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SFY 2008 Performance Contract Reports/Data Requirements
Schedule for
Availability and Location
Requirement DMH/DD/SAS Report Contact LME Action(s) Performance Contract
of Written Guidelines
Report
LME maintains a log for each request for service and submits a
Excel report template and instructions: Quarterly
Bonnie Morell, quarterly report showing the number of persons requesting
LME Access Report Form BP01 (January 2005)
Best Practice & Community Innovations Team services, the number that are determined to need emergent care, Quarterly - due the 20th of the
Access to Care Reports are on the DMH/DD/SAS website:
3005 Mail Service Center urgent care, routine care, and the number for which access is month following the end of the
(Emergent, Urgent, Routine)
Raleigh, NC 27699-3005 provided within the target time standard or the number for which a quarter: 10/20; 1/20; 4/20; 7/20
http://www.dhhs.state.nc.us/mhddsas/manuals/in
(919) 715-2774 Bonnie.Morell@ncmail.net face-to-face service (assessment and/or treatment) is provided
dex.htm
within the target time standard.
LME uses its quality improvement (QI) process to improve the
service delivery system and submits an annual QI report describing
how it has used its QI process to address service delivery system
Maria Fernandez, issues in at least one of the following three areas: (a) building
Quality Management Team service capacity, (b) ensuring continuity of care, and/or (c)
Annually - Fourth Quarter -July
Quality Improvement Process 3004 Mail Service Center ensuring the use of evidence-based practices.
20 http://www.dhhs.state.nc.us/mhddsas/manuals/in
Raleigh, NC 27699-3004 dex.htm
(919) 733-0696 Maria.Fernandez@ncmail.net The LME's annual report shows it has undertaken the minimum
number of QI projects and addressed the number of required
elements for each project to meet the performance standard
defined in the Performance Contract.
10A NCAC 27G .0600 et al are on the
DMH/DD/SAS website:
Providers submit Level II and Level III incident reports to LME.
Candy Helms LME analyzes incident data for patterns and trends and takes http://www.dhhs.state.nc.us/mhddsas/manuals/ap
Quality Management Team appropriate action to make needed system improvements per 10A Quarterly - due the 20th of the s/apsm30-1total7-04.pdf
Incident Reporting 3004 Mail Service Center NCAC 27G .0600 et al. month following the end of the
Raleigh, NC 27699-3004 quarter: 10/20; 1/20; 4/20; 7/20 Level 2 and 3 Incidents Quarterly Report Form
(919) 733-0696 Candy.Helms@ncmail.net LME submits quarterly report summarizing Level II and Level III QM13 (January 2005) and instructions are on the
incidents, trends, system issues identified, actions, and outcomes. DMH/DD/SAS website:
http://www.dhhs.state.nc.us/mhddsas/performanc
eagreement/index.htm
Kent Woodson Quarterly fiscal monitoring report template is on
Budget and Finance Team LME submits a quarterly fiscal monitoring report by the 20th of the Quarterly - due the 20th of the the Controller's Office website:
Quarterly Fiscal Monitoring Reports 3013 Mail Service Center month following the end of the quarter. Reports are accurate and month following the end of the
Raleigh, NC 27699-3013 complete and received by the due date. quarter http://www.dhhs.state.nc.us/control1/amh/amhaut
(919) 733-7013 Kent.Woodson@ncmail.net h.htm
Terrie Qadura, LME submits a semi-annual SAPTBG Compliance Report by the The SAPTBG Compliance Report and
Quality Management Team 20th of the month following the end of the semi-annual period. instructions are on the DMH/DD/SAS website:
Semi-annually - due January 20th
SAPTBG Compliance Report 3004 Mail Service Center Reports are accurate and complete, show at least 48 hours of
& July 20th
Raleigh, NC 27699-3004 Synar activity for the reporting period, and are received by the due http://www.dhhs.state.nc.us/mhddsas/performanc
(919) 733-0696 Terrie.Qadura@ncmail.net date. eagreement-5A (SAPTBG Compliance Report)
The Substance Abuse/ Juvenile Justice Initiative
Antonio Coor, Report and instructions are on the DMH/DD/SAS
LME submits a quarterly Substance Abuse/ Juvenile Justice
Justice Systems Innovations Team Quarterly - due the 20th of the website:
Substance Abuse/Juvenile Justice Initiative Report by the 20th of the month following the end of the
3008 Mail Service Center month following the end of the
Initiative Quarterly Report quarter. Reports are accurate and complete and are received by
Raleigh, NC 27699-3008 quarter: 10/20; 1/20; 4/20; 7/20 http://www.dhhs.state.nc.us/mhddsas/performanc
the due date.
