Board of Directors Meeting Zoom Meeting · 2020-06-15 · Board of Directors Meeting Zoom Meeting...

Board of Directors Meeting

Zoom Meeting

June 18, 2020 - 6:00 PM

AGENDA

I. CALL TO ORDER – Wil Neumann – Chair

II. AGENDA REVISIONS – Wil Neumann

III. PUBLIC HEARING – Wil Neumann

A. Public Comment for Partners BHM FY20/21 Proposed Budget – Public Hearing will remain open

beginning at 6:30 PM for 30 minutes

IV. CITIZEN RECOGNITION – Wil Neumann

Persons wishing to appear before the Board of Directors during this portion of the meeting shall

register their name and the subject they wish to address with the Clerk to the Board prior to the

beginning of the meeting.

V. CONSENT AGENDA – Wil Neumann

A. Approval of May 21, 2020 Board meeting minutes

Pgs. 3-8

VI. REPORTS – Wil Neumann

A. Finance Committee Report – Debra Cheek, Finance Committee Chair

1. Action Items

a. Approval of previous meeting minutes

b. Budget Revision #8 FY20

2. April 2020 Financial Statements – Susan Lackey

B. CFAC Report – Ben Coggins

C. CEO Report – Rhett Melton

Pgs. 9-10

Pg. 11

Pgs. 12-20

VII. DISCUSSION AGENDA – Wil Neumann

A. County Commissioner Advisory Committee Updates – Wil Neumann

B. Executive Dashboard Report – April 2020 – Selenna Moss

C. Tailored Plan Update – Rhett Melton

D. Partners Nominating Committee

1. Approval of Nominations to Partners Board and Slate of Officers FY 20/21 – Pam Poteat

E. Partners Name Change

1. Approval of Organizational Name Change Resolution #2020-06182020-1

Pgs. 21-26

Pgs. 27-28

Pg. 29-30

VIII. CLOSE PUBLIC HEARING

A. Approval of Partners FY20/21 Budget

B. Approval of Budget Resolution #2020-06182020-2

Pgs. 31-32

Pgs. 33-34

IX. CLOSED SESSION – Wil Neumann

Pursuant to NC General Statute, Section 143-318.11, (a)(1); (a)(6); and 122C-126.1

X. ADJOURNMENT – Wil Neumann

Next Regular Meeting: August 15, 2020 – 6:00 PM

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Partners BHM Board of Directors

Regular Meeting Minutes

May 21, 2020 - 6:00 PM

The Partners Behavioral Health Management Board of Directors met by means of a virtual Zoom/conference call for its

regular monthly meeting.

Board Member Attendance

Commissioner Susan Allen P Commissioner Anita McCall P

Barbara Anderson P Linda McCrary P

Commissioner Kitty Barnes P Henry Morphis P

Beth Brown (non-voting) P Wil Neumann – Chair P

Debra Cheek - Treasurer P Commissioner Marvin Norman P

Ben Coggins A Russ Perkins – Vice Chair P

Daryl Cook P Pam Poteat P

Steve Garrison P Joseph Ramey P

Commissioner Bill Goins P Commissioner Maynard Taylor (6:28 p.m.) P

Jane Hinson A Commissioner Frank Zachary P

Mike Hoffman P

Partners Staff Present

Rhett Melton CEO

Susan Lackey Chief Financial Officer

Andrew Walsh Chief Legal Officer

Selenna Moss Chief Performance and Compliance Officer

Libby McCraw Director, Human Resources

Tammy Pyles Clerk to the Board

Kim Powell Deputy Clerk to the Board

Others Present

Yvonne French DHHS Liaison

A. 6:00 p.m. A roll call was conducted, and a quorum was acknowledged. Mr. Neumann acknowledged I. Call to Order

A. Chair Wil Neumann called the meeting to order at 6:02 p.m. A roll call was conducted and a quorum was

acknowledged. Mr. Neumann acknowledged Partners executives and other staff members present.

II. AGENDA REVISIONS – Wil Neumann

A. There were no agenda revisions.

III. CITIZEN RECOGNITION – Wil Neumann

A. There were no citizens in attendance.

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IV. CONSENT AGENDA – Wil Neumann

A. Previous Board Meeting Minutes for Approval

The revised April 16, 2020 meeting minutes were emailed to the board in advance of the meeting. Chair

Wil Neumann asked for a motion to approve. Joe Ramey made a motion to approve the previous meeting

minutes, and Barbara Anderson seconded. The floor was opened for discussion. There being no

discussion, the motion carried unanimously.

V. REPORTS – Wil Neumann

A. Finance Committee Report – Debra Cheek presented the Finance Committee Report.

1. Approval of Previous Meeting Minutes – The April 9, 2020 Finance Committee meeting minutes

were included in the board meeting agenda packet for approval. Debra Cheek set forth for board

approval. Chair Wil Neumann called for a vote. There being no discussion, the motion carried

unanimously.

2. March 2020 Financial Statements – The March 2020 financial statements, along with a detailed

summary, were included as part of the board meeting agenda packet. Susan Lackey provided an

overview of the Balance Sheet and Year-to-Date Income Statements, including Medicaid and non-

Medicaid.

3. Partners Proposed FY20/21 Budget Overview – A copy of the FY20-21 proposed budget was included

in the board agenda packet. Ms. Lackey provided an overview and noted that the information was

reviewed in detail by the Partners Finance Committee at its regular meeting on May 14, 2020.

Following the overview and in accordance with NC General Statute 159-11, Chair Wil Neumann asked

for a motion to display the proposed FY20-21 Budget for public inspection. Finance Committee Chair

Debra Cheek made a motion and the motion carried unanimously. The Budget Ordinance document

will be displayed at the front entrance of Partners Corporate office and posted on Partners external

website. Legal notices will be placed in media outlets in all counties in Partners catchment area. An

opportunity for public comment will be provided at Partners Board of Directors regularly scheduled

meeting on June 18, 2020.

B. CFAC Report – In the absence of Ben Coggins, Linda McCrary reported that the CFAC met on May 11, 2020

and she provided the following information:

Members were encouraged to participate in Legislative Day which would be a virtual meeting held

on May 19 from 10 a.m. to 12 p.m.

Wes Rider, from the Community Engagement & Empowerment Team with DHHS was in

attendance. He guided the members through completing the CFAC Annual Perception SWOT

Survey which lists strengths weaknesses, opportunities, challenges and threats for meeting the

CFAC statutory responsibilities.

A resolution for suspension of the by-laws was passed to allow for voting by email due to the

COVID-19 situation. Ballots were to be emailed on May 12, with two of Partners staff receiving the

email votes by May 29.

The Nominating Committee presented nominations for officers for 2020-2021. The current slate

of officers was presented as follows: Chair - Ginny Hall; Vice Chair - Ben Coggins; Secretary - Linda

McCrary; and Assistant Secretary - Donnie Thurman.

The next meeting will be held on June 8, 2020.

C. CEO Report – Rhett Melton provided the following information:

1. Legislative – The state legislature recently went into session for a few days and passed their COVID-19

legislation which will result in funding for the LME/MCO system to off-set some of the costs related to

the COVID-19 crisis response. The legislature returned to session on Monday, May 18th for a more

normal short session. Partners will keep abreast of DHHS and Budget Appropriations Committee

activities related to COVID-19 and for normal operations. In addition, discussions with key

representatives are planned related Partners priorities, policies and advocacy for Partners members.

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2. Medicaid Transformation/Tailored Plan RFA & Suspension of Standard Plans – Senate Bill 808 was

introduced and the statute mandates aggressively moving forward with Standard Plans. There is no

provision in the bill for Medicaid expansion. The governor has said he will not approve a bill that does

not include Medicaid expansion.

