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HomeMy WebLinkAboutOPC Steering Committee 042804 Orange Person Chatham System Reform Steering Committee April 28 , 2004 � Agenda • Status report on Interlocal Cooperation Agreement for the Provision of Mental Health , Developmental Disability and Substance Abuse Services Between Orange , Person , and Chatham Counties • Division of Mental Health Communication Bulletin # 16 • Division of Mental Health Communication Bulletin # 17 • Divestiture update • Developments among neighboring programs • CFAC report Handouts • Communication Bulletin # 16 • Communication Bulletin # 17 Ann ;dimmer - OPC Steering Committee for Mental Health System Reform Pagel From : " Judy Truitt " < JTRUITT@opc - mhc . org > To . < S . t . schwartz@att . net > , < dbaker@co . orange . nc . us > , < gharvey@co . orange . nc . us > , < JLINK@co . orange . nc . us > , < chatmgr@emji . net > , < mpollard@emji . net > , <jimmyb31 @juno . com > , < Mwbrown@mindspring . com > , <janet . sowers@ncm ail . net > , < scarpenter@ person county . net > Date : 4 /26/2004 5 : 20 : 50 PM Subject : OPC Steering Committee for Mental Health System Reform The OPC Steering Committee for Mental Health System Reform is scheduled to meet Wednesday , April 28 , 2004 , 2 : 00 to 4 : OOpm , at Europa Center Training Room . Proposed agenda items include : 1 . Status report on Interlocal Cooperation Agreement 2 . Division of Mental Health Communication Bulletin # 16 ( attached ) 3 . Division of Mental Health Communication Bulletin # 17 ( attached ) 4 . Divestiture update 5 . Developments among neighboring programs 6 . CFAC report Please do not hesitate to call should you have any questions or concerns . Judy Judy Truitt Director - Quality Improvement OPC Area Program 919 - 9134037 * * * * * * * * * * * * * * * * ** * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * This e - mail message including attachments , if any , is intended for the use of the individual or entity to which it is addressed . This message may contain information that is privileged , proprietary , confidential and exempt from disclosure . If you are not the intended recipient , you are notified that any dissemination , distribution or copying of this communication is strictly prohibited . If you have received this message in error , please notify the sender and erase this message immediately . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** * * CC : < LNease@BROWNANDBUNCH . com > , < arimmer@co . orange . nc . us > , " Tom Maynard " < TMAYNARD@opc- mhc . org > co * 4WM '�• North Carolina Department of Health and Human Services Division of Mental Health , Developmental Disabilities and Substance Abuse Services 3001 Mail Service Center • Raleigh , North Carolina 27699 - 3001 Tel 919 - 733 - 7011 • Fax 919 - 733 - 1221 Michael F . Easley , Governor Richard J . Visingardi , Ph . D , Director Carmen Hooker Odom , Secretary March 29 , 2004 MEMORANDUM To : Legislative Oversight Committee Members MH/DD/SAS Commission Consumer/Family Advisory Committee Chairs Advocacy Organizations and Groups North Carolina Association of County Commissioners County Managers County Manager Chairs North Carolina Council of Community Programs Area Program Directors Area Program Board Chairs Provider Organizations MH/DD/SAS Professional Organizations and Groups MH/DD/SAS Stakeholder Organizations and Groups Other MH/DD/ SA S Stakeholders From : Richard J . Visingardi , Ph . D . Michael Moseley Re : Communication Bulletin # 016 ¢� x <<.� Criteria and Procedure for Approval ofIt Service Delivery by an ArealCounty Program i "" General Statute 122C - 112 . 1 (a) (26) requires the Secretary of the Department of Health and Human Services to " [ e ] stablish a process for approving area authorities and county programs to provide services directly in accordance with G . S . 122C - 141 . " The attached document sets forth the criteria and process for approval of direct service delivery by : (a) an area or county program which serves as the LME ; or (b) by a separate county department when another area/county program serves as the LME . In establishing and applying these criteria, the Department ' s primary considerations are service availability, choice for consumers and compliance with General Statutes . Another consideration is preventing or reducing the potential for conflicts of interest related to LME service management and direct service provision . Please contact Dick Oliver at 919 - 715 - 1294 or e-mail Dick . Oliver@ncmail . net, if you have questions regarding this document . Attachment cc : Carmen Hooker Odom DMH/DD/SAS Executive Leadership Team Jim Klingler Lanier Cansler Dick Oliver Richard Slipsky James Bernstein Kaye Holder DHHS Division Directors Wayne Williams l Criteria for the Approval of Direct Service Provision by Area Authorities and County Programs (G. S . 122C112 . 1 and G . S . 122C141 ) Effective : April 1 , 2004 1 . Area Authority ' /County Program is the Local Management Entity (LME) and also proposes to continue to provide one or more services (see item 3 . a . for LMEs with approved Local Business Plans) : a . List of the services to be provided and a justification for the Area Authority/County Program to directly operate those services , including the impact on consumers and the community if the LME does not provide such services ; b . Documentation of efforts to solicit private providers for the services the LME proposes to provide , including copies of RFPs/RFIs , summary of the RFI responses received, minutes from public meetings , other documentation of provider recruitment efforts , and any concerns raised by the responses to the solicitation ; c . Description of how the LME will continue to develop community capacity and continue to work toward divestiture ; d . Description of how consumers will be offered a choice of providers for the services the LME operates ; e . Description of the process in place to ensure that consumers are not " steered" to LME- operated services and the safeguards the LME will implement to ensure that consumers receive only the services they need; f. Certification from the LME that it understands that it will be reimbursed for the services that it operates in the same manner and at the same rates as any other service provider . No provisions will be made for the payment of any additional administrative cost associated with a governmental entity . 