board of directors meeting - partners health management...2021/02/18 · testerman beeson. the new...

Board of Directors Meeting February 18, 2021 - 6:00 PM

Zoom

I. CALL TO ORDER – Russ Perkins – Chair

II. AGENDA REVISIONS – Russ Perkins

III. CITIZEN RECOGNITION – Russ Perkins

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

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

beginning of the meeting.

IV. APPRPOVAL OF PREVIOUS MEETNG MINUTES – Russ Perkins

A. Approval of January 21, 2021 Board meeting minutes

B. Approval of February 10, 2021 Special Board meeting minutes

Pgs. 2-7

Pgs. 8-15

V. REPORTS – Russ Perkins

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

1. Action Items

a. Approval of previous meeting minutes

b. Budget Revision #6FY21

2. December 2020 Financial Statements – Susan Lackey

B. CFAC Report – Linda McCrary

C. Provider Council President’s Report – Alicia Emmons

D. CEO Report – Rhett Melton

Pgs. 16-18

Pg. 19

Pgs. 20-28

VI. DISCUSSION AGENDA – Russ Perkins

A. County Commissioner Advisory Committee Updates – Russ Perkins

B. Tailored Plan Update – Rhett Melton

C. Compliance Presentation - Information Security – Kenny Swanson

D. Executive Dashboard Report – December 2020 – Shireen Stone

E. Approval of Amended Resolution 2019-91919 PHSI Board Appointments – Drew Walsh

Pgs. 29-34

Pgs. 35-36

VII. CLOSED SESSION – Russ Perkins

Pursuant to NC General Statute, Section 143-318.11, (a)(1); (a)(3); (a)(4); and 122C-126.1

VIII. ADJOURNMENT – Russ Perkins

Next Regular Scheduled Meeting: March 18, 2021 at 6:00 PM

Partners Board of Directors

Regular Meeting Minutes

January 21, 2021 - 6:00 PM

Partners Board of Directors met by means of a virtual Zoom/conference call for its regular monthly meeting.

Board Member Attendance

Commissioner Kevin Austin P Mike Hoffman A

Commissioner Kitty Barnes P Commissioner Anita McCall P

Commissioner Jeffrey Brittain P Linda McCrary P

Robin Testerman Beeson P Henry Morphis - Vice Chair P

Hope Elisa Bryant A Barry Nelson (non-voting) P

Debra Cheek - Treasurer P Commissioner Marvin Norman A

Daryl Cook P David O’Connor P

Alicia Emmons (non-voting) P Russ Perkins – Chair P

Steve Garrison P Joseph Ramey P

Commissioner Bill Goins P Commissioner Ronnie Whetstine P

Jane Hinson P

Partners Staff Present

Rhett Melton Chief Executive Officer

Shireen Stone Chief Operating Officer

Susan Lackey Chief Financial Officer

Andrew Walsh General Counsel & Chief Legal Officer

Selenna Moss Chief Performance & Compliance Officer

Tammy Pyles Clerk to the Board

Kim Powell Deputy Clerk to the Board

Others Present

Yvonne French DHHS Liaison

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

Chair Russ Perkins called the meeting to order at 6:00 p.m. Mr. Perkins stated for the record that the Partners

Board of Directors meeting is an open meeting and is open to the public. He noted that instructions to join the

meeting are posted on the public website. A roll call was conducted to confirm attendance.

Mr. Perkins acknowledged new board members: Alicia Emmons, Commissioner Ronnie Whetstine, and Robin

Testerman Beeson. The new members introduced themselves to the group.

II. Agenda Revisions

A. There were no agenda revisions.

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III. Citizen Recognition

A. There were no citizens present for public comment.

IV. Approval of Previous Meeting Minutes

A. Approval of the November 19, 2020 Meeting Minutes

The minutes from the November 19, 2020 meeting were included in the board meeting agenda packet for

approval. Chair Russ Perkins asked for a motion to approve the previous meeting minutes. Joe Ramey

entered a motion and Kitty Barnes seconded. The floor was opened for discussion. There being no

discussion, the motion carried unanimously.

V. Reports

A. Finance Committee Report – Debra Cheek presented the Finance Committee Report which was included

in the board meeting agenda packet.

1. Approval of Previous Meeting Minutes – The previous Finance Committee meeting minutes were

included in the board meeting agenda packet. At the recommendation of the Finance Committee,

Debra Cheek set forth the November 12, 2020 meeting minutes for board approval. Coming from a

committee no second is required and Russ Perkins called for vote. There being no discussion, the

motion carried unanimously.

2. Budget Revision #5 FY21 – Susan Lackey reviewed budget revision #5 which was included in the

board agenda packet and received prior approval from the Finance Committee. Debra Cheek set

forth a motion from the Finance Committee for board approval. Coming from a committee no

second is required and Russ Perkins called for vote. There being no discussion, the motion carried

unanimously.

3. November 2020 Financial Statements – Financial statements for November 2020, along with a

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

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

Medicaid.

B. CFAC Report – Linda McCrary provided the following report:

1. Partners CFAC met Monday, January 11, 2021 by Zoom at 6pm.

2. Shirley Moore and Allison Crotty were in attendance from Partners as was Stacey Harward from the

State Community Engagement and Empowerment Team.

3. Stacey updated the committee on the CEE calls and meetings. She recommended that our CFAC

consider reaching out more to our legislators and invite them to attend the meetings.

4. Allison Crotty updated the CFAC on the RFA and Tailored plan progress. She provided a PowerPoint

on Medicaid Transformation to Managed Care.

5. The committee voted to move Michael Lennon from representing Burke to representing Catawba

County following a recent move, with an opening in an appropriate discipline.

6. Brenda Phelps from Iredell was removed from the committee with the caveat that she be

reconsidered in the future if she is able and an opening exists.

7. The strategic plan was reviewed with adjustments made to accommodate Zoom meetings and

recommendations to fulfill the goals. It was suggested that county commissioners be encouraged to

help fill vacancies in their counties, and she mentioned that a letter from CFAC may be sent to

commissioners. She noted vacancies as follows:

a. Substance Use Disorder: Lincoln, Surry, Iredell

b. Mental Health: Cleveland, Yadkin, Surry, Burke

c. Intellectual Developmental Disabilities: Rutherford, Surry

8. Stacey Harward reminded members to take time to take care of themselves and to reach out for help

as needed.

9. The next meeting will be held February 8, 2020 at 6:00 p.m. via Zoom.

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C. Provider Council Report – Alicia Emmons provided the following report:

1. The Provider Council will meet on January 22nd at 9:30 a.m. via Zoom. The Provider Council begins

2021 with 31 voting member agencies and one alternate voting member agency.

2. The draft agenda for the January meeting has been distributed to the council. The November 2020

minutes will be voted on at the upcoming January meeting.

3. For 2021, the role of the Chair of the Provider Council will be filled by Alicia Emmons. The role of the

Vice-Chair will be filled by Teagan Brown. The role of the Secretary will be filled by Vickie Smith.

Officers have met to discuss role responsibilities and plan for the upcoming year. Officers will start

the first council meeting of the year with introductions.

4. The council will continue to be assisted by Beth Lackey, serving as Partners representative, who has

been vital to the council. Beth has done an outstanding job with communicating, problem solving, and

helping providers. The council is immensely grateful for her continued service in the coming year.

5. Topics that are expected to be discussed include Tailored Plans, Medicaid Managed Care, County

Expansions, and Electronic Visit Verification. Partners has done an outstanding job at keeping the

council informed on updates regarding these topics. Council members appreciate that open

communication from Partners and hope to continue that practice in the coming year.

D. CEO Report – Rhett Melton provided the following report:

1. State & Local Updates - The state legislature returns to session this month until June and Mr. Melton

noted the long session presents challenges of new bills that are introduced. He stated that Partners

will continue to advocate with the legislative delegation and lobbyists to address Partners key

requests that the legislature:

a. Support and sustain the current LME/MCO model as the state transitions to the Tailored Plan; and

b. Restoration of the funding that has been reduced from the LME/MCO system which has

consequently been a reduction to the members that we serve over the last five years.

