board of directors meeting - partners · 2019. 6. 18. · board of directors meeting 1985 tate...

Board of Directors Meeting 1985 Tate Blvd., Hickory, NC 28602, Basement Multipurpose Room

June 20, 2019 - 6:00 PM

I. CALL TO ORDER – Pam Poteat – Chair II. AGENDA REVISIONS – Pam Poteat (Board Members Only)

III. PUBLIC HEARING – Pam Poteat

A. Public Comment for Partners BHM FY19/20 Proposed Budget - Public Hearing will remain open for 30 minutes.

IV. CITIZEN RECOGNITION – Pam Poteat Persons wishing to appear before the Board of Directors during this portion of the meeting shall register their name and the subject they wish to address with the Clerk to the Board prior to the beginning of the meeting.

V. CONSENT AGENDA – Pam Poteat A. Approval of May 16, 2019 Board meeting minutes Pgs. 3-6

VI. REPORTS – Pam Poteat

A. Finance Committee – Russ Perkins, Chair, Finance Committee 1. Action Items

a. Approval of previous meeting minutes Pgs. 7-9 b. Budget Revision #8 FY19 Pg. 10

2. Financial Reports a. April 2019 Financial Statements – Susan Lackey Pgs. 11-25

B. CFAC Report – Gayle Mitchell C. CEO Report – Rhett Melton

VII. DISCUSSION AGENDA – Pam Poteat A. County Commissioner Advisory Committee Updates – Pam Poteat B. Executive Dashboard Report – April 2019 – Susan Lackey Pgs. 26-36 C. Partners Nominating Committee – Pam Poteat

1. Approval of Partners Board FY 19/20 Slate of Officers VIII. CLOSE PUBLIC HEARING – Pam Poteat

A. Approval of Partners FY19/20 Budget Pgs. 37-38 B. Approval of Budget Resolution #2019-062019 Pgs. 39-40

IX. CLOSED SESSION – Pam Poteat

A. Pursuant to NC General Statute, Section 143-318.11, (a)(1) to prevent disclosure of privileged or confidential competitive healthcare information protected under GS 122C-126.1, or not considered a public record under Chapter 132; (a)(3) to consult with our attorney while preserving privilege; and (a)(6) to consider an individual personnel matter.

X. ADJOURNMENT – Pam Poteat Next Regular Scheduled Meeting: There is no meeting scheduled for July

Next Meeting: August 15, 2019 – 6:00 P.M. Partners Hickory Location-Multipurpose Room

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Partners BHM Board of Directors Regular Meeting Minutes May 16, 2019 - 6:00 PM The Partners Behavioral Health Management Board of Directors met at the Hickory, North Carolina, office for its regular monthly meeting. Board Member Attendance: P= present; A= absent Commissioner Susan Allen A Gayle Mitchell P Barbara Anderson P Commissioner Anita McCall P Commissioner Kitty Barnes P Henry Morphis P Debra Cheek P Wil Neumann – Vice Chair \ P Ben Coggins P Commissioner Marvin Norman P Daryl Cook P Russ Perkins – Treasurer P Steve Epperson P Pam Poteat – Chair P Bill Goins P Joseph Ramey P Jane Hinson P Commissioner Maynard Taylor A Tim Lentz (non-voting) P Commissioner Frank Zachary P Linda McCrary P Partners Staff Present Rhett Melton CEO Will Callison Chief Operating Officer Niels Eskelsen Chief Business Officer Jane Harris Chief Clinical Officer Pearl Burris-Floyd Chief Government Affairs Officer Susan Lackey Chief Financial Officer Selenna Moss Chief Compliance and Performance Officer Jessica Pape Chief Organizational Development Officer Andrew Walsh Chief Legal Officer Anita Lingafelt Clerk to the Board Kim Powell Executive Assistant Others Present Yvonne French DHHS Liaison I. Call to Order A. Chairwoman Pam Poteat called the meeting to order at 6:00 p.m. A quorum was acknowledged. II. Agenda Revisions – Pam Poteat A. Nominations for Partners Board FY 19/20 Slate of Officers (Item 6C) Chairperson Pam Poteat asked for a motion to approve the agenda revision. Steve Epperson entered a motion to approve. Joe Ramey seconded, and the motion carried unanimously. of 40

III. Citizen Recognition – Pam Poteat A. There were no citizens in attendance. IV. Consent Agenda – Pam Poteat A. Previous Board Meeting Minutes for Approval The April 18, 2019, meeting minutes were included as part of the meeting agenda packet. Pam Poteat asked for a motion to approve. Joe Ramey entered a motion and Barbara Anderson seconded. The floor was opened for discussion. With there being no discussion, the motion carried unanimously. V. Reports A. Finance Committee Report – Russ Perkins, Finance Committee Chairman 1. Approval of Previous Meeting Minutes – April 11, 2019 meeting minutes were included in the Board meeting agenda packet for approval. Mr. Perkins set forth for Board approval. Pam Poteat called for a vote. The motion carried unanimously. 2. Budget Revision #7 FY19 – Susan Lackey provided an overview of the budget revision, which included Transitions to Community Living (TCLI) Emergency Funding, Letter #41. Russ Perkins set forth the document for Board approval. Pam Poteat called for a vote and the motion carried unanimously. 3. Financial Statements – March 2019 financial statements were included as part of the Board meeting agenda packet. Ms. Lackey provided an overview of the Balance Sheet and Year-to-Date Income Statements, including Medicaid and non-Medicaid. 4. Partners Proposed FY19/20 Budget Overview – A copy of the FY19/20 proposed budget was distributed. Niels Eskelsen and Susan Lackey provided an overview to the Board. Ms. Lackey noted that the information was reviewed in detail by Partners Finance Committee at its regular meeting on May 9, 2019. Following the overview, and in accordance with General Statute 159-11, Chairperson Pam Poteat asked for a motion to display the proposed FY19/20 Budget for public review according to the statutory timeframe. Russ Perkins entered a motion and the motion carried unanimously. The document will be displayed in the office of Partners’ Clerk to the Board, as well as posted on Partners’ external website. Legal notices will be placed in media outlets in each county of Partners’ catchment area. An opportunity for public comment will be provided at Partners Board of Directors regularly scheduled meeting on June 20, 2019. B. CFAC Report – Gayle Mitchell reported that CFAC met on May 13, 2019. Partners CFAC liaison, Shirley Moore, provided information she learned at the recent NC TIDE conference regarding the Tailored and Standard plans. During the committee meeting, CFAC voted for changes in the Bylaws which will take effect July 1, 2019, to accommodate the addition of Rutherford County. The CFAC Nominating Committee presented the slate of officers to be voted on at the next CFAC meeting scheduled for June 10, 2019. C. CEO Report - Rhett Melton 1. Legislative Update and Funding Cuts – Mr. Melton reported that the Senate is currently debating the budget bill, while the House has completed theirs. Estimated budget cuts of $3.9 million have been built into Partners budget, and if this holds true, $60 million will have been taken back from Partners over the last four (4) years. It is expected that the Senate will come out with a higher number, which Partners lobbyists will be aggressively opposing. Mr. Melton discussed Partners operating budget, Medicaid Savings Reinvestment Plan, and the cost of transitioning to a Tailored plan. Partners operating budget comes from the rates set by Mercer, the actuary contracted by DHHS. He feels the negotiations with DHHS have been successful and the rates given to Partners are fair. Regarding the plans, Mr. Melton asked if Commissioner Barnes or Commissioner Zachary, who are part of the NC County Commissioners Association’s Task Force, would like to comment. - Commissioner Barnes stated the Task Force has had three (3) meetings and the Association will be recommending to the Secretary that the existing seven (7) LME/MCOs remain as they are. Discussions at the meetings have focused on ensuring that the LME/MCOs are strong enough to of 40

compete with private insurance companies. There has been concern that state staff have not been able to answer questions regarding the Standard and Tailored plans. Case management also remains a big question. There has been much discussion regarding foster children and the issues that surround them related to adoption from one county and moving to another county. Commissioner Barnes reported there will be a recommendation that foster children should be considered for Tailored plans. She reported that the DSS director from Yadkin County, who is the President of the NCACDSS (North Carolina Association of County Directors of Social Services), was very persistent and cognizant of the many issues that continue to arise involving social services. Commissioner Barnes stated to the Board that she is proud of the work of the Commissioners Association and is pleased to serve as a member. Mr. Melton thanked both Commissioner Barnes and Commissioner Zachary for their hard work. He discussed the ‘Raise Your Hand’ term being used by the state-which means consumers who go through the algorithm and get bumped into the Standard plan, will be required to ‘raise their hand’ and state that they want to be moved to the Tailored plan. Mr. Melton expressed concern that the severe persistent mentally ill adults and others will not be able to navigate this process. 2. Partners Strategic Plan for FY20 – Mr. Melton gave an overview of the six (6) Strategic Plan goals for FY20, which are: 1) Tailored Plan Infrastructure Development, 2) Value Based Contracting, 3) Social Determinants of Health, 4) Member Engagement, 5) Workforce Development, 6) Member Outcomes. VI. Discussion Agenda A. County Commissioner Advisory Committee – Behavioral Health Focused Updates 1. Burke County – In the absence of Commissioner Maynard Taylor, no report was provided. 2. Catawba County – Commissioner Kitty Barnes provided the following report: a. Catawba County is in the budget process and have had reevaluations. Budget hearings are scheduled for Thursday, May 23, 2019. 3. Cleveland County – In the absence of Commissioner Susan Allen, Daryl Cook reported the following: a. Cleveland County’s budget is being finalized and will be presented at the Commissioners meeting on May 21, 2019. b. Commissioners participated in a ribbon cutting last week at the City of Shelby’s Holly Oak Park, for a new ADA (Americans with Disabilities Act) equipped playground. c. Partnership for Community Prosperity project (jointly created by Cleveland County Schools, Cleveland County Government, and Partners BHM) has expanded their telemedicine program with three (3) additional elementary schools. d. Katie Swanson has been hired as the new DSS director. She is from Buncombe County and previously served as the DSS director for Catawba County. e. Sandra Orbig has been hired as the new Range Master for the Foothills Shooting Complex. She is from Charleston, South Carolina. f. Cleveland County is gearing up for the 2020 census and have had a few preliminary meetings. g. Renovations have been completed on the old Red Cross building. The EMS and Planning Departments will be moving into the renovated building next month. 4. Gaston County – Commissioner designee Joseph Ramey provided the following report: a. Gaston County’s budget is being finalized and will be presented at the Commissioners meeting on May 28, 2019. b. Work continues on a Family Justice Center. 5. Iredell County – Commissioner Marvin Norman provided the following report: a. Iredell County’s budget process is underway and is proposed to be adopted on June 4, 2019. b. Work on the jail addition is nearing completion, with plans to be ready by August 2019. c. Communications Center is ready to move in. 6. Lincoln County – Commissioner Anita McCall provided the following report: a. Opioid seminar with Partners BHM will be held on May 17, 2019. She hopes there will be a large number from Lincoln County in attendance. b. Lincoln County Commissioners recently participated in a County Assembly Day in Raleigh. of 40

