1. Update to the Durham Board of County Commissioners November 4, 2013 Serving Durham, Wake, Cumberland and Johnston Counties

2. Presentation FY14 budget Financial requirements Secretary’s Medicaid reform County Commissioner Advisory Committee Local Business Plan Serving Durham, Wake, Cumberland and Johnston Counties

3. Alliance Funding Serving Durham, Wake, Cumberland and Johnston Counties

4. Durham County Funds Serving Durham, Wake, Cumberland and Johnston Counties

5. Durham County Funds Serving Durham, Wake, Cumberland and Johnston Counties

6. Durham Consumers Served Serving Durham, Wake, Cumberland and Johnston Counties July 2012-March 2013

7. Durham ED Admissions Serving Durham, Wake, Cumberland and Johnston Counties

8. Durham Monthly Hospitalizations Serving Durham, Wake, Cumberland and Johnston Counties February-September 2013

9. Senate Bill 208 Requirements Solvency Timely provider payments Positive ratio of assets to liabilities Ratio of services to administrative expenses Medical Loss Ratio Risk Reserve Serving Durham, Wake, Cumberland and Johnston Counties

10. Paid Within 30 Days Serving Durham, Wake, Cumberland and Johnston Counties

11. DMA Ratios Current Ratio – current assets divided by current liabilities must be greater than 1.0 Serving Durham, Wake, Cumberland and Johnston Counties

12. DMA Ratios Monitoring total service and administrative expenses (including IBNR) compared to capitation Serving Durham, Wake, Cumberland and Johnston Counties

13. DMA Ratios Defensive Interval –days a company can operate without having to access non-current assets; State looking for minimum of 30 Serving Durham, Wake, Cumberland and Johnston Counties

14. DMA Ratios Medical Loss Ratio – medical claims expense divided by the total capitation payment must not fall below 80% at any point in time Serving Durham, Wake, Cumberland and Johnston Counties

15. DMA Ratios Risk Reserve – 2% of monthly capitation deposited within five days of receiving monthly capitation Serving Durham, Wake, Cumberland and Johnston Counties

16. Secretary’s Medicaid Plan DHHS wants fewer MCOs, likely four MCO leaders discussing logical regional structure Counties required to be contiguous Minimum 300,000 covered Medicaid lives Draft map to DHHS Serving Durham, Wake, Cumberland and Johnston Counties

17. Local Business Plan DHHS requirement Originally in NCGS 122C-115.2 To guide the MCOs over the next three years o Five State initiatives o Three local initiatives o Short and long-term measurable goals Regular reporting to DHHS Requires BOCC approval Serving Durham, Wake, Cumberland and Johnston Counties

18. Statewide Initiatives Transition to Community Living o For individuals meeting the definition of need per the DOJ Settlement Agreement should be provided access to community-based supported housing Assertive Community Treatment Team and Supported Employment o Develop a robust provider network and consistent approach to ACTT and Supported Employment Serving Durham, Wake, Cumberland and Johnston Counties

19. Statewide Initiatives Crisis Services/ED Wait Times o Reduce numbers of consumers utilizing crisis services, including EDs Closer to Home – PRTF o Place adolescents needing residential treatment in state and closer to home I/DD Waitlist o Reduce the wait lists and the length of duration to obtain I/DD services Serving Durham, Wake, Cumberland and Johnston Counties

20. Local Initiatives PROACT – Preventable Readmission Options and Care Transitions o Ensuring consumers served receive care coordination for co-occurring behavioral and physical health issues Open Access to Care o To provide same or next day appointments to consumers to prevent crisis events Serving Durham, Wake, Cumberland and Johnston Counties

21. Local Initiatives Jail Initiatives (diversions and post linkages) o Minimum of four different first responder types attending CIT classes in FY14 o May include City/County/university police officers and general first responders such as EMS and fire department personnel Serving Durham, Wake, Cumberland and Johnston Counties

22. In Conclusion Serving Durham, Wake, Cumberland and Johnston Counties County Commissioner Advisory Committee Questions