October 13 NC Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services

Below are some highlights from the meeting today of the Legislative Oversight Committee for MH/DD/SAS. The handouts are on the LOC website at http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=20&sFolderName=\LOC Minutes and Handouts\Minutes and Handouts 2010\October 13, 2010 (Note that they did not get to the CAP-MR/DD Update).


Rep. Insko chaired the meeting, Sen Nesbitt absent

Secretary Cansler not there so he did not make remarks

Dr Gray Expenditures & Utilization (Handout)

• Child Day treatment down, stricter policy criteria and increased staffing reqs

• Moving in more clinically oriented direction

• CST: 25-40% denial rate by VO per month per clinical criteria

• Mobile Crisis – is it really diverting people from ER? They will f/u with data

• CAP Waiver recipients have increased by 7%, non-waiver TCM recipients have decreased by 5% - providers now billing by weekly rate, hopefully will give more flexibility

• Braxton: how do we decide who gets care – from dollar standpoint or needs standpoint? Insko: how do we know we are doing more appropriate services? (My note: you need to assess need, design services to meet needs and plan within budget) Watson: can put max amount on services for adults and adjust rates

• Cost of CST should drop below the cost of ACT

• In context of ACA need to think about moving toward case rate rather than fee for service – case rate allows for more flexibility, and also looks at outcomes

SIS Pilot Project – Rose Burnette (Handout)

• FT staff person at DDTI working on pilot project

• 20 SIS assessors have been trained

• As of Oct 11, 895 assessments have been completed but have not met the numbers in the legislation

• An additional 175 children have been assessed by the tool is not normed for children – data is being included in the norming process

• All participants are volunteers

• Data so far indicates NC recipients have higher support needs as compared to other states

• Insko: 1 LME did a study on patient need and the amount of $ for their services – that study did not show a correlation

• Waiver TA to require SIS but would still do SIS and SNAP?

• Medicaid funding for assessment, negotiating fee for licensing and assessment tool

• Legislation says to assign people to waivers based on SIS assessment but LMEs don’t assign people to waivers, the state does

Independent Assessment – Beth Melcher (Handout)

• FY10 had over 40K new service recipients (Medicaid and iprs)

• Placed assessment within CABHA core services so no infrastructure for IA outside of CABHAs

• Proposed how to implement the legislation in a way that would not interfere with care – at point of service order, review of providers

• Draft plan focuses on duration or frequency for ACTT, CST, PSR, IIH, day treatment, inpatient or crisis (i.e., ACTT for greater than 18 months) – submitted to PAG, will be posted for 45 day comment period

Dix Update – Luckey Welsh (handout)

• To CRH: 60 dult admission, 11 adult long term; 54 forensic med/max and pretrial beds

• To Cherry: 30 long term

• Side note: Secretary plans to give official notice of hospital closure at Gov Ops committee meeting next week

• Reviewed budget shortfall info from last time – about $29 mil

• Insko: Dix appropriations a topic of much discussion during the budget process, in order to fund would have had to take money from other essential services

• Timeline for patient transfers – have moved patients in adult long term to CRH; Oct/Nov move patients in adult long term to Cherry, move clinical research unit (recent development), stop admission to inpatient pretrial eval (but continue outpatient evals – most are already outpatient); Dec move forensic max, stop admissions to DDH, move pretrial eval, move patients in forensic med, move remaining patients in adult admission – working with all hosps, DRNC on moves

• Goal to have completed by December 23

• Cost to operate remaining units on Dix – Child Outpatient and Forensic Min - $9 mil

• Additional 19 adult admission beds at Broughton $2.9 mil

• Division estimates $16.9 mil savings by closing Dix beds

• Investigating employee transportation from Raleigh to CRH

• Insko: HHS budget chairs met with Cansler yesterday and he said that they are maintaining enough at the hospital to bring back up if GA says they want to remain open; discussed how NC overutilizes inpatient beds in large institutions

• Watson – moving toward plan to have 3 regions with 3 hospitals

• Barnhart: Another $3-4 bil shortfall this year; Effects Wake county more than other places; losing jobs everywhere – employees may have to commute but most jobs preserved; have to make hard decisions the next few years; not losing beds

• Braxton: need to consider increasing population (my note: not taking into account current overutilization); Luckey: new Cherry and Broughton have additional capacity

• Had been a plan to open forensic beds at Broughton and that hasn’t happened.

Health Reform – Pam Silberman, IOM (Handout)

• Good Overview for DRNC folks

• Pam highlighted:

o special outreach requirements to people with mental health or addictive disorders

o prevention and wellness – funds for a prevention and public health fund – mh, behavioral health and substance abuse disorder included priority areas

o Efforts to expand health professional workforce, including specifically mh and addiction licensed health professionals

o Expand National Health Service Corps

o Quality Improvement; comparative effectiveness research

o New models of care to improve quality and efficiency, i.e., reverse co-location (primary care provider in community mental health agencies), Medicaid emergency psychiatric coverage in IMDs

o Expansion of community health centers (NC has applied for funding to expand community health centers)

o CLASS

o Options to expand HCBS to achieve an enhanced match rate – Community First Choice Option and state balancing initiative

• Impact on People with MH/DD/SAS Conditions

o Expanded insurance coverage

o Essential benefits plans should include preventative services related to MH/SA

o Many people now receiving state funded services through LME will now have Medicaid or private insurance coverage – LMEs still have role in authorizing services to people who lack insurance coverage, authorizing wrap-around services and in UM

o There will still be a role in state financing for gaps

o Question: what is the role of the LME in the new system?

o No mention of the revised 1915(i) waiver option

• Youth Villages Transitional Living Program, Youth Villages & Guilford Center (Handout)

o Program targets kids coming out of foster care with behavioral health issues

o In NC average daily census 55 kids/day; target number about 400 kids/year

o 10 locations across NC

o Doing clinical trials in TN to compare outcomes; now can compare to national outcomes

Public Comment Portion

• Union member discussed OAH decisions overturning employee terminations, Dix closure, disproportionate effect on black workers

• Louise Jordan spoke in favor of keeping Dix open, no part of discussion is person-centered, only budget centered

• Beverly Moriarty, Dix nurse – declining admissions because all hospitals on delay; reform didn’t happen, we don’t have community services, patients not being treated, building new hospitals in wrong places and staffing shortage

• Current temp psychiatrist at Dix – Dix long term care has better outcomes than other hospitals

Effectiveness of Single Stream Funding, Steve Jordan (Handout)

• Report submitted to GA August 31, 2010

• Put monitoring in place to ensure some maintenance of effort for individual disability services

• Allows LMEs to use funds for projects to fill gaps

• Looking at expenditure comparisons, LMEs spending closer to allocation, increased SA spending significantly

• Majors programming – managing access for juvenile justice – 15 year old JJ initiative to screen, identify and provide treatment for young people with SA issues
Next Meeting November 9th