FAQs [English/Español]
English
SKIP TO MERGER/MEDICAID WAIVER FAQs
Q. What is The Durham Center?
A. The Durham Center is the Local Management Entity (LME) for Durham County. It manages a network of private providers who supply care for Durham County citizens with mental illness, developmental disability and substance abuse diagnoses who have limited or no ability to pay for services.
Q. What is Durham Center Access?
A. Durham Center Access (DCA) is the gateway to all of the local mental health, developmental disability and substance abuse services managed by The Durham Center. You can call Durham Center Access at 800-510-9132 or 919-560-7100 24 hours a day, 7 days a week. Walk-in crisis help is also available for emergency situations 24 hours a day at 309 Crutchfield Street, near Durham Regional Hospital.
Q. What is Durham System of Care?
A. System of Care is an integrated network of community services and resources supported by a partnership between families, professionals and the community in all aspects of service planning and delivery. The goal of System of Care is to establish a seamless array of comprehensive, flexible and effective supports for individuals and families to make the Durham community a better place to live for all.
Q. What number should I call for general information about The Durham Center?
A. (919) 560-7200
Q. How do I get help for myself or someone else?
A. Call Durham Center Access at 800-510-9132 or 919-560-7100 24 hours a day, 7 days a week. Based on the information provided, DCA will give a referral to an agency contracted with The Durham Center for further assessment or will provide immediate assistance in an emergency situation.
Q. How can I file an anonymous complaint?
A. The Durham Center has a Customer Services Department that you can call or visit when you have a question or complaint or want to provide some positive feedback. You can reach Customer Services at (919) 560-7200 or visit our offices at 501 Willard Street in Durham. We are open Monday through Friday from 8:30am to 5:00pm.
Q. How do I report suspected fraud or abuse?
A. A toll-free Compliance Hotline is available at (800) 826-6762 for reporting issues such as suspected fraud or abuse. Callers may remain anonymous.
Q. Where can I get contact information for staff of The Durham Center?
A. You can access a general staff list by clicking on the Contact Us button on the website. You can also access a guide to the right person to contact based on your particular need.
Q. What are good sources of general information about mental illness?
A. Resources include the National Alliance on Mental Illness (www.nami.org) and the state affiliate of that organization (www.naminc.org). Click Other Resources for more information.
Q. What are good sources of general information about developmental disability?
A. Resources include the NC Council on Developmental Disabilities (www.nc-ddc.org) and The Arc of NC (www.arcnc.org). Click Other Resources for more information.
Q. What are good sources of general information about substance abuse/dependence?
A. Resources include the Substance Abuse & Mental Health Services Administration (www.samhsa.gov) and Alcohol/Drug Council of NC (www.alcoholdrughelp.org). Click Other Resources for more information.
Q. What are evidence-based practices?
A. Evidence-based practices are treatments that have been consistently shown in several research studies to assist consumers in achieving their desired goals of health and wellness. The Durham Center focuses on the implementation of these services.
Q. How do you determine what services I need?
A. When you call Durham Center Access, a brief telephone interview will begin to determine which services will most likely to be helpful to you. Then you may be referred to your choice of provider for a formal assessment. A good assessment is the beginning of a good plan for treatment. Based on the information gathered during the assessment, your provider will work with you to make decisions about your treatment needs.
Q. How do you determine what services I am eligible for?
A. Eligibility for services is based on the funding sources available to pay for a service. All basic services and most specialty services are available to individuals with Medicaid coverage or Health Choice for children, and also to those without any insurance. Some specialty services may not be available depending on your coverage. In those cases, we will work with providers to come up with alternatives which will be helpful in your recovery.
Q. What if I don’t have health insurance?
A. When you call Durham Center Access, the representative you talk with can help determine if you are eligible for a variety of publicly-funded services.
Q. How can I learn about and compare local providers?
A. Click the “Provider Search” button on the website to search for providers using your choice of search criteria. The results of your search will provide valuable information which will be useful in comparing providers.