2 . Area Authori L/Counjy Program is the LME and a separate counly program is proposed to be created or expanded as a service provider : a . List of the services to be provided by the new or expanded county department ; b . Rationale for the creation or expansion of a county department to provide services including the impact on consumers and the community if the new or expanded county department does not provide such services ; c . Description of the private providers available in the community to provide the services proposed to be offered by the new or expanded county department ; d . Documentation of efforts to solicit private providers for such services , including copies of RFPs/RFIs , summary of the RFI responses received, minutes from public meetings , other documentation of provider recruitment efforts , and any concerns raised in the responses to the RFP/RFI solicitations ; e . Description of the organizational , management, and supervisory relationship between the LME and the county service provider program and the safeguards that will be in place to ensure that consumers are not " steered" to the county program ; f. Description of how the LME will ensure consumers are offered a choice of providers for services the county operates ; g . Certification of understanding from the Board of County Commissioners of the county proposing to deliver services that the county ' s required Maintenance of Effort contribution to the cost of mh/dd/sa services per G . S . 122C - 115 will be paid to the LME , not to the county program providing services ; h . Certification from the LME that it has advised the Board of County Commissioners of the county proposing to deliver services that that the county program will be reimbursed for the services that it operates in the same manner and at the same rates as any other service provider . No provisions will be made for the payment of any additional administrative cost associated with a governmental entity . 3 . Process for Requesting_Approvals , a . Requests are to be submitted through the LME Systems Performance Team member assigned to the Area/County Program ; b . Division staff will review the request and forward it, with a recommendation , to the DHHS Secretary for review , c . Upon final action by the Secretary, the Division will communicate the decision in writing to the area/county program and county manager( s ) . d . Implementation exception : For area/county programs with approved Local Business Plans (LBPs) which detailed services to be operated by the area/county program during the time period covered by the LBP , the services remain approved and no additional action is required at this time . At the end of the currently approved LBP cycle , or if the area/county program determines that it should provide additional services within its currently approved LBP , this new procedure must be followed to obtain approval from the Secretary for the provision of such additional services . - - -- -- - - - - - - - - - - - - - - - - - - - 1 The term Area Authority is used here to apply to either (a) a multi -county area authority or (b) a multi - county county model via an interlocal agreement organization serving as the LME . 2 This scenario could apply as follows : a single county elects to convert its area authority to a county department to be a service provider and to join with other counties to form an Area Authority or multi- county interlocal agreement to perform LME functions . NOTE : In all of these options , the Secretary may choose to approve the arrangement indefinitely or for a limited time period only . d cSfATE4 C i 40" M1T y � QVAM �• North Carolina Department of Health and Human Services Division of Mental Health , Developmental Disabilities and Substance Abuse Services 3001 Mail Service Center • Raleigh , North Carolina 27699 - 3 001 Tel 919J33J011 • Fax 919 - 733 - 1221 Michael F . Easley , Governor Carmen Hooker Odom , Secretary Michael Moseley , Director April 22 , 2004 MEMORANDUM To : Legislative Oversight Committee Members MH / DD/SAS Commission Consumer/ Family Advisory Committee Chairs Advocacy Organizations and Groups North Carolina Association of County Commissioners County Managers County Manager Chairs North Carolina Council of Community Programs State Facility Directors Area Program Directors Area Program Board Chairs Provider Organizations MH / DD /SAS Professional Organizations and Groups MH / DD /SAS Stakeholder Organizations and Groups Other MH / DD/SAS Stakeholders From : Mike Moseley Re : Communication Bulletin # 017 *Sqwe plan - Maintaining Public Sector Access onununic r to Psychiatrists The purpose of this communication is to provide guidance as area /county programs proceed with divestiture of currently employed psychiatrists . Psychiatrists play a crucial role in diagnosing , treating and medically managing the care of persons with mental illness , developmental disabilities and substance abuse disorders . There are approximately 850 psychiatrists