(919) 715-2771 Antonio.Coor@ncmail.net eagreement/-7A (For Information only: Substance
Abuse Juvenile Justice Monthly Report)
Current as of 5/13/08 Page 1
SFY 2008 Performance Contract Reports/Data Requirements
Schedule for
Availability and Location
Requirement DMH/DD/SAS Report Contact LME Action(s) Performance Contract
of Written Guidelines
Report
Starleen Scott Robbins
Work First Initiative Report is on the
Best Practice Team
LME submits a quarterly Work First Initiative Report by the 20th of Quarterly - due the 20th of the DMH/DD/SAS website:
3005 Mail Service Center
Work First Initiative Quarterly Reports the month following the end of the quarter. Reports are accurate month following the end of the http://www.dhhs.state.nc.us/mhddsas/performanc
Raleigh, NC 27699-3005
and complete and are received by the due date. quarter: 10/20; 1/20; 4/20; 7/20 eagreement-Work First/CPS/SA Reporting Form
(919) 715-2774 Starleen.Scott- 12/07
Robbins@ncmail.net
APSM 70-1, CDW Reporting Requirements
Jeannette Barham, Manual (July 2004) and CDW Data Dictionary are
Information Systems Team Quarterly - due the 20th of the on the DMH/DD/SAS website:
Client Data Warehouse (CDW) - LME collects and submits required Client Data Warehouse (CDW)
3019 Mail Service Center month following the end of the
Screening Record record types by the 15th of each month (1 quarter lag time).
Raleigh, NC 27699-3019 quarter: 10/20; 1/20; 4/20; 7/20 http://www.dhhs.state.nc.us/mhddsas/manuals/in
(919) 733-4460 Jeannette.Barham@ncmail.net dex.htm
APSM 70-1, CDW Reporting Requirements
Manual (July 2004) and CDW Data Dictionary are
on the DMH/DD/SAS website:
Jeannette Barham,
Information Systems Team Quarterly - due the 20th of the
Client Data Warehouse (CDW) - LME collects and submits required Client Data Warehouse (CDW) http://www.dhhs.state.nc.us/mhddsas/manuals/in
3019 Mail Service Center month following the end of the
Admissions record types by the 15th of each month (1 quarter lag time). dex.htm
Raleigh, NC 27699-3019 quarter: 10/20; 1/20; 4/20; 7/20
(919) 733-4460 Jeannette.Barham@ncmail.net Updates and changes were communicated to
LMEs in DMH/DD/SAS memos 10/4/02, 4/9/03,
4/20/04, 1/20/05.
APSM 70-1, CDW Reporting Requirements
Manual (July 2004) and CDW Data Dictionary are
on the DMH/DD/SAS website:
Jeannette Barham,
Information Systems Team LME collects and submits required Client Data Warehouse (CDW) Quarterly - due the 20th of the
Client Data Warehouse (CDW) -ICD- http://www.dhhs.state.nc.us/mhddsas/manuals/in
3019 Mail Service Center record types by the 15th of each month (1 quarter lag time). Data month following the end of the
9 Diagnosis dex.htm
Raleigh, NC 27699-3019 has been entered in all required fields. quarter: 10/20; 1/20; 4/20; 7/20
(919) 733-4460 Jeannette.Barham@ncmail.net Updates and changes were communicated to
LMEs in DMH/DD/SAS memos 10/4/02, 4/9/03,
4/20/04, 1/20/05.
APSM 70-1, CDW Reporting Requirements
Manual (July 2004) and CDW Data Dictionary are
on the DMH/DD/SAS website:
Jeannette Barham,
Information Systems Team LME collects and submits required Client Data Warehouse (CDW) Quarterly - due the 20th of the
Client Data Warehouse (CDW) - http://www.dhhs.state.nc.us/mhddsas/manuals/in
3019 Mail Service Center record types by the 15th of each month (1 quarter lag time). month following the end of the
Unknown Data dex.htm
Raleigh, NC 27699-3019 Required fields contain a value other than "unknown". quarter: 10/20; 1/20; 4/20; 7/20
(919) 733-4460 Jeannette.Barham@ncmail.net Updates and changes were communicated to
LMEs in DMH/DD/SAS memos 10/4/02, 4/9/03,
4/20/04, 1/20/05.