Q. How do I know which provider is best for me?
A. Durham Center Access may refer you to a choice of providers appropriate for your situation. You can compare them using the searchable database by clicking the “Provider Search” button on the website. Also, you can access a booklet that provides tips for choosing a provider. Click Obtaining Services Handbook to view the booklet.
Q. What is a QP, a PP and an AP?
A. “QP” stands for Qualified Professional, “PP” for Paraprofessional, and “AP” for Associate Professional. These designations are determined by the amount of education and supervised training an individual has received.
Q. What are Person-Centered and Family-Centered Planning?
A. Treatment planning that supports individuals with mental illness and their families in their recovery process as a means to achieve their personal goals. It recognizes that recovery is a unique and personal process that involves changing attitudes, values, feelings, goals, skills and roles to live a satisfying, hopeful and contributing life. Providers who work with The Durham Center can explain how a Person-Centered or Family-Centered Plan might assist you in meeting your goals, and you and your provider will create this plan together.
Q. What are Child and Family Teams?
A. Child and Family Teams (for children up to age 19) are made up of healthcare professionals as well as family members, friends, advocates and other people important to the child and family they support. They pool their knowledge and resources to help coordinate the services and supports needed to implement the Family-Centered Plan.
Q. What is Care Review?
A. Care Review is an inter-agency, community-based process that helps adults as well as Child and Family Teams plan services and supports with the adults or the children and families they serve. Care Review can include brainstorming creative best-practice treatment options, ensuring that current services are a good fit, and working to break through barriers that may be keeping the adult or the child and family from reaching their goals.
Q. What are clubhouses and where are they located?
A. Clubhouses are places for adults with mental illness and substance use issues to receive support, learn new skills and be encouraged to reach their goals. In Durham, Wellness City (401 East Lakewood Avenue) is a clubhouse for adults with mental illnesses. A substance abuse clubhouse is located at 307 Corporation Street.
Q. Will The Durham Center come to my church/youth group/community/school to educate us about mental health, developmental disabilities and substance abuse issues?
A. The Durham Center receives many requests for presentations but unfortunately, staff resources for this purpose are limited. To determine availability you may call (919) 560-7256 or email .(JavaScript must be enabled to view this email address).
Q. What is Durham’s Consumer and Family Advisory Committee (CFAC)?
A. CFAC is an advisory committee to The Durham Center that points out gaps in services, offers suggestions for long-term planning, and reviews certain organizational documents. Members are individuals who experience or have family members who experience mental health, developmental disability and/or substance abuse issues.
Q. How can I join CFAC?
A. If you experience or have family members who experience mental health, developmental disability and/or substance abuse issues, email .(JavaScript must be enabled to view this email address) or click CFAC for more information.
Q. What are Medicaid waivers?
A. In a Medicaid waiver certain standard Medicaid requirements are "waived." The provider network can be "right sized" to help ensure high-quality, financially-stable providers chosen by their ability to meet the needs of the community. Savings in the system can be reinvested in additional services. There is greater control of reimbursement rates for services to respond to local needs and the opportunity to create fiscal incentives to providers that can generate improved consumer outcomes.
Q. What is the status of the proposed merger between The Durham Center and the Wake County LME?
A. Leaders of the two LMEs have engaged in informal discussions over the past year or more about possible logical ways for them to work together. When The Durham Center was designated in October 2011 to begin operating as an MCO beginning in January 2013, these discussions accelerated and became focused on merger. A proposed merger agreement is being crafted by the Durham and Wake LMEs in collaboration with their respective county leadership and governing bodies. When finalized, this agreement will spell out the plan for how the new organization will be governed and staffed, what it will be named and where it will be located, how it will handle State and local funding, and so on.
Q. What is the proposed timeline for merger?
A. The proposed merger agreement calls for the two LMEs to begin operating as a merged Area Authority on July 1, 2012. It is hoped that a merger agreement can be finalized early in 2012 to allow ample time for the new organization to prepare for the July 1 merger.