2. Covid-19 – As of Tuesday, January 19, 2021, Partners’ number of total positive cases is 45 with a 5%

stop light rate on the Daily Tracker, which is the system Partners uses for daily reporting of virus

statistics. He noted 11 cases have been reported since Christmas which represents a spike related to

the holidays. He reported there has been no in-office spread of the virus. There are no current

hospitalizations and there was only one staff member who became seriously ill, who is now

recovering. He noted that employees are kept up to date with relevant county information as it is

received related to distribution and availability of the vaccine within their counties.

3. Other – Mr. Melton reported that the National Committee for Quality Assurance has updated

Partners’ status from provisional to full accreditation. Selenna Moss noted that Partners is the third

behavioral health organization in the state to acquire this prestigious accreditation, and the only

organization in the state to be duly accredited by both the NCQA and URAC.

VI. Discussion Agenda

A. County Commissioner Advisory Committee – Behavioral Health Focused Updates

1. Burke County – Commissioner Jeff Brittain provided the following report:

a. Burke County has had ongoing discussions about using the old jail facility as a long-term care

facility for substance abuse treatment. He stated the county has reached out to legislators,

Partners and others in the region. He welcomed involvement by other counties to share what

they are doing as this may benefit the region.

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

a. The NC Association of County Commissioners has put together their legislative goals package, one

of which is to increase state funding for behavioral health services and facilities including

dedicated resources for community paramedicine projects, inpatient crises beds, substance use

disorders, specialty courts for individuals with mental health issues in county jails and single

stream funding for area authorities.

b. Catawba County has been focused on Covid-19 and an online portal has been established to get

vaccine appointments scheduled for people 65 years and older.

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c. The county is making good progress in mental health with the jail diversion project and a meeting

is scheduled for next week.

3. Cleveland County – Commissioner Ronnie Whetstine provided the following report:

a. A mental health group had been meeting to address ways to help keep mental health patients out

of the jail system to reduce overcrowding. Progress was being made until attention and

manpower turned to Covid. The good news is since Covid, judges, magistrates and the sheriff’s

office have agreed on creative ways to reduce the jail population. The county has learned some

things during Covid that can be continued after the pandemic to help reduce jail population in the

county and avoid the need for a new jail facility.

b. Covid – 750 vaccines were administered in one day and the county is waiting for more doses of

the vaccine.

Anita McCall joined the meeting at 6:30 p.m.

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

a. Covid vaccinations are conducted every Friday and between 800 and 1,000 dosed are

administered. CaroMont Regional Medical Center is working to administer 5,000 doses of the

vaccine per week.

b. The county is vetting five candidates today for recovery court.

5. Iredell County – In the absence of Commissioner Marvin Norman no report was provided.

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

a. The county is setting up satellite areas for drive thru Covid vaccinations and the health

department began administering Covid vaccines over the last two weeks and that is going well.

b. The county has a volunteer coordinator to schedule doctors and nurses who have volunteered to

administer vaccines. In addition, a satellite area has been established in senior services for people

to call in and ask questions and be registered for a drive thru vaccine appointment.

c. Construction of the new court house continues.

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

a. The county has been awarded the CBDG CV grant wich will provide over 30 months of funding to

prevent eviction and provide for broadband expansion in the county, which is important for

telehealth, the education system, legal services, addiction prevention funding and expanded

home-based options in the Covid-19 environment.

b. It has been reported that the county has the highest Covid death rate per capita in North Carolina.

In addition to vaccines, the county is focused on testing and providing prevention education in the

community.

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

a. The Emergency Services Director of Surry County passed away on Sunday. The community paid

tribute as his body was transported yesterday. He asked that the family remain in everyone’s

thoughts and prayers and he expressed thanks to surrounding counties who are assisting the

emergency services department and staff.

b. Covid vaccines are being administered at the farmers market. The process is efficient and things

are going smoothly. Delivery of additional doses is expected and the goal of the health

department director is that all doses on hand be administered by Friday.

c. He welcomed Robin Testerman Beeson and stated that she is a fine individual and will serve this

board well.

9. Yadkin County – Commissioner Kevin Austin provided the following report:

a. He noted the Covid vaccine is new and different in terms of delivery, management and

documentation than other vaccines, and that a continuous delivery of vaccine doses is needed.

Over 9,000 people (1/3 of the population) in the county have registered to receive a vaccine.

b. Community paramedicine has been established with funding from the Cares Act. The county will

continue this service after the pandemic ends.

c. The county is paying attention to the effects of the pandemic on children, youth and young adults.

This issue is and will continue to be a focus going forward.

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B. FY21 Strategic Plan Update – The report was included as part of the board meeting agenda packet. Rhett

Melton provided an overview of each of the eight strategic plan goals. He explained Partners approach to

reaching each goal as well as the challenges that impact those efforts. He discussed Partners standing in

statewide measures. He discussed current scores and explained reasons for variances in the scores such

as lag time in reporting or processing delays. He updated the board on progress to date as well as the

likelihood of achieving each of the goals. Mr. Melton expressed optimism that the goals will be met by the

end of FY21. Mr. Perkins asked that the Partners Community Outreach video that Mr. Melton mentioned

be shared with the board.

C. Tailored Plan Update – Mr. Melton provided the following update:

a. Tailored Plan RFA Response Timeline: The RFA was released on November 13, 2020. The response is

due to the state on February 2, 2021 at 2 p.m. Announcement of the award of contracts by the state

is due in June 2021 and the expectation is that all will be quiet until then.

b. Partners hit the ground running in November with high expectations of the team. Mr. Melton noted

that Partners Chief Development Officer, Jessica Pape, has done a phenomenal job managing internal

and external contacts who had roles to play in the completion of the RFA document.

c. Partners team has enjoyed mapping out the future of the organization, highlighting the team, systems

and processes in place now and for future operations as a Tailored Plan.

d. Next steps: The response document will be sent to the printer and will be returned the last weekend

in January for final review and submission to the state.

e. Team Partners remains confident that Partners will be awarded a contract.

D. Executive Dashboard Report- November 2020 – The report was included as part of the board meeting

agenda packet. Shireen Stone provided an overview of the dashboard, including annualized penetration

rates by county which she stated has been steady for several months. She reminded the board that the

penetration rate is the percentage of eligible Medicaid recipients who receive services. She stated Super

Measures were reviewed by Mr. Melton and she had no further comments. Claims processing – She

reported that denials continue to be slightly elevated due to Covid. Analysis is being conducted so that

assistance and training can be provided to providers in effort to reduce the number of claims denials.

E. Approval of Partners Policies and Procedures

1. 3rd Quarter Subset Annual Review

a. Information Technology (IT)

b. MHSU Care Coordination

c. IDD Care Coordination

2. RFA – Tailored Plan Expedited Review

a. Advance Directives

b. HHSU Care Coordination

c. Access to Care

d. IDD Care Coordination

e. Clinical – Utilization Review

The policies and procedures were uploaded to ShareFile for review by board members prior to submission

for approval and the LOR documents were included in the board meeting agenda packet. Russ Perkins

commented on unsubstantial edits to the policies that have or will be addressed by Partners staff and he

welcomed comments, feedback and questions from the board. There being none, he asked for a motion

to approve both the 3rd Quarter Subset Annual Review and the RFA – Tailored Plan Expedited Review

policies and procedures as submitted. David O’Connor made a motion to approve and Joe Ramey

seconded. There being no further discussion the motion carried unanimously.

VII. Closed Session

At 7:13 p.m. Linda McCrary made a motion to enter into closed session pursuant to NC General Statute,

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

public record; a(3) to consult with out attorney in order to preserve attorney-client privilege; a(4) to discuss

matters relating to the location or expansion of business in the area served; and Section 122C-126.1 to

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preserve competitive healthcare information. Kevin Austin seconded and the motion carried unanimously.

With the exception of Rhett Melton-CEO, Shireen Stone-COO, Andrew Walsh-CLO and Tammy Pyles-Clerk,

all remaining Partners staff and non-voting board members were excused from the meeting. During closed

session a business matter was discussed and no action was taken by the board.

