State Funded Mental Health Care Clients Wait Times for Inpt Treatment DAYS and DAYS

This blog response is created as pertaining to Richard Craver's excellent and detail article associated with the wait time for state funded mental health care clients for inpatient hospitalization. 'State funded clients' are those who have no insurance: no Medicaid, no Medicare, nothing. The original purpose of NC mental health care reform, lest we forget what a fine incentive it has become, was to provide mental health care for ALL citizens of NC and thus the category of 'state funded client' was created. The other agenda was to 'privatize' mental health care, because, dontchaknow, there's lots of money to be made doing this and of course that will create competition and then voila the best (read: the biggest company paying their workers the least money) will win out.

Here is Craver's article and below is my comment. You have to be on facebook to create a comment. It would be nice if people would.

http://www2.journalnow.com/news/2012/feb/11/wsmain01-study-wait-times-for-psychiatric-beds-sti-ar-1917925/#fbcomments


THE ORIGINAL INTENTION OF NC MENTAL HEALTH REFORM WAS TO MAKE MENTAL HEALTH CARE AVAILABLE TO ALL CITIZENS

As associated with the massive paperwork for Western Highlands Network (WHN) LME in western NC, I stopped seeing state funded clients over 5 years ago. Now, WHN LME is participating (they are demanded by NC DHHS) in yet another tier of paperwork barriers as associated with mental health care, this time, pertaining to Medicaid clients.

To be truthful, provider applications for being 'in-network' essentially----THOUGH I HAVE BEEN A MEDICAID PROVIDER FOR 10 YEARS IN NC-----were to have been into the Provider Relations Department at WHN LME by the end of December. How I dreaded all those pages of paperwork. I had filled in provider paperwork for WHN LME back when I was seeing state funded clients but of course none of that paperwork could be used though it is completely duplicitous except for the matters of updating one's malpractice insurance coverage.

So, now we have been requested to submit a request to create a request to become an 'in-network' provider as per WHN LME. The first Friday I called about this, two weeks ago this past Friday, I was passed around 7 times until I finally called Arthur Carder's (the CEO) office. I simply had a question about a form.

Then, I was required to turn in my tax return, a page indicating 'who I was servicing' in terms of Medicaid clients (an indication of 'need'), as well as other paperwork. This was ONLY the request to get to the reqesst of the larger body of paperwork. This past week I called the Director of Provider Relations at WHN three separte days, leaving 3 polite messages. Then I decided I would take a go at it again this coming Tuesday, which will be 2 weeks since I turned in the request to get to the request to be an in-network provider----though I have worked w/ NC Medicaid clients and billed and contract completely independently via NC DHHS.

This multi-days wait time in order to get in-patient mental health treatment for state funded clients----which most all providers rid themselves of years ago----even though that was the original intention of NC Mental Health Reform, is simply a preview of the similar treatment now that the LME's have been fully funded, with their waivers, to manage Medicaid $$---LME by LME.

The state legislature should have given the money to the providers in order that we create efficient, motivated, research-driven outpatient therapy. Instead, we now have multi-million $$ funded LME's who cannot answer their phone calls or get their paperwork done.

When it is seen that NC Medicaid has 'saved' all that money----it will be because the providers have sucked wind, gone under, and generally been unable to call day after day, fill in ream after ream of paperwork----to simply see a client for outpatient mental health.

As is true for any health care in the US, it is idiocy to spend much of the health care money for the purposes of administrating something that could be centrally managed.

Marsha V. Hammond, PhD, Licensed Psychologist, Asheville, NC
NC Mental Health Reform blogspot, since 2007: http://madame-defarge.blogspot.com/

Federal Hlth & Human Services Allows States to 'Select' Coverage of Services, Thus Allowing Entities Like BCBSNC To Be In Control

"....One must ask whether it's a good use of resources to have 50 individual states analyze the relative merits of 10 different options for EHBs ..."

Or, one might ask what is the point of having various LME's in the state to manage Medicaid when I called 7, yes 7, times Friday a week ago trying to get an answer to a Western Highlands Network form which is online re: Provider privileges.....and have called the Director of Provider Relations three days in a row now, asking for a response which I submitted 9 days ago in order to request to request to be on the provider network for WHN so that I can be paid for my NC Medicaid work.

Yes, indeed, who profits by divying up all this administrative work? Not the providers; not the recipient of services. But rather the insurance companies and entities that act,look, and smell like insurance companies, such as the LME's in NC. Who profits when tort reform takes place such as was voted in by Republicans in TN, allowing physicians to form their own internal malpractice network? Not the citizens of the state.