3. COVID-19 Response - Partners will move to Partners Stage One of the office reopening plan next

Tuesday, May 26th, which includes reintroducing staff back into the building, while the default

remains telework. Requests to return to the office will be considered on an individual and department

basis. The eight steps of Stage One were reviewed at the All Staff meetings this week. Mr. Melton

noted that many of the changes implemented as part of the COVID-19 response will continue,

including services to our members, telework and the use of Zoom. Wil Neumann commented that

Zoom meetings have been successful and will also continue for Partners board and board committee

meetings.

4. COO Recruitment Update – Mr. Melton announced that Partners has hired a new Chief Operating

Officer (COO), Shireen Stone. He provided a summary of Shireen’s qualifications, experience, and

areas of expertise that will be of tremendous value and importance as Partners moves toward

Tailored Plan Operations. Effective June 1, 2020 Shireen will be onboard and working remotely due to

the current COVID-19 phased reopening. She will be onsite at Partners corporate office effective July

1, 2020. He stated he will look forward to introducing Shireen to the board at the June meeting.

VI. DISCUSSION AGENDA – Wil Neumann

A. County Commissioner Advisory Committee – Behavioral Health Focused Updates

1. Burke County – In the absence of Commissioner Maynard Taylor no report was provided.

2. Catawba County – Commissioner Kitty Barnes provided the following report:

a. The county has been active in mental health activities and has submitted a grant to the Bureau of

Justice Assistance which, if awarded, will provide $300,000 per year for support of diversion and

jail services, as well as the re-entry housing program. In addition, the JCPC funding supports

entities related to mental health and family counseling.

b. Budget hearings occurred today. Partners had a great presentation, has made great strides and

the county is looking forward to next year. The public hearing will occur next Thursday and the

budget will be adopted on June 1st.

3. Cleveland County – Commissioner Susan Allen provided the following report:

a. The county budget presentation occurred on Tuesday and will be approved on June 1st. She stated

she is very proud of the work that has been accomplished over the last few years and is looking

forward to a good budget this year. She reported that issues such as COVID-19 and taxes were not

as impactful as they could have been.

b. The county rolled out a COVID-19 theme, “You can Count on Us”. Notification was sent through

social media to small businesses to come by to pick up supplies, including a bucket containing

disinfectant, masks and paper towels, as well as guidelines and best practices. Approximately 150

businesses came by today to pick up their supplies. They were very appreciative of assistance

from the county. The county plans to reach out to others such as churches as re-openings

progress.

4. Gaston County – Commissioner designee Joseph Ramey provided the following report:

a. Commissioner Hovis expressed appreciation of Partners on behalf of the county.

b. The new animal shelter opened on Monday, May 18th.

c. The new jail should open in a couple of weeks.

d. The county started a small business loan program funded with $600,000.

e. The county has released approximately $6 million in projects to stimulate the economy, such as a

paving project in a commercial development which should be awarded on Tuesday.

f. The budget presentation to commissioners is scheduled for Tuesday, May 19th with plans to vote

on June 9th.

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g. COVID-19 update: 226 positives to date, average age 47 ½. There have been 4600 tests with

between 3600 and 3700 negative results.

5. Iredell County – Commissioner Marvin Norman provided the following report:

a. He thanked Health Director, Jane Hinson for her great work during the COVID-19 crisis.

b. He commented on Debra Cheek’s hard work in preparing for the budget hearing scheduled for

next Thursday, May 28th.

c. Inmates have been moved into the new jail.

6. Lincoln County – Commissioner Anita McCall provided the following report:

a. She reported the county is working on the new fiscal year budget.

b. The county is preparing for economic and financial unknowns related to COVID-19 with fund

balance; double AA rating for bonds, and the county is hoping to be upgraded to AAA rating. The

county is moving forward with some capital projects but holding off on others.

7. Rutherford County – County Manager Steve Garrison provided the following report:

a. He thanked Partners staff members Katie Varnadoe and Tara Conrad for their work with

Rutherford’s Emergency Operations Center which has been open for 60 days now. Katie has been

a valuable resource speaking out on available resources and information for mental and

behavioral health. She and Tara also met with the town manager to discuss employee assistance

resources and to provide information about what other local governments are doing to ensure

that the town’s employees have access to a good employee assistance program. Lastly, Tara

helped with redistribution of funds from Partners back into programs as investments to the

community for behavioral health services.

8. Surry County – Barbara Anderson provided the following report for Commissioner Bill Goins:

a. Due to COVID -19, Community Forums have been postponed until 2021. However, the county felt

the need to reach out to those in need, so five hundred (500) Survivor bags are being distributed

by the local intervention team. The team will carry the bags with them and when they encounter

people in need, they will distribute the bags which contain items such as wash cloth, soap,

toothbrush and toothpaste, hat, etc.

9. Yadkin County – Commissioner Frank Zachary provided the following report:

a. Yadkin County is currently in the new fiscal year budget process and will meet next week to

discuss.

b. COVID-19 update – positive cases have increased considerably due to an outbreak in Wilkes

County at the Tyson plant where many of our citizens work. The health department has been

working frantically with tracing in effort to control the spread.

B. Executive Dashboard Report – March 2020 - The report was included as part of the board meeting agenda

packet. Selenna Moss provided an overview of the report and highlighted areas of accomplishment. The

floor was opened for discussion. Russ Perkins asked the total number of Transitions to Community Living

that were lost since July 1, 2019 and how many have been lost. Selenna replied that this item is reviewed

regularly and she will report this information to the board.

C. Tailored Plan Update – Rhett Melton deferred his comments and will provide a report in the closed

session portion of the meeting.

D. Board Governance Guidelines – Drew Walsh reminded the board that in March and October 2018 with

the board’s approval, board-related policies and procedures (P&Ps) were removed from Partners annual

P&P review process. A separate document named, “Board Governance Guidelines” was created and

approved by the board in October 2018. Since that time, the Guidelines have been reviewed with

formatting and other edits having been made to the document, and the revised version of the document

will be sent to the board for their review soon. Following the board’s review, the revised draft version of

the Guidelines will be presented for the board’s approval at the August 2020 meeting. Although not

required by statute, it has been determined that annual review and approval of the Guidelines is best

practice. The board agreed that an annual review of the Board Governance Guidelines will occur each year

in August.

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E. Nominations for Partners Board FY20-21 Slate of Officers – On behalf of Partners Board Nominating

Committee, Pam Poteat presented to the board for consideration the following FY20-21 Partners Board

Slate of Officers: Chair – Russ Perkins; Vice Chair – Henry Morphis; and Treasurer – Debra Cheek. This

recommendation will be presented for approval at the June 18, 2020 meeting.

VII. Closed Session

At 7:02 p.m. Susan Allen made a motion to enter into Closed Session pursuant to General Statute, Section

143-318.11 (a)(1) to prevent the disclosure of information that is confidential or not considered a public

record; (a)(6) to consider the qualifications, competence, performance, character, fitness, conditions of

appointment or conditions of initial employment of an individual employee or to hear an investigative

complaint or grievance or charge against an individual employee; and 122C-126.1 to preserve competitive

healthcare information. Pam Poteat seconded and the motion carried unanimously. With the exception of

Rhett Melton-CEO, Libby McCraw-HR Director, and Tammy Pyles-Clerk to the Board, all remaining Partners

staff and non-voting members were excused from the meeting. Following a brief break, the meeting began

at 7:13 p.m. During the meeting personnel matters were discussed.

Anita McCall was excused from the meeting at 7:39 p.m., and rejoined the meeting at 8:00 p.m.

VIII. Open Session

At 8:48 p.m. Frank Zachary made a motion to enter back into Open Session. Russ Perkins seconded and the

motion carried unanimously.

Bill Goins was excused from the meeting at 8:48 p.m.

Chair Wil Neumann asked for a motion to accept and approve the status of the FY2020 Goals and Status as

presented by Rhett Melton. Marvin Norman made a motion and Kitty Barnes seconded. The motion passed

unanimously.

Chair Wil Neumann asked for a motion to adopt the FY2021 Proposed Strategic Goals as presented by

Rhett Melton. Kitty Barnes made a motion and Linda McCrary seconded. The motion passed unanimously.

