PBH Documents

 Piedmont Behavioral Health (PBH) documents.

• PBH Press Release and Response to US District Court Judge Louise Flanagan's March 29th ruling for preliminary injunction (DRNC KC et al. v. DHHS and PBH), from PBH Communications Director, Rachel Porter. April 2, 2012.
• PBH Waiver Expansion Frequently Asked Questions. December 19, 2011.
• The PBH Managed Care Experience; A Comparison to Non-Managed Care Local Managed Entities, power point presentation. December 1, 2011.
• PBH Continuous Quality Improvement Program Description, 2011-2012. October 31, 2011.
• The NC NH/DD/SAS Health Plan; PBH Consumer & Family Member Handbook, Fourth Edition, 2010. October 31, 2011.
• The PBH Model; The Provider's Council, by Pam Shipman and Stephen Tomlinson, re: Public Management of a system of care for the delivery of privately operated Mental Health, Intellectual/Developmental Disabilities and Susbtance Use Services; A real public private partnership. October 5, 2011.
• PBH Press Release and Response to Support Needs Matrix Litigation (e.g. lawsuit filed by Disability Rights NC alleging violations of due process rights). July 15, 2011.
• PBH Finance Communication Bulletin FY-1011-FN-10, Innovations Service Rate Revisions. April 14, 2011.
• The PBH Model, a power point presentation entitled, Public Management of a system of care for the delivery of privately operated Mental Health, Intellectual/Developmental DIsabilities and Substance Abuse Services, by Pam Shipman. March 8, 2011.
• PBH Waiver Expansion Advantages. January 11, 2011. 
• PBH 2010 Annual Report.
• PBH Provider Manual, Comprehensive Update. December 22, 2010.
• PBH power point presentation: Medicaid Waivers, PBH Outcomes and Thinking Ahead to 2014; A Presentation for the NC Alliance for the Mentally Ill, by Pam Shipman. September 10, 2010.
• PBH Support Needs Matrix: Words to Know. July, 2010.
• PBH Response to the Position Paper of the Arc of NC entitled, Why People with Intellectual and Developmental Disabilities and their Families should support the expansion of the 1915b/c waiver to other LME's in NC. April 29, 2010.
• PBH Myths and Facts Booklet on Innovations Waiver. April, 2010.
• PBH Board Meeting Minutes. January 21, 2010.
• PBH System of Care Collaborative Minutes. January 19, 2010.
• PBH Press Release announcing Transition to State-wide Waiver Plan. January 6, 2010.
• PBH Legislative Agenda Success announcement. July 7, 2008.
• PBH Request for Intent; Innovations Waiver Community Guide Service. January 16, 2008.
• PBH Local Business Plan, 2007; Executive Summary. May 8, 2007.
• PBH NC Quality Assessments and Improvement Strategies. January 1, 2007.

What's new in April?

April 2012 events and updates.

• PBH Documents post added.
• added Google Calendar for Waiver Events in pages.
• Website launch of NC Mental Health reform by research journalist and UNC student, Lydia Wilson.
• Email from Dr. Pat Porter regarding how changes will affect the salaries and benefits (or lack of) for direct care workers.
• PBH's Press Release and response on federal District Court Judge Flanagan's March 29th ruling in L.S., et al. v. Delia, et al. [No. 5:11-CV-354FL].

[ What's New main ]

Mental Health Reform 3.0

I recently learned of a talented and very ambitious research journalist and UNC student, Lydia Wilson, who chose (yes, chose) to focus on North Carolina's Medicaid Waiver for her master's thesis. 

In her email below, she states that she's "especially interested in human stories of what this system is and why it matters"... A focus on real people? What a novel idea!

Whether you're a parent, provider or any interested stakeholder affected by the new waiver changes and have a story to share, I encourage you to contact Lydia. If you need an introduction, please contact me via no2nchb916@gmail.com.