7. Surry County – Commissioner Bill Goins provided the following report: a. Surry County’s budget process is underway. b. The Opioid Response Director recently organized a faith-based approach to the opioid epidemic in Surry County, meeting with churches and trying to tap in to all available resources to reach people in the county. They have hired an additional person on the Opioid Response Team. 8. Yadkin County – Commissioner Frank Zachary provided the following report: a. Yadkin County’s budget process is underway. A budget hearing will be held on June 13, 2019. b. Commissioner Zachary informed the Board of a situation they were just recently made aware of involving an inmate’s medical bills which have totaled $840,000, thus far. Yadkin County attorney is currently in negotiations with the hospital. B. Executive Dashboard Report – March 2019 – The report was included as part of the Board meeting agenda packet. Susan Lackey provided an overview and the floor was opened for discussion. There was no additional discussion. C. Nominations for Partners Board FY 19/20 Slate of Officers – On behalf of Partners Nominating Committee, Pam Poteat presented to the Board for consideration the following FY 19/20 Partners Board Slate of Officers: Chair – Wil Neumann; Vice Chair – Russ Perkins; Treasurer – Debra Cheek. This recommendation will be presented to the Board for approval at the June 20, 2019 Board meeting. VII. Closed Session At 6:54 p.m., Ben Coggins moved to enter into Closed Session pursuant to NC General Statute, Section 143-318.11 (a)(1) to prevent disclosure of privileged or confidential competitive healthcare information protected under GS 122C-126.1, or not considered a public record under Chapter 132; and (a)(6) to consider an individual personnel matter. Bill Goins seconded and the motion carried unanimously. With exception of Rhett Melton-CEO, Andrew Walsh-Chief Legal Officer, and Jessica Pape-Chief Organizational Development Officer, all remaining Partners staff members, guests and our non-voting board member were excused from the meeting. Rhett Melton and Andrew Walsh remained in the meeting until 7:21 p.m., at which time they were excused, and Jessica Pape remained in the meeting for a personnel discussion among Board members. VIII. Open Session At 7:48 p.m., Bill Goins entered a motion to go back into Open Session. Kitty Barnes seconded and the motion carried unanimously. During open session, Wil Neumann entered a motion to empower Partners management to take all steps and actions necessary to establish a 501C non-profit corporation in order to perform future activities as authorized by the Board of Directors. Joe Ramey seconded and the motion carried unanimously. IX. Adjournment With there being no further discussion, Pam Poteat asked for a motion to adjourn. At 7:51 p.m., Bill Goins entered a motion. Ben Coggins seconded, and the motion carried unanimously. Respectfully submitted, Kim Powell, Deputy Clerk to the Board of 40

Partners BHM Board Finance Meeting Minutes Multi-Purpose Room Hickory

May 9, 2019 | 6:00 PM

FINANCE COMMITTEE MEMBERS

Barbara Anderson P

Debra Cheek P

Steve Epperson P

Russ Perkins P

Joseph Ramey P

Frank Zachary P

GUESTS PRESENT:

Pam Poteat-Board Chair, Ben Coggins-Board Member, Patty Schaeffer-CFAC Member

CALL TO ORDER:

Russ Perkins called the meeting to order at 6:02 PM. A quorum was present.

AGENDA REVISIONS:

None

APPROVAL OF PREVIOUS MEETING MINUTES:

Russ Perkins called for a motion to approve the April 2019 meeting minutes. Barbara Anderson entered a motion to approve the minutes, Joseph Ramey seconded. Motion carried unanimously. MARCH 2019 FINANCIAL STATEMENTS:

Susan Lackey provided an overview of the March 2019 Financial Statements, which were provided to the committee members via the agenda packet prior to the meeting. For the month ending March 31, 2019: Total revenue for Medicaid of $24.6 million, non-Medicaid revenue of $5.3 million, combined total revenue of $30 million. Total service expenses for Medicaid of $19.6 million, non-Medicaid service expenses of $4.4 million, combined total service expenses of $ 24.1 million. Total net profit of $2.5 million. Total assets for Medicaid of $88.9 million, combined total assets of $118.5 million. Total liabilities for Medicaid of $18.2 million, combined total liabilities of $27.2 million. Total MOE used is $8.2 million. Year-to-date (YTD): Medicaid revenue of $209.1 million, non-Medicaid revenue of $44.4 million, combined total revenue of $253.5 million. Medicaid service expenses of $181 million, non-Medicaid service expenses of $39.6 million, combined total service expenses of $220.7 million. Medicaid administrative expenses of

PARTNERS BHM STAFF Rhett Melton Chief Executive Officer P

Will Callison Chief Operating Officer P

Niels Eskelsen Chief Business Officer P

Susan Lackey Chief Financial Officer P

Alan Smith Internal Auditor P

Elizabeth Biggerstaff Finance Director P

Kim Powell Executive Assistant P

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$29.4 million, non-Medicaid administrative expenses of $4.2 million, combined total administrative expenses of $33.6 million. Excluding fund balance, Partners has a YTD net loss of ($4.9 million). Including fund balance, Partners has a YTD net profit of $5.6 million. Susan informed Finance Committee of a change made to the Balance Sheet. The long-term amount of the Wells Investment account was moved out of cash into the long term investment line on the Balance Sheet. This change was made to line up with auditor financials, which the DMA report has to tie back to every year. Items in the Wells Fargo investment account more than a year out have been moved here. Niels Eskelsen explained that the current ratio calculation typically would only include the short-term investments. However, when the state calculates the ratio, they include all investments as a cash equivalent. Thus, when we calculate the ratio, we follow the state’s methodology, even though technically it is not correct. Finance Committee discussed Wells Fargo annual presentation which is coming up soon and expressed desire for them to present to the full Board. Susan Lackey will try to schedule this presentation for the August meeting. MARCH 2019 EXECUTIVE DASHBOARD REPORT: Susan Lackey reviewed the March 2019 Executive Dashboard Reports, noting the following: (1) Service Penetration Rate calculation is on a rolling 12-month calendar basis. Between April 2018 and March 2019, Partners catchment area had 176,563 unduplicated Medicaid eligible individuals and 28,496 consumers received at least one billable service during the year, or a 16.1% penetration rate; (2) Grievances – total number of grievances reported in March (for February) was 10, with 40% being against MCO and 60% against Providers. On average, Partners took 12.16 working days to resolve informal grievances in February (benchmark is 15 days); (3) Current Ratio – Consolidated current ratio is 2.73 to 1. Current ratio for March includes long-term investments, which is the method used by NC Medicaid when calculating MCO current ratios. Minimum solvency requirement is 1 to 1. Internal year-end estimate for Partners is 2.20; (4) Defensive Interval – as of March 31, 2019, Partners had 78.9 days of consolidated service expenses in cash. Legislated minimum requirement is 30 days. Internal year-end estimate for Partners is 60 days; (5) Service Expense Ratio – Medicaid Service Expense Ratio for fiscal year to date was 102.2% (including Fund Balance); (6) State/IPRS Service Expense Ratio was 96.4% (including MOE); (7) Total Medicaid Expense Ratio was 94.5% .Total Medicaid Expense Ratio consists of Medicaid service and administrative expense compared to Medicaid revenue, exclusive of risk reserve funds; (8) Medical Loss Ratio was 90.5% (benchmark is 85%); (9) Super Measures : a) Transitions to Community Living (TCLI) results are reported on a two-month lag. Partners is required to have a net increase of 61 individuals housed for FY19. This means at the end of FY 19 we should have a total of 263 individuals in housing. At the end of January 2019, we had a net of 245 consumers in housing. This represents 93.2% of the FY19 annual target. b) Innovations Integrated Care performance standard is 90% of eligible population will have received a primary care or preventive health service within the measurement period. Partners is at 95.1%, which is well above the benchmark. c) Ambulatory Follow Up – In January 2019, 143 Medicaid consumers were discharged from Inpatient MH services and 66.4% or 94, had follow up services within 7 days. During this same reporting period, 37 Medicaid consumers were discharged from Inpatient SU services and 67.6% or 25, had follow up services within 7 days. In January 2019, 100 State consumers were discharged from Inpatient MH services and 64% or 64, had follow up services within 7 days. During this same reporting period, 165 State consumers were discharged from Inpatient SU services and 66.1% or 109, had follow up services within 7 days.

BUDGET REVISION #7 FY19:

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Susan Lackey presented Budget Revision #7 to the Finance Committee.

Description

REVENUES Beginning Budget $ 353,889,026

25,000 Letter #41 TCLI Emergency Funding

$ 25,000

Revised Budget $ 353,914,026

EXPENSES

Beginning Budget $ 353,889,026 25,000 NON UCR Expenses $ 25,000

Revised Budget $ 353,914,026

Joseph Ramey entered in a motion to accept Budget Revision #7, Frank Zachary seconded. Motion carried unanimously. FY 20 BUDGET PRESENTATION: Niels Eskelsen and Susan Lackey presented Partners proposed FY20 Budget to the Finance Committee. The PowerPoint presentation was provided to the Finance Committee via a handout at the meeting. Following the presentation, the Finance Committee discussed and agreed that the FY20 proposed Budget be sent to the full Board for their approval. Steve Epperson made a motion to present the FY20 Proposed Budget to the Board of Directors for their approval and that it be on public display for nineteen (19) days, then voted on at the June 2019 Board of Directors meeting, Frank Zachary seconded. Motion carried unanimously. ADJOURNMENT: Russ Perkins opened the call to any final questions or comments from the Finance Committee. Being that there were none, Steve Epperson entered a motion to adjourn the meeting and Frank Zachary seconded. Having no further business, Russ Perkins adjourned the meeting at 7:40 PM. Minutes Submitted By: Kim Powell

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REVENUES

Beginning Budget 353,914,026$

47,000$ Letter #41 TCLI CLA Funds

(57,052) Letter #42 Deallocation of TCLI Diversion Screening Staffing Funds

42,864$ Letter #43 TCLI Diversion Screening Costs

47,862$ Increase DLP Frye Hospital 3 Way Funds

(238,632)$ Decrease Catawba Valley Medical Center 3 Way Funds

(120,000)$ Decrease Kings Mountain Hospital 3 Way Funds

(277,958)$

Revised Budget 353,636,068$

EXPENSES

Beginning Budget 353,914,026$

32,812 NON UCR Expenses

(310,770) 3 Way Hospital Expense

(277,958)$

Revised Budget 353,636,068$

PARTNERS BHM

BUDGET REVISION NO.8 FY19

June 13, 2019

Description

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May 29, 2019

To: Finance Committee From: Finance Team RE: Review of April 2019 Financial Statements and Dashboard Results

Summary:

Ten months into Fiscal Year 2019 Partners BHM has positive results overall. As of April 30, we were

above budgeted levels for Medicaid and below non-Medicaid funding with a net surplus overall for the

fiscal year of $5,130,406 (including Fund Balance). Excluding Fund Balance we have a net loss year to

date of ($8,448,360).

The April Dashboard:

Service Penetration Rate:

The service penetration rate calculation is on a rolling 12-month calendar basis. Between May 2018 and

April 2019, Partners catchment area had 182,052 unduplicated Medicaid-eligible individuals and 30,395

members received at least one billable service during the year, or a 16.7% penetration rate.

