Michael F. Easley
Governor

The Great Seal of the State of North Carolina Dempsey Benton
Secretary

North Carolina
Department of Health and Human Services

For Release: IMMEDIATE
Date: November 8, 2007

  Contact: Mark Van Sciver

DHHS Takes Action to Improve Community Support Services;

Improve Quality/Accountability of Mental Health Services

RALEIGH – The Secretary of the North Carolina Department of Health and Human Services today announced a plan to adjust community support services for people with mental health and substance abuse issues. He said the plan will stabilize the community support side of the system, allowing the department and local management entities to focus on overall efforts to improve quality and accountability in the state’s mental health, developmental disabilities and substance abuse services system.

“This plan addresses the quality of services and overall sustainability of the community support services program,” DHHS Secretary Dempsey Benton said. “This will stabilize the community support system, which will allow us to focus on additional priorities for the good of the entire system.”

Benton said this is just one piece of an overall effort to improve mental health, developmental disabilities and substance abuse services, noting that department is working with local management entities to address priorities for the next six months.  Those priorities include:

  • Implementation of crisis service programs across the state.
  • Development of a more effective substance abuse treatment strategy for consideration in next year’s budget.
  • Focus on overall management issues, which include the statewide structure of local management entities and the development of more consistent and standardized processes across the state.

The community support service plan includes suspending the addition of new community support service providers entering the system and partial withholding of future payments to providers who in the past have performed services that were not medically necessary.

“We recognize that there are lots of good providers out there who are providing quality care; this action won’t affect them,” Benton said. “It does put some problem providers on notice that we are watching what they are doing and won’t pay for services that aren’t clinically necessary.”

The suspension of new community support service providers will last until at least July 1, 2008. Exceptions will be granted in instances where access to care – especially for substance abuse services – may be negatively affected. 

During the moratorium on new community service providers, the department will develop new rules that will improve required qualifications for new and existing providers and strengthen the department’s ability to terminate problem providers.

Post-payment reviews of community service providers have identified 185 agencies that have provided services that were not medically necessary. Those providers must develop correction action plans to ensure that doesn’t happen in the future and to improve their quality of services.  They also must pay back dollars that were used inappropriately. Until they do so, the department will withhold 10 percent of their future payments.

Additional parts of the community support services improvement plan include:

  • Producing provider profile reports so that consumers and their families can be better judges of the quality of services.
  • Continuing to conduct medical record reviews and post payment clinical reviews to identify any other inappropriate payments.
  • Sanctioning providers, including termination, for unacceptable services and continued problems.

Community Support is a key service in North Carolina’s new community mental health and substance abuse service array that aims to serve consumers in their home communities and avoid the need for disruptive and costly inpatient care. Launched in March 2006, Community Support provides assistance in living skills with an objective of helping recipients achieve autonomy and stability.

Last month, the department announced the first stage of the community service improvement plan – proposed new definitions for the services.  Those changes, which are in a 45-day public comment period, include:

  • An emphatic statement that Community Support is a rehabilitative treatment service and not a social support, recreational or mentoring program.
  • Clarification as to which activities are covered by the program.
  • Clarification of the role and functions of a “Qualified Professional” and a lesser-trained “Associate/Paraprofessional.”
  • Requirements of minimum percentages of the service that must be provided by the “Qualified Professional.”

For the full list of new Community Support service definitions, log onto http://www.ncdhhs.gov/dma/mp/proposedmp.htm.

 

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Public Affairs Office
101 Blair Drive, Raleigh, NC 27603
(919)733-9190
FAX (919)733-7447

Debbie Crane
Director