Cardinal Innovations Healthcare - Provider Network Capacity, … · 2018-05-15 · Provider Network...

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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.

Transcript of Cardinal Innovations Healthcare - Provider Network Capacity, … · 2018-05-15 · Provider Network...

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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.

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Table of Contents 2016 NC LME-MCO Community Behavioral Health Service Needs, Providers and Gaps Analysis

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 .......................................................................................................................... 12

IV. Crisis Services ................................................................................................................................................. 15

V. Inpatient Services ............................................................................................................................................ 17

VI. Specialized Services ........................................................................................................................................ 20

State-Funded Services Items ................................................................................................................................... 23

GeoAccess Maps ...................................................................................................................................................... 24

Location-Based Services ...................................................................................................................................... 24

Community/Mobile Services ................................................................................................................................ 24

Departmental Initiatives .......................................................................................................................................... 24

Recovery-Oriented System of Care ...................................................................................................................... 24

Crisis Solutions Initiative ...................................................................................................................................... 24

Employment ......................................................................................................................................................... 25

Children’s Services ............................................................................................................................................... 25

Integration of Physical and Behavioral Health Care ............................................................................................ 25

Appendix A Attachments

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Executive Summary 2016 NC LME-MCO Community Behavioral Health Service Needs, Providers and Gaps Analysis

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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.

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Progress and Achievements

Based on the results of last year’s gaps analysis report, Cardinal Innovations set goals for Network development for Fiscal Year 2015-2016 (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.

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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 2015.

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 40.8. 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 FY14-15. 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 FY14-15.

2 Other includes American-Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Asian, two or more races and Unknown.

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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 FY14-15. 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.

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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 2015. Cardinal Innovations sent 867 emails 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:

Medicaid State Funded

Categories

# of enrollees with

choice of two

providers within

30/45 miles*

# of Medicaid

Enrollees %

# of members with

choice of two

providers within

30/45 miles*

# of

Members %

Reside in urban counties 345,778 345,778 100% 16,755 16,755 100%

Reside in rural counties 56,807 56,807 100% 3,410 3,410 100%

Total (standard = 100%) 402,585 402,585 100% 20,165 20,165 100%

Adults (age 18+) 180,059 180,059 100% 19,422 19,422 100%

Children (age 17 and younger) 222,526 222,526 100% 743 743 100%

Total (standard = 100%) 402,585 402,585 100% 20,165 20,165 100%

*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.

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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

Service Gap Goal and Target Date Strategies to achieve goal, noting if

planned or in progress

Psychologists

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.

•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

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•At least six providers will be contracted on the basis of URs; deliverables contractualized.

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.

Psychiatrists

•Cardinal Innovations continues to recognize this need, but market pressures continue to hinder recruitment.

•The need for additional Psychiatrist continues to be formally identified on Cardinal Innovations’ published needs list.

Clinicians Able to Serve Dually-diagnosed Members

•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.

•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

Trauma-Informed Treatment for Special Populations.

Goal: Establish a directory of providers/clinicians with LGBTQ and TF-CBT credentials, for placement and referral purposes by close of FY 2016-17.

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

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

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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 Goal and Target Date Strategies to achieve goal, noting if

planned or in progress

Additional State Funded OPT Sites in Rowan County

• Not pursued at this time.

•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 state-funded 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.

Child/ Adolescent SUD Treatment Options

•Ongoing collaboration with providers to develop service continuum for this previously identified need. •Pilot programs to initiate effectiveness remain an ongoing need.

• 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

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to this amount of time and complete all the necessary school obligations. There are continued efforts to overcome this challenge.

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.

•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.

Medicaid State Funded

Service

# and % of enrollees with choice

of two providers within 30/45

miles of their residences

Total # of

Medicaid

Enrollees

# and % of members with at

least one provider within 30/45

miles of their residences

Total # of

Members

# % # %

Psychosocial

Rehabilitation 179,615 99.8% 180,059 12,406 100% 12,406

Child and Adolescent Day

Treatment 211,542 95.1% 222,526 525 78.8% 666

SA Comprehensive

Outpatient Treatment

Program (SACOT)

340,648 84.6% 402,585 6,431 80.1% 8,031

SA Intensive Outpatient

Program (SAIOP) 401,359 99.7% 402,585 8,031 100% 8,031

Opioid Treatment 126,427 70.2% 180,059 6,049 75.9% 7,967

Day Supports 402,316 99.9% 402,585 861 78.8% 1,093

Adult Developmental

Vocational Program 1,091 99.8% 1,093

Medicaid State-funded

If not at 100%, have exceptions been requested but not yet finalized? YES. If no, briefly explain and give dates each will be requested:

If not at 100%, have written justifications and plans to meet needs been submitted? YES

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Medicaid State-funded

__________________________________________________________ __________________________________________________________

If no, briefly explain and give dates each will be submitted: ________________________________

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. ____________________________________________________________

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 dates of each exception approval: Effective date of each written justification and plan approval:

Next review dates for each exception, if applicable:

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.

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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 dually-diagnosed 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 Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

SACOT

• Clinically, increasing SACOT will not be a focus during FY16-17. 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.

•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.

Opioid Treatment

Due to existing barriers, this perceived need will not be a focus for FY16-17. • 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

•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.

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appropriate service provision will also be developed by the Network Operations Department,

Adult SAIOP: Additional sessions. •Not pursued at this time.

•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.

Access for Single Parent Care Givers •Not pursued at this time.

•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.

Day Programs for I/DD Adults •Not pursued at this time.

•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.

Additional CCC in Mecklenburg County

•Not pursued at this time. •A potential provider was identified, but limited state funding hindered immediate movement forward.

Trauma Informed Treatment for Special Populations

(Refer to I.E. Medicaid Service #3)

Cultural and Linguistic Needs of Members

(Refer to I.E. Medicaid Service #4)

Day Supports in Mecklenburg County

•Not pursued at this time.

•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?

State-Funded

Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

Day Treatment •Not pursued at this time.

• 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.

Day Supports •Not pursued at this time.

•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.

SACOT •Not pursued at this time.

•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.

Opioid Treatment (Davidson County)

•Effort sufficient at this time. •An exception will be requested for this service. •Cardinal Innovations Network Operations

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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) .

ADVP in Mecklenburg County •Not pursued at this time.

•Perceived need is not currently considered 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 State-Funded

Service

# and % of enrollees with choice

of two provider agencies within

the LME-MCO catchment area

Total # of

Medicaid

Enrollees

# and % of members with access to

at least one provider agency within

the LME-MCO catchment area Total # of

Members # % # %

Assertive Community Treatment Team

180,059 100% 180,059 12,406 100% 12,406

Community Support Team 180,059 100% 180,059 18,496 100% 18,496

Intensive In-Home 222,526 100% 222,526 666 100% 666

Mobile Crisis 402,585 100% 402,585 20,165 100% 20,165

Multi-systemic Therapy 222,526 100% 222,526 666 100% 666

Home-based I/DD Services 402,585 100% 402,585 1,093 100% 1,093

(b)(3) MH/I/DD Supported

Employment Services 402,585 100% 402,585

(b)(3) Waiver Community

Guide 402,585 100% 402,585

(b)(3) Waiver Individual

Support (Personal Care) 402,585 100% 402,585

(b)(3) Waiver Peer

Support 402,585 100% 402,585

(b)(3) Waiver Respite

402,585 100% 402,585

I/DD Supported

Employment Services

(Innovations)

402,585 100% 402,585

I/DD Supported

Employment Services

(State-funded)

1,093 100% 1,093

MH/SUD Supported

Employment Services (IPS-

SE) (State-funded)

18,496 100% 18,496

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Medicaid State-funded

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%, 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 exceptions to the standard in place? ____ Please list. If no, briefly explain: _________________________________________ __________________________________________________________

If not at 100%, are written justifications and plans to meet needs in place? _____, attach copy to this report. If no, briefly explain _______________ __________________________________________

Effective dates of each exception approval: Effective date of each written justification and plan approval:

Next review date of each exception, if applicable:

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.

