HomeMy WebLinkAboutAgenda - 03-22-2012 - 7aORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: March 22, 2012
Action Agenda
Item No. ~'] - (~
SUBJECT: OPC Mental Health, Developmental Disabilities & Substance Abuse Authority -
Transition Management and Retiree Health Insurance Continuation
DEPARTMENT: County Manager/County
Attorney/Orange-Person-
Chatham Mental Health
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Joint Resolution Addressing Governance
Draft Memorandum of Agreement on
OPC Retirees Health Insurance
March 15, 2012 Work Session Abstract
and Other Materials Addressing Two
Issues
INFORMATION CONTACT:
Gwen Harvey, Assistant County
Manager, 245-2307
Judy Truitt, OPC Area Program
Director, 913-4000
John Roberts, County Attorney, 245-
2318
PURPOSE: To approve two elements of an agreed upon Orange, Person and Chatham Mental
Health LME (OPC) merger with Piedmont Behavioral Health (PBH) effective April 1, 2012:
1) A joint resolution related to advisory and governance structure for future merged
mental health services that a) creates a Community Oversight Board appointed by
local Commissioners; b) is responsible for oversight of the local service system;
and c) has input at the governance level; and
2) A Memorandum of Agreement providing continuation of health care benefits for
identified Orange Person-Chatham Area Program (OPC) retirees by including
them under Orange County's healthcare plan until such time as they are eligible
for Medicare coverage (age 65), with the OPC Area Authority providing funds for
the purpose of funding the post-retirement health insurance benefits for the
qualified OPC employees.
BACKGROUND: At its March 15, 2012 work session, the Board of Commissioners discussed
two issues related to the Orange Person-Chatham Area Program (OPC). The first issue is a
proposal related to governance for future merged mental health services. The joint resolution
for consideration by the Board of Commissioners, along with the other partner counties, details
the creation of a new Governance Board with representation from each of the local advisory
boards; requires appointment of two Commissioners from within the catchment area; has a
voting seat for a Consumer & Family Advisory Committee representative; and has
representation from subject specific experts in the field. Based on the review at the work
a
session and any additional discussion, staff proposes that the Board consider and approve the
attached joint resolution.
The Board also discussed the second issue at the March 15th work session concerning the
continuation of health care benefits for identified Orange Person-Chatham Area Program (OPC)
retirees until such time as they are eligible for Medicare coverage. A draft Memorandum of
Agreement (MOA) addressing this matter is attached. Proposed for approval by all three
counties, the MOA designates that Orange County would include the identified OPC retirees
under Orange County's healthcare plan. The OPC Area Authority would provide funds to
Orange County for the purpose of funding the post-retirement health insurance benefits for the
qualified OPC employees. Should initial funding from OPC not address all health insurance
cost for the retirees, the MOA stipulates that all three counties would equally share the
remaining costs.
Considerable analysis and negotiation between OPC and PBH - guided and directed by their
appointed boards - has occurred over many months to reach this point in accomplishing a
formal merger. The various attachments contain specific details on the history, evolution, and
current status of OPC in relation to PBH.
Commissioner Steve Yuhasz is the current BOCC liaison to the OPC Board. BOCC Chair
Bernadette Pelissier preceded him in this role.
FINANCIAL IMPACT: There is no financial impact to Orange County associated with approval
of the joint resolution related to governance for future merged mental health services. For the
MOA, OPC will provide funding to the County to cover the projected health insurance costs for
the identified OPC retirees. Should for initial funding from OPC subsequently not address all
health insurance costs for the retirees, the MOA stipulates that all three counties would equally
share the remaining costs.
RECOMMENDATION(S): The Manager recommends that the Board approve the joint
resolution and Memorandum of Agreement and authorize the Chair to sign both documents.
~~.s- ao~a- o3a
JOINT RESOLUTION
OF THE BOARDS OF COUNTY COMIVIISSIONERS
OF ALAMANCE, CABARRUS, CASWELL, CHATHAM, DAVIDSON,
FRAlvI~.IN, GRANVILLE, HALIFAX, ORANGE, PERSON, ROWAN,
STANLY, UNION, VANCE AND WARREN COUNTIES
WI~REAS, the Boards of County Commissioners of Alama,nce, Cabarrus,
Caswell, Chatham, Davidson, Franklin, Granville, Halif~, Orange, Person, Rowan,
Stanly, Union, Vance and Warren Counties previously resolved to be separately served
by the Five County, OPC, and PBH Area Authorities;
Wf~REAS, the State of North Carolina passed Session Law 2011-264, which
requires sta.tewide expansion of the 1915(b)/(c) Medicaid Waiver to be managed by Area
Authorities operating as Managed Caze Organizations;
WI~REAS, the North Carolina General Assembly is currently addressing the
governance needs of Asea Authorities operating as Managed Care Organizations through
a Health and Human Services Subcommittee on LME Governance, and intends to pass
governance legislation in the 2012 legislative short session;
WHEREAS, the Boaxds of County Commissioners of Alarnance, Cabarrus,
Caswell, Chatham, Davidson, Franklin, Granville, Halifax, Orange, Person, Rowan,
Stanly, Union, Vance and Warren Counties now desire to be served by a single Area
Authority operating as a Managed Care Organization with a governance structure that
will function under existing law, as well as under the new governance legislation;
NOW, TF~REFORE, BE IT RESOLVED JOINTLY as follows:
Section 1. Resolution and Purpose
It is in the interest of the public health and welfa.re to create an Area Authority to
operate North Carolina's 1915(b)/(c) Medicaid Waiver as a Managed Caze Organization
and to manage all public resources that may become available for mental health,
intellectual and developmental disabilities, and substance abuse services, including
federal block grant funds, federal funding for Medicaid and Health Choice, and all other
public funding sources.
