By Taylor Sisk
Staff Writer
With a new system for provisioning mental health care services now in effect – one in which most services that will be reimbursed by federal funds will be delivered by large, state-accredited providers – the question remains of what will happen to smaller providers.
It’s a question that’s vexing at least two local providers.
On Jan. 1, the state Department of Health and Human Services (DHHS) introduced the new Critical Access Behavioral Health Agency (CABHA) designation, with the objective of consolidating mental health, developmental disabilities and substance-abuse programs within fewer, larger providers. Of more than 600 applicants for CABHA certification, 175 have been approved by the DHHS, including 25 serving Orange, Person and Caswell counties.
These agencies must provide comprehensive clinical assessment, medication management and outpatient therapy. Additionally, they must provide two services from a list that includes intensive in-home care, community support team, child and adolescent day treatment, psychosocial rehabilitation and substance-abuse outpatient treatment.
Karen Dunn, executive director of Club Nova in Carrboro, had no illusions of becoming CABHA certified. Club Nova operates under the clubhouse model, primarily offering psychosocial rehabilitation, which helps individuals diagnosed with mental illness live better, more productive lives within their communities.
But the reimbursement rate for psychosocial rehabilitation services is only $10.96 an hour, not enough for Club Nova to get by on. The club operates through a combination of funding from Medicaid, the state, the county, Carrboro, Chapel Hill, grants and private contributions.
Club Nova previously provided community support services, which complement psychosocial rehabilitation and reimburse at a higher rate. But now, under the new system, only CABHAs will be reimbursed by Medicaid for these services.
State Sen. Ellie Kinnaird, who represents Orange County, is concerned about Club Nova’s future.
“Clubhouses provide such necessary services,†Kinnaird said, “services that keep people out of emergency rooms and shelters and jails.â€
Those services, Dunn said, are some of the “most comprehensive services available for some of our most seriously disabled individuals living with these illnesses long term.â€
“We know that without these services, people will be back in the hospital a lot more,†Dunn said. “And, already, people are waiting anywhere from a day to a week, languishing in ERs, waiting for a bed to open.â€
Without these fundamental services, Dunn said, “people are going to be more likely to end up homeless or in the legal system – and all of those scenarios cost more than providing the services.â€
Dunn said that last spring a DHHS official told her that the rate for psychosocial rehabilitation services would go back up to at least the rate it was before being cut in 2008. But she acknowledges that in the current budget climate, that might well not happen.
For now, she must try to make due with what’s available.
Uncertainty in the near term
Angela Annas operates another small mental health care services provider in Orange County, called Annas Resources. At present, Annas doesn’t provide the services necessary to become a CABHA. Like Club Nova, she will no longer be reimbursed for community support services. In order to keep her doors open, she’s applied to become a provider of Level II therapeutic foster care, but the licensing process takes nine months, time she’s not certain she has.
Annas has had to lay employees off and cut the benefits of others.
She said that seeing clients who pay with private insurance isn’t sustainable – she sees too few. Most of her clients have modest or no means of income; she offers a sliding scale.
Annas questions at least some of the wisdom behind CABHAs – for example, the requirement for at least a part-time medical director who doesn’t see patients. It’s unnecessary, she says; further administrative waste.
The addition of administrative costs in general is what most worries Kinnaird about CABHAs. She’s in favor of having services delivered directly by local management entities, as was the case prior to mental health care reform.
The CABHA era, though, has now begun.
“Honestly,†Annas said of the future of her agency, which was incorporated in 1997, “I don’t know in the long term.â€
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