MH/MR care to be provided by highest bidder in Texas county

From the San Antonio Express-News in Texas:

After years of false starts and several legal twists and turns, a large part of Bexar County's mental health safety net is about to be spun off to the highest bidders.

The coming change has some local patients worried. But at least one advocacy group is praising the move as long needed.

At the heart of the change is a 2003 state law that forbids local mental health and mental retardation authorities from providing direct care to patients with state money, unless there's no other provider willing or able to do it. In Bexar County, the authority is the Center for Health Care Services

Wearing both hats — authority and caregiver — invites potential conflict of interest, supporters of the law say.

“It's absolutely a good thing,” said John Theiss, vice chairman for public policy with Mental Health America of Texas, an advocacy group. “If you have a structure where the authority is separate, they're going to contract with the cheapest provider who does the best job.”

On March 30, the Texas Department of State Health Services sent a letter rejecting an alternative plan the center had proposed and warning them to move forward quickly with signing up other mental health providers or risk being in noncompliance with the state.

The center is proposing to hand off 2,000 of its 5,000 adult patients and 100 children at first, with others to follow later if enough providers can be found to take them.

Charles Boone, chief operating officer for the center, said he's trying to draw up the requirements for potential bidders to make sure patients don't suffer, and so the center can move back in quickly if the new providers don't work out. The plan must be approved by state health officials.

“If you get somebody who's going to come in, take the profits and leave, and dump those patients, where would they go? They'll go to the emergency room or back to us.”

Boone and others are hoping the center's sponsor and partner, the tax-supported University Health System, will bid on at least part of the contract.

The University System not only provides local matching funds to the center, but enrolls the center's uninsured patients into its CareLink program, which gets deep discounts on expensive psychiatric drugs the center isn't eligible to receive.

“I haven't been with the Center for Health Care Services long, but I depend on them,” said Michael Boesewetter, 46, who suffers from severe bipolar disorder. He has gone from long bouts of hospitalization and frequent scrapes with the law two years ago to being stable on medication today.

“One of my worries is I'm going to break the link with CareLink,” Boesewetter said. “And the other thing is, I'm worried about the quality of care.”

The University System hasn't yet decided if it will bid on the contract, said its president, George B. Hernández Jr.

“We have to be competent in whatever we propose to do. But the (Bexar County) Commissioners want us to seriously look at it, and we will.”

The nonprofit, federally funded CentroMed clinics have expressed interest, Boone said. And so have a number of for-profit firms, including some that already have contracts with the center.

The center — founded in 1966 as the Bexar County Mental Health Mental Retardation Center — gave up its role as mental retardation authority to the Alamo Area Council of Governments almost four years ago, deciding it would rather be a provider of those services.

But some confusion lingered over whether the 2003 law also referred to mental health services. A 2006 attorney general's opinion said it did.

The contract, which could be divided among several providers, is probably worth about $4 million, Boone said. The center won't be out of the treatment business even if it contracts out those services paid for with state funds. It has grants from other sources to provide substance abuse treatment, crisis care, jail diversion and other services.

“A lot of centers leverage the money that they get from the state to bring in other grants,” said Janet Paleo of San Antonio, chairwoman of a state health department advisory committee on the centers, who said she was speaking only for herself.

“Our (Bexar County) jail diversion program started with a grant, and now it's become a model for the nation. With private providers, a lot of times either they don't qualify for grants or they're not interested in expanding their services just because it would serve consumers better.”