Provider Network Capacity, Needs Assessment and Gaps Analysis

Transcription

1 Provider Network Capacity, Needs Assessment and Gaps Analysis 2016 This study assesses the Cardinal Innovations Healthcare community to determine needs and capacity of providers to deliver services. This evaluation will aid in the development of organizational strategic plans, such as local business plans, network development plans and strategic initiatives, as needed to incorporate results from the service needs assessment and gaps analysis.

2 Table of Contents 2016 NC LME-MCO Community Behavioral Table of Contents Executive Summary... i Progress and Achievements...1 Demographic Data...2 Cardinal Innovations General Population Demographics...2 Cardinal Innovations Medicaid Eligible Demographics...2 Penetration and Service Rates...2 Demographics by Diagnosis...2 Special Populations...3 Traumatic Brain Injury...3 Jail/ Detention Coordination...3 Veterans...3 Needs Assessment...3 Members and Families...3 Stakeholders...4 Access and Choice Standards...4 I. Outpatient Services...4 II. Location-Based Services...8 III. Community/Mobile Services IV. Crisis Services V. Inpatient Services VI. Specialized Services State-Funded Services Items GeoAccess Maps Location-Based Services Community/Mobile Services Departmental Initiatives Recovery-Oriented System of Care Crisis Solutions Initiative Employment Children s Services Integration of Physical and Behavioral Health Care Appendix A Attachments

3 Executive Summary 2016 NC LME-MCO Community Behavioral Executive Summary The 2016 Gaps Analysis Report includes data from Cardinal Innovations Healthcare s (Cardinal Innovations) internal databases, the North Carolina State Budget Office (North Carolina OSBM), the Medicaid Global Eligibility File (GEF), the United States Census Bureau (US Census), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Division of Mental Health, Intellectual and Developmental Disabilities and Substance Abuse Services (DMH), the North Carolina Division of Medical Assistance (DMA), Small Area Health Insurance Estimates (SAHIE), the Department of Social Services (DSS), the Department of Health Service Regulation (DHSR) 2014 Medical Facilities Plan and other DHSR licensed provider data. GeoNetworks GeoAccess GIS application was used to analyze the proximity of contracted Network provider locations to member locations. The results of this accessibility analysis determined if Cardinal Innovations met the access and choice standards outlined for each service category by the Department of Health and Human Services (DHHS). Cardinal Innovations fully met the access and choice standards for Outpatient Services, Community/Mobile Services, Crisis Services, Inpatient Services and Specialized Services. In addition, Cardinal Innovations Provider Network met access and choice standards for all Location-Based Services, except for Child and Adolescent Day Treatment (state funded), SA Comprehensive Outpatient Treatment Program (SACOT) (Medicaid and State funded), and Opioid Treatment (Medicaid and state funded), and Day Supports (state funded). For these services where member accessibility was less than 90%, maps displaying provider locations and radii of 30/45 miles are included in Appendix A. Cardinal Innovations Consumer and Family Advisory Council (CFAC), a subset of the Cultural Competence Advisory Council (CCAC), collected information from members, families and community stakeholders on perceived gaps in service and access. The information gathered identifies the gaps and needs outlined in this study. Member, family and stakeholder perception of needs was considered in conjunction with data from the GIS analyses to identify potential gaps and needs. Cardinal Innovations Clinical Operations, Provider Network and Executive Leadership contributed to the development of goals for Network development. Based on the gaps analysis study, Network development goals for Fiscal Year 2017 include: 1. Increase the quality and availability of psychological testing in the Cardinal Innovations Provider Network. 2. Training of providers and clinicians with LGBTQ experience and a trauma-focused specialty for placement and referral. 3. Increase availability and access to the Peer Bridger Program. 4. Increase availability of facility-based crisis beds and services. 5. Explore and identify options to pilot a PRTF program to serve dually-diagnosed members. i