Section 2. Establishment of Cardinal Innovations Healthcare Solutions
There is hereby created and established pursuant to G.S. 122C-115(c) an Area
Authority known as Cardinal Innovations Healthcare Solutions ("Cardinal Innovations").
Pursuant to the 1915(b)/(c) Medicaid Waiver and 42 C.F.R. 438.2, Cardinal Innovations
Healthcare Solutions shall operate as a Managed Care Organization and Prepaid Inpatient
Health Plan. Cazdinal Innovations shall include the Alamance-Caswell, Five County,
OPC, and Piedmont Community Operations Centers.
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Section 3. Governance
There is hereby created and established pursuant to G.S. 122C-118.1 an Area
Board, which shall be the governing uxut of Cardinal Innovations. The Area Board shall
be comprised of a single Governing Board and Community Oversight Boaxds, one for
each Community Operations Center. The appointment of inembers to the Governing
Boaxd and Community Oversight Boards shall be in accorda,nce with bylaws set forth for
such purpose and may be amended as necessary or convenient to comply with changes in
state or federal law or to carry out the functions, powers, duties, and responsibilities
contained in this Joint Resolution. Due to the comple~uty of operations, financial risk,
and responsibility for public funding the Governing Board must be highly functional in
order to ensure accounta.bility to funders, the fma.ncia.l solvency of Card.i.nal Innovations,
compliance with state and federal laws and regulations including quality standards, and a
service delivery system that is customized for localities and which provides access and
choice for citizens in need of inenta.l health, intellectual and developmental disabilities,
substance abuse and related services. ~
(1) Membership of the Goveming Board shall be comprised of a mix of
individuals with the necessary expertise to govern large Managed Caze Organizations and
individuals who represent the constituencies Cardinal Innovations serves. Membership
will be as follows:
(a) Two (2) at-large County Commissioners from among the County
Coxiunissioners serving on Community Oversight Boards (defined below), selected by
the Governing Board, based on diversity of geographic representation;
(b) One (1) member from the Regional Consumer and Family
Advisory Committee, either the Chair or other elected member;
(c) Six (6) members, selected by the Governing Board, with
professional experience and expertise in healthcare, i.nsurance, fmance, health/behavioral
health, intellectuaUdevelopmental disabilities, and a physician or other clinical
professional, and no more than two members from any single specialty area; and
(d) One (1) member from each Community Oversight Board, either
the Chair or other elected member.
(e) Except for members appointed by the Community Oversight
Boards and the Regional Consumer and Family Advisory Committee, the initial members
of the Governing Board shall be nominated by the PBH Board, with consultation from
the Boards of Five County and OPC Area Authorities, and affirmed by the Secretary of
the North Carolina Department of Health and Huma.n Services.
(2) The Goveming Board's primary responsibilities will include determining
policy; strategic planning, including consideration of local priorities as determined by the
Community Oversight Boaxds; budgets; hirixig and evaluations of the Chief Executive
Officer; monitoring of deliverables, including overall perFormance and fmancial
management; government affairs and advocacy; reporting to constituent counties;
responding to concerns and feedback from the Community Oversight Boards; and
ensuring the overall health of Cardinal Innovations.
(3) The bylaws of the Governing Boazd shall establish Community Oversight
Boards, one for each Community Operations Center, which shall ensure involvement of
local stakeholders, promote understanding and collaboration at the local level, and
monitor the performance of each Community Operations Center. Membership of the
Community Oversight Boards will be as follows:
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(a) Three (3) members from each County, appointed by each County's
Board of Commissioners, and will include a County Commissioner or designee, a
consumer or family member, and another citizen or stakeholder; and
(b) One (1) member from the Local Consumer and Family Advisory
Comrnittee, either the Chair or other elected member.