Q. How will The Durham Center operate differently starting January 1, 2013?
A. At that time The Durham Center will begin to operate as a Managed Care Organization (MCO) for mental health, intellectual/developmental disability (IDD) and substance abuse services. As an MCO, The Durham Center will have greater flexibillity to shape the service delivery system to ensure access to quality care that results in better consumer outcomes. Assuming that the Durham-Wake merger becomes reality, staff of The Durham Center will increase from about 75 now to around 380 to accommodate new geographical and MCO responsibilities.
Q. Who will manage State and local dollars?
A. The Durham Center will manage those dollars as well, creating uniform authorization management of Medicaid and State-funded services and a single point of accountability for all public funding.
Q. What is an LME and will The Durham Center still be an LME?
A. LME stands for Local Management Entity, which is an agency of local government - area authorities or county programs - responsible for managing, coordinating, facilitating and monitoring the provision of mental health, intellectual/development disability and substance abuse services. Some North Carolina LMEs have responsibility for a single county while others serve multiple counties. The Durham Center will continue to operate as an LME under contract with the NC Department of Human Services in addition to its MCO operations.
Q. What will The Durham Center's relationship with Cumberland and Johnston counties be?
A. The Durham Center will work with Cumberland and Johnston Area Authorities to manage the behavioral health and IDD services for citizens of these counties. Cumberland and Johnston will have a contract with The Durham Center to perform certain functions of the Managed Care Organization.
Q. What are the advantages to the State and local communities (and taxpayers) of the waivers?
A. The waivers result in stable and predictable Medicaid costs. MCOs are paid a determined amount of money each month for each Medicaid consumer and have the responsibility to manage care with that pool of money. A goal of managed care is to improve the quality of care while controlling the rate of Medicaid growth and managing care for high-risk/high-cost individuals.
Q. Why are the waivers good for consumers?
A. Goals of the Medicaid waiver are to:
-Provide consumers with consistent access to high-quality services in the community
-Use resources in a fair and consistent manner to achieve positive outcomes for consumers
-Provide all services that are in the Medicaid benefit plan available to consumers, so their medically-necessary needs can be met.
Waivers will help enable The Durham Center to "right size" the provider network to better ensure high-quality, financially-stable providers chosen by their ability to meet the needs of the community. Provider credentials will be carefully verified and they will be closely monitored for quality and consumer satisfaction.
The utilization management function of the MCO will provide a powerful tool to help ensure that consumers receive the right service at the right level, and Care Managers will be available to provide direct support to high-cost/high-risk consumers. The Durham Center will have the resources to enhance its focus on consumer-driven care through the expansion of best practices such as recovery, self-direction, System of Care and person-centered planning that use peer support and consumer-led models of care. Waivers provide a strong mandate for The Durham Center to continue its ongoing efforts to integrate behavioral health and intellectual/developmental disability care with the primary health care system, ensuring more comprehensive care for consumers.
As always, The Durham Center will work to ensure consumer choice, to provide local responsiveness to individualized consumer needs and direct relationship with care providers, to give voice to consumers, family members and advocates, to provide 24/7 phone access and crisis services, and to support local CFAC activities.
Q. What about the special concerns of parents and guardians of IDD consumers?
A. Care Coordination through the Managed Care Organization is designed to provide more consistent and effective supports for individuals with intellectual/developmental disabilities. The Innovations Medicaid Waiver under the MCO is designed to allow for more self-directed supports and services for individuals with intellectual/developmental disabilities. Savings that result from effective management of services for these individuals will be reinvested to support more services.
The Durham Center is committed to addressing the unique concerns that caregivers have and will do this through internal workgroups, community forums, and the development of a variety of informational materials.
Q. How will local providers be affected?
A. Over time the MCO will most likely have a smaller network, which adheres to all access standards and better allows for provider collaboration, ensures the health of the provider network, and allows for increased oversight and fiscal management by the MCO. In this way, enrollees are assured of appropriate provider choice while providers in the network have an enhanced opportunity for economic viability in the marketplace.
