| WRAL report re Managed Care and IDD, etc. 1 message |
Patients, advocates wary as NC again reforms mental health system
By MARK BINKER, WRAL.com Multimedia Reporter
Raleigh, N.C. — North Carolina is in the midst of an effort to remake the state's public safety net for those with mental health, substance abuse and developmental disabilities.
Lawmakers, administrators and taxpayers want to see if the change to a "managed care" model can really save millions of dollars and avoid the over-spending debacles that marked the first system remake a decade ago.
At stake is how the North Carolina manages more than $2.4 billion in state and federal mental health dollars that flow through local mental health agencies, and how individuals with mental illness will live their lives every day.
"All I want to do is keep my daughter at home," said Laurie Haley.
For her, reforms success or failure will be measured by how it affects her daughter, Alissa. The 27-year-old woman has severe developmental disabilities and also suffers from seizures. Alissa needs help dressing, eating and taking care of other needs. Those who help her need to be able to administer medicine and prepared to act in case a seizure makes her fall in the shower or comes on her in public.
Haley says that she has, for now, ensured that the transition to managed care won't mean fewer services for her daughter. But she said other families making the switch are still encountering problems.
"What I'm hearing is that they're still trying to reduce services for people," Haley said.
That small-scale skepticism of the new system was amplified this summer when a blistering report said that one of the first local mental health authorities given permission to make the transition was not ready for the switch to managed care.
State and local mental health administrators say that one experience should not color the entire transition effort and that the system is on the road to improvement. Advocates, some who work providing services to clients and even some lawmakers say the process may be moving too fast. They worry that counties such as Wake and Durham, which have just begun the move toward managed care, could encounter the same mistakes and problems seen elsewhere.
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[ There's much more... Read the Full Story on WRAL.com ]
Lawmakers, administrators and taxpayers want to see if the change to a "managed care" model can really save millions of dollars and avoid the over-spending debacles that marked the first system remake a decade ago.
At stake is how the North Carolina manages more than $2.4 billion in state and federal mental health dollars that flow through local mental health agencies, and how individuals with mental illness will live their lives every day.
"All I want to do is keep my daughter at home," said Laurie Haley.
For her, reforms success or failure will be measured by how it affects her daughter, Alissa. The 27-year-old woman has severe developmental disabilities and also suffers from seizures. Alissa needs help dressing, eating and taking care of other needs. Those who help her need to be able to administer medicine and prepared to act in case a seizure makes her fall in the shower or comes on her in public.
Haley says that she has, for now, ensured that the transition to managed care won't mean fewer services for her daughter. But she said other families making the switch are still encountering problems.
"What I'm hearing is that they're still trying to reduce services for people," Haley said.
That small-scale skepticism of the new system was amplified this summer when a blistering report said that one of the first local mental health authorities given permission to make the transition was not ready for the switch to managed care.
State and local mental health administrators say that one experience should not color the entire transition effort and that the system is on the road to improvement. Advocates, some who work providing services to clients and even some lawmakers say the process may be moving too fast. They worry that counties such as Wake and Durham, which have just begun the move toward managed care, could encounter the same mistakes and problems seen elsewhere.
...
[ There's much more... Read the Full Story on WRAL.com ]
And while statewide success will be measured in millions of dollars, Haley and others like her will measure it in terms of what it means for their loved ones.
"My daughter is not a disability, she's a human being with a disability," Haley said. "If I have the right to live at home and you have the right to live at home, she should too."
- Reporter: Mark Binker
- Web Editor: Jodi Leese Glusco
----------- more from Mary Short...
EXTRA: Mercer Report link
2ND EXTRA: Federal Report link and quote from that report
C. Health, Safety and Quality
Abuse, neglect, exploitation, the use of mechanical and chemical restraints, unexplained injuries and denial of services are far too prevalent in our current long-term system of services. CMS has made significant strides in holding states accountable for addressing health and safety issues in the 1915(c) Medicaid Home and Community Based Waiver program; but requirements governing program design, state monitoring and reporting to CMS have not been mandated for managed care programs approved under Section 1115 demonstration waivers or under the dual eligible pilot demonstrations.
3rd EXTRA: Other news reports from Raleigh sources regarding other budget cuts and budget overruns
http://projects.newsobserver.com/under_the_dome/mental_health_office_needs_lots_of_work_consultant_says#storylink=cpy
Submitted by lbonner on 2012-07-26 14:37
Under the Dome | mental health | N.C. Department of Health and
Human Services | Western Highlands Network
Last week, we wrote about a local mental health office that covers
western North Carolina counties losing $3 million since switching to
managed care in January.
A consultant's report issued this week describes problems at Western
Highlands Network, one of the first local mental heath offices to
convert to a managed care system.
Among other things, the report says that the information Western
Highlands leaders receive about services, use and costs is inadequate,
and that it is not keeping good track of Medicaid claims.
The report goes on for nine pages. In short, it says Western Highlands
needs lots of improvements, and the consultant recommends close
monitoring by the state Department of Health and Human Services.
Under managed care, the local mental health office gets a set amount
of money to treat mentally ill patients who rely on Medicaid or state
funds.
Western Highlands Network became a managed care organization in
January. By next January, managed care organizations for
government-paid mental health services will cover the entire state.
And ... news article re WHN & Mercer Report is in it and easy to read!
