiatric care, assessment, and testing. They contract with the MCO as a group.

830


FYTD June 2018

*Please see the Entity Type Definitions (Pg. 8) for additional detail

DAYMARK Recovery Services, Inc.(Cabarrus Center) Comprehensive Community Clinics

The Charlotte - Mecklenburg Hospital Authority dba NorthEast Psychiatric Services, CHSInpatient/Outpatient

RHA Health Services, Inc. Comprehensive Community Clinics

Carolinas Medical Center-Main (FAC) Inpatient

Center For Emotional Health, P.C. LIP Group

Carolinas HealthCare System Northeast Inpatient

DAYMARK Recovery Services, Inc. - Mobile Crisis Management / After Hours EmergencyAgency

McLeod Addictive Disease Center, Inc. Agency

Daymark - Facility Based Crisis of Cabarrus Agency

Monarch Comprehensive Community Clinics

Top 10 Providers by Members Served - Cabarrus Entity Type

Provider Information

Access Call Center

5,341 5,732 5,257 6,287 5,159 4,233 5,141 4,806 5,644 5,305 5,753 5,509

5 5 5 5 5 5 5 5 5 5 5 5

0

1

2

3

4

5

6

0

2000

4000

6000

8000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls

Total Number of Calls and Speed to Answer

2.6% 2.5% 2.6%

1.7% 1.8%2.9%

2.0% 2.3% 2.1% 2.1% 2.1%2.3%

0%

2%

4%

6%

8%

10%

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Per

cen

t o

f C

alls

Ab

and

on

ed

Call Abandonment Rate

Access HEDIS Benchmark 8.6% Cardinal Innovations Target 5.0%

0101010203030407293757

170236

4581,009

0 200 400 600 800 1000

Other

Neuro Behavioral Center State Institution

County Agency

ADATC State Institution

Inpatient/Outpatient

ICFMR State Institution

Psych State Institution

Comprehensive Community Clinics

Inpatient

Physician's Group of Hospitals

Hospital

LIP Group

LIP

Agency

Total Providers

All Cardinal Innovations Providers by Entity Type

Note: The Top 10 Providers by Members Served is based on member's County of Medicaid Eligibility not on the Provider's physical location.

931


FYTD June 2018

FY1718 Analysis:

Members Served by Age and Diagnosis

Innovations Registry of Unmet Needs – A list of members who are waiting for an Innovations Waiver Slot

Members Served and Expense Amounts by Service Category - Medicaid

Members Served and Expense Amounts by Service Category - State

Members Served and Expense Amounts for Crisis Services


Call Center information in the charts above reflect Cardinal Innovations data and are not county specific.

Compared to the previous fiscal year, utilization of Medicaid funded Facility Bases Crisis services increased by 26% (50 to 63), and expenses

increased by 62% ($89,750 to $145,074). Both utilization and expense for Mobile Crisis Management services remained consistent for Medicaid

and State funding.

There was an increase in the Call Abandonment Rate in December'17 due to some calls disconnecting between 1-2 seconds or less of the Call

Center receiving the call. Call Center management has rectified the issue and the rate returned to normal in Jan'18.

From the beginning to the end of FY1718, the number of Child MH Members served has increased by 22% (646 to 790).

After an increase of 12% (129 to 144) in Feb'18, the Innovations Registry of Unmet Needs has remained at a consistent level.

For FY1718, Outpatient services remained the most utilized service, while Innovations and ICF services remained the highest in terms of expense.

Outpatient ED services experienced a decrease of 37% (443 to 280) in utilization and a decrease of 43% ($62,395 to $35,474) in expense. Much of

this decrease can be attributed to denied claims for a single provider, who had been submitting claims with a rendering clinician that is not

credentialed with Cardinal Innovations as a behavioral health clinician. Innovations services experienced a slight increase in utilization, along with

an increase in expense of 10% ($11,020,480 to $12,169,452). PRTF services experienced an increase in utilization of 59% (22 to 35) and in expense

of 87% ($1,059,298 to $1,976,725).

Outpatient services experienced an increase in expense of 114% ($150,450 to $321,644), though utilization only increased by 9% (906 to 984). Most

of this can be attributed to an increase in utilization of Opioid Treatment services. Utilization of Opioid Treatment increased from 3 members in

FY1617 to 90 members in FY1718, and expenses increased from $1,511 to $171,279. ACTT services experienced a decrease in expense of 31%

($148,708 to $103,028) despite an increase in utilization of 65% (17 to 28). This increase in utilization can be attributed to new billing requirements

that were implemented in February of 2017. Providers are now required to submit claims with any member contact with a duration of fewer than

15 minutes.

Please note that providers have up to 90 days to submit claims and that this will affect the number of members served and expense amounts on this report. The

numbers for the previous months will be updated each reporting period.

1032

Davidson County Dashboards

FYTD June 2018


Daymark Mobile CrisisCommunity-based crisis intervention service available 24/7/365 to assist with mental health, substance use, and developmental disability needs. Trained crisis


Indigent Meds Monarch Prescription medications disbursed to indigent clients during the course of treatment


Psych Supp Fam Serv DavidsonPsychiatric Service offering individuals additional hours of access to a clinician for addressing behavioral health needs. This service includes addressing the

needs of individuals who present for care as uninsured/underinsured.





CRC Union OpsFacility based crisis, short-term residential and non-hospital detox facility. The facility is equipped to address detoxification and acute psychiatric needs. The

CRC is able to admit involuntary patients.

Daymark Adv AccessCommunity-based treatment of individuals that assures 'the right treatment at the right time'. Individuals are seen expeditiously in times of stress to attempt

to minimize exacerbation of a crisis and limit the potential of a higher level of care being required.