4 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral Progress and Achievements Based on the results of last year s gaps analysis report, Cardinal Innovations set goals for Network development for Fiscal Year (FY15-16). The four main areas for improvement noted in last year s gaps analysis report, and progress in addressing these gaps, include the following: 1. Increase availability of Level II and III Residential care for youth with IDD and behavioral dual diagnosis. a. Cardinal Innovations worked with one provider to expand its roster of Therapeutic Foster homes, adding approximately 40 additional Therapeutic Foster homes to the Network. b. Cardinal Innovations compensated Level II services at an enhanced rate, and increased clinical expectations, such as consultation from clinical specialty staff and support to families of members receiving these services. c. Cardinal Innovations began and will continue to focus on expanding access to Level III Residential care. 2. Increase availability of Outpatient care for youth with IDD and behavioral dual diagnoses. a. Focus groups were completed with providers in order to gather information, brainstorm options and identify barriers. b. Providers were trained on assessments, tools, behavioral assessment and use of positive behavior supports. Training materials were also posted on the provider section of the Cardinal Innovations website for ongoing provider access. c. Additional training was offered on how to complete assessment with this population, to ensure all diagnoses were identified and/or ruled out when necessary. d. Cardinal Innovations continued to emphasize the importance of psychological testing, particularly identifying the correct diagnosis, and underlying needs that may be missed through standard evaluations. Efforts included starting a utilization review process of providers completing psychological testing. This was to identify standards of practice, areas for training and to incentivize high quality providers (determined by the UR score). The first phase of this was completed and a group of providers identified. This will be ongoing until all providers have been reviewed. e. Next steps will be assessing the Provider Network to identify providers that have expertise in effectively working with this population. Cardinal Innovations also gave providers access to the College of Direct Support, which provides a resource for providers to increase specialty knowledge in interventions/strategies. 3. Implement ACTT Step Down service. a. Cardinal Innovations began implementing this service by piloting with one provider initially, which allowed Cardinal Innovations to identify any modifications in the service that were needed. b. Cardinal Innovations then moved forward to identify five providers under this effort based on their TMACT scores that met high fidelity standards. c. Education then took place with these providers to familiarize them with the service definition. At that time, one provider determined it was not interested in pursuing the service. d. Three of the identified providers confirmed interest in moving forward and had services added to their contracts. The fourth provider is awaiting word on whether this service is feasible for a small team, or if team size would need to increase prior to being able to effectively implement the service. 1

5 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral e. Next, Cardinal Innovations will identify members that would be appropriate for step down service. This will be a collaboration with the Utilization Management department and individual providers. 4. Implement In-Home Therapy service. a. The service definition for this service was approved in June b. Eleven providers were identified and the services were added to their contracts with start dates between July and November of 2015 based on readiness; 10 providers are now actively providing the service. Current evaluation is under way to determine if there is a need for additional providers. c. Cardinal Innovations will now move to an assessment phase with these 10 active providers, to ensure the service is being implemented as outlined. Demographic Data Cardinal Innovations General Population Demographics According to the 2015 North Carolina Office of State Budget and Management (NC OSBM) estimates, there were approximately 2,486,636 people living in the Cardinal Innovations 16-county catchment area. This number increased by nearly 75% from last year s study due to the Mecklenburg expansion. 1 The 2015 NC OSBM general population estimates for Cardinal Innovations Healthcare catchment showed that females comprised 51% and males 49% of the general population. The average median age per county for Cardinal Innovations catchment was Cardinal Innovations Medicaid Eligible Demographics During FY14-15, there were a total of 439,674 individuals eligible for Medicaid covered by Cardinal Innovations Healthcare. Of those, approximately 50.5% were White, 40.5% were African American and 7% were identified as Other. 2 According to internal business intelligence sources, (which rely on self-reporting of ethnicity), 4.3% of Cardinal Innovations Medicaid eligible members were Hispanic. Penetration and Service Rates The Medicaid penetration rate for Cardinal Innovations Healthcare during FY14-15 was 13.4%. There were a total of 58,925 Medicaid members who received at least one service, and 21,535 members who received a state-funded service during FY Demographics by Diagnosis Child/Adolescent members (ages 3-17) with a Mental Health (MH) diagnosis comprised the highest number of members served for Medicaid and/or state funding compared to Intellectual Developmental Disability (IDD) and Substance Use Disorder (SUD) diagnosed members. Among adult members (18+), those with a MH diagnosis comprised the highest number of members served for Medicaid and/or state funding compared to IDD and SUD members. 1 Attachment I includes complete tables that provide general, Medicaid eligible, and members served population figures for FY Other includes American-Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Asian, two or more races and Unknown. 2

6 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral Special Populations Traumatic Brain Injury During FY14-15, Cardinal Innovations collaborated with other LME/MCOs and the Department of Health and Human Services traumatic brain injury (TBI) specialist to develop screening questions related to head injury for the screening, triage, and referral (STR) form used to enroll members. This allows the Clinical Operations team to develop a report to internally identify enrolled members with TBI, and conduct a review of assessments and testing. Cardinal Innovations continued to work to identify current members who have needs that can be met by providers trained in the delivery of TBI services. During this plan year, Cardinal Innovations will continue to provide education to staff and stakeholders on the NC Developmental Disability criteria for coverage of services for individuals with TBI, and will explore potential services or state resource options which may be beneficial on a case-by-case basis. Jail/ Detention Coordination During FY14-15, Cardinal Innovations Access Department focused on increased efforts in partnering with local jail systems within the service region. The Access, Care Coordination and Community Partners departments visited local facilities to learn about behavioral health programming. The Access department provided jail systems with information about services available upon inmate release via the toll-free Access/Crisis Line. The Access Department also provided support to all facilities statewide that were transitioning inmates upon release into the Cardinal Innovations catchment area for behavioral health services. These appointments were categorized as urgent and scheduled within 48 hours of release. Veterans Cardinal Innovations Access department tracked the number of veterans referred to services through the use of the LME/MCO and Provider Screening Triage and Referrals (STR) form during FY Of the 27,647 referrals received for services (Emergent, Urgent and Routine), 110 were identified as having a veteran status. Needs Assessment Members and Families Through the Cardinal Innovations Cultural Competence Advisory Council (CCAC), Cardinal Innovations conducts focus group meetings each year to gather information from members and family, regarding services, gaps and priorities. The focus groups were conducted as part of the Consumer and Family Advisory Council (CFAC), which is a subset of the CCAC. There is a CFAC in each of five service areas, made up of members, family members and community stakeholders. In FY14-15, there were a total of 56 CFAC focus group participants. Participation in each catchment ranged from seven participants to 14 participants. Cardinal Innovations elicited perceptions from the focus group participants, and compiled them into common themes that identified areas to improve service delivery to members. 3