Initially, all providers with existing contracts with The Durham Center and those providing services to Medicaid-funded clients with Medicaid based in the TDC coverage area will be entitled to apply for membership to the network. They will go through a credentialing process, with full details to be communicated in the coming weeks and months. The MCO will conduct an annual capacity and geo-access study to evaluate the capacity of the enrolled and credentialed provider network to meet the needs of the coverage area and to measure geographic access to provider locations. These studies will help the MCO know when to add or limit capacity.
Q. What is The Durham Center's plan for sharing additional information with consumers and families, providers and other stakeholders?
A. The Durham Center understands that there are concerns and questions throughout the community during this period of transition. Compounding the anxiety is that answers to all of the questions that people have simply have not been finalized yet. The Durham Center is committed to the ongoing sharing of information with all affected stakeholders as it become available. This will be accomplished through various means, including keeping these FAQs up-to-date, by use of the Provider Newsletter and regular provider meetings, by holding public forums throughout the MCO region over the coming months, and by creating a revised website and appropriate print materials.
Español
Preguntas más frecuentes – ciudadanos hispanos
P. ¿Qué es el Centro Durham?
R. El Centro Durham es la Entidad de Gerencia Local (LME) para el condado de Durham. Maneja una red de proveedores privados que pueden proporcionar cuidados a los ciudadanos de Durham County con enfermedades mentales, discapacidades de desarrollo y diagnósticos de abuso de sustancias o drogadicción, que tienen una capacidad limitada, o una falta de capacidad para pagar por los servicios.
P. ¿Cuál es el Acceso de Durham Center?
R. El Acceso del Centro Durham (DCA) Es la puerta de entrada para todos los servicios de salud mental local, discapacidad de desarrollo y servicios de abuso de sustancias dirigidos por el Centro Durham. Puede llamar al Acceso de Durham Center al 800-510-9132 ó 919-560-7100 24 horas al día, 7 días a la semana. También hay ayuda de crisis disponibles para aquellos que tengan situaciones de emergencia, 24 horas al día en 309 Crutchfield Street, en el campus del Durham Regional Hospital.
P. ¿Pueden hablarme en español en el Durham Center y en el Acceso a Durham Center?
R. Sí, pueden. Cuando usted llame será puesto en espera por un momento mientras un traductor se une a la conversación.
P. ¿Cómo puedo encontrar a un proveedor que hable español?
R. Cuando usted llama al Acceso al Durham Center, el representante con el que hable le dirá acerca de los proveedores de servicios que hablan español que son apropiados para su situación.
P. ¿Qué es el Sistema de Cuidados de Durham Center?
R. El sistema de cuidados es una red integrada de nuestros servicios comunitarios y recursos apoyado por una asociación entre familias, profesionales y la comunidad en todos los aspectos de la planeación y entrega de servicios. El objetivo del Sistema de Cuidados es establecer un sistema sin fisuras de apoyo extensos, flexibles y efectivos para individuos y sus familias que hacen que la comunidad de Durham sea un sitio mejor para vivir para todos.
P. ¿A qué número debo llamar para obtener información general acerca del Centro Durham?
R. (919) 560-7200
P. ¿Cómo obtengo ayuda para mí o para alguien más?
R. Llame al Acceso al Durham Center al 800-510-9132 o 919-560-7100 24 horas al día, 7 días a la semana. Basándonos en la información que nos proporcione, el DCA le dará una referencia para una agencia contratada por el Durham Center para hacer más valoraciones o para proporcionarle asistencia inmediata en una situación de emergencia.
P. ¿Cómo puedo presentar una queja anónima?
R. El Centro Durham tiene un Departamento de Servicios al Cliente al que puede llamar o visitar cuando tenga una pregunta o una queja y quiera proporcionar sugerencias positivas. Puede llamar al Servicio de Atención al Cliente al (919) 560-7200 o visitar nuestras oficinas en el 501 Willard Street en Durham. Estamos abiertos de lunes a viernes de 8:30am a 5:00pm.