in North Carolina working in various settings , e . g . , academia , private practice , state facilities , federal facilities , public mental health clinics , etc . According to the U . S . Bureau of Primary Health Care , ninety- seven ( 97 ) of the State ' s one hundred ( 100 ) counties are designated as under served relative to psychiatry . The continued availability of this relatively scarce psychiatry resource for public sector clients is pivotal as system reform unfolds and the local authorities assume greater responsibility for serving those clients who are the most disabled . It is , therefore , incumbent upon the managers of the public mental health , developmental disabilities and substance abuse services system to maintain , at the very least , the current level of client access to psychiatrists . As reform proceeds , area/county programs will continue to divest of the responsibility to provide direct client services . In some instances , divestiture may occur without appreciable disruption of psychiatric services to public sector clients . For example , there is an adequate number of private psychiatrists who are willing to assume the responsibility or current area program psychiatrists are able to move to other organizations , existing or new , to provide services to public sector clients . In other cases , however , there is reason to be concerned that psychiatrists may leave public sector work and not be readily replaced by other psychiatrists - whether because they are laid off or because they conclude that given an uncertain professional future they are bette r advised to pursue other career opportunities . Consequently , area /county programs should consider the following issues in proceeding with divestiture of currently employed psychiatrists : 1 . Area Programs should analyze the likely availability of psychiatrists to provide services for their clients , whether by currently employed individuals or by others in the catchment area . In general , contract services relying on " locum tenens " psychiatrists or psychiatrists newly moved into the area should be avoided , since these may not provide a stabl e pool of psychiatrists . 2 . When there are not likely to be psychiatrists available other than those currently employed by the area program , divestiture of those staff physicians should be delayed until measures are in place to ensure continuity of psychiatric services , and consideration should be given to requesting a waiver to continue to employ current psychiatry staff. 3 . When the area program psychiatrist ( s ) is/are the only psychiatrist ( s ) available in the catchment area , strong consideration should be given to requesting a waiver to continue their employment . 4 . If an area /county program determines that psychiatric services cannot be divested at the present time , the program must ensure that adequate safeguards are put in place to segregate the activities of the psychiatrists as service providers from the LME functions that the psychiatrist might perform . Such functions might include utilization management and clinical specialist reviews as part of customer services . This communication should in no way be construed as a retreat from the fundamental requirement for area programs to divest of direct service responsibility . It is , however , an acknowledgement of the differential impact that current reimbursement streams and rate structures , both public and private , have on the practice of psychiatry . Any questions regarding this communication should be directed to Joan Kaye at 919 - 733 - 7011 orjoan . kaye@ncmail . net . cc : Carmen Hooker Odom Jim K lingler Lanier Cansler Dick Oliver James Bernstein Kaye Holder DHHS Division Directors Wayne Williams DMH / DD/SAS Executive Leadership Team Richard Slipsky Rob Lamme DMH / DD /SAS Staff OPC Steering Committee Minutes March 20 , 2004 Members Present : Jimmy Clayton , Steve Carpenter , Margaret Pollard , Charlie Horne , Sue Schwartz , Janet Sowers , Gwen Harvey , John Link , Margaret Brown Staff Present : Tom Maynard , Judy Truitt , LeAnn Brown Call to Order Tom Maynard called the meeting to order at 2 : 10 p . m . Introductions were held . I . Status Report on Draft Interlocal Cooperation Agreement The committee reviewed the drafted agreement with points of consideration recommended by Gwen Harvey , Charlie Horne and Steve Carpenter . They are as follows : Page 4 : Name of Organization — OPC LME Page 6 : Implementation Date — July 1 , 2005 Page 7 : Governing Board of LME — include in Bylaws Change wording to read " either of the three counties " Delete line regarding residence Page 8 : # 7 Changing to 2 - year term from 4 - year term — 1 St Board will serve for 2 years and 6 months and then commencing on January 1st . # 8 Include 90 days to fill the vacancy Page 9 : Meeting of the Governing Board — Board will meet monthly except in the months of July , August and December # 11 majority of members constitute quorum which means 4 must be present Page 10 & 11 : Functions of the Advisory Committee — recommended governing board make these decisions Page 11 : Advisory committee must report to a County Manager . John Link recommended we revert back to the original language rotating on 4 - month intervals . Page 12 : Appointment of LME Director — accept what had previously been proposed Page 14 : #25 : Manner of appointing personnel : three counties Interlocal agreement should be finalized by April 12t" by LeAnn Brown . Margaret Brown requested that Tom Maynard ask for a letter of clarification from DMH regarding comments made by Alice Lin about divestiture at the meeting with Dr . Visingardi . II . Status Report on Proposed Changes to NC General Statute Resolution for legislative action has been stalled by Representative Insko ' s comments to the Legislative Delegation that such a change is not needed . Follow up needed to clarify . III . Review of Appendix A Revised Appendix A distributed for review . Iv . FY2005 Budgeting Process & Schedule Mr . Maynard reviewed proposed changes to budgeting process to include the need for three budgets and how they will work . The three budgets discussed were Management , Client Care and Internal Service Budgets . v . CFAC Report Janet Sowers reported that one of the CFAC ' s main concerns is the Best Practice document distributed by DMH . They do not feel it reflects clients ' thoughts on Best Practice . Ms . Sowers stated that the members were confused about the RFP process that they have been asked to sit in on and needed clarification of this process and their role . Some members feel that Orange County does not offer some of the services that other counties offer and that most of the money is going towards those with Developmental Disabilities . Mr . Maynard recommended CFAC present their budget information to the Board and to the Steering Committee , Ms . Sowers thanked OPC for the strong leadership they provide . Next Meeting The next meeting is scheduled for April 28 , 2004 . 2pm to 4pm . Adjournment Meeting adjourned at 4 : 00 pm . Ann Rimmer - OPC Steering Committee for Mental Health System Reform Page 1 From : "Judy Truitt" < JTRUITT@opc - mhc . org > To . < S . t . schwartz@att . net > , < dbaker@co . orange . nc . us > , < gharvey@co . orange . nc . us > , < JLINK@co . orange . nc . us > , < chatmgr@emji . net > , < mpollard@emji . net > , <jimmyb31 @juno . com > , < Mwbrown@mindspring . com > , <janet . sowers@ncmail . net > , < scarpenter@ person county . net > Date : 4/26/2004 5 : 20 : 50 PM Subject : OPC Steering Committee for Mental Health System Reform The OPC Steering Committee for Mental Health System Reform is scheduled to meet Wednesday , April 28 , 2004 , 2 : 00 to 4 : OOpm , at Europa Center Training Room . Proposed agenda items include : 1 . Status report on Interlocal Cooperation Agreement 2 . Division of Mental Health Communication Bulletin # 16 ( attached ) 3 . Division of Mental Health Communication Bulletin # 17 ( attached ) 4 . Divestiture update 5 . Developments among neighboring programs 6 . CFAC report Please do not hesitate to call should you have any questions or concerns . Judy Judy Truitt Director - Quality Improvement OPC Area Program 919 - 913 -4037 * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * ** * * * * * * ** * * * * * * * * * * * * * * * * This e - mail message including attachments , if any , is intended for the use of the individual or entity to which it is addressed . This message may contain information that is privileged , proprietary , confidential and exempt from disclosure . If you are not the intended recipient , you are notified that any dissemination , distribution or copying of this communication is strictly prohibited . If you have received this message in error , please notify the sender and erase this message immediately . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * CC : < LNease@BROWNANDBUNCH . com > , < arimmer@co . orange . nc . us > , " Tom Maynard " < TMAYNARD@opc- mhc . org > � , iWr •� � North Carolina Department of Health and Human Services Division of Mental Health , Developmental Disabilities and Substance Abuse Services 3001 Mail Service Center • Raleigh , North Carolina 27699 - 3001 Tel 919 - 733 - 7011 • Fax 919 - 733 - 1221 Michael F . Easley , Governor Richard J . Visingardi , Ph . D , Director Carmen Hooker Odom , Secretary March 29 , 2004 MEMORANDUM To : Legislative Oversight Committee Members MH/DD/ SAS Commission Consumer/Family Advisory Committee Chairs Advocacy Organizations and Groups North Carolina Association of County Commissioners County Managers County Manager Chairs North Carolina Council of Community Programs Area Program Directors Area Program Board Chairs Provider Organizations MH/DD/ SAS Professional Organizations and Groups MH/DD/SAS Stakeholder Organizations and Groups Other MH/DD/ SA S Stakeholders From : Richard J . Visingardi , Ph . D . Michael Moseley Re : Communication Bulletin # 016 Criteria and Procedure for Approval of yy Service Delivery by an Area/County Program " t x General Statute 122C4 12 . 1 (a) (26) requires the Secretary of the Department of Health and Human Services to " [ e ] stablish a process for approving area authorities and county programs to provide services directly in accordance with G . S . 122C- 141 . The attached document sets forth the criteria and process for approval of direct service delivery by : (a) an area or county program which serves as the LME ; or (b ) by a separate county department when another area/county program serves as the LME . In establishing and applying these criteria, the Department ' s primary considerations are service availability , choice for consumers and compliance with General Statutes . Another consideration is preventing or reducing the potential for conflicts of interest related to LME service management and direct service provision . Please contact Dick Oliver at 919 - 715 - 1294 or e-mail Dick . Oliver@ncmail . net, if you have questions regarding this document . Attachment cc : Carmen Hooker Odom DMH/DD/SAS Executive Leadership Team Jim Klingler Lanier Cansler Dick Oliver Richard Slipsky James Bernstein Kaye Holder DHHS Division Directors Wayne Williams Criteria for the Approval of Direct Service Provision by Area Authorities and County Programs (G. S . 122C412 . 1 and G. S . 