As the state mental health region that includes Dubuque County prepares for coming operational shifts, its leaders say that unknowns remain about what the end result will be.
Mae Hingtgen, CEO of Mental Health/Disability Services of the East Central Region, addressed the Dubuque County Board of Supervisors this week to lay out the plans and timeline for major changes coming for the region this year.
She said the region’s leadership has been feeling some whiplash after losing a bid to manage a realigned behavioral health district but then being named a disability access point by the Iowa Department of Health and Human Services last month.
“On June 30 of this year, MHDS of the East Central Region, the law that governs us ceases to exist, which means the direction, as far as our governance — what our governing board looks like, our staffing structure — ceases to exist,” she said. “Until we found out that we have been given the intent to award the disability access point (contract), my assumption was that our region has no contract and we must close down.”
Recent state laws are merging the regional bodies that manage state mental health and substance use treatment services into larger behavioral health districts. The state also is shifting disabilities services under the oversight of Iowa’s Area Agencies on Aging and creating a separate agency to cover those services called disability access points.
Leaders of the East Central Region, which includes Clayton, Delaware and Dubuque counties, and the Eastern Iowa Region, which includes Jackson County, applied to become the administrative services organization for the behavioral health district that includes the counties they cover.
In December, however, the Department of Health and Human Services announced that Iowa Primary Care Association will serve as the ASO for the entire state’s behavioral health system. Iowa PCA did not respond to an emailed request for comment Friday.
Beginning July 1, the East Central Region will serve as the primary access point to assist people with disabilities, their families and caregivers in District 7, which covers 14 counties, including Dubuque, Delaware, Jackson and Jones.
Hingtgen told the supervisors that contract negotiations are underway with the state to finalize the funding and guidelines for being the District 7 access point.
However, she said while final numbers are not available yet, the funding for being an access point is significantly less than being an administrative services organization.
She said the region is making a plan to shut down its behavioral health arm while creating another plan to maintain capacity for disability services.
“We just have a lot of dates that we’re working with here to understand our authority and what allowable activities there will be for us as the disability access point,” she said.
In response to a request for comment, an Iowa Department of Health and Human Services spokesperson provided links to information on the department’s website about the realignment, instructions for region close-out plans and operational guidance. The website also includes a letter to Iowa counties stating that officials should review the information published online and submit questions to be addressed during weekly town halls.
Members of the Board of Supervisors this week expressed concern about what bills from the existing region become the county’s responsibility July 1 when Iowa PCA helms the newly launched behavioral health districts. Supervisor Ann McDonough questioned who will be responsible for unemployment payments for region staff or bills from providers seeking reimbursement for care administered prior to June 30.
“I believe that there’s been large bills submitted after a budget cutoff date to the region — even from local vendors — of nearly a million dollars,” she said. “If there’s a bill, let’s just say it’s a million dollars, submitted on Aug. 1, Aug. 15, Sept. 1, Nov. 1, for work that’s been done prior to June 30, is it the state’s position that Dubuque County is going to pay that?”
Hingtgen said the region plans to create a six-month transition plan to address additional payments. She said the region will make unemployment payments and created a plan to regularly remind providers to submit their bills in a timely manner.
She said the region will do all it can to pay those bills, but if unemployment benefits extend past Dec. 31 or a bill comes in after that date, the region will likely not be able to cover it.
Hingtgen said she plans to meet with Iowa HHS officials early next week to continue access point contract negotiations and gather more details about the year ahead.