Who is speaking---in a phrase----and as per French philosopher Michele Foucault's query: WHO IS SPEAKING------ when these kinds of actions take place?

In TN, it would be the insurance companies again...they are the ones that drive tort reform. And as re: NC mental health reform, it would be----again----entities that act or are insurance companies with all their inefficient management that creates barriers to care for both citizens--the insured---and the providers.

Follow the money.
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The Value of Federalism in Defining Essential Health Benefits:

http://www.nejm.org/doi/full/10.1056/NEJMp1200693?query=TOC

New England Journal of Medicine, February 8, 2012

"The promise of nearly universal health insurance coverage embodied in the Affordable Care Act (ACA) has meaning in part because it is tied to a minimum set of covered services called essential health benefits (EHBs). Health and Human Services Secretary Kathleen Sebelius surprised the health care community when, on December 16, 2011, she announced that there would not be one single national definition for EHBs.1 Rather, each state will have 10 options to choose from in defining the EHBs, 7 of which are tied to existing coverage in that state's small-group, state-employee, and health maintenance organization markets.

Although critics of this decision grudgingly acknowledge that it was good politics to avoid a high-profile national battle over benefit design, they generally see little substantive merit in the secretary's approach. Yet her decision is sound public policy and capitalizes on the strengths of American federalism that run throughout the new health care reform law

......Of course, federalism has some costs as well. The primary weakness of the secretary's approach is its potential inefficiency. One must ask whether it's a good use of resources to have 50 individual states analyze the relative merits of 10 different options for EHBs while also considering the very complex matter of the fiscal liability that those options will create for the state.5 And in the current political environment, giving states yet one more choice creates yet another opportunity for opponents of the law to delay its implementation....."

Why Veterans in NC Don't Get Outpatient Mental Health Care

Well, this is reminescent of what is taking place re: Medicaid clients under Western Highlands Network LME which manages many of western NC counties, including Buncombe county, where Asheville is. I have had to send in a request to request getting on the provider network. And that takes days, or weeks....and so we go round and round...every single mental health provider regarding inability to get authorization so we can get paid to see patients.

This is the situation re: Tricare which insures veterans. This is my letter to MHN, Mental Health Network, which credentials and sets the reimbursement rate for providers. This is only the initial letter . There's pages and pages to be filled out after this...and months and months to wait....
*****************************************************************
FROM: Marsha V. Hammond, PhD, Licensed Psychologist, NC
Mailing address: NPI: 1194700591

TO: Michelle Barselo, Manager MHN, credentialing & reimbursement for in-network Tricare Fax: 1 877 821 8215 phone: 1 800 888 4024, x 4517

RE: recommendation by MHN employee to contact you regarding in- network PhD, Psychologist reimbursement rates and CPT coding

February 8, 2012

Dear Michele Barcelo:

