CLAIMS BILLING AND PAYMENT FOR CONSOLIDATION

Beginning with dates of service provided to members on 2/1/2024 and thereafter, providers will be required to submit their claims to Trillium Health Resources for services provided to members/recipients with assigned coverage in one of the following counties that are consolidating with existing Trillium Health Resource counties.

Anson

Lee

Robeson

Duplin

Lenoir

Sampson

Edgecombe

Montgomery

Scotland

Greene

Moore

Warren

Guilford

Randolph

Wayne

Hoke

Richmond

Wilson

Claims may be submitted to Trillium Health Resources by:

· Uploading an 837I or 837P through the Trillium's secure Provider Direct Portal

· Direct entry through the Provider Direct Portal

· Utilizing Change Healthcare at no additional cost

· Utilizing The SSI Group

For any dates of service provided to members 1/31/2024 and prior, providers will continue to submit claims through the appropriate LME/MCO system of Eastpointe or Sandhills based on where the member/recipient is assigned to for coverage. All timely filing and adjustment timeframes will continue to be followed.

· Provider Direct

To obtain access to Trillium's Provider Direct portal for direct claims entry,

1. Complete the Provider Direct System Administrator training on Provider My Learning Campus.

2. Submit a certificate of completion along with the System Administrator Designee Request Form to [email protected].

3. Once you complete the training and System Administrator Designee Request Form, you will receive your login credentials.

If you need technical assistance with this process, please email [email protected].

· Clearinghouses

If you are currently using a clearinghouse other than Change Healthcare or The SSI Group, and wish to continue using them, you will need to provide them with Trillium’s Payer ID – 56089 so they may connect with Change Healthcare or ID 43071 to connect with The SSI Group.

For additional information on Change Healthcare, please visit their website at www.changehealthcare.com.

For additional information on The SSI Group, please visit their website at www.thessigroup.com.

· Payment

Payment for all approved claims will be issued in accordance with the current Check Write Schedule available on Trillium’s website at www.TrilliumHealthResources.org under For Providers and Billing Codes & Rates/ Check Write Schedule.

All Remittance Advices and 835s will be available the day after the designated check write.

Clinical Consolidation: Communication 002

This communication provides information around contracts and rates for all Eastpointe and Sandhills providers.

We understand this change can create anxiety for all stakeholders including members, providers, and community agencies. We want to make the change as easy as possible and transparent for all.

Provider Rates

There have been many questions regarding provider rates. We do not have all the answers at this time, but efforts are underway to analyze rates between the consolidating entities and determine the best path forward.

Trillium has made a commitment to maintain current provider funding levels through consolidation. Member and provider-specific rates will remain in effect upon consolidation. Additional guidance and rate information will be published in the coming weeks.

Provider Contracts

Please be assured that our team is actively working to streamline the contracting transition. We are planning to have contracts migrate to Trillium with the same services. Trillium is committed to ensuring a seamless transfer of services and contracts. Our primary goal is to minimize disruptions and maintain continuity in services. We are in the process of reviewing all existing contracts. We understand the importance of timely communication. Our aim is to provide you with regular updates on the progress of our contracting. To ensure a successful transition of services, we may need your cooperation in reviewing and confirming the details of your existing contracts. We will reach out to you promptly with specific information that might be needed to facilitate this process. Future communication will be sent out to providers on how to receive access to Trillium’s training portal called MyLearningCampus and provider web portal called Provider Direct.

For more information and to submit questions, please visit our Consolidation page

Clinical Consolidation: Communication Bulletin 003

Our mission is to transform lives and build community well-being through partnership and proven solutions. We appreciate your commitment to help us achieve this mission by meeting the needs of members in the newly consolidated region. The purpose of this bulletin is to provide guidance to providers currently contracted with Eastpointe and Sandhills Center on next steps and actions needed prior to consolidation on February 1, 2024.

Required Provider Forms

To ensure your organization’s information is correct and accurately reflected in our business system for claims to process and reimbursement to occur, Trillium Health Resources (Trillium) is requesting for Eastpointe and Sandhills Center providers to complete the following forms and submit a completed packet of forms to this email address: [email protected]. Most importantly, the person completing and signing these forms must be the legally authorized representative for your organization or practice.