Partners BHM received a capitation payment for 152,325 member months in April, based on the month

of payment rather than the month of eligibility. We continue to experience inconsistencies between

eligibility data and the member count in our capitation payments and are reconciling these differences

each month, retroactively, and reporting them to DMA for corrections. The NCTracks system recoups

any PMPM that is within a given time span if any additional payment or change is needed. If the span is

from January to July and only July needs an adjustment, January to July is recouped and repaid. The 24-

month estimated AR capitation we reported to DMA for April 2019 was $2,116,231.99. We use 24

months because DMA will only allow us that amount of time to resolve unpaid eligibility issues.

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Over the last year, the trend of Unduplicated Medicaid Members is declining when looking at 10 months

of actuals. The actual drop that occurs over the most recent 3 months due to eligibility lag in NCTracks is

compensated for with a 3-month projection line. Over the same period, there is a decreasing trend in

the number of Unduplicated Members Receiving Services. Claims lag negatively impacts the count of

Medicaid Members served in the most recent 3 months.

The comparison between the number of members served in a specific Category of Aid (or County of

Medicaid Eligibility) to the total Medicaid-eligible population in the same Category of Aid (or County) is

the Average Penetration Rate by Category of Aid (or County).

The overall Annual Penetration Rate by Category of Aid for April 2019 is slightly higher when compared

to April 2018. The rolling 12-month penetration rate has been essentially flat for the last year. The

limited growth is being driven by the unduplicated count in the number of Medicaid recipients in the

Aid to Families with Dependent Children (AFDC) category which continues to drop. When comparing

March 2019 to April 2019, the unduplicated count for this category dropped from 100,325 to 96,315, or

4.0%. From April 2018 to April 2019, the percent change in the unduplicated count for the AFDC

Category of Service dropped 10% and the Blind/Disabled categories (ages 21+ and 3-20) dropped 11%

and 18%, respectively. These trends tend to flatten out retroactively with the exception of AFDC. The

Monthly Penetration Rate shows a drop off in recent months driven by AFDC. Additionally, a 12-month

penetration rate is based on a larger population of eligible members resulting in a higher annual

penetration rate than those seen on a monthly basis.

The overall Annual Penetration Rate by County of Medicaid Eligibility for YTD April 2019 has decreased

slightly when compared to YTD April 2018. The counties with the greatest increase in penetration rate

were Yadkin and Lincoln (increases of 1.2 and 0.5 percentage points, respectively). Burke, Catawba,

Iredell, and Cleveland Counties had increases of 0.4, 0.4, 0.3, and 0.1 percentage points, respectively.

Gaston and Surry Counties both had declines in penetration rate from YTD April 2018 to YTD April 2019

(-0.1 percentage points each).

Grievances:

The total number of grievances reported in April for March was 7 with 42.9% being against the MCO and

57.1% against Providers. On average, Partners BHM took 14.0 working days to resolve informal

grievances in March with the benchmark being 15 days. On average, Partners BHM took 26.7 calendar

days to resolve formal grievances in March with the benchmark being 30 days. The State requires formal

grievance resolutions to be reported in calendar days.

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Key Balance Sheet Ratios:

Given the new solvency formula in SB99, the MCO’s financial ratios are viewed on a

consolidated basis, so we are only including one year-end estimate for each ratio. The reduction

of our Medicaid fund balance by funding non-Medicaid services takes away any meaningful use

of the Medicaid fund balance compared to the total fund balance. We do not, in fact, really

have a State fund balance related to income. That has been used up early in the Legislative

single stream reduction process. Any cash related to State fund balance is only a residual left

over from MOE transfers from Medicaid to State.

Current Ratio

The Consolidated current ratio for Partners BHM as of April 30, 2019, is 2.95 to 1. The current

ratio for April includes long-term investments, which is the method used by NC Medicaid when

calculating MCO current ratios. The minimum solvency requirement is 1 to 1. The internal year-

end estimate for Partners is 2.20.

Defensive Interval

As of April 30, 2019, Partners BHM had 69.8 days of Consolidated service expenses in cash. The

defensive interval includes long-term investments. The legislated minimum requirement is 30

days. The internal year-end estimate for Partners is 60 days. The basis of this calculation is total

cash to total operating expenses, adjusted for non-cash expenses. The expected decrease in our

financial ratios are the Legislative-Mandated Maintenance of Effort and Medicaid

Reimbursement expenditures.

Financial Statements:

Overall Comments

Partners BHM shows an overall net income of $5,130,406 as of April 30. There is a Medicaid net

loss of ($4,751,039), including $4,059,205 of Fund Balance. The non-Medicaid category has a net

income of $9,881,441 for the month of April, including other non-Medicaid funding of

$9,519,560.

Service Expense

Service Cost: Medicaid service cost consists of paid claims adjusted for estimated outstanding

claims or IBNR. Our IBNR estimate for April was $13,122,454.62. For the month of April, Partners

had $18,837,404.14 in Paid Claims.

Service Expense Ratio: The Medicaid Service Expense Ratio for fiscal year to date was 101.5%

(including Fund Balance).

The State/IPRS Service Expense Ratio was 95.9% (including MOE).

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The Total Medicaid Expense Ratio consists of Medicaid service and administrative expense

compared to Medicaid revenue, exclusive of risk reserve funds. The Total Medicaid Expense

Ratio in April 2019 was 115.9%.

The Medical Loss Ratio is a comparison of the capitation payment against the expenditures that

improve the quality of service and care (I/DD and MH/SU Care Coordination treatment

planning), medical claim expenses, payments made outside of the claim system, and the IBNR

estimate. The benchmark for this measure is 85%. As of April 30, 2019, the Medical Loss Ratio

was 91.5%.

Super Measures:

Transition to Community Living:

Partners BHM uses the TCLI Performance Dashboard from the State to identify our completion

of slot allocation. As a result, TCLI results are reported on a two-month lag. For FY19 Partners is

required to have a net increase of 61 individuals housed for the fiscal year. This means at the

end of FY19 we should have a total of 263 individuals in housing. At the end of February 2019,

we had a net of 244 members in housing. This represents 92.8% of the FY19 annual target.

(There was an adjustment to the December numbers in the January report.)

Innovations Integrated Care Super Measure:

The Innovations Integrated Care measure looks at the percentage of continuously enrolled

Medicaid enrollees under the Innovations Waiver who received a primary care or preventive

health service. For persons ages 3 to 6 and ages 20 through 64, the person received the service

during the measurement period. For persons ages 7 to 19, the person received the service

during the measurement period OR the year prior to the measurement period.

For the period from May 2018 through April 2019, the grand total of Innovations members

eligible for services across all eight counties was 572 with 550 receiving services for an overall

percentage of 96.2%. The performance standard is 90% of the eligible population will have

received a primary care or preventive health service within the measurement period.

Ambulatory Follow Up:

Ambulatory follow up is a Super Measure report starting January 1, 2018. The formula used to

calculate the Medicaid measure is being finalized.

Ambulatory follow up looks at those members with Inpatient discharges who have a follow-up

service (from paid claims) within 7 days of the date of discharge from inpatient care. This is an

evidence-based best practice that reduces recidivism of inpatient care. We report on two

member primary disabilities (Mental Health and Substance Use). There is a two-month lag,

which means this report is based on February 2019 data. There is a retroactive update of this

data each month. We also report on Medicaid and State/Federal funding categories.

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The performance standard for this measure for both Medicaid and State services is that 40% or

more of individuals discharged shall receive a follow-up visit within 7 days after discharge.

In February 2019, 116 Medicaid members were discharged from Inpatient MH services and

67.2%, or 77, had follow up services within 7 days. This measure was met with 46 members.

During this same reporting period, 36 Medicaid members were discharged from Inpatient SU

services and 52.8%, or 19, of them had services within 7 days. This measure was met with 14

members.

In February 2019, 74 State members were discharged from Inpatient MH services and 58.1%, or

42, had follow up services within 7 days. This measure was met with 29 members. During the

same reporting period, 125 State members were discharged from Inpatient SU services and

66.4%, or 83, had follow up services within 7 days. This measure was met with 50 members.

For State-funded members, discharge information is based on paid claims data for Facility-Based

Crisis and 3-Way services.

Claims Processing:

In April, Partners BHM processed $24,869,616 in claims. We paid out $18,837,404 in claims, or

75.7% of those that were processed. In April, there were $6,032,212 (24.3%) in denied or

pended claims. On average, Partners is paying claims within 8.8 days from the received date and

Providers are submitting claims for payment 19.4 days from the date of service. Overall,

Partners BHM paid Providers within 28.2 days from the date of service.

The top five reasons for denials make up approximately $3.56 million of total denied claims for

April. Claims submitted for services without authorization, claims submitted where there is no

coverage available for the Patient/Service/Provider combination, claims received after the

billing period, claims submitted for duplicate services, and claims submitted where the billing

taxonomy submitted is not associated with the billing NPI make up the top 5 reasons for claims

denials in April.

Service is Not Authorized $1,290,424.84

No Coverage Avail for Patient/Service/Provider Combo $664.608.38

Claim Received After Billing Period $569,988.12

Duplicate Claim $560,103.67

Billing Taxonomy Submitted Not Assoc with Billing NPI $478,991.31

TOTAL $3,564,116.32

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Service Authorization Request Processing:

The Utilization Management Department processed 100% of Standard Service Authorization

Requests within 14 days. UM approved 95.4% of authorizations. Of those denied in April, 25.0%

were for administrative reasons and 75.0% were for clinical reasons.

Program Integrity:

Case Activity

As of April 30, there were 60 open investigations. Program Integrity opened 4 new

investigations and closed 3 investigations in April. With the start of FY19, we added a

“Reopened” category to the Case Activity report. This category includes cases that were

previously closed but need to be reopened in the report month due to additional activity on the

case. The Reopened category enables accurate balancing of Total Open Cases from month to

month. In April there were 0 cases reopened.

Recovery Activity

As of April 2019, on a fiscal year-to-date basis, there were 23 overpayments to Providers

identified for a total of $1,297,076. This amount takes into consideration any adjustments due

to interest, penalties, or reductions.

Ten months into FY19, PI has collected $164,545 against outstanding overpayments and $54,482

from Provider self-audits.

The total outstanding balance of overpayments is $5,728,109, inclusive of any amounts that may

have remained unpaid to Partners at the end of prior fiscal years.

Targeted Services:

On a fiscal year-to-date basis, Partners BHM has overspent Medicaid service dollars by

($4,556,613), which is (2.3%) over compared to our FY19 budgeted numbers. For State service

dollars, Partners is under budget by $6,888,304, or 15.2%.

Inpatient Hospital Services

The Medicaid Inpatient admissions per thousand and bed days per thousand both show a

declining trend over the last year. State Inpatient services have a relatively flat trend for

admissions and an increasing trend for bed days based on paid claims. The trends for both bed

days and admissions for Inpatient services in 3-Way Hospitals are declining over the last year.

On a fiscal year-to-date basis, Partners BHM has overspent Medicaid Inpatient by ($1,817,471),

or (34%), compared to our FY19 budgeted numbers. Inpatient YTD reflects a correction to

service expenses for a supplemental payment made in September. On a fiscal year-to-date basis,

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we were under budgeted levels by $126,557, or 39%, for State and over budgeted levels by

($16,650), or (0.2%), for 3-Way Inpatient services.

