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HomeMy WebLinkAboutAgenda - 04-06-2021; 8-i - Approval of the Continuity of Services Plan to Guide Realignment from Cardinal Innovations Healthcare to Alliance Health 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: April 6, 2021 Action Agenda Item No. 8-i SUBJECT: Approval of the Continuity of Services Plan to Guide Realignment from Cardinal Innovations Healthcare to Alliance Health DEPARTMENT: County Manager's Office ATTACHMENT(S): INFORMATION CONTACT: Continuity of Services Plan Travis Myren, Deputy County Manager, 919-245-2308 PURPOSE: To approve the Local Management Entity/Managed Care Organization (LME/MCO) Continuity of Services Plan to guide the process of disengaging from Cardinal Innovations Healthcare and realigning with Alliance Health to administer Medicaid and uninsured behavioral health and intellectual/developmental disability services for Orange County residents that are insured by Medicaid or are uninsured. BACKGROUND: North Carolina General Statutes and the North Carolina Administrative Code authorize and prescribe the process through which a County may seek permission to disengage from one LME/MCO and realign with another. The final decision making authority rests with the Secretary of the North Carolina Department of Health and Human Services. The Board of Commissioners initiated this disengagement process by approving the County's Intent to Disengage on November 5, 2020. Formal notice of the Intent to Disengage was transmitted to the Secretary of the North Carolina Department of Health and Human Services, the Co-Chairs of the Joint Legislative Oversight Committee on Health and Human Services, and the affected counties on November 16, 2020. The disengagement process also required the Board of Commissioners to approve a Disengagement Plan. This Plan created a Realignment Committee consisting of key county officials and agencies, Alliance Health and Cardinal Innovations Healthcare representatives, and other appropriate stakeholders and initiated a sixty (60) calendar day public comment period. During the comment period, the County is required to solicit comments from consumers, advocates, self-advocates, and Consumer and Family Advisory Committees (CFACs). Following the sixty (60) day comment period, the comments will be posted on the County's website for a minimum of thirty (30) calendar days. The Board approved the Disengagement Plan on February 16, 2021. 2 Continuity of Services Plan This abstract continues the legally mandated disengagement process by proposing approval of a Continuity of Services Plan that outlines how the management of Medicaid and uninsured behavioral health and intellectual/developmental disability services will transition from Cardinal Innovations Healthcare to Alliance Health. • Members Served The goal of the Plan is to facilitate a seamless transition for the members served. Alliance Health has committed to bring into its network to continue to serve members all such members' providers that are in good standing and meet all applicable state imposed rules and requirements. Additionally, Alliance Health has committed to honor all open service authorizations for members to prevent any disruption in services. • Community Services Each LME/MCO has some unique services that are not necessarily offered by its counterparts in a different region. Alliance Health has committed to ensuring a full complement of services is available to meet the behavioral health and intellectual and developmental disability needs of County residents that are insured by Medicaid or are uninsured. For example, Alliance will continue to offer transitional employment such as the service administered by Club Nova. Additionally, Alliance will continue to offer peer bridging from crisis facilities, such as Freedom House Recovery Center, to community providers. • Community and Member Engagement Alliance Health will engage the current CFAC members in the County and begin the development of a charter and member recruitment for a local Alliance Orange County CFAC. Alliance Health also employs a system of care approach that will work with local organizations and public partners to address social and environmental factors, including homelessness, food insecurity, and lack of transportation, that particularly impact the overall health and quality of life of individuals that lack health coverage. Finally, Alliance Health will utilize its Outreach and Education and Member and Community Engagement teams to help individuals navigate the human services system and utilize all available resources. • Provider Network Alliance Health has agreed to extend its network of care to include all providers that are currently serving Orange County residents that are in good standing with Cardinal Innovations Healthcare and Alliance and meet all applicable state imposed rules and requirements. Additionally, Alliance Health will develop an expedited credentialing process to assist providers not currently contracted with Alliance. Timeline The realignment process is expected to proceed on the following