The Easley administration already has the power to set payment rates to providers of mental-health services, pursue fraud investigations, fix problems at its hospitals and hire staff. It says it needs more help from the legislature and the federal government on these issues. Some questions and answers:

Q: Why doesn't the state pay less to provider companies for work done by employees with a high school diploma and more for work by employees who are licensed professionals?

A: The state wasted $118 million by initially setting a "blended" rate of $61 an hour for community support services that assumed, but did not require, that at least 25 percent of the workers would have college degrees and experience in mental health care, or be a licensed professional. Dempsey Benton, the new secretary of the Department of Health and Human Services, says he is going to try to eliminate the blended rate and pay according to the educational level of each employee. He says he will need the approval of the Centers for Medicare & Medicaid Services, the federal agency that provides almost two-thirds of the money.

"The governor has said he wants us to do it," Benton said. "At a very important level it's a public credibility point."

Q: So far, the state has tried to recoup $59 million it says community support providers billed improperly. Why have only three providers been referred to the attorney general for criminal investigation?

A: Benton said his department's Program Integrity Unit, which is supposed to work up those cases, doesn't have enough employees to get the job done. Fewer than 50 people are assigned to review audits of hundreds of companies. He said the unit needs 15 or 20 more employees. He said his department may hire an outside group to perform preliminary fraud investigations.

Q: Why doesn't the state inspect its psychiatric hospitals and fix problems before the federal government finds them and then punishes the state by terminating Medicaid and Medicare payments?

A: Benton said that when the General Assembly returns to Raleigh in May, he will ask for $500,000 a year to create an internal inspection team. It could be a good investment; since last August, problems at Broughton Hospital in Morganton have cost the North Carolina taxpayers about $7 million in forfeited Medicaid/Medicare payments, and that cost continues to mount.

Q: What is the state going to do about the projected staff shortage at the new state psychiatric hospital at Butner and at other state facilities?

A: Benton says his department is looking at new ways to recruit doctors, nurses and other key professionals by increasing salaries, offering hiring bonuses and educational loan payment incentives. He also said he will ask the legislature for more staff.

"What we know right now is that ratios are not at the levels of other institutions that are considered to be good practice operations," he said.

(What should be done to fix the mental health system? Share your thoughts at share.triangle.com)