7 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral Stakeholders The CCAC also conducts stakeholder surveys. Stakeholders include members of the local community, advocates and board members. These surveys were administered during March and April of Cardinal Innovations sent 867 s to stakeholders, of which 212 surveys were completed (response rate of 24%). Nine common themes were noted as a result of the stakeholder survey. To integrate what was learned from families and members with what was learned from stakeholders, all perceptions were combined into broad goals used in the assessment of needs. Access and Choice Standards I. Outpatient Services A. Medicaid and state-funded outpatient services access and choice standard: All eligible individuals must have a choice of two different outpatient services provider agencies within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. Outpatient behavioral health services can include psychiatric and biopsychosocial assessment, medication management, individual, group and family therapies, psychotherapy for crisis and psychological testing. Complete the tables below for outpatient services as one group, using geo-mapping software to calculate the number and percentages of individuals with choice: Categories # of enrollees with choice of two providers within 30/45 miles* Medicaid # of Medicaid Enrollees % # of members with choice of two providers within 30/45 miles* State Funded # of Members Reside in urban counties 345, , % 16,755 16, % Reside in rural counties 56,807 56, % 3,410 3, % Total (standard = 100%) 402, , % 20,165 20, % % Adults (age 18+) 180, , % 19,422 19, % Children (age 17 and younger) 222, , % % Total (standard = 100%) 402, , % 20,165 20, % *Members included in all accessibility analyses required a valid address within the Cardinal Innovations catchment area. B. What outpatient service gaps were identified by members and family members? Members and family members throughout Cardinal Innovations catchment area were asked to respond with their perception of Outpatient (OPT) service gaps. Feedback was gathered via on-line questionnaire submissions, and in-person responses provided by members of Cardinal Innovations CFAC. All of the perceived service gaps outlined were based on responses from this sample of members and family members. Although respondent perceptions were a valuable aspect of achieving insights into gaps and potential areas of Network development, they were evaluated in conjunction with all available capacity and accessibility information, in order to formally identify gaps: 1. Respondents indicated a need for additional psychologists, specifically clinicians who are able to perform testing and serve IDD members. 2. Respondents specified a need for psychiatrists in all service areas, citing long wait periods in order to access services. 3. Clinicians who are able to serve adult and child members with IDD and IDD/MH dual diagnosis, were perceived as needed by respondents. 4

8 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral C. What outpatient service gaps were identified by other stakeholders? Stakeholders such as the Department of Social Services (DSS), physical health practitioners and Community Care of NC (CCNC) were asked to provide information related to OPT service gaps, as identified through their interaction with the public behavioral health delivery system in the Cardinal Innovations catchment area. Feedback was gathered via on-line questionnaire submissions and in-person responses during stakeholder meetings. Stakeholders are partners within the continuum of services and resources that members access, and also have unique opportunities to advocate, collaborate and collect insights into possible breaches in the public behavioral health delivery system. 1. Stakeholders stated that providers/psychiatrists may be in proximity to members per access standards, however many were not open to accepting new patients or do not provide appointments within required timeframes. D. What specific geographic, cultural or demographic groups experience outpatient services gaps that need to be addressed? Describe gaps and how the information was gathered. Respondents perceptions of OPT service needs were gathered via on-line questionnaire submissions, and in-person responses from members of Cardinal Innovations CFAC and personnel from collaborative stakeholder organizations. The individuals and families who utilize the services, and Cardinal Innovations partners in the provision of resources and services, continue to be Cardinal Innovations most valuable resource in identifying perceived gaps in services that may not be easily identified by other means. 1. Respondents perceived a gap in trauma informed treatment for members who are LGBTQ, refugees, victims of trafficking, older-aging adults and members with multiple disabilities. 2. Respondents indicated a perception of only one available provider in Rowan County for individuals without insurance, and in need of state funds. 3. Respondents perceived gaps in available providers who were able to meet the cultural needs of members with varied backgrounds and the linguistic needs of non-english speaking members. This includes, but is not limited to, provider-fulfilled interpreter services, and culturally competent provider approaches to treatment and engagement. 4. Respondents indicated that undocumented individuals have limited or no access to basic services. 5. Respondents indicated a perception that there were OPT service gaps for senior/geriatric members, especially aging individuals with IDD and in long-term care facilities. E. Goals, strategies and timelines for addressing outpatient services gaps identified in A, B, C and D for OPT services. Briefly identify the service gap, goal and target date for reducing or eliminating the gap, and strategies planned or in progress to achieve the goal. Medicaid Psychologists Service Gap Goal and Target Date Goal: Increase Quality and Availability of Testing. Current Utilization Reviews in progress to measure quality of testing. Incentivized payment structure for providers scoring well on the reviews and will to increase acceptance of referrals from Cardinal. Strategies to achieve goal, noting if planned or in progress Meeting the need for additional Psychologists in the Network is an ongoing effort. The recruitment of Psychologists who perform testing is formalized by placement on Cardinal Innovations needs list. Ensuring the quality of the testing that members receive is also a necessary focus. Ongoing utilization reviews to measure 5