timeline: • February 17, 2021 — Public comment period opened for sixty (60) days • April 6, 2021 —Approval of the Continuity of Services Plan • April 18, 2021 — Post public comments received (30 days) 3 • May 20, 2021 — Submit the formal Request to Disengage to the Secretary with the required documentation. A decision by the Secretary is required within 90 days. • August 17, 2021 — Anticipated approval by the Secretary • Following Secretary Approval — Implementation phase • January 1, 2022 — Effective date of transition FINANCIAL IMPACT: No financial impact is associated with approving the Continuity of Services Plan. SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable to this item: • FOSTER A COMMUNITY CULTURE THAT REJECTS OPPRESSION AND INEQUITY The fair treatment and meaningful involvement of all people regardless of race or color; religious or philosophical beliefs; sex, gender or sexual orientation; national origin or ethnic background; age; military service; disability; and familial, residential or economic status. • ENSURE ECONOMIC SELF-SUFFICIENCY The creation and preservation of infrastructure, policies, programs and funding necessary for residents to provide shelter, food, clothing and medical care for themselves and their dependents. ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal impact associated with this item. RECOMMENDATION(S): The Manager recommends the Board approve the attached Continuity of Services Plan and authorize the County Manager to take all necessary steps to implement the Plan. 4 Renee Price, Chair Jamezetta Bedford vice-Chair Orange County Board of Commissioners Mark Dorosin Post Office BOX 8181 Amy Fowler 17 5 Sally Greene 300 West Tryon Street Jean Hamilton Hillsborough, North Carolina, 27278 Earl McKee ortn Cap°��� Continuity of Services Plan On February 16, 2021, the Orange County Board of Commissioners unanimously approved an LME/MCO Disengagement Plan to transition the management of Medicaid and uninsured behavioral health and intellectual/developmental disability ("I/DD") services from Cardinal Innovations Healthcare ("Cardinal") to Alliance Health ("Alliance"). This Continuity of Services Plan ("Plan") is intended to outline and frame how services will be managed when transitioning from Cardinal to Alliance. It is recognized that the process must allow for flexibility to respond to changes as the collaborative work moves forward. Throughout this process the Orange County Board of Commissioners has and will continue to focus on listening to and receiving information from stakeholders, including in particular the providers and most importantly the residents who are served by the providers of public behavioral health and I/DD services and supports in Orange County. Both the County and Alliance recognize the importance of sharing information as transparently as possible with County residents and families currently served by Cardinal (such residents receiving services referred to herein as "Members"), current members of the Cardinal provider network working in the County, and other impacted stakeholders. The County, Alliance, and Cardinal will work in collaboration to provide relevant information to such stakeholders throughout this transition in a timely manner, including by utilizing our respective websites and social media platforms and through live and/or virtual town hall meetings and other community events. Members Served We believe that the most important aspect of this disengagement is ensuring that those individuals and families that will be impacted are well informed and understand the change happening in Orange County. It is our collective intent to create a seamless transition from Cardinal to Alliance so that services are not interrupted. Notification of the transition will be made to all Orange County Members at least 60 days prior its effective date, which we anticipate will be January 1, 2022. 5 The County has received assurance from Alliance that it will honor all open service authorizations for Orange County residents from Cardinal. The County will look to and reasonably expects Cardinal to provide that service authorization information to Alliance in a timely and suitable format to ease this transition and to ensure there are no delays in services to existing recipients of care. The County needs and requests the assurance of the North Carolina Department of Health and Human Services ("NCDHHS") that it will assist, as needed, in ensuring this exchange of information. Community Services Cardinal and Alliance are both Local Management Entities/Managed Care Organizations ("LME/MCOs"). Each LME/MCO has some unique services that are not necessarily offered by its counterparts in a different region. Alliance will work with Orange County to ensure a full complement of services is available to meet the behavioral health and I/DD needs of County residents that are insured by Medicaid or are uninsured. Moreover, Cardinal has provided assurances that it will continue to provide services to Members during this transition to Alliance. Through the due diligence process, we learned of some