Posted March 5, 2021

  1. PURPOSE

    Forsyth County is dedicated to improving the quality of life of the residents who have chosen our county as their home. In furtherance of this goal, the Forsyth County Board of Commissioners is choosing to pursue a relationship with Partners Behavioral Health Management (“Partners”) to manage our residents’ behavioral health services funded by federal and state dollars, including Medicaid. Partners is a Local Management Entity/Managed Care Organization (LME/MCO), which is a governmental entity that manages mental health, intellectual/developmental disability and substance use services. Currently, our behavioral health services are managed by Cardinal Innovations Healthcare (“Cardinal”). However, Cardinal has failed to provide Forsyth County residents with the services they are entitled to receive. Partners’ intentional focus on community interaction and high-engagement with stakeholders, among other attributes, more closely aligns with Forsyth County’s vision and strategic planning. Forsyth County believes this realignment will better serve the community and its needs.

    To prevent disruption of the behavioral health system in our county, this Disengagement Plan has been developed to ensure a smooth and seamless transition for all those involved.

    Our primary focus is to carry out this process with transparency, commitment to our community, and the involvement of those who will be impacted by the change. This Plan primarily outlines the process for the County’s disengagement from Cardinal. However, it necessarily also refers to the process by which engagement will occur between Forsyth County, Partners, and all relevant stakeholders. Partners has committed to working collaboratively with Forsyth County and Cardinal to ensure a smooth transition for all involved. Forsyth County has every confidence and expectation that Cardinal will also work collaboratively and cooperatively throughout the transition process.

  2. BACKGROUND

    North Carolina law permits a county to request that it be served by the most appropriate LME/MCO. This decision to disengage from Cardinal was not entered into lightly. During 2020, Forsyth County convened an exploratory workgroup to discuss this process and present its findings to the County Commissioners. On November 12, 2020, the Forsyth County Board of Commissioners voted unanimously to disengage from its current LME/MCO, Cardinal Innovations Healthcare. The resolution is attached (see Appendix 1) and is also on our website at https://forsyth.cc/communityinfo.aspx, where other information on this process (including this disengagement plan) is or will be posted.

  3. RATIONALE

    Forsyth County is committed to ensuring the best behavioral health system is available to residents of Forsyth County. We believe transitioning to Partners’ model of service management and community engagement will best accomplish this goal. Forsyth County has engaged in analysis and review of the Partners model of operations and has concluded it is one of intentional community integration at multiple levels. Leadership and staff throughout Partners are engaged in relationships within their communities, actively collaborating with stakeholders, providers, and consumers.

    As an urban county, Forsyth County appreciates Partners’ approach of inclusion in the development of their provider network. Partners’ action-oriented approach to network development allows for flexibility and does not tightly limit providers or various levels of service. Forsyth County and Partners have significant alignment when it comes to community priorities. Their implementation model is locally driven. Philosophically, their style of execution aligns well with the views of Forsyth County leadership. Forsyth County believes problems are best solved at the local level and not addressed through a regimented process.

    Additionally, Forsyth County aligns well with the current counties in Partners’ catchment area. Partners has routinely demonstrated a high level of consumer engagement when compared to peer LME/MCOs in the state. State reports illustrating the number of individuals accessing care on a per capita basis indicate Partners consistently ranks near the top. This suggests a high level of accessibility of services for residents in the counties served.

  4. TIMELINE

    Disengagement will be effective as soon as reasonable and as permitted by law. Forsyth County provided written notice to the Secretary of the North Carolina Department of Health and Human Services on November 17, 2020. While the default for the effective date of disengagement is nine (9) months after such notice, the Secretary has the ability to shorten the waiting period if it is in the best interests of our community. Forsyth County does not seek to disengage and realign sooner than nine (9) months, in order to address the current state of behavioral health services and to minimize any negative impact to consumers as a result of a slow transition. To protect our residents in greatest need, disengagement with Cardinal will occur simultaneously with realignment and engagement with Partners.

    The process will include a minimum of 60 days for the public to review and comment on this Disengagement Plan. Following the comment period and 30 days of posting such comments, Forsyth County will submit to the Secretary the written documentation which shall constitute its Request to Disengage documentation. The Secretary shall have 90 days to determine whether to approve such Request, but the County seeks as expeditious a determination as possible. A timelier transition, albeit with thorough and thoughtful engagement from the community, will best serve the county residents and minimize the delay in implementing improved behavioral health services and outcomes for our citizens.