(4) Ea.ch Community Oversight Board's prunary responsibilities will include
advising the CEO on the evaluation and hiri.ng of the Community Operations Center
Executive Director; recommending priorities for expenditure of state and county funds
for development of the annual budget; determining local priorities for inclusion in the
overall strategic plan; identifying community needs and concerns; monitoring resolution
of issues; and monitoring performance at the local level, including access to care,
expenditure of service funds, number of consumers served, services delivered, provider
network size and composition, outcomes, and consumer satisfaction.
(5) Each Community Oversight Board will esta.blish its own bylaws based on
local needs, but in compliance with standardized requirements established by the
Governing Board. for quorums, frequency of ineeti.ngs, elections of officers, duties of
members, committees and committee appoinhnents, and attendance standards. Such
bylaws are subject to the approval of the Goveming Board.
Section 4. Functions
Cardinal Innovations shall perform a11 the functions necessary to carry out the
purposes of this Joint Resolution, including, but not limited to, the following:
(1) To establish accounta.bility for the planning, development, and
management of local systems that ensure access to caze, quality of services, and the
availability and delivery of necessary services, for individuals in need of inental health,
intellectual and developmental disabilities, substance abuse, and related services;
(2) To operate the 1915(b}/(c) Medicaid Waiver, a proven system for the
management of inental health, intellectual and c~evelopmental disabilities, and substance
abuse services;
(3) To manage state funded services for menta.l health, intellectual and
developmental disabilities, and substance abuse services, including federal block grant
funds;
(4) To manage all other resources that are or become available for mental
health, intellectual and developmental disabilities, and substance abuse services;
(5) To use managed caxe strategies, including care coordination and utiliza.tion
management, to reduce the trend of escalating costs in the State Medicaid program while
ensuring medically necessary care, and to deploy a system for the allocation of resources
based on the reliable assessment of inedical necessity, functional staxus and intensity of
need. These stra.tegies shall efficiently direct individuals to appropriate services and shall
ensure they receive no more and no less than the amount of services determined to be
medically necessary at the appropriate funding level;
(6) To maintain a local presence in order to respond to the unique needs and
priorities of localities;
(7) To ensure communication with consumers, families, providers, and
stakeholders regarding disability-specific and general 1915(b)/(c) Medicaid Waiver
operations by implementing a process for feedback and exchange of information and
ideas;
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(8) To establish and maintain systems for ongoing communication and
coordination regarding the care of individuals with mental illness, intellectual and
developmenta.l disabilities, and substa.nce abuse disorders with other organized systems
such as loca.l Departments of Social Services, Community Care of North Carolina,
hospitals, school systems, the Deparkment of Juvenile Justice and Delinquency
Prevention, and other community agencies;
(9) To mainta.in disability specific infrastructure and competency to address
the clinical, treahnent, rehabilitative, habilitative, and support needs of all disabilities
served by Cardinal Innovations;
(10) To conduct administrative and clinical functions, including requirements
for customer service, quality management, due process, provider network development,
information technology systems, financial reporting, and staffing;
(11) To maintain full accountability for all aspects of 1915(b)/(c) Medicaid
Waiver operations and for meeting aIl contract requir~ments specified by the Department
of Health and Human Services; and
(12) To authorize the utilization of State psychiatric hospitals and other State
facilities.
Section 5. Powers, Duties and Responsibiiities
Cardinal Innovations shall have the powers, duties, and responsibilities necessary
or convenient to carry out the purposes of this Joint Resolution, including but not limited
to, the following:
(1) To engage in comprehensive planning, development, and management of
local systems for the delivery of inental health, intellectual and developmental
disabilities, and substance abuse and related services;
(2) To comply with federal requirements for Medicaid, Medicare, block
grants, and other federally funded healthcare programs;
(3) To perform public relations and community advocacy functions;
(4) To maintain a 24-hour a day, seven day a week crisis response service.
Crisis response shall include telephone and face-to-face capabilities. Crisis phone
response shall include briage and referral to appropriate face-to-face crisis providers.
