LOCAL BUSINESS PLAN
http://www.dhhs.state.nc.us/mhplan/Local%20Business%20Plan-7-1-02WEB.pdf

This summary of the local business plan is a compilation of the state plan technical document and a clarifying memo from Dr. Visingardi dated July 8, 2002.

In response to feedback, the state’s expectations for planning, writing, and submitting the local business plan have been clarified with specifications for completion, general information and requirements for submission, and an explanation of how each local business plan will be evaluated, including the scoring methodology.

The first section of the document reviews the timeline, process and requirements for submission. Each program must decide whether they desire to be considered for Phase I, II, or III of implementation and communicate this decision by October 1, 2002. All programs must submit a Local Business Plan (LBP) by January 2, 2003 with submission of additional sections and any modifications by April 1, 2003. The LBP should be considered a strategic planning document. The content of the LBPs will vary in nature depending on the phase requested. A first phase program will be expected to submit a LBP that demonstrates readiness to implement on July 1, 2003. Phase II and III programs will be expected to submit an LBP demonstrating strategic planning, with action items and timelines that will be taken prior to the submission date for full certification as an LME. The LBP is certified as a three-year plan, meaning that it is expected that additional strategically planned action will occur over that three-year period.

The local business plan will be reviewed and scored by the Division. All elements will be scored but some items are considered more essential and will be weighted. The technical document indicates which items are weighted. A total of 100 points can be earned. The Division may conduct site reviews to validate responses in the local business plan. The Division will provide pre-submission technical assistance upon request. Following review and scoring of the plan, the Department of Health and Human Services (DHHS) can approve the plan without conditions, approve with conditions (a corrective action plan must be returned by a specified date depending on the phase), or determine the LBP unsuccessful. This would occur if the LBP was received after the deadline, the LME information form was not filled out completely, the LBP did not meet the scoring threshold of 50% of each section, or site review findings resulted in lowered scores that were beneath the approved scoring threshold.

There are ten sections of the local business plan. Each section is comprised of elements that must be addressed. The state provides list of items that it will be looking for as evidence that the requirements of the element have been met. For example, the first section is "planning". One of the required elements is "the local business plan planning process meets state requirements". One of the items the state will be looking for as evidence that the requirements of that element are met is "there is a strength/weakness analysis including a methodology for building on strengths and address and/or ameliorating weaknesses."

This summary provides a listing of the sections of the local business plan and the required elements of that section. It does not review the many items that the state will look for as evidence of meeting the requirement. These items are very detailed and often technical. Individuals who are involved in the local business planning process should review this document (link provided above) and become familiar with the expectations the state is requiring in the local business plan.

I. Planning

The LME must develop methods of collaborative planning. They are expected to plan to maximize community alternatives to more restrictive care, involve individuals in the system of governance, address cultural diversity, promote choice, support independence and wellness. Consumer and family participation must go beyond the current level of involvement and must directly seek input.

    1. The Local Business Plan demonstrates congruence with the mission and principles of the State Plan.
    2. The local business plan planning process meetings State Plan requirements
    3. The local business plan incorporates a 3-year strategic plan (no more than 10 pages) for initial implementation

II. Governance, Management and Administration

The LME will adhere to one of the forms of governance as described in the reform statute. The statute sets parameters and targets for the number and demographic characteristics of the local system and the LME must satisfy these for approval of its local business plan.

  1. The local business plan conforms to a governance structure as described in the NC General Statute 122-C as amended
  2. The local business plan defines the proposed demographic configuration of the LME
  3. The local business plan outlines an administrative and organizational structure adequate to meet the needs of the community that is being served by the LME
  4. The local business plan complies with the State Plan requirements regarding administrative management policy and procedures

III. Qualified provider network development

Provider network development will address access, availability, services array, consumer choice, fair competition, and cultural competence. LME management is also responsible for identifying generic services and supports in their respective communities (e.g. faith-based groups, self-help groups).

  1. The local business plan identifies the current qualified provider services list and service array
  2. The local business plan complies with the State Plan requirements in establishing a qualified provider network
  3. The local business plan demonstrates evidence of procedures to manage the provider network
  4. The local business plan complies with State Plan requirements and establishes a system of services and supports for existing populations

IV. Service Management

LMEs must manage all services, supports and treatment, including appropriate level and intensity of services, use of state hospitals, and internal utilization management in compliance with state standards. Sustaining and accommodating individuals in the community requires an array of care management activities, specialized treatments, rehabilitative services and on-going supports.

