North Carolina’s public system for adult substance abuse treatment has two primary components—the community-based system of Local Management Entities/Managed Care Organizations (LME/MCOs) and the three state-operated Alcohol and Drug Abuse Treatment Centers (ADATCs). Separation of the ADATCs from the community-based system creates operational silos which impose challenges to utilization management and continuity of care and limits the State’s ability to address service gaps and manage cost. North Carolina also lacks an adequate performance management system that tracks long-term outcomes of public substance abuse treatment. The General Assembly should require the Department of Health and Human Services to integrate the ADATCs into the community-based system by transitioning funding to LME/MCOs and requiring LME/MCOs to pay for services at the ADATCs. The General Assembly should also direct the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to strengthen its performance management by tracking long-term outcomes of treatment.
Relevant Legislation:
- Session Law 2015-241, Section 12F.12.(a) terminates all state appropriations for state-operated ADATCs beginning with the 2015-2016 fiscal year and instead appropriates funds to the Department of Health and Human Services, Division of Mental Health, Developmental Disabilities and Substance Abuse Services for community services in order to allow LME/MCOs to assume responsibility for managing the full array of publicly funded substance abuse services, including inpatient services delivered through the ADATCs. Starting September 18, 2015, all direct state appropriations for ADATCs are terminated and the ADATCs will be 100% receipt-supported.
Agency Actions:
- Per legislation, 100% of the allocation has been appropriated to DMH/DD/SAS. In Fiscal Year 2015–16, 100% of the allocation was used exclusively to purchase inpatient alcohol and substance abuse treatment services from ADATCs. Currently, in Fiscal Year 2016–17, although 100% of the allocation is appropriated to DMH/DD/SAS, a minimum of 90% of the allocation shall be used exclusively to purchase inpatient alcohol and substance abuse treatment services from ADATCs. In subsequent fiscal years, the percentage of the allocation that shall be used exclusively to purchase inpatient alcohol and substance abuse treatment services from ADATCs shall decrease by 10 percentage points each fiscal year until it reaches zero percent.
- Additionally, DMH/DD/SAS is working with the Government Data Analytics Center to combine data sets to begin to develop consistent data regarding service delivery, frequency, and cost.