Behavioral Health Long-Term Residential

The bed day utilization trend for this Category of Service is increasing slightly. On a fiscal year-

to-date basis, this Category of Service was $27,211, or 0.2%, under budget for Medicaid service

dollars. The budget for Long-Term Residential was ($38,837) or (0.5%), overspent for State

services.

Long-Term Residential Service budget dollars are to provide youth services. Included in this

service group is Therapeutic Foster Care – a service focused on keeping youth out of PRTF

facilities. Through April 30, 33% of Long-Term Residential service dollars were spent on

Therapeutic Foster Care services. Beginning in November there are two in-lieu-of services being

expensed under Long-Term Residential, Rapid Response Bed TFC and Long-Term Community

Support. A total of $217,774 has been expensed for these two services since November

($289,774 or 2.7% YTD). Another 27% was spent on other Level 1 and Level 2 child residential

services.

Psychiatric Residential Treatment Facility (PRTF)

PRTF admission and discharge data originates from authorization data so the numbers are

current through April 30. Utilization is a comparison of authorizations to paid claims by month of

service. Using this method allows a direct analysis of utilization trends.

Partners BHM had 11 PRTF admissions (a rate of 0.92 admissions per thousand) for the month of

April, with 11 discharges (a rate of 0.92 discharges per thousand), or no net change in census for

the month. Our monthly PRTF cost for April was $584,903 (including IBNR). On a fiscal year

basis, this Category of Service was $1,211,533, or 16%, underspent for Medicaid service dollars.

The youth population is seeing an increased need in the number of members requiring PRTF

services. Partners BHM currently requires 30-day authorizations for PRTF and initial requests are

reviewed with the Chief Medical Officer. Utilization Management is working with Providers to

look at length of stay and other options of care for PRTF members.

Case Management Services

As of April 30, 2019, Partners BHM was overspent in Case Management services by ($158,912),

or (76%). On October 14, 2016, DHHS and Disability Rights NC reached a Settlement Agreement

to outline a plan to assist Medicaid-eligible children with complex needs (ages 5 to under 21).

One of the considerations outlined as part of this settlement was the use of Case Management

Services. Implementation of the in-lieu-of service definition is just beginning and will further

shift children from IIH to pure Case Management services. The increase seen in Critical Time

Intervention (both U5 and U5DJ) for March and April is due to claims from Easter Seals going

back to December and January dates of service in each of those months, respectively. The

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following table provides a breakdown of Case Management dollars spent by procedure code for

FY19 (excluding IBNR):

Procedure Code Description Total Dollars Spent % of Total

H0032 U5 Critical Time Intervention $173,969.33 49.6%

H0032 EP Targeted Case Management $80,876.25 23.0%

H0032 U5DJ Critical Time Intervention $57,482.77 16.4%

H0036 Trauma Informed Care Mgmt $38,756.25 11.0%

TOTAL $351,084.60 100.0%

Outpatient Services

Medicaid dollars for Outpatient services were underspent by $943,120, or 4%, fiscal year to

date. State dollars for Outpatient services were underspent by $1,089,176, or 14%, fiscal year to

date. Outpatient services are often utilized to keep members out of higher-cost services and

authorizations are not required for the first 10 visits.

Assertive Community Treatment Team

Medicaid service dollars for ACTT were overspent by ($364,199), or (5%), based on the FY19

budget. ACTT State service dollars were underspent based on the FY19 budget by $439,537, or

33%. Utilization Management is working with TCLI on strategies to make use of these service

dollars. With the DOJ settlement, it could be expected that this service would show an increase

in volume. For a member to continue receiving State dollars following their first six months of

services, the Provider must demonstrate that they have assisted the member in applying for

Medicaid dollars and been denied.

Intensive In-Home Services

Authorization data based on the count of IIH admissions and discharges is current through

April 30. Utilization is a comparison of authorizations to paid claims by month of service. Using

this method allows a direct analysis of utilization trends.

Medicaid IIH service utilization is relatively flat based on paid claims. Based on authorizations,

there were 93 admissions (a rate of 7.79 per thousand) and 51 discharges (a rate of 4.27 per

thousand) in April.

Partial Hospital/Day Treatment

The Medicaid budget for this Category of Service was overspent by ($674,819) or (17%). We

have seen a higher usage of this service in FY19 than we had in FY18. We will continue to

monitor and review for inconsistencies. The State budget for this Category of Service was

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underspent by 51%, or $194,396. Partners BHM does not necessarily dictate the services on

which Providers spend their capitation. Our FY19 State budget for this service is now $458,563.

Psych Rehab

The FY19 State budget for this Category of Service is $379,384. As of April 30, 2019, Partners

BHM was $28,127, or 8.9%, under budget.

Crisis Services

The Medicaid budget for Crisis Services was overspent by ($231,987) or (15%). State service

dollars for Crisis Services were overspent by ($1,416,655), or (50%), as of fiscal year to date.

Data in the early months of the fiscal year indicated spending of State Crisis Services was much

higher than typical. We reviewed reports of FBC utilization to determine if there are

inconsistencies in the way Providers are using the service. For the first six months of FY19, the

average length of stay for the four FBC Providers was 6.0 days or less. This is an acceptable LOS

for this service. Facility Based Crisis/Detox made up 85% of the total $4.4 million spent for the

fiscal year in Crisis Services State dollars and 79% of the total $1.7 million spent in Crisis Services

Medicaid dollars. No authorizations are required for the first 7 days of Facility Based Crisis

Services. This Category of Service also includes Mobile Crisis services.

1915(b)(3) Services

(b)(3) Services are important for providing services to those on the I/DD waitlist and others. It is

not an entitled Medicaid service and is subject to available funding. Partners BHM budget for

FY19 (b)(3) Services is $6,243,852. As of fiscal year-to-April 30, 2019, we were overspent by

($2,005,458), or (39%). As we continue our efforts to manage spending for (b)(3) service dollars,

the contracts of additional (b)(3) Providers have been capitated. The primary service billed by

these Providers is Peer Supports. Only services that help meet timely follow up will exceed

contracts going forward. The following table provides a breakdown of (b)(3) dollars spent by

procedure base code for FY19 (excluding IBNR):

Procedure Base Code Total Dollars Spent % of Total

H0038 Peer Supports $3,299,934.90 47.9%

H2023 Supported Employment Initial

$1,765,859.81 25.6%

T1019 Individual Supports $816,594.59 11.9%

H0045 Respite $463,147.02 6.7%

H2026 Supported Employment Maintenance

$360,277.01 5.2%

T2041 Community Guide $188,990.00 2.7%

TOTAL $6,894,803.33 100.0%

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Service dollars spent for Individual Peer Supports have a positive bearing on our ability to meet

the 7-day follow up requirement after an Inpatient stay. To protect for overutilizing this service,

the Special Review Unit is reviewing selected Peer Supports claims and documentation to

determine if Providers are following the clinical coverage policy and utilizing this service

appropriately.

Partners has one QIP measure for I/DD related to our increased use of Supported Employment.

We expect to see a continuing rise in these service expenses as we work to meet this objective.

Innovations Trends:

CAP Services

Innovations spending was ($1,132,078), or (2%), overspent as of fiscal year-to-date April 30.

Community Living and Supports (T2013 TF), Respite: Individual (S5150), and Respite: Group

(S5150 HQ) all had rate increases effective August 1, 2018, to align with Vaya rates.

PMPM Utilization

The retroactively-updated Innovations data shows that this category continues to be below

monthly PMPM (per member per month) levels.

Partners Slot Availability for April was 1,488. This includes 39 expansion slots received in January

2018. The current Innovations waiver has been extended to the end of June; however, the slots

were reset in Alpha at the beginning of January to make empty slots available. As of April 30, 21

Regular Slots remain unassigned. Of the 18 Reserved slots, 4 were unassigned (1 CAP-C

Transition and 3 Money Follows Person Slots). The Emergency, CAP-C and MFP Slots are part of

the 18 Reserved Slot allocation that Partners receives at the beginning of the Waiver Year.

Members must meet specific criteria to receive one of the Reserved slots.

Medicaid ED Visits:

One of the areas of focus for Partners BHM is the reduction of ED usage. Based on paid claims

(with a one-month lag), the average monthly number of ED visits for the 12 months ending

March 31, 2019, was 312. Gaston, Cleveland, and Iredell were the counties with the highest

member ED utilization in March. There were 18 Providers represented in the ED utilization

graph for the month. Charlotte-Mecklenburg Hospital and Gaston Memorial Hospital billed for

approximately 42.4% of the total ED visits in the month of March.

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Medicaid State/Federal Local Combined

ASSETS

Current Assets

Cash and cash equivalents 16,176,690$ 9,176,813$ 4,866,165$ 30,219,668$

Medicaid capitation receivable 1,703,874 - - 1,703,874

Receivable from State - 1,570,854 - 1,570,854

Other current assets - 960,726 1,353,769 2,314,495

Total Current Assets 17,880,564 11,708,393 6,219,934 35,808,891

Other Assets

Risk reserve account 34,744,835 - - 34,744,835

Long Term Investments 25,586,639 - 25,586,639

Other non-current assets - 5,416,488 - 5,416,488

Total Other Assets 60,331,474 5,416,488 - 65,747,962

Property and Equipment

Land 315,201 341,467 906,374 1,563,042

Buildings 4,947,459 5,359,748 2,191,584 12,498,791

Leasehold Improvements 325,850 353,004 - 678,854

Furniture and equipment 1,893,372 2,051,152 - 3,944,524

Other property and equipment 492,376 533,407 - 1,025,783

Total Property and Equipment 7,974,257 8,638,779 3,097,958 19,710,994

Accumulated depreciation/amortization 4,963,782 5,377,431 - 10,341,213

Net Property and Equipment 3,010,475 3,261,348 3,097,958 9,369,781

TOTAL ASSETS 81,222,513$ 20,386,229$ 9,317,892$ 110,926,634$

LIABILITIES

Current Liabilities

Accounts payable 1,873$ 330$ -$ 2,203$

Accrued administrative expenses 1,502,299 265,112 - 1,767,411

IBNR claims payable 13,122,455 - - 13,122,455

Other services payable - (144,346) - (144,346)

Payable to State - 98,221 - 98,221

Other current liabilities - 5,974,808 - 5,974,808

Total Current Liabilities 14,626,627 6,194,125 - 20,820,752

Other Liabilities

Other non-current liabilities - 2,006,061 - 2,006,061

Total Other Liabilities - 2,006,061 - 2,006,061

TOTAL LIABILITIES 14,626,627 8,200,186 - 22,826,813

FUND EQUITY

Fund Balances:

Investment in Fixed Assets - 6,047,040 3,610,363 9,657,403

Other- Non Spendable - 1,035,290 - 1,035,290

Reserved: -

Reserved - State Statute and Prepaids - 8,352,195 - 8,352,195

Reserved - Other* - - - -

Restricted:

Restricted -Medicaid Risk Reserve 34,744,836 - - 34,744,836

Restricted - Other 43,997,926 - 5,707,529 49,705,455

Unreserved:

Unreserved - Medicaid Surplus (Deficit) prior years (25,625,520) - - (25,625,520)