VIII. Open Session

At 7:56 p.m. Kitty Barnes made a motion to return to open session. Henry Morphis seconded and the


IX. Adjournment

With there being no further discussion, Chair Russ Perkins asked for a motion to adjourn. At 7:57 p.m., Joe

Ramey made a motion to adjourn and Jane Hinson seconded. The motion carried unanimously.

Respectfully submitted,

Tammy Pyles

Clerk to the Board

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Partners Board of Directors

Special Meeting Minutes

February 10, 2021

Partners Board of Directors met by means of a virtual Zoom/conference call for a special meeting.

Board Member Attendance

Commissioner Kevin Austin P Mike Hoffman P

Commissioner Kitty Barnes P Commissioner Anita McCall P

Commissioner Jeffrey Brittain P Linda McCrary P

Robin Testerman Beeson A Henry Morphis - Vice Chair P

Hope Elisa Bryant A Barry Nelson (non-voting) A

Debra Cheek - Treasurer P Commissioner Marvin Norman A

Daryl Cook P David O’Connor P

Alicia Emmons (non-voting) P Russ Perkins – Chair P

Steve Garrison P Joseph Ramey P

Commissioner Bill Goins P Commissioner Ronnie Whetstine P

Jane Hinson P

Partners Staff Present

Rhett Melton Chief Executive Officer

Andrew Walsh General Counsel & Chief Legal Officer

Selenna Moss Chief Performance & Compliance Officer

Tammy Pyles Clerk to the Board

Kim Powell Deputy Clerk to the Board

Others Present

Yvonne French DHHS Liaison

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

Chair Russ Perkins called the meeting to order at Noon. Mr. Perkins stated for the record that Partners Board

of Directors meeting is an open meeting and is open to the public. He stated that the notice required for

special meetings has been posted and included instructions to join the meeting. A roll call was conducted to

confirm attendance.

II. Agenda Revisions

A. There were no agenda revisions.

III. Citizen Recognition

A. There were no citizens present for public comment.

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IV. Discussion Agenda

1. Approval of Partners Resolutions for County Transitions

a) Cabarrus County Resolution #2021-02102021-1

b) Union County Resolution #2021-02102021-2

c) Stanly County Resolution #2021-02102021-3

The resolutions were included in the agenda packet that was emailed to Partners Board in advance of

the meeting. Rhett Melton reminded board members of recent conversations about counties who

have elected to transition to Partners as their LME/MCO. The Boards of County Commissioners of

three of those counties, Cabarrus, Union and Stanly, have passed resolutions and the counties have

proceeded with the transition process. He explained the timeline and the documentation required for

each step in the process. He stated that the counties are now ready to prepare the package which will

be sent to the NC Department of Health and Human Services Secretary for evaluation and

determination. One of the required elements to be included in the package is a formal resolution from

the board of directors of the receiving LME/MCO indicating their willingness to accept the counties

into the organization should the transition be approved by the secretary. Mr. Melton explained the

roles of Andrew Walsh and Selenna Moss who are leading the transition team and who were present

at the meeting for discussion and to answer any questions. Russ Perkins invited questions from the

board and there were none. He stated that each resolution would be voted on separately.

Chair Russ Perkins asked for a motion to approve the Cabarrus County Resolution #2021-02102021-1.

Joe Ramey made a motion to approve and Linda McCrary seconded. There being no further discussion

the motion carried unanimously.

Chair Russ Perkins asked for a motion to approve the Union County Resolution #2021-02102021-2.

Joe Ramey made a motion to approve and Kitty Barnes seconded. There being no further discussion

the motion carried unanimously.

Chair Russ Perkins asked for a motion to approve Stanly County Resolution #2021-02102021-3. Kevin

Austin made a motion to approve and Kitty Barnes seconded. There being no further discussion the


V. Adjournment

With there being no further business to discuss, Chair Russ Perkins thanked Partners Board members for

being available for the special meeting and stated the next regular meeting of the board is scheduled on

February 18th at 6:00 p.m. He also thanked Partners staff for their continued work on the transition plan.

He asked for a motion to adjourn. At 12:10 p.m., Jeff Brittain made a motion to adjourn and Anita McCall

seconded. The motion carried unanimously.

Respectfully submitted,

Tammy Pyles

Clerk to the Board

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PARTNERS HEALTH MANAGEMENT

FINANCE COMMITTEE MEETING

via ZOOM

January 14, 2021 | 5:00 pm

MINUTES

Finance Committee Members Partners Staff

Debra Cheek P Susan Lackey Chief Financial Officer P

Joseph Ramey P Elizabeth Biggerstaff Finance Director A

Daryl Cook P Alan Smith Internal Auditor P

David O’Connor P Terri Morton Executive Assistant P

Kevin Austin P

GUESTS PRESENT:

Russ Perkins, Chairman, Partners Board of Directors

Brian Green, Wells Fargo

CALL TO ORDER:

Debra Cheek called the meting to order at 5:01 pm acknowledging the presence of a quorum.

AGENDA REVISIONS:

Debra Cheek called for Agenda Revisions. Susan Lackey asked that a Credit Line for the RFA be added at

the end of the Agenda.

APPROVAL OF PREVIOUS MEETING MINUTES:

Debra Cheek called for a motion to approve the November 12, 2020 Meeting Minutes forwarded to the

Committee via email. David O’Connor entered a motion to approve the minutes and Kevin Austin

seconded. The motion carried unanimously.

WELLS FARGO

A review of the Short-Term Asset Management Account was made by Mr. Brian Green with Wells Fargo.

(This information was previously forwarded to the Committee via email.) Since Wells Fargo has been

working with this portfolio we have had interest rates averaging 1.5%. In 2020 alone Wells Fargo was

able to provide yields and returns of 2.1% which translates to $600,000 of interest on portfolio for 2020.

Interest rates are expected to see a slight gradual increase in 2021. With no questions from the

Committee, Mr. Green excused himself from the meeting at 5:12 pm.

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NOVEMBER 2020 FINANCIAL STATEMENTS:

Elizabeth Biggerstaff provided an overview of the Balance Sheet, which is found on page five of the

November 2020 Financial Statements and included as part of the agenda packet. Elizabeth reviewed the

contents of the Balance Sheet and Income Statement, each reflecting data through the end of

November 2020. Total current assets $89,286,354; Noncurrent Assets $57,411,279; Total Assets

$146,697,633; Deferred Outflow of Resources 6,770,017; Total Assets and Outflows of Resources

$153,467,650.

Total Current Liabilities $32,523,313; Total Non-Current Liabilities $12,747,416; Deferred Inflows of

Resources $382,238; Total Fund Equity $107,814,683; Total Liabilities, Deferred Inflows of Resources

and Fund Equity: $153,467,650.

Income Statement covering five months ending November 30, 2020 lists Total Operating Revenues

$191,632,501; Total Expenses $176,904,116; giving a net operating gain of $14,728,386; Net gain of

interest income $17,865; Total operating gain $14,746,251. YTD Fund Balance of $1,358,101 was used.

NOVEMBER 2020 DASHBOARD REPORTS:

Susan Lackey provided an overview of the November 2020 Dashboard. The following items were noted:

The Service Penetration Rate as of the end of November 2020 was 16.4%.

Financial Ratios: Medicaid Service Expense Ratio including fund balance is 92.9%. State/IPRS Service

Expense Ratio including fund balance is 85.5%. Total Medicaid Expense Ratio is 93.5%; Medical Loss

Ratio is 86.6%; Consolidated Current Ratio is 2.11 to 1; Defensive Interval days of cash is 85.3 days in

cash.

Medicaid Services by Categories of Service year to date for the month of November is $986,739 over

budget year to date. We continue to review Case Management, Psych Rehab, and Inpatient services,

but do not expect them to be an issue. Partners Clinical and Finance leadership meet monthly to

monitor any overages and bring these budget numbers more in line.

IPRS services by category of service in November has a variance of $345,041 over budget

For the twelve months ending October 31, 2020 a total of 68 Grievances were reported, 52 against

providers and 16 grievances against the MCO. On average in October, Partners took 22 calendar days to

resolve formal grievances and 11 calendar days to resolve informal grievances.

Super Measures: As of the end of November Partners had eight new members housed, two members

were rehoused, and five members lost housing, giving us a net housed of 5 members, which is 47 below

target.

