Is anybody watching?

Editorial from the 20 November Charlotte Observer

http://www.charlotte.com/171/story/370666.html
Posted on Tue, Nov. 20, 2007

Is anybody watching?

If this doesn't make your blood boil, it ought to: Vague state guidelines
and poor oversight of private mental health contractors in North Carolina
left taxpayers overcharged and mentally ill clients served by
poorly-qualified workers.

The cost? Perhaps as much as $45 million. The result? Scarce public dollars
earmarked for the state's vulnerable citizens were wasted.

When will North Carolina admit that its experiment with mental health reform
(a.k.a. pushing services back to the community level and cutting costs by
privatizing) is failing? Either the state Department of Health and Human
Services is incapable of responsibly instituting reforms or this is an
impractical idea -- or both.

A state HHS audit found that 185 companies have been paid tens of millions
of dollars for providing mental health services that were not medically
necessary. People who didn't need services got them. Others who did need
them got too much service. What a mess.

At issue is an important program called community-support services, which
helps about 31,000 people each month. It provides personal aides and
professional counselors to teach people with mental illness and substance
abusers life skills, such as shopping for groceries or finding a place to
live. It's paid for mainly through state and federal Medicaid dollars and is
intended as a short-term service to help people move toward independent
living.

The program might have worked well if anyone had been watching to make sure
a private company paid to give the go-ahead and charges for services did its
job -- or if state guidelines for the program were tough enough.

This is more evidence that the state is not paying attention to details --
or to the best interests of sick citizens, many of them poor
-- as it has de-centralized its mental health services. Consider what else
has happened:

. North Carolina began closing down state mental hospital beds before
adequate funding was in place for community-based facilities. Meanwhile
psychiatric admissions were on the rise.

. In 2001, a critical leadership failure at HHS put emotionally ill children
in group homes at risk. Slack rules, lucrative reimbursements to private
contractors and scant state oversight surfaced after a girl in a Charlotte
group home suffocated while a worker without proper training restrained her.

The intent behind the state's movement toward community-based services is
good: To serve people in their own surroundings and help them live
independently rather than institutionalizing them.

The concept behind contracting services to private providers also has merit.
More efficient delivery can make limited dollars go further and help more
people.

But somebody has to make sure reforms are well thought-out, the right amount
of funding is in place and that contractors provide the right services at
the right levels to the right people. That's not happening in North
Carolina.