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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 Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

Peer Bridger Program Goal: Increase availability and access to the Peer Bridger Program by close of FY16-17.

• 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.

Trauma-informed Community Based services for members of special populations

(Refer to I.E. Medicaid Service #3)

Cultural and Linguistic Needs of Members

(Refer to I.E. Medicaid Service #2)

Mobile Crisis in the Southern Region (For Dual Diagnosed Members)

•Not pursued at this time. •Mobile Crisis services are available in all areas, and provider is able to respond to members in crisis regardless of disability.

Mobile Crisis in Mecklenburg County •Not pursued at this time.

•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.

I/DD Supported Employment •Not pursued at this time. •Medicaid-funded IDD Supported Employment currently exists in all areas.

State-Funded

Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

State Funded Peer Support Services •Not pursued at this time.

•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.

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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 State-funded

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, 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 exceptions to the standard in place? ____ If no, briefly explain: _________________________________________ __________________________________________________________

If standard not met, are written justifications and plans to meet needs in place?_____, attach copy to this report. If no, briefly explain _______________ __________________________________________

Effective dates of each exception approval: Effective date of each written justification and plan approval:

Next review dates, if applicable:

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.

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1. Respondents indicated a perception of need for at least one provider of Facility Based Crisis

services in each of Cardinal Innovations’ 16 counties.

D. What specific geographic, cultural or demographic groups experience gaps in the crisis services above that

need to be addressed? Describe gaps and how the information was gathered. Respondent’s perception of crisis 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 stated that detoxification options for adults with IDD in the Southern Region were

needed. 2. 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. 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, 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 crisis 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 Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

Crisis Respite Services Goal: Evaluate opportunities to increase access for members during FY16-17.

•Currently being addressed among TFC providers in allowing for crisis respite services at non-contracted sites upon adjudication and/or hospital discharge. •Crisis Respite as a Medicaid service is assumed to refer to the Innovations service. Collaboration with providers and planning teams in ongoing on how to access this service. Discussions with NC Start are ongoing related to this resource and opportunities to expand access.

Catchment-wide Facility Based Crisis Services

Goal: Increase availability of Facility Based Crisis Services by close of FY16-17.

•There are limitations on availability of state funds to have Facility Based Crisis sites in all counties, however: –Additional beds are currently being added to existing providers in Northern Region –Identified provider recruited; supporting its efforts in Davidson County –Mecklenburg site to begin operations November 2016

Trauma-informed Crisis Services for Special Populations

(Refer to I.E. Medicaid Service #3)

Cultural and Linguistic Needs of Members

(Refer to I.E. Medicaid Service #2)

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State-Funded

Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

Detoxification services for IDD members in the Southern Region

•Not pursued at this time. •Members in need of Detox can access this regardless of any additional diagnosis.

Crisis Housing •Not pursued at this time.

•Crisis collaboratives have been established in all of the local catchment areas. While housing is not solely being focused on by Cardinal Innovations, this is discussed within these forums for opportunities for partnership related to this issue that combine service and treatment opportunities with community housing.

V. Inpatient Services

A. Medicaid and state-funded inpatient services access and choice standard: All eligible individuals must have access to at least one inpatient provider agency listed 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

Inpatient Hospital – Adult a. Acute care hospitals with adult inpatient

psychiatric beds b. Other hospitals with adult inpatient

psychiatric beds c. Acute care hospitals with adult inpatient

substance use beds d. Other hospitals with adult inpatient

substance use beds

10 7

0 0

2 2

0 0

Inpatient Hospital – Adolescent a. Acute care hospitals with adolescent

inpatient psychiatric beds b. Other hospitals with adolescent inpatient

psychiatric beds c. Acute care hospitals with adolescent

inpatient substance use beds d. Other hospitals with adolescent inpatient

substance use beds

See Inpatient Hospital– Child

psychiatric numbers below

See Inpatient Hospital– Child psychiatric

numbers below

See Inpatient Hospital– Child

psychiatric numbers below

See Inpatient Hospital– Child psychiatric

numbers below

1 1

0 0

Inpatient Hospital – Child a. Acute care hospitals with child inpatient

psychiatric beds b. Other hospitals with child inpatient

psychiatric beds

4 3

0 0

The number of hospitals in the above table does not reflect the total number of hospitals available to Cardinal Innovations’ members. Cardinal Innovations contracted with a total of 29 hospital and inpatient facilities in North Carolina during the year. Please see the Attachment II for a list of contracted hospitals: Twenty-three of the 29 contracted hospitals in the Network were acute care hospitals. Ten of those were

within the Cardinal Innovations catchment. Hence, there were 19 other hospitals that were located out-of-catchment and available to members.

The six remaining hospitals were considered “Other” hospitals, i.e. Mental Health Private Psychiatric Facilities. Though all of these “Other” hospitals were able to treat all eligible members, none is located in-catchment.

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Medicaid State-funded

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, 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 exceptions to the standard in place?____ If no, briefly explain: ________________________________________ __________________________________________________________

If standard not met, are written justifications and plans to meet needs in place?_____, attach copy to this report. If no, briefly explain ______________________ _____________________________________________

Effective dates of each exception approval: Effective date of each written justification and plan approval:

Next review dates of each exception, if applicable:

Next review dates, if applicable:

B. What inpatient 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 Inpatient 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 there were no available locked facilities for children with challenging

behaviors, which were needed to keep those members safe during treatment.

C. What inpatient 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 Inpatient 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. Respondents cited a need for additional behavioral health services for seniors in long-term care

facilities. 2. Respondents also indicated a need for behavioral health training for staff who serve seniors.

D. What specific geographic, cultural or demographic groups experience gaps in the inpatient services above

that need to be addressed? Describe gaps and how the information was gathered. Respondents’ perceptions of inpatient 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.

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2. 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.

3. Respondents indicated that additional inpatient beds for adults and children were needed in the Southern Region; Davidson and Stanly County were mentioned as areas of particular concern.

4. Respondents indicated a need for locked facility inpatient options in the Southern region for dually-diagnosed children.

E. Goals, strategies and timelines for addressing inpatient 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 Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

Additional Inpatient Beds in the Southern Region

•Not pursued at this time.

•Cardinal Innovations does not control the availability of inpatient beds. However, other services such as the Crisis Recovery Centers and Facility Based Crisis sites are being utilized to offset any deficits that may exist. •Cardinal Innovations has also implemented the CCC model to ensure access to care for all members, and reduce the likelihood of hospitalization through ongoing treatment and medication adherence support. •Cardinal Innovations is encouraging the State to direct funding to hospitals in the Southern Region.

Locked Facilities •Not pursued at this time.

•Treatment for children focuses on clinical interventions. Additional community education is ongoing, conveying the need to focus on member treatment needs, instead of whether a setting is locked or unlocked. There is no current evidence that supports this as leading to different treatment outcomes.

Behavioral Health Services for Seniors

•Not pursued at this time.

•Cardinal Innovations could not substantiate a specific need in that providers in the Network are capable of serving this population; to extent it will be developed as a goal in the future, would need to identify a certification program to demonstrate meeting a particularized need of this population.

