Thursday, June 04, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
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MEMBERS PRESENT: ☒Glenn Adams, Cumberland County Commissioner, JD, ☒Jennifer Anderson, MHSA, ☒Tony Braswell,
Johnston County Commissioner, ☒Heidi Carter, Durham County Commissioner, MPH, MS, ☒David Curro, BS, ☒Angela Diaz, MBA,
☒Greg Ford, Wake County Commissioner, MA, ☒Lodies Gloston, MA, ☒David Hancock, MBA, MPAff, ☒Duane Holder, MPA, ☒D. Lee
Jackson, BA, ☒Donald McDonald, MSW, ☒Lynne Nelson, BS, ☒Gino Pazzaglini, Board Vice-Chair, MSW LFACHE, ☒Pam Silberman,
JD, DrPH, ☒McKinley Wooten, Jr., JD; ☐(vacancy representing Cumberland County; ☐(vacancy representing Durham County);
☐(vacancy representing Durham County); and ☐(vacancy representing Wake County)
GUEST(S) PRESENT: Denise Foreman, Wake County Manager’s office; Yvonne French, NC DHHS/DMH (Department of Health and Human Services/Division of Mental Health, Developmental Disabilities and Substance Abuse Services); Mary Hutchings, Wake County Finance Department;
ALLIANCE STAFF PRESENT: Brandon Alexander, Communications and Marketing Specialist II; Damali Alston, Director of Network Evaluation; Michael Bollini, Executive Vice-President/Chief Operating Officer; Joey Dorsett, Senior Vice-President/Chief Information Officer; Doug Fuller, Director of Communications; Kelly Goodfellow, Executive Vice-President/Chief Financial Officer; Terrasine Gardner, Engagement Manager; Cheala Garland-Downey, Executive Vice-President/Chief Human Resources Officer; Veronica Ingram, Executive Assistant II; Mehul Mankad, Chief Medical Officer; Sara Pacholke, Senior Vice-President/Financial Operations; Brian Perkins, Senior Vice-President/Strategy and Government Relations; Monica Portugal, Chief Compliance Officer; Robert Robinson, Chief Executive Officer; Sean Schreiber, Executive Vice-President/Network and Community Health; Tammy Thomas, Senior Director of Project Portfolio Management; Sara Wilson, Senior Director of Government Relations; Carol Wolff, General Counsel; and Doug Wright, Director of Community and Member Engagement
1. CALL TO ORDER: Vice-Chair Gino Pazzaglini called the meeting to order at 4:03 p.m.
AGENDA ITEMS: DISCUSSION:
2. Announcements A. BOARD MEMBER TERMS: Vice-Chair Pazzaglini shared Alliance’s process of board members continuing to serve as we awaitreappointment from respective boards of county commissioners.
B. MOMENT OF SILENCE: Vice-Chair Pazzaglini asked for a moment of silence. Mr. Robinson read a statement on behalf of Vice-Chair Pazzaglini and himself; it can be found at https://www.alliancehealthplan.org/general-news-announcements/a-public-statement-from-the-leadership-of-alliance-health/. Vice-Chair Pazzaglini reviewed the purpose of the agency’s Code of Ethics, whichis part of the governance policies approved by the Board and is a requirement for employment; it is reviewed and re-attestedannually by all staff. Vice-Chair Pazzaglini recommended revising the Code of Ethics to include additional language related to theagency’s support for diversity and inclusion; the revisions will be reviewed and approved by the Board.
C. NO JULY MEETING: Vice-Chair Pazzaglini reminded board members that there is no board meeting in July.D. LAUNCH OF ONLINE SCREENING TOOL: Mr. Robinson announced this tool (https://www.alliancehealthplan.org/consumers-
families/take-a-screening-2) is designed to help people determine if they or a loved one would like to connect with a behavioralhealth professional.
3. Agenda Adjustments There were no adjustments to the agenda.
4. Public Comment There were no public comments.
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Thursday, June 04, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
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AGENDA ITEMS: DISCUSSION:
5. Committee Reports A. Consumer and Family Advisory Committee – page 7 The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from Durham, Wake, Cumberland or Johnston counties who receive mental health, intellectual/developmental disabilities or substance use/addiction services. This month’s report included draft minutes and supporting documents from the Johnston, Durham, Wake, and Steering Committee meetings. Dave Curro, CFAC Chair, presented the report. Mr. Curro shared that CFAC members have maintained contact throughout the COVID-19 pandemic; each CFAC subcommittee reviewed the quarterly Human Rights Committee report; members attended Alliance virtual resource fairs and a virtual statewide CFAC legislative day. He also shared that Jason Phipps will be the FY (Fiscal Year) 2020-2021 CFAC chair. Mr. Curro shared a request from a CFAC member regarding the number of Alliance members who have contracted COVID-19 and how has COVID19 affected the suicide rate. The CFAC report is attached to and made part of these minutes. BOARD ACTION The Board received the report. B. Finance Committee – page 93 The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Area Board. This month’s report included the draft minutes from the May 7, 2020, meeting, the Summary of Savings/(Loss) by Funding Source and ratios for the period ending April 30, 2020, and recommendations to the Board to approve all presented contracts over $500,000. David Hancock, Committee Chair, presented the report. Mr. Hancock shared that revenues exceeded expenditures and all state and contractual ratios were met. The Finance Committee report is attached to and made part of these minutes. BOARD ACTION A motion was made by Mr. Hancock to approve the FY2019-2020 budget amendment 1; motion seconded by Mr. Curro. Motion passed unanimously. C. Audit and Compliance Committee Report – page 103 The purpose of the Audit and Compliance Committee is to put forth a meaningful effort to review the adequacy of existing compliance systems and functions and to assist the Board of Directors in fulfilling its oversight responsibilities. This month’s report included minutes from its December and May meetings and proposed revisions to the Corporate Compliance Plan reviewed by the Committee on May 27, 2020. Dave Curro, Audit and Compliance Committee Chair, presented a recommendation from the Audit and Compliance Committee, which was also presented to the Executive Committee. BOARD ACTION A motion was made by Ms. Gloston to support the Audit and Compliance Committee’s recommendation to competitively bid auditor services every five years, starting FY2020-2021; motion seconded by Ms. Diaz. Motion passed unanimously.
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Thursday, June 04, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
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AGENDA ITEMS: DISCUSSION:
6. Consent Agenda A. Draft Minutes from May 7, 2020, Board Meeting – page 125B. Executive Committee Report – page 130C. Network Development and Services Committee Report – page 133D. Quality Management Committee Report – page 135E. FY21 HR Classification and Grade Plan – page 140
The consent agenda was sent as part of the Board packet; it is attached to and made part of these minutes. Board members discussed the FY21 HR Classification and Grade Plan including progress of the current market study and the timing of future updates to the board.
BOARD ACTION A motion was made by Mr. Curro to approve the minutes and adopt the consent agenda; motion seconded by Mr. McDonald. Motion passed unanimously.
7. Training/Presentation(s)
A. COVID-19 Update – page 150Alliance staff provided an update on the agency’s efforts to continue operations and to coordinate care for the people Alliance serveswhile maintaining staff and community safety; the update included how the agency is addressing the impact on providers and any changesin federal or state legislation.
Mr. Robinson shared that the majority of staff continue working from home and a gradual re-entry plan is being developed. Staff working within the community will resume doing so June 16, 2020. Staff will continue working from home and meetings or trainings with more than ten attendees are suspended until September 2020.
Mehul Mankad, Chief Medical Officer, provided an epidemiological update for North Carolina. He shared an updated on the number of cases and deaths, which may impact the governor’s implementation of the next phase to open NC. Dr. Mankad also responded to board members questions and shared that suicide rates do not indicated an increase at this time.
Mr. Holder shared an update from an opioid coalition in Cumberland County; their data indicates an increase in overdoses in April 2020, which may be attributable to COVID-19.
Sean Schreiber, Executive Vice-President/Network and Community Health, reviewed Alliance’s support of providers who directly provide care and continue member contact, including Alliance staff and providers supporting county shelters for members experiencing homelessness. He reviewed additional efforts to continue supporting providers.
Brian Perkins, Senior Vice-President/Strategy and Government Relations, reviewed factors impacting the NC state budget process and how NC will utilize the remaining Federal CARES Act funding. The COVID-19 presentation is saved as part of the Board’s files.
BOARD ACTION The Board received the training/presentation.
B. FY (Fiscal Year) 2020-2021 Public Hearing and Approved Budget – page 151
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Thursday, June 04, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
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AGENDA ITEMS: DISCUSSION:
Per GS (General Statute) 159-12 (b), a public hearing was held to allow any persons who wish to be heard on the FY2020-2021 (FY21) budget. Vice-Chair Pazzaglini provided an additional opportunity for members of the public to speak on the FY21 budget; there were no speakers. BOARD ACTION A motion was made by Ms. Nelson to motion to close the public hearing on the FY21 budget; motion seconded by Mr. Curro. Motion passed unanimously. The FY 21 budget was presented to the Board for approval and adoption per GS 159-13. Per Alliance’s by-laws, this item requires a super-majority approval. Kelly Goodfellow, Executive Vice-President/Chief Financial Officer, presented the budget. She expressed gratitude to county partners for continuing to support services for the people Alliance services, in spite of reduced revenue due to COVID-19 restrictions. Ms. Goodfellow reviewed the Medicaid budget including the current PMPM (per member, per month) Medicaid rate, risk corridor, the new target treatment ratio, and the agency’s current Medicaid loss ratio or MLR. Additionally, Ms. Goodfellow reviewed the non-Medicaid budget including the base benefit plan and use of community funds. The FY21 budget presentation is saved as part of the Board’s files. BOARD ACTION A motion was made by Dr. Silberman to approve the FY21 budget; motion seconded by Ms. Anderson. Motion passed unanimously. Ms. Goodfellow reviewed the current reinvestment plan, including an overview for FY21 and the legislative requirement to submit this plan to the State. The presentation of the FY21 budget and reinvestment plan is saved as part of the Board’s files. BOARD ACTION A motion was made by Mr. Wooten to approve the submission of the three-year reinvestment plan to the NC Department of Health and Human Services; motion seconded by Ms. Nelson. Motion passed unanimously. C. Annual Compliance Report – page 152 The Alliance compliance program is designed to deter and mitigate risk to the organization through prevention, detection and remediation activities. In accordance with contractual obligations and federal regulations, Alliance shall have an effective compliance program with reasonable oversight by the governing board, understanding the scope and operations of the compliance program.
Monica Portugal, Chief Compliance Officer, reviewed the agency’s compliance program including its initial creation and approval by the Board, and implementation which includes risk-based efforts, staff trainings, and internal/external audits and monitoring. The presentation of the annual compliance report is saved as part of the Board’s files. BOARD ACTION A motion was made by Mr. Curro to approve the compliance plan; motion seconded by Ms. Nelson. Motion passed unanimously.
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AGENDA ITEMS: DISCUSSION:
8. Election of FY 2020-2021 Board Officers – page 153
As stated in Article II, Section D of the by-laws, at each final regular Board meeting of the fiscal year, the officers of the Board of Directors shall be elected for a one-year term to begin July 1. The officers of the Board of Directors include Chairperson and Vice-Chairperson. Vice-Chair Pazzaglini opened the floor and accepted nominations for FY21 Board Chair. BOARD ACTION A motion was made by Dr. Silberman to nominate Gino Pazzaglini as FY21 Board Chair. There were no other nominations. A motion was made by Mr. Wooten to close nominations and elect Gino Pazzaglini as FY21 Board Chair; motion seconded by Mr. McDonald. Motion passed unanimously. Vice-Chair Pazzaglini opened the floor and accepted nominations for FY21 Board Vice-Chair. BOARD ACTION A motion was made by Mr. McDonald to close nominations and elect Lynne Nelson as FY21 Board Vice-Chair; motion seconded by Dr. Silberman. Motion passed unanimously. Vice-Chair Pazzaglini and Ms. Nelson expressed gratitude for the opportunity to serve as FY21 Board officers.
9. Chair’s Report Vice-Chair Pazzaglini shared that the Executive Committee is recommending Lee Jackson’s reappointment. BOARD ACTION A motion was made by Mr. Holder to recommend to the Johnston Board of County Commissioners the reappointment of Lee Jackson to Alliance’s Board; motion seconded by Ms. Nelson. Motion passed unanimously.
Vice-Chair Pazzaglini reviewed upcoming board meetings.
BOARD ACTION A motion was made by Mr. Holder to convene a special board meeting on Monday, June 29 at 8:00 am pending confirmation from CEO and staff; motion seconded by Ms. Diaz. Motion passed unanimously. Vice-Chair Pazzaglini reviewed the agency’s practice of meeting in county locations, which will be adjusted due to current public health guidelines; he recommended postponing meetings in community locations. BOARD ACTION A motion was made by Mr. Wooten to hold the August meeting virtually and postpone meeting in community locations until feasible to do so per public health guidelines; motion seconded by Mr. Curro. Motion passed unanimously.
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Thursday, June 04, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
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AGENDA ITEMS: DISCUSSION:
10. Closed Session(s) BOARD ACTION A motion was made by Mr. Wooten to enter closed session pursuant to NC §143-318.11 (a) (1), (a) (3), and (a) (6) to prevent the disclosure of information that is confidential and not a public record under NCGS 122C-126.1; to consult with, consider or give instructions to an attorney in order to preserve the attorney-client privilege; and to consider the qualifications, competence, and performance of an employee; motion seconded by Mr. Curro. Motion passed unanimously. The Board returned to open session.
11. Adjournment All business was completed; the meeting adjourned at 7:33 p.m.
Next Board Meeting Thursday, August 06, 2020
4:00 – 6:00 pm
Minutes approved by Board on August 6, 2020.
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5A
(Back to agenda)
Alliance Health BOARD OF DIRECTORS
Agenda Action Form
ITEM: Consumer and Family Advisory Committee (CFAC) Report DATE OF BOARD MEETING: June 4, 2020 BACKGROUND: The Alliance Consumer and Family Advisory Committee, or CFAC, is made up of consumers and/or family members that live in Durham, Wake, or Cumberland Counties who receive mental health, intellectual/developmental disabilities and substance use/addiction services. CFAC is a self-governing committee that serves as an advisor to Alliance administration and Board of Directors. State statutes charge CFAC with the following responsibilities: Review, comment on and monitor the implementation of the local business plan Identify service gaps and underserved populations Make recommendations regarding the service array and monitor the development of additional
services Review and comment on the Alliance budget Participate in all quality improvement measures and performance indicators Submit findings and recommendations to the State Consumer and Family Advisory Committee
regarding ways to improve the delivery of mental health, intellectual/other developmental disabilities and substance use/addiction services.
The Alliance CFAC meets at 5:30pm on the first Monday in the months of February, April, June, August, October and December at the Alliance Corporate Office, 5200 West Paramount Parkway, in Morrisville. Sub-committee meetings are held in individual counties; the schedules for those meetings are available on our website. The Alliance CFAC tries to meet its statutory requirements by providing you with the minutes to our meetings, letters to the board, participation on committees, outreach to our communities, providing input to policies effecting consumers, and by providing the Board of Directors and the State CFAC with an Annual Report as agreed upon in our Relational Agreement describing our activities, concerns, and accomplishments. REQUEST FOR BOARD ACTION: Receive draft minutes and supporting documents from the Johnston May 19, the Durham May 11, the Wake May 12, and the May 4 Steering Committee meetings. Cumberland County had not met at the time of this submission. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Dave Curro, CFAC Chair; Doug Wright, Director of Community and Member Engagement
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Tuesday, May 19, 2020
CFAC MEETING - REGULAR MEETING Virtual Meeting via Zoom 5:30 – 7:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 1 of 3
MEMBERS PRESENT: Jason Phipps, Albert Dixon, Marie Dodson, Jerry Dodson, Cassandra Herbert-Williams, Jessica Storts BOARD MEMBERS PRESENT: None GUEST(S): Roanna Newton, DHHS STAFF PRESENT: Doug Wright, Director of Community and Member Engagement, Terrasine Gardner, Member Engagement Manager, Wes Knepper, Director Quality Management, Noah Swabe, Member Engagement Specialist Join Zoom Meeting https://alliancehealthplan.zoom.us/j/679504681?pwd=LzBlVFVjNFBaTSsyWmljUk16Y1YrQT09 +1 646 558 8656 Meeting ID: 679 504 681 1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – April minutes were reviewed, a motion was made by Marie Dodson, seconded by Albert Dixon, Motion Passed.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
3. Public Comment Individual/Family Challenges and Solutions
Check in with CFAC members on challenges during COVID-19 N/A N/A
4. Global Quality Management Committee
Wes Knepper- Open CFAC Position Wes Knepper, Alliance Health’s QM Senior Director joined us briefly for the first part of our meeting to discuss the CFAC positions that were currently open on the Quality Management Committee. Members were invited to join an open meeting to gather insight on Quality Management measures that Alliance puts forth as well as gain an understanding on what a CFAC member’s role would be on this committee, such as offering solutions to current issues, input on measures, etc. This meeting takes place on the 1st Thursday of every month from 1-2pm. Members are to advise Doug, Terrasine, or Noah if they would like to attend the meeting so Dave Curro, Steering Committee Chair can make an appointment.
CFAC members will let Doug, Terrasine, or Noah know if they are interested in the position.
Ongoing
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Tuesday, May 19, 2020
CFAC MEETING - REGULAR MEETING Virtual Meeting via Zoom 5:30 – 7:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 2 of 3
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 5. LME/MCO
Updates Doug went over the following updates A grant has been approved by FEMA for mental health counseling similar to the grant that was given during the hurricane last year May is Mental Health Awareness Month, Alliance is hosting virtual events and social media campaigns to promote Mental Health Awareness EQR- External Quality Review: Every year Alliance has an EQR that is done to and make sure that Alliance is meeting their contract and fulfilling their contract, basically doing what we say we are doing. This year Alliance’s EQR was completed in March by CCME. Alliance scored a 96% State CFAC held a Virtual Legislative Day Today on May 19 from 10-12 Legislatures passed COVID Relief Bill and Medicaid transformation is still halted until a budget is passed
Alliance will continue to provide updates to CFAC as they become available
Ongoing
5. State Updates Making the Connection: Recruitment and Retention- Roanna Newton, DHHS Roanna presented on recruitment and retention. The key points on this presentation were, ways we can work together to build and maintain effective CFACs, making a connection with your community to encourage and empower those who have yet to find their voice, and community collaboration and engagement
N/A N/A
6. Sub-Committee Elections
Cassandra Herbert-Williams and Marie Dodson have agreed to sit on the nomination committee for the local subcommittee. Elections will be held at next month’s meeting.
Noah will follow up with Cassandra and Marie via email to discuss next steps
June 16, 2020
7. Steering Committee
Jerry Dodson volunteered to be on the nomination committee for the Steering Committee
Romona is assisting the nomination committee and will be following up with Jerry
Ongoing
8. Current Events I2I is hosting a Community Inclusion Webinar May 26th at 2pm Noah will send out the information to the CFAC
May 21, 2020
9. Announcements June meeting will be via Zoom Noah will send out the information ASAP
10. ADJOURNMENT: The next meeting will be June 16, 2020, at 5:30 p.m. Respectfully Submitted by:
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Tuesday, May 19, 2020
CFAC MEETING - REGULAR MEETING Virtual Meeting via Zoom 5:30 – 7:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 3 of 3
Noah Swabe, Individual and Family Engagement Specialist Click here to enter text. Date Approved
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NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 1
NC Department of Health and Human Services
Making the ConnectionMeaningful Recruitment and Retention
Roanna NewtonMental Health Program Consultant Community Engagement & Empowerment TeamNC DHHS DMH DD SAS
Spring 2020
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NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 2
Making the connection with your community
encourages and empowers those who have yet to find their voice.
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NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 3
Purpose
The purpose of this training is to discussways we can work together to build and maintain effective CFACs.
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NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 4
Learning Objectives
By the end of this training, you will be able to
Begin thinking and developing Your “Why” Statement
Collaborate with Your Community
Increase Confidence in Your Ongoing Recruitment Efforts
Actively Recruit & Retain Potential New Members
Practice What You Have Learned
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Your CFAC Why
Why is CFAC important to you?
What keeps you coming back?
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I m a g i n e B e t t e r …
C o l l a b o r a t e To g e t h e r .
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What Are You Currently Involved In?
• Social Groups• Professional Groups• Parent Groups• Interest Groups• Neighborhood
Association• Community Garden
Groups
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Connect with Community Groups
• Advocacy organizations (NAMI, The Arc, Autism Society)
• Recovery Communities of North Carolina
• AA Intergroup Subcommittee
• Providers and other community agencies
• LME/MCO Staff
• LME/MCO Area Board members
• Faith Based organizations
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Envis ion the Futurepage 19 of 153
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CFACs and Community Engagement
Community Engagement
A way to make connections with people who share the same beliefs about what makes the community a good place to live.
- Develop relationships between individuals with a shared interest, common goal to improve the community they live in
- Promotes livable communities: a place where ALL people, of ALL abilities can live, work, play and fully participate in all aspect of life
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Community Engagement
CFACs can host meaningful, informational events that provide the community with a direct link to resources that are important to them while also providing a space for social interaction
Some events CFACs could host:
-You Qualified for Medicaid: Now What?-Understanding the Enrollment Process-Navigating the Service Delivery System-Town Hall Meetings-Veterans Outreach-Supported Employment-Voter Rights & Registration
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Successful Event Tips
Community Engagement Interaction
- Have handouts available
- Include a CFAC brochure with handouts or at the sign-in table
- Talk about your CFAC experience
- Have a sign-in sheet with options to sign up for the Community Engagement & Empowerment emails and listservs, LME/MCO and CFAC emails
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Nourishing Person-to-Person EngagementEngage in Follow-up
• Make connections with potential new members by contacting them−Phone: Make a point to contact people
−Email: Check-in “How are you?” set up a time to talk face to face or by phone
− In-person: have a coffee or tea, make lunch plans, go for a walk/roll
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CFAC Conversation Starters
• How are you doing?
• What are you most passionate about?
• What’s your story?
• What was something good that happened today?
• Talk to the potential new member about your “Why Statement”
• Invite them to a CFAC meeting
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How People Report Becoming Involved
41%
1%
14%
27%
15%
2%
Volunteers
Approached by Organization Asked by Boss/Employer
Asked by relative, friend, or co-worker Asked by someone in organization
Asked by someone else/other Did not report how became involved
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Why People Do Not Volunteer:
Because No One Asked Them!