CRC KannapolisFacility based crisis, short-term residential and non-hospital detox facility. The facility is equipped to address detoxification and acute psychiatric needs. The



133


FYTD June 2018



CRC Kannapolis

CRC Kannapolis Meds

CRC Union Meds

CRC Union Ops

Daymark Adv Access



Indigent Meds Monarch


Psych Supp Fam Serv Davidson

Total:


FY Budget

Amount

100.0%$1,987$1,987

81.8%

$698,290

100.0%

100.0%

100.0%

100.0%

$37,500

$15,000

$38,537

$106,584

$29,680

$75,000

FYTD

Expenses

$18,455$18,455

Davidson Funding

$75,827

$295,154

$106,584

$29,680

$75,827

$295,154

100.0%

100.0%

% Spent

100.0%$38,537

$34,393$42,066



50.0%

$15,000

$653,117 93.5%



234


FYTD June 2018

Registry of Unmet Needs


Number of Members Served All Age and All Diagnosis

464507

584648 677

623663

710758 740 767

623

70 68 63 72 71 70 70 71 71 75 68 73

3 8 5 4 5 6 6 5 9 8 9 100

100

200

300

400

500

600

700

800

900

Jul'1

7

Au

g'17

Sep

'17

Oct

'17

No

v'17

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'18

May

'18

Jun

'18


MH IDD SUD

796859

813 793 807717

782 815 816 831 794719

285 287 290 285 284 278 274 277 278 281 282 280318 297 303 328 316 294 299 315 335 325 335 298

0

100

200

300

400

500

600

700

800

900

1000

Jul'1

7

Au

g'17

Sep

'17

Oct

'17

No

v'17

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'18

May

'18

Jun

'18


MH IDD SUD

90 88 90 90 92 94 93100 99 103 106 102

0

20

40

60

80

100

120

Jul'1

7

Au

g'17

Sep

'17

Oct

'17

No

v'17

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'18

May

'18

Jun

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



12601366 1397 1441 1484

13401445 1525 1574 1571 1561

1342

355 355 353 357 355 348 344 348 349 356 350 353

321 305 308 332 321 300 305 320 344 333 344 308

0

500

1000

1500

2000

Jul'1

7

Au

g'17

Sep

'17

Oct

'17

No

v'17

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'18

May

'18

Jun

'18


All Diagnosis

MH IDD SUD


335


FYTD June 2018


Community

Psych Rehab

Residential

PRTF







Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition




A short-term service for acutely mentally ill children or adults designed to prevent hospitalizations or to serve as a step down for those leaving

an inpatient facility.

Crisis Services


ACTT

ICF


Psychiatric Residential Treatment Facilities provide residential care to persons under the age of 21 who need 24-hour supervision and

specialized interventions.

Inpatient

MST

Outpatient

Innovations




Service Category


436


FYTD June 2018


Members Served is based on Member's County of Medicaid Eligibility not on the Provider's

physical location.



0

17

29

43

40

43

44

68

62

54

149

139

187

383

369

558

3611

0

7

25

37

38

39

46

54

65

67

151

155

187

215

354

563

3601

0 1000 2000 3000 4000

Community

Community Support


MST


Partial Hosp/Day Tx

Psych Rehab


ICF

IIHS


Crisis Services

Innovations

Outpatient ED

Inpatient


Outpatient



$0

$123,799

$936,627

$349,422

$992,081

$524,478

$249,238

$720,537

$7,097,535

$511,494

$1,046,287

$81,080

$9,037,586

$50,278

$1,415,933

$417,122

$2,715,161

$0

$23,960

$1,290,590

$374,062

$765,682

$502,647

$252,486

$681,664

$7,375,514

$540,945

$798,256

$176,166

$9,097,245

$25,900

$2,291,704

$539,932

$2,695,857

$0 $4,000,000 $8,000,000

Community

Community Support

PRTF (Psychiatric Residential Treatment Facility)

MST


Partial Hosp/Day Tx

Psych Rehab


ICF

IIHS


Crisis Services

Innovations

Outpatient ED

Inpatient


Outpatient



537


FYTD June 2018





location.

0

0

2

5

23

82

195

268

238

1003

0

0

3

3

18

79

159

230

327

1065

0 200 400 600 800 1000 1200

IIHS

MST

Partial Hosp/Day Tx

Psych Rehab


Community

Residential

Inpatient

Crisis Services

Outpatient



$0

$0

$3,308

$25,790

$153,243

$453,309

$945,338

$1,231,342

$139,206

$190,358

$0

$0

$2,516

$17,314

$155,253

$499,423

$827,766

$1,065,635

$85,142

$206,323

$0 $500,000 $1,000,000 $1,500,000

IIHS

MST

Partial Hosp/Day Tx

Psych Rehab


Community

Residential

Inpatient

Crisis Services

Outpatient



638


FYTD June 2018




Amount.




Amount.

25

125

62

114

0

20

40

60

80

100

120

140




64

124

193

129

0

50

100

150

200

250




$53,767

$23,406

$153,733

$19,660

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000




$104,435

$20,966

$360,764

$18,835

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000




739


FYTD June 2018







Clinics




Licensed Independent Practitioner (LIP) Groups are a group of clinicians, Therapists, Psychiatrists, Psychologists, etc. providing outpatient

services such as therapy, psychiatric care, assessment, and testing. They contract with the MCO as a group.



Agency

Senate Bill 163




Institution



ICFMR State Institution Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) - State run Intermediate Care Facility serving IDD Adults and children.




oversight required.





LIP Group

840


FYTD June 2018




Lorven Child & Family Development, LLC LIP

Forsyth Memorial Hospital, Inc. dba Novant Health Forsyth Medical CenterInpatient

Wake Forest University Health Sciences Physician's Group of Hospitals


Regional Physicians, LLC LIP Group

Lexington Memorial Hospital Hospital

Nazareth Children's Home, Inc Agency

Daymark - Davidson Crisis Center Agency

Top 10 Providers by Members Served - Davidson Entity Type


Access Call Center

5,341 5,732 5,257 6,287 5,159 4,233 5,141 4,806 5,644 5,305 5,753 5,509

5 5 5 5 5 5 5 5 5 5 5 5

0

1

2

3

4

5

6

0

2000

4000

6000

8000

Jul'1

7

Au

g'17

Sep

'17

Oct

'17

No

v'17

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'18

May

'18

Jun

'18

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.6% 2.5% 2.6%

1.7% 1.8%2.9%

2.0% 2.3% 2.1% 2.1% 2.1%2.3%

0%

2%

4%

6%

8%

10%

Jul'1

7

Au

g'17

Sep

'17

Oct

'17

No

v'17

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'18

May

'18

Jun

'18

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030407293757

170236

4581,009

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



941


FYTD June 2018

FY1718 Analysis:






Please note that providers have up to 90 days to submit claims and that this will affect the number of members served and expense amounts on this report.

