Under the Dome

NC mental health office spending limits get Senate approval

Doctors who refuse Medicaid managed-care contracts won’t get less money for treating people who use the government insurance after all.

Sen. Ralph Hise, a Spruce Pine Republican, dropped his effort to make broad changes to the state’s plan for Medicaid. Doctors, hospitals, dentists, regional mental health offices and mental health advocates had opposed them.

“This is the vanilla version of what was a much bolder sundae,” he said of the remaining changes in a bill approved 36-10 in the Senate on Wednesday night. The bill goes back to the House for a vote on the Senate revisions.

The legislature wants to set limits on the regional mental health offices that use federal, state and local money to arrange patient treatment. Questions about spending at Cardinal Innovations Healthcare inspired the bill. A recent state audit chronicled Cardinal spending on parties, alcohol, first-class airline tickets and other luxuries. The audit found that, over several years, the office paid its CEOs $1.2 million more than the law allowed. Cardinal is the state’s largest regional mental health office.

The state is working on a Medicaid overhaul that will change the government health insurance program from a system in which doctors and hospitals are paid for every visit, X-ray and operation, to managed care, in which the state will give a set amount of money per patient to companies responsible for managing patient care..

Hise wanted those Medicaid changes to go further – to have the state pay lower Medicaid rates to doctors who do not sign managed care contracts. Doctors’ groups are worried that lower payments may push some professionals to stop treating Medicaid patients rather than accept bad contracts. Hise was also pushing to dissolve the regional mental health offices as soon as the state switches to Medicaid managed care. Under current law, the regional mental health offices would remain separate from the larger managed care groups for a few years.

The bill makes some changes to mental health treatment, though they are not as dramatic as in Hise’s first proposal.

The latest changes would have Medicaid patients with mild mental illnesses receive treatment in tandem with their physical health care when the state switches to managed care. It would be up to the state Department of Health and Human Services to suggest a definition for mild mental illness, Hise said. DHHS must report on ways to fold together mental and physical health care for patients with serious mental illnesses.

Lynn Bonner: 919-829-4821, @Lynn_Bonner