1. Authorization Agreement for Automatic Deposit: This form provides Trillium your deposit account information and authorizes Trillium to remit payment and initiate credit entries to your preferred deposit account.

Important – To authorize and ensure payments are applied to the correct deposit account, please email a voided check or letter from the depository bank to Trillium’s Finance Department at [email protected] using a secure/encrypted email service such as Zixmail. Refer to Trillium's Network Communication Bulletin 313 for assistance with sending a secure email using Zixmail or visit the For Providers webpage to learn more about Zixmail Secure for Providers.

2. W-9: This form provides Trillium your taxpayer information. The information provided on this form must match the taxpayer identification number (TIN) and name combination that is registered with the Internal Revenue Service.

3. Provider Direct System Administrator Designee Request Form: This form is used to request and gain access to Provider Direct, the web based provider portal for Trillium’s business system. See STEPS TO RECEIVE ACCESS TO PROVIDER DIRECT below for instructions.

4. Trading Partner Agreement: This form is an agreement and contains provisions for Electronic Data Interchange between a provider and Trillium.

5. Deficit Reductions Act Attestation (DRA): Effective January 1, 2007, the Deficit Reduction Act (DRA) of 2005, requires providers who meet specific criteria to certify that they are in compliance with §1396(a) (68) of the Social Security Act as a condition of enrollment in the North Carolina Medicaid Program.

6. Initial Attestation Statement for New Providers: This form contains 2 statements that every newly contracted provider must attest to regarding sharing of member rights and responsibilities and Trillium not accepting or offering incentives.

Click on this LINK to access the New Network Provider Packet. Complete each form entirely, sign where applicable, and return to Trillium by clicking the green submit button located on the last page.

Behavioral Health Fee Schedule Release Communication

The North Carolina General Assembly appropriated $220 million in recurring funds in the Current Operations Appropriations Act of 2023 (SL 2023-134) to increase Medicaid reimbursement rates for providers of mental health, substance use disorder (SUD) and intellectual/developmental disability (I/DD)-related services. The Divisions of Health Benefits (DHB) and Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS) analyzed which services were priorities for the increases and what forms the increases might take and calculated them at the service level to fully allocate the available funds. The rate increases will be effective Jan. 1, 2024.

Trillium assessed the following services for potential rate impacts based on the guidance provided:

· Inpatient behavioral health services

· Behavioral health residential (levels I-IV)

· Outpatient behavioral health, including psychotherapy, crisis psychotherapy, family/group therapy, diagnostic evaluations, developmental/psychological testing, and various evaluation and management E&M office visits/consultations performed by psychiatrist or psychiatric nurse practitioner

· Diagnostic assessment

· Research Based Intensive Behavioral Health Treatment (RBI-BHT)

· Crisis Services, including Mobile Crisis Management and Facility-Based Crisis

· Community Support Team (CST)

· Assertive Community Treatment (ACT)

· Multi-Systemic Therapy (MST)

· Intensive In-Home Services (IIHS)

· Partial hospitalization

· Child and adolescent day treatment

· Psychosocial Rehabilitation (Psych Rehab)

· Peer Support

· 1915(b)(3) and 1915(i) services

· TBI 1915(c) waiver services

· In lieu of services (ILOSs)

An updated fee schedule containing rate updates for applicable services has been released. Please note that member and provider-specific rates that are above the new rates will retain the higher rate and no action is required by the provider. Additional details regarding the services impacted and the base rate assumptions can be found here: NC Medicaid Behavioral Health Services Rate Increases

Healthy Opportunities Pilot Launch Postponed

NCDHHS has postponed the launch of the Healthy Opportunities Pilot (HOP) scheduled for Feb. 1, 2024.

NCDHHS has not yet announced a new HOP launch date. Vaya will provide additional information in upcoming Provider Communication Bulletins.

HOP is the nation’s first comprehensive program to test and evaluate the impact of providing evidence-based, non-medical interventions related to housing, food, transportation, and interpersonal safety and toxic stress to eligible Medicaid beneficiaries.

NC Innovations Waiver Amendment Requirements for TCM Providers

NCDHHS has published a Notification of Innovations Waiver Amendment Approval. Tailored Care Management (TCM) providers who serve NC Innovations Waiver participants should note the associated changes in the memo linked below.

