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Behavioral Health Realignment

Behavioral Health Realignment

I. Purpose

Union County is dedicated to improving the quality of life of the residents who have chosen our county as their home. It is in consideration of this strategic goal that your Union County Board of County Commissioners chose to pursue a relationship with Partners Health Management to manage our residents’ behavioral health services funded by federal and state dollars, including Medicaid. Partners is a Local Management Entity/Managed Care Organization (LME/MCO), which is a governmental entity that manages mental health, intellectual/developmental disability and substance use services. Currently, our behavioral health services are managed by Cardinal Innovations Healthcare. However, Partners’ intentional focus on community interaction and high-engagement with stakeholders, among other attributes, more closely aligns with Union County’s vision and strategic planning. Union County believes this realignment will better serve the community and its needs.

To prevent disruption of the behavioral health system in our county, this “Union County LME/MCO Disengagement Plan” has been developed to ensure a smooth and seamless transition for all those involved.

Our primary focus is to carry out this process with transparency, commitment to our community, and the involvement of those who will be impacted by the change. This plan primarily outlines the process for the County’s disengagement from Cardinal. However, it necessarily also refers to the process by which engagement will occur between Union County, Partners, and all relevant stakeholders. Partners has committed to working collaboratively with Union County and Cardinal to ensure a smooth transition for all involved. Union County has every confidence and expectation that Cardinal will also work collaboratively and cooperatively throughout the transition process.

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II. Background

North Carolina law permits a county to choose its LME/MCO. On October 19, 2020, the Union County Board of County Commissioners voted unanimously to disengage from its current LME/MCO, Cardinal Innovations Healthcare, to realign with Partners Health Management. The resolution is attached and is also on our website at www.UnionCountyNC.gov, where other information on this process (including this Disengagement Plan) is or will be posted.

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III. Rationale

Union County is committed to ensuring the best behavioral health system is available to residents in the community. We believe that transitioning to the model of service management and community engagement operated by Partners will best accomplish that goal. As we have engaged in analysis and review of the Partners model of operations, we have concluded that it is one of intentional community integration at multiple levels within the counties that they serve. Leadership and staff throughout Partners are engaged in relationships within their communities, actively collaborating with stakeholders, providers, consumers and others to meet the challenges faced.

Union County also supports the Partners way of managing local maintenance of effort contributions. Partners works in collaboration with county government officials and local stakeholders to develop plans to invest those taxpayer-provided funds on mutually developed projects which will have the highest level of benefit to the residents. They provide a transparent accounting of uses of those funds to county leadership and respond to wishes of the county to target the funding to desired projects.

Union County also appreciates the Partners approach of inclusion in the provider network development. Union County has always desired more local services and a choice for county residents, and Partners philosophy of not tightly limiting the network allows greater levels of service on both accounts. Union County also agrees with Partners model of community priorities. As they have focused attention on overarching challenges faced by most all communities around the state, their implementation model is locally driven. Philosophically their style of execution aligns well with the views of Union County leadership as we see healthcare best solved at the local level and not attempted through a cookie cutter, one size fits all model of delivery. From a commuting pattern and “citizen flow” perspective, Union County aligns well with Cabarrus County and shares much in the way of normal flow of local residents. There is a greater sense of connection to Cabarrus County for most local citizens than traveling to Charlotte for goods and services, including healthcare.

Partners has routinely demonstrated a high level of consumer engagement when compared to peer programs in the state. As the state reports on numbers of individuals who access care compared to the population as a whole, Partners consistently is at or near the top, indicating good accessibility of services to residents in the counties served.

Partners is also one of the highest performing programs as evaluated by the state contract external review organization. For the past two years, Partners has been at or near the top in the total score rating the performance by the independent, external review organization which indicates a commitment to excellence that aligns with county goals.

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IV. Timeline

Disengagement will be effective as soon as reasonable and as permitted by law. While the default effective date of nine-months is recognized, Union County may seek to disengage and realign sooner to minimize any negative impact on Union County consumers from a slow transition. The official disengagement date will ultimately be determined by the Secretary of North Carolina’s Department of Health and Human Services (NCDHHS). To protect our residents in greatest need, disengagement with Cardinal will occur simultaneously with realignment or “engagement” with Partners. The process will include a minimum of 60 days for the public to review and comment on this Disengagement Plan. Following the comment period and the 30 days of posting such comments, Union County intends to have ready for submission the Request to Disengage documentation and will look for approval within the 90 days outlined in rule. Further, the County intends to seek a shortening of the overall 9-month requirement outlined in rule for the transition to become effective, as we believe a sooner transition while done thoughtfully and with engagement from the community, will best serve the county residents and minimize the delay in preventing improved services and systems from reaching their full potential.