At the unanimous recommendation by the Executive Committee of the Board, Wil Neumann set forth for

approval a 10% increase in salary for the CEO, effective July 1, 2020. Upon a roll call count of sixteen (16)

yay votes and one (1) nay vote, the motion passed.

At the unanimous recommendation by the Executive Committee of the Board, Chair Wil Neumann set forth

for approval a 30% incentive payment, calculated on the current base salary for the CEO, based upon

FY2020 strategic goal performance and effective on June 30, 2020. Upon a roll call count of sixteen (16) yay

votes and one (1) nay vote, the motion passed.


for approval the FY21 CEO Incentive Plan Structure based upon achievement of the adopted FY21 Strategic

Goals and having met approved budget requirements. Upon a roll call count of fifteen (15) yay votes and

(2) nay votes, the motion passed.

Maynard Taylor was excused from the meeting at 9:05 p.m.


for approval the FY21 Partners Incentive Plan Structure based on Weighting of Strategic Plan Goals for

Partners Executive Leadership Team, Operations Team, and general staff based upon achievement of the

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adopted FY21 Strategic Goals and having met approved budget requirements. Upon a roll call count of

fifteen (15) yay votes and one (1) nay vote, the motion passed.

IX. Adjournment

With there being no further discussion, Chair Wil Neumann asked for a motion to adjourn. At 9:09 p.m. Joe

Ramey entered a motion and Marvin Norman seconded. The motion carried unanimously.

Respectfully submitted,

Tammy Pyles

Clerk to the Board

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PARTNERS BEHAVIORAL HEALTH MANAGEMENT

FINANCE COMMITTEE MEETING

Zoom Video Conference

May 14, 2020 | 5:00 PM

MINUTES A = Absent P = Present

FINANCE COMMITTEE MEMBERS

Debra Cheek P

Barbara Anderson P

Russ Perkins P

Pam Poteat P

Joseph Ramey A

Frank Zachary P

GUESTS PRESENT:

Board members Steve Garrison and Jane Hinson were present.

CALL TO ORDER:

Debra Cheek called the meeting to order at 5:03 p.m. A quorum was present.

AGENDA REVISIONS:

None

APPROVAL OF PREVIOUS MEETING MINUTES:

Debra Cheek called for a motion to approve the April 2020 meeting minutes. Barbara Anderson entered a

motion to approve the minutes and Pam Poteat seconded. The motion carried unanimously.

MARCH 2020 FINANCIAL STATEMENTS:

Elizabeth Biggerstaff provided an overview of the March 2020 Financial Statements, which were included

as part of the agenda packet. Elizabeth reviewed the contents of the Balance Sheet and Income

Statement, each reflecting data up to March 31, 2020. Total assets are $121,648,262, which balances to

our total liabilities and fund equity. Total operating revenues are $295,440,723. Total expenses are

$289,873,638. Total operating gain is $6,256,124, which includes interest income of $689,038. Fund

balance used to date is $7,512,191.

PARTNERS BHM STAFF

Rhett Melton Chief Executive Officer P

Susan Lackey Chief Financial Officer P

Elizabeth Biggerstaff Finance Director P

Alan Smith Internal Auditor P

Kim Powell Executive Assistant P

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MARCH 2020 DASHBOARD REPORTS:

Susan Lackey provided an overview of the March 2020 Dashboard Reports included as part of the agenda

packet. The following was noted: Service Penetration Rate remains steady at 16.9%; Medicaid Service

Expense Ratio for fiscal year is 97.6% (including Fund Balance); State/IPRS Service Expense Ratio is 96.9%

(including MOE); Total Medicaid Expense Ratio is 101.6%; Medical Loss Ratio is 92.3% (benchmark for this

measure is 85%); Consolidated Current Ratio is 1.85; Defensive Interval-as of March 31, 2020, Partners

had 60 days of consolidated service expenses in cash; Grievances against Partners remain relatively low

and are timely resolved. Total number of grievances reported in March for February was 5-with 20%

being against the MCO and 80% against the providers.

Super Measures were discussed, including: Transitions to Community Living (TCLI), Innovations, and

Ambulatory Follow Up. The impending impact of COVID-19 crisis on TCLI housing numbers was also

discussed.

FY 21 BUDGET PRESENTATION:

Susan Lackey presented Partners FY 21 proposed budget (via PowerPoint). She noted that FY 21 rates

have not been received, so the budget is built on FY 20 rates. Once FY 21 rates are received, a budget

revision will be done. Discussion included Operating budget (Services, Administrative and Capital

budgets), Tailored Plan Readiness budget and Medicaid Savings Reinvestment Plan. Partners FY 21 total

proposed budget is $388,707,933.

Debra Cheek called for a motion to approve Partners FY 21 budget and recommend for Board approval.

Pam Poteat entered a motion to approve and Frank Zachary seconded. The motion carried unanimously.

ADJOURNMENT:

Debra Cheek called for any final questions or comments from the Finance Committee. Hearing none,

Pam Poteat made a motion to adjourn. Having no further business, Debra Cheek adjourned the meeting

at 5:44 p.m.

Minutes Submitted By: Kim Powell

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REVENUES

Beginning Budget 399,609,067$

63,406$ Letter #41 TCLI for IPS

84,000 Letter #42 TYSR Funds

127,000 Letter #43 TCLI Mental Health Services

(105,362) Letter #44 Deallocation of MHBG Youth in Foster Care Project

7,554 DLP Frye Rutherford 3 Way funding

8,890 Kings Mountain Hospital 3 Way funding

69,003 DLP Frye Hickory 3 Way funding

23,873 Catawba Valley Medical Center 3 Way funding

278,364$

Revised Budget 399,887,431$

EXPENSES

Beginning Budget 399,609,067$

26,193 NON UCR Expenses

142,851 UCR Expense

109,320 3 Way Hospital expense

278,364$

Revised Budget 399,887,431$

PARTNERS BHM

BUDGET REVISION NO.8 FY20

June 11, 2020

Description

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May 28, 2020

To: Finance Committee From: Finance Team RE: Review of April 2020 Financial Statements and Dashboard Results

Summary:

Ten months into FY20 Partners Behavioral Health Management (BHM) has positive results overall. As of

April 30, we were below budgeted levels for both Medicaid and non-Medicaid funding with a net surplus

overall for the fiscal year of $8,121,946 including fund balance.

The April Executive Dashboard:

Service Penetration Rate:

The service penetration rate calculation is on a rolling 12-month calendar basis and includes Rutherford

County beginning July 1, 2019. Between May 2019 and April 2020, Partners catchment area had 192,643

unduplicated Medicaid-eligible members and 32,166 members received at least one billable service

during the year, or a 16.7% penetration rate.

Partners BHM received a capitation payment for 160,818 member months in April, based on the month

of payment rather than the month of eligibility. We continue to experience inconsistencies between

eligibility data and the member count in our capitation payments and are reconciling these differences

each month, retroactively, and reporting them to DMA for corrections. The NCTracks system recoups

any PMPM that is within a given time span if any additional payment or change is needed. If the span is

from January to July and only July needs an adjustment, January to July is recouped and repaid. We are

also working with DMA on the eligibility corrections related to members moving from one catchment

area to another. Currently when a member moves in Partners catchment the first month of eligibility in

our catchment is not paying. There is also a new issue identified that is not paying when the Medicaid

eligibility code changes from a non-covered code to a covered one. The 24-month estimated account

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receivable (AR) capitation we reported to DMA for April 2020 was $1,409,884. We use 24 months

because DMA will only allow us that amount of time to resolve unpaid eligibility issues.

Over the last year, the trend of Unduplicated Medicaid Members continues to decline overall when

looking at 10 months of actuals (to minimize the impact of eligibility lag). There was an increase in July

2019 because of the Rutherford transition, but the decreasing trend continues from there. Over the

same period, the trend in the number of Unduplicated Members Receiving Services is starting to flatten.

