Last updated: January 02. 2014 10:52AM - 1592 Views
Christina Day Staff Writer cday@civitasmedia.com

A map released by DHHS shows the proposed consolidation of the state's managed care organizations into four regions of service, or LME-MCOs.
A map released by DHHS shows the proposed consolidation of the state's managed care organizations into four regions of service, or LME-MCOs.
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The board of directors at Smoky Mountain Center (SMC) are looking at proposed plans to merge with two other area health centers, according to Ashe County Commissioner Judy Porter Poe.

During the Dec. 16 meeting of the Ashe County Board of Commissioners, Poe, who serves on the Smoky Mountain board of directors, discussed plans proposed by the N.C. Department of Health and Human Services (DHHS) for Smoky Mountain to merge with CenterPoint Human Services in Winston-Salem and Partners Behavioral Health Management in Gastonia.

In late December, a one-page memo regarding the merger was sent to employees of the three managed care organizations (MCOs), which provide state and Medicaid funded mental health, substance abuse and intellectual disability care. The MCOs are sometimes referred to as local management entities (LMEs) or MCO-LMEs.

The N.C. Council of Community Programs represents the MCOs and released the merger plans.

Poe said that the merger would create Western Regional Partnership, which would cover 35 counties (SMC covers 23 counties, including Ashe), and is based on state and federal regulations ordering the consolidation of Medicaid funds.

A DHHS press release from Dec. 17 said the proposed merger, would “increase sustainability of North Carolina’s mental health system.”

Along with the proposed Western Regional Partnership, 10 organizations across the state are considering merging into four regions of coverage (one western, two central and one eastern) each covering approximately 300,000 to 350,000 people per region.

The press release cited the mergers as being a response to 2011 state legislation which “created a plan to move the approximately $2 billion Medicaid dollars for mental health, intellectual and developmental disabilities, and substance abuse into a managed care system by July 1, 2013.”

“The consolidation to four LME-MCOs will help create a more sustainable behavioral health system while continuing to improve services through more efficient delivery of care,” Mary Hooper, executive director of the N.C. Council on Community Programs said in the press release.

Poe said the the proposed Western Regional Partnership is intended to be more streamlined and cost effective, but she is concerned the larger partnership would mean less community input, such as what exists now in the form of MCO board of directors.

Tommy McClure, a board member at SMC and a supervisor of Adult Protective Services in Ashe County said he also has concerns about how the community will be effected by the proposed merger.

“There are always gaps in services and there are always ways for a service agency to improve, but the keys to such improvement are are constant involvement and information provided by people at the grass roots level,” McClure said, “It is my hope that such mergers will not leave us with agencies so large and bureaucratic that it doesn’t hear input from the communities or can no longer easily change to adapt to the changing situations within the communities.”

McClure said he is worried that the feedback from the largely populated urban areas within the same proposed district of coverage will overshadow the feed-back given from rural places, like Ashe.

Poe said that another area of concern for her is the “value-based outcome” the state is imposing on MCOs in which Medicaid payments to the MCOs are based on how well the consumer is progressing.

“I don’t see how state government can put a timetable on how long someone with mental health problems takes to get better,” Poe said in the commissioners meeting.

In a follow-up interview, Poe said that the details of the merger were contingent on a March 17 presentation that state heath Secretary Dr. Aldona Wos is making to the General Assembly regarding Gov. Pat McCory’s Medicaid reform initiative and its implementation date.

A Medicaid reform consultant hired by the state released a statement saying the reforms of Medicaid in North Carolina could take until 2020 to be completed.

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