  5. DISENGAGEMENT

    This Disengagement Plan serves as a guide for the first step in the process of transitioning from one LME/MCO to the other. While this plan should not be considered all-inclusive, Forsyth County has made every effort to identify the areas on which we need to focus and the necessary steps to ensure the needs of our residents are met. Both Forsyth County and Partners are dedicated to carrying out this Plan, as outlined in the following focus areas:

    1. Transition Planning

      To ensure active and robust community involvement in this transition and to facilitate input and feedback from subject matter experts, the Forsyth County Manager will form an LME/MCO Realignment Committee consisting of key County officials and agencies, Partners, and other appropriate stakeholders. This will include the following, or their representatives, plus others as appointed by the County Manager:

      1. Deputy County Manager (Chair)
      2. County DSS Director (or designee)
      3. County Public Health Director (or designee)
      4. Mental Health Association in Forsyth County, Inc. Representative
      5. Mental Health Court representative
      6. District Attorney (or designee)
      7. Sheriff (or designee)
      8. Novant Healthcare System Representative
      9. Wake Forest Baptist Healthcare System Representative
      10. One or more Partners executives and directors
      11. One or more Community Stakeholders appointed by the County Manager

      This Committee will meet as needed to share information; to schedule listening and education meetings with key stakeholders (providers, consumers, advocates); to consult subject matter experts; and to assist the County and Partners in whatever tasks are needed to ensure a smooth disengagement and transition. The County and Partners envision the transition plan to include a focus on our people, supporting the providers of behavioral health services in our community, the continuity of existing behavioral health projects and enhanced outcomes for those receiving services.

    2. Continuity of Services Plan

      Forsyth County recognizes the importance of ensuring services for its community are uninterrupted and provided with high quality, timeliness and a focus on community involvement. Therefore, a separate written Continuity of Services Plan is being developed and will be published shortly after this Disengagement Plan. Partners has committed to ensure all current providers contracted and in good standing with Cardinal and serving our county will be contracted with Partners as well, if not already. Likewise, Partners intends to honor consumer service authorizations, annual plans and other documentation and decisions essential to ensure a smooth transition.

    3. Notification of Stakeholders

      Forsyth County and Partners will collaborate to notify all stakeholders impacted by this transition. Additionally, a concentrated effort will be made to solicit comments, feedback and suggestions from consumers, advocates, self-advocates, providers, State and Local Consumer and Family Advisory Committees (CFACs), and all other interested parties. We will use our usual Forsyth County established communication methods, primarily our website, mailings, stakeholder meetings, press releases, and social media messaging. All input is welcome and encouraged.

    4. Community Initiatives

      Partners is committed to becoming ingrained in our community and supporting our current community initiatives involving behavioral health. A list of all current, planned and proposed projects/initiatives will be compiled and agreed upon prior to the transition effective date.

    5. Distribution of Real Property Plan

      In accordance with State law, a written Distribution of Real Property Plan must be developed during a LME/MCO realignment process. The disengagement from Cardinal Innovations involves no real property (land, buildings, etc.) to be distributed, so a Plan stating as much will be posted with or shortly after this Disengagement Plan.

    6. Financial Liabilities

      Forsyth County affirms that, to its knowledge, it has no outstanding financial liabilities to Cardinal, nor will the County have any within 30 calendar days of the request to disengage. Should Cardinal reasonably disagree, the County will work amicably and promptly with Cardinal to resolve equitably and if unable to do so, defer the matter to the NCDHHS Secretary for resolution. Partners has agreed to work with the County to ensure its financial liabilities under maintenance of efforts requirements are not increased by realigning with Partners.

    7. Written Notice to Providers impacted by decision to disengage

      Forsyth County and Partners will collaborate to notify all providers impacted by this transition.

    8. Written Notice to other Counties served by Cardinal

      Forsyth County will notify all counties in Cardinal’s catchment area.

    9. Approval by Partners’ Board of Directors

      Partners’ Board of Directors will approve a resolution authorizing Forsyth County to align with Partners as its LME/MCO.

  6. NEXT STEPS/PUBLIC COMMENT

    Forsyth County will seek public comment on this Disengagement Plan for 60 days from the posting of this Plan on our website at: https://forsyth.cc/communityinfo.aspx. Public comment is welcome and encouraged by form submission or by mail addressed to:

    Forsyth County Manager’s Office
    ATTN: LME/MCO Realignment
    201 N. Chestnut Street
    Winston-Salem, NC 27101

    Following this public comment period, the County will post the public comments for 30 days. Forsyth County will take into consideration all feedback received, will review all written plans, and submit a written request to disengage to the Secretary of NCDHHS for approval (details of which are outlined in the NC Administrative Code referenced below- See Appendix 2). In keeping with our dedication to transparency, both Forsyth County and Partners commit to keeping the public informed during this process, including public meetings, information and listening sessions with key stakeholders and groups, and more.

  7. AUTHORITY

    This Disengagement Plan has been developed in accordance with current state laws and regulations governing a counties’ disengagement with an LME/MCO. Specifically, the following were used to create the plan and ensure compliance:

    • North Carolina General Statute 122C-115 (a3)
    • North Carolina Administrative Code 10A NCAC26C.0701-.0703.

APPENDIX 1: Notice of Intent and Resolution

APPENDIX 2: North Carolina Administrative Code 10A NCAC26C.0701-.0703

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