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Behavioral Health Realignment - Public Comments

Behavioral Health Realignment - Public Comments

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.

Public Comments

Letter Received from Michael Young on December 9, 2020

Dear Ms. Lancaster:

I was recently contacted by David Casper, Executive Director of Union Diversified Industries, Inc. {UDI), asking if I would be willing to contact you regarding Union County's relationship with Cardinal Innovations Healthcare Solutions {Cardinal). He is concerned Cardinal would retaliate against UDI if it became public David had encouraged Union County to end its relationship with Cardinal. I agreed to do so.

I am the former Executive Director of UDI serving from 1991 until my retirement a couple of years ago. I have never held back regarding my concerns related to Cardinal and provided information to the Board of Commissioners in 2017 showing how Union County was getting screwed by Cardinal in terms of reimbursement rates for services provided. The information I presented came from (for reference):

Rates Paid by LME/MCOs for State/Block Grant Funded Services
In State Fiscal Year 2018
(July 1, 2017-June 30, 2018)
July 2017 Report
Prepared by NC DHHS DMH/DD/SAS Quality Management Section 10/10/2017

I am not, and never have been, a supporter of Cardinal Innovations. From its beginning with Dan Coughlin as CEO of Piedmont Behavioral Healthcare (PBH) - during the administration of Carmen Odom as Secretary of NCDHHS -Cardinal consistently demonstrated little concern for those who needed services. PBH (and now Cardinal) demonstrated it was more interested in trying to impress the folks in Raleigh than support services to people with disabilities. Many of us in administrative positions with organizations in PBH's former catchment area quickly saw the problems associated with the direction toward managed care PBH was headed in and STRONGLY voiced our concerns. Our original concerns have been confirmed. It has been apparent, and it continues to be apparent, Cardinal does not give-a-damn about those with disabilities in its catchment area. Cardinal's approach to services is nothing more than cosmetic smoke and mirrors designed to put on a show.

Before my retirement from UDI, things were so bad between Cardinal and some families of persons with disabilities in Union County, I solicited the assistance of State Representatives Dean Earp, Craig Horn, and Mark Brody. I also contacted State Senator Tommy Tucker. Enough pressure was put on Cardinal to force Cardinal to attend to the needs of these families. Without the assistance of elected officials, there is little doubt Cardinal would not have offered the assistance these families needed.

In my opinion, Cardinal needs to be shut down. But, given the fact Carmen Hooker Odom is on Cardinal's Board of Directors and considering Roy Cooper is Governor and Mandy Cohen is Secretary of NCDHHS, I deem it very unlikely Cardinal is going to receive the "punishment" it has earned. Nor do I feel it is likely NCDHHS will allow any counties in Cardinal's catchment area to join another managed care group without those counties taking legal action to do so. As someone with approximately 50 years of experience working with people with disabilities, I totally support Union County pulling out of Cardinal's control and Union County should do whatever is necessary to do so.

Thank you for your time and attention.

Michael L. Young

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Email Received from Ruth Singer-Strunck on December 11, 2020

I was asked by The Director of advocacy and chapter development for The Arc of NC to share input regarding the proposed disengagement from Cardinal Innovations.

Both of my adult children who live with Autism have been on the Innovations Waiver since we moved here from South Florida almost 16 years ago. We moved to Union County after extensive research on my part and a tip that a pilot managed care Medicaid waiver was opened in 5 counties in NC. I heard there was no wait list. At that lime Cardinal Innovations was PBH and also drove case management for the 5 counties through PDS (People Driven Support) case management. Soon after that case management vanished and was replaced by care coordination.

My desperate fight to retain and attain services began as PBH was trying to gain footing in the managed care marketplace. Back then there were approvals for my daughter or my son that only lasted 2 or 3 months and had me attending tortuous meetings defending the services that my severely Autistic child needed. I found as an advocate, the greater the need of an individual the greater the stress PBH and then Cardinal would put on the parent/guardian. Not that much has changed in that respect.

Over the years I have been asked to serve on the Cardinal Clinical advisory board, to be part of the stakeholder groups, asked to give input by the State on proposed changes in the waiver, and served my community as a Community Guide, (advocate). I have assisted in meetings by request with various officers working with the Cardinal system.

At times, as a parent, it has been harrowing. You might be interested to know that recently most of my son's Community Service hours were only authorized for a 6 month period. The reasons Utilization Management gave for the shortened approval was that there was no up to date SIS, (Support Intensity Scale), assessment on record for my son, and also because we did not have updated behavioral data. Interestingly enough, it is not the job of the parent/guardian to know when a SIS assessment expires, (every three years for adults and every two years for a child), but after I contacted the director of the SIS department I found my son's services were threatened because the computer system the SIS team was using was not up to par. Of note is the fact the exact same thing happened with my daughter's SIS assessment.

