OPC talks merger
By Taylor Sisk
Staff Writer
As the N.C. Department of Health and Human Services prepares for yet another major change to the administration and delivery of behavioral health care services, consumers of these services, their families and their advocates are concerned that once again the state is unprepared.
Under the new plan, providers of mental health, developmental disability and substance abuse services would be granted a 1915(b)(c) waiver of the Social Security Act, freeing them from certain Medicaid provisions. The waiver allows states to move agencies that manage services from a fee-for-service delivery system to a managed-care system.
One local management entity, or LME, Piedmont Behavioral Healthcare (PBH) – overseeing publicly funded behavioral health care services for Cabarrus, Davidson, Rowan, Stanly and Union counties – has been operating under the full 1915(b)(c) waiver model since 2005 as a pilot project. Legislation now pending in the General Assembly would allow all 23 LMEs in the state to operate under the waiver.
But, in fact, soon there will no longer be 23 LMEs operating in the state. Proposed legislation calls for the consolidation of LMEs, thereby, theoretically, creating administrative savings and efficiencies.
Toward that end, OPC Area Program, the LME that serves Orange, Person and Chatham counties, has begun negotiations to merge with PBH.
In a statement to its clients, OPC indicated that at its April 14 meeting, “the OPC Board voted unanimously to move forward in negotiations with PBH and to seek authorization from the Boards of Commissioners in Orange, Person & Chatham counties to do so.â€
OPC announced last November that it was also in merger negotiations with the Alamance-Caswell LME.
Legislation could reduce the number of LMEs in the state to as few as six.
The implications
What all this would mean to consumers of behavioral health care services is up for debate.
Under the waiver, LMEs would be given all Medicaid, state and local funds in a lump sum – thus producing a managed-care system. Proponents of the waiver say this provides for more accountability and improved efficiencies at the local level. LMEs also would be allowed to select the service providers they’ll work with, rather than allowing full freedom of choice to their clients.
That concerns many consumers and their advocates, as does the general managed-care concept, which some perceive as a rationing of services.
And in an FAQ to its clients, OPC writes, “In addition to changes that will be created by the waiver, we also anticipate cuts to the rates paid for services. It is hard to say what impact those cuts will have on services.â€
Of particular concern to many consumers is that case management will no longer be offered as a stand-alone service, but by the LMEs as a component of managed care.
Advocates argue that people with developmental disabilities will be hardest hit if case managers familiar with the particular needs of their clients, whose sole responsibility is to advocate for the individual, are eliminated. People with developmental disabilities often need help accessing a full spectrum of professional services as well as assistance with basic everyday needs.
“It has always been best practice, and is recognized nationally as best practice, that case management be provided by a neutral party that provides no other services for the person,†said Jennifer Hancock, a case manager and advocate based in Wilson.
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Ready?
But beyond the specifics of the proposed change, says David Cornwell, executive director of the advocacy organization N.C. Mental Hope, is the concern that once again consumers and their advocates have been left out of the decision-making process.
“It’s incredible that a change that rivals the magnitude of mental health reform [launched in 2001] could have made it this far without any real due process,†Cornwell said.
“If the managed-care waivers are so good, it begs the question of why public announcement of statewide implementation came three weeks after enabling legislation was filed.â€Â
Cornwell references a report commissioned by the DHHS and released last August by Mercer Government Human Services Consultants that suggested the DHHS was not fully prepared to move forward with the administration of the waiver system. The report cited, for example, “an absence of senior licensed clinicians to help guide policies and procedures and quality management†and a “significant lack of IT tools and a limited number of technical staff to support efficient business operations and reporting requirements.â€
“It is ludicrous to think that with an austere budget and in such a short time, problems of the magnitude found by Mercer could be corrected,†Cornwell said.
But Rep. Verla Insko, who represents Orange County and co-chairs a legislative oversight committee on mental health, developmental disabilities and substance abuse, says trust in the waiver is well-founded.
In a letter in this week’s Citizen (see page 6), Insko writes that PBH “has been assessed and evaluated by outside consultants, inside auditors and national experts. … Over the years, the evaluations have shown consistently that PBH performed as well or better than the other LMEs.â€