Mental health providers need flexibility during COVID-19, the state’s making it happen - North Carolina Health News
By Taylor Knopf
Due to the coronavirus outbreak, many community institutions are making the difficult decision to close their doors.
This includes Club Nova, an accredited clubhouse in Carrboro for adults with severe mental illnesses. It’s a place where more than 100 community members gather to socialize, eat lunch, build life skills and find job opportunities. Having a common meeting place is a huge part of the clubhouse model’s success.
Research on clubhouses around the country shows that, for a relatively small investment, clubhouse members have lower rates of hospitalization and incarceration, reducing the cost burden to municipalities and states.
Many of the clubhouses’ members have co-occurring health problems such as diabetes, respiratory issues and compromised immune systems, putting them in the high-risk category for COVID-19, according to Club Nova’s Director Karen Dunn.
That being the case, she said it was too risky for the clubhouse to keep its door open right now.
Federal and state officials are urging people to stay home as much as possible to minimize the spread of the virus. But mental health providers still need to support their patients, especially during this unusually stressful time.
As the medical systems are gearing up to respond to the coronavirus outbreak, it’s crucial to keep people from devolving into a state of mental health crisis that could require emergency medical services. Hospital leaders are working to free up medical resources, taking measures such as halting non-essential surgeries, so they don’t want to have beds taken up by someone in crisis if it’s at all avoidable.
Serving members at home
So last week, Club Nova mobilized its 10 person staff to serve members at home.
“Our folks need to stay put to the degree that they can, other than getting what they need,” Dunn said. “We are trying to make sure they have their needs met so they don’t have to be taking public transit.”
Clubhouse staff is checking in with members over the phone about their medication and meal supply. They are delivering meals to members who rely on lunches at the clubhouse. And they are holding virtual meetings with members one-on-one and group calls to catch up and check in with each other.
One hold up on video conferences is the lack of smart devices, Dunn said. Not all members have the ability to video call in. She’s requesting donations of smart devices for members right now.
Last week, Dunn was also concerned about the funding stream and paying employees during the virus outbreak. The clubhouse receives state and Medicaid money only for the time members are actively at the clubhouse.
“Since members can’t come in, there’s not a lot we can bill for. There needs to be flexibility,” she said. “We are talking about real boots on the ground. The whole staff is working.”
State grants flexibility and funding
State health officials responded to the need for financial and policy flexibility and gave providers the green light to bill for nontraditional services during this public health crisis, including telehealth visits.
On Friday, DHHS sent a letter to the head of all the mental health local management entities (known as LME-MCOs), which manage the state’s behavioral health dollars. The guidance outlined policy changes and authorized them to use up to 15 percent of their reserve funding to support providers. Additionally, $30 million in state funds has been released to support the state’s mental health system during the state of emergency.
The influx of cash and policy changes are aimed at continuing behavioral health services and supporting providers from going out of business.
DHHS is providing temporary enhanced rates and short-term funding for providers who need it to stay afloat during this crisis, said Kody Kinsley, deputy secretary for Behavioral Health & Intellectual and Developmental Disabilities.
No one wants clubhouse, adult day programs, intensive outpatient therapy, small group homes or other types of services to go under due to lack of funding during COVID-19, he said.
Another major factor behind the policy and funding changes is keeping patients stabilized and out of the emergency rooms.
“When we have a medical pandemic event, the last thing we want is for our health care system to be taxed in any way,” Kinsley said.
Telehealth visits encouraged
A huge piece of this puzzle has been removing barriers to telehealth visits. DHHS has greatly widened the types of services and providers that can use and bill for telehealth.
“Our telehealth policies have moved 10 years forward in 10 days’ time,” Kinsley said.
NC Medicaid policy changes include:
- Payment parity for telehealth visits.
- Allowing all secure technologies for telehealth visits, such as iPhone apps, tablets, etc.
- Expanding the types of providers who can use and bill for telehealth visits, such as mental health counselors and addiction specialists.
- Expanding the location of the patient to include community sites and at home.
- No need for referrals and prior authorizations, removing barriers for providers to see new patients.
These changes will be in effect until the end of the state of emergency in N.C. They are also retroactive to March 10, meaning providers can bill for nontraditional services rendered to patients between then and now.
Insurance companies and federal payers such as Medicare and Medicaid are all making it possible for providers to get the same level of reimbursement for telehealth visits as they would if someone was sitting in their office.
Staying safe during COVID-19
The state health department also published a list of recommendations for mental health outpatient providers and crisis care during this time.
Providers are urged to have a protocol for identifying people who may be infected with COVID-19 and a plan in place, for example. If face-to-face interaction is necessary, providers should train staff in proper ways to use personal protective equipment.
DHHS also published guidance for group homes in the event of a COVID-19 case in the facility. The agency recommends educating group home staff and members on COVID-19 symptoms and protocols and advises specific measures staff should take to prevent a virus outbreak.
The department has also instructed group homes on what to do if someone shows signs or tests positive for the virus and when hospitalization or transfer of a member is necessary.