
{"id":8437,"date":"2009-12-17T12:25:17","date_gmt":"2009-12-17T20:25:17","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=8437"},"modified":"2009-12-17T12:25:17","modified_gmt":"2009-12-17T20:25:17","slug":"advocates-legislators-urge-dhhs-to-slow-down","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2009\/12\/17\/advocates-legislators-urge-dhhs-to-slow-down\/","title":{"rendered":"Advocates, legislators urge DHHS to slow down"},"content":{"rendered":"<p><strong>BY TAYLOR SISK, Staff Writer<br \/>\n<\/strong><br \/>\n\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s just very scary right now,\u00e2\u20ac\u009d said Sen. Ellie Kinnaird, Orange County\u00e2\u20ac\u2122s representative in the state Senate, of the latest developments in the state\u00e2\u20ac\u2122s mental health care morass. \u00e2\u20ac\u0153We\u00e2\u20ac\u2122re all disturbed over what we think is happening. We don\u00e2\u20ac\u2122t think this is the answer to much of anything.\u00e2\u20ac\u009d<!--more--><\/p>\n<p>Specifically, Kinnaird is referring to a proposed new mental health care provider designation called critical access behavioral health agencies, or CABHA, scheduled to take effect Jan. 1. Providers who fail to comply with the standards of the new designation by July 10 of next year will lose Medicaid dollars for a number of essential services, including case management.<\/p>\n<p>Kinnaird is not alone in her concern. <\/p>\n<p>Mental health care advocates from across the state are expressing their displeasure with both the speed and the manner in which this new framework for mental health care services has been introduced. Consumer advocates contend that they have once again been left out of the discussion of how to move forward with the provisioning of mental health care services in North Carolina.<\/p>\n<p><strong>Tough year<br \/>\n<\/strong><br \/>\nWhat most all mental health care advocates in the state agree on is that change must come.<\/p>\n<p>At the Mental Health Association in Orange County\u00e2\u20ac\u2122s annual meeting, held last Saturday at Orange United Methodist Church in Chapel Hill, Judy Truitt, director of the OPC Area Program, said, \u00e2\u20ac\u0153There\u00e2\u20ac\u2122s absolutely no question that this is has been an extraordinarily difficult year and that there are many more to come.\u00e2\u20ac\u009d<\/p>\n<p>The OPC Area Program is responsible for the oversight and management of publicly funded mental health services in Orange, Person and Chatham counties, and Truitt pointed out that as a result of state budget cuts non-crisis services have been reduced 21.5 percent.<\/p>\n<p>In response to the critical state of mental health care services in North Carolina, the N.C. Department of Health and Human Services (DHHS) has introduced the CABHA model, which DHHS officials say is designed to improve services by consolidating them. In order to be accredited as a CABHA, an agency must be able to provide four core services \u00e2\u20ac\u201c case management for those with mental illness or a substance-abuse problem, comprehensive clinical assessment, medication management and outpatient therapy \u00e2\u20ac\u201c and two more from a list of enhanced services.<\/p>\n<p>A Nov. 2 DHHS memo introducing the CABHA designation stated, \u00e2\u20ac\u0153The Department of Health and Human Services (DHHS) and system stakeholders have been discussing for some time the concept of identifying and recognizing provider agencies who deliver a comprehensive array of services.\u00e2\u20ac\u009d<\/p>\n<p>Last Wednesday, Leza Wainwright, director of the DHHS\u00e2\u20ac\u2122s Division of Mental Health, Developmental Disabilities and Substance Abuse (MHDDSA) told Kinnaird and her colleagues on a legislative oversight committee that the process had involved a wide range of stakeholders, including consumers and their family members.<\/p>\n<p>David Cornwell, executive director of North Carolina Mental Hope, a mental health consumer advocacy group, disagrees.<\/p>\n<p>\u00e2\u20ac\u0153Our focus has been and continues to be on the exclusionary process by which CABHA and other designations and policies have been developed,\u00e2\u20ac\u009d Cornwell said.<\/p>\n<p>Cornwell argues that consumer representation has been token, citing the names of only a very few consumer advocates listed as attendees at planning meetings \u00e2\u20ac\u201c which, he believes, were inadequately announced and advanced too rapidly.