different services between the two LME/MCOs. In situations where Cardinal offers a Medicaid service that Alliance does not, we will work with Alliance to either add that service to the Medicaid Benefit Plan, if the County and Alliance agree it is appropriate to do so, or we will ensure Alliance's community array has like or comparable services to meet the needs of Members. All LME/MCOs in the state must offer a basic array of Medicaid services that is substantially comparable, even if named or branded differently, but such services and process for authorization may not be identical. In cases where there are such differences, Alliance will provide training and support to providers impacted by changes and will notify Medicaid beneficiaries at least 30 days prior to the effective date of a significant change to their healthcare plan. In instances where Orange County has non- Medicaid services in place that are not included in the Alliance Non-Medicaid Benefit Plan, Alliance will re-evaluate such service array annually in relation to applicable state funding allocations. Community and Member Engagement Alliance will reach out to current Consumer and Family Advisory Committee (CFAC) members in Orange County to connect with them directly and establish a dialogue to regularly receive their input on issues affecting the public behavioral healthcare system locally and statewide. Alliance will also begin the development of a charter and member recruitment for a local Alliance Orange County CFAC. Alliance prioritizes a system of care approach to build on the strengths of individuals, forge partnerships, improve access to services, and understand the story of the people and families it serves in a more complete way. To build a community-based System of 6 Care in Orange County, Alliance will work with local organizations and public partners to address social and environmental factors, including homelessness, food insecurity, and lack of transportation, that particularly impact the overall health and quality of life of individuals that lack health coverage. Alliance utilizes community collaboratives and roundtables with shared goals and accountability to achieve worthwhile, sustainable outcomes and Alliance will begin to establish these opportunities in Orange County. Additionally, Alliance has Outreach and Education as well as Member and Community Engagement teams that help individuals navigate the human services system and utilize available local resources. These teams provide various trainings on topics including Medicaid transformation and health wellness and prevention. By providing diverse communities the tools they need to succeed —from education and training, to the development of care guidelines and wayfinding through the system —Alliance aims to enable people to lead healthier, more satisfying lives. Provider Network Through the process of due diligence, the County learned that there is some overlap in the provider networks between Cardinal and Alliance, yet there are differences as well. Alliance contracts with 21 of the 38 total Orange County providers currently contracted with Cardinal. In addition to informal outreach to providers, the County, in coordination with Alliance, will send these providers written notice of the transition from Cardinal to Alliance. Alliance has agreed to bring into its network to continue to serve Members and the County providers that are in good standing with Cardinal and Alliance and meet all the applicable state imposed rules and requirements. Further, Alliance will develop an expedited credentialing process to confirm whether a provider is enrolled in the Alliance network and to assist providers not currently contracted with Alliance with entering such network upon confirmation of applicable state and other requirements. Lastly, there are providers in the Alliance network who do not serve individuals in Orange County who have expressed an interest and desire to do so. The Realignment Committee described in the LME/MCO Disengagement Plan will provide guidance on this subject in its work during the transitional phase to help facilitate increased access within the County to provide further choice and service capacity for Members. As the County continues to move forward, the work of the Realignment Committee does as well. This Committee, comprised of a cross section of community leaders overseen by the County Manager, will continue to develop the broader transition plan focused on the impact on individuals in need of services and providers. As part of that work, the Committee will have direct community leadership expectations to ensure the Plan is executed in such a way that minimizes the disruption to individuals receiving services and their providers. The Realignment Committee will also be responsible for coordinating communication sessions with key audiences (including Members and their families, providers, and stakeholders) to ensure the implementation period from 7 approval by the NCDHHS Secretary to the effective transition date is filled with many productive exchanges of information with a wide range of groups.