Memo: NC Innovations Waiver Amendment Requirements for Tailored Care Management Providers (Jan. 4, 2024)

NC Medicaid Providing Free, Printed Educational Materials for Medicaid Expansion and Enrollment

NC Medicaid is providing free, printed educational materials for partners to distribute to individuals and families seeking more information about Medicaid expansion and enrollment. Sign up today for these informative materials that include the NC Medicaid Toolkit in English and Spanish. Materials will begin shipping (at no cost) in January. To order materials, please fill out the print materials order form by Jan. 8, 2024.

Policy Changes Related to Standard Plan Oversight of Care Management Providers

The Department of Health and Human Services (DHHS) is implementing a policy update related to Standard Plan oversight of providers performing delegated care management functions. Under their contracts with the Division of Health Benefits, Standard Plans are required to achieve National Committee for Quality Assurance (NCQA) Health Plan Accreditation (HPA) by July 1, 2025. The updated policy aims to minimize the impact of health plan accreditation on delegated care management entities by exempting providers participating in the following programs from being required to participate in accreditation-related oversight:

Advanced Medical Home Tier 3 (AMH 3).
Care Management for At-Risk Children (CMARC).
Care Management for High-Risk Pregnancies (CMHRP).
Healthy Opportunities Pilots (HOP).
Integrated Care for Kids (InCK).

Standard Plans may continue to monitor delegated entities’ care management activities against other care management or program requirements (e.g., Advanced Medical Home care management requirements) to advance their performance expectations. Standard Plans are also encouraged to work in collaboration with delegated care management entities to prepare for potential future NCQA delegation oversight or otherwise to improve care management performance or build care management capacity.

Details on the policy change can be found in Notice of Policy Changes Related to Standard Plan Oversight of Delegated Care Management. Additional information on the AMH program can be found on the NC Medicaid Advanced Medical Home webpage.

North Carolina MH/BH Stakeholder Community Needs Assessment

The Community Needs Assessment (click to access survey) is designed to assist mental health stakeholders in determining the current strengths and service gaps in the mental health system. The information obtained from the Community Needs Assessment will illuminate for stakeholders what needs to be addressed in North Carolina in order to transform and create recovery-oriented mental health services and systems.

As part of the new NC System of Care – High Fidelity Wraparound Expansion Grant from SAMHSA, this survey will be administered to MH/BH stakeholders statewide once a year for the next four years. It is our hope that our work throughout and beyond the grant period will bring about positive change that is reflected in your responses to this survey over these years.

If you can find approximately 20 minutes to share your experience and viewpoint on NC’s MH/BH System, you will be giving a tremendously valuable gift to young people in our state: the gift of sharing your viewpoint from your unique place in our system. This survey will close on January 12^th. Upon the close of the survey, a raffle for $50 gift cards (provided by non-state and federal funds) will be awarded to 10 individuals who completed the survey. Please feel free to share the link to this survey widely with anyone who has a stake in NC’s MH/BH system.

The National Mental Health Association’s National Consumer

Supporter Technical Assistance Center (NCSTAC) is funded by the federal

Substance Abuse and Mental Health Services Administration (SAMHSA). In order to support consumer organizations in becoming effective change agents, NCSTAC developed The Community Needs Assessment.

Upcoming Changes to NCTracks: EVV Process Updates for Vendors; Changes to Pricing Methodology for 340B Pharmacy Claims

EVV Process Updates for Vendors Coming Soon

Beginning Jan. 28, 2024 the electronic visit verification (EVV) process will be updated for vendors. Currently, vendors are able to update EVV fields using the same visit record after a claim has been paid.

Starting Jan. 28 , 2024, vendors will need to use a new visit record each time an EVV is completed. If a visit record has already been used and a claim has been paid, the visit record will be rejected.

Vendors will receive an error message when their update to an existing EVV record is rejected, but providers will not be notified. It will be the vendor’s responsibility to update their records accordingly.

Changes to Pricing Methodology for 340B Pharmacy Claims

Effective Jan. 28, 2024, the pricing methodology for non-blood clotting factor, 340B pharmacy claims will be updated to the lesser of the 340B acquisition cost or the 340B Ceiling price on file.

If the submitted 340B acquisition cost is higher than the 340B Ceiling price the following message will be displayed on the National Council for Prescription Drug Programs (NCPDP) response transaction: "Submitted 340B acquisition cost was higher than expected. Reimbursement will be calculated based on the 340B Ceiling Rate on file.”