Unreserved - Medicaid Surplus (Deficit) current year (8,810,241) - - (8,810,241)

Unreserved - State/Federal Surplus (Deficit) current year - (3,248,482) - (3,248,482)

Unreserved - Other 22,288,884 - 22,288,884

TOTAL FUND EQUITY 66,595,886 12,186,043 9,317,892 88,099,820

TOTAL LIABILITIES & FUND EQUITY 81,222,513$ 20,386,229$ 9,317,892$ 110,926,634$

Medicaid State Total

*MOE Beginning Balance 10,063,937$ -$ 10,063,937$

Amount Used 9,101,472 -$ 9,101,472$

Balance 962,465$ -$ 962,465$

Partners Behavioral Health Management

Balance SheetApril 30, 2019

unaudited

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Actual Actual Combined

Medicaid Non-Medicaid Total

REVENUE

Service Revenue 194,995,767$ 40,597,194$ 235,592,961$

Administrative Revenue 31,159,795 5,077,861 36,237,656

Risk Reserve Revenue 4,595,504 - 4,595,504

Other Income/Revenue - 2,855,006 2,855,006

TOTAL REVENUE 230,751,067 48,530,061 279,281,127

EXPENSE

Service Expense

Inpatient 7,234,137 7,088,606 14,322,743

Community Support 441,014 5,144,620 5,585,634

BH Long-Term Residential 12,472,789 8,062,829 20,535,618

PRTF 6,288,467 - 6,288,467

Case Management 367,246 - 367,246

Outpatient 20,723,547 6,934,969 27,658,516

ACTT 7,030,866 904,472 7,935,338

MST 731,373 - 731,373

IIHS 8,000,017 - 8,000,017

Partial Hospital/Day Treatment 4,633,152 187,740 4,820,892

Psych Rehab 3,482,776 288,027 3,770,803

Crisis Services 1,773,654 4,240,338 6,013,992

Innovations/IDD Hourly/Day Services 67,338,676 - 67,338,676

ICF/MR 51,990,039 - 51,990,039

1915 (b)(3) Services/(Other for Non-Medicaid) 7,208,668 10,621,499 17,830,167

Medicaid Reinvestment 2,425,654 - 2,425,654

Total Service Expenses 202,142,076 43,473,100 245,615,176

Recoveries

TPL/COB Recoveries - - -

Fraud and Abuse Recoveries 74,145 - 74,145

Other Recoveries (describe) 45,176 - 45,176

Total Recoveries 119,321 - 119,321

Net Services Expenses, Net of Recoveries 202,022,755 43,473,100 245,495,855

Administrative Expense

Salary & Wage Expense 10,603,114 2,131,547 12,734,661

Payroll Benefits & Expense 3,932,740 783,362 4,716,102

Professional Services 1,164,066 274,608 1,438,674

Supplies & Materials 565,205 105,957 671,162

Travel & Vehicles 202,594 47,699 250,293

Utilities & Postage 676,999 426,331 1,103,330

Capital Expense 212,326 46,599 258,925

Other Expense 3,323,484 430,525 3,754,009

DD Treatment Planning 5,609,871 - 5,609,871

MH/SA Treatment Planning 5,351,912 - 5,351,912

Property Expense 1,300,740 448,452 1,749,192

Total Administrative Expense 32,943,051 4,695,080 37,638,131

Risk Reserve Set Aside 4,595,504 - 4,595,504 Total Administrative Expense, including Risk

Reserve Set Aside 37,538,555 4,695,079 42,233,635

TOTAL EXPENSES & RISK RESERVE SET-ASIDE 239,561,310 48,168,179 287,729,489

EARNINGS FROM OPERATIONS (8,810,244) 361,881 (8,448,363)

Other income/(loss) - - - REVENUE OVER (UNDER) EXPENDITURES BEFORE

OTHER FINANCING SOURCES (8,810,244) 361,881 (8,448,363)

OTHER FINANCING SOURCES

Appropriated Fund Balance Medicaid 4,059,205 - 4,059,205

Appropriated Fund Balance MOE - 9,101,472 9,101,472

Appropriated Fund Balance Other - 418,088 418,088

TOTAL OTHER FINANCING SOURCES 4,059,205 9,519,560 13,578,765

NET PROFIT (LOSS) (4,751,039)$ 9,881,441$ 5,130,406$

Unaudited

Partners Behavioral Health ManagementIncome Statement

For Ten Months Ending April 30, 2019

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Actual Actual Combined

Medicaid Non-Medicaid Total

REVENUE

Service Revenue 19,554,831$ 3,321,296$ 22,876,127$

Administrative Revenue 1,635,556 501,151 2,136,707

Risk Reserve Revenue 458,755 - 458,755

Other Income/Revenue - 243,176 243,176

TOTAL REVENUE 21,649,144 4,065,623 25,714,764

EXPENSE

Service Expense

Inpatient 694,428 570,606 1,265,034

Community Support 41,322 472,632 513,954

BH Long-Term Residential 1,329,338 764,681 2,094,019

PRTF 584,903 - 584,903

Case Management 44,117 - 44,117

Outpatient 2,288,684 666,762 2,955,446

ACTT 704,837 64,518 769,355

MST 98,423 - 98,423

IIHS 852,943 - 852,943

Partial Hospital/Day Treatment 552,805 30,618 583,423

Psych Rehab 331,025 10,988 342,013

Crisis Services 186,928 339,091 526,019

Innovations/IDD Hourly/Day Services 6,951,324 - 6,951,324

ICF/MR 5,283,270 - 5,283,270

1915 (b)(3) Services/(Other for Non-Medicaid) 592,804 882,848 1,475,652

Medicaid Reinvestment 481,448 - 481,448

Incurred But Not Reported Claims Expense 0 - 0

Total Service Expenses 21,018,598 3,802,744 24,821,342

Recoveries

TPL/COB Recoveries - - -

Fraud and Abuse Recoveries 25,296 - 25,296

Other Recoveries (describe) 2,593 - 2,593

Total Recoveries 27,889 - 27,889

Net Services Expenses, Net of Recoveries 20,990,709 3,802,744 24,793,453


Salary & Wage Expense 1,121,059 206,326 1,327,385

Payroll Benefits & Expense 396,794 71,766 468,560

Professional Services 150,080 35,234 185,314

Supplies & Materials 45,459 7,094 52,553

Travel & Vehicles 29,269 6,272 35,541

Utilities & Postage 68,277 41,024 109,301

Capital Expense 74,725 14,290 89,015

Other Expense 378,723 33,829 412,552

DD Treatment Planning 579,309 - 579,309

MH/SA Treatment Planning 558,723 - 558,723

Property Expense 134,700 43,263 177,963

Total Administrative Expense 3,537,118 459,098 3,996,216

Risk Reserve Set Aside 458,755 - 458,755

Total Administrative Expense, including Risk

Reserve Set Aside 3,995,873 459,098 4,454,971

TOTAL EXPENSES & RISK RESERVE SET-

ASIDE 24,986,582 4,261,842 29,248,424

EARNINGS FROM OPERATIONS (3,337,439) (196,219) (3,533,661)

Other income/(loss) (3,337,439) (196,219) (3,533,660)

REVENUE OVER (UNDER) EXPENDITURES

BEFORE OTHER FINANCING SOURCES


Appropriated Fund Balance Medicaid 2,206,762 - 2,206,762

Appropriated Fund Balance MOE - 849,674 849,674

Appropriated Fund Balance Other - - -

TOTAL OTHER FINANCING SOURCES 2,206,762 849,674 3,056,437

NET PROFIT (LOSS) (1,130,677)$ 653,455$ (477,225)$


Income StatementFor the Month Ending April 30, 2019

Unaudited

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Year to-date

Budget

Year-to-Date

Actual

Budget to

Actual

Variance Annual Budget Annual Forecast Variance % Year- to-date

Budget

Year-to-Date

Actual

Budget to

Actual

Variance Annual Budget Annual Forecast Variance % Annual Budget Annual Forecast Variance %

Under (Over) Under (Over) Under (Over) Under (Over) Under (Over)

REVENUE

Service Revenue 196,872,770$ 194,995,767$ 1,877,003$ 236,247,324$ 233,994,920$ 2,252,404$ 1.0% 44,497,540$ 40,597,194$ 3,900,346$ 53,397,048$ 54,129,592$ (732,544)$ -1.4% 289,644,372$ 288,124,512$ 1,519,860$ 0.5%

Administrative Revenue 29,976,340 31,159,795 (1,183,455) 35,971,608 37,391,754$ (1,420,146) -3.9% 2,881,230 5,077,861 (2,196,631) 3,457,476$ 6,770,481$ (3,313,005) -95.8% 39,429,084 44,162,236 (4,733,152) -12.0%

Risk Reserve Revenue 4,629,550 4,595,504 34,046 5,555,460 5,514,604$ 40,856 0.7% - - - -$ -$ - 5,555,460 5,514,604 40,856 0.7%

Other Income/Revenue 250,000 - 250,000 300,000 - 300,000 100.0% 1,265,660 2,855,006 (1,589,346) 1,518,792$ 3,806,675$ (2,287,883) -150.6% 1,818,792 3,806,675 (1,987,883) -109.3%

TOTAL REVENUE 231,728,661 230,751,066 977,594 278,074,392 276,901,279 1,173,113 0.4% 48,644,430 48,530,061 114,369 58,373,316 64,706,748 (6,333,432) -10.8% 336,447,708 341,608,027 (5,160,319) -1.5%

EXPENSE

Service Expense

Inpatient 5,416,670 7,234,137 (1,817,467) 6,500,004 7,840,965 (1,340,961) -20.6% 7,075,080 7,088,606 (13,526) 8,490,096 9,451,475 (961,379) -11.3% 14,990,100 17,292,439 (2,302,339) -15.4%

Community Support 666,670 441,014 225,656 800,004 529,217.29 270,787 33.8% 5,485,210 5,144,620 340,590 6,582,252 6,859,493 (277,241) -4.2% 7,382,256 7,388,711 (6,455) -0.1%

BH Long-Term Residential 12,500,000 12,472,789 27,211 15,000,000 14,967,347.35 32,653 0.2% 8,101,670 8,062,829 38,841 9,722,004 10,750,439 (1,028,435) -10.6% 24,722,004 25,717,786 (995,782) -4.0%

PRTF 7,500,000 6,288,467 1,211,533 9,000,000 7,546,160.85 1,453,839 16.2% - - - - - - 9,000,000 7,546,161 1,453,839 16.2%

Case Management 208,330 367,246 (158,916) 249,996 440,694.95 (190,699) -76.3% - - - - - - 249,996 440,695 (190,699) -76.3%

Outpatient 21,666,670 20,723,547 943,123 26,000,004 24,868,255.99 1,131,748 4.4% 8,024,150 6,934,969 1,089,181 9,628,980 9,246,625 382,355 4.0% 35,628,984 34,114,881 1,514,103 4.2%

ACTT 6,666,670 7,030,866 (364,196) 8,000,004 8,437,038.65 (437,035) -5.5% 1,344,010 904,472 439,538 1,612,812 1,205,963 406,849 25.2% 9,612,816 9,643,001 (30,185) -0.3%