122C441 ) Effective : April 1 , 2004 1 . Area Authority ' /County Program is the Local Management Entity (LME) and also proposes to continue to provide one or more services ( see item 3 . a . for LMEs with approved Local Business Plansj : a . List of the services to be provided and a justification for the Area Authority/County Program to directly operate those services , including the impact on consumers and the community if the LME does not provide such services , b . Documentation of efforts to solicit private providers for the services the LME proposes to provide , including copies of RFPs/RFIs , summary of the RFI responses received, minutes from public meetings , other documentation of provider recruitment efforts , and any concerns raised by the responses to the solicitation ; c . Description of how the LME will continue to develop community capacity and continue to work toward divestiture ; d . Description of how consumers will be offered a choice of providers for the services the LME operates ; e . Description of the process in place to ensure that consumers are not " steered" to LME - operated services and the safeguards the LME will implement to ensure that consumers receive only the services they need , f. Certification from the LME that it understands that it will be reimbursed for the services that it operates in the same manner and at the same rates as any other service provider . No provisions will be made for the payment of any additional administrative cost associated with a governmental entity . 2 . Area Authority/County Program is the LME and a separate county program2 is proposed to be created or expanded as a service provider : a . List of the services to be provided by the new or expanded county department; b . Rationale for the creation or expansion of a county department to provide services including the impact on consumers and the community if the new or expanded county department does not provide such services ; c . Description of the private providers available in the community to provide the services proposed to be offered by the new or expanded county department ; d . Documentation of efforts to solicit private providers for such services , including copies of RFPs/RFIs , summary of the RFI responses received, minutes from public meetings , other documentation of provider recruitment efforts , and any concerns raised in the responses to the RFP/RFI solicitations ; e . Description of the organizational, management, and supervisory relationship between the LME and the county service provider program and the safeguards that will be in place to ensure that consumers are not " steered" to the county program ; f. Description of how the LME will ensure consumers are offered a choice of providers for services the county operates ; g . Certification of understanding from the Board of County Commissioners of the county proposing to deliver services that the county ' s required Maintenance of Effort contribution to the cost of mh/dd/sa services per G . S . 122C - 115 will be paid to the LME, not to the county program providing services ; h . Certification from the LME that it has advised the Board of County Commissioners of the county proposing to deliver services that that the county program will be reimbursed for the services that it operates in the same manner and at the same rates as any other service provider. No provisions will be made for the payment of any additional administrative cost associated with a governmental entity . 3 . Process for Requesting Approvals : a . Requests are to be submitted through the LME Systems Performance Team member assigned to the Area/County Program ; b . Division staff will review the request and forward it, with a recommendation , to the DHHS Secretary for review ; c . Upon final action by the Secretary, the Division will communicate the decision in writing to the area/county program and county manager( s ) . d . Implementation exception : For area/county programs with approved Local Business Plans (LBPs) which detailed services to be operated by the area/county program during the time period covered by the LBP , the services remain approved and no additional action is required at this time . At the end of the currently approved LBP cycle , or if the area/county program determines that it should provide additional services within its currently approved LBP , this new procedure must be followed to obtain approval from the Secretary for the provision of such additional services . - - - - - - - - - - - - - - - - -- - - - - - - - i The term Area Authority is used here to apply to either (a) a multi - county area authority or (b ) a multi- county county model via an interlocal agreement organization serving as the LME . 2 This scenario could apply as follows : a single county elects to convert its area authority to a county department to be a service provider and to join with other counties to form an Area Authority or multi - county interlocal agreement to perform LME functions . NOTE : In all of these options , the Secretary may choose to approve the arrangement indefinitely or for a limited time period only . t STAT£ Q I QUAM North Carolina Department of Health and Human Services Division of Mental Health , Developmental Disabilities and Substance Abuse Services 3001 Mail Service Center • Raleigh , North Carolina 27699 - 3 001 Tel 919 - 733 - 7011 • Fax 919 - 733 - 1221 Michael F . Easley , Governor Carmen Hooker Odom , Secretary Michael Moseley , Director April 22 , 2004 MEMORANDUM To : Legislative Oversight Committee Members MH / DD/SAS Commission Consumer/ Family Advisory Committee Chairs Advocacy Organizations and Groups North Carolina Association of County Commissioners County Managers County Manager Chairs North Carolina Council of Community Programs State