The numbers for the previous months will be updated each reporting period.


Outpatient services remained the most utilized Medicaid funded service in FY1718, while Innovations and ICF services remained the highest in

terms of expense. Outpatient ED services experienced a decrease in utilization of 44% (383 to 215), and a decrease in expense of 49% ($50,278 to

$25,900), compared to the previous fiscal year. Much of this decrease can be attributed to denied claims for a single provider, who had been

submitting claims with a rendering clinician that is not credentialed with Cardinal Innovations as a behavioral health clinician. Expenses for

Inpatient services increased by 62% ($1,415,933 to $2,291,704) over the previous fiscal year, even though utilization decreased slightly. This can

be attributed to an increase in the average length of stay, which increased from 15 days in FY1617 to 21 days in FY1718.

Outpatient services remained the most utilized State funded service in FY1718, and utilization increased by 6% (1003 to 1065) compared to the

previous fiscal year. Inpatient services remained the highest in expense, despite a decrease in expense of 13% ($1,231,342 to $1,065,635)

compared to the previous fiscal year. Residential services remained the second-highest in terms of expense, though these services also saw a

decrease in utilization of 18% (195 to 159) and a decrease in expense of 12% ($945,335 to $827,766).

Both Medicaid and State funded Facility Based Crisis services experienced increases in utilization and expense compared to the previous fiscal

year. Medicaid funded Facility Based Crisis services increased in utilization by 148% (25 to 62), and in expense by 186% ($53,767 to $153,733).

State funded Facility Based Crisis services increased in utilization by 202% (64 to 193), and in expense by 245% ($104,435 to $360,764). This

increase can be attributed to the opening of a new Facility Based Crisis provider in Davidson County in October of 2017.


Center receiving the call. Call Center management has rectified the issue, and the rate has returned to normal as of Jan'18.

The number of Child MH Members served has been trending upward for the duration of FY1718, and the monthly total has increased by 34% (464

to 623) since the beginning of the fiscal year.

1042

Rowan County Dashboards

FYTD June 2018











Daymark Adv AccessCommunity-based treatment of individuals that assures 'the right treatment at the right time'. Individuals are seen expeditiously in times of stress to attempt

to minimize exacerbation of a crisis and limit the potential of a higher level of care being required.







143


FYTD June 2018



CRC Kannapolis

CRC Kannapolis Meds

CRC Union Meds

CRC Union Ops

Daymark Adv Access




Total:


99.0%

FY Budget

Amount

$485,041

100.0%

100.0%

100.0%

$1,267

$24,577

$103,847

$80,164

$1,267

FYTD

Expenses

$11,769$11,769

Rowan Funding

$48,358

$188,232

$103,847

$80,164

$48,358

$188,232

100.0%

100.0%

% Spent

100.0%$24,577

$21,934$26,827

Please note that providers have up to 90 days to submit claims and that this will affect the number of members served and expense amounts on this report. The numbers

for the previous months will be updated each reporting period.

100.0%

81.8%

$480,147



244


FYTD June 2018

Registry of Unmet Needs


Number of Members Served All Age and All Diagnosis

585628 645

734 756696

761812

881 861 868

686

61 68 73 84 73 79 84 90 84 80 80 85

12 8 11 11 13 11 16 20 21 15 16 150

100

200

300

400

500

600

700

800

900

1000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


MH IDD SUD

9441047

905 947 936879

944 924 908 892 874 856

269 277 271 277 279 282 275 277 281 273 280 271453 487 466 486 458 436 459 466 442 458 461

401

0

200

400

600

800

1000

1200

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


MH IDD SUD

68 6974

68 66 64 61

69 68 66 68 69

0

10

20

30

40

50

60

70

80

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



15291675

15501681 1692

15751705 1736 1789 1753 1742

1542

330 345 344 361 352 361 359 367 365 353 360 356465 495 477 497 471 447 475 486 463 473 477 416

0

500

1000

1500

2000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


All Diagnosis

MH IDD SUD


345


FYTD June 2018



Community Support


Residential

PRTF







Psych Rehab


Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition







Community



Crisis Services



ACTT

ICF




Inpatient

MST

Outpatient

Innovations

Service Category


446


FYTD June 2018



physical location.



14

14

35

40

35

40

62

71

87

156

173

261

396

415

494

4432

14

16

33

36

46

46

59

66

88

168

214

295

352

448

538

4428

0 1000 2000 3000 4000 5000

MST

Community Support



Partial Hosp/Day Tx

Psych Rehab

ICF


IIHS

Innovations

Crisis Services


Outpatient ED

Inpatient


Outpatient



$75,660

$77,502

$1,483,987

$1,067,123

$476,737

$241,441

$7,266,093

$690,407

$760,141

$7,942,920

$118,272

$1,573,282

$58,407

$2,234,323

$426,897

$3,567,922

$111,681

$57,782

$1,254,507

$791,441

$711,636

$264,462

$7,622,874

$612,980

$736,639

$8,602,717

$177,482

$1,955,945

$55,138

$2,454,430

$482,381

$3,662,968

$0 $2,000,000$4,000,000$6,000,000$8,000,000$10,000,000

MST

Community Support

PRTF (Psychiatric Residential TreatmentFacility)


Partial Hosp/Day Tx

Psych Rehab

ICF


IIHS

Innovations

Crisis Services


Outpatient ED

Inpatient


Outpatient



547


FYTD June 2018




location.


