Retooling the rules

The Buncombe County commissioners unanimously approved a measure March 1 that could have far-reaching implications for Medicaid patients receiving behavioral-health services in eight Western North Carolina counties.

Four of them — Polk, Yancey, Mitchell and Transylvania — had already approved the change. If the remaining three (Madison, Rutherford and Henderson) follow suit, the Western Highlands Network — the “local management entity” responsible for overseeing other mental-health, developmental-disability and substance-abuse programs — would be authorized to manage Medicaid services as well, administering at least $120 million in federal and state funds now handled by ValueOptions, a Norfolk, Va.-based private company. The federal government and the N.C. General Assembly have already signed off on the deal.

Buncombe County Social Services Director Mandy Stone (who also serves on the Western Highlands board) said the Medicaid waiver the quasi-governmental agency is seeking aims to increase consumer access to care, improve quality of care and increase cost-effectiveness. She also emphasized that there would be no additional cost to taxpayers, and the waiver would not expand Medicaid entitlements. Any savings generated by the local takeover could be used for things like providing additional services.

"What it really does is take the same amount of dollars and provide local flexibility and increased efficiency," Stone explained. "It's really your best opportunity to attempt to manage costs and to purchase better services and get a better outcome for citizens."

In 2002, as part of the controversial and harshly criticized statewide mental-health reform that gave birth to the local management entities, North Carolina hired ValueOptions to manage all its Medicaid behavioral-health services. The managed-care company still oversees those services in most of Western North Carolina. However, one other LME has already been granted a similar waiver, and other such deals are in the works.

"It really is the trend in the Medicaid world," Stone observed, adding that she hopes the change will increase accountability, particularly for people denied service.

Christine Smith, who works for the local affiliate of the National Alliance on Mental Illness, said she hopes "the waiver will give us more flexibility in the use of hospital beds and all kinds of things that need to be taken care of. Our phone is ringing off the hook with folks who are frustrated because they can't get the services they need."

The WNC Health Network, a consortium of regional hospitals and other care providers, also endorsed the measure.

In addition, Stone noted that if the waiver is approved, Western Highlands plans to add about 60 full-time positions, most of them in Buncombe County.

"While it is not very popular right now to grow government jobs, I would like to note that when Western Highlands creates these jobs, it will be to do a function that the state of North Carolina is currently contracting with an out-of-state vendor to provide," she explained. "So it is bringing jobs back to our community."

Before casting her vote in favor of the change, Commissioner Holly Jones noted that the county had added a number of "thoughtful safeguards" to its version of the resolution that "are the key to me being able to sleep at night."

Those safeguards include requiring that Western Highlands:

• allow county managers from all eight participating counties to serve on its board of directors;
• fully partner with and support the federally qualified Minnie Jones Health Clinic Family Health Center;
• provide detailed monthly reports to Buncombe County concerning any expansions or denials of service related to the waiver;
• fund a $15 million "risk pool” that would cover liabilities if the agency overspent on a particular service category or inappropriately authorized nonreimbursable services.

Under state law, however, if Western Highlands were dissolved, perhaps due to financial problems or changes in state policy, Buncombe County would be liable for its share of any remaining "unsatisfied indebtedness.”

Cutting remarks

At their Feb. 15 meeting, the commissioners unanimously approved slashing their travel stipends by 50 percent (from $650 to $325 biweekly) and their technology allowances by 85 percent (from $175 to $25 biweekly). The move came after an Asheville Citizen-Times article reported that, counting the stipends, Buncombe’s commissioners were among the highest-paid in the state.

But that didn’t satisfy about 20 demonstrators who greeted the commissioners on March 1 sporting stickers that declared, "Enough is enough: Use a mileage log." During public comment, several of them stood up and lambasted the board.

Weaverville resident Chris Eck, who is hoping to become the next chair of the Buncombe County Republican Party, accused the commissioners of having "a sense of entitlement." Cutting their travel stipends, he asserted, "was not an acceptable solution. … You should be reimbursed for your actual expenses and let the people of Buncombe County know what they are."

Leicester resident Peggy Bennett echoed that sentiment, calling the idea "the right thing to do."

The commissioners listened in silence.

Reisinger sworn in as register of deeds

Seeking to avoid the kind of outrage that has plagued the commissioners in recent weeks, Drew Reisinger, the county’s new register of deeds, made good on a pledge to give himself a pay cut.

When Otto DeBruhl retired Jan. 31 after 32 years, he was one of the highest-paid registers of deeds in the state, making $128,850 a year. Before being elected by the Democratic Party’s Executive Committee to fulfill the remainder of DeBruhl's term, Reisinger had promised to slash that figure by 40 percent, which works out to $77,310.

Before swearing him in, however, Vice Chair Bill Stanley explained that county Human Resources staff had independently determined that an appropriate starting salary for Reisinger would be $78,497. The newly minted official then pledged to donate the $1,187 difference to the Buncombe County and Asheville City schools foundations.

"I'm honored and humbled to serve as Buncombe County's next register of deeds," said Reisinger, vowing, "I will continue to provide the same level of excellent service."

— Jake Frankel can be reached at 251-1333, ext. 115, or at jfrankel@mountainx.com.