AG 2007 05 21 - Laserfiche WebLink

Home Browse Search

PBH Local Business Plan 2007 PBH serves Cabarrus, Davidson Stanly, Rowan and Union Counties, counties surrounding and to the northeast of Charlotte, the largest city in North Carolina. Piedmont is in an area of very rapid population growth and currently has a population of 670,000, making Piedmont the third largest LME in the state, and the largest multi-county LME. The PBH Vision The PBH Demonstration was envisioned as a model of a community system that would illustrate how the public policy goals of the 2001 System Reform Legislation could be implemented. Our 2003 Local Business Plan contained a detailed plan to transform our local system from a static provider driven model, to a system customized by consumer and family priorities, capable of making continual adjustments to meet the changing needs and choices of persons with behavioral health conditions and/or developmental disabilities. One of the major objectives of the Demonstration is the alignment of financial incentives with our values, public policy, best practices in care and the achievement of positive consumer outcomes. Goals Our goals are to address the needs of targeted populations as well as the community as a whole, and provide comprehensive, efficient, cost effective services, that are responsive to the needs of individuals. The PBH Demonstration delivers services more efficiently through a highly organized clinical design and a provider network that has the competency required to deliver quality evidence based practices. Over the past three and a half years, the goal Of PBH has been to serve as a catalyst to initiate and manage changes in the services system to ensure implementation of evidence based and best practice services and supports. This has been achieved through a strong collaborative relationship with a provider network that shares our goals. Community-based and consumer-directed care rather than facility-based care is utilized to the greatest extent possible to accomplish these goals. Demonstration Design The State of North Carolina has provided tremendous support for the Piedmont demonstration. Under the direction of the NC Department of Health and Human Services, combined 1915(b) and 1915(c) waivers were developed and approved by !the Center for Medicare and Medicaid Services. Under section 1915(b) States can request that the regulations governing comparability of services, state wideness and freedom of choice be waived in order to operate a managed care program where freedom of choice of providers is restricted to providers approved and designated by the Managed Care Organization (PBH) and in only certain counties of the state (the PBH catchment area). Section 1915(c) allows states to request that regulations dealing with comparability of services, stpte wideness, and community income and resource rules be waived so that individuals who qualify for Medicaid-funded institutional care (ICF-MR) can be cared for in the community through home and community based services. The two waiver authorities ..have been approved and both have cost neutrality and cost effectiveness requirements. 1915(b) waivers are approved for two-year periods. 1915(c) waivers are approved for three years, initially, and must be renewed every five years thereafter. 1915(b) waivers must be cost effective in that service provision Is based on historical utilization and adjusted for changes in trend; actual per capita expenditures cannot exceed these projections. 1915(c) waivers require that the average cost of care of all Medicaid services for persons participating in the waiver be no more than the average wst of care If the person were living in an ICF-MR. The renewal for the 1915 (b) waiver was submitted in December 2006 for the next waiver period which begins on April 1, 2007. The 1915 (c) is due for renewal in April, 2008. l,3" ' ~I