BY GREGORY PHILLIPS
May 3, 2006 : 7:34 pm ET
DURHAM -- A judge granted a preliminary injunction to the Durham Center that is the first court victory for local mental health providers against North Carolina's statewide reform plan to shift managed care to private companies.
The state Department of Health and Human Services announced in March that a private provider would start managing care for all Medicaid patients statewide as of June 1. On Tuesday, Administrative Law Judge Sammie Chess Jr. blocked that initiative from taking effect in Durham pending a full hearing the week of July 24.
The judge's ruling, the first of its kind in the ongoing dispute, also suspends the state's plan to have a neighboring authority handle all after-hours screening of Durham mental health cases beginning July 1.
The Durham Center is responsible for managing mental health, developmental disabilities and substance abuse services in the county. The state's directives would cost 15-20 of the center's 55 or so employees and $1.4 million in funding.
"This is the best news we've had in a long time," Durham Center Director Ellen Holliman said of the injunction. Durham's state legislators also told county commissioners Tuesday they'd fight to preserve funding for the Durham Center.
Private contractors don't save taxpayer money because they generally authorize more care than patients actually need, according to Durham Center officials. Losing that power to prescribe care and the ability to screen cases locally makes care less personal and not geared toward the patients' best interests.
During five years of mental health reform, local mental health authorities have moved toward service management rather than direct care, which is now handled mostly by private providers. The Durham Center embraced reform. For the most part it was labeled a model system by the state for its efforts to reduce local admissions at state hospitals.
But local officials got indignant when Health and Human Services announced in March that Value Options, a private provider, would handle authorization of all mental health care for Medicaid patients in the state starting June 1. Another blow was the simultaneous order that, beginning July 1, the neighboring Five Counties authority would handle all screening, triage and referral of mental health cases in Durham after 5 p.m. and on weekends.
A week after those announcements, County Attorney Chuck Kitchen filed a petition for a contested case hearing with the Office of Administrative Hearings to void the state's plan. The petition claims the state is violating its own statutes, breaching a contract with The Durham Center to oversee care and denying the center due process rights. That July hearing will result in a recommendation to Health and Human Services, which it can ignore. If the state ignores a ruling in The Durham Center's favor, the case can be appealed to Superior Court.
Health and Human Services spokesman Mark Van Sciver declined to comment on the specifics of the case, but said the state plans to have Value Options start authorizing care for other counties on schedule.
"We are not backing off," Van Sciver said. "Everything is proceeding."
Kitchen also declined to discuss how the state argued against the injunction in a closed hearing Tuesday.
"I don't want to comment on arguments because the case is still pending," Kitchen said.
A preliminary budget supplied to the Durham Center last month included a 28 percent budget cut from the state due to the impending removal of services. But Kitchen said the preliminary injunction also requires the state to continue funding The Durham Center to authorize care for Medicaid patients and conduct after-hours screening pending the hearing.
The center currently contracts with a private provider to screen cases. Holliman said bringing that service back in-house was one way the center might try to avoid losing staff if the state prevails.
The center's budget is up for discussion at a public meeting of its Board of Directors at 4 p.m. Thursday at 501 Willard St. downtown.
Thursday, May 04, 2006
BY GREGORY PHILLIPS
Posted by david at 6:03 PM Permalink