Claims lag negatively impacts the count of Medicaid Members served in the most recent 2 months.

The comparison between the number of members served in a specific Category of Aid (or County of

Medicaid Eligibility) to the total Medicaid-eligible population in the same Category of Aid (or County) is

the Average Penetration Rate by Category of Aid (or County).

It is difficult to compare year over year change in penetration rate because of the Rutherford transition.

However, the overall penetration rate (both by Category of Aid and by County) is unchanged at 16.7%

when compared to this period last year. All the counties in our catchment area saw an increase in

penetration rate except Burke (-0.5%) and Gaston (-0.2%).

Financial Statements:

Overall Comments

Partners BHM shows an overall net income of $8,121,946 as of April 30. There is a Medicaid net

income of $248,652. The non-Medicaid category has a net surplus of $7,873,285 for the fiscal

year to date April 30, 2020 including fund balance.

Service Expense

Service Cost: Medicaid service cost consists of paid claims adjusted for estimated outstanding

claims or incurred but not reported (IBNR) claims. Our IBNR estimate for April was $15,676,055.

For the month of April Partners had $20,274,684 in Paid Claims.

Service Expense Ratio: The Medicaid Service Expense Ratio for fiscal year to date was 97.3%

(including Fund Balance if any).

The State/IPRS Service Expense Ratio was 94.7% (including maintenance of effort (MOE) if any).

A graph has been added that will track usage of MOE over the course of the fiscal year. There

was $3,164,611 in MOE used FYTD April 30, 2020.

The Total Medicaid Expense Ratio consists of Medicaid service and administrative expense

compared to Medicaid revenue, exclusive of risk reserve funds. The Total Medicaid Expense

Ratio in April 2020 was 99.1%.

The Medical Loss Ratio is a comparison of the capitation payment against the expenditures that

improve the quality of service and care (Intellectual/Developmental Disability or I/DD and

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Mental Health/Substance Use or MH/SU Care Management treatment planning), medical claim

expenses, payments made outside of the claim system, and the IBNR estimate. The benchmark

for this measure is 85%. As of April 30, 2020, the Medical Loss Ratio was 92.0%.

Key Balance Sheet Ratios:

Given the solvency formula in SB99, the MCO’s financial ratios are viewed on a consolidated

basis, so we are only including one year-end estimate for each ratio. The reduction of our

Medicaid fund balance by funding non-Medicaid services takes away any meaningful use of the

Medicaid fund balance compared to the total fund balance. We do not, in fact, really have a

State fund balance related to income. That has been used up early in the Legislative single

stream reduction process. Any cash related to State fund balance is only a residual left over

from MOE transfers from Medicaid to State.

Current Ratio

The Consolidated current ratio for Partners BHM as of April 30, 2020, is 2.08 to 1. The current

ratio includes long-term investments. The minimum solvency requirement is 1 to 1. The internal

FY20 year-end estimate for Partners is 2.0.

Defensive Interval

As of April 30, 2020, Partners BHM had 67.9 days of consolidated service expenses in cash. The

defensive interval includes long-term investments. The legislated minimum requirement is 30

days. The internal year-end estimate for Partners is 60 days. The basis of this calculation is total

cash to total operating expenses, adjusted for non-cash expenses. The expected decrease in our

financial ratios are the Legislative-Mandated Maintenance of Effort and Medicaid

Reimbursement expenditures.

Grievances:

Grievances against Partners remain relatively low and timely resolved. The total number of

grievances reported in April for March was 7 with 14% (1) being against the MCO and 86% (6)

against Providers. The 1 grievance against Partners include 1 against MCO Staff. In the past year

(04/01/2020-3/31/2020), there have been 108 grievances, only 28 (26%) of which have been

against Partners; 78 of all contacts were immediately resolved, did not become grievances, and

were taken for information and referral within Partners. On average, in March, Partners took 28

calendar days to resolve formal grievances with the benchmark being 30 days and 13 days to

resolve informal grievances with a benchmark of 15 days. The State requires formal grievance

resolutions to be reported in calendar days.

Super Measures:

Transition to Community Living Initiative (TCLI):

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Partners BHM prefers to utilize the TCLI Performance Dashboard from the State to identify our

completion of slot allocation. However, because of irregular distribution of that report we are

forced to again use internal counts for this month. The TCLI graph is current through March

2020. For FY20 Partners is required to have a net increase of 67 individuals housed for the fiscal

year. This means at the end of FY20 we should have a net of 331 individuals in housing. At the

end of March 2020, we had a net of 275 members in housing which represents 83.1% of the

FY20 annual target.

Innovations Integrated Care Super Measure:

The Innovations Integrated Care measure looks at the percentage of continuously enrolled

Medicaid enrollees under the Innovations Waiver who received a primary care or preventive

health service. For persons ages 3 to 6 and ages 20 through 64, the person received the service

during the measurement period. For persons ages 7 to 19, the person received the service

during the measurement period OR the year prior to the measurement period.

For the period from May 2019 through April 2020, the grand total of Innovations members

eligible for services across all our counties was 564 with 541 receiving services for an overall

percentage of 95.9%. The performance standard is 90% of the eligible population will have

received a primary care or preventive health service within the measurement period.

Ambulatory Follow Up:

Ambulatory follow up looks at those members with Inpatient discharges who have a follow-up

service (from paid claims) within 1-7 days of the date of discharge from inpatient care. This is an

evidence-based best practice that reduces recidivism of inpatient care. We report on two

primary disabilities (Mental Health and Substance Use). There is a two-month lag, which means

this report is based on February 2020 data.

The performance standard for this measure for both Medicaid and State services is that 40% or

more of individuals discharged shall receive a follow-up visit within 1-7 days after discharge.

In February 2020, 150 Medicaid members were discharged from Inpatient MH services and

47.3% (71) had follow up services within 1-7 days. During this same reporting period, 35

Medicaid members were discharged from Inpatient SU services and 42.9% (15) had services

within 1-7 days. While Partners internal benchmark of 75% was not met, Partners exceeded the

external performance standard.

In February 2020, 83 State members were discharged from Inpatient MH services and 44.6%

(37) had follow up services within 1-7 days. During the same reporting period, 150 State

members were discharged from Inpatient SU services and 53.3% (80) had follow up services

within 1-7 days. While Partners internal benchmark of 75% was not met, Partners exceeded the

external performance standard.

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5 | P a g e

For State-funded members, discharge information is based on paid claims data for Facility-Based

Crisis and 3-Way services.

Claims Processing:

In April, Partners BHM processed $25,839,413 in claims. We paid out $20,274,684 in claims, or

78.5% of those that were processed. In April, there were $5,564,729 (21.5%) in denied or

pended claims. On average, Partners is paying claims within 8.9 days from the received date and

Providers are submitting claims for payment 21.7 days from the date of service. Overall,

Partners BHM paid Providers within 30.6 days from the date of service.

The top five reasons for denials make up approximately $2.7 million of total denied claims for

April. Duplicate claim submission, claims submitted after the billing period, claims submitted

with no coverage for the patient/service/provider combination, claims submitted for clients who

have other covered insurance, and claims submitted for an invalid or discontinued service make

up the top 5 reasons for claims denials in April. The COVID-19 pandemic has impacted denials as

Partners and the billing providers navigate the set up and implementation of COVID-19 specific

codes.

Duplicate claim $1,026,172

Claim received after billing period 628,754

No coverage available for patient/service/provider combo

438,616

Client has other covered insurance (COB) 339,251

Invalid service or service discontinued 305,575

TOTAL $2,738,368

Service Authorization Request Processing:

In April the Utilization Management (UM) Department processed 100% of Standard Service

Authorization Requests within 14 days. UM approved 97.2% of authorizations. Of those denied

in April 43.8% were for administrative reasons and 56.3% were for clinical reasons. There is a

decrease in the total number of SARS due to Partners removing the requirement for prior

authorization of all services effective March 19, 2020. Requirement for prior authorization of

services was removed due to the COVID-19 pandemic and will remain in place until the COVID-

19 crisis period ends.

