What signals is DHHS sending to mental health providers and consumers?
Easter Seals UCP delivered a letter to Gov. Easley this week that included a time line of events leading up to the current crisis with our mental health system. The following is a simplified version of that timeline that reveals some interesting things:
Pre-2006: Series of meetings occur that redefine what types of Community Support (CS) services will be provided and the qualifications of staff that will provide them. The state’s new definitions bundle the services together so there is no distinction between services provided by a degreed professional and a high-school graduate. Providers and advocates express concerns that this blending would lead to problems, they warned that DHHS would not be able to determine if services were being appropriately delivered.
Jan. 2006- Federal Government approves the new blended rates for Medicaid services.
Jan. 2006- Sec. Odom orders providers to implement the new blended service definitions by March 2006.
Jan.–Mar. 2006 – Provider and case management organizations have 60 days to totally restructure and reorganize. Organizations were previously told by the Division Director that they would have 6 months to reorganize. Consumers must choose a primary provider between their current case management agency, their direct service provider or a new provider. New authorizations for service must be acquired for every consumer.
April 2006- Sec. Odom announces that all consumer authorizations will be done by one company, Value Options. Providers must transfer all their authorization requests by June 30th. There is a backlog of authorizations at the local and state level as a result of the new system.
Jul 2006- Value Options begins processing authorizations for all mental health services. Volume is more than double the amount the state forecast. Value Options is understaffed. Authorizations back up and processing difficulties result when they try to speed up case reviews. The Division Director issues a memo telling providers to serve consumes regardless of whether an authorization has been issued. Providers may give up to 28 hours of service to a consumer within 30 days while the authorizations are processed.
July-Dec. 2006 – Issues begin to arise because of delayed authorizations. Agencies can’t bill for services without the authorizations, they have cash flow problems. Value Options processes the bulk of requests with minimum changes (i.e. they rubber stamp the authorization requests).
Jan-Mar 2007- The Division of Medical Assistance completes a compliance review of 167 CS program sites (139 distinct agencies). The sites reviewed where those where Value Options has authorized high numbers of service units per customer. The review examined 10 files per program.
This timeline shows that a year ago, DHHS was telling providers to go, go, go. Change the system, blend all the services into one flat rate, reauthorize all the consumers, do it in 2 months not 6 months. Value Options was to provide a check and balance in the system but when they become hopelessly bottlenecked, DHHS signaled everyone to go ahead with services to consumers by instructing providers to authorized 28 hours of service for 30 days.
Now with mental health costs soaring, Secretary Odom is screaming stop. Without notice the rates are being slashed 33%, the hours of allowed services are being cut from 28 hours to 8 hours, and the mental health services, that the state defined as appropriate, are being presented to the public as inappropriate uses of the system.
Our mental health system has serious problems that need to be fixed. The mixed signals coming from the DHHS are part of the problem, not part of the solution. Perhaps the best solution to the crisis would be for everyone involved to proceed with caution.