This is a longer letter outlining matters which is being sent to Senator Burr’s office in keeping with his interest in the difficulties of mental health providers being able to work with veterans. I also am sending you, as requested, three separate letters as associated with the three different query items, which you could perhaps present to the Tricare liason working at MHN, which coordinates Tricare reimbursement rates and credentialing. This information is also forwarded to the Practice Directorate at the American Psychological Association with a membership of 150,000 psychologists throughout the US. The Military Psychology Division of APA is also receiving this important information, given that the VAMC trains more psychologists than any other site in the US. I did such training at the Birmingham, AL, VAMC.
Today, after looking at the significantly less than Medicare/ Medicaid reimbursement rates---about 30-40% less---- for MHN in-network contracted doctoral psychologists and Tricare contracted in-network reimbursement for doctoral level psychologists----- in order to work with (my intention) veterans, I recontacted a helpful gentleman at MHN, Gus X. Riddles. Mr. Riddles called me several weeks ago as Senator Burr’s (NC) office had contacted me several months ago related to persistent problems in being able to become in-network with Tricare in order to work with veterans in rural western NC. In that Mr. Riddles advises me that there are a total of
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less than 175 insured parties in Buncombe and Haywood county, where I work, I am not asking about MHN clients but rather about Tricare matters---
-which MHN coordinates----including the fee structure, according to Mr. Riddles.
I would hope that Tricare could at least pay as much as Medicare/ Medicaid but obviously this is not true per the data at the Tricare page (http://tricare.mil/CMAC/ ProcedurePricing/ProcPricing.aspx.
He advised me to send you separate faxes requesting a review/ negotiation regarding these issues which are barriers to providing outpatient mental health care to veterans in rural western NC. As you perhaps do not know, the county in which I do most of my work, Haywood County, has more veterans than any of the other 100 counties in NC. I have been trying to move into becoming a provider with Tricare for at least two years now, having submitted a variety of pieces of paperwork, attended a MAHEC mental health conference in Asheville 2.5 years ago, and having been called by various people, and now, thankfully, stumbled upon the helpful Mr. Riddles through no effort of my own but in association with Senator Burr’s office. I thank you in advance for your kind assistance. Mr. Riddles advises me that up to 30 days are required for you to interface with the Tricare liason. Then it is 30-45 more days when I put in my application in order to be an in-network provider. As I have indicated above, I am a Medicare provider, NC Medicaid provider, a BCBSNC provider, a Humana provider, etc.. I find it extremely disheartening to have to spend a great deal of my time writing these letters and creating this paperwork in order to re-create the wheel time and again. If NC Medicaid was not collapsing, I would not be trying to become in-network with Tricare.
These are the three areas outlined which are problematic regarding the 70+ page contract which Tricare, via MHN, who handles the credentialing and fee structure for Tricare, that I have noted. This request here is submitted prior to even submitting the 10+ pages of paperwork being requested by MHN and is even in addition to the CAQH ‘attestation’ pages which is required and which has all the information about my license, etc., online.
Specifically, these are the issues and I will create three more letters faxed to you in order that you could perhaps present them to the Tricare liason:

(1) as a general point, the doctoral level rate at the Tricare TMAC
reimbursement rate site is the same as the master’s level rate. Given the
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severity of the issues of returning veterans and the extent of my training
clinical/ health psychology training which includes an internship at the VA in
Birmingham, AL, I would like to maintain that a doctoral level psychologist
be paid more than the master’s degree person. All doctoral level NC psychologists have such training though a modest number train at the VAMC. The master’s level practitioners are not psychologists; they may be Licensed Professional Counselors or in NC, one of about five states, the master’s level people are supervised by the doctoral level people. I realize this is a bigger issue than can perhaps be taken into account regarding my own contract but I want to put this out there so you understand the difference between a master’s level mental health practitioner and a doctoral level psychologist that can provide assessment and more in-depth and thorough outpatient treatment.

(2) Many clients benefit from an extended therapy session, specifically, 70-90 minutes. This would particularly be so since I see many of my clients in their homes and transportation is a very significant issue in rural western NC where there is mostly no public transport. Also, I am not willing to travel to see someone for a 45 minute session. And so, is there a code that would increase the psychologist’s reimbursement re: the rural area and in-home? I also would suggest that when someone is utilizing therapy in order to overcome PTSD (documented one-third of returning veterans) and perhaps associated closed head injury trauma, that an extended session is recommended. I have enough experience now to be wary of my initial request for these longer sessions, a CPT code associated with 90808---given that insurance companies balk at using this code. Is this a ‘stable’ Tricare code?

(3) Most importantly, as regard how I maximize my billing and
reimbursement via Medicare/ CMA, at the Tricare website, the reimbursement for a ‘non-facility, non-physician 90808, 70-90 minute session is $96.72. I do not like to use 90808 as this CPT code pays at the undesirable 50% mental health rate (yes: mental health, regarding of all the talk about parity, is paid at 50% of the ‘Total Maximal Allowable Charge’ whileas non-mental health is paid at 80%). Therefore, I use the Health & Behavior CPT code series, put into place at Medicare/ CMS (Centers for Medicare/ Medicaid Services) back in 2000 by efforts by the American Psychological Association. This 96152 CPT series bills in 15 minute increments. Medicare pays approximately $25/


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15 minute increment for my service and the Tricare page indicates a pay of $16.25. As you perhaps know, in addition, most Medicare patients have
Medicaid and NC Medicaid picks up what Medicare does not. Thus, dually eligible patients, having both Medicare and Medicaid, have no co-pay. Given the dire economic circumstances which are even more dire in rural western NC, I think you might see the logic of ‘no co-pay’ for veterans who cannot find jobs except perhaps at the local WalMart for $7.25/ hour (yes, I know a 4-tour veteran who is working at the Waynesville, NC WalMart for exactly that). So, as I said, I typically see people for, as I said, the 70-90 minutes. You can see the difference in the reimbursement rate.

