12/28/10 — Eastpointe looks on to 2011

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Eastpointe looks on to 2011

By Matthew Whittle
Published in News on December 28, 2010 1:46 PM

Despite the likelihood of more funding cuts in the next budget year, Eastpointe and the rest of the state mental health system were able to avoid the bullet, at least for now, Eastpointe director Ken Jones said.

Unfortunately, he said, the system is at the point where any further cuts -- which may total $1.5 million for Eastpointe -- will likely threaten federal matching funds.

"Anything they cut now will also cut federal dollars," he said.

And typically, he continued, every state dollar generates up to three federal dollars.

"You really do a disservice when you start cutting into the system at this point," he said. "The state really has a difficult decision to make."

In the meantime, the local mental health entity, which manages the mental health system across its four-county cachement area of Wayne, Duplin, Lenoir and Sampson counties, is preparing for a major change come New Year's Day.

On Jan. 1, the much-maligned community support system will officially end. In the latest of a series of changes made the system, all community support services must become part of what are known as Critical Access Behavioral Health Agencies.

These CABHAs will be clinically based providers that have medical oversight. Currently, providers are not required to have a medical professional -- usually a psychologist -- on board.

Additional qualifications include national accreditation, minimum staffing levels and a minimum amount of service that must be provided, including the core mental health and substance abuse services of medical management, outpatient treatment and comprehensive clinical assessment, as well as two enhanced services that create a continuum of care, whether for adults or children. That means, Jones explained, that patients who are being served by these CABHAs will be able to be moved up and down the spectrum of care.

"The idea is the agency will move patients into the appropriate level of care as necessary," Jones said.

"It's so they can get the majority of the services they need under one umbrella," said Becky Cale, Eastpointe provider relations director.

Part of the current problem, Jones explained, is that sometimes patients become stuck with one provider, receiving an inappropriate level of care -- usually one that is more intense, and more expensive, than necessary.

This new system, which providers and patients have been changing over to this year, should allow for a better quality of care and service, as well as save money, he explained.

One concern is that the consolidation of providers may create a shortfall in the marketplace. But so far, they said, that has not been a problem in Goldsboro.

The other, larger concern is that it's another change that patients are having to deal with -- many of whom were forced to change providers last year, are being forced to change again.

In some ways, Ms. Cale and Jones said, it's a re-centralization of the mental health system -- still privatized, but not as open as before.

"You still have choice, but for consumers, it's another change, and it's going to be different," Jones said. "And long-term the state might well require that all services be provided by a certified CABHA. That's a question we're getting, but that's not happening now.

"I don't think the system could handle that right now. There would need to be a lot of planning for something like that."

One change that has gone into effect is that effective Sept. 20, Eastpointe became one of two LMEs in the state that is managing its Medicaid patients. The other is in Durham.

This means that Eastpointe is responsible for overseeing and signing off on the care for indigent and Medicaid mental health and substance abuse patients in its four counties.

Medicaid payments were another controversial issue for the mental health system several years ago when it was discovered that the old community support system was billing for, and private contractor ValueOptions was approving, unnecessary and illegitimate Medicaid claims.

With that function now under local control, however, Jones said because they know both the patients and the providers, they are better able to make sure things are being done appropriately.

"We think it can be done much better by a public agency than a private agency," he said.

Additionally, he said, Eastpointe has also become responsible for a portion of the Medicaid billing for developmentally disabled patients in the 37 counties in eastern North Carolina -- a responsibility that Jones believes will help protect the agency in the face of any future changes, including consolidation.

"It will help Eastpointe maintain stability as an LME. Merging is talked about at every state meeting I go to," Jones said. "The state continues to support the idea of LMEs merging, but from my perspective, an LME can get too big."

However, he added, while merging and growing can help create certain efficiencies that would be beneficial, it's a long process that must be approved by any LME boards, as well as the boards of commissioners of any affected county.

"I don't think it'll happen in the next couple of years," he said.

But when it does, he added, Eastpointe is in a good location, with its cachement area surrounded by seven counties, giving it plenty of options.