MST 791,670 731,373 60,297 950,004 877,647.46 72,357 7.6% - - - - - - 950,004 877,647 72,357 7.6%

IIHS 8,166,670 8,000,017 166,653 9,800,004 9,600,020.95 199,983 2.0% - - - - - - 9,800,004 9,600,021 199,983 2.0%

Partial Hospital/Day Treatment 3,958,330 4,633,152 (674,822) 4,749,996 5,559,782.80 (809,787) -17.0% 382,140 187,740 194,400 458,568 250,320 208,248 45.4% 5,208,564 5,810,103 (601,539) -11.5%

Psych Rehab 3,750,000 3,482,776 267,224 4,500,000 4,179,330.61 320,669 7.1% 316,150 288,027 28,123 379,380 384,036 (4,656) -1.2% 4,879,380 4,563,367 316,013 6.5%

Crisis Services 1,541,670 1,773,654 (231,984) 1,850,004 2,128,384.54 (278,381) -15.0% 2,823,680 4,240,338 (1,416,658) 3,388,416 5,653,784 (2,265,368) -66.9% 5,238,420 7,782,169 (2,543,749) -48.6%

Innovations/IDD/Hourly Services 66,206,600 67,338,676 (1,132,076) 79,447,920 80,806,411.56 (1,358,492) -1.7% - - - - - - 79,447,920 80,806,412 (1,358,492) -1.7%

ICF/MR 50,916,670 51,990,039 (1,073,369) 61,100,004 62,388,046.60 (1,288,043) -2.1% - - - - - - 61,100,004 62,388,047 (1,288,043) -2.1%

1915 (b)(3) Services/(Other for Non-Medicaid) 5,203,210 7,208,668 (2,005,458) 6,243,852 7,196,002 (952,150) -15.2% 19,372,937 10,621,499 8,751,438 23,247,524 14,161,999 9,085,526 39.1% 29,491,376 21,358,000 8,133,376 27.6%

Medicaid Reinvestment 2,428,290 2,425,654 2,636 2,913,948 2,910,784.80 3,163 0.1% - - - - - - 2,913,948 2,910,785 3,163 0.1%

Incurred But Not Reported Claims Expense 0 - -

Total Service Expense 197,588,120 202,142,075 (4,553,956) 237,105,744 240,276,091 (3,170,347) -1.3% 52,925,027 43,473,100 9,451,927 63,510,032 57,964,133 5,545,899 8.7% 300,615,776 298,240,224 2,375,552 0.8%

Recoveries

TPL/COB Recoveries - - - - - - - - - - - - - - -

Fraud and Abuse Recoveries - 74,145 74,145 - 88,974 (3,086) - - - - - - - 88,974 (3,086)

Other Recoveries (describe) - 45,176 45,176 - 54,211 (54,211) - - - - - - - 54,211 (54,211)

Total Recoveries - 119,321 119,321 - 143,185 (57,297) - - - - - - - 143,185 (57,297)

Total Service Expense, Net of Recoveries 197,588,120 202,022,754 (4,434,630) 237,105,744 240,132,906 (3,113,050) -1.3% 52,925,027 43,473,100 9,451,927 63,510,032 57,964,133 5,545,899 8.7% 300,615,776 298,097,039 2,432,850 0.8%


Salary & Wages 11,017,876 10,603,114 414,762 13,221,451 12,723,737 497,714 3.8% 2,007,813 2,131,547 (123,734) 2,409,376 2,842,063 (432,687) -18.0% 15,630,827 15,565,799 65,027 0.4%

Payroll Benefits & Expense 4,752,123 3,932,740 819,383 5,702,548 4,719,288 983,260 17.2% 791,852 783,362 8,490 950,222 1,044,483 (94,260) -9.9% 6,652,770 5,763,771 888,999 13.4%

Professional Services 1,216,192 1,164,066 52,126 1,459,430 1,396,879 62,551 4.3% 226,656 274,608 (47,952) 271,987 366,144 (94,157) -34.6% 1,731,418 1,763,023 (31,606) -1.8%

Supplies & Materials 568,963 565,205 3,758 682,756 678,246 4,510 0.7% 176,626 105,957 70,669 211,951 141,276 70,675 33.3% 894,707 819,522 75,185 8.4%

Travel & Vehicles 233,631 202,594 31,037 280,357 243,113 37,244 13.3% 43,563 47,699 (4,136) 52,276 63,599 (11,323) -21.7% 332,633 306,711 25,921 7.8%

Utilities & Postage 1,093,354 676,999 416,355 1,312,025 812,399 499,626 38.1% 173,651 426,331 (252,680) 208,381 568,441 (360,060) -172.8% 1,520,406 1,380,840 139,566 9.2%

Capital Expenses 790,023 212,326 577,697 948,028 254,791 693,236 73.1% 146,740 46,599 100,141 176,088 62,132 113,956 64.7% 1,124,116 316,923 807,192 71.8%

Other Expenses 2,874,723 3,323,484 (448,761) 3,449,668 3,988,181 (538,513) -15.6% 351,616 430,525 (78,909) 421,939 574,033 (152,094) -36.0% 3,871,607 4,562,214 (690,607) -17.8%

DD Treatment Planning 5,752,934 5,609,871 143,063 6,903,521 6,731,845 171,676 2.5% - - - - - - 6,903,521 6,731,845 171,676 2.5%

MH/SA Treatment Planning 6,460,760 5,351,912 1,108,848 7,752,912 6,422,294 1,330,618 17.2% - - - - - - 7,752,912 6,422,294 1,330,618 17.2%

Property Expenses 915,112 1,300,740 (385,628) 1,098,134 1,560,888 (462,754) -42.1% 170,546 448,452 (277,906) 204,655 597,936 (393,281) -192.2% 1,302,790 2,158,824 (856,034) -65.7%

Total Administrative Expenses 35,675,691 32,943,051 2,732,640 42,810,829 39,531,661 3,279,168 7.7% 4,089,063 4,695,080 (606,017) 4,906,876 6,260,107 (1,353,231) -27.6% 47,717,705 45,791,768 1,925,937 4.0%

Risk Reserve Set Aside 4,629,550 4,595,504 34,046 5,555,460 5,514,605 40,855 0.7% - - - - 5,555,460 5,514,605 40,855 0.7%Total Administrative Expense, including Risk

Reserve Set Aside 40,305,241 37,538,555 2,766,686 48,366,289 45,046,266 3,320,023 6.9% 4,089,063 4,695,080 (606,017) 4,906,876 6,260,107 (1,353,231) -27.6% 53,273,165 51,306,373 1,966,792 3.7%

TOTAL EXPENSES, including RISK RESERVE

SET-ASIDE 237,893,361 239,561,309 (1,667,944) 285,472,033 285,179,172 206,974 0.1% 57,014,090 48,168,180 (606,017) 68,416,908 64,224,240 4,192,668 6.1% 353,888,941 349,403,412 4,399,642 1.2%

EARNINGS FROM OPERATIONS (6,164,700) (8,810,243) 2,645,538 (7,397,641) (8,277,892) 966,139 (8,369,660) 361,881 720,386 (10,043,592) 482,508 (10,526,100) - - -

Other income/(loss) - - - - - - - - - - - - - - -

PROFIT OR (LOSS) (6,164,649) (8,810,243) 2,645,538 (7,397,641) (8,277,892) 966,139 -13.1% (8,369,660) 361,881 720,386 (10,043,592) 482,508 (10,526,100) 104.8% (17,441,233) (7,795,384) (9,559,961) 54.8%


Appropriated Fund Balance Medicaid 6,164,649 4,059,205 2,105,444 7,397,641 4,871,046 2,526,595 34.2% - - - - - - 7,397,641 4,871,046 2,526,595 34.2%

Appropriated Fund Balance MOE - - - - - - 7,724,068 9,101,472 (1,377,405) 9,268,881 12,135,296 (2,866,415) -30.9% 9,268,881 12,135,296 (2,866,415) -30.9%

Appropriated Fund Balance Other - - - - - - 645,592.00 418,088 227,504 774,710 557,450.67 217,260 774,710 557,451 217,260

Total Appropriated Fund Balance 6,164,649 4,059,205 2,105,444 7,397,641 4,871,046 2,526,595 34.2% 8,369,660 9,519,560 (1,149,901) 10,043,591 12,692,747 (2,649,155) -26.4% 17,441,232 17,563,793 (122,560) -0.7%

NET PROFIT OF LOSS -$ (4,751,038)$ 4,750,986$ (0)$ (3,406,846)$ 3,492,671$ (1)$ 9,881,440$ (9,881,442)$ (1)$ 13,175,255$ (13,175,255)$ (1)$ 9,768,408$ (9,682,521)$

Medicaid Non-Medicaid Combined


Income Statement

Budget to Actual ComparisonFor Ten Months Ending April 30, 2019

Unaudited

of 40

Actual Actual Combined Actual Actual Combined

Medicaid Non-Medicaid Total Medicaid Non-Medicaid Total

Service:

Revenue $19,554,831 $3,321,296 $22,876,127 $194,995,767 $40,597,194 $235,592,961

Expense 20,990,709 3,802,744 24,793,453 202,022,755 43,473,100 245,495,855

Net Service (1,435,878) (481,448) (1,917,326) (7,026,988) (2,875,906) (9,902,894)

Administrative:

Revenue 1,635,556 501,151 2,136,707 31,159,795 5,077,861 36,237,656

Expense 3,537,118 459,098 3,996,216 32,943,051 4,695,080 37,638,131

Net Administrative (1,901,562) 42,053 (1,859,509) (1,783,256) 382,781 (1,400,475)

Net Operating Income (3,337,440) (439,395) (3,776,835) (8,810,243) (2,493,125) (11,303,368)

Other:

Risk Reserve Revenue 458,755 458,755 4,595,504 4,595,504

Other Income/Revenue 243,176 243,176 2,855,006 2,855,006

Other Financing Resources 2,206,762 849,674 3,056,437 4,059,205 9,519,560 13,578,765

2,665,517 1,092,850 3,758,368 8,654,709 12,374,566 21,029,275

Risk Reserve Revenue 458,755 458,755 4,595,504 4,595,504

Net Other 2,206,762 1,092,850 3,299,613 4,059,205 12,374,566 16,433,771

Net Income ($1,130,677) $653,455 ($477,225) ($4,751,039) $9,881,441 $5,130,403

For the Month of April , 2019 For the Ten Months ending April 30, 2019

PARTNERS BEHAVIORAL HEALTH MANAGEMENT

of 40

Executive Dashboard, April 2019

Access to Services

12-Month Average Member Months 159,618

Annualized Unduplicated Enrollment 182,052

Annualized MCD Unduplicated Served 30,395

Annualized Non-MCD Unduplicated Served 12,218

Medicaid Penetration Rate 16.7%

Calculations Based on Rolling 12-Month Period

Executive Dashboard Report

April 30, 2019(Report as of April 30, 2019

Apr-19, 16.7%

14.0%

14.5%

15.0%

15.5%

16.0%

16.5%

17.0%

17.5%

18.0%

Annual (12 Months) Medicaid Service Penetration Rate

Based on Category of Aid

12-Month Penetration Rate Linear (12-Month Penetration Rate)