I look forward to speaking and/ or hearing from you at your earliest opportunity and thank you for reading this information. Enclosed or attached please find three separate letters associated with each item outlined above.

Sincerely,

Marsha V. Hammond, PhD

Drugging Up the Family Care Home Residents : NC vs NY

Just who are the prescribers that allow the developmentally disabled to have their anti-psychotic medications tripled without the approval of the family? That's the key to this story and hopefully the NYT reporter will address the issue.

What I have noticed as re: family care home residents in NC, where there has been marked improvement over the past couple of years for the most part, there is a a 'set' provider group that prescribe the medications for the residents of the family care homes. In other words, one practice will service dozens of residents of a family care home.

This, of course, makes sense as the family care homes are expected to provide visits to physicians. What happens is that a medical provider comes around to the family care home about once/ month in order to update medications. There is very little time spent w/ the resident, best I can tell. It is not like going to see your doctor; you don't even get ten minutes.

Is that in itself following Medicaid guidelines which require face to face meeting with clients for a set period of time?

It is usually rather large psychiatric/ medical groups who manage the medications and it is very difficult to get in touch w/ them if there are medication issues. You either catch them when they come around or forget it.

See today's article in the NYT:
Potent Drugs, Few Rules, as State Treats Disabled

http://www.nytimes.com/2011/12/23/nyregion/potent-pills-few-rules-in-states-treatment-of-the-disabled.html?pagewanted=all

Just As Predicted by UNC Chapel Hill School of Law Expert, Piedmont Behavioral Health is Attempting to Confuse, Obfuscate, & Shred Public Records Law

Here is the background information as associated with this critically important matter.

Moreover, this was predicted and outlined by Mark Botts, professor at UNC Chapel Hill's School of Law as associated with a memo handed out by Arthur Carder, CEO of Western Highlands Network LME (WHN LME) during the WHN LME Board meeting in June, 2011. I simply took what Mr. Carder handed out to the audience and copied it and posted it here, previously, at Madame Defarge. Here is Mr. Bott's letter. http://madame-defarge.blogspot.com/2011/06/whn-lme-goes-its-own-way-re-medicaid.html

At that WHN LME June, 2011 meeting, you could have cut the air with a knife for the WHN LME Board knew EXACTLY what was being proposed and what power Piedmont Behavioral Health LME-----the first LME to eagerly obtain a 'Medicaid Waiver' from NC DHHS several years ago----was attempting to establish. What had been driven into that board meeting room in June, 2011, was a Trojan Horse that was The Borg (for you people that watched, Star Trek, The Next Generation w/ Jean Luc Piccard).

During that meeting, what became apparent was that PBH was attempting to develop a position of being able to call the shots for the other LME's and launch their 'methods' for organizing Medicaid mental health at that LME-----with an eye towards being able to commandeer the other LME's and demand that they 'GIVE UNTO CAESAR THAT WHICH IS CAESAR'S' or another way to say it, is 'you can kiss my ring now and by the way hand over the money we demand of you (the other LME's) and allow us to dictate to you just how you will run your LME that is eager and being demanded by NC DHHS to launch into Medicaid Waiver mode'.

I suspect that citizens do not understand why in the world it would matter why one LME dictates to another one how to do their work. But plainly put, PBH has the apparent intention of shredding NC Public Records Law which means that people attempting to obtain Medicaid, such as this child as outlined by David Cornwell, will simply be given----FOR YEARS ON END----the run around as re: denial of services. And if you cannot obtain the records about WHY you are not being given services, then you don't get any services and you cannot find out WHY you cannot get any services.

As Mr. Cornwell clearly outlined, PBH simply told the court to go take a hike and were given yet another opportunity----with the Medicaid child sitting in the background----still with no services. This is, indeed, amazing.

As outlined by Mr. Cornwell re: this court appearance by the PBH CEO, PBH has indicated that it has 'sovereign immunity' as associated with Medicaid Waivers and that it is an 'independent contractor.'

They want the whole cake and they want to eat it all, too. And they want to tell YOU how much cake you can have, when you can eat it, and if you want to know what the ingredients are in the cake, well you can't have the recipe----or the public records.

WE TOLD YOU SO. The WHN LME Board members balked----at least as much as they could----from inviting the Trojan Horse shredding public documents into the lives of western NC citizens. If this is allowed to stand as per the courts, citizens will not be able to know why they cannot obtain Medicaid services.