Additional Behavioral Health Training for Providers serving seniors

•Not pursued at this time.

•The Geriatric/ Adult Mental Health Specialty Team (GAST) provides free education and consultation on a variety of relevant topics (upon request) to staff in Adult Care homes, Nursing homes, Family Care homes, Senior centers, Home Health Care agencies, DSS, faith-based organization, Judicial system, and care givers throughout the Cardinal Innovations catchment area.

Trauma-focused Inpatient Treatment for Special Populations

(Refer to I.E. Medicaid Service #3)

Cultural and Linguistic Needs of Members

(Refer to I.E. Medicaid Service #2)

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State-Funded

Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

No state-funded specific inpatient gaps identified

N/A N/A

VI. Specialized Services

A. Medicaid and State-funded specialized services access and choice standard: All individuals eligible for the services below must have access to at least one provider agency.

Provide a chart for Medicaid and State-funded specialized services of parent agencies’ names (not service site names) the LME-MCO contracts with, by county served. Specialized services are:

Partial Hospitalization

MH Group Homes

Psychiatric Residential Treatment Facility

Residential Treatment Levels 1-4

Child MH Out-of-Home Respite

SUD Non-Medical Community Residential Treatment

SUD Medically Monitored Community Residential Treatment

SUD Halfway Houses

IDD Group Homes and AFLs

IDD Out-of-home respite

IDD Facility-based respite

Intermediate Care Facility/IDD

Cardinal Innovations’ chart of parent providers of Specialized Services is contained in Attachment I of this document. Cardinal Innovations meets the standard of contracting with at least one provider in each of the Specialized Services. For many Specialized Services, such as PRTFs, Residential Treatment Levels 1-4, and I/DD Group Homes and AFLs, Cardinal Innovations contracts with a number that far exceeds the standard.

B. What specialized services gaps were identified by members, family members and other stakeholders? Members and family members throughout Cardinal Innovations’ catchment area were asked to respond

with their perception of Specialized 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 member 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 additional residential treatment options were needed for dually-

diagnosed members, IDD/MH in particular. 2. Respondents indicated a perception of capacity-related issues for adult MH group homes due to

placement challenges. 3. Additional half-way houses in order to serve members with SUD were suggested by respondents.

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C. What specialized services gaps were identified by members, family members and other stakeholders? Stakeholders, such as Department of Social Services (DSS), physical health practitioners, and Community

Care of NC (CCNC), were asked to provide information related to Specialized 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. Respondents suggested that increased services, training, and education on Traumatic Brain Injury

(TBI) is needed for members and providers. 2. Respondents suggested additional training for providers and members on the difference between

the Medicare and Medicaid service arrays is needed.

D. What specific geographic, cultural or demographic groups experience gaps in the specialized services above

that need to be addressed? Describe gaps and how the information was gathered. Respondent’s perceptions of Specialized 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 Innovation’ 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 that additional training, placement, and peer support is needed in

Mecklenburg County for individuals in group homes. 2. 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. 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. Including, but not limited to, provider fulfilled interpreter services, and culturally competent provider approaches to treatment and engagement.

4. Respondents perceive gaps in PRTF and temporary residential options for IDD/MH dually-diagnosed members in the Southern Region.

5. Respondents stated that IDD/MH dually-diagnosed adults and children needed additional out of home respite care options in the Southern Region.

6. Respondents suggested a perception of need for IDD group homes/ AFLs in the Southern Region. 7. Respondents believed that Specialized Service options for seniors with IDD, SUD, and MH needs

were needed in all areas.

E. Goals, strategies and timelines for addressing specialized 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 Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

Additional Residential Options for Dually-Diagnosed Members

•This need was identified previously and steps were taken to address.

•Cardinal Innovations worked with one provider to expand their therapeutic foster care homes, adding approximately 40 additional homes to expand access.

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•Level II services are paid at an enhanced rate, but there are increased clinical expectations. •Next Steps: Cardinal Innovations will now begin to focus on Level III residential care and monitor the effects of steps taken..

Additional TBI Training and

Education for Providers and

Members

•This need was identified previously and steps were taken to address.

•Cardinal Innovations medical staff, a board member of the Brain Injury Association of North Carolina, provided several TBI Trainings for contracted providers. •Trainings will be posted to the website for access by stakeholders, members and providers.

IDD group homes/ AFL in the Southern Region

•This need was identified previously and steps were taken to address.

•Cardinal Innovations is actively reviewing capacity and discussing more proactive ways to engage providers to increase availability of these services within local areas. Currently this has been posted on the external needs list, however, additional recruitment will be an ongoing focus.

Specialized Services for Seniors with Behavioral Health Needs

(Refer to V.E. Medicaid Service #3)

PRTF for Dually-Diagnosed Members in the Southern Region

Goal: Explore, identify options to pilot a PRTF program specific to dually-diagnosed members by close of FY16-17.

•Cardinal Innovations is currently exploring creative solutions to address the needs of these members. •Current programs across the state have limited ability to effectively provide treatment for this population •Provider and site in development for Union County/Marshville; scheduled for operations to begin by end of 2016. •Mecklenburg Network staff in initial discussions with an additional provider to serve this population.

Medicare/ Medicaid Behavioral Health Services Training

•Not pursued at this time.

•Cardinal Innovations provides technical assistance to all providers as requested. Provider cafés are also an opportunity to provide direction on a variety of topics that providers request. •There are on-line resources made available to providers and members who would like additional information about these programs.

Trauma-Specific Specialized Services for Special Populations

(Refer to I.E. Medicaid Service #3)

Cultural and Linguistic Needs of Members.

(Refer to I.E. Medicaid Service #2)

Out-of-Home Respite for Dually-Diagnosed Members in the Southern Region

•Not pursued at this time. •Both (b)(3) and Innovations Respite are available and accessible to these members.

State-Funded

Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or

in progress

SUD Halfway Houses

•Not pursued at this time. •Cardinal Innovations Community Partners to locate and compile list and tracking of all SUD Halfway Houses and funding availability.

Adult MH Group Homes •Not pursued at this time. •State-funded service that has limited capacity. Focused process was implemented

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this year to ensure providers are screening members on an ongoing basis for ability to live independently to increase transition through the continuum and increase access for new members

State-Funded Services Items The following two items apply to services referenced in:

State-funded Enhanced Mental Health and Substance Abuse Services 2015 effective 8/1/15

State-funded ACT Policy

State-funded DMHDDSAS Service Definitions 2003-2014 effective 8/1/14

Individual Supportive Employment with Long-Term Vocational Supports YP630/YM645

A. For state-funded services, describe any geographic discrepancies in services included in the LME-MCO’s local

Benefit Plan. That is, are residents of some counties excluded from coverage under the LME-MCO benefit plan, or have stricter eligibility requirements? Include which services, why this occurred, and whether there is a plan in place to ensure equal access based on need across all geographic areas.

Variations existed as a legacy to LME practices in effect when the LMEs merged with Cardinal Innovations. Cardinal Innovations has focused on increased use of b3 services, or services most consistent with best practice, as the core services in all state benefit plans across all counties. However, all request for services are considered on a member-specific basis and authorizations granted based on priority populations and medical necessity. So any existing state plan service is made available to a member when alternative services are unable to be identified.

Service Available In

Community Support Team AC, OPC, FC

Day Activity FC, Meck, PBH

Day Supports PBH, OPC

Developmental Day AC, OPC

Personal Assistance/Personal Care AC,OPC, FC

Respite OPC

Diagnostic Assessment

None currently- CCAs and psychiatric evaluations are available in all counties and clinically appropriate for assessing need for treatment.