Innovations Slot Tracking:

Partners Innovations entered a new waiver year on July 1, 2019. Partners slot availability for

April was 1,589. This includes slots associated with the Rutherford transition. As of April 30, 0

Regular Slot remains unassigned. The Emergency, CAP-C and Money Follows the Person (MFP)

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Slots make up the 18 Reserved Slot allocation that Partners receives at the beginning of the

Waiver Year. Of the 18 reserved slots, 3 were unassigned (2 CAP-C Transition Slots, and 1 MFP

Slots). Members must meet specific criteria to receive one of the reserved slots.

Program Integrity:

Case Activity

As of April 2020, there were 51 open investigations, one less than last month and the second

largest inventory as compared to other LME/MCOs. Program Integrity opened five new

investigations and closed eight investigations in April. There were zero cases reopened.

Recovery Activity

As of April 2020, on a fiscal year-to-date basis, there were 21 overpayments to Providers

identified for a total of $290,095, including any interest, penalties – which is something we

typically do not add to TNOs - or reductions. We have included two rows on the recovery

activity. The first is Total Amount Reduced by Settlement Offer and the second is Total Amount

Reduced by Dispute Panel Review. This will help us to better track/calculate our metrics around

TNO reductions and should allow for more transparency in our overpayment activities. Of the

$1.8 million in identified overpayments, only $10,116 have been reduced during the disputes

process. For FY20 there have been $1.5 million in settlements from the initially identified

overpayment amounts in return for significant recoveries, saved litigation costs, preserved

provider network adequacy and added protections such as indemnifications and plans of

correction.

FYTD PI has collected $699,553 against outstanding overpayments, the largest amount collected

in any given fiscal year, and $131,628 from Provider self-audits.

The total outstanding balance of overpayments is $6,205,274, inclusive of any amounts that may

have remained unpaid to Partners at the end of prior fiscal years. About 6% of the outstanding

balance is for identified overpayments from providers who are under settlement agreements or

payment plans. The remaining balance is from providers that are no longer in Partners network.

Once out of our network, these companies generally no longer have a revenue stream, greatly

complicating our ability to collect these funds.

Services:

Medicaid

On a fiscal year-to-date basis, Partners BHM has underspent Medicaid service dollars by

$4,274,219 (including IBNR), which is 1.9% under compared to our FY20 budgeted numbers and

inclusive of Medicaid Reinvestment in services and recoveries. The Medicaid categories of

service that are over budget ten months into FY20 are Case Management (10%), Inpatient and

Innovations (5%), Behavioral Health Long Term Residential and ICF-MR (2%), and Partial

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Hospitalization/Day Treatment (1%). Partners Clinical and Finance leadership meet monthly to

monitor these overages and take appropriate action.

State

On a fiscal year to date basis, Partners has underspent State service dollars by $4,185,184, or

8.4% (including approximately $10.7 million in non-UCR expenses). The IPRS categories of

service that are 10% or more over budget ten months into FY20 are Partial Hospital (58%),

Inpatient (28%), 3-Way Hospitals (10%).

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Partners Behavioral Health ManagementBalance Sheet

For the Ten Months Ending Thursday, April 30, 2020

ASSETS

Current AssetsCash and Cash Equivalents $40,409,999

Accounts Receivable,Net 6,567,124

Short-Term Investments

Prepaid Expenses 2,042,869

TOTAL CURRENT ASSETS 49,019,992

Noncurrent AssetsRestricted Cash and Cash Equivalents 35,561,471

Long Term Investments 20,472,665

Capital Assets:

Land 1,563,042

Other Capital Assets, Net of Depreciation 7,957,671

Total Capital Assets 9,520,713

Total Noncurrent Assets 65,554,849

TOTAL ASSETS 114,574,841

Deferred Outflows of ResourcesDefined Benefit Plan 7,645,217

Other Postemployment Benefits 1,463,768

Total Deferred Outflows of Resources 9,108,985

TOTAL ASSETS AND OUTFLOWS OF RESOURCES $123,683,825

LIABILITIES

Current LiabilitiesAccounts Payable and Other Current Liabilities 8,414,090

Liability for Claims Incurred, but not Reported 15,676,055

Compensated Absences - Current Portion 83,776

Total Current Liabilities 24,173,921

Noncurrent LiabilitiesCompensated Absences - Long Term 2,263,797

Other Post Employment Benefits 1,436,215

Defined Benefit Pension Plan Liability 9,275,153

Total Noncurrent Liabilities 12,975,165

Deferred Inflows of ResourcesDefined Benefit Plan 48,007

Other Postemployment Benefits 10,748

Total Deferred Inflows of Resources 58,755

Fund EquityNet Investment in Capital Assets 9,538,291

Other - NonSpendable 1,035,290

Restricted:

Medicaid Risk Reserve 41,730,471

State Statute and Prepaids 8,352,195

Other 47,400,253

Total Restricted 97,482,919

Medicaid Earnings Prior Years (35,769,792)

Unrestricted 14,189,276

Total Fund Equity 86,475,984

TOTAL LIABILITIES, DEFERRED INFLOWS OF RESOURCES AND FUND EQUITY $123,683,825

5/28/2020

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Partners Behavioral Health Management

Income Statement

For the Ten Months Ending Thursday, April 30, 2020

OPERATING REVENUES

Intergovernmental:Federal $3,976,087State 46,932,168Local 3,026,383

Medicaid 265,010,438Other 11,114,956

Total Operating Revenues 330,060,032

EXPENSESPersonnel 30,948,244Professional Services 2,442,754Supplies and Materials 2,272,210Current Obligations and Services 11,062,261Fixed Charges and Expenses 1,478,316Nondepreciable Capital Outlay 162,924Depreciation 697,902Contracts and Grants 272,752,964Medicaid Savings Reinvestment 474,207Pension ExpenseOther 339,127

Total Expenses 322,630,911

OPERATING GAIN/(LOSS) 7,429,121

NONOPERATING INCOMEInterest Income 692,825

Total Nonoperating Income 692,825

TOTAL OPERATING GAIN/(LOSS) 8,121,946

FUND BALANCE USED $8,025,606

5/15/2020

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Executive Dashboard, April 2020

Access to Services Report as of April 30, 2020

Executive Dashboard Report

April 30, 2020

12-Month Average Member Months

160,271

Annualized MCD

Unduplicated Served16.7%

Annualized Medicaid Penetration Rate

TotalUnduplicated

Eligibles

32,166 192,643

Unduplicated # Received Services

7.5%

Members Receiving Servicesfor the month of April 2020

Unduplicated Count

146,270 10,912

Annualized Non-MCD Unduplicated

Served12.1%

Annualized Non-Medicaid Penetration Rate

Non-Medicaid inCatchment Area

12,427

102,790

Penetration Change from

Month: April Served Eligible Rate Prior Year

Burke 3,130 18,248 17.2% -0.5%

Catawba 4,738 29,084 16.3% 0.1%

Cleveland 4,518 26,062 17.3% 0.5%

Gaston 8,441 46,146 18.3% -0.2%

Iredell 4,009 26,738 15.0% 0.1%

Lincoln 2,550 13,747 18.5% 0.5%

Rutherford 2,105 13,906 15.1% --

Surry 2,135 15,656 13.6% 0.5%

Yadkin 969 6,789 14.3% 0.6%

Annualized Penetration Rate by County of Eligibility

Page 1 of 6

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Financial Statements Report as of April 30, 2020

Medicaid Non-Medicaid Combined Total YTD Budget Variance

Service:

Revenue $226,644,260 $48,767,099 $275,411,359 $277,109,292 $1,697,933

Expense 223,970,552 49,254,928 273,225,480 282,397,985 9,172,505

Net Service 2,673,708 (487,829) 2,185,879 (5,288,693) (7,474,572)

Administrative:

Revenue 33,067,515 5,155,066 38,222,581 37,888,535 (334,046)

