Town of Lake Lure
Lake Lure Dam forms Lake Lure on which the town of the same name is nestled, on the Rocky Broad River in western Rutherford County. Colby Rabon / Carolina Public Press

The state recently gave Rutherford County conditional permission to switch from one region to another for behavioral health care management, despite the lack of any evidence that the original agency was having problems.

The move will most directly affect some 3,000 recipients of behavioral health services in Rutherford County, located between Asheville and Charlotte on the southeastern edge of the Blue Ridge Mountains. But it could be significant in what it signals for state policy going forward.

North Carolina currently has seven regional agencies called LME/MCOs – short for local management entity-managed care organizations – to which counties are assigned for their residents who are Medicaid beneficiaries to receive behavioral health services. Although their names, like Vaya Health or Cardinal Innovations, might make them appear to be some type of corporations, the LME/MCOs are legally a form of a local government agency.

As Carolina Public Press reported last year, Rutherford County was part of a block of contiguous counties assigned to Asheville-based Vaya Health. However, Rutherford was also adjacent to the region administered by Gastonia-based Partners Behavioral Health Services.

Rutherford County commissioners petitioned the state Department of Health and Human Services last year to allow them to move to the Partners region. They claimed that they liked certain aspects of the Partners programs but did not cite any concrete objections to Vaya’s services.

They did note that many patients in Rutherford County received services in nearby Cleveland County, which was in Partners’ territory. But Vaya also demonstrated that it had contracts with many care providers in Cleveland County to assist these Rutherford County residents.

Through reviewing email records, CPP found that Partners had hired two individuals as lobbyists who were former state legislators who represented Rutherford County. After being contracted by Partners, these former lawmakers met with county officials in Rutherford County, encouraging them to switch regions.

In the past, two other counties had successfully petitioned to switch LME/MCO regions, but in both cases, they were leaving because an agency faced an embezzlement scandal and not simply because they wanted to be in a new district.

According to DHHS spokesperson Kelly Haight, the Rutherford realignment will be effective on July 1. But DHHS Secretary Mandy Cohen did set some conditions on the move.

“During the six months of transition, a Rutherford County Realignment Committee will be expanded to include executive leadership from Vaya and Partners, Consumer and Family Advisory Committee members and providers to ensure a seamless transition for all individuals,” Haight told CPP on Thursday.

“DHHS staff and LME/MCO staff will monitor the transition plan and progress to ensure continuity of care without disruption for the providers and consumers in Rutherford County.”

Vaya spokesperson Rachel Leonard-Spencer told CPP on Thursday that these provisions to “ensure a smooth transition” mean “there will be a lot of activity on our end going forward.”

Upon learning of the approval earlier this month, county officials issued a statement quoting the chairman of the county commissioners, Bryan King: “I would like to thank everyone that participated in the due diligence period and for those that will serve on the Realignment Committee during the transition period from now to the realignment effective date of July 1, 2019.”

Partners announced the decision on its website without mentioning Vaya’s ongoing role. The Partners statement said care recipients would be “automatically enrolled with Partners” after July 1. “The Partners team will be working closely with DHHS and Rutherford County families, leaders, stakeholders and providers to ensure that individuals receiving services will experience a smooth transition to Partners,” the Partners site said.

Future somewhat murky

Whether the realignment actually takes place or lasts very long remains unclear, however.

As CPP previously reported, state behavioral health policy has been in a perpetual state of flux over the last two decades, with the current arrangement of seven regional LME/MCOs only the latest incarnation of a state policy that has tended toward ever-fewer agencies.

Cohen advised Rutherford County in her decision letter that North Carolina Medicaid is already transforming to a new model of integrated managed care that will change the situation once again.

“As part of that effort, (DHHS) is required by state statute to establish five to seven regions within the state for the operation of Tailored Plans,” Cohen wrote.

“That process will begin soon and will not be restrained by the conditional approval set out in this letter. Establishing Tailored Plan regions could result in further realignment of counties to different LME/MCOs.”

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