GP Health Insurance Coming to Small Business in Asheville

I have been querying the Asheville Chamber of Commerce about the possibilities of health insurance for the myriad small business in Asheville. Carol Hensley, associated w/ that organization, directed me to the Chamber of Commerce website re: this matter and I followed it to the bill which was signed by Governor Easley in August, 2009.

Here is what is at the Asheville Chamber of Commerce:

http://ashevillenccoc.weblinkconnect.com/CWT/External/WCPages/WCNews/NewsArticleDisplay.aspx?ArticleID=146

ARTICLE
Date
ArticleType
8/10/2009
Chamber
Asheville Area Chamber's Health Insurance Pilot Program Passes NC House and Senate
Contact: Carol HensleyAssistant Vice President Small Business and Entrepreneurship (828) 258-6116

The Health Insurance Pilot Program or H.B. 212 passed the North Carolina General Assembly on August 6, 2009 and was delivered to Governor Perdue on Friday, August 7, 2009 where it awaits her signature of approval.

The Health Insurance Pilot Program aims to allow the pooling of small and large businesses with hopes to demonstrate an affordable employer based health insurance plan for businesses. The pilot program could help to insure as many as 25,000 workers in the Asheville area.

The Asheville Area Chamber of Commerce and the Business Healthcare Roundtable have been working on a plan to provide affordable health insurance for local employees and employers for the past six years. The process has involved discussion with and input from large and small business in Buncombe County, physician groups, Blue Cross and Blue Shield, and United Healthcare. “Asheville is comprised of many great small businesses. We have long recognized the rising cost of health insurance and the inability of many of our small businesses to afford insurance for their employees. We are excited that Asheville can lead in the attempt to help bring affordable health insurance to North Carolina,” said Richard J. Lutovsky the President & CEO of the Asheville Area Chamber of Commerce.

Chamber employees and leaders from Western North Carolina are now working diligently to put the pilot program into practice. Many of Buncombe County’s largest employers will be participating in the final design of the product. H.B. 212 received unanimous support of all the members of the Western North Carolina delegation. The bill’s primary sponsors are Representatives Bruce Goforth, Susan Fisher, Ray Rapp and Jane Whilden. “This is a great opportunity for Western North Carolina to be the first pilot program in the state that allows employers to work together to reduce health insurance costs and make it easier for our companies to provide the insurance that so many residents need today,” said Representative Bruce Goforth. Senator Martin Nesbitt led the efforts in the North Carolina Senate.

Here is some info re: the law signed:

http://www.ncga.state.nc.us/Sessions/2009/Bills/House/PDF/H212v1.pdf
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2009
H 1
HOUSE BILL 212
Short Title: Health Insurance Pool Pilot Program. (Public)
Sponsors: Representatives Goforth, Fisher, Rapp, Whilden (Primary Sponsors);
K. Alexander, Bell, Bryant, England, Faison, Hurley, Insko, Lucas, McElraft,
Tarleton, Wainwright, R. Warren, and Wray.
Referred to: Insurance, if favorable, Commerce, Small Business, and Entrepreneurship.
February 18, 2009
*H212-v-1*
1 A BILL TO BE ENTITLED
2 AN ACT TO AUTHORIZE THE ESTABLISHMENT OF HEALTH INSURANCE PILOT
3 DEMONSTRATION PROJECTS IN INTERESTED COUNTIES TO PROVIDE A
4 MODEL FOR AFFORDABLE EMPLOYER-BASED HEALTH INSURANCE.
5 The General Assembly of North Carolina enacts:
6 SECTION 1. Notwithstanding any other provision of law to the contrary, health
7 insurance demonstration projects ("Demonstration Projects") for large and small employees
8 may be established by eligible sponsors ("Eligible Demonstration Project Sponsors"). Specific
9 Demonstration Projects, the goal of which is to reduce the number of uninsured North
10 Carolinians and to reduce the cost of health insurance for all purchasers of health insurance in
11 the Demonstration Project areas, may begin not later than April 1, 2010, and may continue
12 through December 31, 2014. Entities which are eligible under subdivisions (b)(1) and (b)(1a)
13 of G.S. 58-51-80 to have issued a policy of group health insurance are Eligible Demonstration
14 Project Sponsors. A Demonstration Project must comply with the following:
15 (1) The products for any pooling of groups are fully insured by an insurer
16 authorized to issue coverage in North Carolina.
17 (2) The insurance is issued through a group master contract with a bona fide
18 association as defined in G.S. 58-68-25 or a trust or other legal entity that,
19 pursuant to G.S. 58-51-80, is capable of entering into a group master
20 contract.
21 (3) The pooling arrangement requires that all small employers desiring to join
22 be accepted and that all eligible employees of each employer who elect
23 coverage through the participating employers be included in the pool.
24 (4) Each employer participating in the pooling arrangement and its employees
25 are offered the same benefit plan.

