ECBH Finance Called to Question in news

Mary beat me to it... [download the 3 news articles here]


Mary K. Short is a strong and active advocate and the parent caregiver of an adult DD recipient with profound needs. She fights tirelessly for the rights of her daughter, Katie and other special families, as well as a great deal of time keeping folks informed! Posted with Mary's permission.

Mary and her daughter live in NC House District 88 and Senate District 42. Her daughter is being served by Smoky Mountain LME.

MaryKShort@aol.com <MaryKShort@aol.com>	Mon, Jun 25, 2012 at 1:09 PM
To: jjennings@alexandercountync.gov, rmayberry@alexandercountync.gov, jmoose@alexandercountync.gov, drobertson@alexandercountync.gov, lyoder@alexandercountync.gov Cc: MaryKShort@aol.com
Dear Commissioners:  I have appeared before you and I have tried to tell you about my concerns regarding this change from a statewide CAP-MR/DD waiver to an LME/MCO run NC Innovations waiver.  I have expressed my concerns about this change to an "at-risk insurance company."  I am hopeful you will take the time to read this series of newspaper articles regarding ECBH (East Carolina Behavioral Health). I am asking that you contact me by email to tell me that this is NOT also true of what is happening at SMC (Smoky Mountain Center) which is due to "go live" with the change on July 1st.  Mary K. Short 828-632-5888 or 704-451-4144 (cell) In a message dated 6/25/2012 10:31:57 A.M. Eastern Daylight Time,  Begin forwarded message: From: "Crystal J. De la Cruz " Date: June 25, 2012 10:14:44 EDT To: undisclosed-recipients:; Subject: NC Medicaid Waiver - financial mysteries with ECBH Dear US Government Officials, members of the NC General Assembly, DHHS representatives, and fellow concerned parents and NC Citizens, Please find attached 3 news articles from The Daily Advantage, a small paper in the eastern part of the state which highlights some very frightening issues surrounding the Medicaid Waiver and budgetary concerns expressed by Camden Co. Commissioner Mike McClain, also an accountant and ECBH board member. Also attached, my recent open letter and outline (with supporting documents) addressing related concerns, in the event you have not had an opportunity to review. Kind regards, --  Crystal J. De la Cruz - Hopper Mother, Advocate & Concerned Citizen When we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – We Are in Crisis. http://no2nchb916.blogspot.com/ "The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled."           --Hubert H. Humphrey From: ncadvocacy@yahoogroups.com Reply-to: notify-dg-ncadvocacy@yahoogroups.com To: ncadvocacy@yahoogroups.com Sent: 6/25/2012 6:15:48 A.M. Eastern Daylight Time Subj: [ncadvocacy] Digest Number 2039 The Daily Advance ECBH 'lost' $11.4 Million - East Carolina Behavior     Posted by:     Date: Sun Jun 24, 2012 1:05 pm ((PDT)) _Click  here: The Daily Advance_ (http://www.dailyadvance.com/news/mclain-ecbh-8216lost8217-114m-1113601) NC Advocacy: As you have to subscribe to see the article -  I've pasted it below. The Daily Advance June 24,  2012 McLain: ECBH ‘lost’ $11.4M “This is basically Albemarle Mental  Health on steroids.” -quote by Mike McLain Camden  commissioner By Reggie  Ponder East Carolina Behavioral Health — the  Greenville-based agency that oversees mental health services in the region — has  lost $11.4 million in the current fiscal year and is losing about $1 million a  month, an ECBH board member charged last week. Camden County Commissioner Mike  McLain, who sits on ECBH’s Area Board of Commissioners, said the current  management at ECBH is 10 times worse than Albemarle Mental Health Center’s ever  was. “This is basically Albemarle Mental  Health on steroids,” McLain said, referring to the now-defunct organization that  was shuttered in 2009-10 in the wake of a state audit that uncovered glaring  mismanagement. But ECBH Director Leza Wainwright  categorically denies that ECBH is losing money.  “We are not losing money,” Wainwright  said Friday when asked about McLain’s concerns. McLain, an accountant and an  instructor in accounting at Hampton University in Virginia, said he noticed  while reviewing financial statements recently that revenues do not match  expenses. McLain said when he asked about the  discrepancy, which ECBH records show amounted to some $11.4 million for the  2011-12 fiscal year as of May 31, he was told not to worry about the  figures. McLain said he was told that ECBH  expected to lose $6 million when it launched its Medicaid waiver program but the  actual loss has been more than $11 million. ECBH has managed Medicaid funding  for programs serving people with developmental disabilities under a waiver  system since April. Wainwright and ECBH Assistant  Director Joy Futrell insist the loss exists only on paper and is the result of  board-approved fund balance transfers coupled with an especially conservative  way of accounting for potential liabilities. They say the accounting method was  recommended by a consultant as the safest way to begin ECBH’s foray into the  Medicaid waiver field. A financial report for May presented  to ECBH’s Finance Committee shows expenses of $87 million as of May 31 but  revenues of only $75.6 million — a shortfall of $11.4  million. While Wainwright acknowledged that  while the report shows a net loss of $11.4 million, those figures reflect  one-time transfers from fund balance that were authorized by the board, she  said. ECBH transferred $6.7 million out of  fund balance into a retiree health insurance trust account and $4.5 million for  the Medicaid waiver start-up. She said the reality is that ECBH is  not losing money but is between $1 million and $1.5 million to the  good. Futrell explained that once ECBH gets  further along with the Medicard waiver program, staff will be able to estimate  Medicaid service liability more precisely. “Typically and in the future, ECBH  will estimate outstanding Medicaid service liability utilizing data which  considers providers’ billing history, specifically considering the average  number of days it takes for providers to bill and get paid,” Futrell said in an e-mail response to  The Daily Advance. “Due to the waiver starting up in April, there was no history  to estimate the outstanding Medicaid liability and there was no authorization  data to utilize, so the recommendation was made to use the most conservative  approach in estimating the Medicaid liability to be 100 percent of what was not  spent for Medicaid services based on the budget.” As an example, and noting she was  using “completely made-up numbers” for the purpose of the explanation, Futrell  said that if ECBH had budgeted $500 per month for Medicaid outpatient services  but spent only $200 in a given month, ECBH still considered the entire $500 a  liability. This accounting method was chosen  because it is the most conservative, assuming that all Medicaid service funds  will be spent, she said. ECBH plans to use the conservative approach until the  agency has enough history with providers to be able to make accurate  estimations, Futrell said. But McLain said ECBH is making light  of very real risk. The new ECBH model is essentially that of an insurance  company, he said. “There’s a lot of risk in being an  insurance company,” McLain said. “You’ re on the hook for potential  liabilities.” Although the ECBH board has been  assured there are risk management procedures in place, board members have not  been informed of what those procedures are, he said. “That scares the heck out of me,”  McLain said. The ECBH Area Board of Commissioners  will meet Tuesday at 7 p.m. in the EMS building at 205 E. Main Street in  Williamston. The meeting will include a public hearing on ECBH’s 2012-13  budget.