0

7

12

101

94

171

317

954

1

7

13

97

101

132

303

877

0 200 400 600 800 1000 1200

Community Support

Psych Rehab


Residential

Community

Inpatient

Crisis Services

Outpatient



$0

$36,723

$122,724

$447,555

$360,880

$628,612

$40,499

$41,287

$1,054

$31,443

$134,194

$399,032

$402,628

$517,291

$39,427

$73,709

$0 $200,000 $400,000 $600,000 $800,000

Community Support

Psych Rehab


Residential

Community

Inpatient

Crisis Services

Outpatient



648


FYTD June 2018




Amount.




Amount.

52

136

76

157

0

20

40

60

80

100

120

140

160

180




173 169

196

137

0

50

100

150

200

250




$93,224

$22,444

$151,282

$23,922

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000




$320,068

$23,131

$358,116

$18,319

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000




749


FYTD June 2018







Clinics

Agency based entities providing a number of services, including assessment, enrollment, Outpatient and Psychiatric services, and serve at

least two disabilities. They are designated points of entry that ensure easy access for members.





LIP GroupLicensed Independent Practitioner (LIP) Groups are a group of clinicians, Therapists, Psychiatrists, Psychologists, etc. providing outpatient


Senate Bill 163




Institution



ICFMR State InstitutionIntermediate Care Facilities for Persons with Mental Retardation (ICF/MR) - State run Intermediate Care Facility serving IDD Adults and

children.



Residential Facility located in-catchment but affiliated with another MCO/LME with local Quality Management mandated site visits and

limited oversight required.




Agency

850


FYTD June 2018



Rowan Regional Medical Center, Inc. dba Novant Health Rowan Medical CenterHospital

Nazareth Children's Home, Inc Agency

Rowan Psychiatric and Medical Services, PA LIP Group




Natalie Errante, PMH-NP LIP



Top 10 Providers by Members Served - Rowan Entity Type

Access Call Center


5,341 5,732 5,257 6,287 5,159 4,233 5,141 4,806 5,644 5,305 5,753 5,509

5 5 5 5 5 5 5 5 5 5 5 5

0

1

2

3

4

5

6

0

2000

4000

6000

8000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.6% 2.5% 2.6%

1.7% 1.8%2.9%

2.0% 2.3% 2.1% 2.1% 2.1%2.3%

0%

2%

4%

6%

8%

10%

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030407293757

170236

4581,009

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



951


FYTD June 2018

FY1718 Analysis:






Outpatient services remained the most utilized State funded service in FY1718. Despite a decrease in utilization of 8% (954 to 877), expenses for

Outpatient services increased by 79% ($41,287 to $73,709). This can be attributed to an increase in utilization of Opioid Treatment services.

Utilization of State funded Opioid Treatment services increased from 4 in FY1617 to 32 in FY1718, and expenses increased from $5,063 to

$44,554. Inpatient services remained the State funded service with the highest expense, despite decreases in both utilization and expense of

23% (171 to 132) and 18% ($628,612 to $517,291), respectively. State funded Community services experienced an increase in utilization of 7%

(94 to 101) and an increase in expense of 12% ($360,880 to $402,628).

Both Medicaid funded Facility Based Crisis and Mobile Crisis Management services experienced increases in utilization and expense over the

previous fiscal year. The largest increase was with Medicaid funded Facility Based Crisis services, which increased in utilization by 46% (52 to 76)

and in expense by 62% ($93,224 to $151,282). Much of this increase can be attributed to the opening of a new facility in Oct'17. State funded

Mobile Crisis Management services experienced a decrease in utilization of 19% (169 to 137) and a decrease in expense of 21% ($23,131 to

$18,319).




Outpatient services remained the most utilized Medicaid funded service in FY1718, while Innovations and ICF services remained the highest in

terms of expense. Both Innovations and ICF services experienced increases in expense over the previous fiscal year; Innovations by 8%

($7,942,920 to $8,602,717) and ICF by 5% ($7,266,093 to $7,622,874). 1915 (b)(3) services experienced an increase in utilization of 13% (261 to

295) and an increase in expense of 24% ($1,573,282 to $1,955,945) compared to the previous fiscal year. The biggest increase in this category

was with Peer Support services, which saw an increase in utilization of 21% (125 to 151).



The number of Child MH Members served has been trending upward for the duration of FY1718, while the number of Adult MH members

served has been trending downward.

1052

Union County Dashboards

FYTD June 2018



















153


FYTD June 2018



CRC Kannapolis

CRC Kannapolis Meds

CRC Union Meds

CRC Union Ops

Daymark Adv Access




Total:


$709,491

100.0%

% Spent

100.0%$36,316

$32,410$39,641



100.0%

$36,316

$153,449

$118,455

$1,872

FYTD

Expenses

$17,391$17,391

Union Funding

$71,456

$278,142

$153,449

$118,455

$71,456

$278,142

100.0%

81.8%

$716,722

100.0%

100.0%

100.0%

$1,872

FY Budget

Amount

99.0%



254


FYTD June 2018


Number of Members Served All Age and All Diagnosis Registry of Unmet Needs

676 718826

913845 806 835 881

962 937 982

732

106 113 106 103 110 102 100 108 111 112 115 120

3 6 10 7 8 11 9 10 7 7 5 70

200

400

600

800

1000

1200

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


MH IDD SUD

691751 725 730 699 693 698

744702

663705

644

333 334 335 333 330 333 333 335 328 326 330 329

207 227 248 261 256 238 247 247 252 261222 203

0

100

200

300

400

500

600

700

800

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


MH IDD SUD

152

155

160

157

155156 156

164

162

164

162

160

146

148

150

152

154

156

158

160

162

164

166

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



1367 1469 1551 1643 1544 1499 1533 1625 1664 1600 1687

1376

439 447 441 436 440 435 433 443 439 438 445 449

210 233 258 268 264 249 256 257 259 268 227 2100

500

1000

1500

2000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


All Diagnosis

MH IDD SUD


355


FYTD June 2018


ACTT

ICF




Inpatient

MST

Outpatient

Innovations

Service Category




Crisis Services







Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition



Residential

PRTF






Community

Psych Rehab

456


FYTD June 2018


physical location.