This change will not affect claims with dates of service before Jan. 28, 2024.

Delay in Division of Health Service Regulation License Renewal Updates

NC Medicaid requires providers to keep credentials current on their NCTracks provider enrollment record. The expiring credential must be verified as renewed through the licensing entity prior to being updated on the NCTracks record. NC Medicaid is aware and collaborating with the Division of Health Service Regulation (DHSR) regarding the inventory of pending license renewal applications. Any DHSR licensure renewal application that was submitted to DHSR prior to December 31^stwill remain active with NC Medicaid until DHSR processes all the renewals. Any DHSR Providers due to suspend, due to the expired license, will remain in active status until all renewal applications are completed by DHSR.

In addition, DHSR will send to NC Medicaid a licensure file, each week which is used to update the NCTracks provider enrollment record. As provider licenses are renewed, the information is shared with NC Medicaid and updates are automatically made on the NCTracks record. Providers may also report the license renewal using the NCTracks MCR process upon notification from DHSR that the license is renewed, knowing that NCTracks will verify the status and new expiration date using the file received from DHSR prior to updating the NCTracks enrollment record.

For inquiries related to the status of your license, please contact DHSR. For assistance with submitting an MCR, please contact GDIT.

January 2024 Provider Training Schedule Now Available

Registration is open for the January 2024 provider training courses listed below. NCTracks zoom courses can be attended remotely from any location. Courses offered this month include:

· Prior Approval Institutional

· Submitting an Institutional Claim

· Prior Approval Medical

· Submitting a Professional Claim

· Prior Approval Dental/Ortho

· Medicare-Only Lite Enrollment

See the document linked below for more information on course schedule and access to zoom links and QR codes:

January 2024 Provider Training Schedule

EFT Attestation for NCTracks Applications Updated as of Dec. 17, 2023

Effective Dec. 17, 2023 the electronic funds transfer (EFT) attestation for NCTracks applications was updated to state:

I hereby certify that the checking OR savings account indicated on this application is under my direct control and access; therefore, I authorize DHHS and its legally authorized fiscal agents(s), contractors, or vendors, their successors and assigns, to initiate, change or cancel payment to the checking or savings account as indicated on this application. I understand that Medicaid enrolled providers are required to enroll in EFT for claims payment and consent to the Department and its legally authorized fiscal agent(s), contractors, or vendors, their successors and assigns, to make claims payments to the checking or savings account indicated on this application. I consent to the release and communication of the checking or savings account information on this application to DHHS and its legally authorized agents, contractors, or vendors, their successors and assigns for the purposes of DHHS health plan participation and/or program operations. This authority is to remain in full force and effect until DHHS's legally authorized fiscal agent, its successors and assigns has received written notification, from either myself or a verifiable Officer of the Agency, of the account's termination in such time and in such a manner as to afford DHHS and its legally authorized agents, contractors, or vendors, their successors and assigns a reasonable opportunity to act upon it.

Note: All applicable DHHS billing providers will electronically sign the above EFT attestation as part of the provider enrollment online application.

New Exclusion Sanction Questions to be added to Applications for Enrollment

Beginning Jan. 28, 2024, five new additional exclusion sanction questions will be added to enrollment, re-enrollment, full MCRs, office administrator (OA) and re-verification applications:

· L. Has the enrolling provider had any liability insurance carrier canceled, refused coverage, or rated up because of unusual risk or have any procedures been excluded from coverage?

· M. Has the enrolling provider ever practiced without liability coverage?

· N. Does the enrolling provider have any medical, chemical dependency or psychiatric conditions that might adversely affect your ability to practice medicine or surgery or to perform the essential functions of your position?

· O. Has the enrolling provider's hospital and/or Clinic privileges ever been limited, restricted, reduced, suspended, revoked, denied, not renewed, or have you voluntarily surrendered or limited your privileges during or under the threat of an investigation or are any such actions pending?

· P. Has the enrolling provider had a professional liability claim assessed against them in the past five years or are there any professional liability cases pending against them?

All five questions are applicable to individual providers. However; only two of the questions will be applicable to organizations:

· L. Has the enrolling provider had any liability insurance carrier canceled, refused coverage, or rated up because of unusual risk or have any procedures been excluded from coverage?