Facility Directors Area Program Directors Area Program Board Chairs Provider Organizations MH / DD /SAS Professional Organizations and Groups MH / DD /SAS Stakeholder Organizations and Groups Other MH / DD/ SAS Stakeholders From : Mike Moseley It 1- 1 Re : Communication Bulletin # 017 Maintaining Public Sector Access k to Psychiatrists The purpose of this communication is to provide guidance as area/county programs proceed with divestiture of currently employed psychiatrists . Psychiatrists play a crucial role in diagnosing , treating and medically managing the care of persons with mental illness , developmental disabilities and substance abuse disorders . There are approximately 850 psychiatrists in North Carolina working in various settings , e . g . , academia , private practice , state facilities , federal facilities , public mental health clinics , etc . According to the U . S . Bureau of Primary Health Care , ninety - seven ( 97 ) of the State ' s one hundred ( 100 ) counties are designated as under served relative to psychiatry . The continued availability of this relatively scarce psychiatry resource for public sector clients is pivotal as system reform unfolds and the local authorities assume greater responsibility for serving those clients who are the most disabled . It is , therefore , incumbent upon the managers of the public mental health , developmental disabilities and substance abuse services system to maintain , at the very least , the current level of client access to psychiatrists . As reform proceeds , area/county programs will continue to divest of the responsibility to provide direct client services . In some instances , divestiture may occur without appreciable disruption of psychiatric services to public sector clients . For example , there is an adequate number of private psychiatrists who are willing to assume the responsibility or current area program psychiatrists are able to move to other organizations , existing or new , to provide services to public sector clients . In other cases , however , there is reason to be concerned that psychiatrists may leave public sector work and not be readily replaced by other psychiatrists - whether because they are laid off or because they conclude that given an uncertain professional future they are bette r advised to pursue other career opportunities . Consequently , area/county programs should consider the following issues in proceeding with divestiture of currently employed psychiatrists . 1 . Area Programs should analyze the likely availability of psychiatrists to provide services for their clients , whether by currently employed individuals or by others in the catchment area . In general , contract services relying on " locum tenens " psychiatrists or psychiatrists newly moved into the area should be avoided , since these may not provide a stab ) e pool of psychiatrists . 2 . When there are not likely to be psychiatrists available other than those currently employed by the area program , divestiture of those staff physicians should be delayed until measures are in place to ensure continuity of psychiatric services , and consideration should be given to requesting a waiver to continue to employ current psychiatry staff . 3 . When the area program psychiatrist ( s ) is/are the only psychiatrist ( s ) available in the catchment area , strong consideration should be given to requesting a waiver to continue their employment . 4 . If an area /county program determines that psychiatric services cannot be divested at the present time , the program must ensure that adequate safeguards are put in place to segregate the activities of the psychiatrists as service providers from the LME functions that the psychiatrist might perform . Such functions might include utilization management and clinical specialist reviews as part of customer services . This communication should in no way be construed as a retreat from the fundamental requirement for area programs to divest of direct service responsibility . It is , however , an acknowledgement of the differential impact that current reimbursement streams and rate structures , both public and private , have on the practice of psychiatry . Any questions regarding this communication should be directed to Joan Kaye at 919 - 733 - 7011 or joan . kaye@ncmail . net . cc : Carmen Hooker Odom Jim K lingler Lanier Cansler Dick Oliver James Bernstein Kaye Holder DHHS Division Directors Wayne Williams DMH / DD/SAS Executive Leadership Team Richard Slipsky Rob Lamme DMH / DD / SAS Staff QLMM North Carolina Department of Health and Human Services Division of Mental Health , Developmental Disabilities and Substance Abuse Services 3001 Mail Service Center • Raleigh , North Carolina 27699 - 3001 Tel 919 - 733 - 7011 • Fax 919J33 - 1221 Michael F . Easley , Governor Richard J . Visingardi , Ph . D , Director Carmen Hooker Odom , Secretary March 29 , 2004 MEMORANDUM To . Legislative Oversight Committee Members MH/DD/SAS Commission Consumer/Family Advisory Committee Chairs Advocacy Organizations and Groups North Carolina Association of County Commissioners County Managers County Manager Chairs North Carolina Council of Community Programs Area Program Directors Area Program Board Chairs Provider Organizations MH/DD/SAS Professional Organizations and Groups MH/DD/SAS Stakeholder Organizations and Groups Other MH/DD/SAS Stakeholders From : Richard J. Visingardi, Ph. D . Michael Moseley Re : Communication Bulletin # 016 Criteria and Procedure for Approval of 1. ,: . . it Service Delivery by an Area/County Program ' l l f 1 - all aa General Statute 122C- 112 . 