Expense 34,940,197 5,019,323 39,959,520 45,329,817 5,370,297

Intergovernmental Transfers 1,595,720 0 1,595,720 (1,595,720)

Tailored Plan Readiness 2,552,681 0 2,552,681 (2,552,681)

Net Administrative (6,021,083) 135,743 (5,885,340) (7,441,282) (1,555,942)

Net Operating Income (3,347,386) (352,086) (3,699,461) (12,729,975) (9,030,518)

Other:

Risk Reserve Revenue 5,297,510 0 5,297,510 5,279,790 (17,720)

Other Income/Revenue 0 3,795,801 3,795,801 2,520,720 (1,275,081)

Other Financing Resources 3,596,036 4,429,569 8,025,605 10,209,236 2,183,631

Total Other 8,893,546 8,225,370 17,118,916 18,009,746 890,830

Risk Reserve Expense 5,297,509 0 5,297,509 5,279,790 (17,719)

Net Other 3,596,037 8,225,370 11,821,407 12,729,956 908,549

Net Income (Loss) $248,652 $7,873,285 $8,121,946 $0 ($8,121,946)


Income Statement

For the Ten Months Ending April 30, 2020

Medicaid Total Medicaid Total

Cash $33,507,520 $40,409,998 Accounts Payable $57,730 $67,918

Other Current Assets 1,159,124 8,609,993 IBNR-Claims Payable 15,676,055 15,676,055

Total Current Assets 34,666,644 49,019,991 Other Current Liabilities 10,721,931 17,705,101

Total Current Liabilities 26,455,716 33,449,074

Net Property and Equipment 3,082,922 9,520,713 Other Liabilities 3,194,952 3,758,767

Fund Balance:

Investment in Fixed Assets 0 9,538,291

Long-Term Investments 20,472,665 20,472,665 Other Non-Spendable 0 1,035,290

Other Assets 0 9,108,985 Restricted 85,546,901 97,482,918

Risk Reserve 35,561,471 35,561,471 Accumulated Net Surplus (Deficit) (35,769,792) (35,769,792)

Unreserved 14,355,925 14,189,277

64,133,034 86,475,984

Total Assets $93,783,702 $123,683,825 Total Liabilities and Fund Balance $93,783,702 $123,683,825

Assets Liabilities and Fund Balance


Balance Sheet as of April 30, 2020

Page 2 of 6

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Financial Risk Report as of April 30, 2020

Medicaid Service Expense Ratio (includes Fund Balance) 97.3%

Medicaid Net Service (Over)/Under $2,673,708

State Service Expense Ratio (includes Fund Balance, if any) 94.7%

State Net Service (Over)/Under excluding Fund Balance ($1,218,783)

Medicaid Report as of April 30, 2020

Maintenance of Effort:Financial Ratios (YTD):

Category of Service Annual Budget Budget Actual Variance Budget Actual Variance % Variance

Inpatient $10,393,296 $866,108 $856,094 $10,014 $8,661,080 $9,056,228 ($395,148) (5%)

Community Support 1,036,080 86,340 71,798 14,542 863,400 588,215 275,185 32%

BH Long-Term Residential 18,491,640 1,540,970 1,637,525 (96,555) 15,409,700 15,758,207 (348,507) (2%)

PRTF 10,990,032 915,836 758,879 156,957 9,158,360 7,546,478 1,611,882 18%

Case Management 1,226,412 102,201 133,755 (31,554) 1,022,010 1,123,803 (101,793) (10%)

Outpatient 31,135,932 2,594,661 2,624,006 (29,345) 25,946,610 26,000,581 (53,971) (0.2%)

ACTT 9,174,984 764,582 762,538 2,044 7,645,820 7,412,587 233,233 3%

MST 977,340 81,445 39,798 41,647 814,450 748,146 66,304 8%

IIHS/FCT 10,631,016 885,918 938,833 (52,915) 8,859,180 8,702,499 156,681 2%

Part Hosp/Day Treatment 6,330,684 527,557 472,407 55,150 5,275,570 5,324,012 (48,442) (1%)

Psych Rehab 4,767,000 397,250 325,990 71,260 3,972,500 3,834,842 137,658 3%

Crisis Services 2,572,980 214,415 170,505 43,910 2,144,150 1,845,209 298,941 14%

Innovations 86,430,360 7,202,530 7,757,364 (554,834) 72,025,300 75,459,891 (3,434,591) (5%)

ICF-MR 66,191,004 5,515,917 5,630,151 (114,234) 55,159,170 56,018,014 (858,844) (2%)

Peer Support 4,048,956 337,413 17,231 320,182 3,374,130 78,684 3,295,446 98%

1915(b)(3) 6,582,060 548,505 382,738 165,767 5,485,050 4,895,320 589,730 11%

Medicaid Reinvestment 2,913,950 242,829 29,571 213,258 2,428,292 474,206 1,954,086 80%

Recoveries 0 0 (28,682) 28,682 0 (896,367) 896,367

Total $273,893,726 $22,824,477 $22,580,502 $243,975 $228,244,772 $223,970,553 $4,274,219 1.9%

Fiscal Year Medicaid Services Cost

(includes IBNR) Monthly Fiscal YTD

$739,470

$3,164,611

$3,904,081

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000

Remaining Balance

Used to Date

Beginning Balance

99.1%

92.0%

85.0% 85.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

Medicaid ExpenseRatio

Medical Loss Ratio(YTD)

Financial Ratios

Apr-20 Target

2.08

2.00

1.96

1.98

2.00

2.02

2.04

2.06

2.08

2.10

Consolidated Current Ratio

Apr-20 Target

67.9

60.0

54.0

56.0

58.0

60.0

62.0

64.0

66.0

68.0

70.0

# Days Service Expense in Cash

Apr-20 Target

Key Financial Indicators(Includes Long-Term Investments)

Page 3 of 6

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IPRS Report as of April 30, 2020

Quality Improvement Feedback Report as of April 30, 2020

Grievances:

Total = 108

* Grievance data reported on a 1-month delay (following State reporting specs)

14.0

8.8

11.8

13.0

10.3

13.0

11.0

5.0

0.0

13.0

0.0

15.0 13.0

0

5

10

15

20

25

30Average Number of Days to Resolve a

Informal Grievance

Avg Working Days for Informal Grievances Goal to Resolve Informal Grievances

Category of Service Annual Budget Budget Actual Variance Budget Actual Variance % Variance

Inpatient $204,269 $17,017 $464 $16,553 $170,174 $217,948 ($47,773) (28%)

Community Support 6,714,570 559,547 240,151 319,395 5,595,465 5,342,051 253,414 5%

BH Long-Term Residential 9,722,000 810,167 479,040 331,127 8,101,667 8,096,741 4,926 0.1%

Outpatient 11,398,556 949,882 293,639 656,243 9,498,817 7,698,507 1,800,310 19%

ACTT 1,218,605 101,550 37,087 64,464 1,015,504 908,270 107,234 11%

Part Hosp/Day Treatment 228,204 19,017 16,648 2,369 190,170 300,600 (110,430) (58%)

Psych Rehab 379,384 31,615 15,303 16,312 316,153 335,199 (19,046) (6%)

Crisis Services 5,212,960 434,413 138,465 295,948 4,344,133 3,962,226 381,907 9%

3-Way Hospitals 8,486,816 707,235 502,010 205,225 7,072,347 7,782,005 (709,658) (10%)

Non-UCR (excluding County) 15,953,750 1,329,479 2,840,819 (1,511,340) 13,294,792 10,770,491 2,524,301 19%

Total $59,519,114 $4,959,922 $4,563,625 $396,297 $49,599,222 $45,414,038 $4,185,184 8.4%

Fiscal Year IPRS Services Cost Monthly Fiscal YTD

$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000 IPRS Non-UCR FYTD Budget to Actual