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V. Disengagement

This Disengagement Plan serves as a guide for the first step in the process of transitioning from one LME/MCO to the other. While this plan should not be considered all-inclusive, we have made every effort to identify the areas on which we need to focus and the necessary steps to ensuring that the needs of our residents are met. Both Union County and Partners are dedicated to carrying out this plan, as outlined in the following focus areas:

a. Transition Planning
To ensure active and robust community involvement in this transition and to facilitate input and feedback from subject matter experts, the Union County Manager will form an LME/MCO Realignment Committee consisting of key County officials and agencies, Partners, and other appropriate stakeholders. This will include the following, or their representatives, plus others as appointed by the County Manager:

  1. Deputy County Manager (Chair)
  2. County DSS Director
  3. County Public Health Director
  4. Community Health Council Director
  5. District Court representative
  6. District Attorney
  7. Sheriff
  8. County Finance Director
  9. Atrium-Union HealthCare System Representative
  10. One or more Partners executives and directors

This Committee will meet as needed to share information; to schedule listening and education meetings with key stakeholders (providers, consumers, advocates); to consult subject matter experts; and to assist the County and Partners in whatever tasks are needed to ensure a smooth disengagement and transition.

The County and Partners envision the transition plan to include “5 Ps”: People, Providers, Projects, Property and Payments. As county leadership and Partners leadership work alongside those on the LME/MCO Realignment committee, the engagement plan that emerges will be discussed during ongoing meetings with the community and ensure that those “5 P’s” provide for a smooth transition for consumers, providers and community stakeholders. Though such plan is not a required element of the disengagement plan that goes to the Secretary for approval as noted above and is not a document that other counties that have transitioned have published widely, Union County and Partners share a commitment to transparency and intend to be very inclusive in the development and implementation of this plan.

b. Continuity of Services Plan
Union County recognizes the importance of ensuring services for its community are uninterrupted and are provided with high quality, timeliness and a focus on community involvement. Therefore, a separate written Continuity of Services Plan is being developed and published shortly after this Disengagement Plan. Partners has committed to ensure all current providers contracted and in good standing with Cardinal and serving our County will be contracted with Partners as well, if not already. Likewise, Partners intends to honor consumer service authorizations, annual plans and other documentation and decisions essential to ensure a smooth transition.

c. Notification of Stakeholders
Union County and Partners will collaborate to notify all stakeholders impacted by this transition. Additionally, a concentrated effort will be made to solicit comments, feedback and suggestions from consumers, advocates, self-advocates, providers, State and Local Consumer and Family Advisory Committees (CFACs), and all other interested parties. We will use our usual Union County established communication methods, primarily our website, plus likely more, such as mailings, stakeholder meetings, press releases, and social media messaging. All input is welcome and encouraged.

d. Community Initiatives
Union County has ensured that Partners is committed to becoming ingrained in our community and supporting our current community initiatives involving behavioral health, as it has in its other counties. A list of all current, planned and proposed projects/initiatives will be compiled and agreed upon prior to the transition effective date.

e. Distribution of Real Property Plan
In accordance with State law, a written Distribution of Real Property Plan must be developed during a LME/MCO realignment process. This disengagement involves no real property (land, buildings, etc.) to be distributed, so a Plan stating as much will be posted with or shortly after this Disengagement Plan.

f. Financial Liabilities
Union County affirms that, to its knowledge, it has no outstanding financial liabilities to Cardinal, nor will the County have any within 30 calendar days of the request to disengage. Should Cardinal reasonably disagree, the County will work amicably and promptly with Cardinal to resolve equitably and if unable to do so, defer the matter to the NCDHHS Secretary for resolution. Partners has agreed to work with the County to ensure its financial liabilities under maintenance of efforts requirements are not increased by realigning with Partners.

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VI. Public Comment

The law requires Union County to seek public comment on this Disengagement Plan. For 60 days from the posting of this Disengagement Plan on our website at www.UnionCountyNC.Gov, public comment is welcome and encouraged by email or by mail addressed to:

Union County Manager
ATTN: LME/MCO Realignment
500 N. Main Street, Suite 932
Monroe, NC 28112

Following this public comment period, the County will post all responses for an additional 30 days. Union County will take into consideration feedback received, will review all written plans, and submit a written request to disengage to the Secretary of NCDHHS for approval (details of which are outlined in the NC Administrative Code referenced below).

In keeping with our dedication to transparency, both Union County and Partners commit to keeping the public informed during this process, including public meetings, information and listening sessions with key stakeholders and groups, and more.

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VII. Authority

This Disengagement Plan has been developed in accordance with current state laws and regulations governing a counties’ disengagement with an LME/MCO. Specifically, the following were used to create the plan and ensure compliance:

  • North Carolina General Statute 122C-115 (a3)
  • North Carolina Administrative Code 10A NCAC26C.0701-.0703

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