B. For state-funded services, describe any services that were closed to new admissions or not offered during

the year. Include which services, why this occurred, the period of time, and how the LME-MCO ensured priority populations continued to access appropriate levels of care.

All services are considered on a member-specific basis, based on priority populations and sliding scale eligibility requirements. Exceptions are made for services that are not in the standard Cardinal Innovations state benefit plan. Alternative Medicaid services, including b3, are always considered first for Medicaid-eligible members even if service differs slightly from the State service requested. Federally-funded block grant program services are also utilized.

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GeoAccess Maps

Appendix A of this report provides separate maps per funding source, for services where less than 90% of members have the required access and/or choice. Maps were provided according to the following: Location-Based Services One map for each location-based service and funding source where less than 90% of members have the required access and choice was required. Provider locations with a radius of 30 miles for urban counties and 45 miles for rural counties are represented. Community/Mobile Services

Maps representing service coverage for each community/mobile service and funding source where less than 90% of members have the required choice was required, however there were two provider agencies located in Cardinal Innovations’ catchment area for each community based service. Departmental Initiatives Recovery-Oriented System of Care Cardinal Innovations works to establish a recovery-oriented system in many ways. The local system of care collaborative, which include key stakeholders and representation from family members when accessible, address this need for children. Adults with MH needs are able to access training, promotion of activities such as Wellness Recovery Action Plans (WRAP), standardized assessments such as Transition Readiness Tools, Independent Skills Assessments, and promotion of improved clinical assessments. Increased promotion of Peer Support services has also been a way to further develop a recovery-oriented system. For providers of IDD services, access to the College of Direct Support training is a method for promotion of current practices that focus on improvement in the competencies of direct support professional which leads to increased focus on recovery. Additionally, training was held by Cardinal Innovations to promote increased focus on the role of direct support professionals and the individualization of treatment based on member preferences. Separate trainings were also conducted on preference assessments, positive behavior support plans, and working with dual diagnosis to also focus on how to ensure a recovery-oriented system.

Crisis Solutions Initiative Cardinal Innovations participates in two quarterly statewide crisis initiatives: Behavioral Health Urgent Care and Crisis Solutions Committees. In addition, Cardinal Innovations hosts an inter-departmental team meeting quarterly to address organizational Crisis Solutions Initiatives. Each department in this team monitors specific tasks related to crisis, categorized as follows: Pre-crisis tasks, Pre-emergency tasks, Emergency tasks and Post-emergency tasks. These tasks were monitored quarterly, bi-annually, or annually by the inter-departmental team.

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Employment Cardinal Innovations set a goal to increase utilization of MH/SUD Supported Employment Services by 10% by June 2016. As of June 2015, 101 members had received Medicaid MH/SUD Supported Employment Services. One hundred and eighty members received State/block grant funded Supported Employment Services during FY14-15, which will be increased by 10% for each funding source by June 2016. This goal is a focus because increased employment in the MH/SUD population has been demonstrated to help individuals maintain recovery and long-term outcomes. This goal will be accomplished by the following:

1. Education and communication with the Provider Network on the availability of this service. 2. Collaboration with the Network Operations Department to identify areas where there were gaps in the

service to recruit providers. 3. Utilization Management Department (UM) will notify Network Specialists of under-utilization of the

service. 4. UM will make contact with Supported Employment providers to determine the barriers to providing

services or receiving referrals. 5. Continued collaboration with the Transition to Community Living Team to identify opportunities. 6. Continued collaboration with the State Best Practice Team related to barriers and potential solutions.

Children’s Services

In FY14-15, Cardinal Innovations established measurement criteria for Level II Residential services. This initiative was to evaluate the quality of service provision including core functions and interventions that should be routinely part of this level of care. This initiative was also intended to incentivize providers to improve the quality of services being delivered. Quarterly monitoring has been occurring and will continue through this fiscal year to strengthen the therapeutic foster care services in the Network. Also during FY14-15, Cardinal Innovations continued to work with both internal and external teams to ensure this service is operational during FY15-16. Clinical Operations will support development of clinical programming and ensure an appropriate billable service code and rate were identified and loaded into the system. This was initiated through selection for a grant to support this development, and partnership with Monarch, the provider that will operate the child facility-based crisis (FBC) service. Integration of Physical and Behavioral Health Care

In partnership with CCNC, a Network provider approached Cardinal Innovations about improving integration of care, specifically meeting the behavioral health needs of members during medical hospitalizations. Cardinal Innovations worked with the provider and CCNC to identify the gap and brainstorm solutions. The target population was members with bi-polar, anxiety and depression diagnoses who have at least three inpatient visits with concurrent unmet behavioral health needs. Cardinal Innovations’ plan to resolve this gap includes collecting data on the number of unmet needs for 60-90 days, then implementing a work flow solution for the target population. The work flow will involve offering a co-managed solution by linking those members underserved in behavioral health to appropriate treatment services, and then tracking those linkages and increased engagement. Overall, the goal is to increase treatment of members with unmet behavioral health needs by 10% while in medical hospitalization. The workflow implementation for the pilot population was completed in November 2015.

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Section III: GeoAccess Maps

 Appendix A: Less Than 90% of Members Met Access Standard

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Location Based Services

All location based provider groups included contracted providers with an active license during FY14-15 for the evaluated service. All Medicaid member groups included Medicaid eligible members during FY14-15, based on the appropriate age for the evaluated service. State funded member groups included members who received a state funded service during FY14-15, and the appropriate age and diagnosis for the evaluated service. Members may be included in multiple member and benefit groups. Maps reflect all counties in NC, highlighting Cardinal Innovations’ sixteen county catchment area.1

Medicaid Services

SA Comprehensive Outpatient Treatment

There were 340,648 (84.6%) Medicaid eligible members who met the access standard for Substance Abuse Comprehensive Outpatient Treatment (SACOT). There were 61,937 (15.4%) Medicaid eligible members who did not meet the SACOT access standard. Of those, 43,957 resided in urban counties and were within 35.9 miles on average to a second SACOT provider (range 30-54.3 miles). The remaining 17,980 members resided in rural areas, and were an average of 61.8 miles (range 45-71.9 miles) away from a second SACOT provider location. Opioid Treatment

There were 126,427 (70.2%) adult Medicaid eligible members who met the access standard for Opioid treatment. There were 53,632 (29.8%) adult Medicaid eligible members who were not within the Opioid treatment access standard. Of those, 38,296 resided in urban counties and were able to access a second Opioid treatment provider within an average of 36.2 miles (range 30-59.5 miles). The remaining 15,336 members without access in rural counties were an average of 66.1 miles (range 45-84.9) to a second Opioid treatment provider location. Although the access standard was not met for Medicaid SACOT and Opioid treatment, over 90% of Medicaid eligible members located in urban counties were within 30 miles of a SACOT and an Opioid treatment provider. However, less than 90% of members residing in rural counties were within 30 miles of a single SACOT or Opioid provider location. It remains a challenge to ensure accessibility and choice for members residing in our most rural counties, and Cardinal Innovations continues to consider innovative ways to meet this challenge. Cardinal Innovations’ Comprehensive Community Clinics (CCC) were designed to increase access to basic services, as well as some enhanced services for all members. Still, services like Opioid treatment and SACOT continue to present a barrier due to the number of available providers, and best practice concerns around SACOT specifically. As a result, exceptions wil l be requested of NC DHHS

for Medicaid SACOT and Opioid treatment.