9 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral Psychiatrists Clinicians Able to Serve Dually-diagnosed Members Trauma-Informed Treatment for Special Populations. At least six providers will be contracted on the basis of URs; deliverables contractualized. Cardinal Innovations continues to recognize this need, but market pressures continue to hinder recruitment. Additional training for Provider Network. Development of specialty programs better able to serve this population. Ongoing collaboration with the state work to address the needs of children with complex diagnosis/presentation. Goal: Establish a directory of providers/clinicians with LGBTQ and TF-CBT credentials, for placement and referral purposes by close of FY all providers of psychological testing. Identification of providers contracted for psychological testing not actively providing to ensure accurate referral base. Monitoring of sustainability, particularly for smaller providers, at field level. The need for additional Psychiatrist continues to be formally identified on Cardinal Innovations published needs list. Ongoing discussions with Clinical Advisory Committee to identify appropriate strategies to identify these clinicians Focus groups occurred to gather input from providers on barriers and training needed Offering training for providers on tools for assessments for identification of dual diagnosis The goals and strategies outlined below will address all service provisions as related to OPT, Location, Community, Inpatient, Crisis and Specialized service categories. Training continues to occur with Cardinal Innovations staff to enhance knowledge of special populations. Subcommittee of the Cultural Competence Committee evaluates needs and ways to address on an ongoing basis. Cardinal Innovations will develop methods for evaluating provider competence for working with specialty populations. Network Operations goal in relation to LGBTQ population; to be expanded to other unique populations if successful. Outreach and partnering with public stakeholders to identify specific needs within service area Survey clinicians identified within Network as certified for TF-CBT specialty to determine history and experience treating LGBTQ population. Research of service modalities specific to population, training and recruitment based on outcome of survey and research. Cultural and Linguistic Needs of Members There are ongoing efforts to ensure that the cultural and linguistic needs of members are addressed and met. The Cardinal Innovations Cultural Competency Committee works with communities, providers and stakeholders, to ensure these values 6 The goals and strategies outlined below will address all service provision as related to OPT, Location, Community, Inpatient, Crisis and Specialized service categories. Ongoing efforts include providing

10 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral are upheld. It is a contractual mandate that all providers will provide translation services for the members they serve. It is also an expectation that all providers will have a cultural competency plan. Clinicians who identify themselves as multi-lingual are prioritized and heavily recruited. Clinicians who have diverse cultural backgrounds and experiences are also heavily recruited. Competence Committee compiled needs data from members/ families/ providers and stakeholders. additional cultural and linguistic education and training for providers, members, community and staff. Encourage providers to consider the health literacy of members of varied cultural backgrounds that they serve. Assist providers in developing cultural competence plans that cover essential areas, according to National Standards for Culturally & Linguistically Appropriate Services in Health & Health Care (CLAS) standards. Assist providers in seeking affordable and qualified interpreters and translation services. Increase collaboration and partnerships between communities, stakeholders. and providers Considering strategies to address the needs of the special populations in our communities: refugee, immigrant, undocumented. State-Funded Service Gap Additional State Funded OPT Sites in Rowan County Child/ Adolescent SUD Treatment Options Goal and Target Date Not pursued at this time. Ongoing collaboration with providers to develop service continuum for this previously identified need. Pilot programs to initiate effectiveness remain an ongoing need. 7 Strategies to achieve goal, noting if planned or in progress Cardinal Innovations Provider Network was unable to identify a need for additional State Funded OPT sites in Rowan County. There was a CCC located in Rowan County during FY14-15, as well as two LIP providers contracted to provide statefunded OPT. Cardinal Innovations will work with the local community and staff in order to determine what issues in Rowan County may be driving the perception of unavailable state-funded OPT options. Cardinal Innovations is reviewing current programming and limitations, as well as identifying successful treatment models utilized in other states. Provided education on current treatment services that can address SUD needs. Cardinal Innovations also added this service need to the formal service needs list, identified for active recruitment of SUD providers specialized in the treatment of children. Next Steps: Cardinal Innovations is also exploring the use of available services, such as SAIOP, that are traditionally adult focused, in order to determine if modifications could be made to meet the needs of children. However, there are current concerns of the hours for a typical SAIOP program during the school year as adolescents are often not able to adhere