Access to Primary Care Measure is 96.54% with a performance standard of 90%. Members continue to

be concerned about visiting a physician’s office due to COVID.

Super measures for Inpatient Ambulatory follow up:

Medicaid MH 61.8 %

Medicaid Substance Use 75.7 %

State Mental Health 78.6 %

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State Substance Use 74.1 %

Claims Processing, Authorizations and Program Integrity

The top five reasons for denials make up approximately $3.4 million of total denied claims for the month

of November. The top reason for denied claims remains Services not authorized and missing,

incomplete, invalid diagnosis coming from a particular Hospital. Our Claims Department continues to

work with the hospital to correct their billing so that we can get these claims paid. Claims denials due

to service not authorized has decreased to $962,690

BUDGET REVISION #5

Budget Revision #5 which was forwarded to the Committee in the Agenda Packet was reviewed by

Susan Lackey. Budget Revision #5 includes a decrease to the current budget of $3,741,587. This budget

decrease is due to a correction in the 3-Way Hospital Budget not due to a reduction in hospital funding.

We had a duplicate entry in 3-Way funding. Partners Current Budget is $437,913,663. Chief Joseph

Ramey entered a motion to approve Budget Revision #5. Motion was seconded by David O’Connor, and

hearing no objection Budget Revision #5 will be forward to the full Board for Approval.

LINE OF CREDIT

Susan Lackey announced that one of the sections of the Tailored Plan RFA asked for any available lines

of credit. For this reason, Partners has received an unsecured $5,000,000 line of credit through Fidelity.

This line of credit will renew annually. Approval from the Local Government Commission is not required

as the term is under five years. The Origination Fee is $5,000; however, there are no other fees

associated with this Line of Credit if the funds are not used. We are not in need of these funds and have

no intention of using this money. Having the ability to obtain this line of credit helps showcase Partners

current standing.

ADJOURNMENT:

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

Chief Joseph Ramey made motion to adjourn and Kevin Austin seconded. Having no further business,

Debra Cheek adjourned the meeting at 5:28 pm.

Minutes Submitted by: Terri Morton

The Next Regularly Scheduled Finance Committee meeting will be Meeting February 11, 2021

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REVENUES

Beginning Budget 437,913,663$

100,000$ Letter #16 PRTF Pilot

125,000 Letter #33 LEAD Iredell County

2,829,593 Letter #37 FY21 SOR Funding

42,000 Letter #38 TYSR Funding

68,640 Letter #39 CLA Funding

20,296,483 Medicaid Extended Rate increases for COVID-19

142,199 MARS Grant carry over

23,603,915

Revised Budget 461,517,578$

EXPENSES

Beginning Budget 437,913,663$

615,233$ State NON UCR Expense

2,550,000 State UCR Expense

1,344,704 Medicaid Admin Expense

18,554,303 Medicaid Service Expense

397,476 Medicaid Risk Reserve Expense

142,199 Grant Expense

23,603,915

Revised Budget 461,517,578$

PARTNERS BHM

BUDGET REVISION NO.6 FY21

February 11, 2021

Description

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1 | P a g e

January 28, 2021

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

Summary:

Six months into FY21 Partners has positive results overall. As of December 31, we were below budgeted

levels for both Medicaid and non-Medicaid funding with a net surplus overall of $17,922,381 including

fund balance.

The December Executive Dashboard:

Service Penetration Rate:

The service penetration rate calculation is on a rolling 12-month calendar basis Between January 2020

and December 2020, Partners’ catchment area had 190,494 unduplicated Medicaid-eligible members

and 31,134 members received at least one billable service during the year, or a 16.3% penetration rate.

Partners received a capitation payment for 178,395 member months in December, based on the month

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

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

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

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

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

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

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

our catchment is not paying. There is another issue identified that is not paying when the Medicaid

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

receivable (AR) capitation we reported to DMA for December 2020 was $2,860,879. We use 24 months

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

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An increasing trend has continued in the unduplicated count of eligible Medicaid members. This

increasing trend began in March 2020 with the start of COVID. During a crisis the level of Medicaid

coverage for members cannot be reduced or terminated. The end date of the Public Health Emergency

is set to be reconsidered at the state level later this month.

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

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

the Average Penetration Rate by Category of Aid (or County) and is tracked on a rolling 12-month basis.

The overall penetration rate (both by Category of Aid and by County) remains stable at 16.3% when

compared to this period last year. Burke, Gaston Catawba, Iredell, Yadkin, Cleveland, and Lincoln all saw

slight decreases in penetration rate. Rutherford and Surry saw increases.

Financial Statements:

Overall Comments

Partners shows an overall net income of $17,922,381 as of December 31. There is a Medicaid

net income of $11,840,282. The non-Medicaid category has a net surplus of $6,082,100 for the

fiscal year to date December 31, 2020 including fund balance.

Service Expense

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

claims or incurred but not reported (IBNR) claims. Our IBNR estimate for December was

$20,407,008. For the month of December Partners had $24,684,247 in paid claims.

Service Expense Ratio: The Medicaid Service Expense Ratio for fiscal year to date was 92.8%

(including Fund Balance if any).

The State/IPRS Service Expense Ratio was 81.6% (including maintenance of effort (MOE) if any).

The MOE graph was removed for FY21. We do not expect the need for MOE due to the CARES

Act funding.

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

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

Ratio for December 2020 is 95.4%. The benchmark for this measure is 85%.

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

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

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

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

for this measure is 85%. As of December 31, 2020, the Medical Loss Ratio was 86.5%.

Key Balance Sheet Ratios:

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

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

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

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

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

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

from MOE transfers from Medicaid to State.

Current Ratio

The Consolidated Current Ratio for Partners as of December 31, 2020, is 2.15 to 1. The current

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

FY21 year-end estimate for Partners is 2.0.

Defensive Interval

As of December 31, 2020, Partners had 85.4 days of consolidated service expenses in cash. The

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

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

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

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

Reimbursement expenditures.

Grievances:

The total number of grievances reported in January for November was 1 with 100% (1) being

against the MCO. In the past year (12/01/2019-11/30/2020), there have been 62 grievances,

only 15 (24%) of which have been against Partners; 60 of all contacts were immediately

resolved, did not become grievances, and were taken for information and referral within

Partners. On average, in November, Partners took 22 calendar days to resolve formal grievances

with the benchmark being 30 days. The State requires formal grievance resolutions to be

reported in calendar days.

Super Measures:

There will not be penalties associated with the Super Measures during and for one quarter after

the state of emergency. Partners is, however, still tracking our activities during this time.

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Transition to Community Living Initiative (TCLI):

Partners relies on internal counts for to report TCLI activity. The TCLI graph is current through

December 2020. For FY21 Partners is required to have a net increase of 61 individuals housed

for the fiscal year. In December 2020 Partners had eight new members housed, one member

was rehoused, and six members lost housing (reasons for lost housing include a return to ACH,

leaving the TCLI program to live with family, and death). The net housed for the month of

December was 3 members and fiscal year to date is 17 members (28% of the FY target). Partners

experienced an unusually high number of members losing housing last year. We developed an

aggressive plan to rehouse those members and move new members into housing in early 2020.

Unfortunately, we were unable to fully execute this plan due to the COVID pandemic. Our focus

shifted to supporting the members currently in housing while they were not able to participate

in behavioral health services to the extent prior to COVID. Another hindrance is that staff were

not allowed on-site at Adult Care Homes to move members out into the community.

Innovations Integrated Care Super Measure:

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

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

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

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

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

For the period from January 2020 through December 2020, the grand total of Innovations

members eligible for services across all our counties was 608 with 590 receiving services for an

overall percentage of 97.04%. The performance standard is 90% of the eligible population will

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

Ambulatory Follow Up:

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

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

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

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

this report is based on October 2020 data.

The COVID-19 pandemic had a negative impact on Partners’ ambulatory follow up performance.

However, we are seeing more positive ambulatory follow up results as we move through the

year.

The performance standard for this measure for both Medicaid and State services is that at least

40% of individuals discharged shall receive a follow-up visit within 1-7 days after discharge.

