Regional mental health services, finances are questioned

The financial stability of and services provided by Southwest Mississippi Mental Health Complex-Region 11 are being called into question.

Bill Rosamond, who serves as the state coordinator for mental health accessibility, discussed the situation with the Franklin County Board of Supervisors earlier this month.

Rosamond said mental health services had been deemed inadequate after an in-depth review revealed Region 11 — which includes Franklin County — was financially troubled and not able to provide needed services to residents.

“Region 11 was not able to provide the financial information that we requested,” Rosamond said. “Jerry Mayo — the former executive director of Region 12 — is a retired CPA, (and has) compiled the financial numbers for us.

“From what we could tell — based off information we were provided from January through August, 2021 and looking at revenues collected from Medicaid receipts, grants and county support — revenue for services was about $2,100,000.

“Payroll costs were $2,300,000, with the exact difference being a deficit of $233,584.”

Rosamond went on to note Region 11 had not been able to pay its PERS — Public Employees Retirement System of Mississippi — contributions.

On Sept. 28, Region 11 was $190,000 in arrears to PERS, but reportedly caught up around December.

“They fell behind, again, the first part of the year by $100,000,” Rosamond noted.

“In speaking with Ms. Sherlene Vince, who is Region 11’s executive director, there was a check sent to PERS very recently that would catch them up again.

“I spoke with PERS on Friday, (March 4). They weren’t able to confirm or deny receiving that check. However, they said even if they had received it and they were caught up that as of Monday (March 7) — being the fifth working day of the month — they would be behind again between $60,000 to $70,000.

“We have not seen evidence of any financial stability that we believe would allow Region 11 to continue to make those payments. Additionally, Region 11 is not able to provide its employees with health insurance.

“So the region is very vulnerable financially … (and) if you aren’t stable financially, you aren’t going to be able to provide services.”

The operation, which also serves Adams, Amite, Claiborne, Jefferson, Lawrence, Pike, Walthall and Wilkinson counties, has short-term debts of around $317,000 and bank debts of about $292,000, according to Rosamond’s report.

“Some of those debts may be duplicates of accounts payable or other previously paid debts, we just weren’t quite able to tell off the financial information we were provided.” Rosamond added.

He also gave a breakdown of the collective population of the nine counties, the number of residents who are on Medicaid and the amount of funds the region receives via Medicaid billing.

“The collective population of those counties is about 139,000 people,” Rosamond said.

“For operational purposes, the Region 11 Community Health Center (CMHC) that serves all those counties is divided into an east side and a west side. (Franklin County is) considered in the west side.

“The Medicaid breakdown of these counties (shows) about 36,000 people that live in the nine counties are Medicaid beneficiaries and 1,600 are enrolled in CHIP (Children’s Health Insurance Program). So, that accounts for 28 percent of people in this area.

“About 55 percent of CMHC revenue is derived from Medicaid billing. Another large share is derived from federal and state grants. Currently about 2 to 3 percent of the revenue for the CMHCs comes from county contributions. Your county contribution – as you know – is $18,000.

“Additionally, the region is allocated about $2.3 million each year in grant funds. They drew down $1.3 million (in 2021). If they’re not drawing down all their grants, that is a strong indicator that services are not being provided.

“We additionally looked at Medicaid billing. Region 11 bills $2.86 per person on Medicaid. The state average is $26.85. Again, that’s an indicator that services are not being provided.”

Rosamond also noted understaffing factors into the lack of mental health services offered.

“Mr. (Steven) Allen and I, and others on our staff, have visited every county office in the region,” he said.

“We have looked at a number of factors as best we could to try to determine what services are being offered. One factor we looked at was employment. In September, 2021, there were 98 employees with a vacancy rate of 23.4 percent.

“If you don’t have credentialed employees to provide services, you have one of two things — you have people that aren’t qualified to provide services (providing) services, in (which) case you can’t bill for the services, or people in the county go without services.

“(We) visited each one of the county offices and witnessed in a number of areas that services were provided by appointment only, the doors were locked — that’s what we found here in Franklin County, at the office right here across the street (from the courthouse).

“Another thing we looked at, on average community mental health centers served 3 percent of the population in the state of Mississippi. In Region 11, 1.2 percent of the population is served. For all of those reasons we’ve made the determination that services are not being adequately provided in Franklin County.”

Region 11 Executive Director Vince, who was also in attendance at the meeting, spoke to the panel about the issues raised.

“Over the past year, Southwest Mississippi Mental Health has had its challenges with the mandatory PERS contributions and the implementation of new Electronic Health Record (EHR) systems twice over the course of the past three years,” she said.

“The PERS contributions create a tremendous hardship, but we are actively reducing that indebtedness. The implementation of the new EHR has created many set-up issues, preventing billing (from being) sent to most of our major payers.

