
{"id":15846,"date":"2011-02-10T10:22:48","date_gmt":"2011-02-10T15:22:48","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=15846"},"modified":"2011-02-10T10:22:48","modified_gmt":"2011-02-10T15:22:48","slug":"uncertain-days-for-small-mental-health-providers","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2011\/02\/10\/uncertain-days-for-small-mental-health-providers\/","title":{"rendered":"Uncertain days for small mental health providers"},"content":{"rendered":"<p><strong>By Taylor Sisk<br \/>\n<\/strong><em>Staff Writer<br \/>\n<\/em><br \/>\nWith a new system for provisioning mental health care services now in effect \u00e2\u20ac\u201c one in which most services that will be reimbursed by federal funds will be delivered by large, state-accredited providers \u00e2\u20ac\u201c the question remains of what will happen to smaller providers. <\/p>\n<p>It\u00e2\u20ac\u2122s a question that\u00e2\u20ac\u2122s vexing at least two local providers.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>State Sen. Ellie Kinnaird, who represents Orange County, is concerned about Club Nova\u00e2\u20ac\u2122s future.<\/p>\n<p>\u00e2\u20ac\u0153Clubhouses provide such necessary services,\u00e2\u20ac\u009d Kinnaird said, \u00e2\u20ac\u0153services that keep people out of emergency rooms and shelters and jails.\u00e2\u20ac\u009d<\/p>\n<p>Those services, Dunn said, are some of the \u00e2\u20ac\u0153most comprehensive services available for some of our most seriously disabled individuals living with these illnesses long term.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153We know that without these services, people will be back in the hospital a lot more,\u00e2\u20ac\u009d Dunn said. \u00e2\u20ac\u0153And, already, people are waiting anywhere from a day to a week, languishing in ERs, waiting for a bed to open.\u00e2\u20ac\u009d<\/p>\n<p>Without these fundamental services, Dunn said, \u00e2\u20ac\u0153people are going to be more likely to end up homeless or in the legal system \u00e2\u20ac\u201c and all of those scenarios cost more than providing the services.\u00e2\u20ac\u009d<\/p>\n<p>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.<\/p>\n<p>For now, she must try to make due with what\u00e2\u20ac\u2122s available.<\/p>\n<p><strong>Uncertainty in the near term<br \/>\n<\/strong>Angela Annas operates another small mental health care services provider in Orange County, called Annas Resources. At present, Annas doesn\u00e2\u20ac\u2122t 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\u00e2\u20ac\u2122s applied to become a provider of Level II therapeutic foster care, but the licensing process takes nine months, time she\u00e2\u20ac\u2122s not certain she has. <\/p>\n<p>Annas has had to lay employees off and cut the benefits of others. <\/p>\n<p>She said that seeing clients who pay with private insurance isn\u00e2\u20ac\u2122t sustainable \u00e2\u20ac\u201c she sees too few. Most of her clients have modest or no means of income; she offers a sliding scale. <\/p>\n<p>Annas questions at least some of the wisdom behind CABHAs \u00e2\u20ac\u201c for example, the requirement for at least a part-time medical director who doesn\u00e2\u20ac\u2122t see patients. It\u00e2\u20ac\u2122s unnecessary, she says; further administrative waste. <\/p>\n<p>The addition of administrative costs in general is what most worries Kinnaird about CABHAs. She\u00e2\u20ac\u2122s in favor of having services delivered directly by local management entities, as was the case prior to mental health care reform.<\/p>\n<p>The CABHA era, though, has now begun.<\/p>\n<p>\u00e2\u20ac\u0153Honestly,\u00e2\u20ac\u009d Annas said of the future of her agency, which was incorporated in 1997, \u00e2\u20ac\u0153I don\u00e2\u20ac\u2122t know in the long term.\u00e2\u20ac\u009d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>With a new system for provisioning mental health care services now in effect, the question remains of what will happen to smaller providers. <\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-15846","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/15846","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=15846"}],"version-history":[{"count":3,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/15846\/revisions"}],"predecessor-version":[{"id":15864,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/15846\/revisions\/15864"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=15846"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=15846"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=15846"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}