Crisis services do not require prior authorization, but shall be delivered in compliance
with appropriate policies and procedures. Crisis services shall be designed for
prevention, interventian, and resolution, not merely triage and transfer, and shall be
provided in the least restrictive setting possible, consistent with individual and family
need, and community safety;
(5) To accept donations or money, personal property, or real estate for the
benefit of Cardinal Innovations and to take title to the same from any person, firm,
corporation, or society;
(6) To purchase, lea.se, obtain options upon, or otherwise acquire any real or
personal properiy or any interest therein from any person, fum, corporation, city, county,
government, or society;
('~ To sell, exchange, transfer, assign, or pledge any real or personal property
or any interest therein to any person, firm, corporation, city, county, government, or
society;
(8) To own, hold, clear, and improve properly;
(9) To appoint a Chief Executive Officer and to fix his/her compensation;
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(10) To delegate to its agents or employees any powers or duties as it may
deem appropriate;
(11) To employ its own counsel and legal staff;
(12) To adopt, amend, and repeal bylaws for the conduct of its business;
(13) To enter into contxacts or other arrangements for necessary supplies,
equipment, or services for the opera.tion of its business;
(14) To appoint committees or subcornmittees as it shall deem advisable, to fix
their duties and responsibilities, and to do all tllings necessary in connection with the
management, supervision, control, and operation of its business;
(15) To enter into any contracts or other arrangements with any municipality,
other public agency of this or any other State or of the United States, or with any
individual, private organization, corporation, or nonprofit association for the provision,
oversight or management of inental health, intellectual and developmental disabilities,
substance abuse and related services;
(16) To act as an agent for the federal, Sta.te, or local government in connection
with the mana.gement and oversight for the delivery of inental health, intellectual and
developmental disabilities, substance abuse and related services To insure its property or
operations against risks as it may deem advisabI~;
(17) To invest any funds held in reserves or sinking funds, or any funds not
required for ixnmediate disbursement, in property or securities i.n which trustees,
guardians, executors, administrators, and others acting in a fiduciary capacity may legally
invest funds under their control;
(18) To sue and be sued;
(19) To have a seal and to alter it at pleasure;
(20) To have perpetual succession;
(21) To make and execute contracts and other insfruments necessary or
convenient, including to provide services to government or private entities, including
Employee Assistance Programs;
(22) To agree to limitations upon the exercise of any powers conferred upon it
by this Joint Resolution in connection with any loan;
(23) To determine the pay, expense allowances, and other compensation of its
officers and employees, and establish position class~cation and pay plans and incentive
compensation plans;
(24) To provide for biennial assessments of personnel plans by an independent .
entity that specializes in human resources development and management to ensure that
position classifications and compensation are appropriately matched to industry standards
and local job market requirements; and
(25) To exercise any or all of the powers conferred upon it by this Joint
Resolution, either generally or directly, or tt~rough designated agents.
Section 6. Effective Date
This Joint Resolution sha11 be effective as of July 1, 2012.
A.DOPTED AND RATIEIED in counterparts by the Boards of County Commissioners of
Alamance, Cabarrus,. Caswell, Chatham, Davidson, Franklin, Granville, Halifax, Orange,
Person, Rowan, Stanly, Union, Vance and Warren Counties.
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BOARD OF CONIlVIISSIONERS OF ALAMANCE COUNTY
Approved: 2012.
By:
Chairman
This the da.y of 2012.
ATTEST:
Clerk to the Board
BOARD OF CONIlVIISSIONERS OF CABARRUS COUNTY
Approved: 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Boazd
BOARD OF COMIVIISSIONERS OF CASWELL COUNTY
Approved: , 2012.
BY=.
Chauman
This the day of 2012.
ATTEST:
Clerk to the Board
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BOARD OF COIVIlVIISSIONERS OF CHATHAM COUNTY
Approved_ 2012.
By:
Chairman
This the day of _ 2012.
ATTEST:
Clerk to the Board
BOARD OF COMNIISSIONERS OF DAVIDSON COUNTY
Approved: 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Board
BOARD OF COMI~9ISSIONERS OF FR.A.1vKI,IN COUNTY
Approved: , 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Board
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BOARD OF COMM[SSIONERS OF GRANVILLE COUNTY
Approved: , 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Board
BOARD OF COMMIS~IONERS OF HALIFAX COiTNTY
Approved: 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Board
BOARD OF COMIVIISSIONERS OF ORANGE COUNTY
Approved: , 2012_
By:
Chair
This the day of 2012.
ATTEST:
Clerk to the Board
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BOARD OF CODZNIISSIONERS OF PERSON COUNTY
Approved: , 2012.
By:.
Chairman
This the day of 2012.
ATTEST:
Clerk to the Boazd
BOARD OF COMIVIISSIONERS OF ROWAN COUNTY
Approved: . 2012.
By:
cna~~
This the day of 2012.
ATTEST:
Clerk to the Board
BOARD OF CONIlVIISSIONERS OF STANLY COUN~TY
Approved: . 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Board
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BOARD OF COMIVIISSIONERS OF TJNION COUNTY
Approved: . 2012.
By:
Chairman
This the day of _ 2012.
ATTEST:
Clerk to the Board
BOARD OF COMIVIISSIONERS OF VANCE COUNTY
Approved: 2012.
By:
Chauman
This the day of 2012.
ATTEST:
Clerk to the Board
BOARD OF COMIVIISSIONERS OF WARREN COUNTY
Approved: , 2012.
By:
Chairman
This the day of 2012.
ATTEST:
Clerk to the Board
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MEMORANDUM OF AGREEMENT
PROVISION OF HEALTH INSURANCE BENEFITS
for QUALIFIED RETIREES OF ORANGE PERSON CHATHAM MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE AUTHORITY
WHEREAS, effective July l, 2012 Orange, Person and Chatham
Counties will merge with the counties comprising PBH; and
WHEREAS, prior to the merger, Orange, Person and Chatham Counties
were the three counties that comprised Orange Person Chatham Mental
Health, Developmental Disabilities and Substance Abuse Authority d/b/a
OPC Area Program ("OPC").
