FAQs
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 can my agency become enrolled with The Durham Center?
A. In general, The Durham Center selects providers through a Request for Proposal (RFP) process based on identified community needs for particular services. Other selection methods may also be used, including Requests for Information (RFIs) and Requests for Qualifications (RFQs). The Durham Center offers State and County contracts only to providers who take part in an official RFP/RFI/RFQ process. For complete information, contact (919) 560-7366 or .(JavaScript must be enabled to view this email address).
Q: I am interested in providing Medicaid Enhanced Services (i.e. Community Support Team, Intensive In-Home, Residential, CAP, etc.). Where can I find information and a checklist to confirm that I am in compliance with state/federal laws governing these types of services?
A: Information can be found on the NC Division of MH/DD/SA Services website.
Q. What should my agency know about becoming nationally accredited?
A. All Medicaid Enhanced Benefit Services providers must either be nationally accredited or meet the CARF Standards for unaccredited providers. These standards are available from The Durham Center’s Compliance Officer. Click for more information on becoming nationally accredited.
Q. Where do I find bulletins, forms and other documents?
A. These are accessed by clicking on the “Documents and Forms” button on the website and are organized by various sub-categories.
Q. What do I do if I have a billing question or issue?
A. Providers can contact their Billing Coordinator or the Finance Director at The Durham Center. For Medicaid related billing questions, provider can contact EDS Provider Services at 1-800-688-6696.
Q. How can I learn about housing resources available to my consumers in the community?
A. Click the “Housing” button on the website. For information about housing assistance, call (919) 560-7144 or .(JavaScript must be enabled to view this email address).
Q. How do I report an incident involving a consumer?
A. All Level II and Level III incidents must be reported to The Durham Center via the Incident Response Improvement System (IRIS) within 72 hours. Level III incidents also require verbal notification to The Durham Center as soon as possible but within 24 hours. Providers are also required to submit a Provider Quarterly Incident Report (Form Q11) by the tenth of the month following the end of the quarter to report aggregate information on Level I-III incidents. Providers should also track Level I incidents through their own internal processes. For further information, review the Incident Response and Reporting Manual, the IRIS Technical Manual, and IRIS FAQs.
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. What reports do I need to submit to The Durham Center?
A. Please refer to the Operations Manual, Section V – Provider Documentation Submission Requirements.
Q. What needs to be included in a QM Plan?
A. The QM Plan meets NC DHHS requirements if it integrates Quality Assurance and Quality Improvement and includes all of the following:
-composition and activities of a quality assurance and quality improvement committee
-written quality assurance and quality improvement plan
-methods for monitoring and evaluating the quality and appropriateness of client care, including delineation of client outcomes and utilization of services
-professional or clinical supervision, including a requirement that staff who are not qualified professionals and provide direct client services shall be supervised by a qualified professional in that area of service
-strategies for improving client care
-review of staff qualifications and a determination made to grant treatment/habilitation privileges
-review of all fatalities of active clients who were being served in residential programs at the time of death
-adoption of standards that assure operational and programmatic performance meeting applicable standards of practice
-review of incidents and complaints
Q. What is NC-TOPPS?
A. The North Carolina Treatment Outcomes and Program Performance System measures the quality and impact of substance abuse and mental health services. Providers of services to adults and children six and older who receive publicly-funded services complete online surveys about each individual’s service needs and outcomes at the beginning, during and at the end of an episode of care. Data is used by State and local government agencies, provider agencies and consumers and their families in evaluating and improving the quality of care in North Carolina’s public service system. To learn more, visit NC-TOPPS. If you already use NC-TOPPS and are having difficulty, your solution might be available here.
Q. What is the Consumer Satisfaction Survey?
A. An annual survey conducted by providers each year on their adult and child consumers of mental health or substance abuse services. SAMHSA uses data from the survey to evaluate funding to states and in North Carolina, the survey provides data on satisfaction with services to stakeholders in organizations at the State and local levels and to consumers and their families. This data is useful for assessing and improving the quality of mental health and substance abuse services.
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 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 by clicking here. link to Obtaining Services Handbook
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 areindividuals 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.