“Currently, more than 4,800 identified billable service hours are waiting to be billed with an estimated $300,000 in revenue from those services as well as an estimated $150,000 additional revenue from psychosocial rehabilitation services. In spite of these challenges, the PERS indebtedness has been paid in full.

“Nonetheless, the agency has made great strides in increasing funding and expanding services through two federal grants — the Certified Behavioral Health Clinic (CBHC) grant and the Substance Abuse and Mental Health Services Administration (SAMHSA) grant.

“The CBHC grant provided us stability to maintain what we already had. As you know, COVID hit everybody hard. We were having struggles before COVID, I will give you that. However, even before COVID, we had applied for this CBHC grant to help stabilize and to build services in our region.

“So at the start of the pandemic in 2020, we were providing 20,000 plus services across the region. As (we) went through the course of the pandemic, we actually had about half of those services being provided because we didn’t have people coming in the offices … we did some telehealth and did some over the telephone, but we also had issues with people being out sick with COVID.

“When (Rosamond talked) about that $2.3 million (in grants) and we’ve only used $1.3 million, $800,000 of that wasn’t used because we were actually doing renovations (to the crisis unit building) and getting ready for the crisis unit to be put in place.

“The federal initiatives have supported an increase in staffing and provided an opportunity for increased outreach region-wide. With the combined federal funding initiatives and the Department of Mental Health funding, the agency is postured in a much better financial and productivity situation than we have had over the past several years.”

Vince went on to list successes the region has seen over the past year, including:

• Receiving a donation of a 15,000-square-foot facility in Natchez from Merit Health.

• Opening an eight-bed crisis residential unit that serves the entire region. With additional funding from the Department of Mental Health, the unit will increase to a 12-bed facility with security guards and direct care staff.

• Hiring additional staff in Franklin County, allowing the local office to be open for five days a week.

• Offering telehealth and in-person services for medication evaluations and individual therapy.

• Offering Intensive Community Outreach Services and Intensive Community Support Services for Franklin County residents.

• Partnering with Franklin County schools, resulting in more than 40 referrals for outpatient and day-treatment services.

• Re-establishing a relationship with Franklin County Youth Court.

• With additional funding and when a location is found and renovations are made, Region 11 plans to open a Psychosocial Rehabilitation Program in Franklin County for adults with serious mental illnesses.

“Additionally, SWMMHC will expand services throughout the remaining eight counties of the region during this calendar year,” Vince continued.

“The agency will open four additional PSR programs. The next PSR will open within 45 days, serving Claibrone and Jefferson counties. SWMMHC will open seven more children’s day-treatment programs throughout the region this calendar year.

“Additionally, as an agency – region-wide – we have created an opportunity for greater visibility and access to services than we have experienced in a number of years. In Franklin County, SWMMHC participated in the River Fest and Trunk-or-Treat. The agency sponsored Cocoa and Cookies with Santa in all counties, reaching more than 400 children region-wide.

“We are on an upward trend. Our focus is to continue working to provide quality, accessible services to individuals and families throughout our region.”

After hearing from Vince, the board heard from Rosamond once more.

“The reality is, a community mental health center is a business,” he said.

“It is operated with support of county funds, it’s operated with support of state and federal funds, but the fact is, it’s a business. It’s got to be operated like one, and one of the large components of sustainability is billing, and operating effectively and efficiently the way that it should be.

“We’ve looked at this region, and I hope that some progress has been made, but the fact is we’ve seen nothing to show that what’s going on here is sustainable. The grants that were referred to are time limited. There was a very large infusion of cash — COVID relief — provided to all of the CMHCs.

“If (they) didn’t have these grants and the COVID money, I’d hate to see what kind of shape (Region 11) would be in today.

“We have not received the financial information from Region 11 that we have requested. It is the only region that, to any degree, has not provided us with the information we have sought. I don’t see a sustainable plan to pay PERS. I don’t see a sustainable plan to provide health insurance for people.

“We have reviewed all counties in Region 11, including Franklin. We visited your local office and we made a determination that services provided are inadequate.

“According to Mississippi Code Section 41-20-9, we’re required to appear before (the board of supervisors in each county in the region), give you notice services aren’t being provided adequately and ask you for a plan to provide those services and that is the (reason) we’re here today. We’re asking that you provide such a plan within 30 days to our office.”

Rosamond suggested the county consider increasing its contribution to the region, and in the event the county receives American Rescue Plan Act funding, consider using some of those dollars to provide a better-suited building to provide mental health services in Franklin County.

If a plan submitted by the board is deemed insufficient, the Office of the Coordinator of Mental Health Accessibility (OCMHA) can see if another region in the state is interested in providing services to the county.

If another region does not want to provide services locally, the OCMHA can ask for bids from private-sector entities to provide mental health services locally.

The county’s 30-day response deadline is set to expire on Thursday, April 7.