1

8

10

29

24

40

40

48

47

65

141

406

169

246

296

488

3381

1

6

9

34

36

40

43

47

57

66

141

142

165

256

313

503

3589

0 1000 2000 3000 4000

Residential

Community Support

MST



Psych Rehab


ICF

Partial Hosp/Day Tx

IIHS

Crisis Services

Outpatient ED


Innovations

Inpatient


Outpatient



$17,080

$48,099

$83,679

$676,546

$987,408

$346,037

$442,236

$5,364,991

$703,653

$648,857

$151,634

$55,005

$938,576

$10,707,081

$1,514,680

$623,277

$3,018,544

$7,256

$22,396

$74,226

$779,130

$1,665,988

$311,486

$443,858

$5,496,374

$729,645

$607,028

$132,800

$19,855

$874,654

$11,352,679

$1,931,613

$687,982

$3,300,605

$0 $4,000,000 $8,000,000 $12,000,000

Residential

Community Support

MST



Psych Rehab


ICF

Partial Hosp/Day Tx

IIHS

Crisis Services

Outpatient ED


Innovations

Inpatient


Outpatient



557


FYTD June 2018




location.


0

11

9

96

76

95

385

900

0

6

12

63

75

104

428

952

0 200 400 600 800 1000

IIHS

Psych Rehab


Inpatient

Community

Residential

Crisis Services

Outpatient



$0

$54,114

$87,799

$486,317

$384,781

$595,569

$30,579

$35,767

$0

$23,328

$93,932

$343,980

$410,201

$746,008

$31,910

$98,904

$0 $200,000 $400,000 $600,000 $800,000

IIHS

Psych Rehab


Inpatient

Community

Residential

Crisis Services

Outpatient



658


FYTD June 2018




Amount.




Amount.

66

91

65

96

0

20

40

60

80

100

120




272

142

288

154

0

50

100

150

200

250

300

350




$138,127

$13,507

$116,008

$13,164

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000




$515,849

$20,266

$620,998

$25,056

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000




759


FYTD June 2018





Agency

Senate Bill 163




Institution




children.













Clinics





oversight required.

860


FYTD June 2018






Thrive Counseling Services, PLLC LIP Group

DAYMARK Recovery Services, Inc. - CRC Unit - Union County Agency

Union Family Services, PLLC LIP Group




Access Call Center

Top 10 Providers by Members Served - Union Entity Type


5,341 5,732 5,257 6,287 5,159 4,233 5,141 4,806 5,644 5,305 5,753 5,509

5 5 5 5 5 5 5 5 5 5 5 5

0

1

2

3

4

5

6

0

2000

4000

6000

8000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.6% 2.5% 2.6%

1.7% 1.8%2.9%

2.0% 2.3% 2.1% 2.1% 2.1%2.3%

0%

2%

4%

6%

8%

10%

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030407293757

170236

4581,009

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



961


FYTD June 2018

FY1718 Analysis:






Outpatient services remained the most utilized Medicaid funded service in FY1718, and Innovations services remained the highest in terms of

expense. Compared to the previous fiscal year, Outpatient ED services experienced a decrease in utilization of 65% (406 to 142) and a decrease

in expense of 64% ($55,005 to $19,855). Much of this decrease can be attributed to denied claims for a single provider, who had been submitting

claims with a rendering clinician that is not credentialed with Cardinal Innovations as a behavioral health clinician. PRTF services experienced an

increase in utilization of 50% (24 to 36) and an increase in expense of 69% ($987,408 to $1,665,988).

Outpatient services remained the most utilized State funded service in FY1718. Expenses for Outpatient services increased by 177% ($35,767 to

$98,904), though utilization increased by only 6% (900 to 952). Much of this can be attributed to an increase in claims for Opioid Treatment.

Residential services remained the highest in terms of expense, with an increase in utilization of 9% (95 to 104) and an increase in expense of 25%

($595,569 to $746,008). Inpatient services decreased in utilization by 34% (96 to 63) and in expense by 29% ($486,317 to $343,980) compared to

the previous fiscal year.

Compared to FY1617, Medicaid funded Facility Based Crisis services experienced a decrease in expense of 16% ($138,127 to $116,008), though

utilization remained consistent. State funded Facility Based Crisis services experienced an increase in utilization of 6% (272 to 288) and an

increase in expense of 20% ($515,849 to $620,998), while utilization and expense of State funded Mobile Crisis Management services remained

consistent with the previous fiscal year.



The number of Members on the Innovations Registry of Unmet Needs has been trending upward during FY1718.




1062

Stanly County Dashboards

FYTD June 2018


















Indigent Meds Monarch Prescription medications disbursed to indigent clients during the course of treatment


163


FYTD June 2018



CRC Kannapolis

CRC Kannapolis Meds

CRC Union Meds

CRC Union Ops

Daymark Adv Access



Indigent Meds Monarch


Total:


$184,791

100.0%

% Spent

100.0%$10,099

$9,012$11,023



50.0%

$10,099

$23,920

$26,690

$25,000

FYTD

Expenses

$4,836$4,836

Stanly Funding

$19,870

$77,344

$23,920

$26,690

$19,870

$77,344

100.0%

100.0%

100.0%

100.0%

$12,500

FY Budget

Amount

100.0%$520$520

81.8%

$199,302 92.7%



264


FYTD June 2018


Number of Members Served All Age and All Diagnosis Registry of Unmet Needs

230244 232

271257 248

266281 286 287

262

214

21 21 18 22 19 20 22 20 17 20 21 23

4 5 2 3 2 4 5 8 6 8 6 70

50

100

150

200

250

300

350

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


MH IDD SUD

513

595527 545 555

506 511 497541

510 498 500

136 138 136 135 134 134 138 144 144 136 143 140157 169 154 155 129 121 140 140 146 148 164 171

0

100

200

300

400

500

600

700

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


MH IDD SUD

48 48

50 50

49 49 49 49

46

47

48

45

42

43

44

45

46

47

48

49

50

51

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



743839

759816 812

754 777 778 827 797 760 714

157 159 154 157 153 154 160 164 161 156 164 163

161 174 156 158 131 125 145 148 152 156 170 178

0

200

400

600

800

1000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18


All Diagnosis

MH IDD SUD


365


FYTD June 2018


Service Category


ACTT

ICF




Inpatient

MST

Outpatient

Innovations



Crisis Services


Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition








Community Support





Community

Psych Rehab

Residential

PRTF






466


FYTD June 2018


physical location.