MEDICARE:CIGNA Government Services Does not List the 80% Hlth & Behavior Codes But They Do Pay Them

Just a heads up to people: CIGNA Government services, carrier for medicare in NC; TN; ID does not list on its CD that they send you in the mail, the Health & Behavior codes which pay at the 80% medical rate. However, they pay me for it. Even Humana pays me for the H & B codes tho there is no forthcoming information that they will honor these. Caveat: w/ Humana, send all your notes in w/ your CMS 1500 forms or they will balk at paying you.

I was just looking thru the '2009 North Carolina Medicare Clinical Psychologist Fee' and the H & B codes are not there there and that means that psychologists will not be alerted to use it. Interestingly, 90801 is not subject, according to this memo, to 62.5% mental health rate.

These CPT codes also are not subject to 62.5% mental health rate according to that CIGNA bulletin:

90802 96101 96102 96103 96105 96110 96111 96116 96118 96119 96120 96125

Haywood Reg Med Cntr opens Service Member's Counseling & Support Center

Some Mental Health Services Cut While Others Put Into Place
by Marsha V. Hammond, PhD Licensed Psychologist, NC
828 772 1127, cell phone
e mail: chomskysright@gmail.com

On October 16, 2009, in Asheville, Mountain Area Health Education Center made available training for mental health providers who desire to work with veterans and their families. In striking contrast to the cutting of mental health care services, particularly for NC state funded/ IPRS (non-insured; no Medicare, no Medicaid) consumers, monies have been allocated for the mental health care of veterans and their families.

On October 1, 2009, the 'grand opening' of Service Member's Counseling and Support Center took place at Haywood Regional Medical Center Urgent Care Center. Haywood county has more residents in the National Guard than any other county in NC. Additionally, the rates of National Guard veterans reporting mental health problems is 49% according to CSSP (Community Service Systems Providers).

In western NC, veterans can receive health care at the VA in Asheville but there is only one satellite clinic in western NC, specifically, Franklin. Providers can utilize TRICARE as insurance associated with veterans. Health Net Federal Services manages TRICARE for NC.

Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) not uncommonly are experienced by veterans when in Iraq or Afghanistan. The sequelae of PTSD include temper control problems, social isolation, boredom, and contributes significantly to marital and relationship difficulties. TBI can be subtle and is reflected in problems with speaking, hearing, seeing, or organizing one's thoughts, as well as headaches and impulsive behavior.

This support center's available information indicates a strategy of 'no one turned away' and can be contacted at 452 8354. This is a very welcome addition to mental health care services in mostly rural western NC.

Medicare's Telemedicine doesn't work if you don't have a computer w/ a camera

Well, I talked to an employee of CIGNA Government Services which oversees Medicare for NC; TN; ID (weird, true) this past week. I had asked someone in Medicare, via e mail, to advise me of how this telemedicine business works given that you are supposed to have a 'camera' or some similar device associated w/ the computer or other mechanism in order to provide Medicare clinical services.

