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The state of North Carolina is undertaking a comprehensive policy shift on how the government budgets for and manages resources for mental health, developmental disability, and substance abuse services. The 1915 (b)(c) Medicaid Waiver Program was chosen by the North Carolina Department of Health & Human Services, Division of Medical Assistance as a way to control and more accurately budget for the rising costs of Medicaid funded services. The 1915 (b)(c) Waiver Program was initially implemented at one pilot site in 2005 and evaluated for several years. Two expansion sites were then added in 2012. Full statewide implementation is expected by July 1, 2013. ==Mental health reform history== In October 2001, the North Carolina General Assembly ratified House Bill 381 (S.L. 2001-437) on Mental Health System Reform. 〔 〕
Since that time, the state has undertaken additional mental health system reform actions. On January 1, 2002 the NC Division of Medical Assistance (DMA) entered into a contract with ValueOptions Inc. (a private for-profit company) to provide utilization review services for the then 1.3 million Medicaid recipients in North Carolina. The state renewed that contract in 2006 and 2011. ValueOptions provides prior authorization for mental health and substance abuse services.〔 There were significant criticisms of state's shift to privatization, including: * Many highly trained mental health care workers left the field as private providers took control of service delivery, decimating the professional public sector workforce. * The fragmented system created through privatization had a tremendous negative impact on the quality of services provided to clients. Many times, important mental health services were no longer even available to clients. * Private providers engaged in "cherry picking," offering only the most profitable services, such as "community support" services. These services include basic assistance and mentoring, and such tasks as running errands for a client or helping with a child's homework. They could be performed by low-paid, unlicensed personnel. Many providers focused on these highly profitable community support services and left seriously ill clients without the more costly care they needed. * Reports of cost overruns estimate that the state wasted at least $400 million in community support services offered by private providers that were unnecessary for the client or not even performed. As a result of the treatment offered by the private providers, the number of North Carolinians with mental illness who ended up in emergency rooms or jails significantly increased.〔 Additionally, the budget for Medicaid funded services was not adequately managed and continued to grow at a high rate each year. Starting in 2005, the state established one LME as a pilot Medicaid managed care vendor through the use of the Medicaid 1915 (b)(c) Waiver Program.〔 Piedmont Behavioral Health (PBH) served as the pilot program and serves Cabarrus, Davidson, Rowan, Stanly, and Union counties. In 2008, the General Assembly supported the planned expansion of the pilot program through S.L. 2008-107.〔 Then S.L. 2010-31 was adopted and required the designation of two additional expansion sites.〔 Most recently, S.L. 2011-264 〔 instructed the North Carolina Department of Health and Human Services (NC DHHS) to proceed with the statewide restructuring of the mental health, developmental disabilities, and substance abuse services system by implementing the 1915 (b)(c) Waiver Program statewide by July 1, 2013.〔 Area authorities, like PBH, were originally designated by the state of North Carolina in 1985 through the NC Mental Health, Developmental Disabilities, Substance Abuse Service Act.〔 The name change to Local Management Entity (LME) took place in 2001 when North Carolina passed the Mental Health System Reform Act.〔 Authority for LMEs is organized under North Carolina General Statute Chapter 122C. LMEs are considered a local political subdivision of the state per §122C-116. According to G.S. §122C-115.4, LMEs are responsible for management and oversight of the public system of mental health, developmental disabilities, and substance abuse services at the community level.〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Mental health reform in North Carolina」の詳細全文を読む スポンサード リンク
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