§ 122C-115.4. Functions of local management entities. - North Carolina Statutes

§ 122C‑115.4.  Functionsof local management entities.

(a)        Local managemententities are responsible for the management and oversight of the public systemof mental health, developmental disabilities, and substance abuse services atthe community level. An LME shall plan, develop, implement, and monitorservices within a specified geographic area to ensure expected outcomes forconsumers within available resources.

(b)        The primaryfunctions of an LME are designated in this subsection and shall not be conductedby any other entity unless an LME voluntarily enters into a contract with thatentity under subsection (c) of this section. The primary functions include allof the following:

(1)        Access for allcitizens to the core services and administrative functions described in G.S.122C‑2. In particular, this shall include the implementation of a 24‑houra day, seven‑day a week screening, triage, and referral process and auniform portal of entry into care.

(2)        Providerendorsement, monitoring, technical assistance, capacity development, andquality control. An LME may remove a provider's endorsement if a provider failsto do any of the following:

a.         Meet defined qualitycriteria.

b.         Adequately documentthe provision of services.

c.         Provide requiredstaff training.

d.         Provide requireddata to the LME.

e.         Allow the LME accessin accordance with rules established under G.S. 143B‑139.1.

f.          Allow the LMEaccess in the event of an emergency or in response to a complaint related tothe health or safety of a client.

If at anytimethe LME has reasonable cause to believe a violation of licensure rules hasoccurred, the LME shall make a referral to the Division of Health ServiceRegulation. If at anytime the LME has reasonable cause to believe the abuse,neglect, or exploitation of a client has occurred, the LME shall make areferral to the local Department of Social Services, Child Protective ServicesProgram, or Adult Protective Services Program.

(3)        Utilizationmanagement, utilization review, and determination of the appropriate level andintensity of services. An LME may participate in the development of personcentered plans for any consumer and shall monitor the implementation of personcentered plans. An LME shall review and approve person centered plans forconsumers who receive State‑funded services and shall conduct concurrentreviews of person centered plans for consumers in the LME's catchment area whoreceive Medicaid funded services.

(4)        Authorization of theutilization of State psychiatric hospitals and other State facilities.Authorization of eligibility determination requests for recipients under a CAP‑MR/DDwaiver.

(5)        Care coordinationand quality management. This function involves individual client care decisionsat critical treatment junctures to assure clients' care is coordinated,received when needed, likely to produce good outcomes, and is neither toolittle nor too much service to achieve the desired results. Care coordinationis sometimes referred to as "care management." Care coordination shallbe provided by clinically trained professionals with the authority and skillsnecessary to determine appropriate diagnosis and treatment, approve treatmentand service plans, when necessary to link clients to higher levels of carequickly and efficiently, to facilitate the resolution of disagreements betweenproviders and clinicians, and to consult with providers, clinicians, casemanagers, and utilization reviewers. Care coordination activities for high‑risk/high‑costconsumers or consumers at a critical treatment juncture include the following:

a.         Assisting with thedevelopment of a single care plan for individual clients, includingparticipating in child and family teams around the development of plans forchildren and adolescents.

b.         Addressing difficultsituations for clients or providers.

c.         Consulting withproviders regarding difficult or unusual care situations.

d.         Ensuring thatconsumers are linked to primary care providers to address the consumer'sphysical health needs.

e.         Coordinating clienttransitions from one service to another.

f.          Conducting customerservice interventions.

g.         Assuring clients aregiven additional, fewer, or different services as client needs increase,lessen, or change.

h.         Interfacing withutilization reviewers and case managers.

i.          Providingleadership on the development and use of communication protocols.

j.          Participating inthe development of discharge plans for consumers being discharged from a Statefacility or other inpatient setting who have not been previously served in thecommunity.

(6)        Communitycollaboration and consumer affairs including a process to protect consumerrights, an appeals process, and support of an effective consumer and familyadvisory committee.

(7)        Financial managementand accountability for the use of State and local funds and informationmanagement for the delivery of publicly funded services.

(8)        Each LME shalldevelop a waiting list of persons with intellectual or developmentaldisabilities that are waiting for specific services. The LME shall develop the listin accordance with rules adopted by the Secretary to ensure that waiting listdata are collected consistently across LMEs. Each LME shall report this dataannually to the Department. The data collected should include numbers ofpersons who are:

a.         Waiting forresidential services.

b.         Potentially eligiblefor CAP‑MRDD.

c.         In need of otherservices and supports funded from State appropriations to or allocations fromthe Division of Mental Health, Developmental Disabilities, and Substance AbuseServices, including CAP‑MRDD.

Subject to all applicableState and federal laws and rules established by the Secretary and theCommission, nothing in this subsection shall be construed to preempt orsupersede the regulatory or licensing authority of other State or localdepartments or divisions.

(c)        Subject tosubsection (b) of this section and all applicable State and federal laws andrules established by the Secretary, an LME may contract with a public orprivate entity for the implementation of LME functions designated undersubsection (b) of this section.

(d)        Except as providedin G.S. 122C‑124.1 and G.S. 122C‑125, the Secretary may neitherremove from an LME nor designate another entity as eligible to implement anyfunction enumerated under subsection (b) of this section unless all of thefollowing applies:

(1)        The LME fails duringthe previous consecutive three months to achieve a satisfactory outcome on anyof the critical performance measures developed by the Secretary under G.S. 122C‑112.1(33).

(2)        The Secretaryprovides focused technical assistance to the LME in the implementation of thefunction. The assistance shall continue for at least three months or until theLME achieves a satisfactory outcome on the performance measure, whicheveroccurs first.

(3)        If, after threemonths of receiving technical assistance from the Secretary, the LME stillfails to achieve or maintain a satisfactory outcome on the critical performancemeasure, the Secretary shall enter into a contract with another LME or agencyto implement the function on behalf of the LME from which the function has beenremoved.

(e)        Notwithstandingsubsection (d) of this section, in the case of serious financial mismanagementor serious regulatory noncompliance, the Secretary may temporarily remove anLME function after consultation with the Joint Legislative Oversight Committeeon Mental Health, Developmental Disabilities, and Substance Abuse Services.

(f)         The Commissionshall adopt rules regarding the following matters:

(1)        The definition of ahigh risk consumer. Until such time as the Commission adopts a rule under thissubdivision, a high risk consumer means a person who has been assessed asneeding emergent crisis services three or more times in the previous 12 months.

(2)        The definition of ahigh cost consumer. Until such time as the Commission adopts a rule under thissubdivision, a high cost consumer means a person whose treatment plan isexpected to incur costs in the top twenty percent (20%) of expenditures for allconsumers in a disability group.

(3)        The notice andprocedural requirements for removing one or more LME functions under subsection(d) of this section.  (2006‑142, s. 4(d); 2007‑323, ss. 10.49(l), (hh); 2007‑484,ss. 18, 43.7(a)‑(c); 2007‑504, s. 1.2; 2008‑107, s.10.15(cc); 2009‑186, s. 1; 2009‑189, s. 1.)