Partners has an internal benchmark of 75%.

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In October 2020, 138 Medicaid members were discharged from Inpatient MH services and

60.9% (84) had follow up services within 1-7 days. During this same reporting period, 37

Medicaid members were discharged from Inpatient SU services and 70.3% (26) had services

within 1-7 days. Partners exceeded the external benchmark for both measures.

In October 2020, 112 State members were discharged from Inpatient MH services and 67.0%

(75) had follow up services within 1-7 days. During the same reporting period, 134 State

members were discharged from Inpatient SU services and 76.1% (102) had follow up services

within 1-7 days. Partners exceeded the external benchmark for both measures and the internal

benchmark for Inpatient SU services.

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

Crisis and 3-Way services.

Claims Processing:

In December, Partners processed $29,932,528 in claims. We paid out $24,684,247 in claims, or

82.5% of those that were processed. In December, there were $5,248,281 (17.5%) in denied or

pended claims. On average, Partners is paying claims within 10.4 days from the received date

and providers are submitting claims for payment 24.2 days from the date of service. Overall,

Partners paid providers within 34.6 days from the date of service. The uptick seen in December

is an expected seasonal anomaly attributed to the holidays and check write schedule.

The top five reasons for denials make up approximately $3.1 million of total denied claims for

December. Claims submitted without authorization, duplicate claim submissions, claims

submitted after the billing period, replacement claims submitted with a different provider, and

no coverage for the patient/service/provider combination make up the top 5 reasons for claims

denials in December.

Service is not authorized $ 873,310.46

Duplicate Claim 629,147.15

Claim received after billing period 584,817.16

Submitting Replacement Provider does not match original Provider

565,265.37

No coverage available for Patient/Service/Provider combo 405,697.07

Total $ 3,058,237.21

Service Authorization Request Processing:

In December the Utilization Management (UM) Department processed 100% of Standard and

Expedited Service Authorization Requests within 14 days. UM approved 97.0% of authorizations.

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Of those denied in December, 36.7% were for administrative reasons and 63.3% were for clinical

reasons.

Innovations Slot Tracking:

Partners Innovations entered a new waiver year on July 1, 2020. Partners slot availability for

December was 1,607. As of December 31, 1 Regular Slot remains unassigned. The Emergency,

CAP-C and Money Follows the Person (MFP) Slots make up the 18 Reserved Slot allocation that

Partners receives at the beginning of the Waiver Year. Of the 18 reserved slots, 0 Emergency

slots, 1 CAP-C Transition slots, and35 MFP slots were unassigned. Members must meet specific

criteria to receive one of the reserved slots.

Program Integrity:

Case Activity

As of December 2020, there were 50 open investigations, nine less than last month. Program

Integrity opened ten new investigations and closed 19 investigations in December. There were

zero cases reopened.

Recovery Activity

As of December 2020, on a fiscal year-to-date basis, there were seven overpayments to

providers identified. We have included two rows on the recovery activity. The first is Total

Amount Reduced by Settlement Offer and the second is Total Amount Reduced by Dispute Panel

Review. This will help us to better track/calculate our metrics around TNO reductions and should

allow for more transparency in our overpayment activities.

FYTD PI has collected $114,549 against outstanding overpayments, and $31,228 from provider

self-audits.

The total outstanding balance of overpayments is $1,842,111, inclusive of any amounts that may

have remained unpaid to Partners at the end of prior fiscal years. About 15% of the outstanding

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

payment plans or not otherwise finalized. PID reviewed its outstanding final overpayments and

in consult with General Counsel identified $4,645,181 in overpayments wherein it was

determined further collections activities will not be cost beneficial. These were written off in

December 2020. The remaining balance is from providers, most of whom are no longer in

Partners network. Once out of our network, these companies generally no longer have a

revenue stream, greatly complicating our ability to collect these funds.

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Services:

Medicaid

On a fiscal year-to-date basis, Partners has underspent Medicaid service dollars by $5,544,137

(including IBNR), which is 3.5% under compared to our FY21 budgeted numbers and inclusive of

recoveries and Medicaid Reinvestment in services. The Medicaid categories of service that are

over budget by more than 10% at the end of December 2020 are Inpatient (41%), Psych Rehab

and Inpatient (37%), Long-Term Residential (16%), and ACTT (12%). Partners Clinical and Finance

leadership meet monthly to monitor any overages and take appropriate action.

State

On a fiscal year to date basis, Partners has underspent State service dollars by $3,768,368, or

12.8% including $7,850,952 in non-UCR expenses. The IPRS categories of service that are over

budget by 10% or more at the end of December 2020 are Inpatient (78%), Partial Hospital/Day

Treatment (31%), and 3-Way Hospital (28%).

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Partners Behavioral Health ManagementBalance Sheet

For the Six Months Ending Thursday, December 31, 2020

ASSETS

Current AssetsCash and Cash Equivalents $85,201,701

Accounts Receivable,Net 7,291,857

Short-Term Investments

Prepaid Expenses 728,971

TOTAL CURRENT ASSETS 93,222,529

Noncurrent AssetsRestricted Cash and Cash Equivalents 46,905,647

Long Term Investments 1,211,720

Capital Assets:

Land 1,563,042

Other Capital Assets, Net of Depreciation 8,364,779

Total Capital Assets 9,927,821

Total Noncurrent Assets 58,045,188

TOTAL ASSETS 151,267,717

Deferred Outflows of ResourcesDefined Benefit Plan 6,334,667

Other Postemployment Benefits 435,350

Total Deferred Outflows of Resources 6,770,017

TOTAL ASSETS AND OUTFLOWS OF RESOURCES $158,037,734

LIABILITIES

Current LiabilitiesAccounts Payable and Other Current Liabilities 12,519,918

Liability for Claims Incurred, but not Reported 20,407,008

Compensated Absences - Current Portion 558,139

Total Current Liabilities 33,485,065

Noncurrent LiabilitiesCompensated Absences - Long Term 2,094,801

Other Post Employment Benefits 433,636

Defined Benefit Pension Plan Liability 10,355,390

Total Noncurrent Liabilities 12,883,827

Deferred Inflows of ResourcesDefined Benefit Plan 128,397

Other Postemployment Benefits 253,841

Total Deferred Inflows of Resources 382,238

Fund EquityNet Investment in Capital Assets 9,528,773

Other - NonSpendable 1,302,475

Restricted:

Medicaid Risk Reserve 46,656,870

State Statute and Prepaids 3,572,185

Other 50,604,697

Total Restricted 100,833,752

Medicaid Earnings Prior Years (25,800,263)

Unrestricted 25,421,867

Total Fund Equity 111,286,604

TOTAL LIABILITIES, DEFERRED INFLOWS OF RESOURCES AND FUND EQUITY $158,037,734

1/13/2021

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Partners Behavioral Health Management

Income Statement

For the Six Months Ending Thursday, December 31, 2020

OPERATING REVENUES

Intergovernmental:Federal $11,343,544State 24,233,556Local 1,786,580

Medicaid 193,042,064Other 3,075,366

Total Operating Revenues 233,481,110

EXPENSESPersonnel 19,900,042Professional Services 2,155,785Supplies and Materials 1,092,570Current Obligations and Services 7,203,663Fixed Charges and Expenses 826,201Nondepreciable Capital Outlay 113,242Depreciation 499,923Contracts and Grants 183,044,179Medicaid Savings Reinvestment 258,128Pension ExpenseOther 480,294

Total Expenses 215,574,026

OPERATING GAIN/(LOSS) 17,907,083

NONOPERATING INCOMEInterest Income 15,298

Total Nonoperating Income 15,298

TOTAL OPERATING GAIN/(LOSS) 17,922,381

FUND BALANCE USED $1,713,737

1/13/2021

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Executive Dashboard, December 2020