P. ¿Cómo puedo denunciar una sospecha de fraude o abuso?
R. Un teléfono gratuito Compliance Hotline está disponible en (800) 826-6762 para informar sobre asuntos tales como la sospecha de fraude o abuso. Las personas que llaman pueden permanecer en el anonimato.
P. ¿Dónde puedo obtener información de contacto para el personal del Durham Center?
R. Puede obtener acceso a una lista general del personal haciendo clic en el botón de Contáctenos en nuestra página Web. También puede acceder a una guía para encontrar a la persona adecuada, basándose en su necesidad particular.
P. ¿Cuáles son buenas fuentes de información general acerca de enfermedades mentales?
R. Los recursos incluyen la Alianza Nacional para Enfermedades mentales (www.nami.org) y la afiliada estatal de esa organización (www.naminc.org). Haga clic en Otros Recursos para obtener más información.
P. ¿Cuáles son buenas fuentes de información general acerca de las discapacidades en el desarrollo?
R. Los recursos incluyen en Consejo de NC en Discapacidades del Desarrollo (www.nc-ddc.org) y el Arc de NC (www.arcnc.org). Haga clic en Otros Recursos para más información.
P. ¿Cuáles son buenas fuentes de información general acerca del abuso/dependencia de sustancias?
R. Los recursos incluyen la Administración de Servicios para Abuso de Sustancias y Salud Mental (www.samhsa.gov) y el Consejo de Alcohol y Drogas de NC (www.alcoholdrughelp.org). Haga clic en Otros Recursos para obtener más información.
P. ¿Qué son prácticas basadas en la evidencia?
R. Las prácticas basadas en la evidencia son tratamientos para los que se ha mostrado de forma consistente, en varios estudios de investigación, que ayudan al cliente a alcanzar los objetivos de salud y bienestar deseados. El Centro Durham se enfoca en la implementación de estos servicios.
P. ¿Cómo determina usted qué servicios necesito?
R. Cuando usted llama al Acceso al Durham Center, una breve entrevista telefónica le ayuda a determinar qué servicios son los que probablemente le sean más útiles a usted. Luego se le puede dar una referencia de las opciones que tiene de proveedores para una evaluación formal. Una buena evaluación es el comienzo de un buen plan de tratamiento. Basándose en la información reunida durante esta evaluación, su proveedor trabajará con usted para tomar decisiones acerca de las necesidades de tratamiento.
P. ¿Cómo determinan ustedes para qué servicios soy elegible?
R. La elegibilidad a los servicios está basada en las fuentes de financiación disponibles para pagar por un servicio. Todos los servicios básicos y los servicios más especializados están disponibles para individuos con cobertura de Medicaid o con Health Choice para niños y también para aquellos que no tienen ningún seguro médico. Algunos servicios especializados pueden no estar disponibles, dependiendo de su cobertura. En esos casos, trabajaremos con los proveedores para buscar alternativas que le puedan ayudar en su recuperación.
P. ¿Qué puede ocurrir si no tengo seguro de salud?
R. Cuando usted llama al Acceso al Centro Durham, el representante con el que habla le puede ayudar a determinar si es usted elegible para una serie de servicios que reciben fondos públicos.
P. ¿Cómo puedo conocer y comparar a los proveedores locales?
R. Haga clic en el botón de “Búsqueda de proveedores” o en la página Web para buscar proveedores utilizando el criterio de búsqueda de su elección. Los resultados de su búsqueda le proporcionarán información valiosa que será útil para comparar a los proveedores.
P. ¿Cómo puedo saber qué proveedor es mejor para mí?
R. El Acceso al Durham Center puede referirle a una serie de opciones de proveedores apropiados para su situación. Puede compararlos usando la base de datos de búsqueda haciendo clic en el botón de “Búsqueda de proveedor” en al página Web. También puede acceder al cuaderno que proporciona consejos para escoger un proveedor haciendo clic aquí .