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Making the Connection: Recruitment
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“Recruitment is a constant, year-round process of keeping your organization's name and its available volunteer opportunities in front of
people.”
Source: Ellis, Susan J., The Volunteer Recruitment Book : Energize, 1994
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Make an Action Plan
• Add recruitment activities and community engagement efforts to your monthly agenda
• Set some realistic goals for recruitment: −How many community engagement events will you
host or attend?
−How many people do you want to invite or have attend at your community engagement event?
• Make the commitment to bring one new potential to a meeting
• Give regular updates on progress being made or barriers occurring in the process
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Putting it into Practice
Things to Consider
• Strengths based approach: what are the good things that you’ve done as a CFAC?
• Share the meaningful work you’ve done in your community- develop talking points
• Example: #Care4NC, https://www.carefornc.org/−Share the good stories that have come from
someone using services from the LME/MCO
−Share CFAC successes: what are examples of advisory products that have made an impact?
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Maintaining the Connection: Retention
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Commitment to Include
• What do people need to feel supported as a member of CFAC in order to give or contribute to forming a quality advisory product?
• What types of supports can you share with potential and new members that lets them know the CFAC and LME/MCO is committed to reduce barriers to attending meetings?
• How do you make your meetings accessible, so that everyone can attend prior to membership?
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Retention Steps
Retention of
Members
Orientation
Valued Role
Assess Needs
Provide Supports
Information and
Resources
Keep Members Engaged
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Retention Planning
• CFACs should work to have a retention plan that follows the formula on the previous slide
• Orientation-mission, vision, goals, and general operations
• Mentorship• Teambuilding
Orientation
• What are members passionate about?
• Foster leadership opportunities
• Champion others’ ideas
Valued Role
• Work collectively to foster inclusion
• Explore areas that need more information
Assess Needs
• Make a plan to help support members
• Social needs, accessibility needs
• Community Access
Provide Supports
• Equip members with recent information
• Community Resources
• National Resources
Information and Resources
• Motivate your members
• Remember to recharge
• Be open to new ideas
Membership Engagement
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Achieving A Unified Voice
Te a m b u i l d i n g
The ability to work in a team, collaborating with others, the ability to understand one’s own feelings, interests and circumstances and balance them with those of others; ability to treat people with respect, concern and support despite differences.
M o t i v a t i n g O t h e r s
The ability to cause others to do or stop doing something, to express their feelings, interests and circumstances; to internalize a goal or standard; to support or oppose an action, idea, or point of view.
Think ing Creat ive ly
The ability to generate and accept new, creative, unanticipated, previously untried, or unconventional ideas or approaches
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Make Recruitment & Retention Exciting
• Connecting with people is an on-going process
• CFACs should make recruitment of new people a continuous agenda item
• Engage in team building, motivating each other, and thinking creatively
• Face-to-face personal invitations are the best way to recruit new members to volunteer organizations
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Questions and Contact Information
STAFF Roanna NewtonPHONE: 919-715-3197EMAIL [email protected]
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Informational Slides
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Statutory Requirements for Membership
Subsection B of 122-C 170 states :
−Each of the disability groups will be equally
represented on the CFAC
−The CFAC shall reflect as closely as possible
the racial and ethnic composition of the catchment area
−The terms of members shall be three years
−No member may serve more than three
consecutive terms
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Publicize Your Meeting
NC Open Meetings Law requires the regular announcement of CFAC meetings.
One often overlooked approach is to include a statement that the CFAC is actively recruiting membership with the regular announcements of meetings.
Where do you currently announce your meetings?
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Prior to beginning recruitment, it is important to assess the recruitment needs of the CFAC.
Tracking current membership and terms of service is essential to knowing what positions are vacant or what positions will be coming vacant in the near future.
What are the areas of interest your members represent?What areas of expertise does your CFAC need to fill?
Determine Your Membership Needs
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NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 32
Recruitment Planning
• Are steps for actual membership clearly spelled out in the CFAC by-laws and other printed material?
• Who will be the point of contact for the CFAC and what will be the preferred contact method (e-mail, telephone)?
• Is there an orientation process in place to ensure that new members understand the mission and purpose of the CFAC?
page 42 of 153
NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 33
Other items to consider prior to recruitment:
• How does your CFAC identify member expectations?
• How does your CFAC deal with dissatisfied members?
• How have member needs changed during the past year? Which group recruitment/retention activities are yielding results and which aren’t?
page 43 of 153
NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 34page 44 of 153
NC DHHS DMH DD SAS| Recruitment Strategies for CFACs 35
Working Together to Achieve Success!
- Oversee the recruitment and retention planning
- Ensure that everyone is participating in recruitment activities
- Coordinate with the CFAC as a group
- Review applications and set-up interviews with potential new members
- Keep the CFAC on task to reach recruitment goals and milestones
Form a Subcommittee
page 45 of 153
Monday, May 11, 2020
CFAC MEETING - REGULAR MEETING Virtual meeting via videoconference
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 1 of 3
MEMBERS PRESENT: ☒ Steve Hill, ☒ Tammy Shaw, ☐ James Henry, ☒ Latasha Jordan, ☒ Dave Curro, ☒ Trula Miles,
☒ Brenda Solomon, ☒ Chris Dale, ☒ Dan Shaw, ☒ Pinkey Dunston, ☐ Regina Mays, ☒ Charlitta Burruss, ☒ Helen Castillo BOARD MEMBERS PRESENT: None
GUEST(S): ☒ Roanna Newton, DHHS
STAFF PRESENT: ☒ Doug Wright, Director of Community & Member Engagement, ☒ Terrasine Gardner, Member Engagement Manager,
☒ Ramona Branch, Individual & Family Engagement Specialist ☒ Wes Knepper, Senior Director - Quality Management https://alliancehealthplan.zoom.us/j/648683034?pwd=VVIwRTMyTTZkVWhTaTZwZ055NlF1UT09
+1 646 558 8656
Meeting ID: 648 683 034
Password: 060041
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – The minutes from the April 13, 2020, Consumer and Family Advisory Committee (CFAC) meeting were reviewed; a motion was
made by Dan Shaw and seconded by Chris Dale to approve the minutes. Motion passed.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Public
Comments COVID-19- Check In Members were asked how they were doing during these times as we continue to move through the COVID-19 pandemic.
N/A N/A
4. Global Quality Management
Wes Knepper- Open CFAC Position Wes Knepper, Alliance Health’s QM Senior Director joined us briefly for the first part of our meeting to discuss the CFAC positions that were currently open on the Quality Management Committee. Members were invited to join an open meeting to gather insight on Quality Management measures that Alliance puts forth as well as gain an understanding on what a CFAC member’s role would be on this committee, such as offering solutions to current issues, input on measures, etc. This meeting takes place on the 1st Thursday of every month from 1-2pm. Members are to advise Doug, Terrasine, or Ramona if they would like to attend the meeting or commit to the position.
Members will advise Doug, Terrasine, or Ramona if they would like to attend a meeting or commit to the position.
N/A
page 46 of 153
Monday, May 11, 2020
CFAC MEETING - REGULAR MEETING Virtual meeting via videoconference
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 2 of 3
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 5. LME/MCO
Updates Doug went over the LME/MCO updates:
Members were asked to review the Human Rights Committee minutes and Grievance handouts that were sent out electronically with the agenda. If there are any questions or concerns, please email Doug
A grant has been approved by FEMA for mental health counseling
similar to the grant that was given during the hurricane last year
May is Mental Health Awareness Month and both Wake and Durham counties are hosting Virtual Resource Fairs. Wake County is May 12, and Durham County is May 27- Ramona will send out sign up links for both fairs to members in case they would like to attend.
Alliance has been sending CIT officers small treats to thank them for all the work they do for our community members and families
Alliance is recognizing community partners in the catchment area that have gone above and beyond in “Making a Difference” in the lives of our communities. For Durham County, the first recipient, Urban Ministries of Durham
EQR- External Quality Review: Every year Alliance has an EQR that is done to and make sure that Alliance is meeting their contract and fulfilling their contract, basically doing what we say we are doing. This year Alliance’s EQR was completed in March by CCME. Alliance scored a 96%
State CFAC will hold Virtual Legislative Day on May 19 from 10-12
Legislatures passed COVID Relief Bill and Medicaid transformation is still halted until a budget is passed
N/A N/A
6. State Updates Making the Connection: Recruitment and Retention- Roanna Newton, DHHS Roanna presented on recruitment and retention. The key points on this presentation were:
N/A N/A
page 47 of 153
Monday, May 11, 2020
CFAC MEETING - REGULAR MEETING Virtual meeting via videoconference
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 3 of 3
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Discuss ways we can work together to build and maintain effective
CFACs
Making a connection with your community to encourage and empower those who have yet to find their voice
Community collaboration and engagement
7. Steering Committee
Nominations for Steering Committee:
Each county will have a representative to sit on the Steering Committee Nominations Committee
The representatives will come together and compose a ballot of members that would like to represent as Chair or Co-Chair
Pinkey Dunston (D) and Annette Smith (W) so far
Ramona will assist the Nominating Committee
N/A N/A
8. Event Planning
On hold until pandemic restrictions are relaxed.
ADJOURNMENT: the next meeting will be June 8, 2020, at 5:30 p.m.
Respectfully Submitted by: _________________________________________________________________________________________________________________________________ Ramona Branch, Community Engagement Specialist 05.13.2020
page 48 of 153
Q2 Complaint AnalysisQM Quality Assurance
page 49 of 153
OverviewQ2 FY20 yielded 235 entries
• 108 (46%) Grievances – Members/legal guardians
• 84 (36%) Internal Employee Concerns – Alliance staff
• 40 (17%) External Stakeholder Concerns – Outside entities
• 3 (1%) Compliments
page 50 of 153
Nature of Issue DefinitionsReporting Category Definition
Abuse, Neglect and Exploitation
Any allegation regarding the abuse, neglect and/or exploitation of a child or adult as defined in APSM 95-2 (Client Rights Rules in Community Mental Health)
Access to Services Access to Services as any complaint where an individual is reporting that he/she has not been able to obtain services
Administrative Issues any complaint regarding a Provider’s managerial or organizational issues, deadlines, payroll, staffing, facilities, etc.
Authorization/Payment
Issues/Billing PROVIDER ONLY
Any complaint regarding the payment/financial arrangement, insurance, and/or billing practices regarding providers
Basic Needs Any complaint regarding the ability to obtain food, shelter, support, SSI, medication, transportation, etc.
Clients Rights Any allegation regarding the violation of the rights of any consumer of mental health/developmental disabilities/substance abuse services. Clients Rights include the rights and privileges as defined in General Statutes 122C and APSM 95 -2 (Client Rights Rules in Community Mental Health)
Confidentiality/HIPAA Any breach of a consumer’s confidentiality and/or HIPAA regulations.
LME/MCO Functions Any complaint regarding LME functions such as Governance/ Administration, Care Coordination, Utilization Management, Customer Services, etc.
LME/MCO Authorization/
Payment/Billing
Any complaint regarding the payment/financial arrangement, insurance, and/or billing practices of the LME/MCO
Provider Choice Complaint that a consumer or legally responsible person was not given information regarding available service providers.
Quality of Care – PROVIDER ONLY
Any complaint regarding inappropriate and/or inadequate provision of services, customer services and services including medication issues regarding the administration or prescribing of medication, including the wrong time, side effects, overmedication, refills, etc.
Service Coordination between
Providers
Any complaint regarding the ability of providers to coordinate services in the best interest of the consumer.
Other Any complaint that does not fit the above areas.
page 51 of 153
Nature of Issue/Type (Top 5)
0
10
20
30
40
50
60
Administrative Issues Access to Services Quality of Services LME/MCO Functions Abuse, Neglect,
Exploitation
55
3634
30
24
page 52 of 153
Source: Who submitted concerns?
0
10
20
30
40
50
60
70
80
90
MCO Staff Member Guardian Provider Parent Other Family
Member
Anonymous DMA
86
56
51
17
118
3 2 1
page 53 of 153
Complaints Against Alliance
34 Complaints Against Alliance
Nature of Issue Description
29 LME/MCO Functions Complaints related to Care
Coordination (staff), housing, changes
in care management, and Innovations
wait list
5 Authorization/Payment/Billing Complaints related to denials for
services, improper billing of members,
guardian’s concerns for budget letter
reductions
page 54 of 153
Service Breakdown
• 19% from Residential Services
• 12% Outpatient Services
• 7% Innovations Waiver Services
• All others represented 6% or less or were non-service related
0
5
10
15
20
25
30
35
40
45
Residential Outpatient Services NC Innovations Waiver Services
44
29
17
Top 3
page 55 of 153
Service Breakdown
• 7% - NC Innovations Waiver Services
• 5% - IDD Care Coordination
• 2% - Respite
0
2
4
6
8
10
12
14
16
18
NC Innovations Waiver Services IDD Care Coordination Respite
17
11
4
(IDD Services)
page 56 of 153
Service Breakdown
• 38% - Enhanced Services
• 17% - Basic Services
• 9% - Crisis Services
• 3% - SUD Services
• 2% - MH/SUD Care Coordination
0
10
20
30
40
50
60
70
80
90
Enhanced Services Basic Services Crisis Services SUD Services MH/SUD Care
Coordination
90
41
21
84
(MH/SUD Services)
page 57 of 153
Human Rights Complaints
0 5 10 15 20 25
Abuse/Neglect/Exploitation
Client Rights
Confidentiality/HIPAA
Basic Needs
24
13
5
4
page 58 of 153
Human Rights Complaint/Grievances
Service Breakdown
page 59 of 153
Abuse/Neglect/Exploitation
1
1
1
1
1
1
1
1
1
1
2
2
3
3
4
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
Access/Scrrning, Triage and Referral
Child & Adolescent Day Treatment
Crisis -Behavioral Health Urgent Care
Crisis - Emergency Department
Crisis Other
Innovations Services (Non-residential)
Intermediate Care Facility (ICF)
Psychosocial Rehabilitation (PSR)
Unknown
Outpatient services
Adult Day Vocational Program
Psychiatric Services
Residential Services (Include Innovations)
Other
Crisis - Inpatient
page 60 of 153
Confidentiality/HIPAATotal of 5
Adult Day Vocational Program 1
Other (TMS) 1
Outpatient Services 1
Psychiatric Services 1
Respite 1
page 61 of 153
Basic NeedsTotal of 4
Residential Services (Include Innovations) 1
Crisis - Inpatient 1
Community Support Team 1
Other1
page 62 of 153
45 Human Rights Complaints/GrievancesNature of Issue Description Resolutions
24 Abuse/Neglect/Exploitation 11 – Potential licensing rule violations
3– Sexual Assault/Inappropriate Sexual
Behavior
5 – Physical/Verbal Abuse
6– Improper care/supervision
3 – Exploitation related to payment for
services
14 – Referred to Division of Health Services
Regulations (DHSR)
4- Provider initiated corrective action
8 – Worked with provider for
solution/Corrective action
4 – Information/Technical Assistance to
provider.
13 Client Rights 6 – Access to services/resources
1 – Payment/finances
2 – Provider Practices
3 – Current living conditions
1 – Provider Choice
3 – Provider initiated corrective action
8 – Info/Technical Assistance provided
4 – Worked with provider for resolution
4 Basic Needs 1 – Housing issues
1 – Basic needs while IVC’d
2– Management of funds
3 – Worked with provider for resolution
1 – Info/Tech Asst. provided
4 Confidentiality/HIPAA 3 – Unauthorized disclosure of member
information
1 – Wrong information on member
documents
2 – Provider initiated corrective action
1 – Information/Tech Assistance provided
page 63 of 153
Incident Trends Report Q2 FY20
page 64 of 153
Incident Report Breakdown • 745 Reports were entered in
to NC-IRIS for 502 members
• 479 reports involved children, 266 involved adults
LEVELS
• 667 Level 2 reports
• 78 Level 3
page 65 of 153
Wake County submitted the largest number of Level 2 (342)and Level 3 (45)
reports in the 1st quarter of FY20
Incident Levels by County
0
50
100
150
200
250
300
350
Wake Durham Cumberland Johnston
342
145
9981
45
15 13 5
Level 2s and Level 3s
L2 L3
page 66 of 153
Adults vs. Children(By Level)
• A total of 479 Incidents were reported for children: (460 L2 and 19 L3)
• A total of 266 Incidents were reported for Adults: (207 L2 and 59 L3)
0
50
100
150
200
250
300
350
400
450
500
L2 L3
207
59
460
19
Adults Children
page 67 of 153
Service Breakdown
• This chart represents the top 10 services reporting incidents during Q2 of FY20
• PRTF service category remains the highest reporting service; 21% of all reports
16
16
18
19
22
22
25
51
60
60
153
0 20 40 60 80 100 120 140 160 180
.4300 TROSA
Therapeutic Community
H2015 HT- Community Support Team/HT/
RC-100 - ICFMR
Individual Therapy
H0040 - Assertive Community Treatment Team/IDDT
90806 - Individual Therapy (45-50 min)
H0019 HQ - HRI Res Level III, 4 beds or less/HQ/
H2022 - Intensive In Home
H2012 HA- Day Tx Behavioral Health Child/HA/
RC911 - PRTF
Top 10 Services
page 68 of 153
REPORTS BY INCIDENT CATEGORY
(Primarily Human Rights Related)
page 69 of 153
• 93% of Restrictive interventions in Q2 were Physical Restraints
0
50
100
150
200
250
Physical Restraints Seclusion Isolation
208
16
0
Restrictive Interventions
page 70 of 153
Restrictive Intervention Breakdown
• 66% from PRTF Programs
• 27% from Day Treatment Programs
• Higher numbers/percentages in Child and Adolescent programs
0 20 40 60 80100
120140
160
S9484 HA - Facility Based Crisis/HA/
YP620 - ADVP
H2022 - Intensive In Home
Innovations Residential Supports Level IV and Level IV AFL
H0019 HQ - HRI Res Level III, 4 beds or less/HQ/
H0019 TJ HE- HRI Res Level III 5 beds or more/TJ/HE/
Partial Hospitalization
H2012 HA- Day Tx Behavioral Health Child/HA/
RC911 - PRTF
1
1
1
1
1
1
11
60
147
Service Categories
page 71 of 153
• 52 Total – 51 were L2; 1 was L3
• 1 L3 due an injury that resulted in police involvement and missing persons
report
0
5
10
15
20
25
Other Trip/Fall Auto Accdent Aggressive Behavior Unknown Accident Self Mutilation
24
14
7
4
21
Injury Categories
page 72 of 153
• 82 reported in this category
• 4 Substantiated: 3 Staff Abuse, 1 Staff Neglect
• Staff and Caregiver Abuse were the most commonly reported in the category
(49% of reports in this category)
0
5
10
15
20
25
Staff Abuse Caregiver
Abuse
Sexual
Assault
Abuse Alleged Caregiver
Neglect
Staff Neglect Exploitation Sexual
Assault by
Staff
Neglect
Alleged
22
18
13
10
8
6
2 21
Abuse/Neglect/Exploitation
page 73 of 153
• A total of 37 deaths were reported during the 2nd quarter
• 22 (59%) L3, 15 (41%) L2
• 43% of reports due to Unknown Causes
• Could be downgraded to L2 when the OCME report is received
• 3 OMT (Opioid Maintenance Therapy) are included in Unknown Death
reports
0
2
4
6
8
10
12
14
16
Accident Suicide Terminal Illness Unknown
13
2
4 4
14
Member Deaths(Category and Level)
L2 L3
page 74 of 153
Incident Report Compliance
page 75 of 153
Incident Report Compliance Process (Q2 FY2020)
• 20 Late Incident Report emails were sent out in Q2
• 1 less than Q1 (21)
• 3 Plans of Corrections (POC) were issued for late reports in Q2
• 1 POC was closed from 1st Quarter
page 76 of 153
• Late submissions in the 2nd quarter decreased by 1 percentage point in Q2. (Q1: 12%)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
October 2019 November 2019 December 2019 AVERAGE
17%
8%9%
11%
Late Incident Report Submission
page 77 of 153
Tuesday, May 12, 2020
Wake CFAC Subcommittee Meeting Healing Transitions 1251 Goode Street, Raleigh, NC 27603 5:30 pm – 7:00 pm
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 1 of 3
MEMBERS PRESENT: ☒Carole Johnson, ☒ Megan Mason, ☒ Karen McKinnon, ☐ Connie King-Jerome, ☒ Israel Pattison, ☒ Annette Smith ☒, Ben Smith
☒, Wanda (Faye) Griffin, ☒ Diane Morris, ☐ Jessica Larrison, ☐ Vicky Bass, ☒ Gregory Schweitzer, ☐Bradley Gavriluk
BOARD MEMBERS PRESENT: GUEST(S): ☒ Roanna Newton, DHHS; ☒ Wes Knepper Alliance Health; ☒
STAFF PRESENT: ☒ Doug Wright, Director of Individual and Family Affairs, ☒ Terrasine Garner, Engagement Manager, ☒ Stacy Guse, Community Engagement Specialist *******Please register for the this meeting as you will get a unique link to the meeting**********
Join Zoom Meeting:
https://alliancehealthplan.zoom.us/j/580377458?pwd=d3dUbk1vWm82SG1IOTdVT3VJdG5nZz09
+1 646 558 8656
Meeting ID: 580 377 458
Password: 404259
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – The minutes from the April 14, 2020, Wake Consumer and Family Advisory Committee (CFAC) Subcommittee meeting were
reviewed; a motion was made by Karen McKinnon and seconded by Vicky Bass to approve the minutes. Motion passed unanimously.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Public Comments
Individual and Family Challenges
COVID19 Check-in Karen attended the Alliance Health Zoom resource fair earlier today and was impressed with the quality of information provided and with the speakers. Israel found an interesting site called Virbela.com for 3rd world experiences where you can drop down and in virtual meetings and trainings. VirBELA's immersive software enables next-generation remote collaboration. Used for remote teams, distance learning, and more. Israel also discussed things were promised with CMS Appendix K approval and wondered where the PPE materials are. Doug explained Alliance does not distribute the PPE but our providers will. Doug suggested contacting your provider for the promised PPE supplies.
None N/A
page 78 of 153
Tuesday, May 12, 2020
Wake CFAC Subcommittee Meeting Healing Transitions 1251 Goode Street, Raleigh, NC 27603 5:30 pm – 7:00 pm
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 2 of 3
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: Annette explained the progress of the DSP committee and how they will reach out to other county CFAC committees for input. May 19th bill 488 part of the bill will include a wage salary for DSP and is this bill has already received a lot of legislative support. Doug promised to discuss the progress of the Wake DPS committee at the state CFAC meeting and will distribute the white paper created by Wake DSP when given to Doug. Vicky expressed her gratuity for Alliance extending/expanding enhanced services as she was able to return to work last week.
4. Global Quality Management Committee
Wes. Knepper explains there is a need for 1 more CFAC representative to ascertain the quality measures for Alliance Health. Israel is on the GQM Committee and Wes is requesting for 1 more CFAC member. Doug explains the importance of this position as it recommends what quality programs and/or improvements are needed to determine the needs and what needs to get fixed. Wes invited those interested to join the next GQM Committee meeting which is held on the 1st Thursday @ 1pm for 1 hour.
Please advise Doug, Terrasine, or Stacy if interested
1 month
4. MCO/LME Updates
Doug explained Alliance Health is expanding Crisis Counseling by the end of June. Alliance Health is committed to recognize CIT officers for the dedication to treat all individual’s with dignity and respect and not as criminals. Alliance Health is recognizing The POE Center for Wake County for their advocacy. Alliance Health received a score of 96% for our policy and practices from External Quality Review held virtually. Presently the state of NC is in phase 1 of COVID 19 and phase 2 may or may not go into effect May 22nd.
None N/A
6. State updates Effective Systems Advocacy-Roanna Newton, NCDHHS 7. Steering Committee Updates
Dave Curro advises each subcommittee needs to elect or re-elect officers in June.
8. FYI HOPE4NC Helpline 1 855 587-3463 FAQ’s For Phase 1, 2, 3
None N/A
9. Opportunities ?June 15-16, 2020 i2i Conference North Raleigh Hilton Reg.opens Mid-April None N/A
4. ADJOURNMENT: the next meeting will be June 9, 2020, at 5:30 p.m.
page 79 of 153
Tuesday, May 12, 2020
Wake CFAC Subcommittee Meeting Healing Transitions 1251 Goode Street, Raleigh, NC 27603 5:30 pm – 7:00 pm
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 3 of 3
Respectfully Submitted by: Stacy Guse, Individual and Engagement Specialist. Date Approved
page 80 of 153
By Alliance Wake Consumer and Family Advisory Commi�ee May 2020
* Urgent Need to Include DSPs in Minimum Wage Increases *
There are currently 20,000 individuals with intellectual and/or developmental disabili-
�es (I/DD) receiving services through North Carolina’s Medicaid-funded Innova�ons
Waiver. There are over 13,000 on the Innova�ons waitlist; over 9,000 of those on the
waitlist receive no LME-MCO funded services and the others receive minimal services.
Shortage Crisis of DSPs in I/DD Community
This program is historically underfunded and the situa�on will only get worse as we transi�on to meet the
updated standards of community service delivery. The direct labor support budget usually takes most of the
shor�all and the availability and quality of support for individuals with I/DD suffers greatly.
Direct Support Professionals (DSP) are specially trained health professionals on the front line of I/DD care.
Their daily responsibili�es include assis�ng and encouraging independence and inclusion at home, work, and
in the community. DSPs must be able to manage challenging situa�ons that could directly affect the individ-
ual’s health, safety, and well-being. Specific job du�es are based solely on the individual’s needs and de-
sired goals. These include suppor�ng an individual’s efforts to make
choices, form posi�ve social rela�onships, learn skills, and communi-
cate thoughts and feelings. The specific tasks range from basic self-
care to complex medical and behavioral supports. Their range of du-
�es requires, at a minimum, CPR and First Aid. They may also need
specialized training to implement behavior interven�on plans, adminis-
ter medica�ons, respond to seizures, or use assis�ve technologies.
Na�onally, the turnover rate for direct support roles was 43.8%. In large part, this can be explained by low median hourly wages for DSPs, which stood at just $12.09 na�onally. (Case for Inclusion 2020 Report) *
* Wage data sourced from NCI 2017 Staff Stability Report
Perspectives from the Wake County Trenches
Need for DSPs has increased by 86% between 2005 – 2016 as the number of service recipients has grown from 433K to 807K na�onally
Turnover rates for DSPs are soaring due to high stress of job responsibili�es coupled with low wages
Wages have not kept up with infla�on rate and do not meet the standards of a “living wage”
Hourly workers do not qualify for benefits such as sick leave and vaca�on
“Almost half of DSPs receive publicly funded benefits, such as medical, food or housing assistance” (PHI, 2017)-Presidents Commi�ee for People with Intellectual Disabilites-2017 Report
There are not enough DSPs to meet the needs of all individuals with I/DD
Key DSP Workforce Dynamics
page 81 of 153
The Alliance Wake Consumer and Family Advisory Commi�ee (CFAC) consists of individuals and family members who receive mental health , intellectual/developmental disabili�es, and/or substance use /addic�on services and live in Wake County in the Alliance LME-MCO regional area of central NC.
The Alliance CFAC is a self-governing commi�ee that serves as an advisor to Alliance administra�on and the Board of Directors.
h�ps://www.alliancehealthplan.org/consumers-families/alliance-cfac/
ALLIANCE WAKE CFAC
Individuals and families affected by I/DD are in crisis due to the shortage of DSP workers. Already, approxi-
mately 80% of those who have an Innova�ons Waiver slot have unstaffed hours due to the shortage of DSPs.
This directly impacts the quality of life for I/DD service consumers, whether living in the community or in an
ins�tu�on. It is crucial to recruit more DSPs to address current needs and the long wai�ng list. Without an
increase in the number of workers, the current crisis will only worsen.
The direct impact on individuals with I/DD and their families is increased stress and trauma. With an in-
sufficient number of DSP staff and high turnover rates, families must serve as both the frontline and the back-
up support.
Without an adequate supply of well-trained DSP workers, parents are o�en required to:
Adjust their lives and work schedules to cover hours when no DSP support is available
Have con�ngency plans for what to do when DSP staff is late, out sick, or suddenly unavailable; parents are “on call” 24/7
Make hard choices that impact rela�onships at home, work and in the community; they may miss out on family events due to the need to provide care for their loved one when no DSP staff is available
Priori�ze the individual’s needs over the emo�onal and daily needs of family, o�en straining rela�onships which reduces natural supports and increases need for paid supports long term
Give up a career in order to fill in for the long periods during staff absences and vacancies
Spend their free �me repeatedly training new staff with specific knowledge required for person-centered support due to frequent turnover
Neglect their own health and emo�onal welfare causing further stress at home
Handle their loved one’s increased behaviors, depression and feelings of rejec�on as a result of the ab-sence of staff
The Lack of a Robust DSP Workforce: Why it matters so much!
- Turnover Costs Taxpayers, Too - “For agencies that support people with disabili�es, because of recruitment and training costs, it can cost up to $5,000 to fill each DSP vacancy.”
(Raus�ala et al., 2015).—State U�liza�on of Direct Support Professionals in Medicaid HCBS Waivers, AAIDD Journal 2019, Vol. 57, No. 1, 1-13)
To Join Our Effort - Contact: Anne�e Smith
Alliance Wake CFAC DSP Workforce Chair ne�[email protected]
page 82 of 153
Monday, May 04, 2020
CFAC MEETING - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 5:30 – 7:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 1 of 2
MEMBERS PRESENT: ☒Dave Curro, ☒ Vicky Bass, ☒ Charlotta Burrus, ☒Megan Mason, ☒ Jason Phillips ☒ Felisha McPherson ☒ Carole Johnson,
☒ Pinky Dunston, ☐
BOARD MEMBERS PRESENT: None
GUEST(S): None
STAFF PRESENT: Doug Wright, Director of Community and Member Engagement
1. WELCOME AND INTRODUCTIONS
2. REVIEW OF THE MINUTES – The minutes from the April 6, 2020, Consumer and Family Advisory Committee (CFAC) meeting were reviewed; a motion was
made by Click here to enter text. and seconded by Click here to enter text. to approve the minutes. Choose an item.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
3. Public Comment
Individual/Family Challenges
and Solutions
COVID-19 Check in – making sure everyone is doing okay.
Charlita Burness stated she just found out she lost a friend from a
shooting at the McDougal Terrace. Lack of B-3 services with many
limits.
N/A N/a
4. State Updates FEMA Online assistance https://www.fema.gov/coronavirus N/a N/A
5. LME-MCO Updates Not much to report at this time. Listen for the NCDHHS updates. N/A
6. Subcommittees
• Wake
• Durham
• Cumberland
• Johnston
• Area Board
• Human Rights
• Quality Management
Wake DSP has been working hard how to tackle a living wage
Doug broke down type of incidents and reported to the state.
Doug explained definitions and broke down difference concerns.
N/A N/A
7. Announcements Pinky Johnston has agreed to be on the nomination committee. N/A N/A
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Monday, May 04, 2020
CFAC MEETING - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 5:30 – 7:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date. Page 2 of 2
8. ADJOURNMENT: the next meeting will be June 1, 2020, at 5:30 p.m.
Respectfully Submitted by:
Stacy Guse, Community Engagement Specialist Date Approved 5-7-2020
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Frequently Asked Questions for Executive Order No. 138
May 5, 2020
This Frequently Asked Questions (“FAQ”) document provides guidance for the implementation of Executive Order No. 138 (“Order”). The Order moves North Carolina into “Phase 1” of easing certain COVID-19 restrictions to help revive the economy while protecting public health.
This information is subject to change in light of new CDC guidance and additional Executive Orders or local government declarations.
When does Phase 1 go into place? This Order begins Phase 1 at 5 PM on Friday, May 8, 2020 and remains in place through 5 PM on May 22, 2020.
Does this Order lift the Governor’s Stay at Home Order? No, people should still stay at home, but it increases the number of reasons people are allowed to leave. All North Carolina residents should continue to stay at home except for the purposes outlined in this Order. Anyone who is feeling sick should stay home and should leave the house only to seek health care or for some other necessary reason.
What is different about Phase 1? This Phase 1 Executive Order does the following:
• Eliminates the distinction between essential and non-essential businesses; • Allows most retail businesses (with exceptions) that can comply with specific
requirements to open at 50 percent capacity; • Allows people to leave home for non-essential goods or services; • Encourages state parks and trails that are closed to open; • Specifically allows people to gather outdoors while following the
Recommendations to Promote Social Distancing and Reduce Transmission, and with up to ten people;
• Opens child care to working families; and • Encourages North Carolinians to wear cloth face coverings when outside the
home in order to protect others.
What stays the same in Phase 1? This Phase 1 Executive Order does not change the following:
• A Stay at Home Order remains in place; • Mass gatherings are generally limited to no more than ten people; • Teleworking is encouraged; • Social distancing, hand hygiene, and other methods to slow the spread of
COVID-19 should be practiced, including staying at least six feet apart; • Restaurants and bars remain closed for dine-in service and on-premises
beverage consumption;
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• Personal care and grooming businesses, including barber shops, beauty, hair, nail, and tanning salons, and tattoo parlors, remain closed;
• Entertainment facilities, including movie theaters, bowling alleys, and performance venues, remain closed;
• Fitness facilities such as health clubs and gyms remain closed; • People may leave their homes to obtain medical services, obtain goods and
services, engage in outdoor exercise, take care of others or volunteer; • Playgrounds remain closed; • Open retail businesses must meet certain requirements to ensure the safety of
their employees and customers; and • Visitation continues to be banned at long-term care facilities, except for
certain compassionate care situations.
What are the allowable activities for which North Carolinians may leave their homes? North Carolinians may leave their homes in Phase 1 to:
• Work at any business, nonprofit, government, or other organization that is not closed by an Executive Order, or seek employment;
• Take care of health and safety needs, including to seek emergency medical services, obtain medical supplies and medication, or visit a health care professional or veterinarian;
• Receive goods, services, or supplies from any business or operation that is not closed by an Executive Order;
• Engage in outdoor activities, including to walk, hike, run, golf, hunt, fish, or bike outdoors;
• Take care of others, including assisting a family member, friend or pet, or attend weddings or funerals;
• Worship or exercise First Amendment rights, outdoors and following Recommendations to Promote Social Distancing and Reduce Transmission;
• Travel between places of residence, including child custody or visitation arrangements;
• Volunteer with organizations that provide charitable and social services; • Gather at other people’s homes with no more than ten people outdoors while
following Recommendations to Promote Social Distancing and Reduce Transmission Requirements; and
• Provide or receive government services.
Does this mean that residents of North Carolina are safe from COVID-19? The State of North Carolina is guided by data and facts. Enough of the key indicators are moving in the right direction to make this transition to Phase 1. Public health experts’ analysis indicate that if restrictions are eased gradually with safety practices still in place, North Carolina can benefit from increased economic activity without a surge in new cases.
Despite this progress, COVID-19 is a highly contagious virus, and state officials will continue to monitor key metrics. COVID-19 spreads from person to person easily,
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especially indoors or if people come in close contact for more than ten minutes. While this Order will ease certain restrictions, there remains a need for a Stay at Home Order and other COVID-19 rules remain in place.
What does this Executive Order mean for North Carolina businesses? Phase 1 removes the designation of essential and non-essential businesses, allowing a business to open if it can practice social distancing and other transmission reduction strategies. Retail businesses can operate at 50 percent capacity. A business cannot re-open if it has been specifically closed, such as bars, personal care or grooming establishments, and entertainment venues. North Carolinians are allowed to leave their homes to engage in commercial activity at businesses that are open.
What businesses must remain closed during Phase 1? The following businesses remain closed:
• Restaurants remain closed for dine-in services, but may continue to stay open to provide drive-through, take-out, and delivery;
• Personal care and grooming businesses, including barber shops, hair salons, and nail salons, remain closed;
• Health clubs, fitness centers, gyms, and other indoor exercise facilities remain closed, including yoga studios, martial arts facilities, indoor trampoline and rock climbing facilities; and
• Entertainment facilities remain closed, including performance venues, movie theaters, bowling alleys, and indoor and outdoor pools.
Are North Carolina’s restaurants allowed to open for dine-in meals? No. Based on public health advice, restaurants will remain closed for dine-in meals. Take-out, drive-through, and delivery services continue to be allowed.
What requirements do retail businesses need to follow? All retail businesses open to the public must:
• Direct customers and staff to stay at least six feet apart except at point of sale if applicable;
• Limit occupancy to not more than 50 percent of stated fire capacity and ensure that social distancing of six feet apart is possible;
• Mark six feet of spacing in lines at point of sale and in other high-traffic customer areas;
• Perform frequent and routine environmental cleaning and disinfection of high-touch areas with an EPA-approved disinfectant for COVID-19;
• Provide, whenever available, hand sanitizer stations, and ensure soap and hand drying materials are available at sinks;
• Conduct daily symptom screening of employees before entering the workplace and immediately send symptomatic workers home;
• Have a plan in place to immediately isolate an employee from work if symptoms develop; and
• Post signage at the main entrances to remind people about Recommendations to Promote Social Distancing and Reduce Transmission, to request people who
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are or have recently been symptomatic not to enter, and to notify customers of the reduced store capacity.
Retail businesses are also strongly encouraged to: • Direct workers to stay at least six feet apart from one another and from
customers, to the greatest extent possible; • Provide designated times for seniors and other high-risk populations to access
services; and • Develop and use systems that allow for online, email, or telephone ordering,
no-contact curbside or drive-through pickup or home delivery, and contact-free checkout.
High-volume retail businesses, such as grocery stores and pharmacies, are strongly encouraged to:
• Install acrylic or plastic shields at cash registers; • Clearly mark designated entry and exit points; and • Provide assistance with routing through aisles in the store.
What are recommended policies all businesses should follow to reduce the spread of COVID-19? In addition to the required activities above, all businesses, retail and otherwise, are strongly encouraged to:
• Continue to promote telework and limit non-essential travel whenever possible;
• Promote social distancing by reducing the number of people coming to the office, providing six feet of distance between desks, and/or staggering shifts;
• Limit face-to-face meetings to no more than ten people; • Promote hygiene, including frequent hand washing and use of hand sanitizer; • Recommend employees wear cloth face coverings and provide employees with
information on proper use, removal, and washing of cloth face coverings, which protect other people more than the wearer;
• Make accommodations for workers who are at high risk of severe illness from COVID-19, such as having high risk workers work in a position that is not public facing;
• Encourage sick employees to stay home and provide support to do so by providing sick leave policies;
• Follow CDC guidance if an employee has been diagnosed with COVID-19; • Provide education on COVID-19 strategies for staff such as videos, webinars,
FAQs; and • Promote information on helplines for employees such as 211 and Hope4NC
Helpline.
Does Phase 1 change the gathering limit of ten people? Most gatherings of more than ten people are still prohibited.
Should North Carolinians continue to work from home if possible?
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Yes. All businesses in North Carolina are strongly encouraged to direct employees to telework, if possible. Additionally, non-essential travel and in-person meetings should be avoided.
Does this Executive Order mean that I can gather freely with individuals outside of my household? When Phase 1 starts, North Carolinians can once again hold small outdoor get-togethers that follow Recommendations to Promote Social Distancing and Reduce Transmission and do not have more than ten people. Because studies show that the risk of spreading COVID-19 is much greater indoors than outdoors, these social gatherings should be outdoors.
What does this Executive Order mean for schools and graduations? School facilities remain closed for in-person instruction for the remainder of the 2019-2020 school year. NCDHHS, the North Carolina Department of Public Instruction (NCDPI), and the North Carolina State Board of Education will continue to work together to provide for the educational needs, health, nutrition, safety, and well-being during the school closure period.
Local school boards and superintendents will determine whether to conduct graduation and/or other year-end ceremonies. If these events are held, they must operate in compliance with all Executive Orders and NCDHHS and NCDPI guidelines in effect at the time of the event. Local school leaders are encouraged to engage with students and families to identify best solutions for their communities. Local plans should include consultation with local public health officials and, where appropriate, local law enforcement.
What does this Executive Order mean for childcare? Childcare facilities will be open for the children of North Carolinians who are working at a business that is not closed by an Executive Order, who are seeking employment, or who are homeless or receiving child welfare services. Childcare facilities must follow the health and safety requirements in Executive Order No. 130 and all guidelines issued by NCDHHS.
What does this Executive Order mean for camps? Day camps and programs for children and teens may operate only if they are in full compliance with the CDC’s guidance for these programs. Day camps may not allow sports except for those sports where close contact is not required, and any activities where campers cannot maintain at least a six foot distance from one another are not allowed. If a day camp is operating within a business, facility, or school that is closed per this Executive Order, the camp may operate but the location must otherwise remain closed to the general public. Overnight camps may not operate under Phase 1.
What does this Executive Order mean for parks, trails, and playgrounds? The Order encourages the reopening of all state parks and trails. North Carolinians are encouraged to engage in outdoor activities, so long as they maintain
5
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Recommendations to Promote Social Distancing and Reduce Transmission. The same policies to reduce transmission in retail settings should be followed in parks. Public playgrounds remain closed under Phase 1 because public playground equipment may increase the spread of COVID-19. What does this Executive Order mean for places of worship? Places of worship may hold services that exceed the Mass Gathering Limit of ten people if those services are held outdoors in an unenclosed space and if attendees follow Recommendations to Promote Social Distancing and Reduce Transmission.
Does this Executive Order allow for people to stay at hotels or other short-term vacation rentals? Yes, hotels and short-term vacation rentals are allowed. However, individuals should practice Stay at Home, Recommendations to Promote Social Distancing and Reduce Transmission, and other COVID-19 mitigation measures at any short-term rental. Rental landlords should follow CDC guidelines on cleaning hotels and rental units including using an EPA-approved disinfectant for COVID-19 between customers.
What actions are recommended to protect North Carolinians from contracting COVID-19 when they are not at home? North Carolinians are encouraged to limit non-essential travel and stay at home if they are sick. People can protect themselves against the spread of COVID-19 by following the Phase 1 rules and remembering the three Ws:
• Wear a face covering; • Wash your hands for 20 seconds or use hand sanitizer; and • Wait six feet apart from other people to keep your distance.
Does this Executive Order require North Carolinians to wear masks when outside the home? It is strongly recommended but not required that a cloth face covering of the nose and mouth should be worn when you leave your house and may be within six feet of other people who are not household and family members. This would include indoor community, public and business settings. These coverings function to protect other people more than the wearer. Face coverings should also be worn outdoors when you cannot stay at least six feet away from other people.
Some populations experience increased anxiety and fear of bias and being profiled if wearing face coverings in public spaces, but everyone should adhere to this guidance without fear of profiling or bias. If someone is the target of ethnic or racial intimidation as the result of adhering to the protective nose and mouth covering guidance or as a result of the pandemic, they are encouraged to report the matter to local law enforcement agencies or other government entities.
What if I am stopped by a law enforcement officer and directed to remove my face covering?
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A person wearing a cloth face covering for the purposes of ensuring the physical health or safety of the wearer or others needs to remove the cloth face covering, upon request by a law enforcement officer, in any of the following circumstances:
• During a traffic stop, including a checkpoint or roadblock, as required by law; and/or
• When a law enforcement officer has reasonable suspicion or probable cause during a criminal investigation, as required by law.
Are funerals allowed under Phase 1? Yes, funerals continue to be permitted to have up to fifty people in attendance. People attending a funeral should observe Recommendations to Promote Social Distancing and Reduce Transmission as much as possible.
Are individuals allowed to gather but stay in their vehicles in Phase 1? Yes, events such as drive-in worship services or drive-in movies are allowed if all participants stay inside their vehicles.
Why does the Executive Order allow for some gatherings outdoors but not indoors? When people gather together, there is always a risk of transmitting COVID-19. Therefore, gatherings of large groups of people must be restricted in accordance with this Executive Order. Where people gather together indoors, the air they breathe is recirculated, and they are likely to touch the same surfaces. As a result, the risk of spreading COVID-19 is high. A recent study found that people spread diseases like COVID-19 in a closed, indoor environment at a rate 18.7 times higher than when they are outdoors in an open-air environment.
How does this Executive Order impact policies set by local government? Most of the restrictions in this order are minimum requirements, and local governments, like cities and counties, can impose greater restrictions. However, local governments cannot restrict state government operations, and local restrictions cannot set different requirements for the maximum occupancy standard of retail establishments.