  1. The local business plan provides for adequate management of core service functions in accordance with the State Plan
  2. The local business plan describes how the LME will conduct service authorization within state standards
  3. The local business plan demonstrates responsibility for oversight of the local delivery of services to target populations
  4. The local business plan complies with the essential elements of the models of best practice as determined by the state

V. Access to Care

Prompt and easy access to services is critical. Outreach is needed to support access to services and supports for under-served and hard-to-reach populations. Services must be available within a reasonable distance of an individual’s residence.

  1. The local business plan describes the operation of a local access system in compliance with the uniform portal of entry and exit in the State Plan
  2. The local business plan provides sufficient evidence of the capacity to support a system of uniform portal of access in compliance with the State Plan
  3. The local business plan indicates the number and location of designated entry points into the system and the types of practitioners/programs that are being designated to perform such services.
  4. The local business plan describes a mechanism or provision of interim services
  5. The local business plan adequately addresses physical and programmatic accessibility issues

    6.  

VI. Service monitoring and oversight: Quality Management

The LME must ensure that services provided to consumers and families meet federal and state regulations and outcomes standards, and ensure quality performance by qualified providers. The quality management system must integrate and analyze information from multiple sources and functions within the organization such as customer services, access, consumer advisory groups and programs as well as external sources.

  1. The local business plan describes a quality management process to meet the State Plan requirements
  2. The local business plan contains a policy that adopts state identified best practices for each target population and individual outcome-based goals
  3. The local business plan describes management information systems (MIS) capabilities sufficient to meet State Plan requirements including the ability to effectively track service events, track outcome date related to public funding and generate performance indicators
  4. The local business plan describes how the LME will provide the state with timely and accurate federal and state data as required

 

VII. Evaluation

Self-evaluation is based on statewide outcome standards and participation in independent evaluation studies

  1. The local business plan provides for external accreditation or certifications consistent with state standards
  2. The local business plan is consistent with State Plan requirements for managing a continuous quality improvement process
  3. The local business plan meets State Plan requirements (per State Plan section on quality management) for evaluating system performance

 

VIII. Financial management and accountability

The LME must complete financial stability checklist requirements, standardized reports, and other reports and data submissions as required. The state may impose sanctions for failure to comply with reporting requirements. Any data, information or reports collected or prepared by the LME or its network providers will e owned by the State of North Carolina

  1. The local business plan includes a financial management plan that assures proper internal controls throughout the operation in accord with state, federal and professional requirements
  2. The local business plan ensures that the LME and qualified providers in the local network understand and comply with applicable federal and state fiscal requirements
  3. The local business plan provides for an adequate audit trail
  4. The local business plan provides for an accounting of all real assets of the LME

    5.  

IX. Information system and data management
  1. The local business plan is in compliance with IPRS (Integrated Payment and Reporting System) and MMIS (Medicaid Management Information System) requirements
  2. The local business plan adhere to the state technology standards
  3. A policy is evident that adopts all security procedures established by the Division of MH/DD/SAS both for the protections and the safeguarding of electronic data financial assets and other material resources

X. Collaboration

LMEs are expected to cultivate partnerships among community agencies.

  1. The local business plan delineates a process that supports and encourages collaboration among community agencies and organizations
  2. The local business plan meets the requirements of all applicable state rules and regulations regarding collaborative relationships
  3. The local business plan describes how the LME will identify, build on, develop and manage a network of informal services and resources necessary to provide the foundation for individualized support and community integration at the consumer, family and community level (e.g. medical services, transportation services, self-advocacy groups, shelters, etc.)
  4. The local business plan has a plan to meet the federal Synar amendment

Appendix A: County/Area Program as LME and Direct Service Provider

The program is responsible for insuring objective case management (independent of service provision) and service coordination. Programs may not be a provider of direct services other than management functions, core services and case management functions unless permitted by the DHHS secretary. Approval may be granted for a temporary period based on one or more of the following conditions:

LMEs authorized to provide direct services must obtain independent case management with the single exception of psychiatric medication management.

A series of documents and requirements must be met for each service the LME plans to offer aimed at ensuring consumer choice and limiting conflict of interest. If the LME is approved to provide services, the program must adopt written policies to assure that consumers are informed about the full array of provider choices and that they are not steered toward services owned, operated, managed or affiliated with the program. Care management must be provided independent of the county/area program.

 

Appendix B. Service Delivery Divestiture Options

Area programs that decide to spin out or spin off staff or programs must meet a series of requirements to ensure continuity and transition of service, fair competition, and best practice. These efforts must adhere to the following: