BY TAYLOR SISK
Staff Writer
Lanier Cansler, secretary of the state’s Department of Health and Human Services (DHHS), has proposed four changes to the forthcoming implementation of a new designation of mental health care provider in North Carolina, called critical access behavioral agencies (CABHA). The department announced last November its intention to implement the new designation on July 1, subject to approval by the federal Centers for Medicare and Medicaid Services (CMS).
These new mental health care facilities must meet newly stipulated requirements in order to provide certain critical services, and in a letter to the N.C. Legislative Black Caucus published in Wednesday’s edition of the Winston-Salem Journal, Cansler listed four changes to those requirements that his department has now submitted for CMS’s consideration.
These changes seem to address some of the concerns raised by mental health care advocates from across the state. Smaller service providers expressed concern that they will be driven out of business under the CABHA model, citing, in particular, the requirement that each CABHA have at least a half-time medical director onsite, depending on clients served. Small providers contend that such a requirement is unnecessary and unaffordable for all but the largest providers.
According to Cansler’s letter, the potential changes the DHHS is discussing with CMS are to:
• provide an additional transition period of up to six months to establish or join a CABHA;
• provide greater flexibility for smaller providers to subcontract with CABHAs to provide services;
• provide an option for an eight-hour per week medical director for small CABHAs; and
• evaluate opportunities for additional flexibility for local management entities to contract with small providers to enhance access to services.
The concept behind the CABHA model is to create a new definition and description of mental health care providers to offer a comprehensive set of services to people living with mental illness. CABHAs must provide four core services: case management for those with mental illness or a substance-abuse problem, comprehensive clinical assessment, medication management and outpatient therapy. They also must provide two additional services from a list that includes intensive in-home care, therapeutic family services, day treatment, psychosocial rehabilitation, a mobile crisis team and six others.
Mental health care consumer advocate Martha Brock said she felt Cansler’s letter “reflects needed changes,†most particularly in allowing for an eight-hour-a-week medical director for smaller CABHAs.
However, she said, “it does not address the question of why the clinician has to be a psychiatrist and where these psychiatrists are going to come from given the shortage and lack of funds for hiring them.â€