There is little doubt of the importance of greater accountability in service utilization, in particular for long-term care whose outcome gain may be preventative or modest upon first examination.  

Inceasing eligibility criteria, however, would seem counter-intuitive as basis for improving accountability since the successful provision of a needed service in itself lowers the threshold for its continued use. For example, requiring recent hospitalization as an eligibility requirement for a service that, by its very nature, is intended to reduce the likleyhood of hospitalization, would seem counter-productive and arbitrary.

Eligibility for Mental-health Skill Building should, instead, rely on the same healthcare standard expected in primary care treatment, the expert opinion of an independednt evaluation.

It would seem that such a determination of need could mirror the VICAP assessmnet process, recently imposed to accomplish the same for children’s services. This would base service access on a current clinical evaluation of need, rather than thrshold markers that may or may not be germain to the actual health status of the individual.   

Providing greater accountability, savings and the more appropriate match of service to need for patient, should be the goal of regulatory reform and the interet of all parties.