Grand hoo-ha: Medicare! It now provides telemedicine!....particularly useful for people in isolated rural areas!

Ahem: most indigent clients don't have computers much less cameras linked to them.

You guessed it: telemedicine is non-existent for most people who could benefit from it----those living in isolated rural areas.

Rich people have other insurance in addition to Medicare.

And when Congress gets through working over the 'public option' the 'public' won't have access to Medicare EITHER.

Telemedicine arrives to Medicare

incredible.

http://www.cms.hhs.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

Medicare will pay for a limited number of Part B services that are furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for a face-to-face, "hands on" encounter.

Distant Site Practitioners
Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to State law) are:
Physicians;
Nurse practitioners (NP);
Physician assistants (PA);
Nurse midwives;
Clinical nurse specialists (CNS);
Clinical psychologists (CP) and clinical

Telehealth Services
As a condition of payment, an interactive audio and video telecommunications system must be used that permits real-time communication between the physician or practitioner at the distant site and the beneficiary at the originating site. Asynchronous "store and forward" technology is permitted only in Federal telehealth demonstration programs conducted in Alaska or Hawaii.
The current list of Medicare telehealth services includes:
n Consultations (CPT codes 99241 – 99255);
n Office or other outpatient visits (CPT codes 99201 – 99215);
n Individual psychotherapy (CPT codes 90804 – 90809);
n Pharmacologic management (CPT code 90862);
n Psychiatric diagnostic interview examination (CPT code 90801);

NC contact:
DCREGION IV – ATLANTA Lana DennisE-mail: lana.dennis@cms.hhs.gov Telephone: (404) 562-7379States: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee

Group Home Manager arrested for taking disabled residents' money

my opinion piece to the Winston Salem Journal that ran the related piece:

RE: this article in your paper: http://www2.journalnow.com/content/2009/aug/15/ex-worker-of-services-group-faces-felony-counts/

Group / Family Care Homes' Complaints are Ignored by NC DHHS
by Marsha V. Hammond, PhD Clinical Psychologist

Earlier this year, I was threatened with arrest by the manager of a family care aka group home in Leicester, NC, outside of Asheville. He called the Buncombe County Sheriff's Department when I refused to leave my therapy session when the Supervisor in Charge began to harass me and the client as we were in therapy.

My crime? I was seeing my client for therapy early on a Sunday evening, at his request and as associated with my availability.

I created a paper complaint to the official agency which is within the Department of Health & Human Services, specifically, the Department of Health Services Regulation (DHSR). Indeed, I created over a dozen complaints pertaining to clients' complaints that they were not receiving their $66 (what is left over after all of their checks are utilized by the family care homes) at all or in a timely manner. Neither did residents receive their stimulus checks in a timely manner (as in months out from the payment date). Neither would the family care management participate in any way with me as I attempted to track clients' medications in order to interface with their physicians.

I had a meeting w/ the family care home management at the Buncombe County Department of Social Services in February, 2009. The two local people in Buncombe associated with DHSR did not say a word in over an hour of this meeting which lead nowhere. The family care home continued to police the clients and the clients continued to be afraid of voicing any concerns.

After over six months and a file over an inch thick, I have thrown in the towel as there was very obviously no one at these agencies who was going to attend in any manner at all to the complaints. Lanier Cansler, Secretary of NC DHHS: stop the farce of grading these agencies. Its all chicanery.

Marsha V. Hammond, PhD: Clinical Psychologist, Asheville, NC

NC Medicaid Provider Enrollment : new private company! takes mental health provider information: DMA/EDS/ CSC in same mix

If you want to change anything about your provider status as a mental health provider accepting Medicaid in NC (DMS), note that EDS---- not any other entity---- is still doing this. (OH, EDS will send you the 'welcome letter': that's efficiency for you: one part of the Medicaid monies goes to EDS; one goes to CSC; one goes to the state; and who knows who else has their hand in the pie).

