(Special Legislative Page)

Summary of the MH/DD/SA Reform Bill

The bill identifies core services available to all North Carolinians for which state and local governments are jointly responsible. Core services are defined as those that are necessary for the basic foundation of any service delivery system and are of two types: front end service capacity such as screening, assessment, and emergency triage; and indirect services such as prevention, education, and consultation at a community level. Core services are:

Screening, assessment, referral
Emergency Services
Service Coordination
Consultation, prevention, and education

The state is responsible for ensuring that services to targeted populations are provided.

The bill creates a new section of the law that requires the development of a State Plan for MH/DD/SA services. The bill is very detailed about what must be included in the plan, including target populations, service descriptions and standards, outcome measures, implementation strategies, organization of the Department, client rights and consumer involvement, and implementation timelines. The State Plan for MH/DD/SA Services will be completed no later than December 1, 2001 and submitted to the Joint Legislative oversight Committee on MH/DD/SA Services for review. Quarterly reports will be submitted thereafter.

Further, the bill adds to the powers and duties of the Secretary of DHHS, including the development of the state plan, review and approval of plans submitted by local programs, and comprehensive oversight and monitoring of standards and procedures. This includes the development of performance measures and report cards for each program. The Secretary is also required to adopt fiscal and administrative requirements, develop a unified system of services between state and local facilities, and is given the power to contract with private or other public service agencies if it is found that a local program is unwilling or unable to provide services.

Each local program (area program or county program) will be required to submit a local business plan to the state. The requirements for the plan are very specific and include areas such as:

• Identifying service gaps and methods for filling those gaps
• Ensuring available and qualified provides to deliver services and address consumer choice
• Provide uniform portal management of all services on the continuum
• Financial management and accountability
• Service monitoring and oversight
• Evaluation based on statewide outcome standards
• Collaboration with other local service systems to ensure access and coordination of services (e.g. DSS, schools, jails, etc.)
• Ensuring access to core and targeted services

The local business plan must be approved by the county commissioners and the Secretary of DHHS. It becomes a part of the Memorandum of Agreement, a type of "contract" between the State and local programs.

It is the intent of the bill that area authorities and county programs become managers of service instead of service providers. Area authorities and county programs must contract with public or private agencies, institutions or other resources to provide services. Subject to the approval of the Secretary they can offer services directly. The Secretary will consider issues of access, availability of qualified providers, and consumer choice and fair competition in making a determination regarding approval.

The bill requires that the state plan establish and implement a standardized process and procedures to ensure consumer access to, and exit from, public services. Termed "uniform portal process" this type of process previously was required only for DD services. The bill details actions the Secretary may take when an area authority or county program is not providing minimally adequate services and provides a process of notification carrying out these actions. Actions include suspension of funding, assumption of service delivery or management, and appointment of a caretaker board.

The bill establishes term limits of three consecutive two-year terms for members of the Commission for MH/DD/SA, the rule-making commission. It also adds to and clarifies rule-making authority for the Commission.

Statute will now require human rights committees at both state institutions at in local programs. Currently human rights committees are required only in state institutions and rules require client rights committees at local program. In multi-county programs, membership of the human rights committee will include a representative from each participating county. Rules will be adopted regarding the functioning of these committees and their coordination with the new State and Local Consumer Advocacy Programs.

The bill establishes a new statewide MH/DD/SA Consumer Advocacy Program within the Office of the Secretary of DHHS. Through State and Local Advocates, the program will provide consumers, their families, and providers with the information and advocacy needed to locate appropriate services, and resolve complaints, or address concerns and promote community involvement. The program will also play a role in monitoring the quality of services and provide reports to the Secretary and local programs. Reports will be made to the Secretary and to the Legislature. The Local Consumer Advocate will coordinate with local human rights committees. By March 1, 2001 criteria and operational procedures for the Consumer Advocacy Program will be developed and reported to the Oversight Committee. Included in this report will be a study of the consolidation of the various consumer advocacy and ombudsman programs within the Department. If funds are appropriated, the program becomes effective July 1, 2002.

Current statute requires that counties provide mental health services through area programs. The revised reform bill gives counties the option of providing services through an area program or county government, either through a single county or a group of counties. Counties must declare their intention in writing of which option, area authority or county, they are going to pursue by October 1, 2002. Regardless of whether the area program or county option is chosen, the requirements of the law for local business plans, services, rules, etc. are the same. Counties must hold a public hearing prior to establishing a county program.

A group of counties that decide to offer services through county governance will form an interlocal agreement to provide for the adoption and administration of the program budget and appoint an area director. These multi-county arrangements must have a targeted population of 200,000 or a minimum of 5 counties.

Counties will need to submit a business plan by January 1, 2003. The State, in consultation with counties and area programs, will develop a consolidation plan by January 1, 2005 to reduce the number of area and county programs to no more than a target of 20 by January 1, 2007.

County Option: Adoption and administration of the program budget must be in accordance with statutory requirements for county government. A citizen advisory board, with representation comparable to that of an area program board, is required to provide input to planning, service development, and policy. In single counties the citizen board is appointed by the county commissioners and reports to the county manager. In multi-county programs appointment and reporting of the citizen board is determined in the interlocal agreement. County commissioners have governing authority. Program directors must meet minimum qualifications. In a single county program the director is appointed by the county manager and is a county employee. In a multi-county program the director is appointed in accordance to the interlocal agreement. County programs must submit to the Secretary and to the Board of County Commissioners, service delivery reports on a quarterly basis that assess the quality and availability of public services within the service area. An annual report also must be given regarding progress in implementing the local service plan. Fiscal reports must also be provided to the Boards of County Commissioners on a quarterly basis.

Area Program Option: The governing unit of area authority remains the area board. The area board will have between 11-25 members. In a single county area authority members are appointed by the county commissioners. In a multi-county area authority each board of county commissioners will appoint one commissioner as a member of the area board and these commissioners will appoint the other members of the board. Boards of county commissioners can appoint the members to the area board in a different manner if they adopt a resolution to that effect. The bill maintains the required diversity of board members representing various constituencies, including family members, primary consumers, clinical professional, a person representing the interest of children, etc. An individual with financial expertise or a county finance officer shall be appointed. It establishes terms of four years with a limit of two consecutive terms. County commissioners serve concurrent with their term as county commissioner.

The Board develops plans and budgets for the area authority that are subject to the approval of the Secretary. The approved budget is submitted to the county commissioners and county manager and quarterly reports on financial status will be made. A yearly report is also made to the county commissioners detailing services delivered, recipients, services requested by not delivered, etc.

Area directors must meet minimum qualifications. Appointment of the area director is based on selection by a search committee of the area board and subject to the approval of the county commissioners, unless one or more board of county commissioners waives its authority to approve the appointment. The search committee will include consumer board members, a county manager, a member appointed by the Secretary, and one or more county commissioners. The director is an employee of the area board.

The bill defines a process to allow a board of county commissioners to withdraw from an area authority if they determine the needs of their citizens are not being met. A public hearing must be held before this action is taken.

The bill also establishes a state appeals panel for clients or contractors who have exhausted the appeals process at the area authority or county program.

• It requires core services to all citizens and focuses state resources to targeted populations including SPMI, SED.

• It clarifies the roles and responsibilities between the state and local programs.

• It increases accountability through the establishment of a type of "contract" agreement between state and local programs.

• The State plan will establish clear service standards and expectations across the state.

• It requires human rights committees and establishes a Consumer Advocacy Program.

• It encourages growth of local provider networks to expand access to services. Local programs can focus on becoming care coordinators, managers, monitors of service.