· M. Has the enrolling provider ever practiced without liability coverage?

Affirmative answers to exclusion sanction questions on all applications require a written explanation AND supporting documentation.

A thorough written explanation for each question answered affirmatively must be signed and dated by the responsible party within six months of the application date. Failure to disclose documentation related to an affirmative response will result in a denial of the application. A full explanation of the new documentation requirements can be found at: https://www.nctracks.nc.gov/content/public/providers/provider-communications/2023-Announcements/Update-to-Documentation-Requirements-for-Exclusion-Sanction-Questions.html

New Medicaid Bulletin Articles Available

The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles:

· Rezafungin for Injection, for Intravenous Use (Rezzayo™) HCPCS Code J3490 - Unclassified Drugs: Billing Guidelines- Effective with date of service July 31, 2023, NC Medicaid covers rezafungin for injection, for intravenous use (Rezzayo)

· Pegunigalsidase Alfa-Iwxj Injection, for Intravenous Use (Elfabrio®) HCPCS Code J3590 - Unclassified Biologics: Billing Guidelines- Effective with date of service June 14, 2023, NC Medicaid covers pegunigalsidase alfa-iwxj injection, for intravenous use (Elfabrio).

· Glofitamab-Gxbm Injection, for Intravenous Use (Columvi™) HCPCS Code J9999 - Not Otherwise Classified, Antineoplastic Drugs: Billing Guidelines- Effective with date of service June 27, 2023, NC Medicaid covers glofitamab-gxbm injection, for intravenous use (Columvi)

· Efgartigimod Alfa and Hyaluronidase-Qvfc Injection, for Subcutaneous Use (Vyvgart® Hytrulo) HCPCS code J3590 - Unclassified Biologicals: Billing Guidelines- Effective with date of service July 11, 2023, NC Medicaid covers efgartigimod alfa and hyaluronidase-qvfc injection

· COVID-19 Vaccine and Reimbursement Guidelines for 2023-2024 for NC Medicaid- This bulletin replaces NC Medicaid COVID-19 Vaccine and Reimbursement Guidelines for 2023-2024

· Beremagene Geperpavec-Svdt Biological Suspension Mixed with Excipient Gel for Topical Application (Vyjuvek™) HCPCS Code J3590 - Unclassified Biologics: Billing Guidelines- Effective July 15, 2023, NC Medicaid covers beremagene geperpavec-svdt biological suspension mixed with excipient gel for topical application

· Point-of-Sale (POS) Vaccine Reimbursement Updates- NC Medicaid will begin publishing the POS vaccine rate file in January of 2024

· UPDATED: Requirements for Filling Prescriptions for Medicaid Beneficiaries: Reminder for the Expansion Population- NC Medicaid requires prescriptions to be ordered by Medicaid enrolled providers.

Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.

New Law Creates Long-term Change in North Carolina’s Guardianship System

January 4, 2024 (NORTH CAROLINA) – With a focus to promote less restrictive alternatives to guardianship, otherwise known as supported decision-making, and to ensure the rights of people before and after the appointment of a guardian), Senate Bill 308, otherwise known as the Guardianship Rights Bill, was passed unanimously in the Senate (47-0), and later became Senate Bill 615 which passed in the Senate and the House. Governor Roy Cooper signed it into law on September 28, 2023.

According to the American Civil Liberties Union, supported decision-making (SDM) allows people with disabilities to retain their decision-making capacity by choosing supporters to help them make choices. A person using SDM selects trusted advisors, such as friends, family members, or professionals, to serve as supporters. The supporters agree to help the person with a disability understand, consider, and communicate decisions, giving the person with a disability the tools to make their own informed decisions.

“The right to make decisions is the essence of becoming an adult and making choices about one’s life,” said Linda Kendall-Fields, Director of the UNC Cares Program and leader of the initiative. “Guardianship should always be used as a last resort as it removes the individual’s constitutional right to make important life decisions, such as how to use money and where to live. Sometimes it is necessary and then it should be practiced with great consideration of the individual’s expressed wishes. But in North Carolina, like other places in the United States, it has been used too easily, with great consequence for people with IDD. This law is a triumph for choice and self-determination.”