Access to Services Report as of December 31, 2020

Executive Dashboard Report

December 31, 2020

12-Month Average Member Months

166,926

12-Month MCD Unduplicated

Served16.3%

12-Month Medicaid Penetration Rate

TotalUnduplicated

Eligibles

31,134 190,494

Unduplicated # Received Services

7.7%

Members Receiving Servicesfor the month of December 2020

Unduplicated Count

166,344 12,885

12-Month Non-MCD Unduplicated

Served10.5%

12-Month Non-Medicaid Penetration Rate

Non-Medicaid inCatchment Area

10,811

102,790

Penetration Change from

Month: DecemberServed Eligible Rate Prior Year

Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%

12-Month Penetration Rate by County of Eligibility



Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%




Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%




Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%




Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%




Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%




Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%




Burke 2,909 17,626 16.5% -1.1%

Catawba 4,455 28,548 15.6% -0.9%

Cleveland 4,284 25,486 16.8% -0.3%

Gaston 8,004 45,682 17.5% -1.0%

Iredell 4,040 27,161 14.9% -0.4%

Lincoln 2,469 13,368 18.5% -0.3%

Rutherford 2,233 14,065 15.9% 2.2%

Surry 2,204 15,236 14.5% 1.2%

Yadkin 925 6,632 13.9% -0.3%


Page 1 of 6

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Financial Statements Report as of December 31, 2020

Medicaid Non-Medicaid Combined Total YTD Budget Variance

Service:

Revenue $164,860,144 $34,281,165 $199,141,309 $193,314,722 ($5,826,587)

Expense 154,546,088 28,756,224 183,302,312 192,672,637 9,370,325

Net Service 10,314,056 5,524,941 15,838,997 642,085 (15,196,912)

Administrative:

Revenue 24,308,118 3,070,364 27,378,482 25,805,722 (1,572,760)

Expense 23,076,328 3,208,990 26,285,318 32,908,558 6,623,240

Intergovernmental Transfers 957,432 0 957,432 (957,432)

Tailored Plan Readiness 1,155,159 0 1,155,159 (1,155,159)

Net Administrative (880,801) (138,626) (1,019,427) (7,102,836) (6,083,409)

Net Operating Income 9,433,255 5,386,315 14,819,570 (6,460,751) (21,280,321)

Other:

Risk Reserve Revenue 3,873,803 0 3,873,803 3,722,688 (151,115)

Other Income/Revenue 797,860 591,216 1,389,076 1,860,426 471,350

Other Financing Resources 1,609,169 104,567 1,713,736 4,401,565 2,687,829

Total Other 6,280,832 695,783 6,976,615 9,984,679 3,008,064

Risk Reserve Expense 3,873,803 0 3,873,803 3,523,950 (349,853)

Net Other 2,407,029 695,783 3,102,812 6,460,729 3,357,917

Net Income (Loss) $11,840,282 $6,082,100 $17,922,381 $0 ($17,922,381)


Income Statement

For Six Months Ending December 31, 2020

Medicaid Total Medicaid Total

Cash $74,122,935 $85,201,701 Accounts Payable $2,090,437 $2,459,338

Other Current Assets 1,126,591 8,020,828 IBNR-Claims Payable 20,407,008 20,407,008

Total Current Assets 75,249,526 93,222,529 Other Current Liabilities 11,022,113 20,974,110

Total Current Liabilities 33,519,558 43,840,456

Net Property and Equipment 3,278,334 9,927,821 Other Liabilities 2,474,074 2,910,675

Fund Balance:

Investment in Fixed Assets 0 9,528,773

Long-Term Investments 1,211,720 1,211,720 Other Non-Spendable 0 1,302,475

Other Assets 0 6,770,017 Restricted 93,397,159 100,833,750

Risk Reserve 46,905,647 46,905,647 Accumulated Net Surplus (Deficit) (25,800,263) (25,800,263)

Unreserved 23,054,700 25,421,868

90,651,596 111,286,603

Total Assets $126,645,227 $158,037,734 Total Liabilities and Fund Balance $126,645,227 $158,037,734

Assets Liabilities and Fund Balance


Balance Sheet as of December 31, 2020

Medicaid Non-Medicaid Combined Total YTD Budget Variance

Service:

Revenue $164,860,144 $34,281,165 $199,141,309 $193,314,722 ($5,826,587)

Expense 154,546,088 28,756,224 183,302,312 192,672,637 9,370,325

Net Service 10,314,056 5,524,941 15,838,997 642,085 (15,196,912)

Administrative:

Revenue 24,308,118 3,070,364 27,378,482 25,805,722 (1,572,760)

Expense 23,076,328 3,208,990 26,285,318 32,908,558 6,623,240

Intergovernmental Transfers 957,432 0 957,432 (957,432)

Tailored Plan Readiness 1,155,159 0 1,155,159 (1,155,159)

Net Administrative (880,801) (138,626) (1,019,427) (7,102,836) (6,083,409)

Net Operating Income 9,433,255 5,386,315 14,819,570 (6,460,751) (21,280,321)

Other:

Risk Reserve Revenue 3,873,803 0 3,873,803 3,722,688 (151,115)

Other Income/Revenue 797,860 591,216 1,389,076 1,860,426 471,350

Other Financing Resources 1,609,169 104,567 1,713,736 4,401,565 2,687,829

Total Other 6,280,832 695,783 6,976,615 9,984,679 3,008,064

Risk Reserve Expense 3,873,803 0 3,873,803 3,523,950 (349,853)

Net Other 2,407,029 695,783 3,102,812 6,460,729 3,357,917

Net Income (Loss) $11,840,282 $6,082,100 $17,922,381 $0 ($17,922,381)


Income Statement

For Six Months Ending December 31, 2020

Medicaid Total Medicaid Total

Cash $74,122,935 $85,201,701 Accounts Payable $2,090,437 $2,459,338

Other Current Assets 1,126,591 8,020,828 IBNR-Claims Payable 20,407,008 20,407,008

Total Current Assets 75,249,526 93,222,529 Other Current Liabilities 11,022,113 20,974,110

Total Current Liabilities 33,519,558 43,840,456

Net Property and Equipment 3,278,334 9,927,821 Other Liabilities 2,474,074 2,910,675

Fund Balance:

Investment in Fixed Assets 0 9,528,773

Long-Term Investments 1,211,720 1,211,720 Other Non-Spendable 0 1,302,475

Other Assets 0 6,770,017 Restricted 93,397,159 100,833,750

Risk Reserve 46,905,647 46,905,647 Accumulated Net Surplus (Deficit) (25,800,263) (25,800,263)

Unreserved 23,054,700 25,421,868

90,651,596 111,286,603

Total Assets $126,645,227 $158,037,734 Total Liabilities and Fund Balance $126,645,227 $158,037,734

Assets Liabilities and Fund Balance


Balance Sheet as of December 31, 2020

Page 2 of 6

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Financial Risk Report as of December 31, 2020

Medicaid Service Expense Ratio (includes Fund Balance) 92.8%

Medicaid Net Service (Over)/Under $10,314,056

State Service Expense Ratio (includes Fund Balance, if any) 81.6%

State Net Service (Over)/Under excluding Fund Balance $4,823,834

Medicaid Report as of December 31, 2020

Financial Ratios (YTD):

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

Inpatient $10,433,436 $869,453 $1,426,146 ($556,693) $5,216,718 $7,360,414 ($2,143,696) (41%)

Community Support 1,800,641 150,053 125,991 24,062 900,321 892,265 8,055 1%

BH Long-Term Residential 19,892,712 1,657,726 1,924,646 (266,920) 9,946,356 11,515,697 (1,569,341) (16%)

PRTF 10,700,698 891,725 735,027 156,698 5,350,349 4,827,261 523,088 10%

Case Management 1,565,088 130,424 127,674 2,750 782,544 782,553 (9) (0%)

Outpatient 36,297,288 3,024,774 3,145,318 (120,544) 18,148,644 19,259,650 (1,111,006) (6%)

ACTT 9,538,516 794,876 850,026 (55,150) 4,769,258 5,362,864 (593,606) (12%)

MST 1,065,087 88,757 90,917 (2,160) 532,544 377,984 154,559 29%

IIHS/FCT 11,735,000 977,917 926,300 51,616 5,867,500 5,798,752 68,748 1%

Part Hosp/Day Treatment 7,523,671 626,973 365,109 261,863 3,761,836 2,797,905 963,931 26%

Psych Rehab 4,887,111 407,259 529,205 (121,946) 2,443,556 3,352,668 (909,112) (37%)