8

3

6

10

10

24

26

26

54

64

78

77

200

191

172

1796

2

4

4

7

8

16

24

25

50

62

77

88

101

171

207

1819

0 500 1000 1500 2000

MST

Community Support

Partial Hosp/Day Tx



IIHS

Psych Rehab

ICF


Crisis Services

Innovations


Outpatient ED

Inpatient


Outpatient



$54,126

$3,666

$128,196

$224,529

$219,561

$237,802

$142,453

$3,274,430

$643,755

$39,458

$4,702,397

$318,545

$29,973

$741,337

$185,445

$1,165,621

$21,716

$13,053

$29,840

$295,760

$183,954

$155,695

$167,342

$3,339,816

$495,699

$62,837

$4,984,868

$487,707

$11,455

$1,058,742

$253,755

$1,171,028

$0 $2,000,000 $4,000,000 $6,000,000

MST

Community Support

Partial Hosp/Day Tx



IIHS

Psych Rehab

ICF


Crisis Services

Innovations


Outpatient ED

Inpatient


Outpatient



567


FYTD June 2018






Amount.

0

11

14

48

95

108

132

719

0

8

20

47

67

95

173

710

0 200 400 600 800

MST

Psych Rehab


Community

Inpatient

Residential

Crisis Services

Outpatient



$0

$51,534

$110,154

$182,150

$269,140

$1,195,331

$20,675

$94,760

$0

$38,471

$128,623

$217,405

$282,348

$1,080,823

$22,642

$86,601

$0 $500,000 $1,000,000 $1,500,000

MST

Psych Rehab


Community

Inpatient

Residential

Crisis Services

Outpatient



668


FYTD June 2018




Amount.


location.


18

52

28

47

0

10

20

30

40

50

60




7968

101 98

0

20

40

60

80

100

120




$27,325

$12,133

$52,904

$9,933

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000




$176,081

$10,895

$193,565

$20,313

$0

$50,000

$100,000

$150,000

$200,000

$250,000




769


FYTD June 2018




Senate Bill 163




Institution




children.




oversight required.

Entity Type









Definition

Agency






Clinics

870


FYTD June 2018






Veleka Y. Barbee Therapy Services, Inc. LIP Group


Creative Counseling and Learning Solutions, PLLC LIP Group

Western Carolina Emergency Physicians, PLLC Physician's Group of Hospitals

Daymark - Facility Based Crisis of Cabarrus Agency

InPatient Consultants of NC PC LIP Group

Access Call Center


Top 10 Providers by Members Served - Stanly Entity Type

5,341 5,732 5,257 6,287 5,159 4,233 5,141 4,806 5,644 5,305 5,753 5,509

5 5 5 5 5 5 5 5 5 5 5 5

0

1

2

3

4

5

6

0

2000

4000

6000

8000

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.6% 2.5% 2.6%

1.7% 1.8%2.9%

2.0% 2.3% 2.1% 2.1% 2.1%2.3%

0%

2%

4%

6%

8%

10%

Jul'1

7

Au

g'1

7

Sep

'17

Oct

'17

No

v'1

7

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Ap

r'1

8

May

'18

Jun

'18

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030407293757

170236

4581,009

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



971


FYTD June 2018

FY1718 Analysis:


Innovations Registry of Unmet Needs - A list of members who are waiting for an Innovations Waiver Slot





Outpatient services remained the most utilized State funded service for FY1718. Residential services remained the highest in terms of expense,

although utilization decreased by 12% (108 to 95) and expenses decreased by 10% ($1,195,331 to $1,080,823). Expenses for Inpatient services

experienced a slight increase over the previous fiscal year, even though utilization decreased by 29% (95 to 67). Expenses for Inpatient

Psychiatric services increased by 36% ($127,644 to $173,363) compared to the previous fiscal year.



For FY1718, Outpatient services remained the most utilized Medicaid funded service, while Innovations and ICF services remained the highest in

terms of expense. Outpatient ED services experienced a decrease in utilization of 50% (200 to 101), and a decrease in expense of 62% ($29,973 to

$11,455) compared to the previous fiscal year. Much of this decrease can be attributed to denied claims for a single provider, who had been

submitting claims with a rendering clinician that is not credentialed with Cardinal Innovations as a behavioral health clinician. Expenses for

Inpatient services increased by 43% ($741,337 to $1,058,742), though utilization of this service decreased by 10% (191 to 171). This can be

attributed in part to an increase in the average length of stay (from 17 days in FY1617 to 19 in FY1718).

The number of Adult SUD Members served has been trending upward since Jan'18.

The number of members on the Innovations Registry of Unmet Needs experienced a drop in Mar’18.

Compared to the previous fiscal year, Medicaid funded Facility Based Crisis services experienced an increase in utilization of 56% (18 to 28) and

an increase in expense of 94% ($27,325 to $52,904). Medicaid funded Mobile Crisis Management services experienced a slight decrease in both

utilization and expense. Utilization of State funded Facility Based Crisis services increased by 28% (79 to 101), and expenses increased by 10%

($176,081 to $193,565). State funded Mobile Crisis Management services experienced increases in both utilization (44% - 68 to 98) and expense

(86% - $10,895 to $20,313).