146,314

14,420

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

130,000

135,000

140,000

145,000

150,000

155,000

160,000

165,000

170,000

175,000

180,000

Monthly Unduplicated Count of Membersand Members Served

Unduplicated Count of Medicaid Members

Unduplicated # That Received MH/DD/SU Services

85,000

90,000

95,000

100,000

105,000

110,000

0

5,000

10,000

15,000

20,000

25,000

30,000

Unduplicated Count of Eligibles by Category of Aid

Aged, Ages 65+ Blind/Disabled (21+) Blind/Disabled (3-20)

Foster Children Innovations AFDC (Ages 3+)

9.1%9.7% 9.5%

9.0%

9.9% 9.8% 9.7%

8.6%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Monthly Percentage of Members Receiving Services

Page 1 of 11

of 40


Acceptability of Services

Consumer and Family Grievances:

(Report as of April 30, 2019

* Grievance data reported on a 1-month delay (following State reporting specs)

10

6

11

5

10

7 7 7 8

9 9 8

7

0

5

10

15

20

25

30Medicaid Grievances

Grievances Against MCO

Grievances Against Providers

Grievances Against Other

3 2 2

1 1 1 2 2

1 0

2 2

0

0

5

10

15IPRS Grievances

Grievances Against MCO Grievances Against Providers

Grievances Against Other Total Number of Grievances

12.410.8 11.3

9.2 9.0

12.0

15.0

9.311.0

7.3

11.8 12.214.0

0

5

10

15

20

25

30Average Number of Days to Resolve a

Informal Grievance

Avg Working Days for Informal Grievances Goal to Resolve Informal Grievances

21.024.5

26.2 28.0

22.0

16.0

22.524.2 22.9 23.0 24.3 24.5

26.7

0

10

20

30

40

50Average Number of Days to Resolve a

Formal Grievance

Avg Calendar Days for Formal Grievances Goal to Resolve Informal Grievances

Page 2 of 11

of 40


Summary Balance Sheet

Key Financial Indicators

3.14 3.25 3.23

3.91

3.16

2.70 2.97

2.79 2.62

3.01 2.78

2.73 2.95

2.20

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Current Ratio (including Long-Term Investments)

Consolidated Current Ratio Consolidated Year-End Estimate

* ratio of assets to expenses

108.0 106.9

98.1

128.6

90.3 90.181.4 83.9

92.6

82.076.9 78.9

69.8

60

30

0

20

40

60

80

100

120

140

160

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Defensive Interval (including Long-Term Investments)(Days of Service Expense in Cash)

# of Days Consolidated Consolidated Year-End Estimate Legislated Target

Medicaid Total Medicaid Total

Cash $16,176,690 $30,219,668 Accounts Payable $1,873 $2,203

Other Current Assets 1,703,874 5,589,223 IBNR-Claims Payable 13,122,455 13,122,455

Total Current Assets 17,880,564 35,808,891 Other Current Liabilities 1,502,299 7,696,094

Total Current Liabilities 14,626,627 20,820,752

Net Property and Equipment 3,010,475 9,369,781 Other Liabilities 0 2,006,061

Fund Balance:

Investment in Fixed Assets 0 9,657,403

Long-Term Investments 25,586,639 25,586,639 Other Non-Spendable 0 1,035,290

Other Assets 0 5,416,488 Restricted 78,742,762 92,802,486

Risk Reserve 34,744,835 34,744,835 Accumulated Net Surplus (Deficit) (34,435,761) (34,435,761)

Unreserved 22,288,885 19,040,403

66,595,886 88,099,821

Total Assets $81,222,513 $110,926,634 Total Liabilities and Fund Balance $81,222,513 $110,926,634

Assets Liabilities and Fund Balance


April 30, 2019

Page 3 of 11

of 40


Financial Risk

101.5%

($7,026,988)

95.9%

($7,220,619)

$ Variance (Over)/Under

State (includes Fund Balance, if any)

$ Variance (Over)/Under

Financial Summary: Income Statement Service Expense Ratio (YTD):

Medicaid (includes Fund Balance)

101.5%

95.9%

60%

70%

80%

90%

100%

110%

120%Service Expense Ratio

Medicaid SER State SER 100% Target

115.9%

20%

40%

60%

80%

100%

120%

140%

160%Total Medicaid Expense Ratio(including MTD Fund Balance Revenue)

Total Expense Ratio 85% Target

91.5%

70%

75%

80%

85%

90%

95%

100%Medical Loss Ratio (YTD)

Loss Ratio 85% Target

Medicaid Non-Medicaid Combined Total YTD Budget Variance

Service:

Revenue $194,995,767 $40,597,194 $235,592,961 $241,370,361 $5,777,400

Expense 202,022,755 43,473,100 245,495,855 250,513,147 5,017,292

Net Service (7,026,988) (2,875,906) (9,902,894) (9,142,786) 760,108

Administrative:

Revenue 31,159,795 5,077,861 36,237,656 32,857,570 (3,380,086)

Expense 32,943,051 4,695,079 37,638,130 39,764,754 2,126,624

Net Administrative (1,783,256) 382,782 (1,400,474) (6,907,184) (5,506,710)

Net Operating Income (8,810,244) (2,493,124) (11,303,368) (16,049,970) (4,746,602)

Other:

Risk Reserve Revenue 4,595,504 0 4,595,504 4,629,550 34,046

Other Income/Revenue 0 2,855,006 2,855,006 1,515,660 (1,339,346)

Other Financing Resources 4,059,205 9,519,560 13,578,765 14,534,309 955,544

Total Other 8,654,709 12,374,566 21,029,275 20,679,519 (349,756)

Risk Reserve Expense 4,595,504 0 4,595,504 4,629,550 34,046

Net Other 4,059,205 12,374,566 16,433,771 16,049,969 (383,802)

Net Income (Loss) ($4,751,039) $9,881,441 $5,130,406 $0 ($5,130,406)


For the Ten Months Ending April 30, 2019

Page 4 of 11

of 40


Medicaid (Report as of April 30, 2019

Category of Service Annual Budget Budget Actual Variance Budget Actual Variance% Variance

Inpatient $6,500,000 $541,667 $694,428 ($152,761) $5,416,667 $7,234,137 ($1,817,471) (34%)

Community Support 800,000 66,667 41,322 25,345 666,667 441,014 225,652 34%

BH Long-Term Residential 15,000,000 1,250,000 1,329,338 (79,338) 12,500,000 12,472,789 27,211 0.2%

PRTF 9,000,000 750,000 584,903 165,097 7,500,000 6,288,467 1,211,533 16%

Case Management 250,000 20,833 44,117 (23,284) 208,333 367,246 (158,912) (76%)

Outpatient 26,000,000 2,166,667 2,288,684 (122,017) 21,666,667 20,723,547 943,120 4%

ACTT 8,000,000 666,667 704,837 (38,170) 6,666,667 7,030,866 (364,199) (5%)

MST 950,000 79,167 98,423 (19,256) 791,667 731,373 60,294 8%

IIHS/FCT 9,800,000 816,667 852,943 (36,276) 8,166,667 8,000,017 166,649 2%

Part Hosp/Day Treatment 4,750,000 395,833 552,805 (156,972) 3,958,333 4,633,152 (674,819) (17%)

Psych Rehab 4,500,000 375,000 331,025 43,975 3,750,000 3,482,776 267,224 7%

Crisis Services 1,850,000 154,167 186,928 (32,761) 1,541,667 1,773,654 (231,987) (15%)

Innovations 79,447,918 6,620,660 6,951,324 (330,665) 66,206,598 67,338,676 (1,132,078) (2%)

ICF-MR 61,100,000 5,091,667 5,283,270 (191,603) 50,916,667 51,990,039 (1,073,372) (2%)

1915(b)(3) 6,243,852 520,321 592,804 (72,483) 5,203,210 7,208,668 (2,005,458) (39%)

Total $234,191,770 $19,515,981 $20,537,150 ($1,021,169) $195,159,808 $199,716,422 ($4,556,613) (2.3%)

Fiscal Year Medicaid Services Cost

(includes IBNR) Monthly Fiscal YTD

$14

$16

$18

$20

$22

$24

$26

Month

ly E

xpense (

Mill

ions)

Month to Date Budget to Actual Comparison -Medicaid

Total Actual Total Budget

$0

$50

$100

$150

$200

$250

$300

Tota

l S

erv

ice C

ost

(M

illio

ns)

Fiscal YTD Budget to Actual Comparison - Medicaid

FYTD Actual FYTD Budget Linear (FYTD Actual)

Page 5 of 11

of 40


IPRS (Report as of April 30, 2019

Category of Service Annual Budget Budget Actual Variance Budget Actual Variance% Variance

Inpatient $385,000 $32,083 $39,425 ($7,342) $320,833 $194,276 $126,557 39%

Community Support 6,582,251 548,521 472,632 75,889 5,485,209 5,144,620 340,589 6%

BH Long-Term Residential 9,722,000 810,167 764,681 45,485 8,101,667 8,062,829 38,837 0.5%

Outpatient 9,628,974 802,415 666,762 135,652 8,024,145 6,934,969 1,089,176 14%

ACTT 1,612,811 134,401 64,519 69,882 1,344,009 904,472 439,537 33%

Part Hosp/Day Treatment 458,563 38,214 30,618 7,596 382,136 187,740 194,396 51%

Psych Rehab 379,384 31,615 10,988 20,628 316,153 288,027 28,127 8.9%

Crisis Services 3,388,420 282,368 339,092 (56,723) 2,823,683 4,240,338 (1,416,655) (50%)

3-Way Hospitals 8,253,217 687,768 531,182 156,586 6,877,681 6,894,330 (16,650) (0.2%)

Non-UCR 14,122,683 1,176,890 531,941 644,949 11,768,903 5,704,513 6,064,390 52%

Total $54,533,303 $4,544,442 $3,451,839 $1,092,603 $45,444,419 $38,556,116 $6,888,304 15.2%

Fiscal Year IPRS UCR Services Cost Monthly Fiscal YTD

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

$45,000,000IPRS UCR FYTD Budget to Actual

FYTD Actual FYTD Budget Linear (FYTD Actual)

$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000IPRS Non-UCR FYTD Budget to Actual

YTD Actual YTD Budget Linear (YTD Actual)

Page 6 of 11

of 40


Super Measures

Access to Primary/Preventive Care for Individuals Under the Innovations Waiver

TCL - Reported on 2-Month Lag / Ambulatory Follow Up Reported on 2-Month Lag

Source: Innovations Super Measure (Reports Manager - DMA-DMH Super Measures: DMA Innovations Integrated Care Super Measure)

202 209 215 221 226 238 242 245

244

263

0

50

100

150

200

250

300

350

400

Count

of

Indiv

iduals

Transitions to Community Living(LIfe of Program)

Net Housed Fiscal Year-End Benchmark

Source: Transitions to Community Living Program Reporting

Additional Placements Needed to Meet FY Goal: 19

551 547 537529

547 553 553 551

510

550

571 572 566 562 569 577 577 573536

572

96.5%95.6%

94.9%94.1%

96.1% 95.8% 95.8% 96.2%95.1%

96.2%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

0

100

200

300

400

500

600

700

800

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19

Perc

enta

ge

Num

ber

of

Consum

ers

Innovations Integrated Care Super Measure

Received Eligible Percent Benchmark %

Page 7 of 11

of 40


166 125 148 144 134 166 101 115 143 116

53.0%55.2%

58.8%55.6%

59.7%

68.7%

56.4%

63.5%67.1% 67.2%

0

20

40

60

80

100

120

140

160

180

200

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Fo

llow

Up P

erc

enta

ge

Medicaid Inpatient Ambulatory Follow Up - MH(from Claims Data)