11 Cardinal Innovations Healthcare Basic Services for Undocumented Individuals. Access to Basic services for undocumented people is a previously identified need. There are ongoing efforts to strategize partnerships with Federal block grant providers, and identify additional local community resources that may exist NC LME-MCO Community Behavioral to this amount of time and complete all the necessary school obligations. There are continued efforts to overcome this challenge. Continue to ensure that individuals in crisis are eligible to receive crisis services, even as ongoing and routine services remain limited. Cardinal Innovations will continue to provide referrals to a limited number of community providers with MH and SUD funds made available through Federal Block Grants when available. Cardinal Innovations trained all staff to ensure that there is organization wide knowledge in the availability of federal block grant monies for undocumented individuals. Next Steps: Cardinal Innovations is making efforts toward ensuring that these funds are used in efficient ways to meet the needs of more members. II. Location-Based Services A. 1. Medicaid location-based services access and choice standard: All eligible individuals must have a choice of two different provider agencies for each location-based service in the chart below within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. 2. State-funded location-based services access and choice standard: All eligible individuals have access to at least one provider agency for each location-based service in the chart below within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. Psychosocial Service Rehabilitation Child and Adolescent Day Treatment SA Comprehensive Outpatient Treatment Program (SACOT) SA Intensive Outpatient Program (SAIOP) Medicaid State Funded # and % of enrollees with choice # and % of members with at Total # of of two providers within 30/45 least one provider within 30/45 Medicaid miles of their residences miles of their residences Enrollees # % # % Total # of Members 179, % 180,059 12, % 12, , % 222, % , % 402,585 6, % 8, , % 402,585 8, % 8,031 Opioid Treatment 126, % 180,059 6, % 7,967 Day Supports 402, % 402, % 1,093 Adult Developmental Vocational Program 1, % 1,093 Medicaid If not at 100%, have exceptions been requested but not yet finalized? YES. If no, briefly explain and give dates each will be requested: State-funded If not at 100%, have written justifications and plans to meet needs been submitted? YES 8

12 Cardinal Innovations Healthcare Medicaid If not at 100%, are exceptions to the standard in place? NO Please list: If no, briefly explain: Exception requests were submitted with the study. Effective dates of each exception approval: Next review dates for each exception, if applicable: 2016 NC LME-MCO Community Behavioral State-funded If no, briefly explain and give dates each will be submitted: If not at 100%, are written justifications and plans to meet needs in place? NO attach copy to this report. If no, briefly explain: Submitted with the study. Effective date of each written justification and plan approval: Next review dates, if applicable: B. What location-based services gaps were identified by members and family members? Members and family members throughout Cardinal Innovations catchment area were asked to respond with their perception of Location Based service gaps. Feedback was gathered via on-line questionnaire submissions, and in-person responses provided by members of Cardinal Innovations CFAC. All of the perceived service gaps outlined were based on responses from this sample of members and family members. Although respondent perceptions were a valuable aspect of achieving insights into gaps and potential areas of Network development, they were evaluated in conjunction with all available capacity and accessibility information, in order to formally identify gaps: 1. Respondents indicated a perception of need for additional SAIOP and sessions for members receiving those services. 2. Respondents indicated that additional Opioid Treatment providers were needed in all service areas. 3. Respondents also indicated a need for Child/Adolescent SUD Services across all service areas. SAIOP and seven challenges were identified as specific services that were needed to fill this perceived gap. C. What location-based services gaps were identified by other stakeholders? Stakeholders such as the Department of Social Services (DSS), physical health practitioners and Community Care of NC (CCNC), were asked to provide information related to location-based service gaps, as identified through their interaction with the public behavioral health delivery system in the Cardinal Innovations catchment area. Feedback was gathered via on-line questionnaire submissions and in person responses during stakeholder meetings. Stakeholders are partners within the continuum of services and resources that consumer s access, and also have unique opportunities to advocate, collaborate, and collect insights into possible breaches in the public behavioral health delivery system. 1. Stakeholders expressed a need for additional comprehensive services for members with Opiate addiction. D. What specific geographic, cultural or demographic groups experience gaps in the location-based services above that need to be addressed? Describe gaps and how the information was gathered. Respondent s perception of location-based service needs were gathered via on-line questionnaire submissions, and in person responses from members of Cardinal Innovations CFAC and personnel from collaborative stakeholder organizations. The individuals and families, who utilize the services, and Cardinal Innovations partners in the provision of resources and services, continue to be Cardinal Innovations most valuable resource in identifying perceived gaps in services that may not be easily identified by other means. 9