State Funded Services

Adolescent Day Treatment

There were 525 (78.8%) state funded MH/SA served children who met the access standard for state funded Adolescent Day Treatment (Day Treatment) services. There were 141 (21.2%) state funded MH/SA

1 Maps 1-2 reflect Medicaid service providers, and outline rural counties in orange and urban counties in red. Maps 3-6 reflect State-funded

service providers, where rural counties are outlined in green and urban counties are outlined in blue.

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ii

served members who did not meet the state funded Day Treatment access standard. Of those, 86 resided in urban counties and were able to access a state funded Day Treatment provider within an average of 38.4 miles (range 30–58.9 miles). The 55 members without access who resided in rural counties were within an average of 68.8 miles (range 45- 95.2 miles) from a state funded Day Treatment provider location. SA Comprehensive Outpatient Treatment

There were 6,431 (80.1%) state funded SA served members who met the access standard for state funded SACOT. There were 1,600 (19.9%) state funded SA served members who did not meet the state funded SACOT access standard. Of those, 1,400 resided in urban counties and were able to access a state funded SACOT provider within an average of 47.2 miles (range 30-67.7 miles). The 200 members without access who resided in rural counties were within an average of 68.8 miles (range 45-96.9 miles) from a state funded SACOT provider location.

Day Supports

There were 861 (78.8%) state funded I/DD served members who met the access standard for state funded Day Supports. There were 232 (21.2%) state funded I/DD served members who did not meet the state funded Day Supports access standard. Of those, 124 resided in urban counties and were able to access a state funded Day Supports provider within an average of 38.9 miles (range 30-56 miles). The 108 members without access who resided in rural counties were within an average of 65 miles (range 45-90.1 miles) from a state funded Day Supports provider location.

Opioid Treatment

There were 6,049 (75.9%) state funded SA served adult members who met the access standard for state funded Opioid Treatment. There were 1,918 (24.1%) state funded SA served adult members who did not meet the access standard for state funded Opioid Treatment services. Of those, 1,307 resided in urban counties and were able to access a state funded Opioid provider within an average of 47.1 miles (range 30-93.9 miles). The 611 members without access who resided in rural counties were within an average of 94.4 miles (range 45-135.9 miles) from a state funded Opioid provider location. The SUD measurement standards are based on all members with an SUD diagnosis. However, the population that is appropriate to receive Opioid treatment is much more limited. So the percentage of individuals who did not fall within the access standards are not accurately representative based on the access standards. This population is also transient at times, and may move to alternative locations temporarily while accessing treatment. Limitations in state funding continue to impact how service provision is managed and dictates strategic administration of scarce resources. The MCO is continuously evaluating resource allocations and outcomes to promote best practice within limited funds. It remains a challenge to ensure accessibility and choice for members in need of state funding who reside in our most rural counties. For example, high cost substance use disorder services require overhead for implementation and maintenance that is not supported by sparse populations, while specialized staff i s in short supply in rural NC. The proportion of members who will access the service will also dictate provider viability, which will impact network stability. High staff turn-over, and populations who are challenging to serve create

additional difficulties. As a result, exceptions will be requested of NC DHHS to adjust access and capacity

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expectations for Cardinal Innovations’ state funded Day Treatment, SACOT, Day Supports, and Opioid Treatment.

Page 33: Cardinal Innovations Healthcare - Provider Network Capacity, … · 2018-05-15 · Provider Network Capacity, Needs Assessment and Gaps Analysis 2016. This study assesses the Cardinal

Alamance

Alexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Davidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyYancey

Virginia

South Carolina

Tennessee

Cardinal Innovations Healthcare Solutions

Provider Locations

Medicaid Contracted SACOT Providers

21 Providers at 33 locations

Single Provider locations (31)

Multiple Provider locations (2)

30 mile radius

45 mile radius

50 miles

1

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Alamance

Alexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Davidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyYancey

Virginia

South Carolina

Tennessee

Cardinal Innovations Healthcare Solutions

Provider Locations

Medicaid Contracted Opioid Providers

6 Providers at 14 locations

Provider locations (14) 30 mile radius

45 mile radius

50 miles

2

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Alamance

Alexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Davidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyYancey

Virginia

South Carolina

Tennessee

Cardinal Innovations Healthcare Solutions

Provider Locations

State Funded Adolescent Day Treatment Providers

6 Providers at 12 locations

Provider locations (12) 30 mile radius

45 mile radius

50 miles

3

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Alamance

Alexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Davidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyYancey

Virginia

South Carolina

Tennessee

Cardinal Innovations Healthcare Solutions

Provider Locations

State Funded SACOT Providers

7 Providers at 12 locations

Single Provider locations (10)

Multiple Provider locations (2)

30 mile radius

45 mile radius

50 miles

4

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Alamance

Alexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Davidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyYancey

Virginia

South Carolina

Tennessee

Cardinal Innovations Healthcare Solutions

Provider Locations

State Funded Day Support Providers

4 Providers at 5 locations

Provider locations (5) 30 mile radius

45 mile radius

50 miles

5

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Alamance

Alexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Davidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyYancey

Virginia

South Carolina

Tennessee

Cardinal Innovations Healthcare Solutions

Provider Locations

State Funded Opioid Providers

2 Providers at 4 locations

Provider locations (4) 30 mile radius

45 mile radius

50 miles

6

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Demographic/ Geographic Attachment I

Cardinal Innovations Healthcare

2014-2015

The following tables show gender information for the general population in Cardinal Innovations’ service area, as well as Medicaid penetration and members served by funding, and member age, race, and diagnosis data, for Fiscal Year 2014-2015.

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Table 1 - General Population by Gender (2015) – County (North Carolina OSBM website)

County Female Male Total

Alamance 83,278 53% 74,346 47% 157,624

Cabarrus 100,753 51% 95,246 49% 195,999

Caswell 11,613 49% 12,030 51% 23,643

Chatham 36,401 52% 33,450 48% 69,851

Davidson 84,002 51% 80,925 49% 164,927

Franklin 32,003 50% 31,845 50% 63,848

Granville 26,845 46% 31,435 54% 58,280

Halifax 27,544 52% 25,332 48% 52,876

Mecklenburg 529,079 51% 503,541 49% 1,032,620

Orange 73,933 52% 67,666 48% 141,599

Person 20,192 51% 19,130 49% 39,322

Rowan 70,363 51% 68,347 49% 138,710

Stanly 30,788 50% 30,467 50% 61,255

Union 112,284 51% 108,262 49% 220,546

Vance 23,989 53% 21,033 47% 45,022

Warren 9,985 49% 10,529 51% 20,514

Cardinal Innovations 1,273,052 51% 1,213,584 49% 2,486,636

Table 2 - General Population by Gender (2015) – Catchment (North Carolina OSBM website)

Geographic Area Female Male Total

Piedmont 398,190 51% 383,247 49% 781,437

Alamance-Caswell 94,891 52% 86,376 48% 181,267

Five County 120,366 50% 120,174 50% 240,540

OPC 130,526 52% 120,246 48% 250,772

Mecklenburg 529,079 51% 503,541 49% 1,032,620

Cardinal Innovations 1,273,052 51% 1,213,584 49% 2,486,636

Table 3 - Medicaid Penetration FY1415

Geographic Area Medicaid

Members Served Medicaid Eligible Penetration Rate

Piedmont 18,488 134,198 13.8%

Alamance-Caswell 4,758 35,293 13.5%

Five County 8,331 58,819 14.2%

OPC 5,230 31,328 16.7%

Mecklenburg 22,287 176,915 12.6%

Cardinal Innovations 58,925 439,674 13.4%

Overall penetration rate for Cardinal Innovations Catchment for FY1415 was 13.4%

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Table 4 - Members Served by Region by Benefit Plan FY1415