This new private company, CSC, does the provider enrollment management; another private company, EDS, tries to manage, some pieces (after waiting for 10 minutes, the CSC guy tells me to go back to EDS)......

So, I asked for the supervisor and he somehow came up w/ this link which is associated w/ EDS which of course is associated w/ provider enrollment matters (which CSC has been stated to manage): http://www.ncdhhs.gov/dma/forms/eft.pdf.

WHOOPEE! One hour on the phone and I get to the Electronic Funds transfer form.

Oh, and more information will be required of providers creating more work for mental health providers e.g., criminal background checks, etc.----yet more paperwork. (see below, FAQ).

And the payments are now irregular since CSC came online. No one at the EDS line (1 800 688 6696) knows ANYTHING about why this has taken place. For the past two years, when I would submit a very efficient webclaims payment request (easiest part of mental health billing), I would get paid like clockwork the following Wednesday when I submitted on the prior Thursday by 5 pm. This past submission, created on June 25, 2009, was not paid until today, July 7.

THAT'S A 12 DAY DIFFERENCE INSTEAD OF A SIX DAY DIFFERENCE. TWICE AS LONG.

After April 20, 2009, a company (a large contract obtained by someone associated w/ NC Medicaid/ NC DHHS you can bet) called Computer Sciences Corporation is whom you need to contact.

You look at the NC website and you think, OK, part of state government. Nope. Behind the link (http://www.nctracks.nc.gov/) is a private company (remember: we're trying to strangle government so that we can pad private pockets).


The FAQ of the web site takes you to the information:

1. Who is CSC?

CSC is the entity that has assumed the Medicaid provider enrollment, verification, and
credentialing (EVC) activities previously performed by DMA Provider Services.

2. What is the EVC Call Center?
The EVC Call Center is CSC’s dedicated Medicaid provider enrollment, verification, and
credentialing center for providers to inquire on the status of their Medicaid applications
or change requests. The Call Center staff also assists providers with questions
regarding completion of enrollment and change forms. The EVC Call Center hours of
operation are 8:00 a.m. to 5:00 p.m., Monday through Friday, except for State approved
holidays.

3. How can I contact the EVC Center?

Beginning April 20, 2009, you may contact the EVC Call Center as follows:
EVC Call Center Toll Free Number 866-844-1113
EVC Call Center Fax 866-844-1382
EVC Call Center E-Mail Address NCMedicaid@csc.com
CSC Mailing Address NC Medicaid Provider Enrollment
CSC
PO Box 300020
Raleigh NC 27622-8020
CSC Site Address NC Medicaid Provider Enrollment
CSC
2610 Wycliff Road
Suite 102
Raleigh NC 27607-3073
CSC Website Address http://www.nctracks.nc.gov

4. Where can I find more information about the new enrollment/credentialing
processes?
You can obtain information from the DMA website
(http://www.ncdhhs.gov/dma/provider/mmis.htm) as well as the CSC website
(http://www.nctracks.nc.gov).

5. Where can I access applications for new enrollments?
Providers can continue to access applications from a link on DMA’s website at
http://www.ncddhs.gov/dma/provenroll/ or directly from CSC’s website at
http://www.nctracks.nc.gov.

6. Will the enrollment process change since there is a new vendor?
No. At this time the enrollment process will remain paper-based.

7. Can I complete my application online?
A web-based application will be available to providers in late summer of 2009. As this
date approaches, there will be more information available.

8. How long does it take to process a provider enrollment package?
Once a completed enrollment package is received in the EVC Call Center, it should take
approximately 2 to 3 weeks to process.

9. How will I know that my application has been received?
The receipt of your application will be acknowledged by e-mail or in writing.

10. How can I check the status of my enrollment package?
Beginning April 20, 2009, you may contact the EVC Call Center at 866-844-1113 to
check the status of your enrollment package.

11. How will incomplete applications be processed?
Whenever possible, CSC will communicate via e-mail if missing or additional information
is needed from providers.

