For Release: IMMEDIATE
Date: April 26, 2007

State Sets Final Community Support Services Rate

Rate Accurately Reflects Real Cost of Service Provision

RALEIGH – Officials with the North Carolina Department of Health and Human Services today announced a final Medicaid rate to cover the reimbursement of Community Support (CS) services for people with mental health and substance abuse issues. The rate, $51.28 per hour, was based on a cost analysis of services. It is effective retroactive to April 5.

“We feel that this is a fair rate that covers the actual cost of the services,” said DHHS Secretary Carmen Hooker Odom. “We wanted this to be a transparent process and have worked with providers to determine this rate. We believe that this rate change, coupled with other changes, will make certain that the right people are receiving the right services at a cost that ensures that taxpayer dollars are well spent.”

The original rate of $60.96 per hour was instituted on March 20, 2006 when Medicaid began to pay for community services. Earlier this month, based on a service audit of 167 providers who had been billing for large numbers of hours of CS for individual consumers, the rate review board had reduced the hourly rate to $40.

“That reduction was made based on the best available data we had at the time, which showed that those 167 providers were billing for services that were almost totally provided by people with high school degrees or less,” she said. “The original rate was set up with the idea that a quarter of the services would be provided by professional staff with master’s degrees. Certainly, with those 167 providers, who represented 16 percent of the CS providers, that wasn’t happening.

“But, we had committed since 2006 to work with a group of providers who were chosen by their trade associations or local mental health agencies on determining real cost of service,” she said. “We expedited that work, looking at 16 providers and found that the rate we decided on today reflects the actual cost of service provision.”

She said that the new rate, coupled with proposed changes in the way that use of the services is reviewed, will ensure that’s the case.

The state has tightened up the way use of CS will be reviewed. Those changes include:

• Post-payment reviews will be conducted for all CS recipients who receive more than 12 hours of service a week. Findings that services have been provided improperly could result in legal action.
• The claim of any recipient for an increase in CS will be flagged and reviewed for clinical appropriateness.

The state has proposed other changes that are currently out for a 45-day comment period. Those proposed changes include:

• Prior approval will be required for all CS services, except for an initial 8-hour review by a qualified professional such as a psychologist to ensure that CS is the proper service.
• For adults, the maximum amount of CS that will be approved is no more than 15 hours a week.

Community support services, which are part of a range of new services, are supposed to be a relatively low intensity service for people in need of clinical services to live successfully in the community. Examples of CS include: case management functions to link consumers to other services, including physical health services, clinical counseling to address issues of symptom monitoring and behavior management, and skill building activities to help the consumer master the skills needed to live independently and function in their environment.