Geographic Area Medicaid State Funding Total

Piedmont/Southern 18,488 31% 8,068 37% 25,758 33%

Alamance-Caswell 4,758 8% 2,000 9% 6,528 8%

Five County 8,331 14% 2,792 13% 10,763 14%

OPC 5,230 9% 2,203 10% 7,151 9%

Northern 18,262 31% 6,933 32% 24,303 31%

Mecklenburg 22,287 38% 6,253 29% 27,773 36%

Cardinal Innovations 58,925 100% 21,535 100% 77,959 100%

Mecklenburg region served the most Medicaid members for Cardinal Innovations. The Piedmont/Southern and Northern Cardinal Innovations regions served a similar number of Medicaid members for FY1415. Table 5 - Child/Adolescent Members (Ages 3-17) Served by Diagnosis and Benefit Plan FY1415

Geographic Area Medicaid State

I/DD MH SA Other Total I/DD MH SA Other Total

Grand Total

Piedmont/Southern 686 7,624 241 107 8,178 6 319 40 2 361 8,484

Alamance-Caswell 127 1,813 34 12 1,906 25 68 3 0 95 1,974

Five County 238 2,964 34 144 3,145 3 117 2 0 121 3,245

OPC 160 2,070 52 36 2,197 52 75 6 0 131 2,300

Northern 523 6,833 120 192 7,232 80 260 11 0 347 7,500

Mecklenburg 752 9,697 324 545 10,589 2 172 47 0 217 10,773

Other 0 5 0 0 5 1 22 17 0 39 44

Cardinal Innovations 1,957 24,111 684 843 25,949 88 771 114 2 960 26,738

Child/Adolescent members (Ages 3-17) with a MH diagnosis comprised the highest number of members served for Medicaid and/or State funding compared to I/DD and SA members.

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Table 6 - Adult Members (18+) Served by Diagnosis and Benefit Plan FY1415

Geographic Area Medicaid State

I/DD MH SA Other Total I/DD MH SA Other Total Grand Total

Piedmont/ Southern 1,235 8,047 2,415 128 10,486 384 4,744 3,143 194 7,713 17,455

Alamance-Caswell 333 2,413 490 20 2,885 131 1,459 459 9 1,906 4,588

Five County 521 4,423 958 137 5,270 149 1,996 785 7 2,673 7,604

OPC 532 2,358 650 17 3,083 170 1,352 752 12 2,073 4,902

Northern 1,379 9,165 2,090 174 11,197 447 4,783 1,961 28 6,590 16,974

Mecklenburg 1,706 9,363 2,019 524 11,891 221 3,092 3,150 21 6,039 17,196

Other 1 5 0 0 6 12 222 309 2 531 537

Cardinal Innovations 4,310 26,528 6,518 826 33,512 1,050 12,750 8,389 245 20,590 51,773

Adult members (18+) with a MH diagnosis comprised the highest number of members served for Medicaid and/or State funding compared to I/DD and SA members.

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Table 7 - Members Served by Race and County

*“Other” includes Native Hawaiian, Other Pacific Islander, two or more races, and Unknown.

County White Black or African-

American

American Indian and Alaskan

Native Asian Other Race Other* Total

Alamance 2,430 59% 1,314 31.92% 13 0.32% 8 0.19% 330 8.02% 22 1.48% 4,117 100%

Cabarrus 2,792 65% 1,144 26.72% 12 0.28% 23 0.54% 280 6.54% 30 2.01% 4,281 100%

Caswell 395 61% 238 36.73% 1 0.15% 1 0.15% 12 1.85% 1 0.07% 648 100%

Chatham 606 57% 255 23.85% 2 0.19% 2 0.19% 180 16.84% 24 1.61% 1,069 100%

Davidson 3,255 80% 519 12.82% 12 0.30% 17 0.42% 213 5.26% 32 2.15% 4,048 100%

Franklin 861 55% 611 38.89% 6 0.38% 2 0.13% 83 5.28% 8 0.54% 1,571 100%

Granville 727 54% 528 39.02% 4 0.30% 3 0.22% 80 5.91% 11 0.74% 1,353 100%

Halifax 786 31% 1,510 59.97% 125 4.96% 4 0.16% 89 3.53% 4 0.27% 2,518 100%

Mecklenburg 7,573 34% 12,489 56.09% 55 0.25% 205 0.92% 730 3.28% 1,213 81.46% 22,265 100%

Orange 1,622 58% 755 27.13% 9 0.32% 69 2.48% 269 9.67% 59 3.96% 2,783 100%

Person 856 61% 483 34.70% 6 0.43% 2 0.14% 39 2.80% 6 0.40% 1,392 100%

Rowan 3,435 72% 996 20.86% 17 0.36% 19 0.40% 286 5.99% 21 1.41% 4,774 100%

Stanly 1,546 75.49% 402 19.63% 6 0.29% 14 0.68% 64 3.13% 16 1.07% 2,048 100%

Union 2,138 61.94% 940 27.23% 13 0.38% 10 0.29% 324 9.39% 27 1.81% 3,452 100%

Vance 730 32.93% 1,359 61.30% 3 0.14% 1 0.05% 112 5.05% 12 0.81% 2,217 100%

Warren 214 28.53% 468 62.40% 34 4.53% 1 0.13% 30 4.00% 3 0.20% 750 100%

Cardinal Innovations

29,966 50.54% 24,011 40.50% 318 0.54% 381 0.64% 3,121 5.26% 1,489 2.51 59,286 100%

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Hospitals Attachment II

Cardinal Innovations Healthcare

2014-2015

The following table shows the hospitals which with Cardinal Innovations contracted with during Fiscal Year 2014-2015, including those located both in-catchment and out-of-catchment.

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Cardinal Innovations Contracted Hospitals, 2014-2015

Name Acute or

Other Medicaid IPRS County

In-Catchment

Alamance Regional Medical Center Acute X X Alamance

Carolinas HealthCare System NorthEast Acute X X Cabarrus

Carolinas Medical Center/Center for Mental Health Acute X X Mecklenburg

Halifax Regional Medical Center Acute X X Halifax

Novant Health Franklin Regional Medical Center Acute X Franklin

Novant Health Presbyterian Medical Center Acute X X Mecklenburg

Novant Health Rowan Medical Center Acute X X Rowan

Novant Health Thomasville Medical Center Acute X Davidson

Stanly Regional Medical Center Acute X X Stanly

University of North Carolina Hospitals Acute X Orange

Out of Catchment

Brynn Marr Behavioral Health System Other (psy) X Onslow

Holly Hill Hospital Other (psy) X X Wake

Old Vineyard Youth Services Other (psy) X X Forsyth

Strategic Behavioral Center Other (psy) X Brunswick

Strategic Behavioral Center-Garner * Other (psy) X Wake

UNC Hospitals at WakeBrook * Other (psy) X Wake

Carolinas HealthCare System Blue Ridge Morganton

Acute X Burke

Carolinas HealthCare System Kings Mountain Acute X Cleveland

CaroMont Regional Medical Center Acute X Gaston

Cone Health Acute X X Guilford

Duke Regional Hospital Acute X Durham

Duke University Hospital Acute X Durham

First Health Moore Regional Hospital Acute X Moore

Haywood Regional Medical Center Acute X Haywood

High Point Regional Health System Acute X X Guilford

Novant Health Forsyth Medical Center Acute X Forsyth

Park Ridge Health Acute X Henderson

Pioneer Community Hospital of Stokes Acute X Stokes

St. Luke's Hospital Acute X Polk

Wake Forest Baptist Medical Center Acute X Forsyth

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Specialized Services Attachment III

Cardinal Innovations Healthcare

2014-2015

The following table represents Cardinal Innovations’ Specialized Services providers by county during FY14-15.

