OPC/LME Provider Survey on Impact of Budget Reductions

OPC/LME Provider Survey on Impact of Budget Redu= ctions

Su= mmary and Comments

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An OPC Provider Survey was administered via Survey Monkey to our provider community from 11/5/09 to 11/20/09 to gather information on the Impact of Budget and Rate Reductions. T= he survey also included a question about the provider’s readiness to bec= ome a Critical Access Behavioral Health Agency (CABHA) if applicable. Initial and reminder email were sen= t to IPRS and/or MOA providers requesting that they respond to this survey. In addition a link to the su= rvey was posted on OPC’s website on the home page.

A total of 34 providers responded. Respondents indicated a range in the years of service provision from <1 to 110 years. The= mean number of years of service provision was 15 years with the median number being 6.5 years. Fifteen of the 34 providers who responded had 5 > years of service experience.

Of the 34 providers who responded, 47.1% serve our Adult Developmental Disabil= ity (ADD) population. Forty-four percent serve our Mental Retardation/Mental Illness (MR/MI) consumers, 41.2= % serve our Adult Mental Health (AMH) and 41.2 % Child Mental Health (CMH) consumers. Fifteen perc= ent serve our Adult Substance Abuse population and 8.8% serve our children with substance abuse diagnoses. The percentages for counties served were Orange (79.4), Person (73.5) and Chatham (64.7).

For the 18 providers who indicated that they had taken an IPRS budget reduction, 31.0% responded that their agency had taken a > 10% but < 30% reducti= on; 13.8 % reported a <10% IPRS reduction; 13.8% reported a > 30% but < = 50% reduction and 3.4% reported t= hat they had a 50% or greater IPRS budget reduction.

Providers indicated that a reduction in staff, change in salary to employees and chan= ge in how service(s) is delivered were most often used measures to respond to = IPRS budget reductions. Some= of the comments listed in this section include:

“We may look at taking limit= ed referrals, have already spent half of the IPRS monies in the first quarter.”

“We are not rehiring a staff= who has left their position. And we are putting efficiencies in place such as WMR and IDDT to replace some of the individual services to clients”

“We have had to extend our l= ine of credit to a dangerous level because we had several individuals who, were ov= er the 75 percentile. We h= ave not discharged anyone and do not wish to but we have and continue to prepare plans to change how services are delivered.”

We will not rehire our Nurse who l= eft and we let go of a driver. We also are movi= ng 4 staff positions to a new grant rather than hiring new people. We will not rehire our= front office manager when she moves to the new residential program.” =

“The main reduction in our l= imited IPRS funding was the elimination of public psychiatry funds. We continue to provide servi= ces to uninsured. Our CA= SP funds help support this.”

“Closed one level III site a= nd reduced staff 60%”.

“All new referrals go on a w= aiting list.”

“The primary service reducti= on has been our ability to provide transportation as easily.”

Sixteen providers indicated that consumers had their services reduced as a result of IPRS budget reductions with 33.3% responding that 1 to 10 consumers experie= nced a reduction, 13.3% indicated that 11 to 20 consumers had a reduction and 6.= 7% reported that 21 to 30 consumers had a reduction in service. Five providers reported that= 1 to 10 consumers were discharged as a result of IPRS budget reductions.

Fifty percent of providers who responded indicated that the Medicaid rate reducti= on had a moderately impacted their agency and 26.7% indicated that Medicaid ra= te reductions had greatly impacted their agency. Providers reported that they= had a reduction in staff (46.7%), change in how service is delivered (43.3%), and change in salary to employees (33.3%) as most used measures taken to address rate cuts. Providers, 26.7%, reported a reduction/change in employee benefit package and 76.7 % of provi= ders responded that no consumers were discharged as a result of Medicaid rate reductions. Five = of the 30 providers (16.7%) who responded to this question indicated that consumers had been discharged.

Provider responses regarding how agencies and consumers have been impacted by the Medicaid rate reductions include:

“Few changes so far felt by consumers, but future case management changes will have a huge impact on our consumers.”

“Long term, our agency will = have to look at the level of service provided to CAP clients. Further cuts will most defin= itely result in clients losing services and perhaps their placement as it will be= come financially impossible to continue to provide services beyond what is reimb= ursed – high need clients stand to lose the most here.”

“They will not feel the dire= ct impact currently, but will in the future as children lose case management function of community support, assistance with the PCP updates, assistance = with requested therapeutic placements, the time frame and speed of service will decline due to no one being in charge of the PCP process. We need PCP updates for cont= inued authorization in therapeutic foster care.”

“A small positive is we now = only have consumers who really want/need the service and those that just wanted mentors have been discharged to community referrals. We are fighting hard with our consumers to retain services when needed. This is frustrating fo= r both consumers and staff.”

“We have had to hold off on getting endorsed for other services due to rate reductions.”

“Reduction in the amount of = face to face time, delays on call back”.

“Transportation availability= is one concern.”

“There have been some consum= ers who are in dire need of services, but have had service hours reduced. This has caused great concern beca= use of crises that occur with consumers.”

“The 3% cut in rates was not= as great an impact as the DD allocation reduction of 15.5%. Some consumers did= get an increase in Medicaid hours to make up for the loss of ADVP billing. This helped with the cut in = the rates.”

“No longer accepting new Med= icaid referrals.”

“Further reductions in case management will have other impacts; we are waiting to see what these new cu= ts will do. So far, 2 rate reductions this year have not caused us to reduce services yet, but most li= kely further changes to case management (like setting limits of hours) will have significant impact on this agency and the people we serve.”