13 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral 1. Respondents believe that single-parent care givers experienced a lack of access to location-based services across the board. 2. It was suggested that Day programming option for adults with I/DD, with community involvement and individual choice, in the Southern Region represented a service gap according to respondents. 3. Respondents believe there is a need for an additional Comprehensive Community Clinic (CCC) in Mecklenburg County due to growth in Mecklenburg County, and suggested that long wait times were a concern. 4. Respondents indicated that Mecklenburg County Day Support and adult development vocational programs were needed, due to loss of agencies and funding. 5. Respondents indicated that there were limited SA services in the Southern Region for duallydiagnosed IDD/MH adults. 6. Respondents indicated a perception of limited Opiate addiction treatment choices specifically in Davidson County. 7. Respondents perceived a gap in trauma-informed treatment for members who are LGBTQ, refugees, victims of trafficking, older-aging adults, and members with multiple disabilities. 8. Respondents perceived gaps in available providers who were able to meet the cultural needs of members with varied backgrounds, and the linguistic needs of non-english speaking members. Including, but not limited to, provider fulfilled interpreter services, and culturally competent provider approaches to treatment and engagement. E. Goals, strategies and timelines for addressing location-based services gaps identified in A., B., C. and D. Briefly identify the service gap, goal and target date for reducing or eliminating the gap, and strategies planned or in progress to achieve the goal. Medicaid Service Gap SACOT Opioid Treatment Goal and Target Date Clinically, increasing SACOT will not be a focus during FY This is a difficult program to sustain outside of the Women's specialty programs. SAIOP is widely available to meet the needs of members on a as needed basis, and can be authorized for more days as clinically appropriate Network Operations considers this a quality issue rather than a capacity issue. SAIOP is considered the more viable treatment option to support among Network providers. Due to existing barriers, this perceived need will not be a focus for FY However, Cardinal Innovations Regional Network Operations staff are working with an already-identified provider to open a clinic in Davidson County. A provider in the Cardinal Innovations Northern Region agreed to increase capacity for this service, and the Network Operations Department will support this additional capacity through referral and technical assistance, as well as budgetary assistance if appropriate. Formal education and training around 10 Strategies to achieve goal, noting if planned or in progress An exception will be requested for this service. Education and training on the ASAM Criteria and service continuum will be provided to providers. This training will also focus on movement from "fixed length of treatment" to individual assessment, and placement based on readiness for change of the members. An exception will be requested for this service. Utilization Reviews are ongoing to ensure quality of treatment within service provision. The delivery of educational opportunities on the use of Suboxone as an appropriate treatment intervention for Opioid Treatment.

14 Cardinal Innovations Healthcare Adult SAIOP: Additional sessions. Access for Single Parent Care Givers Day Programs for I/DD Adults Additional CCC in Mecklenburg County Trauma Informed Treatment for Special Populations Cultural and Linguistic Needs of Members Day Supports in Mecklenburg County State-Funded Day Treatment Day Supports SACOT Service Gap Opioid Treatment (Davidson County) appropriate service provision will also be developed by the Network Operations Department, Not pursued at this time. Not pursued at this time. Not pursued at this time. Not pursued at this time. (Refer to I.E. Medicaid Service #3) (Refer to I.E. Medicaid Service #4) Not pursued at this time. Goal and Target Date Not pursued at this time. Not pursued at this time. Not pursued at this time. Effort sufficient at this time NC LME-MCO Community Behavioral The service definition for SAIOP has specific limitations on the length of treatment that is applied. Additional education on ASAM is necessary to ensure focus is on individual needs vs. fixed length of treatments. Respondent concerns were not detailed, as a result this expressed need was difficult to identify and address. Cardinal Innovations Provider Network currently includes outpatient therapists in all areas, able to provide clinically appropriate services. Promotion of increased opportunities for integrated settings is consistent with best practice. Focus on Supported Employment, Community Guide, and In Home Skill Building help achieves this and have been the focus of development. A potential provider was identified, but limited state funding hindered immediate movement forward. In Mecklenburg County, state and county dollars were blended, and as a result there was a lack of clarity on what service dollars were being utilized for vs. County dollars. This perceived need refers to community-based service appears to be more of a community activity than a service? Strategies to achieve goal, noting if planned or in progress There continues to be limited funding for state services, and day treatment is a difficult program to sustain. Continued collaboration with stakeholders to further define need and resources is needed. An exception will be requested for this service. Although there are providers identified from which capacity could be built, funding shortfalls hinder immediate movement forward. An exception will be requested for this service. Sustainability of service outside of the women's specialty programs is problematic. SAIOP is widely available and can be authorized for more days as clinically appropriate. An exception will be requested for this service. Cardinal Innovations Network Operations

