Joint Legislative Subcommittee on Mental Health Meeting

The Joint Legislative Oversight Committee on Health and Human Services, Subcommittee on Mental Health met on Monday, December 10 to discuss the following items.  The committee also discussed proposed committee recommendations.

• Laura White, Division of State-Operated Healthcare Facilities, presented on the history and process of determining facilities' catchment areas.  In the past, the Division attempted to keep all counties served by a single LME in the same region and thus served by a single state  facility.  However, the increased size of LMEs will prevent this in the future.
• Beth Melcher presented on Three-way contract Payments, in follow-up to questions raised at the last committee meeting.  They are proposing that hospitals that have had trouble being paid promptly can submit an alternative claim directly to state (the claims must go through the LME now).  The LMEs still need to manage and pay long-term but this will help with cash flow issues for now.  There was also discussion about using a higher rate for higher acuity patients to be served in certain units (but not numbers or specifics).  They are due to review the rates in 2013.
• Sheila Davies from the Albemarle Hospital Foundation and Edward Spencer from the South Carolina Division of Mental Health discussed the use of Telepsychiatry.  Ms. Davies spoke about a grant-funded expansion in NC that is showing reduced length of stay, reduced readmissions, patient satisfaction on surveys, and reduction of unnecessary Involuntary Commitments (223 IVCs overturned). She also discussed their challenges to growth: credentialing/privileging with multiple LMEs, navigating the Medicaid waiver with LMEs, sustainability (indigent care reimbursement), limited resources (bed availability, lengthy wait times for outpatient referrals, and law enforcement strain).  Mr. Spencer discussed the expansion of telepsychiatry in South Carolina. They have reduced length of stay by 50%; 43% of patients are discharged the same day as the consult; and reduced involuntary commitments by 60%.
• Mark Botts from the School of Government gave an overview of the Involuntary Commitment process in North Carolina.  Mr. Botts highlighted the laws and procedures, as well as areas where there are issues or a lack of knowledge, including underutilization of outpatient commitment (vs. inpatient); the stress of law enforcement for transportation, particularly when no beds available; and the need for better communication between LMEs and magistrates.
• Finally, there were presentations from the NC IOM, Durham Veterans Administration, and National Guard regarding services for members of the military and veterans with PTSD.

Proposed Findings and Recommendations to HHS Oversight were discussed:

• To direct DHHS to determine the cost to increase the number of beds in state psych hospitals, explore creating a south central mental health region, and investigate the possibility of placing a new psych facility in that region.
• Work with community hospitals to develop a plan to revise three- way contract payments from a single rate model to a tiered rate structure based upon the patient's acuity level.  Submit a plan by October 1, 2013.
• Direct DHHS to investigate, develop and provide incentives to increase the overall supply of psychiatrists, psychologists and other MH professionals, especially in rural and underserved areas of the state.  Submit a written report by Oct 1, 2013.
• Members also mentioned adding recommendations  around training on Veterans' issues and telepsychiatry.