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Piedmont Behavioral Health

TAC assisted Piedmont Behavioral Healthcare (PBH), a multi-county mental health/substance abuse/development disabilities authority in North Carolina, with planning and implementing a combined Medicaid 1915 (b) and (c) waiver to demonstrate the feasibility of a capitated financing approach to community services within its region. The 1915 (b) and (c) waiver capitation is blended with state general funds for both community and inpatient services to create a global budget for all services, and incorporates capitated risk for both Home and Community Based Services and the local community ICF/MRs serving that region. 

Over a several year period, TAC assisted PBH to: (a) design all managed care functions, including access, utilization management, care coordination and quality management; (b) design and implement provider network development, contracting and rate setting; (c) coordinate actuarial analyses of Medicaid claims relevant for capitation; (d) specify information technology functionality for managed care operations; and (e) develop a performance based contract for PBH and the state Medicaid authority.

The PBH 1915 (b) and (c) waivers have produced positive outcomes for enrolled populations and have substantially reduced the overall systems costs of serving these members. The federal Centers for Medicare and Medicaid Services (CMS) has renewed both the (b) and (c) waivers for an additional several years. In addition, the state has adopted large portions of the original PBH (b) and (c) waiver design and operational protocols for expansion to other geographic regions of the state.