This Executive Order is Phase 1 of lifting restrictions. What will be the next restrictions the Governor will lift in Phase 2, and when will that happen? The end of this Order does not necessarily mean the state will move to Phase 2. Phase 1 will be extended unless data shows the state is prepared to move to Phase 2. Phase 2 will likely open more businesses to the public. Social distancing, hand hygiene, and use of cloth face coverings will still be recommended. Depending on state COVID-19 trends, restrictions may be lifted more slowly or some restrictions might have to be re-instated to ensure the health and safety of North Carolinians.
Why is it an appropriate time to lift some restrictions related to COVID-19? North Carolina is guided by data and science. State officials are monitoring key metrics to know when it is acceptable to move to the next phase of easing restrictions. This is a careful, deliberate process because removing all restrictions at
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once would cause a dangerous spike in infections that North Carolina has so far avoided. Public health experts and analyses indicate that if we gradually ease restrictions but keep safety practices in place, North Carolina can benefit from economic recovery without a renewed outbreak.
The key metrics show that North Carolina can move to Phase 1, which keeps critical safety measures in place. People can protect themselves against the spread of COVID-19 by following the Phase 1 rules and remembering the three Ws:
• Wear a face covering; • Wash your hands for 20 seconds or use hand sanitizer; and • Wait six feet apart from other people to keep your distance.
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5B
(Back to agenda)
Alliance Health BOARD OF DIRECTORS
Agenda Action Form
ITEM: Finance Committee Report DATE OF BOARD MEETING: June 4, 2020 BACKGROUND: The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Board. The Finance Committee meets monthly at 2:30 p.m. prior to the regular Board Meeting. This month’s report includes the draft minutes from the May 7, 2020, meeting, the Summary of Savings/(Loss) by Funding Source and ratios for the period ending April 30, 2020 and recommendations to the Board to approve all presented contracts over $500,000. REQUEST FOR BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): David Hancock, Committee Chair; Kelly Goodfellow, Executive Vice-President/Chief Financial Officer
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Next Meeting: Thursday, August 6, 2020 from 3:00-4:00
Alliance Health
5200 W. Paramount Parkway Suite 200
Morrisville, NC 27560
Finance Committee Meeting Thursday, June 4, 2020
2:30-4:00 pm
AGENDA
1. Review of the Minutes – May 7, 2020
2. Monthly Financial Reports as of April 30, 2020
a. Summary of Savings/(Loss) by Funding Source
b. Statement of Revenue and Expenses (Budget & Actual)
c. Cash Trend
d. Senate Bill 208 Ratios
e. DMA Contractual Ratios
3. FY20 Amended Budget for Approval
4. Approval of Contract(s)
5. FY21 Recommended Budget for Approval
6. Adjournment
Finance Committee Meeting 6/4/20
Meeting Packet Page 1 of 9
page 94 of 153
Thursday, May 07, 2020
BOARD FINANCE COMMITTEE - REGULAR MEETING Choose an item. Virtual meeting via videoconference - 2:30-4:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 1 of 2
APPOINTED MEMBERS PRESENT: ☒Jennifer Anderson ☒David Hancock, MBA, MPA (Committee Chair), ☒Gino Pazzaglini,
BOARD MEMBERS PRESENT: n/a GUEST(S) PRESENT: Denise Foreman, Wake County, Mary Hutchings, Wake County STAFF PRESENT: Rob Robinson, CEO, Kelly Goodfellow, EVP/CFO, Sara Pacholke, Senior Vice-President/Financial Operations, Ashley Snyder, Accounting Manager 1. WELCOME AND INTRODUCTIONS – the meeting was called to order at 2:30 PM
2. REVIEW OF THE MINUTES – The minutes from the April 2, 2020, meeting were reviewed; a motion was made by Mr. Pazzaglini and seconded by Ms.
Anderson to approve the minutes. Motion passed unanimously.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Monthly Financial Report The monthly financial reports were discussed which includes the Summary of Net
Position, Summary of Savings/(Loss) by Funding Source, the Statement of Revenue and Expenses, Cash Trend Analysis, Senate Bill 208 Required Ratios, and DMA Contract Ratios as of March 31, 2020. Ms. Pacholke discussed the monthly reports.
• As of 3/31/20 we have net position of $103.9M with $18M unrestricted • As of 3/31/20 we have savings of $16M • We are meeting all SB208 and DMA contract ratios.
4. Approval of Contracts Ms. Pacholke summarized two contracts that need Board approval under the sole source exceptions. The following motions were made by Mr. Pazzaglini and seconded by Ms. Anderson related to contract approvals. Motions passed unanimously.
• A motion to recommend to the Board to approve a sole source exception
under NC G.S. 143-129-(e)(g) and to authorize the CEO to enter into a
contract with McSilver Institute for poverty policy and research NYU
training and technical assistance for an amount not to exceed $215,000.
• A motion to recommend to the Board to approve a sole source exception
under NC G.S. 143-129-(e)(g) and to authorize the CEO to enter into a
contract with Homecare Software Solution, LLC dba HHAeXchange for
electronic verification and validation (EVV) services for an estimated
amount of $199,000.
Finance Committee Meeting 6/4/20
Meeting Packet Page 2 of 9
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Thursday, May 07, 2020
BOARD FINANCE COMMITTEE - REGULAR MEETING Choose an item. Virtual meeting via videoconference - 2:30-4:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 2 of 2
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
5. Quarterly Updates • Ms. Pacholke summarized the reinvestment plan for FY20 noting that we
would likely not spend all of the reinvestment-service funds related to Cumberland Crisis renovations due to delay in construction. In addition, if possible we will use State funds before fund balance for these expenses.
• Ms. Goodfellow said solvency standard discussions are on hold since COVID-19 and so far we have not received the December 2019 solvency report.
• Ms. Goodfellow discussed that we received a PMPM increase for April – June 2020 of 1.5%, which equates to $1.6M. As of this meeting, we have not heard from the State regarding FY21 PMPM rates.
• Ms. Pacholke presented the Non-Medicaid report as of 3/31/20. For the Alliance base benefit plan looking at Unit Cost Reimbursement (UCR) funds we are close to break even.
6. FY21 Recommended Budget
Ms. Goodfellow went through the FY21 Recommended budget slides highlighting the key assumptions. An additional presentation will be given to the full Board.
7. Annual Review of Business Operations Policies
The Business Operation Policies were previously sent out to the Finance Committee members for review. During the meeting two policies with proposed changes were discussed:
• BO4 Travel and Employee Expense Reimbursement • BO11 Accounting Manual
The Finance Committee supports the changes to the two policies and no additional changes were identified during the annual review.
The policies with tracked changes will be shared with the Policy Committee.
8. ADJOURNMENT: the meeting adjourned at 3:52 pm; the next meeting will be June 4, 2020, from 2:30 p.m. to 4:00 p.m.
Finance Committee Meeting 6/4/20
Meeting Packet Page 3 of 9
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Revenue Expense Savings/(Loss)
Projection as of June
30, 2020
Medicaid Waiver Services 327,470,758$ 315,322,639$ 12,148,119$ 12,208,343$ Medicaid Waiver Risk Reserve 7,478,520 - 7,478,520 9,023,540 Federal Grants & State Funds 57,727,835 57,747,027 (19,193) - Local Funds 24,362,517 23,964,694 397,822 250,000 Administrative 49,325,133 52,397,363 (3,072,230) (4,822,550) Total 466,364,762$ 449,431,724$ 16,933,039$ 16,659,333$
CommittedLegislative Reductions - - Intergovernmental Transfers (2,506,514) (3,007,817)
Reinvestments-Service (1,675) (382,000)
Reinvestments-Administrative (1,913,892) (2,413,892) Total Committed (4,422,081) (5,803,709)
Restricted 7,667,811 7,871,443
Unrestricted 13,687,308 14,591,599 Total Fund Balance Change 16,933,038$ 16,659,333$
June 30, 2019 Change April 30, 2020
Projection as of June
30, 2020
Investment in Fixed Assets 4,946,365 (456,249) 4,490,116 4,136,281
Restricted - Risk Reserve 51,602,006 7,478,520 59,080,526 60,625,546
Restricted - Other
State Statutes 7,005,672 - 7,005,672 7,005,672
Prepaids 858,436 645,540 1,503,975 516,423
Restricted - Other 7,864,108 645,540 8,509,648 7,522,095
Committed
Legislative Reductions 7,342,029 - 7,342,029 7,342,029
Intergovernmental Transfer 3,007,817 (2,506,514) 501,303 -
Reinvestments-Service 1,832,000 (1,675) 1,830,325 1,450,000
Reinvestments-Administrative 4,953,013 (1,913,892) 3,039,121 2,539,121
Total Committed 17,134,859 (4,422,081) 12,712,778 11,331,150
Unrestricted 6,426,721 13,687,308 20,114,029 21,018,320
Total Fund Balance 87,974,059 16,933,038 104,907,097 104,633,392
Fund Balance as of April, 30 2020
Summary of Savings/(Loss) by Funding Source as of April 30, 2020
4%
57%
8%
12%
19%
April 30, 2020 Actual
4%
58%7%
11%
20%
June 30, 2020 Projection
Finance Committee Meeting 6/4/20
Meeting Packet Page 4 of 9
page 97 of 153
A Projected Administrative Loss as of 6/30/20 (4,822,550)$
Committed-Intergovernmental Transfers 3,007,817
Committed-Reinvestments-Administrative 2,413,892
Net Administrative Savings/(Loss) After Committed Funds 599,158$
B FY20 Committed Reinvestment Plan
Crisis Services
Committed Funds
FY20
Spent
March 31, 2020
Projection
June 30, 2020
Cumberland Crisis Facility 1,200,000 - -
NC START 132,000 - 132,000
Subtotal 1,332,000$ -$ 132,000$
Engagement and Self-Management
Misc 500,000$ 1,675 250,000$
Subtotal 500,000$ 1,675$ 250,000$
Total - Services 1,832,000$ 1,675$ 382,000$
Administration
Tailored Plan planning and implementation 4,953,013$ 1,913,892$ 2,413,892$
Total - Administrative 4,953,013$ 1,913,892$ 2,413,892$
Total Service and Administration 6,785,013$ 1,915,567$ 2,795,892$
C Key Assumptions
3) Projections are based on currently available information and therefore are subject to change.
1) Restricted - Other State Statutes - using 6/30/19 amount. This will change once 6/30/20 is closed.
2) The savings related to Medicaid Waiver Services is 75% of the average of year to date revenues vs.
expenses.
Finance Committee Meeting 6/4/20
Meeting Packet Page 5 of 9
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% Received/Budget Current Period Year to Date Balance Expended
REVENUES
Local Grants $38,787,140 $3,888,685 $24,362,517 $14,424,623 62.81%State & Federal Grants $53,383,119 $5,532,578 $57,727,835 ($4,344,716) 108.14%Medicaid Waiver Services $385,741,463 $33,830,357 $334,949,278 $50,792,185 86.83%
Total Revenue $477,911,722 $43,251,620 $417,039,629 $60,872,093 87.26%
Administrative
Local Administration $387,584 $32,299 $322,993 $64,591 83.33%LME Administrative Grant $4,359,385 $363,283 $3,632,830 $726,555 83.33%Medicaid Waiver Administration $52,601,109 $4,569,241 $44,833,219 $7,767,890 85.23%Miscellanous Revenue $500,000 $17,560 $536,091 ($36,091) 107.22%
Total Administrative Revenue $57,848,078 $4,982,384 $49,325,133 $8,522,945 85.27%
Total Revenues $535,759,800 $48,234,003 $466,364,762 $69,395,037 87.05%
EXPENSES
Local Services $38,787,140 $3,633,070 $23,964,694 $14,822,446 61.79%State & Federal Services $53,383,119 $5,539,514 $57,747,027 ($4,363,908) 108.17%Medicaid Waiver Services $385,741,463 $33,020,876 $315,322,639 $70,418,824 81.74%
Total Service Expenses $477,911,722 $42,193,460 $397,034,361 $80,877,361 83.08%
Administrative
Operational $9,335,253 $756,760 $8,466,172 $869,081 90.69%Salaries, Benefits, and Fringe $43,819,039 $3,959,488 $39,275,393 $4,543,646 89.63%Professional Services $4,193,786 $412,268 $4,655,797 ($462,011) 111.02%Miscellanous Expense $500,000 $0 $0 $500,000 0.00%
Total Administrative Expenses $57,848,078 $5,128,516 $52,397,363 $5,450,715 90.58%
Total Expenses $535,759,800 $47,321,976 $449,431,724 $86,328,076 83.89%
CHANGE IN NET POSITION $912,028 $16,933,039
Statement of Revenue and Expenses (Budget and Actual) - As of April 30, 2020
Finance Committee Meeting 6/4/20
Meeting Packet Page 6 of 9
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Senate Bill 208 Ratios - As of April 30, 2020
100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
86%
88%
90%
92%
94%
96%
98%
100%
102%
N O V - 1 9 D E C - 1 9 J A N - 2 0 F E B - 2 0 M A R - 2 0 A P R - 2 0
PERCENT PAIDBench Mark Alliance
Percent Paid = Percent of clean claims paid within 30 days of receiving. The requirement is 90% or greater.
Current Ratio = Compares current assets to current liabilities. Liquidity ratio that measures an organization's ability to pay short term oblications. The requirement is 1.0 or greater.
1.651.60
1.67 1.70 1.71 1.75
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2.00
N O V - 1 9 D E C - 1 9 J A N - 2 0 F E B - 2 0 M A R - 2 0 A P R - 2 0
CURRENT RATIOBench Mark Alliance
Finance Committee Meeting 6/4/20
Meeting Packet Page 7 of 9
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DMA Ratios - As of April 30, 2020
30.94
40.24
43.24
47.44
52.63
48.76
0
10
20
30
40
50
60
N O V - 1 9 D E C - 1 9 J A N - 2 0 F E B - 2 0 M A R - 2 0 A P R - 2 0
DEFENSIVE INTERVAL
Bench Mark Alliance
Defensive Interval = Cash + Current Investments divided by average daily operating expenses. This rato shows how many
days the organization can continue to pay expenses if no additional cash comes in. The requirement is 30 days or
greater.
89.63% 89.67%89.03% 88.76%
87.89% 88.26%
75%
80%
85%
90%
95%
100%
N O V - 1 9 D E C - 1 9 J A N - 2 0 F E B - 2 0 M A R - 2 0 A P R - 2 0
MEDICAL LOSS RATIO
Bench Mark Alliance
Medical Loss Ratio (MLR) = Total Services Expenses plus Administrative Expenses that go towards directly improving
health outcomes divided by Total Medicaid Revenue. The requirement is 85% or greater cumulative for the rating period
(7/1/19-6/30/20).
Finance Committee Meeting 6/4/20 Meeting Packet Page 8 of 9
page 101 of 153
YE Projection
Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20
Beginning Balance 17,096,453.02 15,803,111.57 19,291,219.05 11,863,779.47 19,587,929 14,000,791 37,420,115 41,546,502 47,764,946 55,341,483 15,361,715
Medicaid
Cash Received 34,379,665 39,565,818 36,370,928 38,227,395 36,503,478 36,932,757 38,525,385 37,849,643 42,469,717 38,015,846 74,000,000
Disbursements (40,094,727) (35,077,313) (40,049,192) (35,221,948) (33,739,203) (33,990,750) (38,862,231) (36,891,679) (40,705,612) (37,744,970) (77,900,000)
Risk Reserve Transfer (687,533) (789,605) (727,303) (749,528) (719,119) (737,672) (766,148) (756,987) (849,394) (760,253) (1,480,000)
Medicaid Total (6,402,594) 3,698,900 (4,405,567) 2,255,920 2,045,156 2,204,336 (1,102,993) 200,977 914,711 (489,377) (5,380,000)
State/Federal
Cash Received 4,352,036 2,238,756 2,240,828 3,569,074 1,247,167 17,729,145 6,633,993 7,100,036 16,560,719 2,264,033 5,590,000
Disbursements (6,484,252) (5,104,369) (6,307,748) (10,085,534) (6,200,801) (6,319,130) (6,050,125) (5,041,649) (7,987,297) (6,757,801) (12,700,000)
State Claims Reclass 520,666 1,921,504 395,372 (153,127) (598,610) 51,320 1,885,091 (160,644) (705,891) 1,409,018 5,600,000
State/Federal Total (1,611,550) (944,109) (3,671,547) (6,669,588) (5,552,244) 11,461,335 2,468,959 1,897,743 7,867,531 (3,084,749) (1,510,000)
Local
Cash Received 1,513,184 2,819,188 1,331,607 2,784,188 - 2,693,522 5,343,985 6,084,191 1,200,000 1,584,188 11,600,000
Disbursements (4,271,716) (164,367) (286,560) (799,498) (2,678,661) (2,888,548) (698,473) (2,125,110) (3,111,595) (1,580,813) (4,150,000)
State Claims Reclass (520,666) (1,921,504) (395,372) 153,127 598,610 (51,320) (1,885,091) 160,644 705,891 (1,409,018) (5,600,000)
Local Total (3,279,198) 733,317 649,675 2,137,817 (2,080,050) (246,347) 2,760,420 4,119,725 (1,205,704) (1,405,643) 1,850,000
Investment Transfer 10,000,000 - - 10,000,000 - 10,000,000 (35,000,000) -
Cash Balance 15,803,112 19,291,219 11,863,779 19,587,929 14,000,791 37,420,115 41,546,502 47,764,946 55,341,483 15,361,715 10,321,715
Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 YE Projection
Beginning Balance 50,338,095 40,431,176 40,504,223 40,571,450 30,634,845 30,677,034 20,706,390 20,734,367 20,759,766 20,779,774 55,802,323
Interest Earned 93,082 73,047 67,226 63,395 42,190 29,355 27,977 25,399 20,008 22,549 56,000
Transfer (10,000,000) - - (10,000,000) - (10,000,000) 35,000,000 -
Investment Balance 40,431,176 40,504,223 40,571,450 30,634,845 30,677,034 20,706,390 20,734,367 20,759,766 20,779,774 55,802,323 55,858,323
Cash Analysis - As of April 30, 2020
Investment Analysis
Actual
‐
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
Jul‐19 Aug‐19 Sep‐19 Oct‐19 Nov‐19 Dec‐19 Jan‐20 Feb‐20 Mar‐20 Apr‐20
Cash AnalysisCash Balance Investment Balance
Finance Committee Meeting 6/4/20
Meeting Packet Page 9 of 9
page 102 of 153
5C
(Back to agenda)
Alliance Health BOARD OF DIRECTORS
Agenda Action Form
ITEM: Audit and Compliance Committee Report
DATE OF BOARD MEETING: June 4, 2020
BACKGROUND: The purpose of the Audit and Compliance Committee is to put forth a meaningful effort to review the adequacy of existing compliance systems and functions and to assist the Board of Directors in fulfilling its oversight responsibilities.
This report includes minutes from its December and May meetings and proposed revisions to the Corporate Compliance Plan reviewed by the Committee on May 27, 2020.
The Alliance Corporate Compliance Plan includes the following elements: 1) the designation of a compliance officer and a compliance committee that are accountable to senior management; 2) written policies, procedures, and standards of conduct that articulate the organization's commitment to comply with all applicable Federal and State standards; 3) effective training and education for the compliance officer and the organization's employees; 4) effective lines of communication between the compliance officer and the organization's employees; 5) enforcement of standards through well-publicized disciplinary guidelines; 6) provision for internal monitoring and auditing; 7) provision for prompt response to detected offenses, andfor development of corrective action initiatives; and other elements as required and outlined in Alliance’sNC Medicaid contract and the Code of Federal Regulations.
The Alliance Board approved the Corporate Compliance Plan in 2012 and annually thereafter in accordance with the Corporate Compliance Plan Policy. The Audit and Compliance Committee reviewed and voted to accept proposed revisions to the Plan and is recommending approval by the Board.
REQUEST FOR BOARD ACTION: Accept the report and approve the plan.
CEO RECOMMENDATION: Accept the report and approve the plan.
RESOURCE PERSON(S): Dave Curro, Committee Chair; Monica Portugal, Chief Compliance Officer
page 103 of 153
Wednesday, December 18, 2019
BOARD AUDIT AND COMPLIANCE COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 4:00-5:30 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 1 of 2
APPOINTED MEMBERS PRESENT: ☒David Curro, BS, (phone) ☐Lodies Gloston, MA, ☐Duane Holder, MPA, ☐D. Lee Jackson,
☒Lascel Webley, Jr., MBA, MHA (Committee Chair) BOARD MEMBERS PRESENT: George Corvin, MD (Board Chair) (phone) GUEST(S) PRESENT: Mary Hutchings STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Joshua Knight, Internal Auditor
1. WELCOME AND INTRODUCTIONS – the meeting was called to order at 4:05 pm
2. REVIEW OF THE MINUTES – The minutes from the August 28, 2019, meeting were reviewed; a motion was made by Dr. Corvin and seconded by Mr. Curro
to approve the minutes. Motion passed unanimously.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Updates A. Block Grant Audit and LME Systems Review: The Plan of Correction has been
approved by DMH/DD/SAS and an implementation review should take place sometime in January, 2020.
B. URAC Reaccreditation Validation Review: Onsite Visit went well. Alliance achieved full accreditation for 3 years.
C. Annual Single Audit: Results were presented to the full Board by the Auditors at the December Board Meeting. Board Chair Corvin proposed a standard annual meeting with the Auditors, separate from the Board Meeting and without staff. Committee Chair Webley discussed rotating auditing firms every five (5) years and proposed to begin the search of a new CPA firm to conduct the audit next year. A motion was made by Dr. Corvin to rotate auditing firms every five years, starting next year with a new auditing firm. The motion was seconded by Mr. Curro. Motion passed unanimously. A motion was made by Dr. Corvin to have a meeting with select Board Members and the Auditors, without staff present, as part of the annual single audit process. The motion was seconded by Mr. Curro. Motion passed unanimously.
These minutes will be submitted to the next Board meeting.
February 2020
4. Annual Risk Assessment An overview of the 2020 annual risk assessment scope, methodology and results were reviewed. Committee discussed the ranked risk, vulnerabilities and internal controls currently in place to mitigate the risk. Staff answered questions related to the process and results. A motion was made by Dr. Corvin to accept the Risk Assessment as presented. Mr. Curro seconded. Motion passed unanimously.