The policy education and advocacy efforts that led to guardianship reform were led by “Making Alternatives to Guardianship a Reality in North Carolina (MAR-NC),” an initiative funded by the North Carolina Council on Developmental Disabilities (NCCDD) and administered by the Cares Program at the UNC Chapel Hill School of Social Work. MAR-NC was instrumental in the passage of a consensus bill for guardianship reform by creating a coalition aimed to affect long-term changes in North Carolina’s guardianship system that would increase choice and self-direction for individuals with intellectual or other developmental disabilities (I/DD).

The MAR-NC statutory writing team created a draft spelling out important reforms and then partnered with the Conference of Superior Clerks of Court, the UNC School of Government, and the Estate Planning & Fiduciary Law Sections of the state bar to finalize proposed statutory changes. The agreed upon changes were, (1) a mandate to consider alternatives that carry the least restrictions for the lives of people facing potential guardianship; (2) a need to make sure all parties are fully informed about relevant rights; and (3) the ability of courts to monitor guardianships and call for hearings if needed.

Passage of Senate Bill 615 is important for individuals with I/DD and their families, specifically in allowing people with I/DD to choose the people they want to help them make choices and expand their freedom of how they choose to live.

“This law is a great example of how policy education and advocacy with a collective effort can lead to systems change that benefits individuals with I/DD and their families,” said Talley Wells, executive director of NCCDD. “People with disabilities should be able to make well-informed decisions about their lives, and this law empowers them to be aware of their rights to do so.”

The MAR-NC initiative was built upon the successes from a five-year Collective Impact initiative called “Rethinking Guardianship,” a statewide workgroup that has, with support from UNC Cares at the School of Social Work in Chapel Hill, established strong partnerships with individuals with I/DD, their families, leaders in the North Carolina State Bar and other stakeholders.

In addition to the passage of the bill, the MAR-NC initiative’s activities included reaching over 1,400 individuals through educational trainings and outreach; creating awareness among self-advocates, family, friends and professionals of the concept of supported decision-making; and developing educational materials in English and Spanish about supporting choice and self-determination.

Learn more about the MAR-NC initiative by reading its final report by visiting the Rethinking Guardianship website at https://rethinkingguardianshipnc.org/.

Free Decision-Making Resources – Download Now!

People with intellectual and developmental disabilities (IDD) must make many daily and major life decisions, just like people without disabilities.

This can include decisions about buying things they need, managing a budget, and talking with doctors about their health care.

There are many ways people with IDD make decisions, both on their own and with support. But a person’s ability to make decisions can change throughout their life.

It is important to have a plan for how decisions are made and to update this plan regularly.

This way, everyone can make the decisions they want.

The Arc's Center for Future Planning has created free resources to help.

Lawsuit Seeks to End Institutionalization and Confinement of Children in Georgia

ATLANTA January 3, 2024 – Civil rights attorneys filed a class action lawsuit today charging Georgia officials with violating federal law for their well-documented, longstanding failure to provide mandated home and community-based mental health services to thousands of children who experience repeated, prolonged, unnecessary institutionalization and the avoidable harm associated with this confinement.

Among the named plaintiffs is a 15-year-old who, in 2022, was admitted to psychiatric institutions 16 times because of the absence of needed services. Like the other plaintiffs, he is a Medicaid-eligible child with serious mental health needs that limit his ability to function. Under federal law, these children are entitled to receive home and community-based intensive mental health services, such as Intensive Care Coordination, Intensive In-Home Services, and Mobile Crisis Response Services.

Other named plaintiffs have experienced repeated out-of-home placements from an early age, including a 9-year-old who has been admitted to psychiatric institutions over a dozen times and an 11-year-old boy who has been hospitalized or institutionalized at least ten times. They, too, have been routinely discharged without the intensive services they need to be successful in their homes and communities.

These children are seeking to represent a class of thousands of Medicaid-eligible children with serious mental health needs who are experiencing repeated and prolonged institutionalization.

“Georgia’s children belong at home with their families. Due to Georgia’s failings, children are unnecessarily thrust into institutions and child welfare. Georgia can and must do better to support children to live at home with their parents and siblings.” Ruby Moore, the Executive Director of the Georgia Advocacy Office (GAO), which brought the lawsuit along with the National Health Law Program (NHeLP), the Center for Public Representation (CPR), and two national law firms with offices in Atlanta.