P. ¿Qué es un QP, un PP y un AP?
R. “QP” son las siglas de Qualified Professional o profesional cualificado, “PP” significa Paraprofesional y “AP” Associate Professional o profesional asociado. Estas designaciones están determinadas por la cantidad de educación y entrenamiento supervisado que un individuo ha recibido.
P. ¿Qué es planeación centrada en la persona y planeación centrada en la familia?
R. Planeación de tratamiento que soporta individuos con enfermedades mentales y a sus familias en el proceso de recuperación como medio de alcanzar sus objetivos personales. Reconoce que la recuperación es un proceso único y personal que envuelve un cambio de actitudes, valores, sentimientos, objetivos, habilidades y roles para vivir una vida satisfactoria, esperanzadora y que contribuya. Los proveedores que trabajan en el Durham Center, pueden explicar cómo plan centrado en la persona o un plan centrado en la familia puede ayudarle a cumplir con sus objetivos y usted y su proveedor pueden crear este plan juntos.
P. ¿Qué son los equipos de niños y familias?
R. Los equipos para niños y familias (para niños hasta la edad de 19 años) están hechos de profesionales del cuidado de la salud, así como de miembros de la familia, amigos, defensores y otras personas importantes para el niño y la familia a la que apoyan. Unen sus conocimientos y recursos para ayudar a coordinar los servicios y soportan la necesidad de implementar un plan centrado en la familia.
P. ¿Qué es Care Review?
R. La revisión de cuidados es un proceso basado en la comunidad de una inter-agencia que ayuda a los adultos, así como a los niños y a los equipos de niños y familias a planear servicios y apoya a los adultos de los niños y familias que sirven. La revisión del cuidado puede incluir opciones de tratamiento creativas de las mejores prácticas, que aseguran que los servicios que se dan sean los adecuados y que trabajan para romper las barreras que puedan estar impidiendo que el adulto o el niño y su familia, alcancen sus objetivos.
P. ¿Qué son los clubhouses y donde están localizados?
R. Los Clubhouses son lugares para adultos con enfermedades mentales y problemas de drogadicción en los que reciben apoyo, aprenden nuevas habilidades y son alentados a alcanzar sus objetivos. En Durham, Wellness City (401 East Lakewood Avenue) es un clubhouse para adultos con enfermedades mentales. Hay un clubhouse para drogadicción localizado en 307 Corporation Street.
P. ¿Vendrá el Centro Durham a mi iglesia/grupo de juventud/comunidad/escuela, para educarnos acerca de la salud mental, discapacidades del desarrollo y asuntos relacionados con el abuso de sustancias o drogadicción?
R. El Durham Center recibe muchas solicitudes para presentaciones, pero desafortunadamente, los recursos para el personal para este propósito, son limitados. Para determinar si están disponibles puede llamar al (919) 560-7256 o para enviar un correo electrónico haga clic .(JavaScript must be enabled to view this email address)
P. ¿Qué es el Comité de Asesoramiento a la Familia y al Consumidor de Durham (CFAC)?
R. CFAC es un comité de asesoramiento del Centro Durham que muestra vacíos en el desarrollo de servicios, ofrece sugerencias para la planeación a largo plazo y revisa ciertos documentos de la organización. Los miembros son individuos que experimentan, o tienen miembros de la familia que han experimentado, problemas de salud y problemas de discapacidad en el desarrollo y /o problemas de abuso de sustancias o drogadicción.
P. ¿Cómo puedo unirme a la CFAC?
R. Si usted experimenta, o tiene miembros de la familia que experimentan problemas de discapacidad en el desarrollo y/o abuso de sustancias o drogadicción, envíe un correo electrónico a .(JavaScript must be enabled to view this email address) o haga clic en CFAC para obtener más información.
