New DHHS reality series offers fresh take on Dancing With The Stars

If former president Gerald Ford was correct in his observation that moral progress comes not from comfortable and complacent times but out of trial and confusion, North Carolina is well on its way to becoming saintly with regards to its mental health system.

As Local Management Entities across the state scramble to meet requirements of a Department of Health and Human Services mandate, the fact that the entities they are being asked to form aren’t even legal yet is certainly no cause for delay. And for those LMEs that aren’t quite prepared to meet the new requirements, there’s apparently the option to join the state in the make-it-up-as-you-go-along theory of system building. [Read more…]

Note: It’s been 16 years now since Mom died and I wrote this tribute to her. I reprint it here in honor of her and in thanks to all moms. Never underestimate your power to change the universe through your deeds and through your children. I hope in some small way my advocacy efforts help keep my Mom’s spirit alive.

It’s a rare privilege to be with your parents when they die – to comfort them, to say your good-byes, to hold their hand as they take the last breath that separates them from this world and the next.

I was with my Dad when he died one hot August afternoon in 1990. He died at home, a home he built himself 40 years before. The doctors said he would never leave the hospital; my Mom said he would. That he died in the home he so loved was a tribute to my Mom’s determination. [Read more…]

So, my education on how an idea becomes law continues with the introduction of yet another bill yesterday to expand Medicaid 1915(b)(c) waivers statewide. House Bill 916 goes into a good deal more detail than its predecessor H424/S316, which pretty much just gave the Department of Health and Human Services the go-ahead as long as LMEs proved readiness. It’s hard to say if these bills assume or ignore the issue of DHHS readiness.

House Bill 916 also addresses the loss of case management services to the IDD community by creating a Community Guide service, officially sanctions the PBH model as the blueprint for all, and covers a number of issues that makes it worth a read by those more knowledgeable than myself. I’d certainly welcome your feedback.  [Read more…]

With declining readership and faced with the same economic realities that stare us all in the face, you can’t expect a newspaper to stay on top of everything. It’s not necessarily that truth doesn’t sell anymore, but with fewer resources, less of it gets processed and passed on to the public. The newsworthiness of what does get passed along is based largely on what reporter and editors think is important because of its impact or potential impact on citizens or because of the ever vague concept of human interest.

I’ve criticized the Raleigh News & Observer several times over the past year for what I consider gross dereliction of its journalistic responsibilities in not covering the evolution of Crticial Access Behavioral Health Agencies, the new entity of larger mental health service providers mandated by the Department of Health and Human Services. The pros and cons of CABHAs was a topic of significant debate in the mental health community for most of 2010, with the Winston-Salem Journal producing at least 26 articles on the topic last year, while the News & Observer produced none, making it safe to say that one organization or the other exercised extremely poor news judgment. [Read more…]

By David Cornwell
Executive Director
North Carolina Mental Hope

I’d be a fish out of water working in the statehouse and bureaucracies of Raleigh. My ADD and I would be instantly lost in the swirl of acronyms, rules and regulations of compliance, and the finances that hold it all tenuously together.

Simple is better for me, and I tend to judge things on whether they simply make sense or not. And common sense tells me that the proposed expansion of Medicaid Waivers to all of the state’s Local Management Entities makes no sense, at least not now. And in this case my common sense is backed by a Department of Health and Human Services report and one from the consulting firm that DHHS likely paid oodles of money for a report to ignore.

Is it common sense to think that the myriad of shortcomings Mercer Consulting reported last August in the Division of Mental Health, Developmental Disabilities and Substance Abuse Services have been overcome? Mercer reported significant needs in staff training, IT infrastructure and expertise, and certainly not the least the need to develop a vision, guidelines, policies and procedures?

[Read more…]

While legislators may not listen to advocates’ concerns over the rush to implement 1915(b)(c) Waivers statewide, perhaps they’ll listen to the concerns of the top official now pushing for that implementation, Department of Health and Human Services Secretary Lanier Cansler.

“Using a Medicaid waiver to shift to managed behavioral healthcare represents a significant shift in thinking for all stakeholders in North Carolina. Such a change takes multiple years to research, implement and refine. Most states who used waivers to implement MBH (Medicaid Behavioral Healthcare) plans recommend extensive research of the current system and proposed options and planning involving all stakeholders.” [Read more…]

Where, you might ask, has the Mercer Report been? It might be easier to ask where the report, which found the state woefully unprepared to oversee a statewide waiver system, has not been since its release last August.

A quick search of the Joint Legislative Oversight Committee for MH-DD-SAS using the keyword “Mercer” shows it apparently didn’t make it to the lead Legislative body at the time. Most of the 14 results retrieved from that search deal with a much more visible 2008 Mercer Report on Local Management Entities. And looking through LOC meetings and handouts doesn’t show any evidence of the report, either. You won’t find it in DHHS press releases, either (although a press release from then Sec. Benton on the 2008 report can be read here).

You won’t find it in Division Director Steve Jordan’s report at the November meeting of the state’s Commission for Mental Health, Developmental Disabilities and Substance Abuse Services, although Jordan does give a waiver update on the planned additions of Mecklenberg and Western Highlands. [Read more…]

An organizational review of the state division responsible for the oversight of statewide Medicaid waivers for mental health, developmental disability and substance abuse services found the division acutely unprepared for that oversight role.

Despite findings of the report that warn of ineffective and inefficient oversight, the Department of Health & Human Services has announced plans to forge ahead with plans to implement the waivers statewide.

Released last August, the report from Mercer Consulting found DHHS’s Division of Mental Health, Developmental Disabilities, and Substance Abuse Services with significant needs in staff training and IT infrastructure, key positions that were vacant, and the need to develop a vision, guidelines, policies and procedures for monitoring new waiver entities. (A summary of findings begins on page 16 or the report, with recommendations on page 19.)  [Read more…]

Perhaps after his stint as Secretary of the Department of Health and Human Services, Lanier Cansler could become a NASCAR driver. It’s a job that might satisfy his need for speed and some might argue, recklessness.

Earlier this month, DHHS announced plans to zoom ahead in instituting Medicaid waivers statewide, waivers that will once again change the landscape in which services for mental health, substance abuse and developmental disabilities are provided.

While the April 1 “news alert” announcing the greatly accelertaed timetable caught many advocates off guard, it was essentially public notification after the fact, with legislation that will make the changes possible being filed March 8. (Senate Bill 316, House Bill 424 with primary sponsors being GOP Senator Fletcher Hartsell, Jr. and GOP Representatives Jeff Barnhardt and Dan Ingle and Democrat Verla Insko. The bill has passed its third reading by the Senate and has passed a first reading in the House before being referred to that chamber’s Health and Human Services Committee.)

[Read more…]

When Asheville behavior therapist Trent Codd saw that Cognitive Behavior Therapy was included in the state’s latest revision of its Enhanced Mental Health and Substance Abuse Services, he was, to say the least, pleased.

“We applauded their interest in evidence-based treatments and thought it was a wonderful move on their part,” Codd said. But with DHHS’s minimal requirement that to provide Cognitive Behavior Therapy, a mental health worker must simply be a professional and take a 24-hour workshop, he’s now, to say the least, dumbfounded.

“North Carolina has a real opportunity here to bring treatments that are largely unavailable to many,” Codd said. “But the state must impose some reasonable standards in order for this to happen. Just saying a licensed professional must provide the training is absurd.” And, he said, the notion that someone can become competent in CBT with just 24 hours training further defies common sense. [Read more…]