Lydia's email:

I've just published "Mental Health Reform 3.0," the multimedia news website about North Carolina's Medicaid reform for which I interviewed you recently (or read your writing, blogging, reporting, etc...). This was started as my Masters thesis for the School of Journalism at UNC-Chapel Hill. I'm writing to thank you for your time contributing to the reporting and invite your feedback.

The website can be found at http://www.ncmentalhealthreform.com. At its core are four text articles, called "Reform 101," explaining the story of how N.C.'s reforms to the services for people with mental health or substance abuse disorders or intellectual or developmental disabilities came to be and where they're going. You'll also find an interactive timeline of the reforms, a glossary of key terms, graphics explaining certain issues and personal stories of those affected by the policy.

I will continue covering news of North Carolina's Medicaid reform through 2013 at least. So, please do call or email if there's something that is not covered that should be.

I'm especially interested in human stories of what this system is and why it matters. From policy makers to consumers, if you know people who want to share their story, please send them my way.

I hope you'll excuse the formality of this group email. But it's in part because so many people gave so much time, information and perspective. I appreciate your time sharing your story and hope you'll continue to do so.

As a last note, Rose Hoban of North Carolina Health News has been doing an immense amount of reporting about these reforms and the broader context of healthcare and policy in our state. Follow her site for comprehensive journalism, as well: http://www.northcarolinahealthnews.org/  

email from Dr. Pat Porter

09 April 2012

Received via email from Dr. Pat Porter, DHHS consultant to the NC General Assembly:

Hello Crystal, I followed up on your question regarding the rates of pay for direct care workers per the changes in approved service definitions.  While this seems to be resolved for now, there were a couple of issues that caused some confusion with the transition of ECBH to the B-C Innovations Waiver.

The CAP IDD waiver is not a perfect crosswalk to the Innovations waiver.  In the CAP Waiver, recipients have had access to Home and Community Support (HCS), which is primarily a habilitative  service with a very small amount of personal care (PCS) blended in.  (CAP IDD also has the basic PCS).  So, HCS in CAP cross-walks to In-home Skill Building and PCS in the Innovations waiver.   In-Home Skill Building (a hab service) pays more than PCS.

As ECBH was cross-walking the services during transition, they cross-walked much of the HCS to PCS, rather than In-Home Skill Bldg.   Again, HCS/In-Home Skill Bldg. pays a higher rate than PCS.  But, there was a reason for this. ECBH could find very few habilitation  goals on the plans being reviewed and, unfortunately,  they found little or no evidence of assessments supporting the recipient's ability to benefit from habilitation.  Based on the assessment information they found, it appeared that most recipients were actually receiving more PCS than hab. As you know, the Managed Care sites  must pay for the actual services needed and rendered.

With further review and technical assistance from the Division of Medical Assistance,  ECBH elected that the wisest course of action on behalf of their consumers would be to cross-walk HCS directly to In-Home Skill Bldg for ease of transition.  I am told that these cross-walked plans will last for the remainder of the plan year.  This is the action that had already been taken by Western Highlands and PBH as they made these transitions.  I am told that ECBH alerted the providers in a March 22 Communication and in a town-hall meeting in Greenville but, apparently, not everyone has gotten the word yet.

At some point soon, ECBH will be compelled to address the  habilitation/PCS issue. Perhaps this will occur in Annual Revisions. Care Coordinators have been alerted to pay attention to additional assessments that may be needed to support habilitation goals.  Be assured that the Care Coordinators will develop plans based on what the recipient needs and wants ( that’s the rule). Utilization Management may, however, deny a habilitation service if there is not demonstrated medical necessity per CMS rules.  Certainly, if that should occur, ECBH will offer review and appeal rights. The DHHS will be monitoring the process to assure due process.

This is a long reply but I hope it is helpful to you

PBH Press Release on federal Court ruling

02 April 2012


Press Release and response from Piedmont Behavioral Health (PBH) Director of Communication, Rachel Porter on federal District Court Judge Flanagan's ruling in L.S., et al. v. Delia, et al. [No. 5:11-CV-354FL].