Here is the link to Mr. Cornwell's excellent outline of the court room travesty that just took place. http://ncmentalhope.org/commentary/2011/compliance/

"PBH: Compliance and Contempt"

Incredible.

Will There Be Any Reason to Have Massively Funded MH LME's to Manage Medicaid When There is no Medicaid?

oops. Seems like the $1 million slotted for the LME's to manage Medicaid is going to be a challenge if there is massive defunding of Medicaid. You can thank the Republican driven NC State Legislature.

"Budget shortfall could mean catastrophic Medicaid cuts after allWRAL.comRaleigh, NC — North Carolina Department of Health and Human Servicesofficials said Monday that state lawmakers have changed their tune aboutfinding funds to fill a projected $139 million Medicaid budget shortfall,forcing them to consider making ...<http://www.wral.com/news/state/nccapitol/story/10466208/....."

The below is from the article at the above URL:

"....Unless lawmakers find more money for Medicaid, many adult services, like hospice care and mental health care, could be on the chopping block. The state could also reduce reimbursements to physicians who treat Medicaid patients by up to 20 percent, DHHS officials have said.

They say lawmakers publicly pledged to help fill the shortfall in October after it became clear that the agency couldn't make the $356 million in cuts required in the state budget....."

WaPo:Senate Panel (Senator Burr-R, NC) Calls for Probe of VA MH Services: Providers Tangled in Red Tape Trying to See Vets for Outpatient MH Care

Senate Panel Calls for Probe of VA Mental Health Services

"After hearing testimony about the continued long waits faced by veterans seeking mental health care, a Senate committee Wednesday called for an investigation of the problem and an audit of the Department of Veterans Affairs’ $5.7 billion mental health care budget.

“Especially at a time when we are seeing record suicides among our veterans — we need to meet the veteran’s desire for care with the immediate assurance that it will be provided — and provided quickly,” said Sen. Patty Murray, (D-Wash.), chairman of the Senate Veterans Affairs Committee, who asked the VA’s Office of Inspector General to examine the issue....."

http://www.washingtonpost.com/politics/senate-panel-calls-for-probe-of-va-mental-health-services/2011/11/30/gIQA1AtHEO_story.html

___________________________________________________

As per a handout from Reverend Scott Rogers, Executive Director of Asheville buncombe Community Christian Ministries, presented at the Western Highlands Network LME Board on May 6, 2011,

'VETS WHO HAVE A 100% DISABILITY CAN BE ELIGIBLE TO RECEIVE MH TREATMENT SERVICES FROM A PRIVATE COMMUNITY PROVIDER." Otherwise, you're outta luck soldier; go to the VA.

And how many VA sites are there that might even offer mental health care in western NC?

1. Asheville VA Medical Center 2. Community Based Outpatient Clinic, Franklin 3. Rutherford County Community Based Outpatient Clinic (I don't know if outpatient Mental Health is being offered at the latter two sites, neither which are in Haywood County which has more veterans than any other county in NC.

I did my internship at the VA in Birmingham. Do you know how difficult it is for a vet to get 100% Service Connection, approximately 36 grand in tax free monies IS? I may have seen one person at the VA with this. Service Connections are calculated in terms of percentages depending on the impairment of the vet and I have seldom seen someone w/ a mental health diagnosis w/ a 100% Service Connection.

This is the primary reason why it does not make any sense for any private provider to try and see veterans via Tricare. There are next to no vets with 100% Service Connections. Even though I worked in the VA System, this entire area of outpatient MH Services is a complete enigma to me in terms of where do I fit in it; how do I get clients; how do referrals get made, etc.

No wonder Senator Burr is investigating the matter.

I don't know if it is standard for each of the DSS (Department of Social Services) to have a 'liason' person but Buncombe County DSS does and have my more recent complaint about how I could not get onto the panel at Tricare in order to offer vets outpatient Mental Health Services got his attention and he referred me to Senator Burr's office as there apparently has been quite a lot of talk about how services are not getting to vets. Moreover, reportedly, Western Highlands Network LME has a veteran's liason: julie@westernhighlands.org

Having started the long long process of being able, as a PhD/ doctoral level psychologist offering services to vets (only doctoral level internship sites are at the VA and the one in Birmingham is where I did my internship)-----over two years ago, I sighed and recently called Tricare again to see what the hang-up is. I looked at my notes I had taken during a Tricare presentation given via MAHEC training up at Mission Hospital, Asheville, NC, 2.5 years ago. The presenter gave a number, 336 607 8300, which was supposed to take you to MHN or the company which Tricare has apparently outsourced to. When you call it, all you get is a fast busy signal indicating a non-functional number .

