Reorganization, billing procedures draw complaints

PROVIDENCE, R.I. — New billing procedures and a state-mandated restructuring of how community mental health organizations care for some of their neediest clients have created new turmoil in Rhode Island’s community system. State officials say they have been cooperative during the transition and that ultimately, client care will improve and tax dollars will be saved.

“It’s very frustrating,” Dr. Stephen DiZio, medical director for Woonsocket’s Community Care Alliance, said in an interview. State officials, he said, are “looking at individual pieces and they’re not paying attention to the big picture.” More comprehensive reform must come, he and others maintain, if the goals of better care and financial savings are to be achieved.

The reorganization and billing changes exacerbate long-standing insufficiencies in Rhode Island’s mental-health system, which three decades ago was held as a national model, David S. Lauterbach, CEO and president of The Kent Center in Warwick, said in recent testimony to the state Senate Health and Human Services Committee.

“Since that time, over $30 million has been stripped from the funding to support these services,” Lauterbach said. “This year alone, we have been cut another $6 million despite being told in the beginning that we would not be subject to further cuts. We cannot continue to function effectively under such financial cuts.”

In an interview Thursday, Executive Office of Health and Human Services Secretary Elizabeth Roberts acknowledged the “stress” of the new changes. Some resulted from the recommendations of last year’s Working Group to Reinvent Medicaid, charged with finding savings from the federal program, among the sources of financing behavioral-health care.

“I recognize that it’s a difficult, complex set of changes,” Roberts said. “We’re trying to provide as much support as possible.”

Anya Rader Wallack, state Medicaid director and a member of Roberts’ staff, said that the changes involve implementing a type of care known as Assertive Community Treatment for some clients, new software and billing procedures, and “modernizing business processes,” as she described it.

“There have been some pain points around all three of those and what we’ve tried to do is be flexible and back off on some of our requirements,” Wallack said.

Originally scheduled to take effect on Oct. 1, the changes were postponed to Jan. 1 after centers said they needed more time. Just recently, full implementation has been delayed to the end of March. Despite fears by centers that they would not receive payment for services they provide since they had not mastered the new billing software and procedures, payments are being made under the old system, the EOHHS officials said on Thursday.

Roberts maintained that these reforms will result in both better care for the state’s most severely mentally ill people, some of whom cycle in and out of emergency rooms or stay for long periods in acute-care beds in local hospitals. Such care is considerably more expensive than many non-hospital programs.

“It's about cost savings because we’re delivering care better,” Roberts said. “We need to be partners with our community mental health organizations in helping people stay in the community as functional as they can be. We want them as our partners in keeping people independent and well in the community rather than in and out of the ER.”

Not everyone is convinced.

“Rhode Island has slowly been destroying its system of care for those with severe and persistent mental illness,” Lauterbach asserts. “These people are among the most vulnerable populations in Rhode Island. When I hear people say that our mental health system is a mess in R.I., I say it is because we took $30 million out of the system. We are building the plane while flying it with the plan the state is proposing.”

Said David Spencer, head of the Substance Use and Mental Health Leadership Council, which represents the interests of the state’s eight community mental health organizations: “I don’t think the state fully understands the impact of these changes not only on the programs but most importantly, the thousands of patients they serve.”

gwmiller@providencejournal.com

(401) 277-7380

On Twitter: @GWayneMiller