Crisis Services 3,781,451 315,121 206,621 108,499 1,890,726 1,188,058 702,668 37%

Innovations 100,126,280 8,343,857 8,023,303 320,553 50,063,140 47,413,567 2,649,573 5.3%

ICF-MR 90,864,327 7,572,027 7,100,185 471,842 45,432,164 40,990,495 4,441,668 9.8%

Peer Support 3,235,324 269,610 19,031 250,580 1,617,662 109,165 1,508,497 93%

1915(b)(3) 6,048,159 504,013 449,308 54,705 3,024,080 2,411,807 612,273 20%

Medicaid Reinvestment 685,661 57,138 68,818 (11,680) 342,831 258,128 84,703 25%

Recoveries 0 0 (55,203) 55,203 0 (153,146) 153,146

Total $320,180,450 $26,681,704 $26,058,424 $623,280 $160,090,225 $154,546,088 $5,544,137 3.5%

Fiscal Year Medicaid Services Cost

(includes IBNR) Monthly Fiscal YTD

95.4%

86.5%

85.0% 85.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Medicaid ExpenseRatio

Medical Loss Ratio(YTD)

Financial Ratios

Dec-20 Target

2.15

2.00

0.00

0.50

1.00

1.50

2.00

2.50

Consolidated Current Ratio

Dec-20 Target

85.4

60.0

0.0

20.0

40.0

60.0

80.0

100.0

# Days Service Expense in Cash

Dec-20 Target

Key Financial Indicators(Includes Long-Term Investments)


Inpatient $10,433,436 $869,453 $1,426,146 ($556,693) $5,216,718 $7,360,414 ($2,143,696) (41%)

Community Support 1,800,641 150,053 125,991 24,062 900,321 892,265 8,055 1%

BH Long-Term Residential 19,892,712 1,657,726 1,924,646 (266,920) 9,946,356 11,515,697 (1,569,341) (16%)

PRTF 10,700,698 891,725 735,027 156,698 5,350,349 4,827,261 523,088 10%

Case Management 1,565,088 130,424 127,674 2,750 782,544 782,553 (9) (0%)

Outpatient 36,297,288 3,024,774 3,145,318 (120,544) 18,148,644 19,259,650 (1,111,006) (6%)

ACTT 9,538,516 794,876 850,026 (55,150) 4,769,258 5,362,864 (593,606) (12%)

MST 1,065,087 88,757 90,917 (2,160) 532,544 377,984 154,559 29%

IIHS/FCT 11,735,000 977,917 926,300 51,616 5,867,500 5,798,752 68,748 1%

Part Hosp/Day Treatment 7,523,671 626,973 365,109 261,863 3,761,836 2,797,905 963,931 26%

Psych Rehab 4,887,111 407,259 529,205 (121,946) 2,443,556 3,352,668 (909,112) (37%)

Crisis Services 3,781,451 315,121 206,621 108,499 1,890,726 1,188,058 702,668 37%

Innovations 100,126,280 8,343,857 8,023,303 320,553 50,063,140 47,413,567 2,649,573 5.3%

ICF-MR 90,864,327 7,572,027 7,100,185 471,842 45,432,164 40,990,495 4,441,668 9.8%

Peer Support 3,235,324 269,610 19,031 250,580 1,617,662 109,165 1,508,497 93%

1915(b)(3) 6,048,159 504,013 449,308 54,705 3,024,080 2,411,807 612,273 20%

Medicaid Reinvestment 685,661 57,138 68,818 (11,680) 342,831 258,128 84,703 25%

Recoveries 0 0 (55,203) 55,203 0 (153,146) 153,146

Total $320,180,450 $26,681,704 $26,058,424 $623,280 $160,090,225 $154,546,088 $5,544,137 3.5%

Fiscal Year Medicaid Services Cost

(includes IBNR) Monthly Fiscal YTD

Page 3 of 6

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IPRS Report as of December 31, 2020

Quality Improvement Feedback Report as of December 31, 2020

Grievances:

Total = 62

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

0.0

13.0

0.0

15.0 13.0

12.0

15.0 15.013.0

12.011.0 11.0

0.00

5

10

15

20

25

30Average Number of Days to Resolve a

Informal Grievance

Avg Working Days for Informal Grievances Goal to Resolve Informal Grievances


Inpatient $900,004 $75,000 $536,535 ($461,534) $450,002 $802,531 ($352,529) (78%)

Community Support 7,098,602 591,550 283,104 308,446 3,549,301 1,738,103 1,811,198 51%

BH Long-Term Residential 10,471,750 872,646 636,707 235,939 5,235,875 4,471,922 763,953 15%

Outpatient 16,289,888 1,357,491 584,269 773,221 8,144,944 3,663,985 4,480,959 55%

ACTT 1,383,427 115,286 78,574 36,712 691,714 489,297 202,416 29%

Part Hosp/Day Treatment 242,321 20,193 33,762 (13,569) 121,161 159,276 (38,116) (31%)

Psych Rehab 402,851 33,571 13,651 19,920 201,426 61,896 139,529 69%

Crisis Services 4,918,815 409,901 357,718 52,183 2,459,408 2,541,675 (82,268) (3%)

3-Way Hospitals 6,177,672 514,806 275,100 239,706 3,088,836 3,962,522 (873,686) (28%)

Non-UCR (excluding County) 11,127,981 927,332 2,581,363 (1,654,031) 5,563,991 7,850,952 (2,286,962) (41%)

Total $59,013,311 $4,917,776 $5,380,783 ($463,007) $29,506,656 $25,738,287 $3,768,368 12.8%

Fiscal Year IPRS Services Cost Monthly Fiscal YTD

$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

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

YTD Actual YTD Budget

28.0 26.0 27.0 28.0 28.0 28.0

22.0

28.0

25.0 25.0 24.022.0 22.0

0

10

20

30

40

50Average Number of Days to Resolve a

Formal Grievance

Avg Calendar Days for Formal Grievances Goal to Resolve Informal Grievances

15 24%

47 76%

0 0%

Grievances12 Months Ending November 30, 2020

Grievances Against MCO Grievances Against Providers

Grievances Against Other


Inpatient $900,004 $75,000 $536,535 ($461,534) $450,002 $802,531 ($352,529) (78%)

Community Support 7,098,602 591,550 283,104 308,446 3,549,301 1,738,103 1,811,198 51%

BH Long-Term Residential 10,471,750 872,646 636,707 235,939 5,235,875 4,471,922 763,953 15%

Outpatient 16,289,888 1,357,491 584,269 773,221 8,144,944 3,663,985 4,480,959 55%

ACTT 1,383,427 115,286 78,574 36,712 691,714 489,297 202,416 29%

Part Hosp/Day Treatment 242,321 20,193 33,762 (13,569) 121,161 159,276 (38,116) (31%)

Psych Rehab 402,851 33,571 13,651 19,920 201,426 61,896 139,529 69%

Crisis Services 4,918,815 409,901 357,718 52,183 2,459,408 2,541,675 (82,268) (3%)

3-Way Hospitals 6,177,672 514,806 275,100 239,706 3,088,836 3,962,522 (873,686) (28%)

Non-UCR (excluding County) 11,127,981 927,332 2,581,363 (1,654,031) 5,563,991 7,850,952 (2,286,962) (41%)

Total $59,013,311 $4,917,776 $5,380,783 ($463,007) $29,506,656 $25,738,287 $3,768,368 12.8%

Fiscal Year IPRS Services Cost Monthly Fiscal YTD

Page 4 of 6

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Super Measures

Transitions to Community Living

as of December 31,2020

Ambulatory Follow Up Reported on 2-Month Lag

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

60.9%

70.3% 67.0%

76.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Oct-20

Follo

w U

p P

erc

en

tage

Inpatient Ambulatory Follow Up(from Claims Data)

MCD MH MCD SU State MH

State SU Internal Benchmark Performance Measure

Innovations Members Receiving Services

97.04%

Access to Primary/Preventive Care for Individuals Under the Innovations Waiver as of December 31, 2020

590

EligibleMembers

608

Source: TCLI Manager

17 Net Housed q 44 Below Target

Net Housed FYTD: 17 Total Rehoused FYTD: 8

817

0 10 20 30 40 50 60 70

Benchmark (61) Current (17) Target (61)