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Provider by Contracted Service

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Partial Hospitalization

Carolinas Medical Center – Main

Keystone WSNC, LLC dba Old Vineyard Behavioral Health Services

Transformative Life Center, LLC

Provider by Contracted

Service

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MH Group Homes

Alberta Professional Services, Inc. Alliance Rehabilitative Care, Inc. Apogee Homes Eason Court Group Home, LLC Easter Seals UCP NC & VA, Inc. Melange Health Solutions, LLC Monarch New Destinations, Inc. Primary Care Solutions, Inc. Residential Treatment Services of Alamance, Inc. White Oak Homes II, Inc.

Provider by Contracted Service

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Psychiatric Residential Treatment Facility

Alexander Youth Network, Inc.

Avalonia Group Homes, Inc. dba Hampton PRTF

Barium Springs Home for Children

Brynn Marr Hospital, Inc.

Chestnut Hill Mental Health Center, Inc. dba Springbrook

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Behavioral Health System

Cornerstone Treatment Facility Program, Inc.

Cornerstone Treatment Facility, Inc.

Devereux Georgia Treatment Network

Eliada Homes, Inc.

Excalibur Youth Services, LLC dba Venice PRTF

Grandfather Home for Children, Inc.

New Hope Carolinas, Inc.

NOVA, Inc.

Premier Healthcare Services, Inc.

Premier Services of the Carolinas, LLC

SBH Raleigh, LLC dba Strategic Behavioral Center – Garner

SBH Wilmington, LLC dba Strategic Behavioral Center

Thompson Child & Family Focus

Three Rivers Residential Treatment/Midlands Campus, Inc.

Village Behavioral Health, LLC dba The Village

Walkers Group Home, Inc.

Yahweh Center Children’s Village

Youth Focus

Provider by Contracted Service

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Residential Treatment Level II A Caring Home, Inc. Access Family Services, Inc. ACI Support Specialists, Inc. Agape Services, Inc. Alamance Academy, LLC Alberta Professional Services, Inc. Alexander Youth Network, Inc.

Alpha Management Community Services, Inc.

Barium Springs Home for Children

Carolina Therapeutic Services

Charter’s Circle of Care, Inc.

Children’s Home Society of North Carolina, Inc.

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Coastal Behavioral Health Services, Inc.

Community Specialized Services, Inc.

Community Support Services, LLC

Community Treatment Alternatives, Inc.

Easter Seals UCP North Carolina & Virginia, Inc.

Echelon Consulting, Inc. dba Echelon Care

Eliada Homes, Inc.

Family Services of America Corp.

KidsPeace National Centers of NC, Inc. dba North Carolina Foster Care and Community Programs

Lutheran Family Services in the Carolinas

My B.R.O.T.H.E.R.S House, Inc.

National Mentor Healthcare, LLC dba North Carolina Mentor

Nazareth Children’s Home

New Beginnings Youth Facility, LLC dba Steps for Change Behavioral Healthcare, LLC

New Place, Inc.

New Possibilities Home for Children, LLC

Omni Visions, Inc.

Primary Care Solutions, Inc.

Solutions Community Support Agency, LLC

Provider by Contracted Service

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Residential Treatment Level II, cont’dSupport, Inc.

The Methodist Home for Children, Inc.

The Unique Caring Foundation, Inc.

Thompson Child & Family Focus

Timber Ridge Treatment Center, Inc. (SAY Program)

Triad Treatment Homes, LLC

Turning Point Homes, Inc.

Vince Marley, LLC dba Ethel’s Footprints

VOCA Corporation of NC dba Community Alternatives of North Carolina

Youth Focus

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Provider by Contracted Service

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Residential Treatment Level III A Better Path, Inc. A Sure House, Inc. Adolescent Alternatives, LLC Agape Services, Inc. All God’s Children of Burlington, LLC

Alternative Behavioral Solutions, Inc.

Barium Springs Home for Children

Community Treatment Alternatives, Inc.

Dreams and Vision, LLC

Echelon Consulting, Inc. dba Echelon Care

Eliada Homes, Inc.

Falcon Crest Residential Care, Inc.

First Genesis Group Home, Inc.

Focus Point, Inc.

Foundation Strong, LLC

Grandfather Home For Children, Inc.

Just In Time Youth Services, Inc.

KMG Holdings, Inc.

Life Changez, Inc.

Miracle Houses, Inc.

My B.R.O.T.H.E.R.S House, Inc.

National Mentor Healthcare, LLC dba North Carolina Mentor

New Leaf Adolescent Care, Inc.

New Place, Inc.

One Love Periodic Services, Inc.

Primary Care Solutions, Inc.

Quality Care Developmental Services

Solutions Community Support Agency, LLC

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Provider by Contracted Service

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Residential Treatment LevelII, cont’dSteps For Success Family Services, LLC

Successful Transitions, LLC

The Bruson Group, Inc.

The Methodist Home for Children, Inc.

Timber Ridge Treatment Center

Trinity House, Inc.

Turning Point Homes, Inc.

WesCare Professional Services, LLC

Wilson’s Constant Care, LLC

Youth Builders, LLC

Youth Enrichment Group Home, Inc.

Youth Unlimited, Inc.

Provider by Contracted Service

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Child MH Out-of-Home Respite Community Specialized Services, Inc. Dream Makers Assisted Living Services, LLC

Easter Seals UCP North Carolina & Virginia, Inc.

Educare Community Living Corporation of NC dba Community Alternatives

Elite Care Services, Inc.

Family First Community Services, LLC

GIC of Charlotte

Ideal Response Services, LLC

Independent Opportunities, Inc.

L&M Management Services, Inc.

MHS Unlimited Corporation

Person Centered Partnerships, Inc.

Rainbow 66 Storehouse, Inc.

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Provider by Contracted Service

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SA Non-Medical Community Residential Treatment Addictions Recovery Care Association (ARCA) McLeod Addictive Disease Center, Inc. Mecklenburg Area Mental Health Program Path of Hope, Inc.

Provider by Contracted Service

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SA Medically Monitored Community Residential Treatment UNC Faculty Physicians

Provider by Contracted Service

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SA Halfway House Addictions Recovery Care Association (ARCA)

Freedom House Recovery Center, Inc.

Hope Haven, Inc.

Path of Hope, Inc.

REMMSCO, Inc.

Residential Treatment Services of Alamance, Inc.

Provider by Contracted Service

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I/DD Group Homes and AFLs Ablecare Corp. ACI Support Specialists, Inc. Advance Behavioral Health Services, Inc. Alpha Management Services, Inc.

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Ambleside, Inc. Apogee Homes Autism Services of Mecklenburg County Autism Services, Inc. Baptist Children’s Home of NC, Inc. Better Connections, Inc. Better Days AHEAD of Rocky Mount, Inc. Beyond Challenges Community Services, LLC Break Out, LLC Bridging The Gap Residential Services, LLC Cabarrus County Group Homes, Inc. Care Well of Charlotte, NC, Inc. Caring Hands and Supplementary Enrichment Education, LLC Chatham County Group Homes, Inc. Classic Care Family Services, LLC Community Living Concepts Comprehensive Community Care, Inc.

ComServ, Inc.

D.D. Residential Services, Inc.

Davidson Homes, Inc.

Developmental Disabilities Resources, Inc.