Staff will develop the annual work plan based on the results and will present at the next meeting.
February 2020
page 104 of 153
Wednesday, December 18, 2019
BOARD AUDIT AND COMPLIANCE COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 4:00-5:30 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 2 of 2
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 5. Quarterly Reports Committee reviewed the quarterly reports for FY19, including Network Compliance,
Corporate Compliance and HIPAA Incidents and Complaints. There were no questions.
N/A N/A
6. ADJOURNMENT: the meeting adjourned at 4:59 pm; the next meeting will be February 26, 2020, from 4:00 p.m. to 5:30 p.m.
page 105 of 153
Wednesday, May 27, 2020
BOARD AUDIT AND COMPLIANCE COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 3:00-4:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 1 of 2
APPOINTED MEMBERS PRESENT: ☒Jennifer Anderson, MHSA, PMP, ☒David Curro, BS (Committee Chair), ☒Lodies Gloston,
MA, ☐Duane Holder, MPA, ☐D. Lee Jackson BOARD MEMBERS PRESENT: None GUEST(S) PRESENT: Alysse Swink Cherry Bekaert, Eddie Burke, Cherry Bekaert STAFF PRESENT: Monica Portugal, Chief Compliance Officer; Josh Knight, Internal Auditor; Jamie Preslar, Administrative Assistant III
1. WELCOME AND INTRODUCTIONS – the meeting was called to order at 4:19 pm
2. REVIEW OF THE MINUTES –
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. Annual Single Audit and Audit of Financial Statements
Alysse Swink and Eddie Burke of Cherry Bekaert presented this year’s audit plan, including an introduction of the audit team and timeline, details of the audit scope in the areas of internal controls, significant audit areas with the addition of COVID-19 as requested by management, and the single audit plan including audit risks and planned responses. Swink also reviewed the audit timeline. Committee was in agreement with the audit plan. Members asked questions, answered by Swink and Burke.
Audit results will be presented by the Auditors
December 2020
4.Updates 2019 External Quality Review: Committee received a summary of the results and next steps of the EQR. Block Grant Audit and LME Systems Review: POC was fully implemented and closed out in January 2020.
N/A N/A
5. Annual Independent Auditor Evaluation and Contract Review
Knight provided a summary of the audit firm’s recent peer review, which examines the system of quality control for the accounting and auditing practice. The review was accepted by the National Peer Review Committee on January 15, 2020 with a passing score. Firms can receive a rating of pass, pass with deficiencies, or fail. The FY20 Contract and Scope of Work between Alliance and the audit firm was reviewed. All relationships between Alliance and the firm were disclosed. Anderson asked a question about conflict, which was answered by Knight. A motion was made by Gloston and seconded by Anderson to accept the peer review report and to approve the audit contract as presented. Motion passed unanimously.
Curro will sign the audit contract on behalf of the Committee
May 2020
6. Annual Review of Corporate Compliance Plan
Committee reviewed the proposed revisions to the Corporate Compliance Plan. Changes included removal of corporate compliance committee membership terms, which are spelled out in the charter, added details around Alliance’s internal audit activity, a functional chart for the Office of Compliance, and a few non-substantive revisions. The proposed revisions have been reviewed by the CEO and the NC Medicaid Office of Compliance and Program Integrity. A motion was made by Gloston and seconded by Anderson to recommend to the Board that the Corporate Compliance Plan be approved as presented. Motion passed unanimously.
Plan will be submitted to the Board of Directors for approval
June 2020
page 106 of 153
Wednesday, May 27, 2020
BOARD AUDIT AND COMPLIANCE COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 3:00-4:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 2 of 2
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
7. Annual Review of Compliance Policies
All Compliance Policies had been distributed prior to the meeting. There were no proposed changes to any of the policies. A motion was made by Gloston and seconded by Anderson to approve the policies as presented. Motion passed unanimously.
Policies will be submitted to the Policy Committee
June 2020
8. Annual Report to OCR Committee reviewed HIPAA breaches for calendar year 2019 and the annual report to the Office of Civil Rights (OCR), submitted in February. Number of breaches went down from previous year.
N/A N/A
9. 2020 Risk Mitigation Plan An overview of the annual risk management process was provided, Committee reviewed the proposed 2020 Risk Mitigation Plan developed by the executive leadership. Committee asked questions and discussed a few of the items.
N/A N/A
10. 2020 Work Plan and Audit Plan
Committee reviewed the proposed 2020 compliance work plan and discussed a few of the items. Curro asked how COVID-19 had altered compliance operations and Portugal provided a few examples. The proposed 2020 audit plan was introduced, including a list of recurring and non-recurring audits of different operational functions as well as several privacy and security audits. A motion was made by Anderson and seconded by Gloston to approve the 2020 Compliance Work Plan and Audit Plan as presented. Motion passed unanimously.
Committee will receive updates on the implementation of the plans at the quarterly meetings
Quarterly
11. Annual Compliance Report to the Board of Directors
Portugal provided a summary of the annual compliance report. Questions, which were answered by Portugal, covered topics such as HIPAA incidents, fraud and abuse. Committee provided feedback.
Report will be presented to the Board of Directors
June 2020
12. ADJOURNMENT: the meeting adjourned at 6:04 pm; the next meeting will be August 26, 2020, from 4:00 p.m. to 6:00 p.m.
page 107 of 153
Corporate Compliance Plan
FY201
Adopted by the Board of Directors: October 4th, 2012 Reviewed and Approved by the Board of Directors: June 11, 2013 Reviewed and Approved by the Board of Directors: June 5, 2014 Reviewed and Approved by the Board of Directors: June 4, 2015 Reviewed and Approved by the Board of Directors: June 2, 2016 Reviewed and Approved by the Board of Directors: June 1, 2017 Reviewed and Approved by the Board of Directors: June 7, 2018 Reviewed and Approved by the Board of Directors: June 6, 2019
Reviewed and Approved by the Board of Directors: October 3, 2019 Reviewed and Approved by the Board of Directors:
page 108 of 153
Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
2
Table of Contents
I. Introduction and Statement of Purpose………………………………………………………………..3
II. Compliance Infrastructure ……..…………………………………………………………………………….5
A. Chief Compliance Officer
B. Board Audit and Compliance Committee
C. Corporate Compliance Committee
III. Policy Guidelines and Standards of Conduct……………………......................................8
IV. Effective Education and Training…………………………………………………..………………………8
V. Effective Lines of Communication…………………….…………………………………..…………..….9
A. Reporting Compliance Issues
B. Investigating Compliance Issues
VI. Enforcement of Standards and Disciplinary
Guidelines…….…………………………………101
VII. Internal Auditing and Monitoring………………………….……………………………………………11
VIII. Response and Remediation……………………………………….……………………………………….12
IX. Effectiveness of the Compliance Program.……………………..…………………………………..13
A. Annual Compliance Report
B. Annual Risk Assessment and Compliance Work Plan
C. Revisions to the Compliance Plan
Appendix A – Office of Compliance Functional Structure……………………………………14
Appendix BA – Federal Criminal and Civil Statutes Related to Fraud and Abuse in
the Context of Health
care…………………………..……………………………………………………………15
Criminal Statutes
Civil and Administrative Statutes
References…………………………………………………….……………………………………………………16
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
3
CORPORATE COMPLIANCE PLAN
________________________________________________________________________
I. Introduction and Statement of Purpose
It is the policy of Alliance Health (Alliance) to follow ethical standards of business practice
established by Alliance’s Board of Directors and Management Team, by oversight agencies, and
state and federal law. Alliance has an ongoing commitment to ensure that its affairs are
conducted in accordance with applicable law and sound ethical business practice. Alliance
Board of Directors, employees, and Provider Network are fully informed of applicable laws and
regulations to which Alliance is obligated so that they do not inadvertently engage in conduct
that may raise compliance issues. Alliance recognizes that its business relationships with
contracted providers, and vendors and , members (Medicaid enrollees, and recipients of
behavioral healthcare services) are subject to legal requirements and accountability standards.
To further its commitment to compliance and to protect its employees and contracted
providers, Alliance places emphasis on its Compliance Plan to address regulatory issues likely to
be of most consequences to Alliance operations. The Compliance Plan establishes the following
framework for corporate compliance by Alliance Board of Directors, management, employees
and providers:
A. Designation of a Chief Compliance Officer, a Board Audit & Compliance Committee and
Corporate Compliance Committee charged with directing the effort to enhance
compliance and implement the Compliance Plan;
B. Incorporation of standards, policies, and administrative guidelines directing Alliance
personnel and others involved with operational practices;
C. Prevention and identification of criminal and unethical conduct and legal issues that
may apply to business relationships and methods of conducting business;
D. Effective education and training for the Chief Compliance Officer, Board of Directors,
management and employees addressing obligations for adherence to applicable
compliance requirements;
E. Development and implementation of informational materials and training for
employees, subcontractors, providers, and enrollees members addressing obligations
for adherence to applicable compliance requirements and information to prevent
dishonest behavior which results in fraud, waste of public funding, and program abuse;
F. Implementation of mechanism for employees to raise questions and receive appropriate
guidance concerning regulatory and operational compliance issues;
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
4
G. Development and implementation of an ongoing monitoring and auditing process
identifying potential risk areas and operational issues requiring remediation;
H. Development and implementation of a process for employees, subcontractors,
providers and recipients to report possible compliance issues, such as legal and ethical
violations, or to report fraud, waste, and abuse, including a process for such reports to
be fully and independently reviewed;
I. Enforcement of standards through documented disciplinary guidelines, policies and
training addressing expectations and consequences;
J. Formulation of plans for corrective action or remediation plans to address identified
areas of noncompliance;
K. Evaluation of the effectiveness of the overall compliance efforts of Alliance to ensure
that operational practices reflect current compliance requirements and address
strategic goals to improve Alliance operations.
This Compliance Plan is not intended to set forth all of the substantive programs and practices
of Alliance that are designed to achieve compliance and integrity. In addition to this Plan,
Alliance has developed and implemented a variety of monitoring processes for providers. The
compliance practices included in those efforts will be coordinated with this Plan to direct
Alliance’s overall compliance efforts.
It is intended that the scope of all compliance activities promotes integrity, ensures objectivity,
fosters trust and supports the stated values of Alliance.
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
5
II. Compliance InfrastructureProgram Structure
A. Chief Compliance Officer (CCO)
The Chief Compliance Officer has been delegated day-to-day operational responsibility for the
Alliance compliance program. The CCO will report compliance efforts and identified issues
directly to the Chief Executive Officer (CEO) who has overall responsibility to ensure that
Alliance has an effective compliance program. The CCO will report directly as necessary and
required to the Board of Directors. The Alliance Board of Directors is accountable for governing
Alliance as a knowledgeable body regarding the scope and operations of the compliance
program, including expectations, practices, identified risk issues and compliance remediation.
The Chief Compliance Officer is responsible for the following activities:
1. Formulate, review, and revise policies and procedures to guide all activities and
functions of Alliance that involve issues of compliance;
2. Ensure processes for compliance integrate with and support Alliance quality
management and provider network monitoring processes;
3. Develop, in conjunction with the Audit & Compliance Committee and other relevant
parties, the Code of Ethics and Conduct for Alliance employees and providers;
4. Develop methods to ensure that employees and providers are aware of Alliance’s Code
of Ethics and Conduct and understand the importance of compliance;
5. Develop and deliver educational and training programs;
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
6
6. Develop and monitor internal systems and controls to carry out Alliance standards,
policies and procedures as part of Alliance’s daily operations;
7. Receive, review, and investigate instances of suspected internal and external
compliance issues, communicate findings and develop action plans with the program
suspected of noncompliance and as appropriate with the assistance of the Compliance
Committee;
8. Oversee program integrity activities, such as claims audits, data analytics, and special
investigations to detect and resolve instances of provider and enrollee fraud and abuse;
9. Refer to NC Medicaid Office of Compliance and Program Integrity suspected cases of
fraud for determination of credible allegation;
10. Prepare annual compliance summary for the Board Audit and Compliance Committee to
evaluate the effectiveness of compliance efforts, as set forth in this Plan;
11. Conduct an annual risk assessment, as set forth in this Plan, with Alliance leadership
and the Board Audit and Compliance Committee;
12. Prepare the annual compliance work plan, as set forth in this Plan, with the Board Audit
and Compliance Committee;
13. Prepare revisions to the Compliance Plan together with the Board Audit and Compliance
Committee, as set forth in this plan;
14. Report to the Board of Directors and assist them in fulfilling their oversight
responsibilities through the Audit and Compliance Committee; and
15. Provide other assistance with compliance initiatives as directed by the CEO and/or
Board of Directors.
B. Board Audit and Compliance Committee (ACC) of the Board of Directors
The purpose of the Audit and Compliance Committee (ACC) is to put forth a meaningful effort
to review the adequacy of existing compliance systems and functions. To assist the Board of
Directors in fulfilling its oversight responsibilities for:
1. The integrity of the organization’s annual financial statements;
2. The system of risk assessment and internal controls by, among other things, approving
the annual risk assessment methodology and the annual compliance work plan;
3. The organization’s compliance with legal and regulatory requirements by reviewing
results of external and internal audits and monitoring;
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
7
4. The independent auditor's qualifications and independence;
5. The performance of the organization’s internal audit function; and
6. To provide an avenue of communication between management, the independent
auditors, and the Board of Directors.
C. Corporate Compliance Committee (CCC)
To assist the Chief Compliance Officer (CCO) with the development and implementation of
compliance efforts, a Corporate Compliance Committee has been formed representative of the
clinical and administrative services of Alliance. The CCO or the Program Integrity Director will
serve as the chair of the Committee and will not vote on any matters, unless the vote is
required to break a tie. Committee members will serve one-year terms with no limitations on
the number of terms to serve. The make-up of the committee will be re-evaluated at the end of
each fiscal year. For the sake of maintaining the integrity of the Committee, no more than 50%
of committee members may resign from the Committee in the same year. New members will
be nominated by their Department Head and will be selected by majority vote by the current
Committee. The CCO must be consulted on the selection of membership.
The role of the CCC is to advise the CCO, to assist in the implementation of the compliance
program, and to evaluate the effectiveness of Compliance efforts. The Committee’s responsibilities include:
1. Analyzing the organization’s regulatory obligations;
2. Working with employees and providers to develop standards of conduct and policies
and procedures that promote compliance;
3. Determining the appropriate strategy and approach to promote compliance and
detection of potential risk areas through various reporting mechanisms;
4. Assisting, as appropriate, with the development of preventive and remediation plans;
5. Review provider compliance violations and oversee enforcement of disciplinary
guidelines, including making determinations regarding the approval of corrective actions
and other sanctions as appropriate and per Alliance policies and procedures;
6. Developing a system to solicit, evaluate and respond to compliance issues, grievances,
and other problems;
7. Monitoring findings of internal and external reviews for the purpose of identifying risk
areas or deficiencies requiring further monitoring or preventive and corrective action;
and
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
8
8. Reviewing and analyzing trends such as results from exclusions checks, internal and
external monitoring and auditing efforts, fraud, waste and abuse investigations, billing
audits, enforcement actions, and final disposition.
III. Policy Guidelines and Standards of Conduct
Alliance has adopted policies and procedures specific to Alliance’s operational practices. These policies and procedures are reviewed at least annually and revisions are made, as necessary.
The policies and procedures specific to Alliance’s compliance efforts are intended to support and further define the operational practices and responsibilities and, when possible, are
integrated within existing policies and procedures.
Alliance has also adopted an Employee Code of Ethics and Conduct to guide all business activity.
This code reflects a common sense approach to ensuring legal and ethical behavior. All new
employees receive training and provide acknowledgement of receipt of the Alliance Code of
Ethics and Conduct. As a condition of employment the Code of Ethics and Conduct is reviewed
and acknowledged annually thereafterevery year.
It is the intent of Alliance to adopt and implement a Code of Ethics specific to the Alliance
Provider Network. The Network Provider Code of Ethics will guide business activities of
providers who contract with Alliance.
IV. Effective Education and Training
It is essential to the Alliance Compliance Program to ensure that the Chief Compliance Officer
receives effective training and education on an ongoing basis. The CCO shall seek out
opportunities to receive Continuous Education Credits in order to maintain Compliance
Certification and to enhance job related skills.
The CCO and CCC are responsible for ensuring Alliance policies regarding compliance are
disseminated and understood by employees. To accomplish this objective, the CCO will assist
with the development of a systematic and ongoing training program that enhances and
maintains awareness of Alliance policies. Training materials directed to clinical, administrative
or other regulatory compliance issues will be submitted to the CCO for review.
Upon hire and each year thereafter, all Alliance employees will participate in compliance
training whereby a system is in place to document that such training has occurred. Compliance
training may be offered as micro-training learning or as one comprehensive training and may
therefore occur at different times during the fiscal year. Employees will be required to take a
post-test in order to measure the effectiveness of training efforts. Training materials will
identify Alliance’s CCO as available to respond to questions specific to compliance training or
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
9
regulatory issues. Employees are made aware of their compliance obligations as a condition of
employment.
Adherence to policies will be addressed within the New Employee Orientation and ongoing
training programs, and employee job descriptions. Employees will be expected to demonstrate
a sufficient level of understanding as a result of compliance training. If a particular compliance
or risk issue develops, the CCO may recommend that identified persons attend training
addressing the risk issue.
The CCO and CCC will develop compliance training opportunities for providers in the Alliance
Network. Such training may include for example how to develop and implement an effective
compliance program to prevent and detect healthcare fraud, waste, and abuse.
To promote compliance throughout the Alliance Network, the CCO and CCC will develop and
offer training and information to Enrolleesmembers. Such training may include client rights and
healthcare fraud, waste, and abuse.
V. Effective Lines of Communication
A. Reporting Compliance Issues
In keeping with Alliance policies, all employees are required to report promptly all known or
suspected violations of an applicable law or regulation, the Code of Ethics and Conduct, breach
of privacy or security or any Alliance policies and procedures to their supervisor, the Chief
Compliance Officer (CCO), or the confidential Compliance Line. As a general practice,
employees are directed to address questions about operational issues to persons having
supervisory responsibility of that function. Supervisors are responsible for ensuring that issues
or violations of which they are aware are immediately reported to the CCO.
As another reporting option, training materials will inform employees that they may report
directly to the Alliance CCO or to a confidential third party 24 hour Hotline, Compliance Line.
The training materials will provide a contact method(s) to address compliance issues to the CCO
and to the Compliance Line. The CCO will use various communication methods, including
electronic, web based and telephonic communication methods, to ensure timely
communication of the elements of this compliance program. The various communication
methods will be available 24 hours a day. The intent of publicizing various methods of
communication is to ensure both convenience and confidentiality for employees and enable
immediate response to submitted issues. All reports will be investigated unless the information
provided contains insufficient information to permit a meaningful investigation.
Failing to report violations may result in disciplinary action. Employees reporting in good faith
possible compliance issues will not be subjected to retaliation or harassment as a result of the
report. Concerns about possible retaliation or harassment should be reported to the CCO or the
CEO.
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The Compliance Program will also include a confidential third party 24 hour Fraud and Abuse
Line, as a means to offer providers, enrolleesmembers, or other persons in the community an
opportunity to report suspected fraud, waste of funding, or abuse of services anonymously. The
Fraud and Abuse Line will be advertised on the Alliance website, in Consumer Handbooks,
Provider Manual, and other informational and training materials. The Alliance Access and
Information line is another option for placing reports of this nature.
Reported compliance concerns related to providers will be logged in the Alliance grievance
database. Concerns regarding fraud, waste, and abuse will be tracked in a separate compliance
software by the CCO,The Senior Director of Program Integrity and/or Special Investigations
UnitSupervisor will track concerns regarding fraud, waste, and abuse in a separate compliance
software. Compliance concerns related to Alliance employees will be treated as a confidential
document whereby access will be limited to the CCO and designated Compliance employee/s as
requested by the reporter and as allowed by law. Internal compliance matters will be tracked
using a confidential compliance software available to the CCO and designated Compliance
employee/s.
B. Investigating Compliance Issues
When conduct is reported that is determined to be inconsistent with regulations, rules or laws
or Alliance policies and proceduresy, the CCO will determine the level of potential risk and
respond accordingly. If this preliminary review indicates that a problem may exist, the CCO will
promptly report the risk issue to the CEO and inquiry into the matter will be undertaken. This
inquiry may include appropriate assistance from Legal Counsel. If potential significant risk
exists, the CCO will promptly report it to the CEO. Alliance employees and providers will be
expected to cooperate fully with any inquires undertaken. The CCO shall report any compliance
issues that may result in negative publicity and significant risk to Alliance to the Board of
Directors.
Responsibility for conducting the investigation will be decided on a case-by-case basis by the
CCO. The CCO will delegate investigations of suspected provider or recipient member abuse or
fraud to the Senior Director of Program Integrity and Special Investigations Unit. The findings
will be reviewed by the CCO Senior Director of Program Integrity to ensure consistency in the
investigative process. All investigations will be documented in a confidential compliance
software. Suspected cases of provider or enrollee member fraud will be referred to NC
Medicaid Office of Compliance and Program Integrity for determination of credible allegation of
fraud. Alliance will cooperate with NC Medicaid and/or the Department of Justice Medicaid
Investigations Division on all fraud investigations.
When the compliance issue concerns an Alliance employee, the investigative process will
adhere to Alliance policies and procedures regarding internal investigations and applicable
Human Resources policies. To the extent practical and appropriate, efforts will be made to
maintain the confidentiality of such inquires and the information gathered. Consequences for
conduct inconsistent with Alliance’s policyies and procedures will be addressed according to the
provisions identified in the applicable policies.
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
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VI. Enforcement of Standards and Disciplinary Guidelines
Compliance standards will be consistently enforced through appropriate disciplinary actions, up
to and including termination of employment. For providers in the Alliance Network compliance
with standards will be enforced through sanctions up to and including termination of contract.
The following guidelines will be used. Discipline must be:
1. documented and well-publicized;
2. consistent;
3. dependent on the severity of the violation;
4. enforced for those who commit a violation; and
5. enforced for those who fail to report a known violation
The CCO in collaboration with Human Resources, will develop policies and procedures to guide
disciplinary actions. The CCO will ensure that such policies and procedures are made available
to employees and providers through electronic means as well as incorporated into manuals and
training materials. Disciplinary procedures will be approved by the CEO. The CCO will monitor
to ensure consistent implementation of disciplinary guidelines.
VII. Internal Auditing and Monitoring
Audits and monitoring are preventative and detective compliance measures, which assist
Alliance in identifying and acting on real or potential issues before they become larger
compliance risks.
Audit activities are performed to ensure operational, reporting, and compliance objectives are
met, and that effective and sufficient internal controls are in place. The purpose of Alliance’s
internal audit activity is to provide independent, objective assurance and consulting services
designed to add value and improve Alliance’s operations. The internal audit activity helps Alliance accomplish its objectives by bringing a systematic, disciplined approach to evaluate and
improve the effectiveness of governance, risk management, and control processes. The Office
of Compliance conducts internal audits on an ad hoc and scheduled basis, in accordance with
the annual Audit Plan approved by the ACC. Audit activities may include:
Assessing and making appropriate recommendations to improve Alliance’s processes.
Evaluating risk exposures, including those related to fraud, and how risk is managed.
Aiding Alliance in maintaining effective controls by evaluating their effectiveness and
efficiency and by promoting continuous improvement.
Comprehensive review of Alliance’s adherence to regulatory requirements and
guidelines.
Audits are objective and independent planned activities determined by the annual risk
assessment and included in the annual compliance work plan, which includes the annual audit
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
12
plan. Monitoring is a subjective, detective control done often completed as a self-review audit
within a Department or by the Office of Compliance, for example as follow up to compliance
remediation plans. Monitoring may be planned and part of the annual compliance work plan or
may be conducted as a reaction to concerning trends identified as part of the Continuous
Quality Improvement process, or based on concerns from within a Department, etc.
Internal audits and monitoring will be completed using tools as appropriate and will be
documented in the Compliance Audit or Monitoring Report. At a minimum, the following
components will be included in all audits and monitoring:
Sample selection
Data review and collection
Data analysis; and
Reporting
Techniques may vary depending on the nature of the area reviewed and may be a combination
of two or more of the following:
On-site visits;
Unannounced mock audits;
Interviews;
Questionnaires;
Trend analysis;
Review and tracking of work flow and processes;
Reviews of written materials and documentation prepared by the different departments; and
Other
The CEO has delegateds authority to the CCO to seek consultation with legal counsel when
expert review is necessary to analyze the risk issue. If a review identifies risk issues for Alliance,
the CCO will report the facts to the CEO. In consultation with legal counsel, as appropriate, the
CCO will review the situation to determine whether there appears to have been activity
inconsistent with federal and state rules and regulations, Alliance policies, procedures or the
Code of Ethics and Conduct.
In addition to internal audits and monitoring, the Provider Network Operations Department will
conduct ongoing provider monitoring and billing audits according to Alliance’s policies and
procedures on provider monitoring. Results of these reviews will be communicated to the CCC
by the Provider Network Evaluators and/or Quality Management Department.
All audit and monitoring activities will be reviewed by the CEO and ACC and summarized for
Alliance Board of Directors, including sufficient information to evaluate the appropriateness of
responses to identified violations of Alliance’s policies, procedures and Federal or State laws.
VIII. Response and Remediation
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When an internal compliance issue has been identified through an audit, monitoring or
investigative activity, the CCO will ensure the issue is reported to the CEO and will facilitate the
process to develop corrective action initiatives or to enforce standards through disciplinary
actions promptly as required by policies and law.
As appropriate, the CCO will develop a remediation plan. Plans may include:
1. additional or modified training and education;
2. corrective action;
3. development of new policies and procedures;
4. revision to existing policies and procedures;
5. revision to the Compliance Plan;
6. additional monitoring and auditing; or
7. reporting to outside agencies
The CCO must be involved in the development of all remediation plans that:
1. result from a significant compliance violation;
2. affect multiple departments; or
3. involve revisions or additions to the Compliance Plan or policies and procedures.
Reporting a compliance violation to an outside agency must be coordinated through the CCO
prior to reporting. The Office of Compliance monitors settlement of issues reported to outside
authorities.
Remediation plans, including any reporting to an external agency, should be attached to the
investigative documentation in the confidential compliance software, or to the Compliance
Audit/Monitoring Report. Remediation plans that require further monitoring are considered
“open” and are not resolved and closed until the monitoring period is successfully completed.
In accordance with Alliance’s policies and procedures, providers who have engaged in legal or
ethical misconduct will be subject to consideration of penalties, sanctions, termination of
contract for services and/or excluded from providing local, state, grant, and/or Medicaid
funded services in the Alliance Provider Network, and/or other sanctions and penalties as
required by law or state policy.
All providers’ corrective action plans will be maintained electronically and will be used as
historical reference tools whereby identified issues may be included in Alliance’s provider profiling and review processes.
IX. Effectiveness of the Compliance Program
A. Annual Compliance Report
The Chief Compliance Officer (CCO) will ensure a review of Alliance’s status with current compliance and regulatory operations. The purpose of the review is to ascertain whether the
compliance operations of Alliance are of sufficient scope and within substantial compliance
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
14
with Alliance’s policy and regulatory requirements. The results of the self-assessment process
along with a report of compliance efforts during the preceding year will be prepared by the
CCO. With review and comments provided by the Corporate Compliance Committee (CCC) and
Board Audit and Compliance Committee (ACC), the Annual Report will be presented to the
Alliance Board of Directors.
B. Annual Risk Assessment and Compliance Work Plan
Annually, the CCO in collaboration with leadership will conduct a compliance risk assessment
using an approved Risk Assessment tool. Risk will be identified through interviews with
department heads, document reviews with input from management, results from previous
audits and investigations, and review of the annual Office of Inspector General work plan, Fraud
Alerts, Special Advisory Bulletins, and advice and guidance by NC Medicaid. The level of risk will
be assessed based on legal, reputational and financial risk to Alliance. Based on the assessment,
the ACC will prioritize the highest scored risk areas and will include at a minimum the top 5 to
10 areas in the annual compliance work plan.
C. Revisions to the Compliance Plan
This Compliance Plan is intended to be flexible and readily adaptable to changes in regulatory
requirements and in the health care system as a whole. The plan will be regularly reviewed by
the CCO and the ACC to assess the viability of the Plan and the inclusion of all appropriate
Alliance policies and regulatory requirements. The Plan will be revised as experience
demonstrates that a certain approach is not effective or suggests a better alternative. The
Board of Directors will review and approve the Compliance Plan annually.
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
15
APPENDIX A
Office of Compliance Functional Structure
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Alliance Health Corporate Compliance Plan, Adopted October 2012, Rev. October 2019
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APPENDIX B
Federal Criminal and Civil Statutes Related to Fraud and Abuse in the
Context of Health care
Criminal Statutes
This section contains references to criminal statutes related to fraud and abuse in the context
of health care. It is not intended to be a compilation of all federal statutes related to health
care fraud and abuse. It is merely a summary of some of the more frequently cited federal
statutes.
Health Care Fraud (18 U.S.C. 1347)
Theft of Embezzlement in Connection with Health Care (18 U.S.C. 669)
False Statements Relating to Health Care Matters (18 U.S.C. 1035)
Obstruction of Criminal Investigations of Health Care Offenses (18 U.S.C. 1518)
Mail and Wire Fraud (18 U.S.C. 1341 and 1343)
Anti-Kickback law/Criminal Penalties for Acts Involving Federal Health Care Programs
(Section 1128B of the Social Security Act/42 U.S.C. 1320a 7b)
Civil and Administrative Statutes
This section contains a description of civil and administrative statutes related to fraud and
abuse in the context of health care. It is not intended to be a compilation of all federal statutes
related to health care fraud and abuse. It is merely a summary of some of the more frequently
cited federal statutes.
The False Claims Act (31 U.S.C. 3829-3733)
Civil Monetary Penalties Law (Section 1128A of the Social Security Act/42 U.S.C. 1320a-
7aa)
Stark/Self-Referral Law/Limitations on Certain Physician Referrals (Section 1877 of the
Social Security Act/42 U.S.C. 1395nn)
Exclusion From Federal Health Care Programs (Section 1128(a), (b) and (c) of the Social
Security Act/42 U.S.C. 1320a-7a)
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17
REFERENCES
Bellucci, Margaret, Thornton, Mary, Corporate Compliance Manual for Behavioral Healthcare
Providers, National Council for Community Behavioral Healthcare
Troklus, Debbie, Warner, Greg, Compliance 101 Third Edition, Health Care Compliance
Association
42 CFR § 438.608 Program Integrity Requirements.
2013 Federal Sentencing Guidelines Manual Chapter 8, Part B –Effective Compliance and Ethics
Program
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6A
(Back to agenda)
Alliance Health BOARD OF DIRECTORS
Agenda Action Form
ITEM: Draft Minutes from the May 7, 2020, Board Meeting DATE OF BOARD MEETING: June 4, 2020 REQUEST FOR BOARD ACTION: Approve the draft minutes from the May 7, 2020, meeting. CEO RECOMMENDATION: Approve the minutes. RESOURCE PERSON(S): Robert Robinson, CEO
page 125 of 153
Thursday, May 07, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
Page 1 of 4
MEMBERS PRESENT: ☒Glenn Adams, Cumberland County Commissioner, JD, ☒Jennifer Anderson, MHSA, ☐Tony Braswell,
Johnston County Commissioner, ☒Heidi Carter, Durham County Commissioner, MPH, MS, ☒David Curro, BS, ☐Angela Diaz, MBA,
☐Greg Ford, Wake County Commissioner, MA, ☒Lodies Gloston, MA, ☒David Hancock, MBA, MPAff, ☒Duane Holder, MPA, ☐D. Lee
Jackson, BA, ☐Donald McDonald, MSW, ☒Lynne Nelson, BS, ☒Gino Pazzaglini, Board Vice-Chair, MSW LFACHE, ☒Pam Silberman,
JD, DrPH (exited at 6:12 pm), ☒McKinley Wooten, Jr., JD; ☐(vacancy representing Cumberland County; ☐(vacancy representing
Durham County); ☐(vacancy representing Durham County); and ☐(vacancy representing Wake County)
GUEST(S) PRESENT: Denise Foreman, Wake County Manager’s office; Yvonne French, NC DHHS/DMH (Department of Health and Human Services/Division of Mental Health, Developmental Disability and Substance Abuse Services); and Mary Hutchings, Wake County Finance Department ALLIANCE STAFF PRESENT: Brandon Alexander, Communications and Marketing Specialist II; Michael Bollini, Executive Vice-President/Chief Operating Officer; Joey Dorsett, Senior Vice-President/Chief Information Officer; Doug Fuller, Director of Communications; Terrasine Gardner, Engagement Manager; Kelly Goodfellow, Executive Vice-President/Chief Financial Officer; Cheala Garland-Downey, Executive Vice-President/Chief Human Resources Officer; Veronica Ingram, Executive Assistant II; Mehul Mankad, Chief Medical Officer; Jennifer Meade, Community Health and System of Care Manager; Brian Perkins, Senior Vice-President/Strategy and Government Relations; Monica Portugal, Chief Compliance Officer; Robert Robinson, Chief Executive Officer; Sean Schreiber, Executive Vice-President/Network and Community Health; Tammy Thomas, Senior Director of Project Portfolio Management; Sara Wilson, Senior Director of Government Relations; Carol Wolff, General Counsel; and Doug Wright, Director of Community and Member Engagement 1. CALL TO ORDER: Vice-Chair Gino Pazzaglini called the meeting to order at 4:05 p.m.
AGENDA ITEMS: DISCUSSION:
2. Announcements Vice-Chair Pazzaglini welcomed Board members, staff and guests. Ms. Ingram confirmed all virtual attendees. Mr. Robinson notified the board that the 2019 annual report is completed and congratulated the Communications Staff for their work on it, which is Alliance’s first fully electronic edition. Mr. Robinson reminded Board members that May is Mental Health Awareness Month and today’s Child Mental Health Awareness Day. A listing of Alliance involved activities was provided. Mr. Robinson thanked Board members for contributing to staff lunches for staff whose job duties requires that they come into the office regularly. Mr. Robinson congratulated staff for their efforts on the EQR audit, which the agency scored 96% and was conducted entirely remotely due to COVID-19 restrictions.
3. Agenda Adjustments There were no adjustments to the agenda.
4. Public Comment There were no public comments.
5. Committee Reports A. Consumer and Family Advisory Committee – page 4 The Alliance Consumer and Family Advisory Committee (CFAC) is composed of consumers and/or family members from Durham, Wake, Cumberland or Johnston Counties who receive mental health, intellectual/developmental disabilities or substance use/addiction
page 126 of 153
Thursday, May 07, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
Page 2 of 4
AGENDA ITEMS: DISCUSSION:
services. This month’s report included draft minutes and supporting documents from the Johnston April 21, the Durham April 13, the Wake April 14, the Cumberland April 23, and the April 6 Steering Committee meetings. Dave Curro, CFAC Chair, presented the report. Mr. Curro shared that CFAC members have maintained virtual contact with each other; he reviewed updates from recent CFAC meetings which were held remotely. The CFAC report is attached to and made part of these minutes. BOARD ACTION The Board received the report. B. Finance Committee – page 67 The Finance Committee’s function is to review financial statements and recommend policies/practices on fiscal matters to the Board. The Finance Committee meets monthly at 2:30 p.m. prior to the regular Board Meeting. This month’s report included draft minutes from the April 2, 2020, meeting, the Statement of Net Position, the Summary of Savings/(Loss) by Funding Source and ratios for the period ending March 31, 2020, and recommendations to the Board to approve all presented contracts over $500,000. David Hancock, Committee Chair, presented the report. Mr. Hancock shared that revenues exceeded expenditures and all state and contractual ratios were met or exceeded. The Finance Committee report is attached to and made part of these minutes. BOARD ACTION A motion was made by Mr. Hancock to authorize a sole source exception under NC General Statute 143-129 (e) (g) to authorize the CEO to enter into a contract with McSilver Institute for poverty policy research at NY University training and technical assistance in an amount not to exceed $215,000.00; motion seconded by Mr. Wooten. Motion passed unanimously. A motion was made by Mr. Hancock to authorize a sole source exception under NC General Statute 143-129 (e) (g) to authorize the CEO to enter into a contract with Homecare Software Solution LLC dba HHAeXchange for electronic verification and validation for an estimated amount of $199,000; motion seconded by Ms. Gloston. Motion passed unanimously.
6. Consent Agenda A. Draft Minutes from April 2, 2020, Board Meeting – page 77 B. Executive Committee Report – page 82 C. Human Rights Committee Report – page 85 D. Network Development and Services Committee Report – page 122
The consent agenda was sent as part of the Board packet; it is attached to and made part of these minutes. There were no comments or discussion about the consent agenda. BOARD ACTION A motion was made by Dr. Silberman to approve the minutes and adopt the consent agenda; motion seconded by Mr. Hancock. Motion passed unanimously.
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Thursday, May 07, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
Page 3 of 4
AGENDA ITEMS: DISCUSSION:
7. Training/ Presentation(s)
A. COVID-19 Update – page 124 Alliance staff provided an update on the agency’s efforts to continue operations and to coordinate care for the people Alliance serves while maintaining staff and community safety; the update also included how the agency is addressing the impact on providers, and any changes in federal or state legislation. Vice-Chair Pazzaglini shared that he directed staff to revise the agency’s Tailored Plan implementation due to COVID-19 delays. Mr. Robinson introduced the presentation; he shared that most staff are working from home; he shared about the agency’s efforts to accommodate scheduling needs for staff who are caring for others. He also shared that staff will work from home until May 31, 2020, and a comprehensive re-entry plan is being developed and includes input from staff, providers and people Alliance serves. Mehul Mankad, Chief Medical Officer, provided an epidemiological update; he noted NC governor, Roy Cooper, and NC DHHS Secretary, Mandy Cohen’s press conferences and current plans to implement phase 1 on May 8. Dr. Mankad also provided a general overview of the agency’s plan for staff to return to Alliance offices; this date is currently estimated for June 2020. Sean Schreiber, Executive Vice-President/Network and Community Health, reviewed the agency’s efforts to support its providers, which includes increasing telehealth services. He noted that recent claims do not indicate a decrease in services except at emergency departments. Mr. Schreiber shared that urgent care, crisis facilities and mobile crisis services continue to operate. He reviewed efforts to expand stabilization payments and some cell phone reimbursements for providers; he also shared about unique opportunities to partner with county agencies to expand provider support for individuals experiencing homelessness who may have been exposed to COVID-19. Commissioner Carter thanked Alliance staff for their efforts in supporting Durham shelters and people experiencing homelessness. Brian Perkins, Senior Vice-President/Strategy and Government Relations, and Sara Wilson, Senior Director of Government Relations, reviewed recent legislative activity. Mr. Perkins provided an overview of legislation that was passed recently (May 2) and signed into law by the governor on May 4, 2020: HB 1043 which directs NC’s portion of the federal COVID relief funds and SB 704 which addresses NC policy changes. He also reviewed notable provisions in the NC COVID-19 Recovery Act. The COVID-19 presentation is saved as part of the Board’s files. BOARD ACTION The Board accepted the training/presentation. B. Fiscal Year (FY) 2020-2021 Recommended Budget – page 125 Kelly Goodfellow, Executive Vice-President/Chief Financial Officer, presented the FY 2020-2021 recommended budget for consideration. The Board will vote on the FY 2020-2021 budget at its June meeting. Ms. Goodfellow reviewed the budget process, which included information presented at the March 2020 Board budget retreat. She also reviewed background for the agency’s budget process including legislative requirements and guidelines for service and administrative operations.
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Thursday, May 07, 2020 AREA BOARD REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
Page 4 of 4
AGENDA ITEMS: DISCUSSION:
Ms. Goodfellow reviewed the total budget, revenue sources, PMPM (per member, per month) rate, and the number of covered lives; she also compared the recommended budget with the previous year’s budget and noted areas of interest such as accuracy of covered lives (which is used to set the agency’s PMPM) and the impact of increased services due to COVID-19. She reviewed federal, state and local service budget items and the overall administrative budget. The FY 2020-2021 presentation is saved as part of the Board’s files. BOARD ACTION The Board accepted the training/presentation.
8. Chair’s Report Vice-Chair Pazzaglini shared that the June Board meeting may also be held remotely. He also reminded Board members of current vacancies on the Board. Vice-Chair Pazzaglini reviewed the agency’s process for electing Board officers (Chairperson and Vice-Chairperson), which will occur at the June Board meeting. He shared his willingness to serve as Chair and Lynne Nelson’s willingness to serve as Vice-Chair; he encouraged other Board members to share if they were willing to serve as a Board officer.
9. Closed Session(s) BOARD ACTION A motion was made by Dr. Silberman to enter closed session pursuant to NC General Statute (NCGS) 143-318.11 (a) (1) and (a) (6) to prevent the disclosure of information that is confidential and not a public record under NCGS 122C-126.1 and to consider the qualifications, competence, and performance of an employee; motion seconded by Ms. Nelson. Motion passed unanimously. The Board returned to open session.
10. Adjournment All business was completed; the meeting adjourned at 6:18 p.m.
Next Board Meeting Thursday, June 04, 2020
4:00 – 6:00 pm
Minutes approved by Board on Click or tap to enter a date..
page 129 of 153
6B
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Alliance Health BOARD OF DIRECTORS
Agenda Action Form
ITEM: Executive Committee Report DATE OF BOARD MEETING: June 4, 2020
BACKGROUND: The Executive Committee sets the agenda for Board meetings and acts in lieu of the Board between meetings. Actions by the Executive Committee are reported to the full Board at the next scheduled meeting. This month’s report includes draft minutes from the May 18, 2020, meeting. REQUEST FOR BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Gino Pazzaglini, Board Vice-Chair; Robert Robinson, CEO
page 130 of 153
Monday, May 18, 2020
BOARD EXECUTIVE COMMITTEE - REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 1 of 2
APPOINTED MEMBERS PRESENT: ☒David Curro, BS (Audit and Compliance Committee Chair); ☒Lodies Gloston, MA (Policy
Committee Chair); ☒David Hancock, MBA, PFAff (Finance Committee Chair) – joined at 4:05 pm, ☒Donald McDonald, MSW (Network
Development and Services Committee Chair); ☒Lynne Nelson, BS (Human Rights Committee Chair) – joined at 4:04 pm, ☒Gino
Pazzaglini, MSW LFACHE (Board Vice-Chair), and ☒Pam Silberman, JD, DrPH (Quality Management Committee Chair) APPOINTED, NON-VOTING BOARD MEMBERS PRESENT: None BOARD MEMBERS PRESENT: None GUEST(S): None STAFF PRESENT: Kelly Goodfellow, Executive Vice-President/Chief Financial Officer; Veronica Ingram, Executive Assistant II; Brian Perkins, Senior Vice-President/Strategy and Government Relations; Monica Portugal, Chief Compliance Officer; Robert Robinson, CEO; and Carol Wolff, General Counsel
1. WELCOME AND INTRODUCTIONS – the meeting was called to order at 4:01 p.m.
2. REVIEW OF THE MINUTES – The minutes from the April 20, 2020, meeting were reviewed; a motion was made by Ms. Gloston and seconded by Mr. Curro to
approve the minutes. Motion passed unanimously.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME: 3. Updates a) COVID-19: Mr. Robinson shared that staff will continue working from home through June 15,
2020, and that a plan for staff to return to working in the office/community is under development. b) Legislative/Medicaid Reform: Mr. Perkins provided an update about recent NC legislature events. c) June Committee Meeting: Vice-Chair Pazzaglini shared that next month’s meeting may be held
remotely.
a) None specified. b) None specified. c) None specified.
a) N/A b) N/A c) N/A
4. Audit and Compliance Committee Recommendations
Monica Portugal, Chief Compliance Officer, presented the recommendation. COMMITTEE ACTION: A motion was made by Mr. Curro to support and forward to the Board, the Audit and Compliance Committee’s recommendation to rotate auditing firms every five years, starting next year. Motion seconded by Dr. Silberman. Motion passed unanimously. COMMITTEE ACTION: A motion was made by Mr. Curro to have a meeting with auditors without staff present; seconded by Mr. Hancock. Motion passed unanimously.
None specified. N/A
5. Agenda for June Board Meeting
Committee reviewed the draft agenda and provided input. Committee requested removing reports for committees that did not meet. COMMITTEE ACTION: A motion was made by Ms. Gloston to approve the agenda as amended. Motion seconded by Mr. McDonald. Motion passed unanimously.
Ms. Ingram will forward the agenda to staff.
5/19/20
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Monday, May 18, 2020
BOARD EXECUTIVE COMMITTEE - REGULAR MEETING (virtual meeting via videoconference) 4:00-6:00 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 2 of 2
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME
FRAME: 6. Closed Session COMMITTEE ACTION:
A motion was by Mr. Curro to enter closed session pursuant to NC General Statute (NCGS) 143-318.11 (a) (6) and (a) (3) to consider the qualifications, competence, and performance of an employee and to consult with, consider or give instructions to an attorney in order to preserve the attorney-client privilege. Motion seconded by Dr. Silberman. Motion passed unanimously. Committee returned to open session. A motion was made by Dr. Silberman to amend the agenda for the June Board meeting by adding additional closed session topics (litigation consultation and personnel matter). Motion seconded by Mr. McDonald. Motion passed unanimously.
None specified. n/a
7. ADJOURNMENT: the meeting adjourned at 6:21 pm; the next meeting will be June 15, 2020, at 4:00 p.m.
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6C
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Alliance Health BOARD OF DIRECTORS
Agenda Action Form
ITEM: Network Development and Services Committee Report DATE OF BOARD MEETING: June 4, 2020 BACKGROUND: The committee reviews progress on the agency’s network development plan and progress on service development. The committee reports to the Board and provides guidance and feedback on development of the needs and gaps assessment to meet state and agency requirements. This month’s report includes draft minutes from the May 13, 2020 meeting. REQUEST FOR BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Donald McDonald, Committee Chair; Sean Schreiber, Executive Vice-President/Network and Community Health
page 133 of 153
Wednesday, May 13, 2020
BOARD NETWORK DEVELOPMENT & SERVICES COMMITTEE - MINUTES Virtual Meeting via Video Conference 4:00-5:00 p.m.
Page 1 of 1
APPOINTED MEMBERS PRESENT: ☒ Marilyn Avila, ☐ Heidi Carter, MPH, MS, Board member, ☐ Angela Diaz, Board member,
☐ Sally Hunter, ☐ Donald McDonald, MSW, Board member (Committee Chair), ☒ Lynne Nelson, BS, Board member;
BOARD MEMBERS PRESENT: ☐George Corvin, MD (Board Chair)
GUEST(S) PRESENT: ☒Yvonne French (NC DHHS/DMH Liaison), ☒ McKinley Wooten, Jr., JD
STAFF PRESENT: ☒ Sean Schreiber, Executive Vice-President/Network and Community Health, ☒Carlyle Johnson, Director of Provider Network Strat & Ini,
Network Development & Evaluation, ☒ Sandra Ellis (Scribe)
1. WELCOME AND INTRODUCTIONS – The meeting was called to order by McKinley Wooten, Jr., JD.
2. REVIEW OF THE MINUTES – March 11, 2020 minutes reviewed for action. Motion to Approve Marilyn Avila; second Lynn Nelson. Minutes were unanimously approved. (Update: Committee did not have a quorum therefore March 11, 2020 minutes will require a vote for approval at the July 9, 2020 meeting)
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME: 3. COVID 19 Impact on
Access and Adequacy (Sean Schreiber)
Presentation tracking impact of COVID 19 on Access Utilization • Childhood Residential • Community Support Services • Innovations Services • Utilization • Outpatient Services
On-going July 8, 2020
4. Move to NCQA Standards (Sean Schreiber)
Provided overview of NCQA network standards • Availability standards • Network Adequacy standards • Discussed Provide to member ratios •
On-going July 8, 2020
5. Gaps and Needs Assessment for 2021 (Carlyle Johnson)
Dr. Carlyle Johnson provided an update on the annual Needs and Gaps Assessment • Surveys/analysis is delayed • Snapshot analysis of Network may be an insufficient representation of true
access and accessibility due to COVID 19 impacts • Continued focus on getting greater member participation in the process.
On-going July 8, 2020
6. Next Meeting July 8, 2020
7. Adjournment 4:45pm
page 134 of 153
(Back to agenda)
6D
ITEM: Quality Management Committee Report
DATE OF BOARD MEETING: June 4, 2020
BACKGROUND: The Global QMC is the standing committee that is granted authority for Quality Management by the MCO. The Global QMC reports to the MCO Board of Directors which derives from General Statute 122C-117. The Quality Management Committee serves as the Board’s monitoring and evaluation committee charged with the review of statistical data and provider monitoring reports. The goal of the committee is to ensure quality and effectiveness of services and to identify and address opportunities to improve LME/MCO operations and local service system with input from consumers, providers, family members, and other stakeholders.
The Alliance Board of Directors’ Chairperson appoints the committee consisting of five voting members whereof three are Board members and two are members of the Consumer and Family Advisory Committee (CFAC). Other non-voting members include at least one MCO employee and one provider representative. The MCO employees typically assigned are the Director of the Quality Management (QM) Department who has the responsibility for overall operation of the Quality Management Program; the MCO Medical Director, who has ultimate responsibility of oversight of quality management; the Quality Review Manager, who staffs the committee; the Quality Management Data Manager; and other staff as designated.
The Global QMC meets at least quarterly each fiscal year and provides ongoing reporting to the Alliance Board. The Global QMC approves the MCO’s annual Quality Improvement Projects, monitors progress in meeting Quality Improvement goals, and provides guidance to staff on QM priorities and projects. Further, the Committee evaluates the effectiveness of the QM Program and reviews and updates the QM Plan annually.
The draft minutes from the previous meeting are attached
REQUEST FOR AREA BOARD ACTION: Accept the report.
CEO RECOMMENDATION: Accept the report.
RESOURCE PERSON(S): Pam Silberman, Committee Chair; Wes Knepper, Director of Quality Management
Alliance Behavioral Healthcare BOARD OF DIRECTORS
Agenda Action Form
page 135 of 153
Thursday, May 07, 2020
BOARD QUALITY MANAGEMENT COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 1:00-2:30 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 1 of 4
APPOINTED MEMBERS PRESENT: ☒David Curro, BS (Board member); ☐David Hancock, MBA, MPAff (Board member); ☐ Angela Diaz (Board Member)
☒Duane Holder, MPA (Board member); ☒Pam Silberman, JD, DrPH (Board member; Committee Chair) by phone; ☒ Israel Pattison (CFAC); ☐ Gino Pazzaglini
(Board Chair);
APPOINTED, NON-VOTING MEMBERS PRESENT: ☒Diane Murphy, (Provider, IDD) ☒Dava Muserallo, (Provider MH/SUD);
BOARD MEMBERS PRESENT:
GUEST(S) PRESENT: ☐ Mary Hutchings; ☒Yvonne French (LME Liaison)
STAFF PRESENT: Michael Bollini, Chief Operating Officer; Diane Fening, Executive Assistant I; Tia Grant, QI Manager; Wes Knepper, Quality Management
Director; Doug Wright, Director of Community and Member Engagement
1. WELCOME AND INTRODUCTIONS – the meeting was called to order at 1:00 pm
2. REVIEW OF THE MINUTES – The minutes from the March 5, 2020, meeting were reviewed. David Curro moved that we approve the minutes. Duane Holder
seconded and the motion passed.
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
3. OLD BUSINESS
QIP Updates (Wes)
• Proposed Closures
o Access to Care
Recommending that we close this longtime QIP, without hitting
benchmark, so we can use these resources to focus on projects
that we consider more important and that impact a larger section
of the population we are taking care of. The QIP wasn’t effective
but we are still working on it. Wes checked with URAC and the
accreditation agency and found that we can close QIPs without
meeting goals. We’ll still be monitoring it and we report on it
quarterly anyway. Dave Curro moved to close the QIP and Duane
Holder seconded the motion. The motion passed.
o Care Coordination Clinical Contacts
Recommending this one be changed. This QIP is about our care
coordinators seeing people face to face in a crisis orientation
facility. This project struggled to get going because as soon as we
started this, business changed their operations and protocols to
QIP-Quality
Management Plan
page 136 of 153
Thursday, May 07, 2020
BOARD QUALITY MANAGEMENT COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 1:00-2:30 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 2 of 4
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
keep pace with how providers wanted to work with them. This
effort was being duplicated. Duane moved to close this QIP and
David seconded the motion. The motion passed.
o Expedited Care
This was to get authorization for services for a provider before that
provider was identified. We thought our system would allow us to
do it but it can’t. Israel Pattison moved to approve the closure of
this QIP, Dave Curro seconded the motion. The motion passed.
o Upgrade provider profiles QIP – we worked with networks and have hit the
project goal for two consecutive measurement periods. We will also do a
post closure one-year measurement. Will be important in the Tailored
Plan. Dave moved to remove this as a QIP, Israel seconded the motion.
The motion passed.
• Updates on other projects:
Improving adverse letters – seen some gains but thinks there are some staff
retraining issues. Hope it will continue to go up. March best month yet, and
hope to close this one soon.
TCLI Supported Employment- now at 35, benchmark is 33. Will be
recommending this be closed when year is up. Pam suggested that data pre-
Covid-19 and after Covid-19 would be useful.
• PROPOSED NEW QIPs
These are new QIPs, but we’ve been talking about them for a while.
o 7 Day Follow Up – Medicaid SUD
o 7 Day Follow Up – State SUD
o 7 Day Follow Up State MH
Review TCLI-Transitions
to Community Living
Initiative QIP for possible
closure
page 137 of 153
Thursday, May 07, 2020
BOARD QUALITY MANAGEMENT COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 1:00-2:30 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 3 of 4
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
We have not paid a fine or hit these measures consistently. We need to improve
whether we are penalized or not.
David made a motion for all three to become new QIPs, Duane seconded and the
motion carried.
o HEDIS – SAA (Schizophrenia Antipsychotic Adherence) measures the
percentage of adult members getting the medications that have been
prescribed to them. This one should not be impacted much by COVID-19.
o HEDIS – SDD Monitoring Adults on Antipsychotics – people that have
schizophrenia, schizoaffective disorder or bipolar disorder that have been
dispensed antipsychotic mediation and have been screened for diabetes.
We get this information from claims.
o HEDIS – Monitoring Children on Antipsychotics – APM measure. This is the
kids measure. Most kids don’t get these screenings routinely.
These measures only measure those on Medicaid. We don’t get claims for others
not on Medicaid, so we don’t have a good way to measure them accurately.
Israel moved to adopt the three HEDIS measures as new QIPs, Dave seconded the
motion and the motion passed.
HEDIS-Healthcare
Effectiveness Data and
Information Set
• Wes will find out the
percentage of
people we see with
underlying
conditions with
Medicaid vs those
that are uninsured.
• 6/4/20
4. NEW BUSINESS • Review of QM Policies (Wes) these have not changed since last year. QM 1 is
member and provider satisfaction, QM 2 is management and investigation of
grievances, and QM3 is management of incidences. Dave moved that we
accept these with no changes; Duane seconded and the motion passed.
• Performance Dashboard (Wes) sent this out to the committee as pdf file.
DMH has decided to stop asking that we submit monthly report to them. DHB
has not yet done that. Wes wants to look at measures quarterly (rather than
monthly) and do deeper dive, giving more analysis.
• Wes will look for a
schedule of reports
and decide how he
will divide them up
• 6/4/20
page 138 of 153
Thursday, May 07, 2020
BOARD QUALITY MANAGEMENT COMMITTEE - REGULAR MEETING 5200 W. Paramount Parkway, Morrisville, NC 27560 1:00-2:30 p.m.
Draft minutes may be submitted with the monthly Board packet. Minutes will be approved by this Committee at a later date; minutes approved on Click or tap to enter a date..
Page 4 of 4
AGENDA ITEMS: DISCUSSION: NEXT STEPS: TIME FRAME:
Pam suggested that we look at the QIPs every month and then discuss a subset
of quarterly reports so we have more time with each. Focus particularly on
ones where we are having problems.
• Recruiting New CFAC Member – Dave said that they’ve had no success in
finding any one. We’ll bring it up at county meetings. County CFAC is always
looking for programming and hearing from the agency would be good. Wes
will virtually attend for 5 minutes. Wes also offered that a prospective
member could attend one of the QMC meetings as a trial run. Pam suggested
that we ought to do a training before any new person attends meetings. Doug
Wright will talk to Wes about when the CFAC meetings are held.
Pam moved to adjourn the meeting.
to be discussed at
each meeting
*CFAC-Consumer and
Family Advisory
Committee
• Wes will attend the
each of the next
CFAC meetings
virtually for a short
period of time
• Doug will be his
contact for specifics
5. ADJOURNMENT: the meeting adjourned at 1:54 pm; the next meeting will be June 4, 2020, from 1:00 p.m. to 2:30 p.m.
page 139 of 153
(Back to agenda)
6E
ITEM: HR FY21 Classification and Grade Plan DATE OF BOARD MEETING: June 4, 2020 BACKGROUND: Annually in July, Alliance is required to report its classification and grade plan to the North Carolina Office of State Human Resources (OSHR). This report requires that the Alliance Board review and approve this Annual Plan. REQUEST FOR AREA BOARD ACTION: Approve the report. CEO RECOMMENDATION: Approve the report. RESOURCE PERSON(S): Cheala Garland-Downey, Executive Vice-President/Human Resources
Alliance Behavioral Healthcare BOARD OF DIRECTORS
Agenda Action Form
page 140 of 153
Created and/or modified position classifications-Reclassifications: Total Number - 34
Working Title Classification Salary Grade
Access Director Program/Unit Director III 42 Working Title change to Sr. Director and reclassified
Appeals Coordinator Administrative Clinical Support Specialist III 29
Working Title changed and reclassified (see
Grievance/Appeals Analyst)
Chief Compliance Officer Compliance Program Administrator 53 Classification Salary Grade Change
Chief Medical Officer Medical Director III 68 Classification Salary Grade Change
Director of Purchasing Purchasing Director 42
New Working title and Classification (reclassification of
Purchasing Administrator)
Director-HIPAA Privacy & Security HIPAA Privacy and Security Director 38
New Working title and Classification (reclassification of
HIPAA Privacy & Security Officer)
Director-Quality Management Quality Management Director 42 Working Title change to Sr. Director and reclassified
Executive Vice President-CFO Chief Financial Officer 63 Classification Salary Grade Change
Executive Vice President-COO Chief Operations Officer 61 Classification Salary Grade Change
Executive Vice President-HR HR Executive 55 Working Title Change, classification salary grade change
Executive Vice President-Network &
Community Health Service Delivery Executive 61 Classification Salary Grade Change
Family Navigator Advocate 28 Reclassification
General Counsel Attorney III 59 Classification Salary Grade Change
Grievance/Appeals Analyst Social Research Associate I 31
New working title & reclassification of Appeals
Coordinator
IT Security & Compliance Specialist Network Specialist II 38 New Working Title, Classification Salary Grade Change
Medical Records Manager Medical Records Manager I 27 New Working title and Classification
Physical Health Consultant Nurse Consultant II 34 New Working title and Classification
Quality Improvement Manager Buisness Systems Manager 40 Reclassification-new classification
RN Healthcare Coordinator Nurse Consultant II 34 Reclassification-new classification
Senior Director Access Program Administrator I 44
New Working Title, Reclassified, Classification Salary
Grade Change
Senior Director Care Coordination Program Administrator I 44 Classification Salary Grade Change
Senior Director Clinical Innovations Program Administrator II 52 Classification Salary Grade Change
Senior Director Government Relations Program Administrator I 44
New Working Title, Reclassified, Classification Salary
Grade Change
Senior Director Project Portfolio Management Project Management Program Director 50 New Working Title, Salary Grade Change
Senior Director Quality Management Program Administrator I 44
New Working Title, Reclassified, Classification Salary
Grade Change
Senior Director Utilization Management Program Administrator I 44
New Working Title, Reclassified, Classification Salary
Grade Change
Senior Director-Claims Claims Director 44 New Working Title, Classification Salary Grade Change
Senior Director-Program Integrity Program Administrator I 44
New Working Title, Reclassified, Classification Salary
Grade Change
Senior Vice President-Community Health &
Well-Being Vice President-Community Health 48 Reclassification-new classification
Senior Vice President-CIO Information Technology Executive 59 Classification Salary Grade Change
Senior Vice President-Financial Operations Vice President-Financial Operations 55 Classification Salary Grade Change
Senior Vice President-Strategy & Gov
Relations Vice President-Government Relations 58 New Classification
page 141 of 153
SharePoint Manager Information Technology Manager 43 New Working Title
TCLI RN Health Coordinator Nurse Consultant II 34 New Classification
Working title changes only: Total Number - 6
Working Title Classification Salary Grade
Individual & Family Engagement Specialist Advocate 28 Working Title changed to Member Engagement Spec.
Power Analyst Business Analyst Business & Technology Analyst I 37 Working Title change
Org. Development & Learning Onboarding
Program Manager Staff Development Coordinator 35 Working Title change
Diversity & Inclusion Program Manager Staff Development Coordinator 35 Working Title change
Transition Team Care Navigator MH/SUD Clinician I 32
New Working Title-transitioning MH/SUD Care
Coordinator positions to new title.