Current as of 5/13/08 Page 2
SFY 2008 Performance Contract Reports/Data Requirements
Schedule for
Availability and Location
Requirement DMH/DD/SAS Report Contact LME Action(s) Performance Contract
of Written Guidelines
Report
APSM 70-1, CDW Reporting Requirements
Manual (July 2004) and CDW Data Dictionary are
LME collects and submits required Client Data Warehouse (CDW)
on the DMH/DD/SAS website:
Jeannette Barham, record types by the 15th of each month (1 quarter lag time). Open
Information Systems Team clients who are enrolled in a target population and receive a billable Quarterly - due the 20th of the
Client Data Warehouse (CDW) - http://www.dhhs.state.nc.us/mhddsas/manuals/in
3019 Mail Service Center service will have a completed identifying record (record type 10) month following the end of the
Identifying and Demographic Records dex.htm
Raleigh, NC 27699-3019 and a completed demographic record (record type 11) in CDW quarter: 10/20; 1/20; 4/20; 7/20
(919) 733-4460 Jeannette.Barham@ncmail.net within 30 days of the beginning date of service on the paid claims Updates and changes were communicated to
record.
LMEs in DMH/DD/SAS memos 10/4/02, 4/9/03,
4/20/04, 1/20/05.
APSM 70-1, CDW Reporting Requirements
Manual (July 2004) and CDW Data Dictionary are
LME collects and submits required Client Data Warehouse (CDW)
on the DMH/DD/SAS website:
Jeannette Barham, record types by the 15th of each month (1 quarter lag time). A
Information Systems Team drug of choice record (record type 17) is completed within 60 days Quarterly - due the 20th of the
Client Data Warehouse (CDW) - http://www.dhhs.state.nc.us/mhddsas/manuals/in
3019 Mail Service Center of the beginning date of service for clients enrolled in any of the month following the end of the
Drug of Choice dex.htm
Raleigh, NC 27699-3019 following target populations: ASDHH, ASCDR, ASCJO, ASDSS, quarter: 10/20; 1/20; 4/20; 7/20
(919) 733-4460 Jeannette.Barham@ncmail.net ASDWI, ASHMT, ASWOM, CSSAD, CSWOM, CSCJO, CSDWI,
Updates and changes were communicated to
CSMAJ.
LMEs in DMH/DD/SAS memos 10/4/02, 4/9/03,
4/20/04, 1/20/05.
APSM 70-1, CDW Reporting Requirements
Manual (July 2004) and CDW Data Dictionary are
LME collects and submits required Client Data Warehouse (CDW)
on the DMH/DD/SAS website:
Jeannette Barham, record types by the 15th of each month (1 quarter lag time). A
Information Systems Team drug of choice record (record type 17) is completed within 60 days Quarterly - due the 20th of the
Client Data Warehouse (CDW) - http://www.dhhs.state.nc.us/mhddsas/manuals/in
3019 Mail Service Center of the beginning date of service for clients enrolled in any of the month following the end of the
Episode Completion Record dex.htm
Raleigh, NC 27699-3019 following target populations: ASDHH, ASCDR, ASCJO, ASDSS, quarter: 10/20; 1/20; 4/20; 7/20
(919) 733-4460 Jeannette.Barham@ncmail.net ASDWI, ASHMT, ASWOM, CSSAD, CSWOM, CSCJO, CSDWI,
Updates and changes were communicated to
CSMAJ.
LMEs in DMH/DD/SAS memos 10/4/02, 4/9/03,
4/20/04, 1/20/05.
LME, through providers, collects and submits initial assessment Forms, instructions, and FAQs are on the NC-
Ward Condelli, Compliance reports are produced
information on all consumers within specified substance abuse TOPPS website:
NC Treatment Outcomes and Quality Management Team monthly and quarterly. The
populations following sampling methods and reporting schedules
Program Performance System 3004 Mail Service Center quarterly reports are distribibuted
specified in the NC-TOPPS Manual. Initial assessments are due https://nctopps.ncdmh.net/
(NC-TOPPS) - Initial Assessments Raleigh, NC 27699-3004 on the first day of November,
by the last day of the month following the month the initial form is
(919) 733-0696 Ward.Condelli,@ncmail.net February, May, and September
administered.