Over the years, plaintiffs’ attorneys have called upon officials to deal with gross deficiencies within the state’s children’s mental health system, but Georgia consistently has failed to deliver – and has denied youth with significant needs access to critical services that are mandated by federal law.

As Geron Gadd, a senior attorney with NHeLP, noted, “Thousands of Georgia’s most vulnerable children and young adults are in crisis because the state fails to meet their mental health needs.”

The crisis is well documented. Annual reports issued by Georgia’s Office of the Child Advocate from 2001-2008 repeatedly found services for children with mental health conditions were fragmented, underfunded, and difficult to access or unavailable.

In 2017, the Governor’s Commission for Children’s Mental Health, the Interagency Directors Team, and the Center of Excellence for Children’s Behavioral Health acknowledged that “Georgia’s community-based provider system is not prepared to address the behavioral health challenges that are present in the home, school, and community” – a decades-long failing that especially harms children in crisis and those with serious mental health needs and conditions.

“Georgia’s Medicaid program has failed our plaintiffs and the children they represent,” said Kathryn Rucker, senior attorney at CPR. “They are experiencing more harm, more out-of-home placements, and more of them are being relinquished to state custody – and still denied appropriate services.”

When children with serious mental health conditions enter the child welfare system, Georgia’s Division of Child and Family Services (DCFS) routinely funnels youth into what former DFCS Director Tom Rawlings calls “deep-end” psychiatric institutions, away from their homes and schools.

Candice Broce, the Commissioner of the Georgia Department of Human Services and the Director of the Division of Family and Children Services (DFCS), a named defendant in the lawsuit, has admitted: “The State’s most vulnerable children cannot access the physical, mental or behavioral health treatment they need—and deserve—in custody or through post-adoptive care.”

Plaintiffs allege violations of the Medicaid Act, the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act and seek to compel the state to provide and arrange for medically necessary services in the community and prevent the unnecessary institutionalization of Georgia’s children.

Read Complaint

NC: Alexander County Social Services Director Steps Down

Alexander County Director of Social Services Thomas Mitchell resigned his position Tuesday morning.According to County Public Information Director Gary Herman, Mitchell resigned effective immediately. Herman said he could not comment further due the matter being a personnel issue.

Mitchell was hired as Alexander County DSS Director on March 28th, 2022.

He took the position after serving 13 years in Lincoln County in a variety of roles including Economic Services Program Manager.

Read Here

NC: Guilford County approves creation of 27 DSS positions

News & Record - December 29, 2023

High stress, an insurmountable caseload, inconsistent pay, and eventually job burnout. Most workers in the field of social services deal with these aspects of the job -- all of which have led to a major staffing crisis in most North Carolina counties. In Guilford County, more help appears to be on the way. On Dec. 21, the county's board of commissioners approved the creation of 27 Department of Social Services (DSS) positions to support child welfare.

Also: Most other states avoid hiring issues that plague NC DSS agencies: https://www.carolinacoastonline.com/regional/article_2b78e7a6-a5d3-11ee-8294-57079af458b1.html

https://greensboro.com/news/local/government-politics/guilford-county-approves-creation-of-27-dss-positions/article_c105f81a-a5c2-11ee-83f5-dbc46feafbd3.html

NC: Aging out of foster care in North Carolina (Includes video)

WGHP - December 26, 2023

In her 22 years, Mary Doms has overcome a lot. "There were times growing up where I didn't have food, I didn't have power, I didn't have clothes," said Doms. "I was lucky to get a meal from school." She was in and out of the foster care system before being adopted by the Doms family when she was 16 years old. But many of the young people Doms works with today as a Regional Assistant with SaySo are not that lucky. "When you're aging out, the world is a lot," said Doms. "It's hard to live in a world where you don't have these simple skills." There are roughly 11,000 children in foster care in North Carolina. In late 2015, the State General Assembly passed legislation extending foster care benefits and services to young people ages 18 to 21 as long as they're in school or working.

https://myfox8.com/news/north-carolina/aging-out-of-foster-care-in-north-carolina/

NC: NC law setting minimum standards for DSS hires goes unenforced (Commentary)