WHEREAS, certain qualified employees had retired from OPC and
therefore were receiving post retirement health insurance benefits as
set forth in policies approved by the OPC Board; and
WHEREAS, after the merger, OPC will be dissolved and will not be
an ongoing entity; and
WHEREAS, funds will be provided by OPC prior to the merger for
the purpose of funding the post retirement health insurance benefits
for qualified OPC retirees as shown on Exhibit A hereto; and
WHEREAS, County has agreed to handle the
administration of providing the retiree health insurance and therefore
County will take possession of the funds available for
same and County is willing to do so for no compensation
but also has no individual liability to provide these benefits in the
event the funds set aside for this purpose are exhausted; and
WHEREAS, County will provide a financial report to
each of the county managers of Orange, Person and Chatham Counties no
later than July 315t each year which will include at a minimum the
beginning balance of the fund, charges to the fund and the ending
balance of the fund; and
WHEREAS, in the event funds remain at the end of the obligations
set forth on Exhibit A, the excess funds shall remain with
County for its use and purposes but in the event the
funds are exhausted prior to the time retirees would no longer have
been eligible for coverage had OPC remained an ongoing entity, the
three counties to this Agreement will make up the shortfall, one-third
each. This shortfall sum will be paid to County within
thirty days of determination of a shortfall; and
WHEREAS, the county managers of each county are collectively
given the authority to make any necessary administrative decisions
regarding these funds with the exception of decisions regarding funds
being exhausted.
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NOW, THEREFORE BE IT RESOLVED that each of the counties named
below evidenced by the signature of the Chairman of the Board of
Commissioners hereby agrees to the recitals above regarding the
provision of post retirement health insurance benefits to those
eligible former employees of OPC.
BE IT FURTHER RESOLVED, that no individual liability shall accrue
to County based on its acts or any failure to act in
the performance of its responsibilities pursuant to this Memorandum of
Agreement and that in the event any group, individual, entity, or
qualified OPC employee brings any suit, complaint, claim, or legal
action regarding County's acts or failures to act in
the performance of its responsibilities, such suit, complaint, claim
or legal action shall be defended jointly by each party to this
Memorandum of Agreement.
ORANGE COUNTY DATE
CHAIR CLERK TO THE BOARD
This instrument has been pre-audited in the manner required by
the local government Budget and Fiscal Control Act.
PERSON COUNTY
CHAIRMAN
(SEAL)
Finance Officer for Orange County
DATE
CLERK TO THE BOARD
This instrument has been pre-audited in the manner required by
the local government Budget and Fiscal Control Act.
(SEAL)
Finance Officer for Person County
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CHATHAM COUNTY
CHAIRMAN
DATE
CLERK TO THE BOARD
This instrument has been pre-audited in the manner required by
the local government Budget and Fiscal Control Act.
( S EAL )
Finance Officer for Chatham County
11096\O1\m\100Agreement for Provision of Insurance Benefits for Retirees - Final 03.19.12
Exhibit A
OPC Area Authority Retiree Profile
As of 7/ 1 /2012
Name
DOB Months until
Age 65
Projected Cost
A 1/23/48 6 4,157.16
B 7/21/48 12 4,365.02
C 8/5/48 13 9,492.18
D 3/17/50 32 25,207.63
E 3/31/51 44 36,458.43
F 11/23/S 1 52 44,573.76
G 1/14/52 54 46,602.60
H 4/14/53 69 63,675.22
I 4/13/54 81 78,772.78
J 3/17/55 92 93,894.89
K 9/14/55 95 102,806.13
50~ Benefit
16
GRAND TOTAL $ 510,005.80
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ORANGE COUNTY
~~~~ BOARD OF COMMISSIONERS
ACTION AGEND
Meeting Date: March 15, 2012
Action Agenda
Item No. 1
SUBJECT: OPC Local Management Entity (LME) - Transition Management and Retiree
Health Insurance Plannin
DEPARTMENT: County ManageNOPC PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): INFORMATION CONTACT:
- Gwen Harvey, Assistant County
Materials Addressing Two Discussion Manager, 245-2307
Topics including Proposed Resolution Judy Truitt, OPC Area Program
Director, 913-4000
PURPOSE: OPC (Orange, Person and Chatham Mental Health LME) is effecting elements
of an agreed upon merger with PBH (Piedmont Behavioral Health) effective April 1, 2012.
The BOCC is asked to review two management proposals pertinent to the merger - First,
creation of an advisory and governance structure; and Second, a transition plan that
provides continuation of healthcare benefits for OPC retirees. Details are presented in
the following narrative and attachments.
BACKGROUND: Considerable analysis and negotiation befinreen OPC and PBH - guided and
directed by their appointed boards - has taken place over many months to reach this point in
accomplishing a formal merger. The various attachments contain specific details on the history,
evolution, and current status of OPC in relation to PBH.
The work session setting allows the BOCC dedicated opportunity to discuss concerns in an
informal setting. Judy Truitt, OPC LME Director, will guide the BOCC through the proposed
measures and summarizing collective efforts.
Commissioner Steve Yuhasz is the current BOCC liaison to the OPC Board. Commission Chair
Bernadette Pelissier preceded him in this role.
Contingent upon work session discussion, the Board of Commissioners is tentatively scheduled
to formally consider the attached resolution approving the proposal at the March 22, 2012
regular Board meeting.
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FINANCIAL IMPACT: There is no financial impact associated with discussion of the finro issues
related to the Orange Person-Chatham Area Program (OPC).
RECOMMENDATION(S): The Manager recommends that the Board discuss both issues as
outlined above and in the attachments and provide any direction to staff. Contingent upon
discussion, staff will move forward with scheduling the resolution for consideration at the March
22, 2012 regular Board meeting.
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AGENDA ABSTRACT BACKGROUND
Meeting Date: March 15, 2012
Agenda Title: OPC Mentcxl Health, Developmentai Disabilities 8~ Substance
Abuse Authority - Transition Management
Item 1- Resolution Regarding Governance for Consolidated
Pubiic Mental Health Entity Operating as a Managed Care
Organization
Item Z- Healthcare Benefits for OPC Area Authority Retirees
Summary of information - item 1: In Februory2011 the Norfh Carolina General
Assembly passed legislation which required both implementation of a statewide
Medicaid waiver for the public mental health system, as well as consolidation of
existing area authorities based on total population.
On May 17, 2011 the Orange County Board of Commissioners voted unanimously to
move forward in merger negotiations with PBH, the area authority serving Cabarrus,
Davidson, Rowan, Stanly and Union Counties. Since that time Alamance, Caswell,
Franklin, Granville, Warren, Vance & Halifax have joined with PBH. On April 1, 2012
the Medicaid waiver will be opened in Orange, Person and Chatharn counties,
creating what will be at that time a service area of fifteen (15) counties, with a total
covered population of 1,442,989. OPC will then move fonvard in a due diligence
process that is expected to lead to the dissolution and subsequent consolidation of
OPC into the PBH system on June 30, 2012.
In October 2011 PBH hosted a work session with representatives from OPC,
Alamance Caswell and Five County to review existing statute regarding
governance of public mental health authorities and to consider possible
governance options for the new consolidated entity that would be operating as a
managed care organization.
Under current Norfh Carolina General Statute § 122C-1 18.1 area mental health
authorities are governed by Area Boards established by the Boards of
Commissioners in each catchment area (see attached). 122C-118.1 indicates that
"an area board shall have no fewer than 1 l and no more
20
than 25 members. However, the area board for a mvlticovnty
area authority consisting of eight or more covntres may have
up to 30 members... appointments shall take into accovnt sufficient
citizen parficipation, representation of the disability grovps,
and eqvitable representation of the parficipating covnties."
Area authorities across the state are concerned that the existing governance
model will not adequately supporf operations in a managed care environment
from the perspective of both board size and subject specific expertise on the
board. On the other hand there are also concerns about the role of the
parficipating counties in the management of behavioral healthcare in the future.
A placeholder bill was introduced in the 2011 long session of the North Carolina
General Assembly that opened the door for discussions related to possible changes
in the governance model, with the hope that either new or revised legislation could
be considered in the 2012 shorf session.
To respond to all aspects of this issue and to prepare our communities for successful
implementation of the Medicaid waiver, PBH and their participating partners have
created the attached proposal related to governance. In summary this proposal
creates a Community Oversight Board that is appointed by local Commissioners; is
responsible for oversight of the local service system; and has input at the
governance level. A new Governance Board would be created with
representation from each of the local advisory boards; requires appointment of two
Commissioners from within the catchment area; has a voting seat for a Consumer 8~
Family Advisory Committee representative; and has representation from subject
specific experfs in the field.
The proposed model could be adopted under NCGS § 122C-118.1 which reads
"The boards of counfiy commissioners within the multicounty area
shall have the option to appoint the members of the area board in a
manner other than as reqvired under this section by adopting a
resolution to that effect."
Recommended Action:
PBH and their participating parfners would ask that the Orange County Board of
Commissioners pass the attached resolution. The OPC Area Board met on February
13th and all members in attendance dgreed to supporf the model as presented.
Summary of information - Item 2: OPC Area Authority is considered a local
political subdivision of the state and as such our employees have been eligible to
participate in the state employees' retirement system. At the time of retirement
healthcare coverage for eligible retirees was defined by policy established by the
21
OPC Area Board (see attached). In summary an individuai who was enrolled in the
agency's health care plan during their employment would be eligible to continue
healthcare coverage as a retiree under specific criteria defined by agency policy.
