05/24/09 — Eastpointe to get back control over patients' care

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Eastpointe to get back control over patients' care

By Matthew Whittle
Published in News on May 24, 2009 2:00 AM

Before mental health reform in North Carolina, local management entities were in charge of authorizing and approving plans of care for all patients receiving either state or federal dollars.

In 2006, the state changed the procedure -- contracting with a private company, ValueOptions, to oversee Medicaid claims and billing, while leaving state-paid indigent care under the purview of the LMEs.

However, said Eastpointe Director Ken Jones, that created a system in which some patients' care was being overseen by the LMEs, others whose care was being overseen by ValueOptions and some who were being overseen by both.

"You had some clients with two different plans of care going on," Jones said. "We really couldn't track where the Medicaid clients were."

And, he said, it is that situation that some have blamed for clients falling through the cracks in recent years, and for the extraordinarily high Medicaid reimbursement claims seen in the mental health system in 2006 and 2007.

Then in December, the state took steps to improve the system, allowing all 24 LMEs in North Carolina to apply to once again manage Medicaid dollars, which make up a "very large percentage" of mental health patients, including most children and about half of adults.

Of those LMEs that applied, only four were selected -- The Durham Center, Mecklenburg County Area Mental Health, Western Highlands Network (includes Asheville) and Eastpointe, the LME for Wayne, Duplin, Sampson and Lenoir counties.

"It was a pretty stringent review," Jones said. "You had to be a pretty good LME to be selected."

Now, since late February, Eastpointe has been working with the state to begin implementing the necessary procedures for making the transition.

"We will be the approver of all services -- Medicaid and state," Jones said. "That's something we've been trying to get back, and legislators all over the state are very supportive of returning this back to the local agencies.

"We know the clients. We know what their needs are. And we feel like we can manage those better than a private entity like ValueOptions."

The goal, he said, is to have employees and software in place and everybody trained and ready to go by Jan. 1, 2010. And, he added, if everything goes well, it's a program that could be extended across the state.

"This really puts Eastpointe out there. Other LMEs are looking at us. The state is looking at us. We're in the forefront," Jones said.

The only obstacle, he continued, could be the budget. But despite the cuts that the state Department of Health and Human Services is likely to suffer, he is confident this effort will continue.

"This has the support of the secretary and a lot of legislators," he said.