Carolina Public Press - December 26, 2023

With Theresa Slocum's master's degree in social work from the University of Pittsburgh and as a licensed clinical social worker with multiple years of supervisory experience, she thought she had a lot to offer Cherokee County. Instead, Cherokee County's Social Services Board picked a local, Cindy Palmer, the wife of the county sheriff, who did not meet minimum qualifications for the job, an Office of State Human Resources employee said. At first, Palmer started on an interim basis. By the spring of 2016, the Social Services Board had named her the permanent replacement for a director who had long planned on retiring and had been grooming Palmer for the role, documents say. Palmer led the department as it dramatically accelerated its unlawful practice of separating dozens of children from parents, in which social workers closed cases without ever involving the legal system. A federal jury called the practice unconstitutional. The fallout may lead to the county's financial ruin. When Slocum learned this month that the woman who actually got the job in 2015 wasn't qualified, she wasn't happy. "In a position like that, people need certifications and qualifications to provide services to the community effectively," said Slocum, now a self-employed therapist. Slocum's instinct matches state law, which prohibits hiring an unqualified director when qualified applicants are willing and able to work -- but state agencies are powerless to do anything if counties hire unqualified people anyway. Each social services department director commands an office that exercises immense power over the lives of children, families, adults with disabilities and others. These county social services departments handle an array of local and federal services that can address poverty, such as food stamps or utility assistance, and child and elder abuse.

https://www.carolinacoastonline.com/regional/article_1a109262-a3e3-11ee-8955-87ca737106eb.html

Upcoming Webinars & Events

New: Monday, January 8, 2024

Side by Side with DMHDDSUS

Time: 2:00 pm thru 3:00 pm

New: Tuesday, January 16, 2024

Hear. Share. Act. I/DD in Schools

Time: 12:00 pm thru 1:00 pm

New: Wednesday, January 17, 2024

Inclusion Works: Lunch and Learn Series

Time: 12:00 pm thru 1:00 pm

New: Wednesday, January 17, 2024

Self-Advocate Discussion Series

Time: 1:00 pm thru 2:00 pm

New: Wednesday, January 17, 2024

Time: 7:30 pm thru 8:30 pm

New: Thursday, January 18, 2024

NC Medicaid Managed Care Back Porch Chats

Time: 5:30 pm thru 6:30 pm

New: The Link Center Shared Learning Groups - Supports for Trauma

These Shared Learning Groups are an opportunity to dive into important topics and tap into your expertise and experiences related to people with cognitive disabilities, including I/DD, brain injury and others, and MH conditions.

There are four sessions on the same topic for different audiences. Please register for the session that is most relevant to you.

Workshop Flyer: Download flyer

Direct Support Professionals

Date: Tuesday, Jan. 23, 2024

Time: 1:00-2:30 p.m.

Join Link: Register here

Clinical Professionals

Date: Tuesday, Jan. 23, 2024

Time: 3:00-4:30 p.m.

Join Link: Register here

Families of People with Lived Experience with I/DD and MH Conditions

Date: Wednesday, Jan. 24, 2024

Time: 1:00-2:30 p.m.

Join Link: Register here

Individuals with Lived Experience with I/DD and MH Conditions

Date: Wednesday, Jan. 24, 2024

Time: 3:00-4:30 p.m.

Join Link: Register here

New: Friday, January 26, 2024

Benchmarks' Friday Membership Webinar with Jay Ludlam & Karen McLeod

Time: 8:30 am thru 9:30 am

New: Thursday, February 8, 2024

Benchmarks' Members Child Welfare Webinar with NC DSS & Karen McLeod

Time: 8:00 am thru 9:00 am

New: Monday, February 12, 2024

Money Follows the Person (MFP) Lunch and Learn

Time: 12:00 pm thru 1:00 pm

New: Monday, March 11, 2024

Money Follows the Person (MFP) Lunch and Learn

Time: 12:00 pm thru 1:00 pm

Tailored Care Management Educational Offerings

Ongoing Webinar Sessions and Trainings: Some are free, some require a fee, and some are for CMA organizations that have passed the desk review only.

NC AHEC has partnered with the NC Department of Health and Human Services and Division of Health Benefits to equip Tailored Care Management (TCM) candidates with the tools and knowledge to effectively provide care management services to North Carolina’s Tailored Plan beneficiaries through Continuing Professional Development (CPD) opportunities. Find a list of monthly offerings below and join us for one or for all!

See Full Catalog Here