15 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral Department is working with an identified provider to open a clinic in Davidson County. Child/Adolescent SUD Services (Refer to I.E. State Funded Service #2). Perceived need is not currently considered ADVP in Mecklenburg County Not pursued at this time. acute. Current focus is on the exploration of integrated activities and Supported Employment III. Community/Mobile Services A. 1. Medicaid community/mobile services access and choice standard: All eligible individuals must have a choice of two provider agencies for each community/mobile service in the chart below within the LME-MCO catchment area. 2. State-funded community/mobile services access and choice standard: All eligible individuals have access to at least one provider agency for each community/mobile service in the chart below within the LME-MCO catchment area. Medicaid # and % of enrollees with choice of two provider agencies within the LME-MCO catchment area Total # of Medicaid State-Funded # and % of members with access to at least one provider agency within the LME-MCO catchment area Total # of Service # % Enrollees # % Members Assertive Community Treatment Team 180, % 180,059 12, % 12,406 Community Support Team 180, % 180,059 18, % 18,496 Intensive In-Home 222, % 222, % 666 Mobile Crisis 402, % 402,585 20, % 20,165 Multi-systemic Therapy 222, % 222, % 666 Home-based I/DD Services 402, % 402,585 1, % 1,093 (b)(3) MH/I/DD Supported Employment Services (b)(3) Waiver Community Guide (b)(3) Waiver Individual Support (Personal Care) (b)(3) Waiver Peer Support (b)(3) Waiver Respite 402, % 402, , % 402, , % 402, , % 402, , % 402,585 I/DD Supported Employment Services (Innovations) I/DD Supported Employment Services (State-funded) MH/SUD Supported Employment Services (IPS- SE) (State-funded) 402, % 402,585 1, % 1,093 18, % 18,496 12

16 Cardinal Innovations Healthcare Medicaid If not at 100%, have exceptions been requested but not yet finalized?. If no, briefly explain and give dates each will be requested: If not at 100%, are exceptions to the standard in place? Please list. If no, briefly explain: Effective dates of each exception approval: Next review date of each exception, if applicable: 2016 NC LME-MCO Community Behavioral State-funded If not at 100%, have written justifications and plans to meet needs been submitted? If no, briefly explain and give dates each will be submitted: If not at 100%, are written justifications and plans to meet needs in place?, attach copy to this report. If no, briefly explain Effective date of each written justification and plan approval: Next review dates, if applicable: B. What community/mobile services gaps were identified by members and family members? Members and family members throughout Cardinal Innovations catchment area were asked to respond with their perception of Community Based service gaps. Feedback was gathered via on-line questionnaire submissions, and in-person responses provided by members of Cardinal Innovations CFAC. All of the perceived service gaps outlined below were based on responses from this sample of members and family members. Although respondent perceptions were a valuable aspect of achieving insights into gaps and potential areas of Network development, they were evaluated in conjunction with all available capacity and accessibility information, in order to formally identify gaps: 1. Respondents cited a need for state-funded Peer Support Services. 2. Respondents indicated a need for Peer Bridgers to link members to services once discharged from Facility Based Crisis. C. What community/mobile services gaps were identified by other stakeholders? Stakeholders such as the Department of Social Services (DSS), physical health practitioners, and Community Care of NC (CCNC), were asked to provide information related to community-based service gaps, as identified through their interaction with the public behavioral health delivery system in the Cardinal Innovations catchment area. Feedback was gathered via on-line questionnaire submissions and in person responses during stakeholder meetings. Stakeholders are partners within the continuum of services and resources that members access, and also have unique opportunities to advocate, collaborate, and collect insights into possible breaches in the public behavioral health delivery system. 1. Stakeholders expressed concern that Mobile Crisis has capacity issues and long wait times in Mecklenburg County. Mobile Crisis provides good services, but overall needs a quicker response time. D. What specific geographic, cultural or demographic groups experience gaps in the community/mobile services above that need to be addressed? Describe gaps and how the information was gathered. Respondents perceptions of community-based service needs were gathered via on-line questionnaire submissions, and in person responses from members of Cardinal Innovations CFAC and personnel from collaborative stakeholder organizations. The individuals and families who utilize the services, and Cardinal Innovations partners in the provision of resources and services, continue to be Cardinal Innovations most valuable resource in identifying perceived gaps in services that may not be easily identified by other means. 1. Respondents perceived a gap in trauma-informed community-based services for members who are LGBTQ, refugees, victims of trafficking, older-aging adults, and members with multiple disabilities. 13

