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By Thomas Goldsmith

North Carolinians from Buncombe County to Little Washington, with a stake in the consumer side of mental health care, had some sharp questions last week for the state Department of Health and Human Services about coverage provided by state- and Medicaid-funded managed care organizations provide.

The occasion was the monthly meeting of the state Consumer and Family Advisory Committee (CFAC), an oversight body that has corresponding committees across the state.

The committees provide mental health care consumers and their relatives with oversight of state government-funded care that’s coordinated by North Carolina’s seven local management entities, known as LME-MCOs.

[pullquote_left]”The State CFAC shall be a self-governing and self-directed organization that advises the Department and the General Assembly on the planning and management of the State’s public mental health, developmental disabilities, and substance abuse services system,” the statute establishing the committee reads. [/pullquote_left]

Members met at the Brown Building on the Dorothea Dix campus, the grounds of the former state psychiatric hospital that closed in 2010. The state sold the campus to the city of Raleigh for $52 million, with some of the proceeds are earmarked for mental health programs.

Then there were four

State DHHS officials announced in March that the then-eight regional LME-MCOs would be consolidated into four. CFAC members heard from state officials on a variety of initiatives in the mental health field, and several expressed concerns that constant changes could upset the system.

North Carolina DHHS official Dale Armstrong addresses the August meeting of the statewide Consumer and Family Advisory Committee on behavorial health issues. Photo credit: Thomas Goldsmith

“It frightens to me to think of the people that are going to wind up in the ER again,” said state committee member Marie Britt, of Lumberton. “We are taking away what was basically a stable situation.

“So, what are we going to do? Is there somebody talking, somebody planning?”

In a follow-up interview, Britt said her concern arose from changes that seem to occur regularly in the state’s system of behavioral health care: This time, it’s the coming consolidation down to four LME-MCOs, the transfer of substance-abuse centers to LME-MCOs, and a new requirement for higher levels of certification for nurse practitioners to treat people with severe mental illness.

She said she was encouraged by some of the new crisis-management techniques the state is undertaking.

The committee appears to be attracting attention from lawmakers for some comments from families about the existing system. Five legislators have said they will attend next month’s meeting.

But for Wednesday’s meeting, Dale Armstrong, DHHS deputy secretary of facility-based behavioral health/developmental disabilities services, answered questions at length.

How well, members asked, will it work to transfer substance abuse services to the LME-MCOs?

“Personally, I think it’s going to be a challenge, because the current legislation has some gaps that no one would have anticipated that need to be addressed, related to how do you operate a facility whose primary population is indigent,” said Armstrong, who oversees 14 state facilities.

Some attendees at Wednesday’s meeting seemed more focused on the overall quality of care than on changes in the system.

“Whether we are 23 counties or whether we grow, people should get the help they need when they need it,” state CFAC member Pat McGinnis, of Marion, said in a follow-up interview.

McGinnis is also a local member of the Smoky Mountain LME-MCO community and family advisory committee.

The state’s overhaul of mental health care has since 2010 increasingly relied on state-backed managed care organizations to care for people who have problems with behavioral health, intellectual and developmental disabilities, and substance use. The LME/MCOs (local management entities/ managed care organizations) receive a fixed rate for clients, and make money if they spend less than the allotted amount.

Renee Rader, waiver program manager for the Division of Medical Assistance, said the state has renegotiated its contracts with the LME/MCOs to make sure the companies aren’t spending too large a percentage of revenue on administration, as opposed to program costs.

One more question came from board members: Who oversees the LME-MCOs?

Armstrong said that another official who deals with community-based care could better answer the question. But according to state law, the committee itself is tasked with a key part of that duty.

Looking back at the years before the state took on behavioral health reform, committee chairman Kurtis Taylor said that North Carolina has accomplished much in the mental health field. He specifically cited the money that is coming to the mental-health care sector as a result of the Dorothea Dix sale.

“If God opens the door, we are going to walk right through it,” Taylor said.

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DHHS officials listed other new or developing services that should help the situation of people in crisis because of behavioral health problems:

++ Screenings for traumatic brain injury, piloted by the Alliance Behavioral Health Care, the LME- MCO that includes Wake County.
++ Training of education specialists for children in psychiatric residential treatment facilities.
++ Guardianship and adult protective services training in sessions across the state.
++ Tenancy training for people transitioning from assisted living facilities to independent living.
++ A close examination of policies that are supposed to ensure parity between mental-health and medical care.[/box]

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...