BHA, Humbug

Ten years after Mental Health Reform started, we know some things that work in local care managers (LMEs) and in state-run hospitals, but not enough. Legislators and regulators continue to experiment with how care is provided and paid for.

The latest experiment is called a “behavioral health authority” (BHA) and is not to be confused with last year’s experiment, the Critical Access Behavioral Health Agency (CABHA). However, it’s not exactly clear what a behavioral health authority will do or why it is needed. Furthermore, it seems that county commissioners can simply create one if they can justify it.

The only thing more worrisome than a health care-related bill that sets bad precedent is one that bases its precedent on vague language and countless unknowns. This is exactly the trouble health policy analysts are having with Senate Bill 465.

The bill sponsored by Sen. Feltcher Hartsell would permit counties to create a BHA. These authorities would be created under a Medicaid 1915(b)/(c) waiver program, potentially convert current LMEs to BHAs, and simply call all of these health care entities “hospital authorities.”

The first evident concern with the bill is that BHAs are never defined. No one in the General Assembly, legislator or staff, knows what one would look like or how it would operate. Would it be public or private? If it replaces LMEs how does it differentiate a BHA from them, and what new duties and responsibilities would it have? Furthermore, would it carve out a niche from LMEs that undermines their productive and effective work with Community Care of North Carolina (CCNC), as well as destabilize the hard work of the Health and Human Services committee this session?

Additionally, it is not clear whether county commissioners could replace a functioning LME with anything they want, allowing them access to the Medicaid waiver funds for personal discretion. Hospital authorities are also single-county units, while LMEs can be multi-county, raising questions about what changes need to be considered for multi-city accommodation. Moreover, due to being classified as hospital authorities under county commissioners it becomes a concern whether or not these entities have taxing authority.

To add confusion to already growing concerns, Sen. Hartsell says the existing SB465 language is merely a placeholder, meaning it will soon have changes requiring further clarifications by analysts.

Nicole Fisher

Nicole Fisher is a current PhD candidate at the University of North Carolina in the Health Policy and Management Department. She also currently writes health care policy for t...

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