17 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral 2. Respondents indicated that additional IDD Supported Employment in the Southern Region are needed. 3. Respondents stated that Mobile Crisis services specifically for IDD/MH dually-diagnosed members in the Southern Region were needed. 4. Respondents also expressed concern that Mobile Crisis may have capacity issues in Mecklenburg County due to long wait times. 5. Respondents perceived gaps in available providers who were able to meet the cultural needs of members with varied backgrounds, and the linguistic needs of non-english speaking members, including, but not limited to, provider-fulfilled interpreter services, and culturally competent provider approaches to treatment and engagement. E. Goals, strategies and timelines for addressing community/mobile services gaps identified in A., B., C. and D. Briefly identify the service gap, goal and target date for reducing or eliminating the gap, and strategies planned or in progress to achieve the goal. Medicaid Service Gap Peer Bridger Program Trauma-informed Community Based services for members of special populations Cultural and Linguistic Needs of Members Mobile Crisis in the Southern Region (For Dual Diagnosed Members) Mobile Crisis in Mecklenburg County I/DD Supported Employment State-Funded Service Gap State Funded Peer Support Services Goal and Target Date Goal: Increase availability and access to the Peer Bridger Program by close of FY (Refer to I.E. Medicaid Service #3) (Refer to I.E. Medicaid Service #2) Not pursued at this time. Not pursued at this time. Not pursued at this time. Goal and Target Date Not pursued at this time. 14 Strategies to achieve goal, noting if planned or in progress Formal Network Operations goal for 2016, with active recruitment and partnership between local networks and hospitals being identified. Continued evaluation of the outcomes and best practice with use of peer support programs. Additional education with providers and stakeholders will be implemented in order to promote this service and ensure that it is considered as a treatment recommendation when appropriate. Mobile Crisis services are available in all areas, and provider is able to respond to members in crisis regardless of disability. Based on existing provider review, provider is consistently able to meet the expected timelines for contact when dispatched. Additional outreach to CFAC or other stakeholders will occur to determine any specific experiences that may have been outliers. Medicaid-funded IDD Supported Employment currently exists in all areas. Strategies to achieve goal, noting if planned or in progress State-funded rate has been approved for Peer Support, to be consistent with the (b)(3) Peer Support reimbursement. Providers have been identified that can provide state-funded Peer Support.

18 Cardinal Innovations Healthcare 2016 NC LME-MCO Community Behavioral IV. Crisis Services A. Medicaid and state-funded crisis services access and choice standard: All eligible individuals must have access to at least one provider agency for each crisis service in the chart below within the LME-MCO catchment area. Service Number Facilities in LME-MCO Catchment Area with Medicaid Contract Number Facilities in LME-MCO Catchment Area with Contract for State-Funded Services Facility-Based Crisis 6 5 Respite Services 47 5 Detoxification (non-hospital) 3 3 Note that the numbers above reflect contracted, active and licensed facilities that were located within the catchment area. There were 12 licensed Facility Based Crisis providers, six of which were in catchment. There were 78 Respite providers, 47 of which were in catchment. There were nine Non-Hospital Detox providers, three of which were in catchment. Medicaid If standard not met, have exceptions been requested but not yet finalized?. If no, briefly explain and give dates each will be requested: If standard not met, are exceptions to the standard in place? If no, briefly explain: Effective dates of each exception approval: Next review dates, if applicable: State-funded If standard not met, have written justifications and plans to meet needs been submitted? If no, briefly explain and give dates each will be submitted: If standard not met, are written justifications and plans to meet needs in place?, attach copy to this report. If no, briefly explain Effective date of each written justification and plan approval: Next review dates, if applicable: B. What crisis services gaps were identified by members and family members? Members and family members throughout Cardinal Innovations catchment area were asked to respond with their perception of Crisis service gaps. Feedback was gathered via on-line questionnaire submissions, and in-person responses provided by members of Cardinal Innovations CFAC. All of the perceived service gaps outlined below were based on responses from this sample of members and family members. Although respondent perceptions were a valuable aspect of achieving insights into gaps and potential areas of Network development, they were evaluated in conjunction with all available capacity and accessibility information, in order to formally identify gaps: 1. Respondents stated that Crisis Respite services for MH/SUD, and IDD children and adults were needed in all service areas. 2. Crisis housing was also identified by respondents as a needed service. C. What crisis services gaps were identified by other stakeholders? Stakeholders, such as the Department of Social Services (DSS), physical health practitioners and Community Care of NC (CCNC), were asked to provide information related to crisis service gaps, as identified through their interaction with the public behavioral health delivery system in the Cardinal Innovations catchment area. Feedback was gathered via on-line questionnaire submissions and in person responses during stakeholder meetings. Stakeholders are partners within the continuum of services and resources that members access, and also have unique opportunities to advocate, collaborate, and collect insights into possible breaches in the public behavioral health delivery system. 15