Payroll Accountant Accountant I 33 Working Title change from Accountant
Eliminated Working Titles: Total Number - 8
Working Title Classification Salary Grade
Asst Director-I/DD Care Coord I/DD Program Manager38
Working Title eliminated
Asst Director-MH/SUD Care Coord Program/Unit Director II40
Working Title eliminated
Director-Individual & Family Engagement MH/SUD Unit Supervisor II 37 Working Title eliminated
Director-Long Term Services Care
Coordination I/DD Program Director 40 Working Title eliminated
Director-System Engagement Program/Unit Director III 42 Working Title eliminated
Executive Vice President-Care Management Working Title eliminated
HIPAA Privacy and Security Officer HIPAA Privacy and Security Officer 37 Working Title eliminated
Senior Vice President-Organizational
Effectiveness Vice President-Organizational Effectiveness 55 Working Title eliminated, New classification
page 142 of 153
Classification and Grade Schedule FY20
Job Title Classification FLSA Status Salary Grade Min Mid Max
Accountant Accountant I Exempt 33 46,115 62,750 79,385
Payroll Accountant Accountant I Exempt 33 46,115 62,750 79,385
Accounting Manager Accounting Manager Exempt 40 65,104 88,590 112,076
Accounts Payable Manager Accounting Manager Exempt 40 65,104 88,590 112,076
Finance Manager Accounting Manager Exempt 40 65,104 88,590 112,076
Accounts Payable Specialist Accounting Specialist I Non-Exempt 30 39,779 54,128 68,478
Senior Accounts Payable Analyst Accounting Specialist II Non-Exempt 33 46,115 62,750 79,385
Accounts Payable Clerk Accounting Technician IV Non-Exempt 26 32,664 44,447 56,230
Administrative Assistant I Administrative Assistant I Non-Exempt 24 29,599 40,276 50,953
Administrative Assistant II Administrative Assistant II Non-Exempt 26 32,664 44,447 56,230
Administrative Assistant III Administrative Assistant III Non-Exempt 28 36,046 49,049 62,052
Administrative Clinical Support Specialist Administrative Clinical Support Specialist I Non-Exempt 26 32,664 44,447 56,230
Provider Network Helpdesk Specialist Administrative Clinical Support Specialist I Non-Exempt 26 32,664 44,447 56,230
Contract Specialist Administrative Clinical Support Specialist II Non-Exempt 27 34,313 46,691 59,069
Credentialing Specialist I Administrative Clinical Support Specialist II Non-Exempt 27 34,313 46,691 59,069
Provider Enrollment Specialist Administrative Clinical Support Specialist II Non-Exempt 27 34,313 46,691 59,069
Appeals Coordinator Administrative Clinical Support Specialist III Non-Exempt 29 37,866 51,526 65,186
Credentialing Specialist II Administrative Clinical Support Specialist III Non-Exempt 29 37,866 51,526 65,186
Credentialing Supervisor Administrative Officer I Exempt 32 43,898 59,733 75,569
Credentialing & Enrollment Manager Administrative Officer II Exempt 35 50,890 69,248 87,605
Healthcare Network Program Manager II Administrative Officer III Exempt 38 58,995 80,277 101,559
Olmstead Liaison Manager Administrative Officer III Exempt 38 58,995 80,277 101,559
Family Navigator Advocate Non-Exempt 28 36,046 49,049 62,052
Individual & Family Engagement Specialist Advocate Non-Exempt 28 36,046 49,049 62,052
Inreach Peer Support Specialist Advocate Non-Exempt 28 36,046 49,049 62,052
Member Engagement Specialist Advocate Non-Exempt 28 36,046 49,049 62,052
Assistant General Counsel Attorney I Exempt 43 75,474 102,701 129,927
Deputy General Counsel Attorney II Exempt 45 83,290 113,335 143,381
General Counsel Attorney III Exempt 59 166,010 225,897 285,783
Budget Analyst Budget Analyst Exempt 35 50,890 69,248 87,605
Quality Improvement Manager Buisness Systems Manager Exempt 40 65,104 88,590 112,076
Applications Support Spec Business & Technology Analyst I Exempt 37 56,159 76,418 96,677
Applications System Analyst Business & Technology Analyst I Exempt 37 56,159 76,418 96,677
Power Analyst Business Analyst Business & Technology Analyst I Exempt 37 56,159 76,418 96,677
BI Report Developer Business & Technology Analyst II Exempt 39 61,975 84,331 106,688
EDI Specialist Business & Technology Analyst II Exempt 39 61,975 84,331 106,688
Applications Configuration Specialist Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
Data Integration(ETL) Developer Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
Data Scientist I Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
Database Administrator I Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
Database/Sharepoint Developer Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
IT Business Analyst Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
IT Quality Engineer Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
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page 143 of 153
Classification and Grade Schedule FY20
Sharepoint/Web Developer Business & Technology Application Specialist I Exempt 40 65,104 88,590 112,076
Application/Web Developer Business & Technology Application Specialist II Exempt 42 71,846 97,763 123,681
Data Architect Business & Technology Application Specialist II Exempt 42 71,846 97,763 123,681
Microstrategy Administrator Business & Technology Application Specialist II Exempt 42 71,846 97,763 123,681
Senior Sharepoint Architect Business & Technology Application Specialist II Exempt 42 71,846 97,763 123,681
Database Administrator III Business & Technology Application Specialist III Exempt 44 79,286 107,887 136,488
Business & Technology Applications Technician Non-Exempt 32 43,898 59,733 75,569
Business Analyst Exempt 35 50,890 69,248 87,605
Financial & Purchasing Administrator Business Officer Exempt 38 58,995 80,277 101,559
Business Systems Analyst I 36 53,460 72,745 92,029
IT Quality Assurance Specialist Business Systems Analyst II Exempt 38 58,995 80,277 101,559
Business Systems Analyst III Exempt 40 65,104 88,590 112,076
Business Systems Manager Exempt 43 75,474 102,701 129,927
Area Director/CEO CEO Exempt CEO 208,400 291,700 375,100
Executive Vice President-CFO Chief Financial Officer Exempt 63 202,171 275,102 348,033
Executive Vice President-COO Chief Operations Officer Exempt 61 183,201 249,288 315,376
Claims Auditor Claims Analyst I Non-Exempt 28 36,046 49,049 62,052
Claims Research Analyst Claims Analyst I Non-Exempt 28 36,046 49,049 62,052
Senior Claims Analyst Claims Analyst II Non-Exempt 29 37,866 51,526 65,186
Senior Director-Claims Claims Director Exempt 44 79,286 107,887 136,488
Claims Manager Claims Manager Exempt 35 50,890 69,248 87,605
Claims Specialist 24 29,599 40,276 50,953
Claims Supervisor Claims Supervisor I Exempt 33 46,115 62,750 79,385
Claims Audit Supervisor Claims Supervisor II Exempt 36 53,460 72,745 92,029
Community Education Specialist Community Relations Specialist Non-Exempt 30 39,779 54,128 68,478
Community Liaison Community Relations Specialist Non-Exempt 30 39,779 54,128 68,478
Criminal Justice Specialist Community Relations Specialist Non-Exempt 30 39,779 54,128 68,478
Disaster Recovery Coordinator Community Relations Specialist Non-Exempt 30 39,779 54,128 68,478
Care Review Coordinator Community Services Consultant Non-Exempt 28 36,046 49,049 62,052
Family Partner Coordinator Community Services Consultant Non-Exempt 28 36,046 49,049 62,052
Family Specialist Community Services Consultant Non-Exempt 28 36,046 49,049 62,052
Regional Child Specialist Community Services Consultant Non-Exempt 28 36,046 49,049 62,052
Transition Coordinator Community Services Consultant Non-Exempt 28 36,046 49,049 62,052
Youth Coordinator Community Services Consultant Non-Exempt 28 36,046 49,049 62,052
Compliance Analyst Compliance Analyst Exempt 34 48,443 65,919 83,394
Chief Compliance Officer Compliance Program Administrator Exempt 53 123,526 168,087 212,647
Contract Administrator Contract Administrator Exempt 34 48,443 65,919 83,394
Controller Exempt 45 83,290 113,335 143,381
Data Consultant I Data Analyst (Non-IT) I Non-Exempt 33 46,115 62,750 79,385
Data Consultant II Data Analyst (Non-IT) II Exempt 35 50,890 69,248 87,605
Data Specialist Non-Exempt 29 37,866 51,526 65,186
Eligibility Specialist Eligibility Specialist Non-Exempt 25 31,093 42,310 53,527
Executive Assistant I Executive Assistant I Non-Exempt 30 39,779 54,128 68,478
Executive Assistant II Executive Assistant II Exempt 32 43,898 59,733 75,569
Facilities Director Facilities Director Exempt 42 71,846 97,763 123,681
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page 144 of 153
Classification and Grade Schedule FY20
Facilities Manager Facilities Manager Non-Exempt 35 50,890 69,248 87,605
Finance Director Exempt 45 83,290 113,335 143,381
Financial Analyst Financial Analyst Exempt 34 48,443 65,919 83,394
Health Information Data Manager 32 43,898 59,733 75,569
Director-HIPAA Privacy & Security HIPAA Privacy and Security Director Exempt 38 58,995 80,277 101,559
HIPAA Privacy and Security Officer HIPAA Privacy and Security Officer Exempt 37 56,159 76,418 96,677
Human Resources Business Partner HR Analyst Exempt 32 43,898 59,733 75,569
Director-Organizational Development & Learning HR Director Exempt 41 68,392 93,064 117,735
Executive Vice President-HR HR Executive Exempt 55 136,317 185,492 234,667
Human Resources Manager HR Manager Exempt 38 58,995 80,277 101,559
Human Resources Specialist HR Specialist Non-Exempt 29 37,866 51,526 65,186
Community Health Worker-Benefits Consultant-MH/SUD Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
Diversion Housing Specialist Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
Housing Specialist Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
Independent Living Initiative Coordinator Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
Post Transition Engagement Specialist Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
Service Integrity Consultant-MH/SUD Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
System of Care Coordinator Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
Tenancy Support Coordinator Human Services Coordinator II Non-Exempt 30 39,779 54,128 68,478
UM I/DD Supervisor Human Services Coordinator III Exempt 38 58,995 80,277 101,559
Access Coordinator Human Services Counselor I Non-Exempt 30 39,779 54,128 68,478
Administrative Care Coordinator Human Services Counselor I Non-Exempt 30 39,779 54,128 68,478
Diversion Qualified Professional Human Services Counselor I Non-Exempt 30 39,779 54,128 68,478
School Based Diversion Coordinator Human Services Counselor I Non-Exempt 30 39,779 54,128 68,478
Youth Resource Specialist Human Services Counselor I Non-Exempt 30 39,779 54,128 68,478
Behavioral Health Consultant-Long Term Services I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
Care Navigator-Long Term Services I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
Community Health Worker-Benefits Consultant-Long Term Services I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
I/DD Olmstead Liaison I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
School Based IDD Care Coordinator I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
Service Integrity Consultant-Long Term Services I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
Traumatic Brain Injury (TBI) Care Coordinator I/DD Care Coordinator Non-Exempt 31 41,787 56,862 71,936
Director-CM Operational Integrity I/DD Program Director Exempt 40 65,104 88,590 112,076
Director-Long Term Services Care Coordination I/DD Program Director Exempt 40 65,104 88,590 112,076
Asst Director-I/DD Care Coord I/DD Program Manager Exempt 38 58,995 80,277 101,559
Medicaid Waiver Program Manager I/DD Program Manager Exempt 38 58,995 80,277 101,559
Clinical Fidelity Supervisor-Long Term Services I/DD Program Supervisor Exempt 36 53,460 72,745 92,029
Operational Integrity Supervisor-Long Term Services I/DD Program Supervisor Exempt 36 53,460 72,745 92,029
SIS Evaluation Supervisor I/DD Program Supervisor Exempt 36 53,460 72,745 92,029
Long Term Services Access Coordinator I/DD Specialist I Non-Exempt 29 37,866 51,526 65,186
SIS Evaluator I/DD Specialist II Non-Exempt 31 41,787 56,862 71,936
UM Care Manager-I/DD I/DD Specialist II Non-Exempt 31 41,787 56,862 71,936
Information and Communication Specialist I 26 32,664 44,447 56,230
Communications & Marketing Specialist Information and Communication Specialist II Exempt 31 41,787 56,862 71,936
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page 145 of 153
Classification and Grade Schedule FY20
Director-Communications Information and Communication Specialist III Exempt 41 68,392 93,064 117,735
Director-Core Systems Development Information Technology Director Exempt 48 96,556 131,387 166,218
Director-Data Science & Analytics Research Information Technology Director Exempt 48 96,556 131,387 166,218
Director-Enterprise Analytics Information Technology Director Exempt 48 96,556 131,387 166,218
Director-Infrastructure and Security Information Technology Director Exempt 48 96,556 131,387 166,218
Director-IT Applications Development Information Technology Director Exempt 48 96,556 131,387 166,218
Director-Product Management & Support Information Technology Director Exempt 48 96,556 131,387 166,218
Director-Strategic Analytics Information Technology Director Exempt 48 96,556 131,387 166,218
Senior Vice President-CIO Information Technology Executive Exempt 59 166,010 225,897 285,783
IT Quality Engineering Manager Information Technology Manager Exempt 43 75,474 102,701 129,927
Manager of Enterprise Reporting Information Technology Manager Exempt 43 75,474 102,701 129,927
SharePoint Manager Information Technology Manager Exempt 43 75,474 102,701 129,927
Internal Auditor 28 36,046 49,049 62,052
Investigator I Investigator I Non-Exempt 32 43,898 59,733 75,569
Physician Advisor & Peer Reviewer Medical Director I Exempt 55 136,317 185,492 234,667
Associate Medical Director Medical Director II Exempt 57 150,433 204,700 258,967
Chief Medical Officer Medical Director III Exempt 68 258,642 351,944 445,246
Medical Records Manager Medical Records Manager I Non-Exempt 27 34,313 46,691 59,069
ED Claims Reviewer Mental Health Nurse II Exempt 34 48,443 65,919 83,394
Healthcare Integration Nurse Mental Health Nurse II Exempt 34 48,443 65,919 83,394
I/DD Integrated Care Nurse Mental Health Nurse II Exempt 34 48,443 65,919 83,394
UM Care Manager-MH/SUD RN Mental Health Nurse II Exempt 34 48,443 65,919 83,394
Behavioral Health Consultant-MH/SUD MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
Care Navigator-Community Team MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
Care Navigator-Transition Team MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
Diversion Care Coordinator MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
Hospital Liaison MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
I/DD Care Coordination Critical Response Clinician MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
MH/SUD Care Coordinator MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
School Based Care Coordinator MH/SUD Clinician I Exempt 32 43,898 59,733 75,569
Access Clinician MH/SUD Clinician II Exempt 34 48,443 65,919 83,394
School Based Care Coordination Team Lead MH/SUD Clinician II Exempt 34 48,443 65,919 83,394
Investigator II MH/SUD Clinician III Exempt 36 53,460 72,745 92,029
UM Care Manager-MH/SUD MH/SUD Clinician III Exempt 36 53,460 72,745 92,029
Senior UM Care Manager-MH/SUD MH/SUD Clinician IV Exempt 37 56,159 76,418 96,677
Inreach Program Supervisor MH/SUD Unit Supervisor I Exempt 33 46,115 62,750 79,385
Transition Program Supervisor MH/SUD Unit Supervisor I Exempt 33 46,115 62,750 79,385
Access Supervisor MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
Clinical Fidelity Supervisor-MH/SUD MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
Director-Individual & Family Engagement MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
MH/SUD Care Coordination Supervisor MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
Operational Integrity Supervisor-MH/SUD MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
Provider Network Development Supervisor MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
Provider Network Evaluation Supervisor MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
Transitions to Community Living Supervisor MH/SUD Unit Supervisor II Exempt 37 56,159 76,418 96,677
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Classification and Grade Schedule FY20
Desktop Infrastructure Supervisor Network Analyst (Senior) Exempt 38 58,995 80,277 101,559
Network Analyst I 33 46,115 62,750 79,385
Network Analyst II 34 48,443 65,919 83,394
Network Specialist I 35 50,890 69,248 87,605
IT Security & Compliance Specialist Network Specialist II Exempt 38 58,995 80,277 101,559
Senior Network Security Specialist Network Specialist-Senior Exempt 40 65,104 88,590 112,076
Senior Network Specialist Network Specialist-Senior Exempt 40 65,104 88,590 112,076
Server Administrator Network Specialist-Senior Exempt 40 65,104 88,590 112,076
Physical Health Consultant Nurse Consultant II Exempt 34 48,443 65,919 83,394
RN Healthcare Coordinator Nurse Consultant II Exempt 34 48,443 65,919 83,394
TCLI RN Health Coordinator Nurse Consultant II Exempt 34 48,443 65,919 83,394
Receptionist Office Assistant III Non-Exempt 20 24,305 33,072 41,840
Office Assistant Office Assistant IV Non-Exempt 22 26,821 36,497 46,172
Paralegal Paralegal Non-Exempt 29 37,866 51,526 65,186
Pharmacist Pharmacist Exempt 46 87,496 119,059 150,622
Medical Records Specialist Processing Assistant V Non-Exempt 24 29,599 40,276 50,953
Eligibility & Enrollment Supervisor Processing Unit Supervisor Non-Exempt 29 37,866 51,526 65,186
Director-Healthcare Integration Program Administrator I Exempt 44 79,286 107,887 136,488
Hospital Relations Director Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director Access Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director Care Coordination Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director Government Relations Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director Quality Management Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director Utilization Management Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director-Program Integrity Program Administrator I Exempt 44 79,286 107,887 136,488
Senior Director Clinical Innovations Program Administrator II Exempt 52 117,588 160,006 202,425
Special Investigations Supervisor Program Integrity Unit Supervisor Exempt 36 53,460 72,745 92,029
CIC Child Services Specialist Program/Services Development Specialist I Non-Exempt 32 43,898 59,733 75,569
Provider Network Development Specialist I Program/Services Development Specialist I Non-Exempt 32 43,898 59,733 75,569
Practice Transformation Specialist Program/Services Development Specialist II Non-Exempt 34 48,443 65,919 83,394
Provider Network Development Specialist II Program/Services Development Specialist II Non-Exempt 34 48,443 65,919 83,394
Community Engagement Manager Program/Unit Director I Exempt 38 58,995 80,277 101,559
Community Health & Strategy Manager Program/Unit Director I Exempt 38 58,995 80,277 101,559
Member Engagement Manager Program/Unit Director I Exempt 38 58,995 80,277 101,559
Special Populations Manager Program/Unit Director I Exempt 38 58,995 80,277 101,559
Supportive Housing Manager Program/Unit Director I Exempt 38 58,995 80,277 101,559
Asst Director-MH/SUD Care Coord Program/Unit Director II Exempt 40 65,104 88,590 112,076
Director-Community Education & Outreach Program/Unit Director II Exempt 40 65,104 88,590 112,076
Provider Network Operations Manager Program/Unit Director II Exempt 40 65,104 88,590 112,076
Transitions to Community Living Manager Program/Unit Director II Exempt 40 65,104 88,590 112,076
UM MH/SUD Supervisor Program/Unit Director II Exempt 40 65,104 88,590 112,076
Access Director Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Behavioral Healthcare Management Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-CC Regional Initiatives & Staff Development Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Community & Member Engagement Program/Unit Director III Exempt 42 71,846 97,763 123,681
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Classification and Grade Schedule FY20
Director-Housing Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-MH/SUD Care Coordination Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Network Evaluation Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Physical Healthcare Management Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Program Integrity Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Provider Network Operations Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Provider Network Strategic Initiatives Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-System Engagement Program/Unit Director III Exempt 42 71,846 97,763 123,681
Director-Utilization Management Program/Unit Director III Exempt 42 71,846 97,763 123,681
Medicaid Program Director Program/Unit Director III Exempt 42 71,846 97,763 123,681
Senior Director Project Portfolio Management Project Management Program Director Exempt 50 106,554 144,992 183,430
Healthcare Network Project Manager Project Manager Exempt 37 56,159 76,418 96,677
Project Manager Project Manager Exempt 37 56,159 76,418 96,677
Strategic Project Architect Project Manager Exempt 37 56,159 76,418 96,677
Purchasing Agent Purchasing Agent Non-Exempt 34 48,443 65,919 83,394
Director of Purchasing Purchasing Director Exempt 42 71,846 97,763 123,681
Provider Network Evaluator I QA Specialist II Non-Exempt 30 39,779 54,128 68,478
Provider Network Evaluator II QA Specialist III Exempt 34 48,443 65,919 83,394
Director-Quality Management Quality Management Director Exempt 42 71,846 97,763 123,681
Accreditation Manager Quality Management Manager I Exempt 37 56,159 76,418 96,677
Quality Management Data Manager Quality Management Manager I Exempt 37 56,159 76,418 96,677
Quality Management Incident & Grievance Manager Quality Management Manager I Exempt 37 56,159 76,418 96,677
Accounts Payable Supervisor Senior Accountant Exempt 35 50,890 69,248 87,605
Senior Accountant Senior Accountant Exempt 35 50,890 69,248 87,605
Senior Compliance Analyst Senior Compliance Analyst Exempt 36 53,460 72,745 92,029
Senior Financial Analyst Senior Financial Analyst Exempt 37 56,159 76,418 96,677
Senior HR Business Partner Senior HR Analyst Exempt 35 50,890 69,248 87,605
IT Project Manager Senior Project Manager Exempt 42 71,846 97,763 123,681
Senior Project Manager Senior Project Manager Exempt 42 71,846 97,763 123,681
Senior Psychologist Senior Psychologist Exempt 40 65,104 88,590 112,076
Executive Vice President-Network & Community Health Service Delivery Executive Exempt 61 183,201 249,288 315,376
Site Director 39 61,975 84,331 106,688
Clinical Service Evaluator I Social Research Associate I Non-Exempt 31 41,787 56,862 71,936
Grievance/Appeals Analyst Social Research Associate I Non-Exempt 31 41,787 56,862 71,936
Quality Assurance Analyst Social Research Associate I Non-Exempt 31 41,787 56,862 71,936
Quality Review Coordinator I Social Research Associate I Non-Exempt 31 41,787 56,862 71,936
Clinical Service Evaluator II Social Research Associate II Exempt 33 46,115 62,750 79,385
Quality Review Coordinator II Social Research Associate II Exempt 33 46,115 62,750 79,385
Instructional Design Consultant Staff Development Consultant II Exempt 37 56,159 76,418 96,677
Org. Development & Learning Consultant Staff Development Consultant II Exempt 37 56,159 76,418 96,677
Diversity & Inclusion Program Manager Staff Development Coordinator Exempt 35 50,890 69,248 87,605
Org. Development & Learning Onboarding Program Manager Staff Development Coordinator Exempt 35 50,890 69,248 87,605
Org. Development & Learning Analyst Staff Development Specialist I Non-Exempt 33 46,115 62,750 79,385
Statistical Assistant 25 31,093 42,310 53,527
Statistical Research Assistant I 26 32,664 44,447 56,230
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Classification and Grade Schedule FY20
Statistical Research Assistant II 28 36,046 49,049 62,052
Statistician 30 39,779 54,128 68,478
Desktop Infrastructure Technician Technology Support Analyst Non-Exempt 31 41,787 56,862 71,936
Helpdesk Coordinator Technology Support Analyst Non-Exempt 31 41,787 56,862 71,936
Senior Vice President-Community Health & Well-Being Vice President-Community Health Exempt 48 96,556 131,387 166,218
Senior Vice President-Financial Operations Vice President-Financial Operations Exempt 55 136,317 185,492 234,667
Senior Vice President-Strategy & Gov Relations Vice President-Government Relations Exempt 58 158,030 215,037 272,044
Senior Vice President-Organizational Effectiveness Vice President-Organizational Effectiveness Exempt 55 136,317 185,492 234,667
Executive Vice President-Care Management Exempt
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(Back to agenda)
7A
ITEM: COVID-19 Update
DATE OF BOARD MEETING: June 4, 2020
BACKGROUND: Alliance staff will provide an update on the agency’s efforts to continue operations and to coordinate care for the people Alliance serves while maintaining staff and community safety; the update will also include how the agency is addressing the impact on providers, and any changes in federal or state legislation.
REQUEST FOR AREA BOARD ACTION: Accept the report.
CEO RECOMMENDATION: Accept the report.
RESOURCE PERSON(S): Robert Robinson, CEO; Mehul Mankad, Chief Medical Officer; Sean Schreiber, Executive Vice-President/Network and Community Health; and Brian Perkins, Senior Vice-President/ Strategy and Government Relations
Alliance Behavioral Healthcare BOARD OF DIRECTORS
Agenda Action Form
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7B
ITEM: FY21 Budget Approval DATE OF BOARD MEETING: June 4, 2020 BACKGROUND: Per GS 159-12 (b), a public hearing shall be held to allow any persons who wish to be heard on the budget to appear. The FY 2020-2021 Budget is also being presented to the Board for approval and adoption per GS 159-13. REQUEST FOR AREA BOARD ACTION: Approve the report. CEO RECOMMENDATION: Approve the report. RESOURCE PERSON(S): Robert Robinson, CEO; Kelly Goodfellow, Executive Vice-President/Chief Financial Officer
Alliance Behavioral Healthcare BOARD OF DIRECTORS
Agenda Action Form
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7C
ITEM: Annual Compliance Report DATE OF BOARD MEETING: June 4, 2020 BACKGROUND: The Alliance compliance program is designed to deter and mitigate risk to the organization through prevention, detection and remediation activities. It is intended that the scope of all compliance activities promotes integrity, ensures objectivity, fosters trust and supports the stated values of Alliance. In accordance with contractual obligations and federal regulations, Alliance shall have an effective compliance program with reasonable oversight by the governing board; understanding the scope and operations of the compliance program. The Board approved Corporate Compliance Plan states that a report of compliance efforts will be presented annually to the Alliance Health Board of Directors. REQUEST FOR AREA BOARD ACTION: Accept the report. CEO RECOMMENDATION: Accept the report. RESOURCE PERSON(S): Dave Curro, Audit & Compliance Committee Chair; Monica Portugal, Chief Compliance Officer
Alliance Behavioral Healthcare BOARD OF DIRECTORS
Agenda Action Form
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8
ITEM: Election of FY21 Board Officers: Chairperson and Vice-Chairperson DATE OF BOARD MEETING: June 4, 2020
BACKGROUND: As stated in Article II, Section D of the by-laws, at each final regular Board meeting of the
fiscal year, the Officers of the Board of Directors shall be elected for a one-year term to begin July 1. The
Officers of the Board of Directors include: Chairperson and Vice-Chairperson.
No officer shall serve in a particular office for more than two consecutive terms. Each Board of Directors
member, other than County Commissioners, shall be eligible to serve as an officer. Duties of officers shall
be as follows:
• Chairperson – this officer shall preside at all meetings and generally perform the duties of a presiding officer. The Chairperson shall appoint all Board of Directors committees.
• Vice Chairperson – this officer shall be familiar with the duties of the Chairperson and be prepared to serve or preside at any meeting on any occasion where the Chairperson is unable to perform his/her duties.
Nominations will be presented and Board members will elect officers at the June 4, 2020, Board meeting. REQUEST FOR AREA BOARD ACTION: Elect FY21 Chairperson and Vice-Chairperson. CEO RECOMMENDATION: Elect FY21 Chairperson and Vice-Chairperson. RESOURCE PERSON(S): Robert Robinson, Chief Executive Officer
Alliance Behavioral Healthcare BOARD OF DIRECTORS
Agenda Action Form
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