YTD Actual YTD Budget

26.7

24.9 22.7

28.225.4

30.0 25.0

8.0

28.0 26.0 27.0 28.0 28.0

0

10

20

30

40

50Average Number of Days to Resolve a

Formal Grievance

Avg Calendar Days for Formal Grievances Goal to Resolve Informal Grievances

28 26%

80 74%

0 0%

Grievances12 Months Ending March 31, 2020

Grievances Against MCO Grievances Against Providers

Grievances Against Other

Page 4 of 6

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Super Measures

Transitions to Community Living

as of March 31, 2020

Ambulatory Follow Up Reported on 2-Month Lag

Performance Standard = 90%Source: Innovations Super Measure (Reports Manager - DMA-DMH Super Measures: DMA Innovations Integrated Care Super Measure)

47.3%42.9% 44.6%

53.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Feb-20

Follo

w U

p P

erc

enta

ge

Inpatient Ambulatory Follow Up(from Claims Data)

MCD MH MCD SU State MH

State SU Internal Benchmark Performance Measure

Innovations Members Receiving Services

95.9%

Access to Primary/Preventive Care for Individuals Under the Innovations Waiver as of April 30, 2020

541

EligibleMembers

564

Fiscal Year-End Benchmark: 67

Source: TCLI Manager

275 Placements q 56 Below Target

Net Housed FYTD: 19

275

0 50 100 150 200 250 300 350

Benchmark (67) Current (275) Target (331)

Page 5 of 6

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Operational Performance Report as of April 30, 2020

Claims:

Number of Days to Process and Pay All Claims:

Feb'20 Mar'20 Apr'20

Service Date to Received Date 19.1 25.2 21.7

Received Date to Paid Date 9.0 8.7 8.9

Service Date to Paid Date 28.1 33.9 30.6

Top 5 Reasons for Denied Claims:

Feb'20 Mar'20 Apr'20

Duplicate Claim 726,800$ 409,204$ 1,026,172$

Service is not authorized 1,046,887$ 526,425$

Claim received after billing period 641,306$ 805,698$ 628,754$

No coverage available for

Patient/Service/Provider combo 438,616$

Invalid DCN (Document Ctrl #) or resubmission

ref #756,461$ 287,021$

Invalid Units: units claimed does not equal # of

days for Discharge Claim385,553$

Client has other covered insurance (COB) 266,188$ 339,251$

Invalid Service or Service Discontinued 305,575$

Total 3,557,008$ 2,294,536$ 2,738,368$

#1 Denial Code #2 Denial Code #3 Denial Code

#4 Denial Code #5 Denial Code

Treatment Authorization Requests (TAR):

Authorization Requests Feb-20 Mar-20 Apr-20

Total Number of Auth Requests Received 2,937 3,301 2,326

% Processed in 14 Days 100.0% 100.0% 100.0%

# Auth Requests requiring Expedited

Decisions, inclusive of Inpatient 153 164 48

% Processed in 3 Days 100.0% 100.0% 100.0%

Total % of Auth Requests Processed in Required

Timeframes 100.0% 100.0% 100.0%

# of Auth Requests Denied for Clinical Reasons 118 103 36

# of Administrative Denials 42 33 28

Total # of Auth Requests Denied 160 136 64

% of Total Auth Requests Approved 94.6% 95.9% 97.2%

Program Integrity

Innovations Slot Tracking

$5,564

$25,839

$20,275

7.6%9.1%

14.5%

9.0%

11.7%

6.8%

8.6% 8.5%7.3%

9.3% 9.3% 8.9%

15.4%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

Perc

ent o

f Denie

d C

laim

s

Cla

ims (

$0

00

)Claims Processing

Claims Denied and Pended Total Claims Processed (000)

Total Claims Paid (000) Claims Percent Denied

8.8 9.1

8.1 8.4 9.1 9.3 9.1 8.9

10.1

9.0 9.0 8.7 8.9

4.0

6.0

8.0

10.0

12.0

14.0

# o

f D

ays

Days to Pay Clean Claims *

Average Number of Days * Clean claims contain all

Calculation of percentage of denied claims does not include claims denied for either of the following reasons:- Non-Billable Service- Non-Covered Ancillary Services

TNO Prior Years FY'2018 FY'2019 FY'2020 TD

Initial TNO Amount 2,415,696$ 4,569,188$ 2,651,069$ 1,809,834$

No. of TNO's Issued 158 23 31 21

Total Amount Reduced by Dispute Panel Review -$ -$ -$ 10,116$

Total Amount Reduced by Settlement Offer -$ -$ -$ 1,509,623$

Adjusted TNO Amount 967,055$ 4,544,475$ 2,260,833$ 290,095$

% Reduction of Initial TNO -60% -1% -15% -84%

Amount Collected during the Fiscal Year* 796,200$ 142,809$ 237,991$ 699,553$

Total Amount of Adjusted TNO Recouped** 825,922$ 109,170$ 851,941$ 70,150$

% of Adjusted TNO Recouped 85.41% 2.40% 37.68% 24.18%FY Outstanding Balance 141,133$ 4,435,304$ 1,408,892$ 219,945$

Total TNO Outstanding Balance $6,205,274

Total Self-Audit Recoveries YTD $131,628

New Cases 5

Closed Cases 6

Reopened 0

Total Open Cases 51

For FY20 there have been $1.5m in reductions from the initially identified overpayment amount in return for significant recoveries, saved litigation costs, preserved provider network adequacy and added protections such as indemnifications and plans of correction.Seperately tracking Settlement Offers and Disputes Panel Review adjustment amounts started in FY2020 and is being tracked for TNOs issued in FY20.

*Actual Recoupment: Amount received during the fiscal year. (Some recoupments are from TNOs issued in previous fiscal years) ** Total amount of the Fiscal Year TNO that was recouped. Note: TNO recoupments are reported on a Cash Basis.

Page 6 of 6

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Nominations of New Board Members

to Partners Board of Directors for FY2021

Presented for Board Approval - June 18, 2020

Reappointments for FY2021

Burke County – Linda McCrary; eligible for reappointment to a second 3-year term and has confirmed

her interest in the reappointment – Category Representation #2 CFAC family member IDD.

The Burke County Board of County Commissioners has recommended Ms. McCrary for reappointment

effective July 2020.

Catawba County – Katherine (Kitty) Barnes; eligible for reappointment to second 3-year term and has

confirmed her interest in the reappointment – Category Representation #1 Commissioner.

The Catawba County Board of County Commissioners has recommended the reappointment of

Commissioner Barnes effective July 2020.

New Appointments for FY2021

Burke County

Nomination - The Burke County Board of County Commissioners has submitted the recommendation of

Jeff Brittain County Commissioner, effective July 2020 – Category Representation #1 Commissioner.

Nomination - The Burke County Board of County Commissioners has submitted the recommendation of

Barry Nelson, MSN, RN, CENP, Vice President of Nursing/Chief Nursing Officer, Carolinas HealthCare

System Blue Ridge, effective July, 2020 – Category Representation #13 Administrator of a hospital

providing MH, IDD, and SUD emergency services (non-voting).

Catawba County

Nomination - David O’Connor, EVP & CFO, CaroMont Health has expressed an interest to serve and is

eligible for appointment by the Catawba County Board of County Commissioners effective July, 2020 –

Category Representation #11 - A member who represents the general public as appointed by the

Secretary of HHS and #8 – An individual with insurance expertise consistent with the MCO.

Surry County

Nomination - The Surry County BOCC has recommended and approved the appointment of Richard

Merlo, MD, effective July 2020 – Category Representation – At-large.

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Yadkin County

Nomination – CFAC Chair, Virginia “Ginny” Hall on behalf of CFAC, has submitted the recommendation

of Hope Elisa Bryant effective July 2020 – Category Representation #2 CFAC Chair-designee and #4-iii

Consumer SA.