17 Net Housed q 44 Below Target

Net Housed FYTD: 17 Total Rehoused FYTD: 8

817

0 10 20 30 40 50 60 70

Benchmark (61) Current (17) Target (61)

Page 5 of 6

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Operational Performance Report as of December 31, 2020

Claims:

Number of Days to Process and Pay All Claims:

Oct'20 Nov'20 Dec'20

Service Date to Received Date 19.9 19.1 24.2

Received Date to Paid Date 9 8.8 10.4

Service Date to Paid Date 28.9 27.9 34.6

Top 5 Reasons for Denied Claims:

Oct'20 Nov'20 Dec'20

Duplicate Claim 683,288.21$ 763,062.55$ 629,147.15$

Service is not authorized 1,247,235.88$ 962,690.10$ 873,310.46$

Claim received after billing period 419,375.69$ 584,817.16$

Missing/incomplete/invalid diagnosis or

condition.593,434.62$

No coverage available for

Patient/Service/Provider combo666,961.17$ 405,697.07$

Invalid DCN (Document Ctrl #) or resubmission

ref #436,692.90$

R&B service already exists - cannot bill another

one488,877.00$

Submitting Replacement Provider does not

match original Provider680,337.52$ 565,265.37$

Total 3,519,114$ 3,422,841$ 3,058,237$

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

#4 Denial Code #5 Denial Code

Treatment Authorization Requests (TAR):

Authorization Requests Oct-20 Nov-20 Dec-20

Total Number of Auth Requests Received 3,542 3,077 3,676

% Processed in 14 Days 100.0% 100.0% 100.0%

# Auth Requests requiring Expedited

Decisions, inclusive of Inpatient 240 232 237

% Processed in 3 Days 100.0% 100.0% 100.0%

Total % of Auth Requests Processed in Required

Timeframes 100.0% 100.0% 100.0%

# of Auth Requests Denied for Clinical Reasons 90 71 69

# of Administrative Denials 35 51 40

Total # of Auth Requests Denied 125 122 109

% of Total Auth Requests Approved 96.5% 96.0% 97.0%

Program Integrity

Innovations Slot Tracking

$5,249

$29,933

$24,684

8.8%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

Perc

ent o

f Denie

d C

laim

s

Cla

ims (

$000)

Claims Processing

Claims Denied and Pended Total Claims Processed (000)

Total Claims Paid (000) Claims Percent Denied

10.1

9.0 9.0 8.7 8.9 8.9 8.4

8.8 8.7 8.9 9.0 8.8

10.0

4.0

6.0

8.0

10.0

12.0

14.0

# o

f D

ays

Days to Pay Clean Claims *

Average Number of Days * Clean claims contain all

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

TNO Prior Years FY19 FY20 FY21 TD

Initial TNO Amount 6,984,885$ 2,651,069$ 1,809,834$ 821,892$

No. of TNO's Issued 181 31 21 7

Total Amount Reduced by Dispute Panel Review -$ 183,369$ 10,116$ -$

Total Amount Reduced by Settlement Offer -$ 363,782$ 1,316,399$ 302,444$

Adjusted TNO Amount 966,287$ 2,045,405$ 161,065$ 787,011$

% Reduction of Initial TNO -86% -23% -91% -4%

Amount Collected during the Fiscal Year* 939,010$ 258,655$ 824,814$ 114,549$

Total Amount of Adjusted TNO Recouped** 935,117$ 1,027,522$ 81,693$ 73,325$

% of Adjusted TNO Recouped 96.77% 50.24% 50.72% 9.32%FY Outstanding Balance 31,170$ 1,017,883$ 79,373$ 713,686$

Total TNO Outstanding Balance $1,842,111

Total Self-Audit Recoveries YTD $31,228

New Cases 10

Closed Cases 19

Reopened 0

Total Open Cases 50

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

For FY20 there have been $1.6m in reductions from the initially identified overpayment amount in return for significant recoveries, saved litigation costs, preserved provider network adequacy and added protections such as indemnifications and plans of correction.Seperately tracking Settlement Offers and Disputes Panel Review adjustment amounts started in FY2020 and is being tracked for TNOs issued in FY20.

TNO Prior Years FY19 FY20 FY21 TD

Initial TNO Amount 6,984,885$ 2,651,069$ 1,809,834$ 821,892$

No. of TNO's Issued 181 31 21 7

Total Amount Reduced by Dispute Panel Review -$ 183,369$ 10,116$ -$

Total Amount Reduced by Settlement Offer -$ 363,782$ 1,316,399$ 302,444$

Adjusted TNO Amount 966,287$ 2,045,405$ 161,065$ 787,011$

% Reduction of Initial TNO -86% -23% -91% -4%

Amount Collected during the Fiscal Year* 939,010$ 258,655$ 824,814$ 114,549$

Total Amount of Adjusted TNO Recouped** 935,117$ 1,027,522$ 81,693$ 73,325$

% of Adjusted TNO Recouped 96.77% 50.24% 50.72% 9.32%FY Outstanding Balance 31,170$ 1,017,883$ 79,373$ 713,686$

Total TNO Outstanding Balance $1,842,111

Total Self-Audit Recoveries YTD $31,228

New Cases 10

Closed Cases 19

Reopened 0

Total Open Cases 50

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

For FY20 there have been $1.6m in reductions from the initially identified overpayment amount in return for significant recoveries, saved litigation costs, preserved provider network adequacy and added protections such as indemnifications and plans of correction.Seperately tracking Settlement Offers and Disputes Panel Review adjustment amounts started in FY2020 and is being tracked for TNOs issued in FY20.

Page 6 of 6

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Partners Board of Directors Resolution 2021-02182021-4 PHSI BOD p.1 of 2

BOARD OF DIRECTORS

Resolution Number: 2021-02182021-4 Resolution Sponsor: Office of Legal Affairs (OLA) Date: February 18, 2021

I, Clerk to the Board of Directors, hereby certify that the Resolution below is a true and exact copy of a resolution adopted by the Board of Directors during a regular meeting on February 18, 2021. ______________________________________ Clerk to the Board Date WHEREAS, Partners Health Management (“Partners”) is a multi-county local political subdivision of the State operating as a Public Authority, Area Authority, Local Management Entity (LME) and LME/Managed Care Organization (LME/MCO) as defined by North Carolina General Statutes § 159-7(b)(10) and §§ 122C-3(1), -3(20b), -3(20c) and -116(a); and WHEREAS, this Board previously approved by proper motion to “[e]mpower staff to take all steps & actions necessary to establish a 501c nonprofit corporation in order to perform future activities as authorized by the Board of Directors”; and WHEREAS, on June 20, 2019, Partners did create with the North Carolina Secretary of State’s office, such a 501(c)(4) nonprofit corporation entitled Partners Health Solutions, Inc. (“PHSI”); and WHEREAS, PHSI needs the PARTNERS Board to appoint from 1 to 21 initial directors to the PHSI Board to lead the new nonprofit corporation; NOW, THEREFORE, BE IT RESOLVED, that PARTNERS’s Board of Directors hereby:

1. Appoints the following first five named persons for the following terms on the initial PHSI Board, with a star, asterisk, initials, or other emphasis added for the additionally named persons appointed as alternates should any of those persons appointed are unable or unwilling to serve as initial PHSI Board Directors:

PHSI Director Name Term expires

Wil Neumann 6/30/22

Debra Cheek 6/30/23

Gayle Mitchell 6/30/24

Larry Phillips 6/30/23

J. Russ Perkins 6/30/24

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Partners Board of Directors Resolution 2021-02182021-4 PHSI BOD p.2 of 2

2. Authorizes PARTNERS management to pay or transfer to PHSI up to $10,000 in

FY20-21 for PHSI to open a bank account and to fund initial, reasonable expenses of that new entity consistent with PHSI’s Articles of Incorporation and applicable laws.

BOARD ACTION: MOTION _____________ SECONDED __________________

AYE NAY UNANIMOUS _____________________

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board of directors meeting - partners health management...2021/02/18 · testerman beeson. the new...

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