LME, through providers, collects and submits update assessment
Forms, instructions, and FAQs are on the NC-
Ward Condelli, information on all consumers within specified substance abuse Compliance reports are produced
TOPPS website:
NC Treatment Outcomes and Quality Management Team populations following sampling methods and reporting schedules monthly and quarterly. The
Program Performance System 3004 Mail Service Center specified in the NC-TOPPS Manual. The 3-month update form quarterly reports are distribibuted
https://nctopps.ncdmh.net/
(NC-TOPPS) - Update Assessments Raleigh, NC 27699-3004 shall be administered between 76 and 104 days after the initial on the first day of November,
(919) 733-0696 Ward.Condelli@ncmail.net form and shall be submitted by the last day of the month following February, May, and September
the month it is due.
DMH/DD/SAS-Community Policy Management
Maria Fernandez,
LME, through providers, annually submits a consent form and a pre- Section annually sends correspondence to LMEs
Quality Management Team
National Core Indicators (NCI) survey for each person selected to participate in the NCI project Report published annually - Third explaining the NCI process and what is required
3004 Mail Service Center
Consents and Pre-Surveys within the specified timeframes. All submissions are complete and Quarter -May 20 (e.g. database, consent forms, pre-surveys,
Raleigh, NC 27699-3004 submitted by the due date. refusal forms, and names and addresses of legal
(919) 733-0696 Maria.Fernandez@ncmail.net guardians/family members).
Current as of 5/13/08 Page 3
SFY 2008 Performance Contract Reports/Data Requirements
Schedule for
Availability and Location
Requirement DMH/DD/SAS Report Contact LME Action(s) Performance Contract
of Written Guidelines
Report
NC SNAP Users Guide, version 1.2.1 (currently
Rodney Realon, being updated to version 2.0, 2/1/05, to
State Operated Services Team LME, through providers, collects and submits a file, by the 15th of Quarterly - due the 20th of the incorporate recent database revisions).
NC Support Needs Assessment
3006 Mail Service Center each month, containing current assessment forms for all month following the end of the
Profile (NC-SNAP)
Raleigh, NC 27699-3006 consumers receiving DD services quarter: 10/20; 1/20; 4/20; 7/20 Questions regarding day-to-day operations
(919) 855-4700 Rodney.Realon@ncmail.net should be referred to Regina Blalock at:
Regina.Blalock@ncmail.net
Jeannette Barham,
LME, through providers, administers the DHHS Client Satisfaction
Information Systems Team DMH/DD/SAS-Community Policy Management
Survey, consistent with DHHS standards, to 10% of its active Report published annually - Third
Consumer Satisfaction Survey (CSS) 3019 Mail Service Center Section annually sends correspondence to LMEs
mental health and substance abuse caseload, and submits the Quarter -May 20
Raleigh, NC 27699-3019 providing instructions for submitting the surveys.
data received by the due date.
(919) 733-4460 Jeannette.Barham@ncmail.net
Kelly Crowley
Prevention & Early Intervention Team Quarterly - due the 15th of the
System of Care Report 3021 Mail Service Center System of Care Report month following the end of the CPM Memo-5/31/07
Raleigh, NC 27699-3021 quarter: 10/15; 1/15; 4/15; 7/15
(919) 733-0696 Kelly.Crowley@ncmail.net
Bonnie Morell,
Best Practice & Community Innovations Team Quarterly - due the 20th of the
Crisis Services 3005 Mail Service Center Crisis Service Report month following the end of the MHDDSAS Memo 4/18/2007
Raleigh, NC 27699-3005 quarter: 10/20; 1/20; 4/20; 7/20
(919) 715-2774 Bonnie.Morell@ncmail.net
Kelly Crowley
Prevention & Early Intervention Team
Report describes how CTSP non-UCR funds are expended Report published annually -
CTSP non-UCR Activity Report 3021 Mail Service Center Senate Bill 1005, Section 21.60
annually. Fourth Quarter - August 20
Raleigh, NC 27699-3021
(919) 733-0696 Kelly.Crowley@ncmail.net
Current as of 5/13/08 Page 4
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