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MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 June 26, 2008 24/7. UNC wants to continue onsite clinics and does not screen for payment ability. Sometimes there is a wait period. There is also a problem retaining qualified practitioners who are leaving to take better paying positions in other states. He would like to see more settings where there would be a broader array of services. One step to developing a better system to serve these needs is establishment of regional care centers where all the core services would be in one place. Many rural hospitals have licensed psychiatric beds that are not utilized because they are large money losers. The state hospital used by UNC to receive patient overflow is John Umstead State Psychiatric Hospital, built in the mid-40’s. He stated that Umstead is not the place for a mentally ill patient to be when they are suffering the way they are suffering. He reemphasized a need for a more modern facility where all services would be in one location. Dr. Carey asked if Orange County had any oversight responsibility other than funding. Ms. Truitt answered that under the community support system currently in effect, county authority is statutorily governed by a board with a commissioner representative from each county within the region served plus representation from citizen at-large representatives and professionals. Dr. Carey asked if there was a reduction in services due to the restructuring, visits not necessarily being restricted but the amount that can be reimbursed by Medicaid is restricted. Ms. Truitt replied that value options authorizes the amount of services the provider can give to the consumer. She stated that when mental health support was reorganized in March 2006, Medicaid reimbursed services were reduced and severely limited available services, although most providers do pro bono work. Now, full service array is being looked at more closely. Rosemary Summers asked if the definition for Community Support services is case management support service that enhances the actual psychiatric treatment. Ms. Truitt replied that for years Case Management was the service that was presented to consumers. Generally Case Management is considered the professional level and Community Based Intervention (CBI) is the paraprofessional skill building level. In 2006 these two services were combined into a new service called Community Support. The expectation was that both would be provided to the consumer but what happened was that there was a tendency with some agencies to shift much of the case management duties to the paraprofessional workers. Dr. Lindsey stated that case management is an important core service for the mentally ill population because many experience additional health needs. Tracking is done by the amount of paid claims. A specified percentage of care must be provided by the professional and the balance by the paraprofessional or the provider will lose their certification. The federal government thinks that there should only be one case manager in an individual’s care management. This tends to shut out health, social services, or mental health depending on which system began management. Dr. Lindsey said that the case manager is crucial in the mentally ill population because of additional health needs that are common in this group.