1 (a) (26) requires the Secretary of the Department of Health and Human Services to " [e] stablish a process for approving area authorities and county programs to provide services directly in accordance with G . S . 122C- 141 . " The attached document sets forth the criteria and process for approval of direct service delivery by : (a) an area or county program which serves as the LME ; or (b) by a separate county department when another area/county program serves as the LME. In establishing and applying these criteria, the Department ' s primary considerations are service availability, choice for consumers and compliance with General Statutes . Another consideration is preventing or reducing the potential for conflicts of interest related to LME service management and direct service provision. Please contact Dick Oliver at 919-7154294 or e-mail Dick. Oliver@ncmail . net, if you have questions regarding this document. Attachment cc : Carmen Hooker Odom DMH/DD/SAS Executive Leadership Team Jim Klingler Lanier Cansler Dick Oliver Richard Slipsky James Bernstein Kaye Holder DHHS Division Directors Wayne Williams Criteria for the Approval of Direct Service Provision by Area Authorities and County Programs (G. S . 122C412 . 1 and G. S . 122C441 ) Effective : April 1 , 2004 1 . Area Authority ) /County Program is the Local Management Entity (LME) and also proposes to continue to provide one or more services (see item 3 . a. for LMEs with approved Local Business Plans) . a. List of the services to be provided and a justification for the Area Authority/County Program to directly operate those services , including the impact on consumers and the community if the LME does not provide such services ; b . Documentation of efforts to solicit private providers for the services the LME proposes to provide , including copies of RFPs/RFIs , summary of the RFI responses received, minutes from public meetings , other documentation of provider recruitment efforts , and any concerns raised by the responses to the solicitation; c . Description of how the LME will continue to develop community capacity and continue to work toward divestiture ; d. Description of how consumers will be offered a choice of providers for the services the LME operates ; e . Description of the process in place to ensure that consumers are not "steered" to LME-operated services and the safeguards the LME will implement to ensure that consumers receive only the services they need; f. Certification from the LME that it understands that it will be reimbursed for the services that it operates in the same manner and at the same rates as any other service provider. No provisions will be made for the payment of any additional administrative cost associated with a governmental entity . 2 . Area Authority/County Program is the LME and a separate county program2 is proposed to be created or expanded as a service provider : a. List of the services to be provided by the new or expanded county department; b . Rationale for the creation or expansion of a county department to provide services including the impact on consumers and the community if the new or expanded county department does not provide such services , c . Description of the private providers available in the community to provide the services proposed to be offered by the new or expanded county department; d. Documentation of efforts to solicit private providers for such services , including copies of RFPs/RFIs , summary of the RFI responses received, minutes from public meetings , other documentation of provider recruitment efforts , and any concerns raised in the responses to the RFP/RFI solicitations ; e . Description of the organizational, management, and supervisory relationship provider program and the safeguards that between the LME and the county service will be in place to ensure that consumers are not " steered" to the county program; f. Description of how the LME will ensure consumers are offered a choice of providers for services the county operates ; g . Certification of understanding from the Board of County Commissioners of the county proposing to deliver services that the county ' s required Maintenance of Effort contribution to the cost of mh/dd/sa services per G . S . 122C- 115 will be paid to the LME , not to the county program providing services ; h . Certification from the LME that it has advised the Board of County Commissioners of the county proposing to deliver services that that the county program will be reimbursed for the services that it operates in the same manner and at the same rates as any other service provider. No provisions will be made for the payment of any additional administrative cost associated with a governmental entity. 3 . Process for Requesting Approvals : a . Requests are to be submitted through the LME Systems Performance Team member assigned to the Area/County Program; b . Division staff will review the request and forward it, with a recommendation, to the DHHS Secretary for review; c . Upon final action by the Secretary, the Division will communicate the decision in writing to the area/county program and county manager(s) . d. Implementation exception : For area/county programs with approved Local Business Plans (LBPs) which detailed services to be operated by the area/county program during the time period covered by the LBP , the services remain approved and no additional action is required at this time . At the end of the currently approved LBP cycle, or if the area/county program determines that it should provide additional services within its currently approved LBP, this new procedure must be followed to obtain approval from the Secretary for the provision of such additional services . - - -- -- -- - - - ---- ------- - -- 1 The term Area Authority is used here to apply to either (a) a multi -county area authority or (b) a multi-county county model via an interlocal agreement organization serving as the LME . z This scenario could apply as follows : a single county elects to convert area authority to a ider and to join with other counties to form an Area county department to be a service prov Authority or multi- county interlocal agreement to perform LME functions . NOTE : In all of these options , the Secretary may choose to approve the arrangement indefinitely or for a limited time period only . 