Guest Post from Mark Sullivan
The most recent debacle in the now seven year old process of mental health reform involves billing for Community Support Services, the flagship service of the newly designed Mental Health, Substance Abuse, and Developmental Disability system. Headlines above the fold in the News and Observer in recent weeks included “Audit: mental health providers cheat.”
Health and Human Services Secretary Carmen Hooker Odom cited results of a recent audit of 172 service providers, and listed encouraging an individual to take his medicine, and taking a child swimming as examples of possible criminal abuses of the public system. With such little context, it is difficult to determine whether these are actual abuses, or are merely being drummed up to justify a radical slash of funding. It is very likely that in some of these cases the real explanation is that under-qualified, overworked employees did not adequately document their activities. The fact that these services were approved by Value Options, the managed care company designated by DHHS to perform authorization and utilization review under the new system, seems to have been omitted so that providers could be smeared.
Abuses may have occurred, and the system that Secretary Hooker Odom has signed off on is deeply flawed. However, the responsibility for this most recent development lies squarely on the shoulders of Secretary Hooker Odom and Governor Easley. They have developed a system that not only allows for the gaming of the system that has occurred, but systematically promotes it.
When the new definitions and rates were released, advocates charged that they were designed to insure that lower qualified workers were used to deliver services in order to save money. It appeared obvious that when high school graduate and masters prepared workers could perform essentially the same functions and bill at the same rate, lower qualified people would be used. Architects of the new system vociferously denied this. Now the worse case scenario has unfolded; the new model encourages the use of lower qualified workers, but is not saving money either.
By cutting reimbursement rates, Secretary Odom only confirms that the Department’s intention was to have these least qualified workers providing the bulk of this important service, despite the rhetoric. In a recent letter to the editor, Odom pointed out that high school graduates were providing services that, if provided by more qualified workers, would lead to better outcomes. Rather than designing a solution to this very real problem, the department has simply reduced the rates, insuring that the status quo is unchanged. This decision demonstrates either serious incompetence, or a real disinterest in developing an effective and efficient system.
Mark D. Sullivan, MSW
Mental Health Association in Orange County, NC