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UPDATE: Southeastern Center runs out of state funds; Responds via news release

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UPDATE (11/29): HERE IS A NEWS RELEASE SENT THIS AFTERNOON IN REPSONSE TO OUR STORY LAST WEEK. NO ONE FROM SECMH PICKED UP THE PHONE WHEN WE CALLED OR CALLED US BACK WHEN WE ORIGINALLY PRODUCED THE STORY:

Southeastern Center Continues to Provide Consumers with Mental Health, Development Disabilities and Substance Abuse Services

Southeastern Center Area Director Foster Norman wants to assure the community that “we are not out of funds.” Southeastern Center is making adjustments to the array of services offered based on the recent utilization and the need to stay within the budget.

This year Southeastern Center and the community providers have delivered more services to more consumers and expanded the array of services as compared to last year. This 58% increase in demand must come from the same limited budget as last year.

The budget adjustments will assure that funds are available for the remainder of the fiscal year. The benefit plan includes preventative measures such as freeing up funds designated for services that were not being used and limiting the number of high cost services.

New consumers can continue to contact the Call Center at 1-866-875-1757 for assessment and crisis services. Southeastern Center will continue to review and work with the providers to deliver quality services and meet the needs of the consumers and families in our area.

HERE IS A COPY OF THE ORIGINAL MEMO POSTED ON 11/17 ON SECMH'S WEBSITE:

COMMUNICATION MEMO # 136

To: SOUTHEASTERN CENTER COMMUNITY OF STATE FUNDED PROVIDERS
FROM: WILLIAM HOLTZ, DIRECTOR OF PROVIDER SERVICES
SUBJECT: FY 10-11 BUDGET AND BENEFIT PLAN CHANGES
DATE: NOVEMBER 17, 2010

Southeastern Center has been carefully monitoring the service activity, comparing this to the FY 10-11 service budget. The analysis of the first quarter of the fiscal year 2010-2011 has been completed. This analysis included the level of authorizations, percent of units claimed by providers, spending trends against available dollars and the level of service specific authorization limits. Based on this analysis, Southeastern Center has determined that the current budget plan has reached capacity for consumer volume and service units. Current spending is above our target for the quarter; therefore, we are making some adjustments in order that funds are evenly accessible for the remainder of the fiscal year. Southeastern Center will conduct this same analysis in January 2011 (reviewing the first and second quarter). We also have a summary report of this data that is reviewed monthly.

The following changes are effective Monday, November 22, 2010
(A) Adjust Benefit Plan service limits; Updated Benefit Plan
(B) Close some high-use services to new referrals;
(C) Eliminate underused services from the benefit plan;
(D) Adjust line-item budget allocations
For specific information as to the benefit plan changes for age/disability groups and services, please refer to the State-Funded Benefit Plan posted on the Southeastern Center website. Southeastern Center appreciates the assistance and collaboration of the provider network as we attempt to balance authorizations, claims paid and funds available to ensure that state-funded services are available to consumers for the entire fiscal year.

Please note that current certifications remain in effect for the certification period and the new benefit limits will take effect with the next cycle of certification requests received November 19, 2010 and after. Any certification requests that exceed the new limits will be returned as unable to process and are not subject to appeal.

HERE IS A COPY OF A SECOND MEMO POSTED ON 11/22 ON SECMH'S WEBSITE:

COMMUNICATION MEMO # 137

To: SOUTHEASTERN CENTER STATE CONTRACTED COMMUNITY OF PROVIDERS

FROM: WILLIAM HOLTZ, DIRECTOR OF PROVIDER SERVICES

SUBJECT: BUDGET CAPACITY FOR NOVEMBER AND DECEMBER

DATE: NOVEMBER 22, 2010

Due to the increased number of new consumers and the high volume of concurrent certification requests (CRF), the state funded service budget has reached capacity for November and December 2010. Currently pending requests for prospective and concurrent certifications will be returned as Unable to Process. For services that are budgeted with slots, as new slots open new consumers will be certified.

In the future, when our budgeted service dollars are totally encumbered for the month, CRFs will be returned as Unable to Process. We will post on the SEC website a notice any time we have reached our monthly capacity. Once posted, please do not submit any additional CRF’s for that month; these will be returned as Unable to Process.

