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House could mandate some managed mental health care in Travis County

Wednesday, March 30, 2011 by Michael Kanin

The private firm that manages mental health care for Medicaid patients in seven Dallas-area counties may be looking to expand to Travis County—without the county’s approval. The move would come as an amendment to the Texas House version of the state’s upcoming budget.


As county officials scrambled to understand what such an arrangement might mean for their constituents, Austin Travis County Integral Care Executive Director David Evans told In Fact Daily that the change “would have a lot of very serious implications for our county.”


The news came as part of Travis County Intergovernmental Relations Coordinator Deece Eckstein’s weekly commissioners court briefing on legislative issues. After the briefing, Pct. 2 Commissioner Sarah Eckhardt said that the amendment was news to her.


“(I don’t know) whether it’s about mental health managed care generally or whether it’s actually a big government boost to (that firm) specifically,” she said.


Eckstein said that he’d only just learned of the managed care amendment himself on Monday night. He offered the court a summation of what he had heard so far. “There is now some talk going on over at the Capitol about trying to save some money in the budget by mandating managed care for behavioral health issues,” he said. “There is a program in Dallas called the NorthSTAR program. There are some positive results (there) but there is a lot of resistance to trying to expand that statewide.”


Eckstein told In Fact Daily he believes that lobbyists for ValueOptions are shopping a potential amendment to House members. ValueOptions is a subsidiary of Norfolk, Va.-based FHC Health Systems. The company currently holds a contract with Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties to manage behavioral health services for residents eligible for Medicaid and other public assistance there.


Eckstein reported that there had been 371 amendments offered to the budget bill thus far. On Thursday evening, it remained unclear who might have filed the one that would bring managed mental health care to Travis County. It was also not evident if that effort would be focused only on the Austin area or whether it would also affect other jurisdictions.


According to Evans, ValueOptions became involved in those areas as part of a 1999 experiment that carved out the public assistance portion of the region’s psychiatric and substance abuse care. In each subsequent legislative session there has been some push to extend the program to other portions of the state.


After the hearing, Eckstein said there had indeed been other attempts this session to mandate managed care for some Travis County mental health patients. “The was an effort, in particular in the House Appropriations Committee and in the Subcommittee on Health and Human Services, to try and do this, and it went nowhere,” he said.


Evans compared the ValueOptions NorthSTAR program – as it is known in the Dallas area – to charter schools and toll roads. “It would … after taking a set of profits off the top … pull (state and Medicaid) dollars into an independently managed system,” he said.


This style of management, he later added, would conflict with the effort currently in practice in Travis County. “As a local entity, we’re trying to integrate with our local community,” he said.


Keeping it local is also key, added County Integral Care Communications Director Iliana Gilman. “Each county has their own specific needs,” she said.


Eckhardt emphasized that the county needs to make sure that it doesn’t make a mistake with its mental health care. “We’ve got to be open-minded about our partnership with the private sector to meet these needs, and also we need to be mindful of the effects on the availability and the quality of that care,” she said. “If you don’t do this segment of the population right, it costs you more.”


Eckhardt said that “Travis County does a pretty darn good job” with its current system. She added that she’d heard “complaints about the quality of service and the duration of service out of NorthSTAR.”

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