Devereux Residential Services, LLC

Diamonds Community Based Services, Inc.

Diana’s HomeCare, Inc.

Easter Seals UCP North Carolina & Virginia, Inc.

Educare Community Living Corporation of NC dba Community Alternatives

Elite Care Services, Inc.

Enhancement Health Care, Inc.

Family Support Services

Gaston Residential Services, Inc.

Genesis Residential Care Center, LLC

GHA Autism Supports

Provider by Contracted Service

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I/DD Group Homes and AFLs, cont’dGIC of Charlotte

Guardian Angel Healthcare, LLC

HeartSpring, Inc.

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Herbert Way of Living, LLC

Holy Angels Services, Inc.

HomeCare Management Corp.

Independent Opportunities, Inc.

Innovative Support Services

InReach, Inc.

J-1 Consultants, LLC

Jones Health Services, Inc.

Kerr Homes, Inc.

L & J Homes, Inc.

Life, Inc.

LSM Enterprizes, Inc. dba Disability Management Services

Lutheran Family Services in the Carolinas

M & M Special Services

McDaniel Homes, LLC

Monarch

More than Conquerors Youth Center, Inc.

North Carolina Life of Rehabilitation, Inc.

P & W Group, LLC

Person Centered Partnerships, Inc.

Person County Group Homes, Inc.

Praising Hands, LLC

QC, Inc.

Ralph Scott Lifeservices, Inc.

Renu Life, LLC

Residential Services, Inc.

RHA/Howell Care Centers, Inc.

RHA Health Services NC, LLC

RHA Health Services, Inc.

Rouse’s Group Home II, Inc.

Securing Resources for Consumers, Inc.

Simplicity Care, Inc.

Southwood Place Group and Developmental Center, Inc.

Provider by Contracted Service

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I/DD Group Homes and AFLs, cont’dSpecialized Services and Personnel, Inc.

Still Family, LLC

The Arc of Davidson County, Inc.

The Arc of the Triangle, Inc.

The Kid’s Workshop, Inc.

The Workshop of Davidson, Inc.

Therapeutic Alternatives, Inc.

Therapeutic Services Group, Inc.

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Thursher Goodman Winstead Carehome

Total Care and Concern, Inc.

Turning Point Services, Inc.

UMAR

Union County Residential Services

Unique Caring Network

Unique Services

United Support Services, Inc.

Universal Mental Health Services, Inc.

VOCA Corporation of NC dba Community Alternatives of North Carolina

WesCare Professional Services, LLC

Western North Carolina Group Home for Autistic Persons, Inc.

White Oak Homes II, Inc.

Provider by Contracted Service

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I/DD Out-of-Home Respite A Small Miracle, Inc. A.D.E.P.T. Non-Profit Services ACI Support Specialists, Inc. Alpha Management Services, Inc.

Ambleside, Inc.

American Health, LLC

ARMC Health Care dba Alamance Regional Medical Center

Autism Society of North Carolina

Bayada Home Health Care, Inc.

Bethesda Care, LLC dba Keston Care

Better Connections, Inc.

Beyond Challenges Community Services, LLC

Britesmilz Family and Community Connections, LLC

C.F. Marketing, LLC

Care Well of Charlotte, NC, Inc.

Caring Hands and Supplementary Enrichment Education, LLC

Charles Hines & Sons, Inc.

CNC/Access, Inc. dba ResCare HomeCare

Community Support Service, LLC

Comprehensive Community Care, Inc.

Davidson Homes, Inc.

Developmental Disabilities Resources, Inc.

Dream Makers Assisted Living

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Services, LLC Easter Seals UCP North Carolina & Virginia, Inc.

Educare Community Living Corporation of NC dba Community Alternatives

Elite Care Services, Inc.

Enhancement Health Care, Inc.

Family Support Services

First Choice Community Services, Inc.

GIC of Charlotte

Guardiantrac, LLC dba GT Independence

HeartSpring, Inc.

HomeCare Management Corp.

Provider by Contracted Service

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I/DD Out-of-Home Respite, cont’dIdeal Response Services, LLC

Independent Opportunities, Inc.

Innovative Support Services

InReach, Inc.

Inspiration for Aspiration, LLC

J-1 Consultants, LLC

Jireh’s Place

Kerr Homes, Inc.

LifeSpan, Inc.

Lindley Habilitation Services, LLC

M & M Special Services

Maxim Healthcare Services, Inc.

Monarch

Nevins, Inc.

New Beginnings Day Treatment Center, LLC

New Beginnings of NC, LLC

North Carolina Life of Rehabilitation, Inc.

P & W Group, LLC

Pathways for People, Inc.

Person Centered Partnerships, Inc.

PHP of NC, Inc.

Praising Hands, LLC

Q-1 Clinical Consultants, LLC

QC, Inc.

Quality Home Care Services, Inc.

Quest Provider Services, Inc.

Rainbow 66 Storehouse, Inc.

RHA Health Services, Inc.

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Rusmed Consultants, LLC

S.T.E.P.s Developmental Academy, Inc.

Securing Resources for Consumers, Inc.

Special K Enrichment, Inc.

Still Family, LLC

Provider by Contracted Service

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I/DD Out-of-Home Respite, cont’dSuccessful Solutions, MHS, Inc.

The Arc of North Carolina, Inc.

The Arc of the Triangle, Inc.

The Kid’s Workshop, Inc.

Therapeutic Alternatives, Inc.

Therapeutic Services Group, Inc.

Thursher Goodman Winstead Carehome

Total Care and Concern, Inc.

Triangle Comprehensive Health Services, Inc.

Turning Point Services, Inc.

UMAR

Union Diversified Industries

Unique Caring Network

United Support Services, Inc.

Universal Mental Health Services, Inc.

VOCA Corporation of NC dba Community Alternatives of North Carolina

Wee Care Christian Child Development Center, LLC

WesCare Professional Services, LLC

Provider by Contracted Service

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I/DD Facility-based Respite Bayada Home Health Care, Inc. Easter Seals UCP North Carolina & Virginia, Inc.

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Provider by Contracted Service

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Intermediate Care Facility/IDD Autism Services of Mecklenburg County

Autism Services, Inc.

Blue Ridge Area Foundation, Inc. Carobell, Inc.

Community Innovations, Inc.

ComServ, Inc.

D&L Healthcare Services, Inc.

Educare Community Living Corporation of NC dba Community Alternatives

GHA Autism Supports

Greater Image Healthcare, Corp.

Holy Angels Services, Inc.

Horizons Residential Care Center, Inc.

Howell Child Care Centers, Inc.

Life, Inc.

LifeSpan, Inc.

Lutheran Family Services in the Carolinas

Macon Citizens Habilities, Inc.

Monarch

North Carolina MR, Inc.

NOVA IC, Inc.

Person County Group Homes, Inc.

Piedmont Residential Development Center, Inc.

Pitt County Group Home Board for Mentally Retarded, Autistic Persons, Inc.

Ralph Scott Lifeservices, Inc.

Residential Services, Inc.

RHA/Howell Care Centers, Inc.

RHA Health Services, Inc.

Rouse’s Group Home, Inc.

Skill Creations, Inc.

T.L.C. Home, Inc.

TEACCH

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Intermediate Care Facility/IDD, cont’d

The Carter Clinic, P.A.

The Keywest Center, Inc.

VOCA Corporation of NC dba Community Alternatives of North Carolina

Wake County Specialized Residential Home for Children, Inc. t/a Hilltop Home

Watson’s Group Home

Western North Carolina Group Home for Autistic Persons, Inc.