The Information Portal to the North Carolina Mental Health Community
We started this website proclaiming that this was the year of the CABHA. We were wrong. Sure, January 2011 marked the month of the CABHA, because 1800 companies were forced out of the mental health business as of that date. But, this has been the year of the Medicaid Waiver expansion, and we didn't even see it coming. Well, we saw it coming, just not this fast. Thought we were going to analyze the results of the Mecklenburg expansion, and see if the PBH model worked in a more metropolitan area. Two months seemed like hardly enough time.
For those that know the history of the changes in the industry in the last seven years, you know that we now are back where we started. We went from doing away with the 'Mental Health Area Authority' because they were not effective in providing community based services; to doing away with the community based service providers because they cost us too much money; to recreating and privatizing the "Area Authority" and renaming them Local Management Entity (LME).
Can somebody explain how the 1915 Waiver expansion benefits the consumers
How does 'Waiver' benefit the consumer.
Yeah, yeah, we know the flowery language that DHHS is publishing, -- but can we break that language down to a 6th grade reading level like we have to do for the PCP's.
We know how it benefits the LME. Moreover, based on a recent proposal from the NC Providers Council, there is a push to lift the executive salary cap for the LME. So, we are getting an even clearer picture about how Waiver does benefit the LME.
This just in... we are hearing unconfirmed rumors that the LME gets to keep the money that it does not spend in providing service to consumers! Is that true? Seems like a disincentive to provide services. But we are just asking. If anybody knows the answer, there are consumers and stakeholders waiting to hear.
Centrepoint LME has a CABHA question and answer bulletin.
Also, read the article and the comments following the article here.
The Winston Salem Journal opinion page discusses CABHA here.
NC DHHS has issued its own press release describing CABHA.
What will happen to consumers in rural North Carolina? Many consumer advocacy groups are expressing concerns that consumers living in the rural areas of North Carolina will be under-served. This is a legitimate concern particularly in light of the state sponsored studies that were done in 2000 that prompted the ill-fated change to "community based" access to mental health services.
By federal law, the state must provide medically necessary services to a consumer under the age of 18. If you or your child is in need of mental health services, contact a Local Management Entity or the 800 Crisis line. The contact information can be found on our Consumer page or on the LME page.
A recent topic during the Pinehurst Conference was "Are We There Yet?" The answer depends on where we are headed. If the goal was to reduce the number of Community Based Mental Health Providers from over 1400 to less than 170 in under six months...., yeah, we are there.
But, if the goal is to create monopolies for a few large agencies in the state to provide mental health services...., no, we are not there yet..., but we are well on our way.
We are concerned, and are already seeing signs that this was just the first round of reduction in the number of agencies providing mental health services.
If you are not one of the very large agencies, you should be concerned. 2011 will see an increased level of regulatory scrutiny, both at the state and federal level. Drastic change is required.
NC CABHA is committed to the survival of "Community Based" providers. We define a "Community Based" provider as one whose owners have some personal relationship to the community which it serves.
Some advice for "Community Based" CABHA owners:
Develop sophisticated financial systems that will allow you to monthly monitor your profit margins and make adjustments to your business model based on the actual numbers, not just the projected numbers.
Develop a working relationship with your LME. This is essential. In this CABHA era, the LME is going to be receptive to providing guidance on specific issues. Call your provider relations representative frequently. Audits are coming. Ask questions now, not during the audits.
Focus on the documentation of the clinically appropriate delivery of services. Hire more medical records staff and teach them to perform Q/A on the records daily. Empower the medical records staff with the authority to demand a high level of regulatory compliance. Agencies that have the foresight to place emphasis on the medical records documentation aspect of the business, will significantly increase the chances of surviving the CABHA era regulatory environment.
REMEMBER: Making CABHA is not the same as staying CABHA.
What happened to the consumers!
This is a question that a lot of people are asking--, but no one seems to know the answer.
It was expected that CABHA agencies would see a dramatic increase in consumer numbers because of the drastic reduction in the number of mental health providers. But that dramatic increase never occurred.
So where are the consumers? The answer is obvious, they are not receiving services. Some of this is by design, the state cannot recoup the losses of the past few years simply by reducing the number of companies providing services, the intended by-product was to reduce the number of consumers receiving services. We understand that.
But, the state is under a federal mandate to provide appropriate mental health services. How can we determine whether the services provided are appropriate if we simply lost track of the consumers? Where is the publicly available information, that proves to our community stakeholders, that these consumers continue to get appropriate services?
We will continue to seek the answer to this question. We will post it here, at NCCABHA.COM, when we find it.
NC DHHS WEBSITE
North Carolina has a CABHA website. It provides the latest information on CABHA from the Department of Health and Human Services. The site is: http://www.ncdhhs.gov/mhddsas/cabha/
There is an Implementation update site that lists the latest changes to the mental health rules. That site is: http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdates/index.htm
The North Carolina Department of Medical Assistance controls the Medicaid funds. It acts as the representative of the Federal government for all federal Medicaid funds. Before NC DHHS can enact changes to the Medicaid funded programs, it must get permission from NC DMA. Once approved, these changes are documented in the "Service Definitions". Each medicaid funded program is individually listed. The service definitions can be found at http://www.ncdhhs.gov/dma/mp/8A.pdf .
The DMA website lists the CABHA programs under Enhanced Mental Health Services. The DMA site is at http://www.ncdhhs.gov/dma/services/enhancedbh.htm
NC CABHA is creating partnerships with state and local agencies to provide consumer and provider information and training. We will post those trainings here.
Each LME has a website that has a training calendar. Go to the website in your area to participate in the latest training opportunities.