My son's behavioral data was not up to date because the agency we used for SCS services for some 13 years discharged him. They could no longer afford to be a provider of SCS services through Cardinal since Cardinal swapped an hourly rate of pay for behavior services to a monthly flat rate. As you might imagine, none of this was the fault of my 300 plus pound aggressive and self injurious adult son, yet UM chose to only approve his services for 6 months. During this time I was in constant anxiety during a pandemic that our family would be without services and that it would damage the fabric of a delicate family structure. Keep in mind that there is no maintenance of service in place and if UM decided my son did not need his community support services he would loose them until we could go to a fair hearing. I had to do the following:

  1. Call all of the existing agencies to find a SCS provider who is taking new clients. I called 7 corporations and finally found one provider who returned my call. The quality of the service is diminished however, I remain with the provider to satisfy UMDD Cardinal and assure a proper done behavior support plan BIP and FBA are in place.
  2. I wrote a letter from a parents perspective about why I felt my son needed all of his services as requested.
  3. Have exit meetings and new patient meetings for both of my children.. fill out exit forms and submit needed information. (4-5 hours)
  4. Collect extensive data and train my entire team on new behavior plan, task analysis and submit required data to providers.
  5. Have a full SIS assessment with my team on a new virtual platform (2 hours each child). SIS scores remain consistent because the individual with IDD remains the same person only a year or two older. I'd like to note here that although families are made to reassess the entire SIS the State is using an algorithm that only quantifies catagory A,B, and E and this decides to a great extent the funding stream for that individual.
  6. meet with my OP and my community guide to assure all goals were still appropriate and that some progress was being made.
  7. Assure the Psychiatrist submitted notes containing pertinent information.

Let me apologize for the girth of this email.

I use this information as an example of a recent event that I felt was unnecessary. I believe the brunt of the problems for most of the individuals that are served by Cardinal lies with Utilization Management. The recent exit of some key individuals, (Melissa Covert), who were managing UMDD has in my opinion left UM even more than before bereft of compassion. There are stories of families that have lost almost all of their community living hours to an uninformed compassionless UM department member.

Only until Union County threatened to disengage have approvals become shockingly rapid through UM. You will note that my son's services were approved in a matter of days not the 14 day period, (or more), that has been the norm.

There is a lack of connection to the community and a lack of continuity as well as, I believe a lack of accountability, which for me is a cornerstone of superb customer assistance.

There are good things to be said about Cardinal.

I have had an amazing competent care coordinator for quite some time now. I will add that I had to fight to get and retain her assistance after seeing way too many care coordinators come and go quickly.

I have advocated for many families and seen quite a bit of the good and not so good that Cardinal has presented over the years.

I have worked as a provider of services and am a QP and can attest to the disorganization and confusion that has at times become the hallmark of Cardinal.

I would welcome the opportunity to meet with you and further discuss this opportunity for disengagement.

I am familiar with Partners Behavioral and there are both excellent and concerning pieces of the transition to be considered, such as the B-3 services individuals who do not have the Innovations Waiver now served by Cardinal receive, (32 hours a month) versus what they may receive from Partners.(less?)

Historically Partners does not value the role of the Community Navigator and as a person who filled this role for 5 years I can tell you this service would be irreplaceable during a transition process.

Thanks for your indulgence with the length of this letter and please feel free to contact me via email or phone.

Ruth Singer-Strunck

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Email Received from Carol Cranford on December 16, 2020

Family Support Network of Southern Piedmont (FSNSP) has served families of children with special healthcare needs and disabilities in Union County for over 20 years, helping them find resources, navigating the service systems, offering workshops, and connecting parents through parent to parent matching or support groups for support. We partner with other agencies in Union County that support and advocate for families of children with special healthcare needs and disabilities. FSNSP helped connect many families with Cardinal Innovations Healthcare for services, particularly through the NC Innovations Waiver or B3 Services. The Union County Board of Commissioners decision to disengage from Cardinal came as a big surprise to our agency and other agencies that serve individuals with intellectual and developmental disorders (IDD). The voices of the agencies advocating for individuals with IDD were not considered when the decision was made to disengage.

While we realize that Cardinal has not been without fault over the years, they have made many positive changes with the new leadership. We recognize there may still be issues with placing children or adults with extreme mental health needs. Placing those individuals in an appropriate setting is crucial and we believe this is a small minority. Cardinal has put a plan in place to quickly rectify that situation. The majority of families of children with IDD that our agency works with are satisfied with the services their child gets through Cardinal. Families do complain about the long waiting list but that is the case with all LME/MCOs across the state. That will not change by engaging with a new LME/MCO. While a family is waiting on waiver services, they are able to get limited services if they have Medicaid. Receiving the NC Innovations Waiver or other services is life changing for families. I know this from personal experience with my own son.

Thousands of families in Union County will be negatively impacted by changing to another LME/MCO. Some may not be able to afford the adjustment period of finding new providers. It will cause undue anxiety and financial hardship on these families. We ask that you reconsider your decision and continue allowing Cardinal to serve Union County families.

If you have any questions or concerns, please don't hesitate to contact me.

With gratitude,
Carol Cranford

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Email Received from Sen. Todd Johnson on December 21, 2020

I appreciate the opportunity to comment on the proposed disengagement of Union County from Cardinal Innovations LME/MCO. I am supportive of the request from Union County to disengage from Cardinal Innovations and move to engagement with Partners. For too long I have heard from family members, providers and county leaders in my district that the relationship with Cardinal Innovations is not beneficial to our residents. Based on the information I have gathered, alignment for Union County with Partners will be a positive move and one that benefits the residents of Union County. I am hopeful that the work DHHS is doing to improve the performance of Cardinal is successful, however I believe a realignment is appropriate for Union County at this time. If there is anything I can do to assist with the transition please let me know.

Senator Todd Johnson
Union County

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