OPC currently has seven retirees who qualified for healthcare coverage, with five
a~lditional employees who will be retiring at the end of March. Of the seven
current retirees, one will reach will reach the age of 65 at the end of June and
would no longer be e(igible for the healthcare benefit. A basic profile of the other
retirees is attached.
When OPC dissolves on June 30, 2012 the agency's current health plan will
terminate, including coverage for e(igible retirees. As pdrt of our due diligence
process OPC has been exploring options regarding continued coverage for
retirees, as well as identifying potential funding to do so. A workgroup was
established that included Commissioners and county management
representatives, as well as management staff and legal counsel for OPC. One of
the options discussed by the workgroup was for OPC retirees to be covered under
a county health plan. Investigation of this option is currently underway.
Recommended Action: The OPC Area Board and senior management would ask
that the Orange County Board of Commissioners approve identified OPC retirees
being included under the covnty healthcare plan until such time as they are
eligible. for Medicare coverage. OPC Area Authority will provide funds for the
purpose of funding the post-retirement health insurance benefits for qualified OPC
employees.
Submitted By: Judy R. Truitt, OPC Area DirectoNCEO'
' Please note that PBH will be changing the name of the new fiffeen county area
authority from PBH to Cardinal lnnovations Healthcare Solutions. Local community
operations centers will continue under their current names, i.e. Orange, Person 8~
Chatham counties will be known as OPC Community Operations Center.
GS 122C-I18.1
§ 122C-118.1. Structure of area board.
Page 1 of 2 2 2
(a) An area board shall have no fewer thau 11 and no more than 25 members. However, the area
board for a multicounty area authoriiy consisting of eight or mare counties may have up to 30 members.
In a si.ngle-county azea authority, the members shall be appointed by the board of county
commissioners. Except a.s otherwise provided, in areas consisting of more than one county, each board
of couniy commissioners withiu the area shall appoint one commissioner as a member of the area board.
These members shall appoint the other members. The boards of counfy commissioners within the
multicounty area shall ha.ve the option to appoint the members of the area board in a manner otlier than
as required under this section by adopting a resolution to that effect. The boards of county
con~unissioners in a multicounty area authority shall iudicate in the business plan each board's method of
appointment of the area board members in accbrdauce with G.S. 122C-115.2(b). These appoin#~nents
shall take into account su~cient citizen participation, representation of the disabiliiy groups, and
equita.ble representa.tion of participating counties. Individuals appointed to the board sl~.all include ri~o
individuals with financial e~pertise, an individual with expertise in maiiagement or business, aud au
individual representing the interests of children. A member of the board may be removed with or
without cause by the uutial appointing authority. Vacancies on the board shall be filled by the initial
appoint~ng authority before the end of the term of the vacated seat or withiii 90 days of the vacaiicy;
whichever occurs first, and the appointments shall be for the remainder of the unexpired terrn.
(b) Except as otherwise provided iri this subsection, not more tha.n fifly percent (50%) of the
members of the. area board shall represent the following:
(1) A physician licensed under Chapter 90 of the General Statutes to practice medicine in
North Carolina who; when possible, is certified as having complefed ~a residency in
~ . PSY~~~'- . .
(2) A clinical professional from the fields of inental health, clevelopmental disabiIities, or
, substance abuse.
. (3) At least one family member or individual from a citizens' organizatian composed
prisnarily of consumers or their family members, representing the interests _ of
individuals: ~
a. With mental illness; .
b. In recovery,from addiction; or ~ .
c. With developmental disabilities.
(4) At least one openly declared consumer:
a. With mental illness;
b. With development~l disabilities; or ~~ .
c. In recovery from addiction. ~
An individual that contracts with a local management entity (LME) for the c~elivery of inental health,
developmental disabilities, aud substance abuse services may not serve on the board of the LME ~for tlie
period during which the contract for services is ui effect.
(c). The board of county commissioners may elect to appoint a member of the area authority
board to fill concurrently no more than two categories of inemberslup if the member has the
qualifications or attributes of the two categories of inembership.
(d) Any member of an area board who is a couniy commissioner serves on the boazd in an ex
officio capacity at the pleasure of the initial appointing authority, for a term not to exceed the member's
service as a county commissioner. Any member of an area board who is a county manager serves on the
board at the pleasure of the initial appointing authority, for a term not to exceed the duration of the
meznber's employment as a counfy manager. The terms of the other members on the area board shaIl be
for three years, except that upon the initial fom~ation of an area board one-fliud shall be appoiuted for
one year, one-thud for two years, aitd all remaining members for three years. MernUers, otlier than
coiulty commissioners and county managsrs, shall not be appointed for nzore than two consecutive
http_//www.ncleg.net/EnactedLegislatioriJStatutes/HTIv1I,BySection/Chapter 122C/GS 1... 2/20/2012
GS 122C-118.1
Page 2 of Z 23
tenns. Board members serving as of July 1, 2006, may remain on the board for one additional terxn.