<\/p>\n<p>\u00e2\u20ac\u0153CABHA as a definition wasn\u00e2\u20ac\u2122t unveiled until November,\u00e2\u20ac\u009d said Martha Brock, a mental health care consumer advocate. \u00e2\u20ac\u0153And they\u00e2\u20ac\u2122re talking about instituting it Jan. 1? That\u00e2\u20ac\u2122s crazy. Just plain crazy.\u00e2\u20ac\u009d<\/p>\n<p>Kinnaird said she is concerned that \u00e2\u20ac\u0153we\u00e2\u20ac\u2122re going to put something in place that\u00e2\u20ac\u2122s not going to work any better than what we have right now.\u00e2\u20ac\u009d<\/p>\n<p>Rep. Verla Insko said at Saturday\u00e2\u20ac\u2122s mental health care forum in Chapel Hill that she hopes to see the CABHA process slowed. Insko represents southern Orange County in the state House and is co-chair of the legislative MHDDSA committee.<\/p>\n<p><strong>Out of business<br \/>\n<\/strong><br \/>\nDHHS Assistant Secretary Michael Watson has said that the CABHA concept is founded in the concern that the state not repeat mistakes made in the provisioning of community support services, for which some providers were found to be dramatically overbilling. He said it was the department\u00e2\u20ac\u2122s conclusion that services should be \u00e2\u20ac\u0153housed within a clinical organization that promoted accountability and best practice.\u00e2\u20ac\u009d<\/p>\n<p>DHHS officials have indicated they believe the CABHA designation will facilitate easier management because there will be fewer providers.<\/p>\n<p>But smaller service providers have expressed concern that they will be driven out of business under the CABHA model. One worry is the requirement that each CABHA have at least a half-time medical director onsite, depending on clients served \u00e2\u20ac\u201c a requirement many small providers say isn\u00e2\u20ac\u2122t always necessary and that they can\u00e2\u20ac\u2122t afford.<\/p>\n<p>But, says Brock, even those providers that may be financially able to meet the CABHA criteria will be hard pressed to meet the deadline. <\/p>\n<p> \u00e2\u20ac\u0153They can\u00e2\u20ac\u2122t gear up and hire staff and everything by the deadline to get certified,\u00e2\u20ac\u009d Brock said.<\/p>\n<p><strong>At the table<br \/>\n<\/strong><br \/>\n\u00e2\u20ac\u0153It needs to be modified,\u00e2\u20ac\u009d Kinnaird said of the CABHA designation. \u00e2\u20ac\u0153If they\u00e2\u20ac\u2122re going to do this, they need to make sure that the small provider that\u00e2\u20ac\u2122s doing a good job is able to stay in business.<\/p>\n<p>\u00e2\u20ac\u0153I want to see everybody at the table and have a chance to really discuss the vision,\u00e2\u20ac\u009d Brock said. \u00e2\u20ac\u0153I\u00e2\u20ac\u2122m tired of going through change after change with no real philosophy or thought behind it.\u00e2\u20ac\u009d<\/p>\n<p>Kinnaird agrees that all concerned parties must be in on the decision-making process.\u00e2\u20ac\u009d<\/p>\n<p> She said she\u00e2\u20ac\u2122s hoping the DHHS is \u00e2\u20ac\u0153not going to steam ahead without a lot more input and a lot more tinkering\u00e2\u20ac\u009d with the specifics of the CABHA model.<\/p>\n<p>\u00e2\u20ac\u0153I don\u00e2\u20ac\u2122t really understand what\u00e2\u20ac\u2122s behind this,\u00e2\u20ac\u009d said Brock, \u00e2\u20ac\u0153but I know there\u00e2\u20ac\u2122s no vision behind it.\u00e2\u20ac\u009d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>BY TAYLOR SISK, Staff Writer \u00e2\u20ac\u0153It\u00e2\u20ac\u2122s just very scary right now,\u00e2\u20ac\u009d said Sen. Ellie Kinnaird, Orange County\u00e2\u20ac\u2122s representative in the state Senate, of the latest developments in the state\u00e2\u20ac\u2122s mental health care morass. \u00e2\u20ac\u0153We\u00e2\u20ac\u2122re all disturbed over what we think is happening. We don\u00e2\u20ac\u2122t think this is the answer to much of anything.\u00e2\u20ac\u009d<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-8437","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/8437","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\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=8437"}],"version-history":[{"count":1,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/8437\/revisions"}],"predecessor-version":[{"id":8438,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/8437\/revisions\/8438"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=8437"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=8437"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=8437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}