Partners Board Slate of Officers for FY 2021

Nominating Committee Chair, Pam Poteat presented the following Slate of Officers for FY 2021 for the

board’s consideration at the meeting on May 21, 2020, which is now presented for the Board’s approval

at the June 18, 2020 meeting:

Chair – Russ Perkins

Vice Chair – Henry Morphis

Treasurer – Debra Cheek

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BOARD OF DIRECTORS

Resolution Number: 2020-06182020-1

Resolution Topic: Organizational Name Change

Date: June 18, 2020

I, Clerk to the Board of Directors, hereby certify that the Resolution below is a true and exact copy

of a resolution adopted by the Board of Directors during a regular meeting on June 18, 2020.

______________________________________

Clerk to the Board

WHEREAS, Partners Behavioral Health Management (“Partners”) is a multi-county local

political subdivision of the State operating as a Public Authority, Area Authority, Local

Management Entity (LME) and LME/Managed Care Organization (LME/MCO) as defined by

North Carolina General Statutes §§ 122C-3(1), -3(20b), -3(20c) and -116(a); and

WHEREAS, the State of North Carolina is moving forward with “Medicaid Transformation” to

integrate physical, behavioral and pharmaceutical health through “Standard Plans” and “Tailored

Plans”; and

WHEREAS, to operate a Tailored Plan, it is important that Partners’ name, brand, and trademarks

are recognized as and reflect an entity that manages for its health plan members whole-person

integrated health care, covering behavioral, physical, pharmaceutical and any other health care

matters, duties, powers and opportunities assigned by the State or presented in the future to

Partners; and

WHEREAS, Partners Behavioral Health Management is the only LME/MCO to retain

“behavioral” in its name; and

WHEREAS, Partners has operated since 2012 as "Partners Behavioral Health Management" and

since 2007 or earlier with “Partners” in its name (e.g., “Mental Health Partners”) with no incident

and is commonly referred to as, has developed much goodwill in, and is widely recognized by the

valuable brand "Partners" and associated Partners’ trademarks.

WHEREAS, Partners seeks by this Resolution only to modify its name, but none of its powers,

duties, structure, “ownership” or other substantive aspects of its organization.

NOW, THEREFORE, BE IT RESOLVED, that this Board of Directors hereby:

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1. Approves changing the name of "Partners Behavioral Health Management" to "Partners

Health Management", effective July 1, 2020 or as soon thereafter as legally and reasonably

feasible; and

2. Resolves that "Partners" and any reasonable variation thereof shall remain the "doing

business as” (dba) name of the organization before, during and after such formal name

change; and

3. Authorizes the CEO and his designees to take under this Resolution, without further

Board action, all further action on behalf of Partners to effectuate this name change,

including all appropriate notifications to and approvals from relevant persons and

entities; and modification of all official documents of the organization.

BOARD ACTION: MOTION _____________ SECONDED __________________

AYE NAY UNANIMOUS _____________________

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PARTNERS BEHAVIORAL HEALTH MANAGEMENT

BUDGET ORDINANCE

FISCAL YEAR 2020-2021

The proposed budget for Partners Behavioral Health Management has been prepared in accordance with the North Carolina Local Government Budget and Fiscal Control Act and General Statute 159-11. The Fiscal Year 2020-2021 Partners Behavioral Health Management Budget will be displayed for nineteen (19) days to provide sufficient opportunity for public review. An opportunity for the public to comment on the FY 2020-2021 Partners Behavioral Health Management Budget Document will be made available June 18, 2020, at 6:30 p.m. during the monthly board or directors meeting. This period of public comment will be followed by a vote by the Area Board of Directors on final adoption of the FY 2020-2021 Partners Behavioral Health Management Budget. REVENUES AND EXPENDITURES I. REVENUES

Medicaid 1915 b/c Waiver $ 320,187,751 State and Federal Block Grant 41,596,016 Fund Balance Appropriated 12,260,602 Medicaid Risk Reserve 6,534,986 County Maintenance of Effort 3,140,204 SAMHSA and other Grants 2,530,312 Other Funding sources 2,458,062 TOTAL REVENUES $ 388,707,933

II. EXPENDITURES

Services Expenditures $ 323,422,157 Administration and Operations 41,862,320 Care Coordination 16,006,971 Tailored Plan Readiness 6,730,824 Medicaid Savings Reinvestment 685,661 TOTAL EXPENDITURES $ 388,707,933

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III. PROJECTION OF MEDICAID REVENUE AND EXPENDITURES Medicaid Revenues and related transactions are the most significant change to the budgeting process. The Medicaid Revenues in this budget have been based on estimated capitation payment rates that are estimates using historical Medicaid claims data, trended Medicaid eligible plan members, and comparisons to actual rates of other LME-MCOs of similar size.

IV. SPECIAL AUTHORIZATION - AREA FINANCE DIRECTOR/CHIEF FINANCIAL

OFFICER The Area Finance Director shall be authorized to reallocate appropriations among the various line item expenditures based on the North Carolina General Statutes and Division of MH/DD/SA Services.

V. BUDGET CHANGES BY AGENCIES

The Area Finance Director shall provide notification of any changes in the Budget presented to the Area Board of Directors immediately, or within sixty days of the change by any agency having statutory authority to change line items.

VI. TRANSFER OF FUNDS BETWEEN OBJECT ACCOUNTS

The Area Finance Director is authorized to transfer monies from one appropriation to another in accordance with provisions of the Local Government Budget and Fiscal Control Act and Department of Human Resources Regulations.

VII. CONTINGENCY

The utilization of any contingency appropriation shall be accomplished only with Area Board approval.

VIII. RESERVE FUNDS

The funds set aside by Area Board resolution in accordance with NC General Statutes shall continue to be reserved funds unless modified by subsequent Board action.

IX. APPROVAL OF BUDGET

This ordinance and the Budget Document shall be the basis of the financial plan for Partners Behavioral Health Management during the 2020-2021 Fiscal Year. The Area Finance Director shall administer the budget and shall insure that operating officials are provided guidance and sufficient details to implement their appropriate portion of the budget. The accounting section shall establish records which are in consonance with the budget and this Ordinance and the appropriate statutes of the State of North Carolina and budget procedures of the Department of Human Resources, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.

____________________________________ ____________________________________ Rhett Melton – Chief Executive Officer Wil Neumann – Board Chairman

____________________________________ Susan Lackey – Area Finance Director/Chief Financial Officer

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BOARD OF DIRECTORS

Resolution Number: 2020-06182020-2 Resolution Sponsor: Finance Dept. Date: June 18, 2020

I, Clerk to the Board of Directors, hereby certify that the Resolution below is a true and exact copy of a resolution adopted by the Board of Directors during a regular meeting on June 18, 2020. ______________________________________ Clerk to the Board WHEREAS, Partners Behavioral Health Management (“Partners BHM”) is a multi-county local political subdivision of the State operating as a Public Authority, Area Authority, Local Management Entity (LME) and LME/Managed Care Organization (LME/MCO) as defined by North Carolina General Statutes § 159-7(b)(10) and §§ 122C-3(1), -3(20b), -3(20c) and -116(a); and WHEREAS, Partners BHM is required by North Carolina General Statutes § 122C-144.1 to maintain its budget in accordance with the requirements of Article 3, Subchapter III of Chapter 159 of the North Carolina General Statutes (“Local Government Budget and Fiscal Control Act”); and WHEREAS, under the North Carolina General Statutes, Partners BHM is required to and able to maintain an unreserved fund balance; and WHEREAS, Partners BHM is charged with the duty and responsibility to engage in comprehensive planning, budgeting, implementing and monitoring the provision of mental health, developmental disabilities and substance abuse services (“Services”) to the communities it serves; and

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NOW, THEREFORE, BE IT RESOLVED, that Partners BHM Board of Directors hereby authorizes management to budget and utilize the following fund balance for expenditures throughout the year. Fund Balance Appropriated Tailored Plan Readiness $6,730,824 Medicaid Reinvestment 685,661 State MOE 4,330,117 Capital Expenditures 514,000 Total $12,260,602 BOARD ACTION: MOTION _____________ SECONDED __________________

AYE NAY UNANIMOUS _____________________

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