How much change, how soon?

Sometimes it’s important to note things if only to have them on record. Such is the case with DHHS Deputy Secretary Mike Watson’s comments Tuesday regarding proposed changes to provisions of Chapter 122c of state statutes governing Local Management Entities.

In presenting a broad overview of the issues DHHS says have arisen as LMEs become the new Super LME/MCOs (managed care organizations), Watson said: “The overall plan would be to come back in a session in November with a very limited request granting the Secretary the opportunity to perhaps waive some provisions of 122C and then to have the opportunity in the short session to have a more robust discussion about what changes might need to be made.”

And while Watson told the committee the same thing a bit later as well, that’s not necessarily a reason to believe proposals dramatically changing the nature and power of LMEs won’t pop up during next month’s special session anyway, introduced by a legislator at special interests request. During his presentation, Watson noted areas for change might include: board size and composition, the role of the executive committee, pay, fund balance restrictions, the ability to own property and borrow money.

DHHS has laid claim to those proposals, saying they are the result of input solicited from a broad range of groups and stakeholders.

A near-sighted legislature

A couple of thoughts after listening to yesterday’s presentations to the LOC: First is the tendency for me to forget that the ultimate blame for our state’s mental health woes lies with our elected officials, both past and present.

While DHHS staff can make matters better or worse, it’s still our legislators who sign off on it all. And listening to Secretary Cansler describe the complexities of dealing with a bevy of unknowns, including a $100 million hole in Medicaid, it’s hard to forget that it’s the General Assembly’s budget cuts that have made it all so difficult.

Secondly, between changes OK’d by House Bill 916 and proposed changes in Chapter 122c, it’s not just a wrecking ball that will be slamming into our state’s system, it’s an army of bulldozers and backhoes and mammoth dump trucks lining up to roll over it. And the same legislators that can’t see further than next year’s budget also don’t care if there’s a blueprint for the final product, only that there is a sketch of what the next phase will look like.

Anybody who doesn’t believe that only has to look at Central Regional and the new Cherry and Broughton hospitals as proof. While recent Department of Justice findings underscore the human and legal needs for de-institutionalization, the bulldozers are busy adding institutional capacity at Broughton just as they already have at Cherry and Central.

David Cornwell

Executive Director

North Carolina Mental Hope

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