HERE IS A FOLLOW-UP MEMO POSTED ON THE 24TH ON THE WEBSITE:

COMMUNICATION MEMO # 138

To: SOUTHEASTERN CENTER STATE CONTRACTED COMMUNITY OF PROVIDERS

FROM: WILLIAM HOLTZ, DIRECTOR OF PROVIDER SERVICES
SUSAN HANSON, DIRECTOR OF UTILIZATION MANAGEMENT

SUBJECT: BUDGET MANAGEMENT; QUESTIONS & ANSWERS

DATE: NOVEMBER 24, 2010

Benefit Management Q & A
After posting Communication Memos # 136 and 137, providers have had many questions regarding the implementation of the changes to the state-funded benefit plan and restrictions to the certification of services for November and December 2010. Those questions and the associated answers have been compiled and are available for review at the following link: (link to be inserted when posted)

Benefit Certification changes
When a Certification Request Form (CRF) is submitted to UM and approved, the approved service units encumber (reserve) the associated units and funds in the monthly budget line. Historically, requests for certification greatly exceed what is actually provided and claimed. In order to consider re-opening concurrent certification requests for December 2010, Southeaster Center must reduce the encumbrance of funds. The following steps have been implemented, effective November 24, 2010, to make available units and funds:

 Southeastern Center is deleting the Certifications in December for all Respite service and asking that CRFs for Respite be submitted only when the service is needed and expected to be provided.

 All current Personal Assistance Certifications will be reduced to the monthly service limit of the state-funded benefit plan.

 Targeted Case Management for all disability groups will be limited to two (2) case rate units per month.
 ADVP and Supported Employment will be reduced to 80 hours per month.

Both Respite and Personal Assistance are currently encumbered beyond the utilization ratio in the 1st quarter FY 10-11 and that inflated encumbrance amount is preventing other consumers from receiving the services.

Certain diagnostic categories are not covered in the state benefit plan: Not Otherwise Specified (NOS) with the exception of Psychotic Disorder NOS; Personality Disorders; Anxiety Disorders with the exception of Post-traumatic Stress Disorder and Attention Deficit Hyperactivity Disorders (ADHD) in adults.

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WILMINGTON, NC (WWAY) -- The Southeastern Center for Mental Health, Developmental Disabilities and Substance Abuse Services spent all of it's state funds and now new patients have no where to turn. The center is supposed to provide help for those in need, but now it's causing more problems for it's patients and other local agencies.

According to the website, the center is refusing to see any new patients and will cut back on services to current ones. It's something that former Southeastern sub-contractor Carlos Jones says will have major affects on our community.

"You can really just get into all type of things and again an individual that has a mental they are not mentally stable and you're just asking for them to get themselves in trouble," said Jones. "You're just opening up avenues and doors where those doors would not be open if they were getting the proper services."

Southeastern board member Jonathan Barfield agrees. The memo says they've reached budget capacity for the months of November and December and Barfield says this kind of notice is unacceptable.

"There's a tremendous concern on my part and I mentioned that to Foster Norman," said Barfield. Norman is the area director for the Southeastern Center.

"I feel like we are past the stage of coming up short with our budget," said Barfield. "I thought we had things better under wraps than what they are. I know there was some kind of mistake on Southeastern's part."

Jones and Aundrey Johnson work for the Youth Enhancement Center in Wilmington. Youth Enhancement was sub-contracted to work with Southeastern years ago but never got paid for the majority of their services.
The two say state funds were never allocated correctly for patients or contractors and as a result Youth Enhancement never got their money.

"It's not only us," said Johnson. "There's been several agencies who were caught in the trap of whether or not we were gonna support the individuals who had become so dependent on us or if we were just going to cut out and leave and run."

Youth Enhancement decided to stick it out for the sake of the patients but are no longer working with the Southeastern Center.

Youth Enhancement is now in the process of appealing to the state for the money they say they are owed. Barfield says Southeastern's services will be reduced for the rest of 2010. He says they hope to analyze their numbers over the holidays and start fresh in the new year. However, many patients are left with limited options and care until their full services resume.

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