12. How will I be notified once I am enrolled?
Once you have been approved for participation in the N.C. Medicaid Program, you will
receive a Welcome Letter from EDS.

13. What happens to an enrollment application that is submitted to DMA before
April 20, 2009?
All enrollment packages that are not processed by DMA prior to April 20, 2009, will be
screened for completion by DMA staff. If all information is complete the application will
be forwarded to the EVC Call Center for completion. If an application is incomplete it will
be returned to the provider to complete and send to CSC.

14. What happens to an enrollment application that is submitted to DMA after
April 20, 2009?
All enrollment packages that are received by DMA after April 20, 2009, will be forwarded
to the EVC Call Center for completion.

15. Will existing Medicaid providers be required to re-enroll?
No. However, CSC will verify information in the Medicaid provider file and will credential
providers who have not been not credentialed in the last 14 months.

16. As a currently enrolled provider will I be required to complete a new or additional
enrollment application?
No. However, each provider must verify information in the Medicaid provider file and
furnish additional information on ownership and criminal background as required by
Federal and State regulations. CSC will notify each provider prior to initiating the
verification and credentialing process and will request providers to complete and return
the forms within 30 days.

17. Will DMA allow providers that are credentialed by other agencies to be
grandfathered and avoid credentialing by CSC?
No. DMA has determined that other credentialing agencies do not collect all required
information needed to satisfy all federal and state requirements for Medicaid enrollment.
Since CSC will source verify the credentials of providers, providers will not be required to
submit copies of licenses, certifications, accreditations or endorsements.

18. Will my Medicaid claims payments be impacted when CSC begins processing
applications on April 20, 2009, or when CSC begins verifying information for
currently enrolled Medicaid providers?
No. There will be no impact to claims submitted to EDS for processing and payment will
not be impacted. EDS will continue to process all Medicaid claims until August 2011

********************************

Right now, I am sitting on a 10 minute plus hold waiting to find out where the 'change of banking information Electronic Funds Transfer ' form is.

Given that it took CIGNA Government Services 6 months to change my address about 1.5 years ago, I figure this will (NOT) be a snap.

There will be little success as associated w/ mental health care in terms of efficiency until there are efficient systems undergirding authorization/ utilization / billing.

Some investigative reporter should figure out who got them the contract.

WAIT! WAIT! Someone answered the phone. He did not identify his name (always get the name). The information about the Electronic Funds Transfer is not on the NC Tracks website, he says. OH: you need to contact EDS.

I'm contacting Rep Verla Insko & Martin Nesbitt, co-chairs of NC mental health reform committee.

CIGNA: 19.1 BILLION Sales in 2008: CNN: Former CIGNA VP/ exec outlines how insured are 'purged' from being insured

"Potter (a Vice President at CIGNA) started thinking about leaving CIGNA in 2007 after he visited a medical charity event at a Virginia fairground. 'It was almost like an electrical jolt,' Potter said. At the event, Potter took pictures of doctors offering free 'health care' to the uninsured. 'The volunteer doctors were seeing patients in barns, people in animal stalls,' Potter said. 'It changed it for me.'

HERE is Potter's blog on health care reform: http://www.prwatch.org/blog/35267

BCBSNC has been giving out free generic medication for the past six months. This practice stopped on July 1, 2009.

NC Psychological Association encourages psychologists to give 'free' depression assessments during certain times of the year.

Sorry: but the providers need to be paid and the patients need to be properly cared for and NOT utilizing some jump and start system smacking of Animal Farm.

BTW: It is CIGNA GOVERNMENT SERVICES that administers MEDICARE at this time for: ID; TN; NC.

It took me SIX MONTHS to get my billing address changed w/ them about two years ago.

So, you see, what 'looks' like Medicare right now is not Medicare in terms of all the little CIGNA's around the country. Whopping article here for some diligent writer.

GIVE US THE PUBLIC OPTION.