1.4 SrMt , �K North Carolina Department of Health and Human Services Division of Mental Health , Developmental Disabilities and Substance Abuse Services 3001 Mail Service Center • Raleigh , North Carolina 27699 - 3001 Tel 919 - 733 - 7011 • Fax 919J33 - 1221 Michael F . Easley , Governor Carmen Hooker Odom , Secretary Michael Moseley , Director April 22 , 2004 MEMORANDUM To : Legislative Oversight Committee Members MH / DD /SAS Commission Consumer/ Family Advisory Committee Chairs Advocacy Organizations and Groups North Carolina Association of County Commissioners County Managers County Manager Chairs North Carolina Council of Community Programs State Facility Directors Area Program Directors Area Program Board Chairs Provider Organizations MH / DD /SAS Professional Organizations and Groups MH / DD /SAS Stakeholder Organizations and Groups Other MH / DD/SAS Stakeholders From : Mike Moseley - Re : Communication Bulletin # 017 g . = ` Maintaining Public Sector Access ' to Psychiatrists The purpose of this communication is to provide guidance as area/county programs proceed with divestiture of currently employed psychiatrists . Psychiatrists play a crucial role in diagnosing , treating and medically managing the care of persons with mental illness , developmental disabilities and substance abuse disorders . There are approximately 850 psychiatrists in North Carolina working in various settings , e . g . , academia , private practice , state facilities , federal facilities , public mental health clinics , etc . According to the U . S . Bureau of Primary Health Care , ninety- seven ( 97 ) of the State ' s one hundred ( 100 ) counties are designated as under served relative to psychiatry . The continued availability of this relatively scarce psychiatry resource for public sector clients is pivotal as system reform unfolds and the local authorities assume greater responsibility for serving those clients who are the most disabled . It is , therefore , incumbent upon the managers of the public mental health , developmental disabilities and substance abuse services system to maintain , at the very least , the current level of client access to psychiatrists . As reform proceeds , area/county programs will continue to divest of the responsibility to provide direct client services . In some instances , divestiture may occur without appreciable disruption of psychiatric services to public sector clients . For example , there is an adequate number of private psychiatrists who are willing to assume the responsibility or current area program psychiatrists are able to move to other organizations , existing or new , to provide services to public sector clients . In other cases , however , there is reason to be concerned that psychiatrists may leave public sector work and not be readily replaced by other psychiatrists - whether because they are laid off or because they conclude that given an uncertain professional future they are better advised to pursue other career opportunities . Consequently , area/county programs should consider the following issues in proceeding with divestiture of currently employed psychiatrists : 1 . Area Programs should analyze the likely availability of psychiatrists to provide services for their clients , whether by currently employed individuals or by others in the catchment area . In general , contract services relying on " locum tenens " psychiatrists or psychiatrists newly moved into the area should be avoided , since these may not provide a stable pool of psychiatrists . 2 . When there are not likely to be psychiatrists available other than those currently employed by the area program , divestiture of those staff physicians should be delayed until measures are in place to ensure continuity of psychiatric services , and consideration should be given to requesting a waiver to continue to employ current psychiatry staff. 3 . When the area program psychiatrist( s ) is/are the only psychiatrist (s ) available in the catchment area , strong consideration should be given to requesting a waiver to continue their employment . 4 . If an area/county program determines that psychiatric services cannot be divested at the present time , the program must ensure that adequate safeguards are put in place to segregate the activities of the psychiatrists as service providers from the LME functions that the psychiatrist might perform . Such functions might include utilization management and clinical specialist reviews as part of customer services . This communication should in no way be construed as a retreat from the fundamental requirement for area programs to divest of direct service responsibility . It is , however , an acknowledgement of the differential impact that current reimbursement streams and rate structures , both public and private , have on the practice of psychiatry . Any questions regarding this communication should be directed to Joan Kaye at 919 - 733 - 7011 or Joan . kaye@ncmall . net . cc : Carmen Hooker Odom Jim Klingler Lanier Cansler Dick Oliver James Bernstein Kaye Holder DHHS Division Directors Wayne Williams DMH / DD/SAS Executive Leadership Team Richard Slipsky Rob Lamme DMH / DD /SAS Staff