Providers slow to sign up: Initial deadline for agencies is near

With the initial deadline just two days away, only 7 percent of mental-health and substance-abuse agencies in the region have applied for a new provider status.

The N.C. Department of Health and Human Services updated its list Monday, and 112 providers statewide have filed letters of attestation -- essentially proof that a provider can meet service requirements. That is up from 73 letters two weeks ago. The letters are the first step toward becoming a Critical Access Behavioral Health Agency, or CABHA.

Leza Wainwright, the director of the N.C. Division of Mental-Health Services, said yesterday that another 48 providers have submitted letters. Because of the April 1 deadline, she said that the division did not have time to say where those providers are based.

The state has said that the program will help reduce costs and inefficiency regarding services.

Critics say that CABHA is too dependent on a bigger-is-better strategy, which is likely to eliminate quality small providers and could lead to longer waits and clients potentially falling through the gaps. They also are concerned about how often would CABHA providers refer patients to non-CABHA providers.

There were 22 providers in the Triad and Northwest North Carolina to apply out of 321 based in the 14-county area. Some providers offer two or more services falling under the CABHA umbrella.

The requirements are scheduled to go into effect July 1.

The categories requiring CABHA designation are:

• Case management.

• Peer support for recovery initiatives.

• Community support teams for adults.

• Intensive in-home treatment for children.

• Day treatment for children and adults dealing with such issues as substance or sexual abuse.

Just 55 to 65 providers statewide are expected to qualify out of several hundred. CABHA providers can offer services statewide regardless of where they based.

"Many of the providers that have submitted letters of attestation already provide services throughout North Carolina through satellite offices," Wainwright said.

However, some advocates are concerned that tight budgets will limit the reach of CABHA.

The annual cost of meeting CABHA requirements, which includes adding three to four high-profile medical-staff positions, could range from $100,000 for small providers to $450,000 for large providers. A small provider is defined as having fewer than 750 cases a year.

"If the cost to distribute mental-health services to outlying areas becomes too great, then the CABHAs will either reduce the frequency of when those services get delivered or stop the distribution of those services altogether," said Danny Freeman, the executive director of N.C. Quality Care Provider Association.

"If the cost or effort to access the mental-health service becomes too great, then the end consumer will either seek services closer to home or do without," Freeman said.

Providers that don't apply, or don't gain accreditation, will be required to help their local management entity, such as CenterPoint Human Services locally, transfer their clients to a CABHA provider. That means many current providers will have to either shift into other services with lower client demand, try to find merger partners or go out of business.

"If the Triad wound up having a shortage of providers for any specific service -- which, right now, appears unlikely -- we would work with the local management entity in that area to recruit providers to those underserved areas," Wainwright said.

Local advocates say they are concerned that providers who can't -- or choose not to -- qualify for CABHA status will lose enough employees that their remaining services will suffer.

Freeman also questions whether a local management entity can terminate its endorsement of a provider based on failure to meet the CABHA standards.

Of the 112 providers, only 21 have met the first phase of accreditation, known as the desk or application review. Forty-five providers have not passed the desk review. There also is a clinical review that includes an interview of provider staff.

Among the seven local-management entities serving the Triad and Northwest N.C., six of the 22 applying providers have passed the desk review, five did not, and 11 are under review.

The Children's Home of Winston-Salem is the only one based within CenterPoint's area of Davie, Forsyth, Rockingham and Stokes counties to meet the criteria.

Faith in Families Inc. of Reidsville did not pass its first desk review and resubmitted its application. People Helping People of NC LLC and Top Priority Care Services LLC, both of Winston-Salem, did not pass the desk review. It is not clear whether they have resubmitted.

NuDay Case Management Services Inc., also of Winston-Salem, is under review.

Two prominent providers serving CenterPoint passed the desk review on their second try -- Daymark Recovery Services of Concord and Monarch of Albemarle.

New River Behavioral Health Care of Boone, PQA Healthcare Inc. of Dobson and Youth Focus Inc. of Greensboro passed the desk review on the first try.

rcraver@wsjournal.com


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More information can be found at www.dhhs.state.nc.us/mhddsas/cabha/index.htm.