03/05/08 — Agency weighs Easley's proposal

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Agency weighs Easley's proposal

By Matthew Whittle
Published in News on March 5, 2008 1:46 PM

Faced with a mental health system in constant turmoil since he signed the 2001 reform package into law, Gov. Mike Easley seemed to be backtracking from his original role as he laid out a comprehensive plan of action Tuesday for his last year in office, laying much of the responsibility at the feet of the state legislature and the local management entities.

Calling for more state control over the local agencies, more state control over the private providers and increased funding of crisis response teams, he said the reforms, which were designed to move patients from state institutions to community-based care, were not working as well as originally hoped.

"We need dramatic change and we need it quickly," Easley said. "We had our concerns about the reforms of 2001. It was privatization that went too far."

Today, mental health consumers receive all their services from private providers that are overseen by the local management entities (LMEs). Until divestiture, the LMEs had been the agencies providing many of the services.

In Wayne, Sampson, Lenoir and Duplin counties, that LME is Eastpointe. It serves a population of nearly 300,000 people. There are 25 LMEs in the state, each required to serve populations of at least 200,000.

Changes to LMEs

Under the governor's proposal, though, that number could decrease if the state General Assembly agrees that the secretary of the Department of Health and Human Services needs to have more direct control.

Currently the LMEs are overseen by local boards appointed by the various county commissions.

"Secretary Dempsey Benton needs to be the one to evaluate the LMEs, to appoint the LME directors and be able to fire the LME directors, and to do that in a timely fashion. He does not have that authority today," Easley said. "We need to allow the secretary to reduce the number LMEs to avoid variations in quality of care and to make it possible to hold these programs accountable.

"If we can't control it, we cannot change it."

It was an announcement that state Rep. Van Braxton, D-Lenoir, a member of the House Mental Health Oversight Committee, was glad to hear.

"If he's saying the LMEs need to be more accountable, that's way overdue," Braxton said. "DHHS needs to hold the LMEs accountable and the LMEs need to hold the private providers accountable."

Local officials, however, disagreed that the LMEs need more state control, noting that Eastpointe has been a model agency. They also noted that there has been nothing released saying which LMEs the governor considers to have performed well and which he considers under-performing, although an independent consultant has been reviewing the state division.

"Eastpointe has done everything that the secretary and the legislature have required, and not all LMEs have done that," Eastpointe Director Ken Jones said. "As far as I know, Eastpointe would be considered a good LME. I consider Eastpointe to be a good LME."

In fact, because they knew the new secretary was concerned about efficiencies, Eastpointe had already begun partnering with the four LMES overseeing services in Wilson, Edgecombe, Nash, Greene, Onslow, Carteret, Pender, New Hanover, Brunswick, Bladen, Columbus, Robeson and Scotland counties in an effort to work together on projects such as substance abuse programming, and to standardize paperwork for consumers and providers, he said.

"We're not talking about merging or combining functions, but we saw this coming," Jones said. "As far as I know, we are one of the few such alliances."

But even with the regional cooperation, he believes that the local entities play an important role.

"This is not something that needs to be done in a year. There are a lot of local (county) dollars involved. This is something that needs to be planned carefully," Jones said. "This would be upsetting to the community if done quickly, and I'm not sure it needs to be done at all.

"There needs to be a local presence in the community because we need to know our consumers and we need to know our providers. I think that the LME/provider network can and will eventually work. It works in other states. There are functions of an LME I feel very strongly need to be local. "

Wayne County Manager Lee Smith, who sits on the Eastpointe Board, agreed.

"It's just one more area the state is taking control away from local officials," he said. "My preference is that the LMEs would be run by local officials. Every county in the state is different. I don't think you can make cookie-cutter programs."

Other pieces of the governor's speech, however, were better received.

Provider reform

One of those was a differentiated pay scale based on the type treatment provided.

The governor said he expects such a system would help reduce the overcharging by providers, but, Jones explained, any such changes would likely need to be first approved by the federal Centers for Medicare and Medicaid Services.

And while he thinks that's a good idea, he does not expect it to fully address the problem.

"I don't think that's going to fix it," he said. "The guidelines that have been implemented, because of what's happened with community support, will do more to correct it than the payment structure.

"A lot of the problem was Value Option, the statewide vendor that authorizes Medicaid services."

A better solution, he continued, would be to give more authority back to the LMEs.

"I would suggest No. 1, we have the authority again to authorize service for Medicaid consumers," Jones said. "I would, No. 2, give all LMEs the ability to bill in the same manner and they need to make the billing process easier.

"And No. 3, we need to get back to the basics of providing basic services. We need more funding to develop care management for clients that fall through the cracks or that need to be walked through the system. We need to have the ability to get the client where they need to go."

And part of that, he continued, fits right in with the governor's third initiative -- a $40 million request for the legislature to expand mobile crisis teams and provide more psychiatric beds at (regular) local hospital facilities.

Because the shift to community-based mental health care has not eased the burden on the state's mental health hospitals as planned, Jones explained, there is a need for acute psychiatric care so that state institutions like Cherry Hospital can be used primarily for longer-term treatment.

"It would be our hope that we can expand the psych units we already have," Jones said.

Although for now, the state is gaining 60 mental health care hospital beds with the opening the new $120 million Central Regional Hospital in Butner -- but only by keeping open John Umstead Hospital, which was originally slated to close this year.

But more important, Jones continued, "I think crisis service is exactly what they need to be looking at right now."

Such service would ideally help keep mental health patients out of local hospital emergency rooms, especially on nights and weekends.

Currently in the Eastpointe catchment area, Jones said, they are contracting with a provider to soon begin operating a mobile crisis team in Sampson County, which has the fewest service options and the highest number of people per capita going to emergency rooms.

It's a program he hopes to expand to all four counties as the resources become available.

"In the meantime we still support on-call services," he said.

What it means for now

Also in the meantime -- at least until the General Assembly reconvenes in May and takes up the governor's proposals -- Jones plans to continue working to ensure mental health services in his four counties.

"There is no new news here for us. I am encouraged but also hesitant about the sudden changes. Encouraged because the system needs attention. Hesitant because the system is so fragile. The system is at a point decisions are going to be made, but whatever decisions are made to this system should always be made with consideration to our local community and consumers," he said. "But we will continue working to become one of the best LMEs in the state. We are going to focus on what we're doing well, and what we're not doing well, we're going to focus on trying to do better.

"Eastpointe will continue to build a stable network of providers, work on crisis services, develop evidenced-based services and ensure that clients are safe and have adequate care."

-- The Associated Press contributed to this report.