1072

APPENDIX C: Quality Assurance Annual Performance

Improvement Plan NOTES

73

APPENDIX D: Quality Management Annual Report NOTES

119

Piedmont Community OfficeQuality Management Dashboard

FYTD June 2018

## ##

% Served

Report data from September 4, 2018

Southern

Mecklenburg

Triad

Northern Region

Central

10%59,870 9,139Five County 15%

14%

Incidents

The number of Level II incidents in the Piedmont catchment area for the 4thQtr. of FY1718 increased 9% (234 to 254) compared with the 3rd Qtr. of FY1718.

Level II Incidents involving Member Behavior were the most prevalent for the 4th Qtr. of FY1718 (59% - 150/254), with Member Injury being the second-most

common (15% - 39/254).

Medicaid Population - FYTD June 2018

Members

Served

20,046

22,475

14,866

20,244

11,105

% Eligible in

Cardinal

Innovations

Population

25%

33%

19%

23%

12%

Eligible

Population

141,203

190,117

111,521

130,821

12%

13%

15%

16%70,951

Region

94 71 68 81 90 68 77 86 71 87 84 83

9.70

6.836.35

7.44

8.41

6.767.28

7.92

6.38

7.947.58

8.19

0.00

2.00

4.00

6.00

8.00

10.00

12.00

0

50

100

Jul'17 Aug'17 Sep'17 Oct'17 Nov'17 Dec'17 Jan'18 Feb'18 Mar'18 Apr'18 May'18 Jun'18

Level II Incidents Count & Rate of Incidents Per 1,000 Members Served

Level II Incidents Rate/1,000 Members Served

FYTD: July 2017 - June 2018

121


FYTD June 2018

Incidents (continued)

Level III Incidents reported in the Piedmont catchment area in the 4th Qtr. of FY1718 remained consistent (from 46 to 46) with the previous quarter (3rd Qtr. of

FY1718). Abuse, Neglect, and Explotiation accounted for 67% (31/46) of the Level III incidents in the 4th Qtr. of FY1718 of which 32%(10/31) occured in

Group Homes/Supported Living areas. There was 1 Incident of Substantiated Physical Abuse during the 4th Qtr. of FY1718 which received QM interventions and

resulted in staff termination. There were 30 Level III Alleged Abuse, Neglect, and Exploitation Incidents for the 4th Qtr. of FY1718. (12 Neglect, 8 Physical Abuse,

5 Sexual Abuse, 3 Verbal, and 2 Emotional). There were 10 Level III Member Deaths (6 Unknown Cause, 3 Accident, and 1 Terminal Illness) Of the remaining

Level III Incidents, 4 involved Member Behavior (2 Illegal Acts, 1 Aggressive Behavior, and 1 AWOL>3), and 1 Member Injury (Environmental).

Starting in December of 2017, any Abuse/Neglect/Exploitation incident naming a staff member was automatically classified as Level III. As a result, the number

of Level II incidents decreased, and the number of Level III incidents increased, even though the combined number of incidents remained consistent.

The number of Restrictive Interventions reported in the Piedmont catchment area increased 22% (90 to 110) from 3rd Qtr. to the 4th Qtr. of FY1718. Of the 108

Level II Restrictive Interventions, 105 were Physical Restraint (79 Standing, 26 Seated), 2 were Isolation Time Out, 1 was Protective Device. There were two Level

III Restrictive Intervention (both Physical Restraint - Standing) reported during the 4th Qtr.

14 19 11 10 5 19 9 14 23 14 18 14

1.45

1.83

1.030.92

0.47

1.89

0.85

1.29

2.07

1.28

1.63

1.38

0.00

0.50

1.00

1.50

2.00

2.50

0

5

10

15

20

25


Level III Incidents Count & Rate of Incidents Per 1,000 Members Served

Level III Incidents Rate/1,000 Members Served


23 37 25 35 28 16 35 24 30 47 38 23

12

2.37

3.56

2.34

3.212.62

1.59

3.31

2.212.78

4.29

3.43

2.47

0.00

2.00

4.00

6.00

0

10

20

30

40

50


Restrictive Intervention Count & Rate of Incidents Per 1,000 Members Served

Level II Incidents Level III Incidents Rate/1,000 Members Served


122


FYTD June 2018

37% (546/1494) of the Incidents reported were due to Member Behavior, of which 70% (380/546) occurred with the CMH population. 24% (364/1494) of the

Incidents reported were due to Restrictive Interventions, of which 93% (338/364) also occurred with the CMH population.

Incidents (continued)

88% (359/410) of the Incidents reported in the Piedmont catchment area were received within 3 days of learning of the incident during the 4th Qtr. of FY1718.

There were 9 incidents reported in the Piedmont catchment area during FY1718 that did not have a target population listed: 3 Member Behavior, 4 Restrictive

Intervention, 1 Medication Error, and 1 Abuse, Neglect or Exploitation.

For Abuse, Neglect or Exploitation Incidents in the 4th Qtr. of FY1718, 43% (100/232) occurred with the CMH population, and 40% (95/232) occurred with the

ADD population.

0

100

200

300

400

500

600

Abuse, Neglect orExploitation

Restrictive Interventions Member Behavior Member Death Member Injury Medication Error Suspsension

Incidents by Type & Target Population

ADD AMH ASA CDD CMH CSA


123


FYTD June 2018

57 69 229 121 113

88

In the Piedmont catchment area, the number of Grievances reported increased 48% (23 to 34) from the 3rd Qtr. to the 4th Qtr. of FY1718. The majority of this

increase occurred in May'18 where there were 12 Quality of Care grievances.