******************************************
(Note: 'revenue' = 'sales' in the article below: http://www.msnbc.msn.com/id/7477449/)

Ex-executive accuses insurance giant of 'purging' customers

Wendell Potter says insurance companies only out to please Wall Street investors

By Jim Acosta and Bonney KappCNN's CNN American Morning
http://www.cnn.com/2009/US/07/02/insurance.purging/index.html

PHILADELPHIA, Pennsylvania (CNN) -- Wendell Potter says he is finished defending the insurance industry, which he says is "beholden to Wall Street."

Wendell Potter once was a vice president in the public relations department for insurance giant Cigna.

At a hearing last week before the Senate Commerce Committee, the former vice president of corporate communications at the insurance giant Cigna testified, "I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry."

The committee's chairman, Jay Rockefeller, D-West Virginia, told Potter, "You are better than Russell Crowe on 'The Insider,' " referring to the award-winning 1999 film about cigarette company executive Jeffrey Wigand, who blew the whistle on the tobacco industry's practices.

In his testimony and during an interview with CNN, Potter described how underwriters at his former company would drive small businesses with expensive insurance claims to dump their Cigna policies. Industry executives refer to the practice as "purging," Potter said.

"When that business comes up for renewal, the underwriters jack the rates up so much, the employer has no choice but to drop insurance," Potter said.

CNN obtained a transcript of a 2008 Cigna conference call with investors in which company executives use the term "purge."

But in an e-mail to CNN, Cigna spokesman Chris Curran denied the company engages in purging.
"We do not practice that. We will offer rates that are reflective of the competitive group health insurance market. We always encourage our clients to compare our proposed rates to those available from other carriers," Curran wrote.

Cigna had revenue of $19.1 billion in 2008, according to the company Web site.
Potter started thinking about leaving Cigna in 2007 after he visited a medical charity event at a Virginia fairground.
"It was almost like an electrical jolt," Potter said.
At the event, Potter took pictures of doctors offering free health care to the uninsured.
"The volunteer doctors were seeing patients in barns, people in animal stalls," Potter said. "It changed it for me."

He says he finally decided to quit in 2007 after Cigna's controversial handling of an insurance claim made by the family of a California teenager, Nataline Sarkysian.

The Sarkysian family made repeated appeals at news conferences for Cigna to approve a liver transplant for the 17-year-old, who had leukemia. Cigna initially declined to cover the operation, then reversed its decision.

Sarkysian died hours after the company's reversal.

As Cigna's spokesman during the controversy, Potter had no role in the decision to deny coverage. But he was inundated with angry phone calls.

"After she died, my voice mail and my e-mail inbox were just filled with messages from people who were just outraged, " Potter said.

Don't Miss
In Depth: Money and Main Street
Potter's blog
Now a senior fellow on health care for the nonpartisan watchdog group Center for Media and Democracy, Potter writes a blog on health care reform. In particular, he is keeping an eye on efforts to defeat legislation that would give Americans the option of joining a government health care plan, something he now supports.
He says he witnessed how the insurance industry torpedoed health care reform efforts during the Clinton administration.
"They conduct what I call duplicitous PR campaigns. They'll say what people want to hear," Potter says. "It's how they operate. You cannot trust these guys."
Potter is also taking aim at some of the TV commercials aired by groups opposed to changes. One such ad caught Potter's eye. Run by the conservative organization Patients United Now, the ad says that "now, Washington wants to bring Canadian-style health care to the U.S."
"Sometimes you'll see misleading information. And sometimes you'll see outright lies, like that [ad] is," Potter said, referring to the spot.
Patients United Now spokeswoman Amy Menefee disagreed.
"We're not saying there's a Canada health care act of 2009," Menefee said. "It is a trend. It's trending in that direction."
Potter notes that the leading proposals for health care in Congress do not seek to set up Canadian-style health care in the United States. He says claims that overhauling the system would lead to "rationing" of care are missing his point.
"What we have is rationing by corporate executives who are beholden to Wall Street. And it happens all the time," Potter said.
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