Tlus subsection applies to all area authoziiy board members regardless of the procedure used to appoint
members under subsection (a) of this section.
{e) Upon request, the board shall provide informa.tion pertaining to the memberslup of the board
that is a public record un.der Chapter 132 of the General Staiutes. (2001-437, s. l.l l(b); 2002-159, s.
40(a); 2006-142, s. 4(e); 2007-504, s: 1.4; 2010-31, s. 10.7.) ~
http://vaww.ncleg.net/EnactedLegislation/Statutes/HTMLByS ection/Chapter_122C/GS_ 1... 2/20/2012
24
~~~~~~~~ ~~~~~~~~~ ~~~~~~~
• 1 CFAC Chair or designee
• 3 members from each county,
appointed by the County Commission
- County Commissioner or designee
- Consumer or family member
- Other citizen or stakeholder
~~t~~~~~~ t~~r~t~i~h~ ~t~~~
1- /
~ 3
~' ~ ~ ~`~,
~Orang~~~
~.~-~..;: ,~..~~:
~.~o~nt~r ~
€~.~,._~ ~:'
3
~ ~
, Person
County
~ - °:~
25
~Qr~rnur~it~ ~~~r~i~~~ ~a~rc~
R~~~~n~i~i~i~t~~E
- Advise the CEO on the evaluation and hirin~ of the
Community Operations Center Executive D~rector
- Recommend priorities for expenditure of state/county
funds for development of the annual budget
- Determine local priorities for inclusion in the area wide
strategic plan, as possible
- Identif~r community needs and concerns, monitor
resolution of issues
- Monitor performance at the local (COC) levet:
• Access to care
• Financial status and eacpenditures
• Service delivery
• Provider Network size and composition
• Outcomes
• Consumer satisfaction
~c~~~rn~ n~ ~a ~-c~
i~ M~m~r~
Terms of office: max two four year terms; as long as the individual remains a
member of the Community Operetions Center Board, regional CFAC, and
County Commission.
• One representative from each Community Oversight Board (Chair or other
elected member)
• Two at large County Commissioners from among the counties. Governing
Board asks for interested parties among commissioners serving on the
Community Operations Center Boards. Governing Board elects two.
• One representative from the regiona) CFAC, elected by the regional CFAC.
• Six members with special expertise in healthcare, irtsurence, finance, and
health/behavioral health physician or other professionai ; no more than 2
from any specialty area; from corsstituent counties if at aIi possibie.
(Initially appointed by the Seaetary of DHHS. Board ~mmittee recruits
for vacancies and recommends replacement to the full Board. Vacancies to
be elected by the board. )
26
Governance Board
Responsible for:
-Policies
-Strategic ptan
-Budget
-Hire, fire and evaluate CEO
-Monitor deliverables (e.g., performance, financial
management)
-Political advocacy
-Strategic planning, including consideration of Iocal priorities
brought forward by the COC Boards
Accountabfe for organizational perFormance
-Responsible for the overall health of the organization
-Reporting to the constituent counties
-Responsible for responding to concerns and feedback from
COC Boards.
27
~,, ~~~:".
OPC Area Program Policy and Procedures
Subject: Heafth Care Beneftts
For Eligible Retirees
Policy Manual: Human Resources
Area Board Approvat: October 2Q08
Procedures fmplementation Date: 4/97
Revision Date: Nov 2000, Dec 2007
P~{icy:
OPC Area Program wifl pravide health insurance benefits to etigible retirees as
approved by the Area Board.
An employee enrolled in an OPC heaith care pian wiil be eligibie to cantinue healthcare
coverage as a retiree untii they are eligibie for Medicare, provided they meet the
following criteria:
a. They are retiring from OPC, and;
b. They have 10 years of service with ~PC, and;
c. They are at leasf fi0 years old; ~R ~
d. They have 30 years of service w~th OPC at the time of fheir retirement.
OPC wii! contribu#e one-half of the employer's portion of the health insurance premium
for an employee with 10 years of service who meets the above criteria. The
percentage wiil increase by 5% for each additional year of employmenE with OPC. This,
for example, wauld resuft in. OPC paying 75°!o af the employer's premium for an
employee retiring with 15 years of service with OPC_ Er~ployees with 20 or mare years
of service at OPC and who are 60 years of age or older wifl receive credif for the entire
employer premium.
OPC does nat contribute to the cost of dental, life, disability or Medicare supplemenfs
for retirees.
Employees are responsible for the premiums associated with spousal or dependent
c~verage. When an employee becomes Medicare-eligible, dependents covered under
the OPC healthcare plan are eligible to continue coverage under COBRA in accordance
with specific legal requirements that govem that program.
6