0

19%

99.6%

0 0 0

100%

19.0

100%

17.7

12%

1

11

2

86

0

0

21

54

3

64

0

3

8

67

153

Please Note: The State benchmark for grievances requires that 90% of grievances are resolved within 30 days of submission. Two Grievances were Out-

of-Catchment

39% 20%

21.2

Grievances - FYTD June 2018

9

15

167

1

8

97

All Grievances

238

133

28

11

4

15

28

15

2

22

0

1

1

17

100%

0

2

0

00

0

18.3

46

1

3

70

43

2

35

1

49

20

50

62

167

72

Total # of Grievances

Total # Grievances Against Providers

Total # Grievances Against Cardinal Innovations

0

100%

19.0

591

Total # Grievances Resulting in Investigations

1

16

100%

18.7

0

46

2

0

420

171

0

0

1

15

41

0

10%

0

Total # Grievances Not Against Provider or MCO

0

Measure

Total # of Grievances by

Disability

405

Child

Adult

Unknown

Does Not Apply

Total # Grievances by Age Group

Subcategory

MH Only

IDD Only

SUD Only

Multi-Disability

TBI Only

Unknown

Does Not Apply

Average Days to

Resolve% Resolved within 30

Days

For Resolved Grievances

Total # Grievances Pending

0

Piedmont

Catchment

Mecklenburg

Catchment

Central

Catchment

Five County

Catchment

16

180

1

32

48

Triad

Catchment

36

21

7

42

0

4

3

1

2

1

0

36

13 14 14 7 8 8 5 7 11 13 17 4

1.34 1.35 1.31

0.640.75 0.80

0.470.64

0.99

1.19

1.53

0.39

0.00

0.50

1.00

1.50

2.00

0

5

10

15

20


Grievance Count & Rate of Complaints Per 1,000 Member Served

Grievances Rate/1,000 Members Served


124


FYTD June 2018

Grievances (continued)

4

5

6

6

6

7

7

8

10

33

0 5 10 15 20 25 30 35

Neglect

Confidentiality/HIPAA violation by Provider/Facility

Inadequate Treatment

Potential Fraud

Complaint Against Department

Customer Service (CS) Telephone Responsiveness

Individual Budget Tool

Lack of Coordination of Benefits

Delay in Treatment

Conflict with Provider (disagreement with treatment, diagnosis, etc)

Top 10 Grievances TypesFYTD: June 2018

3

3

3

5

5

6

8

10

26

37

0 5 10 15 20 25 30 35 40

Medication Administration

Assertive Community Treatment Team

Respite

Inpatient

Child Adolescents Day Treatment

Intensive In-Home Services

Peer Support Services

Outpatient Services

Innovations

Residential Services

Top 10 Services with GrievancesFYTD: June 2018

125


FYTD June 2018

Due to adjustments in scheduling, Innovations AFL reviews were not completed during FY1617, and were completed at the beginning of FY1718.

Provider Monitoring Reviews

Please note: Cardinal Innovations Quality Management requires any provider receiving out of compliances on selected review items and trending out of

compliance areas to complete a POC as a standard measure to prevent future out of compliances.

In the 4th Qtr. Of FY1718, 9 providers of the 22 reviewed in the Piedmont catchment area scored 100%. Three providers reviewed scored below the 85% target

on their NC Provider Monitoring Reviews during the 4th Qtr. of FY1718. (82%, 59%, 57%)

1

8

1

4

9

3

7

3

3

7

1

2

1

5

5

9

5

1

4

6

10

4

18

10

22

1

1

1

7

2

2

15

22

0 20 40 60

Justified Cause Audit

Investigation

Incident

Unlicensed AFL Review

Block Grant ReadinessReview

EOR

Innovations Specific AnnualAFL Monitoring

Self-Audit

Concern Module

Clinical Quality Review

Cultural Competency

New Unlicensed SiteReview

NC Provider Monitoring

Monitoring Reviews

Jul-Sep'17 Oct-Dec'17 Jan-Mar'18 Apr-Jun'18

95.8% 96.4% 91.3% 92.7% 92.6%

0%

25%

50%

75%

100%

Five County Central Mecklenburg Piedmont Triad

NC Provider Monitoring Review Scores

85% Target

July 2017 - June 2018

July 2017 - June 2018

126


FYTD June 2018

For FY1718 'Documentation does not reflect required elements' was the top reasons for identifying paybacks, and one provider was responsible for all 45%

(61/135) of the paybacks identified under this category in a Self-Audit. Nine providers were responsible for 89% (289/323 ~30 records requiring POC's per

provider) of the POC's under the 'Assessment doesn't contain required elements'. There were 3 providers that were responsible for 58% (85/136 ~30 records

requiring POC's per provider) of the POC's for Other-Quality of Care.

Provider Monitoring Reviews (All)

Of the 18 reviews with paybacks, 11 were a result of Provider Monitoring review and 6 were a result of a Self-Audit.

Please Note: Payback values reflect the number of claims involved in each Out of Compliance category. The POC values reflect the number of records involved in

each Out of Compliance issue.

4 5

9

18

15

20

2623

0

10

20

30

Jul-Sep'17 Oct-Dec'17 Jan-Mar'18 Apr-Jun'18

Monitoring Review Outcomes

Reviews requiring Paybacks Reviews requiring POC's

FYTD: July 2017 - June 2018 by Quarter

135

63 61 55 54 52 41 36 35 33

92 89

437 45

21 21

146

323

20

0

50

100

150

200

250

300

350

Do

cum

enta

tio

n d

oes

no

tre

flec

t re

quir

ed e

lem

ents

Do

cum

enta

tio

n is

no

tco

mp

lete

Ser

vic

es b

illed

but

no

tre

nder

ed

No

val

id s

ervic

e o

rder

Ed

uca

tio

n/E

xper

ien

ceR

equir

emen

ts

Pla

n is

no

t p

rese

nt

Pla

n d

oes

no

t in

clude

requir

ed e

lem

ents

Oth

er -

Qual

ity

of

Car

e

Ass

essm

ent

do

esn

'tco

nta

in r

equir

ed e

lem

ents

Mis

sin

g do

cum

enta

tio

nfo

r se

rvic

e b

illed

Top 10 Out of Compliance Trends

Paybacks POCs

FYTD: June 2018

127

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