AG 2002 12 16 (Regular) - Laserfiche WebLink

Home Browse Search

model that will blend as many funding sources as possible under a single financial manager including categorical dollars, starting with Medicaid and state funding. We want to explore financing arrangements wl~ich include prepaid arrangements, including sub-capitation, case rates, target population based and enrollee-based payments (PMPM), with appropriate adjustments. We propose that the Piedmont LME would serve as the payer of all claims and will provide "encounter" data to the IPRS system as a stand-behind reporting and shadow claims system (not as a billing function). This will enable the state to maintain the database necessary to draw down Medicaid FFP and block grants through Medicaid, while also supporting movement toward prepayment (including Medicaid FFP) to Piedmont as the LME. We believe that various state and federal level waivers, such as 1915 b and 1915 c, or 11:1.$ waivers, as well as waivers in state funding requirements should be examined to identify the best ways to support this systems change and, at the same time, enable federal, state and local payers to contain their overall costs, while achieving reimbursement and benefits management flexibility.. Re-direction of Medicaid resources through waivers will allow flexibility for supportive services in less restrictive settings that reduce reliance on high cost, poor outcome, facility-based services. Waivers that are developed need to include capitation that provides for prospective rates which reasonably support the system, accomplish flexible use of dollars, provide a cap on expenditures, and achieve budget neutrality on PMPM. It is very important that county Medicaid costs be contained in the process of implementing this financial reform process. Ultimately, we want to avoid the inefficiency of a unit-based fee for service cost system in favor of a prospective methodology based on estimated utilization of a defined benefit by a specified population. Re-engineering the system away from high-cost and institutional use, to a community-based system will require that the LME be given the authority to manage the full continuum of care. Piedmont is urging that all state and federal dollars including those currently allocated to regional facilities (state hospital, MR Center, state Alcohol and Drug Treatment Center and ICF dollars) be included in its prepayment arrangement. Summary: "It was saJ~ in an earlier age, that the mind ora man is a far country which can neither be approached nor explored. BuG today~ under pre~ent conditions of scientific achievemen~ it will be possible for a nation as rfch in human and material resources as ours to make the remote reaches of the mind accessible. The mentally ill and the mentally retarded need no longer be alien to our affections or beyond the help of our communities. # 3ohn Kennedy~ October :~963 The past 39 years have seen the proliferation of community mental health services. We have seen the development of pharmacological interventions that have yielded major life improvements for many people who experience the effects of mental illness, in ways which could not be imagined in 1963. We have seen the movement of the developmentally disabled from institutions to the community and the humanization of institutions for all disability groups. We have seen the difference that person centered planning and consumer empowerment can make in the lives of consumers and families. Today, the Recovery Movement offers hope never before envisioned for people with serious and persistent mental illness to live with and manage mental illness within the context of full lives rather than as life's single focus. The treatment of addictions within the context of community, friends, and family support has demonstrated important success in the recovery of people with addictive disorders. We have also seen the skyrocketing use of illegal drugs by children and young adults in unimagined proportions and the effect this has had on our communities. ]~n North Carolina, we still rely heavily on the use of large regional facilities to provide treatment and care for people of all disabilities. We have long waiting lists for services in the community. We lack essential services in the community. We still have much work to be done. Page4 Piedmont Local Business Plan Executive Summary