“It is difficult to estimate= the impact of just this one factor because it is the combination of the State a= nd Smart Start cuts, loss of CSS, and service rate cuts that are impacting us = all at once.”

“Have one vacant position un= able to fill at this time. I= mpact of other staff with increased work loads.”

“Reduction in hours of servi= ces beginning 1/4/09. Servi= ce reduced by 30 minutes per day.” (Person Industries)

Nine providers of Community Support Services (CSS) responded to a question about= the financial impact of the elimination of CSS. The majority indicated that their = agency has been greatly impacted by the elimination of this service. Seventeen providers indicated that their agency would be impacted in other ways (clinical home = and first responders’ duties) by the elimination of CSS. Narrative respon= ses include:

“Adults that do not fit the = model for Community Support Team (CST) are virtually left without supports.”= ;

“Increases the demand for our services.” (written by Intensive In Home Provider)<= /i>

“If we are not able to quali= fy to do case management with the clients in our residential and intensive outpat= ient treatment programs, then we will have to further reduce staff.”<= /o:p>

“Intensive in Home (IIH) cli= ents often need CSS as a step down from IIH to support and monitor and enhance skills development.”

“We have 6 CS workers in the agency as well as many other staff who bill CSS.   The loss of CS is significan= t in terms of revenues but also in terms of staffing issues.    For example, we will n= ow place some of these staff in SACOT and IOP services where they can bill and= use the licensed clinicians in other services for which they can bill.”

Three providers, 15.4 %, indicated that they are certain their agency will qualif= y as a Critical Access Behavioral Health Agency (CABHA).    Twelve, 46.2%, responde= d that they currently do not have the required staffing needed but plan to make the needed changes to meet the requirement. Thirty one percent responded that C= ABHA requirements are not applicable to their agency due to services provided.

Eleven providers responded to the prompt, “Anything else that you would like= to share?”   Here are = the responses to that question:

“It appears that the Division is in a cons= tant state of confusion and disarray as they continuously seem to put the prover= bial cart before horse. Community Support should not have been eliminated until = such time a definition for Case Management had been established and approved. Th= is situation is creating an issue for person(s) that only need basic case management. Additionally, Value Options is still suggesting Community Suppo= rt as a viable option for consumers new into service(s).”

“Future changes and reductions in hours wi= ll definitely impact our ability to serve our consumers.”

“This agency has been in business for 10 y= ears, and we have a great reputation and do a good job serving children and adult= s. One of the things I have observed over the past 8 years is how agencies are pushed to pick up this new service or that new service (carrots are dangled constantly). We have stuck with what we do best and it has proved to be a g= reat strategy. I have watched as other agencies added new services and it did not turn out well. I have been proud to work at this agency for the past 8 year= s, because we specialized in CAP residential servi= ces and therapeutic foster care and we do it well. We weren't spread so thin, we weren't expected to be everything for everyone...the agencies that tried th= at have ended up with their business closed or just being mediocre in everythi= ng they do. The set up of a Critical Access Behavioral Health Agency looks lik= e a way to make us all alike with no-one specializing in anything. In my opinion this will not turn out well for the consumers. We have done a great job wit= h residential services, we are able to avoid con= flicts of interests because we don't make the placements (an outside comm. support= or case management agency does this), and so the family gets the most appropri= ate service from many choices. Of course I agree that the community support definition has not worked, but actually our agency knew that it would not f= rom the day we read the definition. Too much open for interpretation... This mo= del appears to give no one an "expert role." This is just my opinion = but given with much experience and observation over many years of what I have s= een work and what did not work. Thank you for allowing me to share my thoughts.”

“Thank you, this was a nice venting tool :)”

“I am very disappointed with how the state= runs mental health. It clearly gives sweet-heart deals to companies like CSC (wh= ich does a terrible job and has no accountability) and fails to include smaller agencies, consumers, and researchers in development of policy.”<= /o:p>

“The way CABHA has been developed is not i= n the best interest of the agencies and the consumers. For example, I have a MD t= hat I consult with and a PA that comes to my center on a regular basis. I have = 24/7 access to both the MD and PA. This meets the needs of my center. My center = does not require nor does it need a full time MD. To impose this on a well ran clinical organization (I am a psychologist and have been doing this work fo= r 23 years) is not fair nor is it needed. The concept is good and I support it, however my center has maintained very well with the arrangement I have with= the MD and PA.”

“If UNC Horizons does not become a Critical Access agency, I think that the future will be bleak.”

“Medical Doctors are stating that it shoul= d not be necessary for a Medical Director to be a full time employee at agencies.= In addition, there is a concern about Qualified Professionals having to be licensed (or provisionally licensed) to lead teams in Community Support Team.”

“There have been cuts in rates which has l= ed to reduction in staff but so far no reduction in required paperwork. If existi= ng staff could put more effort into direct service and a little less time into paperwork, it would help the quality of our service. We are seeing a reduct= ion in quality due to staff loss.”

“I believe the community we serve will har= med by the lack of agencies to provide services due to this new requirement.”= ;

“We planned a budget with a $16,000 shortf= all to come out of our fund balance. However, sales and other revenues have increa= sed since July 1 such that we expect to lose only $4,000. We are the exception rather than the rule.”

OPC/LME will continue to request feedback from our provider community through provi= der meetings and future surveys.  &n= bsp; We will explore ways to elicit provider feedback from agencies that = did not participate in this survey as well as encourage providers who did respo= nd to continue providing feedback as the service system changes.   We especially welcome more provider response from agencies within our OPC catchment area as new CABHA = requirements are implemented and agencies are affected by other various changes in the system.