Unique Consumers <7 Days Benchmark Internal Benchmark

78 83 116 137 100 126 112 83 98 74

43.6% 44.6% 44.0%

35.8%

42.0%

58.7%

43.8%

49.4%

57.1% 58.1%

0

20

40

60

80

100

120

140

160

180

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Fo

llow

Up P

erc

enta

ge

State Inpatient Ambulatory Follow Up - MH(from Claims Data)

Unique Consumers 1-7 Days Benchmark Internal Benchmark

141 126 170 147 155 171 160 115 163 125

47.5%

38.9%43.5%

49.0% 50.3%52.6% 51.3%

54.8%

66.9% 66.4%

0

20

40

60

80

100

120

140

160

180

200

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Fo

llow

Up P

erc

enta

ge

State Inpatient Ambulatory Follow Up - SU(from Claims Data)

Unique Consumers 1-7 Days Benchmark Internal Benchmark

Source: QM Data Analyst

Source: QM Data Analyst

47 38 42 49 35 42 30 41 37 36

38.3% 39.5% 40.5% 38.8%42.9%

52.4%

40.0%

51.2%

67.6%

52.8%

0

5

10

15

20

25

30

35

40

45

50

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Fo

llow

Up P

erc

enta

ge

Medicaid Inpatient Ambulatory Follow Up - SU(from Claims Data)

Unique Consumers <7 Days Benchmark Internal Benchmark

Page 8 of 11

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Operational Performance

Claims:

Number of Days to Process and Pay All Claims:

Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Service Date to Received Date 27.6 22.6 24.6 30.0 22.8 19.3 20.6 19.9 20.0 19.4 19.4

Received Date to Paid Date 8.7 8.4 8.9 8.9 8.7 8.9 11.4 8.9 8.9 8.7 8.8

Service Date to Paid Date 36.3 31.0 33.5 38.9 31.5 28.2 32.0 28.8 28.9 28.1 28.2

Top 5 Reasons for Denied Claims:

Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Duplicate claim $812,773.98 $1,140,091.52 $520,242.14 $763,814.66 $581,071.56 $756,301.42 $618,461.95 $505,324.01 $560,103.67

Service is not authorized $1,064,899.31 $1,527,567.28 $1,156,953.86 $2,789,603.91 $1,322,666.08 $895,451.12 $792,198.58 $1,258,160.01 $789,583.19 $1,083,536.65 $1,290,424.84

Claim received after billing period $1,134,774.64 $2,343,099.13 $1,323,341.09 $618,978.91 $1,574,367.56 $858,106.11 $1,005,503.79 $550,885.29 $728,089.96 $659,458.42 $569,988.12

No coverage available for

Patient/Service/Provider combo$852,049.16 $800,807.29 $775,903.74 $1,157,442.21 $1,023,529.55 $279,718.21 $385,691.89 $557,363.58 $507,633.89 $664,608.38

Referenced claims already been

resubmitted; multiple resubmissions not

allowed

$1,114,198.06 $1,366,027.30

Invalid Units: Units Claimed Not Equal # of

Days for Discharge Claim$1,396,255.51 $1,412,403.30

Invalid DCN (Document Ctrl #) or

Resubmission Ref #$609,916.49

Client has other covered insurance (COB) $313,985.52

The procedure code/bill type is inconsistent

with the place of service$929,079.30

Billing Taxonomy submitted is not

associated with the Billing NPI$1,810,371.32 $796,893.27 $881,896.09 $381,516.20 $353,432.03 $369,995.53 $478,991.31

$5,674,868.41 $6,582,565.03 $5,278,186.30 $6,482,522.68 $6,604,543.54 $3,922,417.64 $2,972,477.66 $3,304,470.64 $3,063,494.21 $3,365,869.46 $3,564,116.32

#1 Denial Code #2 Denial Code #3 Denial Code #4 Denial Code #5 Denial Code

(Report as of April 30, 2019

$6,033

$24,870

$18,837

11.7%12.9%

15.6%

12.0%

9.1% 9.3%

10.8%

9.0%7.8%

9.5% 9.2% 8.7%9.7%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

Perc

ent o

f Denie

d C

laim

s

Cla

ims (

$000)

Claims Processing

Claims Denied and Pended Total Claims Processed (000)

Total Claims Paid (000) Claims Percent Denied

8.8 9.0 8.7

8.4 8.9 8.9 8.7 8.9

11.4

8.9 8.9 8.7 8.8

4.0

6.0

8.0

10.0

12.0

14.0

# o

f D

ays

Days to Pay Clean Claims *

Average Number of Days* Clean claims contain all information

needed in order to make paymentCalculation of percentage of denied claims does not include claims denied for either of the following reasons:- Non-Billable Service- Non-Covered Ancillary Services

Page 9 of 11

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Treatment Authorization Requests (TAR):

Authorization Requests - Medicaid Only Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Total Number of Auth Requests Received 3,702 3,388 3,684 3,026 3,430 3,304 3,303 3,733 3,388 3,731 3,692

# Standard Auth Request Decisions 3,485 3,178 3,444 2,773 3,211 3,149 3,127 3,477 3,203 3,569 3,522

# Standard Auth Requests Processed in 14

Days3,471 3,153 3,420 2,740 3,198 3,138 3,124 3,475 3,201 3,569 3,521

% Processed in 14 Days (Standard = 95%) 99.6% 99.2% 99.3% 98.8% 99.6% 99.7% 99.9% 99.9% 99.9% 100.0% 100.0%

# Auth Requests Requiring Expedited

Decisions, Inclusive of Inpatient 217 210 240 253 219 155 176 256 185 162 170

# Expedited and Inpatient Auth Requests

Processed in 3 Days217 210 240 253 219 155 176 256 185 162 170

% Processed in 3 Days (Standard = 95%) 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Total % of Auth Requests Processed in

Required Timeframes (Standard = 95%)99.6% 99.3% 99.3% 98.9% 99.6% 99.7% 99.9% 99.9% 99.9% 100.0% 100.0%

# of Auth Requests Denied for Clinical

Reasons216 261 229 193 210 169 169 155 183 174 126

% of Total Auth Requests Denied for

Clinical Reasons5.8% 7.7% 6.2% 6.4% 6.1% 5.1% 5.1% 4.2% 5.4% 4.7% 3.4%

# of Administrative Denials 20 40 77 36 45 39 32 47 34 44 42

% of Total Auth Requests Denied for Admin

Reasons0.5% 1.2% 2.1% 1.2% 1.3% 1.2% 1.0% 1.3% 1.0% 1.2% 1.1%

Total # of Auth Requests Denied 236 301 306 229 255 208 201 202 217 218 168

% of Total Auth Requests Approved 93.6% 91.1% 91.7% 92.4% 92.6% 93.7% 93.9% 94.6% 93.6% 94.2% 95.4%

Number of Consumer Authorization Appeals

Received34 45 32 32 40 23 13 15 19 49 23

Rate of Consumer Auth Appeals per 1,000

Persons Served2.5 3.4 2.4 2.5 3.0 2.0 1.3 1.4 1.7 4.0 2.0

Number of Authorizations Overturned Due

to Consumer Appeals (Reconsiderations)1 1 0 0 0 0 0 0 0 1 1

Page 10 of 11

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Program Integrity (Report as of April 30, 2019

2 0

1 0 0 0 0 0 0 0

8

17

7 6

4

0

6 5 5

4

17

13

3

7 7

2

5 5 4

3

54 58

63 62 59

57 58 58 59 60

0

10

20

30

40

50

60

70

80

0

5

10

15

20

25

30

35

40

45


PI Investigation Activity

Total Reopened Total New Total Closed Total Open

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000

$5,000,000

FY'2016 FY'2017 FY'2018 FY'2019-TD

PI Tentative Notice of Overpayment

Initial TNO Amount Adjusted TNO Amount ** Total Amount of Adjusted TNO Recouped

$149 $2,987

$4,575

$733

$21,911

$3,553 $1,914

$12,509

$3,418 $2,732

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000


Self-Audit Recoveries by Month Received

Recoveries FYTD

YTD -$54,482

TNO FY'2016 FY'2017 FY'2018 FY'2019-TD

Initial TNO Amount $543,556 $668,490 $4,569,188 $1,398,076

Number of TNOs Issued 55 51 23 23

Adjusted TNO Amount $215,303 $391,222 $4,544,475 $1,297,076

% Reduction of Initial TNO -60% -41% -1% -7%

* Amount Collected During the Fiscal Year $189,067 $325,993 $135,809 $164,545** Total Amount of Adjusted TNO

Recouped $211,810 $253,582 $109,170 $145,404

% of Adjusted TNO Recouped 98.38% 64.82% 2.40% 11.21%

Outstanding Balance $3,493 $137,640 $4,435,304 $1,151,672

(some recoupments cross over fiscal years)

** Total amount of the TNO that was recouped

Note: TNO recoupments are reported on a Cash Basis

* Actual Recoupment: Amount received during the fiscal year

Page 11 of 11

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BOARD OF DIRECTORS

Resolution Number: 2019-062019 Resolution Sponsor: Finance Dept. Date: June 20, 2019 I, Clerk to the Board of Directors, hereby certify that the Resolution below is a true and exact copy of a resolution adopted by the Board of Directors during a regular meeting on June 20, 2019. ______________________________________ Clerk to the Board WHEREAS, Partners Behavioral Health Management (“Partners BHM”) is a multi-county local political subdivision of the State operating as a Public Authority, Area Authority, Local Management Entity (LME) and LME/Managed Care Organization (LME/MCO) as defined by North Carolina General Statutes § 159-7(b)(10) and §§ 122C-3(1), -3(20b), -3(20c) and -116(a); and WHEREAS, Partners BHM is required by North Carolina General Statutes § 122C-144.1 to maintain its budget in accordance with the requirements of Article 3, Subchapter III of Chapter 159 of the North Carolina General Statutes (“Local Government Budget and Fiscal Control Act”); and WHEREAS, under the North Carolina General Statutes, Partners BHM is required to and able to maintain an unreserved fund balance; and WHEREAS, Partners BHM is charged with the duty and responsibility to engage in comprehensive planning, budgeting, implementing and monitoring the provision of mental health, developmental disabilities and substance abuse services (“Services”) to the communities it serves; and

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2NOW, THEREFORE, BE IT RESOLVED, that Partners BHM Board of Directors hereby authorizes management to budget and utilize the following fund balance for expenditures throughout the year. Fund Balance Appropriated Tailored Plan Readiness $4,537,649 Medicaid Reinvestment 2,913,950 State MOE 3,904,081 Capital Expenditures 428,000 County Expenditures 372,571 Total $12,156,251 BOARD ACTION: MOTION _____________ SECONDED __________________ AYE NAY UNANIMOUS _____________________

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board of directors meeting - partners · 2019. 6. 18. · board of directors meeting 1985 tate...

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