201204-05 TheDailyAdvance - ECBH Money Management.zip 5029K

email from Dr. Pat Porter

09 April 2012

Received via email from Dr. Pat Porter, DHHS consultant to the NC General Assembly:

Hello Crystal, I followed up on your question regarding the rates of pay for direct care workers per the changes in approved service definitions.  While this seems to be resolved for now, there were a couple of issues that caused some confusion with the transition of ECBH to the B-C Innovations Waiver.

The CAP IDD waiver is not a perfect crosswalk to the Innovations waiver.  In the CAP Waiver, recipients have had access to Home and Community Support (HCS), which is primarily a habilitative  service with a very small amount of personal care (PCS) blended in.  (CAP IDD also has the basic PCS).  So, HCS in CAP cross-walks to In-home Skill Building and PCS in the Innovations waiver.   In-Home Skill Building (a hab service) pays more than PCS.

As ECBH was cross-walking the services during transition, they cross-walked much of the HCS to PCS, rather than In-Home Skill Bldg.   Again, HCS/In-Home Skill Bldg. pays a higher rate than PCS.  But, there was a reason for this. ECBH could find very few habilitation  goals on the plans being reviewed and, unfortunately,  they found little or no evidence of assessments supporting the recipient's ability to benefit from habilitation.  Based on the assessment information they found, it appeared that most recipients were actually receiving more PCS than hab. As you know, the Managed Care sites  must pay for the actual services needed and rendered.

With further review and technical assistance from the Division of Medical Assistance,  ECBH elected that the wisest course of action on behalf of their consumers would be to cross-walk HCS directly to In-Home Skill Bldg for ease of transition.  I am told that these cross-walked plans will last for the remainder of the plan year.  This is the action that had already been taken by Western Highlands and PBH as they made these transitions.  I am told that ECBH alerted the providers in a March 22 Communication and in a town-hall meeting in Greenville but, apparently, not everyone has gotten the word yet.

At some point soon, ECBH will be compelled to address the  habilitation/PCS issue. Perhaps this will occur in Annual Revisions. Care Coordinators have been alerted to pay attention to additional assessments that may be needed to support habilitation goals.  Be assured that the Care Coordinators will develop plans based on what the recipient needs and wants ( that’s the rule). Utilization Management may, however, deny a habilitation service if there is not demonstrated medical necessity per CMS rules.  Certainly, if that should occur, ECBH will offer review and appeal rights. The DHHS will be monitoring the process to assure due process.

This is a long reply but I hope it is helpful to you