The Greensboro News & Record provides a case study in how government bureaucracies kill the best of intentions to improve care.


Guilford Center business manager Glenna Harford said the biggest challenge is spelled out, at length, in a 189-page ring binder of ?service definitions,? ?billing guidelines? and ?documentation requirements? printed by the state.

The upshot of these densely worded rules and regulations is this: If a private provider spends state money incorrectly, that contractor has to pay back the money ? perhaps a few hundred dollars, perhaps a few hundred thousand.

[snip]

For an example of how the Guilford Center lost out on approximately $200,000 in anticipated state funding last year, consider the county?s effort to open a ?drop-in? center for the mentally ill.

The idea was for a safe haven that would be informal, come-as-you-are. State regulators had a different concept, citing ?N.C. Administrative Code T10:14V.5400.? From a section titled ?Documentation Requirements? on page 49:

?Documentation is required in a client record,? the rule book says, ?or in a separate or pending file (some type of form which identifies the individual by name, or unique identifier on a daily basis is recommended.)?

As the Guilford Center staff read it, that meant people with diagnoses ranging from clinical depression to schizophrenia, looking for a calm place to stay for a few hours, would need an ID badge and a file.

?That kind of defeats the purpose of a drop-in center,? noted Harford, who holds an MBA and a master?s in social work. ?We couldn?t figure out how to make it work.?

For private providers and nonprofits without the staff and expertise of the Guilford Center, navigating these ever-shifting regulatory channels is even more daunting.

Some contracts put out for bid simply draw no takers, Pierce observed, explaining part of the unspent money. And when the rules are being rewritten and the budget still in negotiation two months into the fiscal cycle, private providers have no way of know what services will be reimbursed.

Makes you feel all warm and fuzzy thinking about the president’s speech tomorrow night, doesn’t it?