More Trouble Ahead for Mental Health

During the 2011 session, the NCMS reported to you on another round of mental health reforms outlined in HB 916. The bill sought to transition Local Management Entities (LMEs) into Managed Care Organizations (MCOs) over the course of one year. The concept was based on a pilot project that has been underway for nearly seven years at Piedmont Behavioral Health (PBH). While PBH has been working under a capitated system of care delivery for some time, other LMEs have had trouble making the transition from managing provider contracts to adjudicating and paying claims in a very short window of time. So far, just three LMEs have made the transition. Two more are scheduled to come online by the end of July with the remaining six not scheduled to go live until closer to January 2013.

Physicians and other mental health care providers have faced a myriad of problems in the areas that have made the transition. For those that have not transitioned, questions abound about the process and what to expect. A few of the problems that we have heard from NCMS members include:

  • Blanket denials of service/non-payment for services previously reimbursed.
  • Cumbersome re-credentialing requirements with 11 different LME/MCOs versus the previous single process with Medicaid.
  • Over-flowing emergency departments because of a lack of local outpatient services.
  • Back logs of patients at state mental health facilities.

NCMS is working with a coalition of partners to ensure that this transition has more predictability, more standardization across the different LME/MCOs, and less interruption of services to patients. We are working with legislators to identify additional oversight and assistance that can be provided to the LME/MCOs in order to support this policy change that the North Carolina General Assembly has determined will go forward.

It is important that we continue to hear from you through this transition to ensure that we are being proactive, not only at the North Carolina General Assembly, but also at the DMA. Please continue to reach out to our Government Affairs team with your concerns so that we can ensure that you are not only compensated for the vital work that you provide but that your services continue to be available to this fragile patient population. Please contact Amy Whited, Director of Health Policy at [email protected] or Conor Brockett, Associate General Counsel at [email protected] for assistance.


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