One of the first things this provider had to do over two years ago was to sign up w/ a service called CAQH (Council for Affordable Quality Healthcare), a clearinghouse, which takes all the information about the provider e.g., training, internship, license number, and in NC, malpractice insurance---and keeps it updated----a matter which the provider is demanded to do every 90 days. You go online and 'attest' that the information is the same, if it is. I understand that BCBSNC also uses this CAQH mechanism and for the life of me I cannot understand why the LME's must have pages and pages of paperwork filled out when there is CAQH that does this. If someone knows the answer to this question, please tell me (chomskysright@gmail.com).

In any case, I carved out an hour to try and talk to Tricare again last week. This is what I found out and its just more of what I found out 2.5 years ago and I still cannot get onto the provider panel for Tricare to see vets in a timely manner. Even though I have twice before interfaced in terms of application as provider to Tricare, I still have to wait 90-120 days to get some paperwork from someone leading to being 'on the panel' which as I stated above, does not lead anywhere, because there are no vets with a 100% Service Connection.

This time around I was told that though they have my application materials from before, every six months, if the provider has not seen a client from their roster, the application is 'inactive' and you have to restart the entire process again. There is NO health care company that does anything like this. If you decide you do not want to be a Medicare provider any longer after having signed up, you have to tell the in writing. Ditto re: Medicaid.

So, Tricare was long ago out-sourced to a company called MHN (1 800 541 3353). You have to go to their website and have sent in paperwork to create a pin number, etc. CAQH gives you a provider number which you will also need to use vis a vis MHN (to sign up as a provider go to: www.mhn.com/provider/start.do) .

There are three tiers, if you will, associated with outpatient mental health care. And you can get entangled at any point in trying to understand where you are supposed to fit if you merely want to provide and get paid for providing outpatient mental health services to vets.

One tier is a 'Family Service' which involves going to military bases and providing psychoeducation to families and service-people. I'm not sure how this works, exactly, but I did go through the interview process back in May, 2011. Somebody calls you up on the phone and grills you for over an hour (though you are licensed as a psychologist) asking you questions about various vignettes and 'what would you do.' What I wouldn't do is go to live on a military base, far away from my home, for long weekends of such. So, that didn't go anywhere.

Prior to that, over two years ago, I had signed up as an 'Out of network" provider for what Tricare/ MHN (you can't tell them apart) calls their 'Standard Program.' I have no idea why a service-person would use this program, which undoubtedly causes them to pony up more money in order to see a professional, than the next program which is the "Tricare Provider In Network" program.

Though I had received in November, 2009 "Notification of Provider Certification Action" from 'Health net' (who knows how they fit in w/ Tricare and MHN and they sure do not tell you) with a checked box indicating that I was a designated provider---along with having sent in an Electronic funds Transfer completed form; a Provider's Notarized Facsimile or Stamp Signature Authorization completed page; License Number and training completed page; Criminal Records check; W-9 Form; Tricare Non-network Individual Clinical Psychologist Application, I still could not interface w/ seeing clients.

All my calls to the Haywood county veteran's liason person sitting on the bottom floor of Haywood Regional Hospital----who was at the MAHEC Tricare presentation over two years ago---- were never returned even though she had been a presenter at the dog and pony show along w/ the Tricare Northern Region (NC is in the Northern Region of Tricare).

To make it even more confusing, the conversations re: the above paperwork was with a company called PGBA, LLC Provider Data Management POB 870156 Surfside Beach, SC 29857-9756 (you can only talk to them 10-2 PST), and under that header was the Tricare 1877 874 2273 number.

When I went to the Western Highlands Network LME Board meeting May 6, 2011, ReverendScott Rogers, Executive Director of Asheville-Buncombe Christian Ministries, who was apparently there due to all the homeless vets he comes into contact with, gave out the following information.

Most notably, in his one page of handout notes he gave to anyone who asked for them at the WHN LME meeting, "Dave Wright, the supervisor in the MY Clinic at the VA Medical Center in Oteen (the Asheville VA)....advised against trying o access MH services by phone---saying the process is slow, frustrating and sometimes unreliable. " DUH.

Mr. Wright, the director, indicated that the following MH services are available for vets: psycho-education; MST (I have no idea what this is and I hate acronyms that are untethered); PTSD treatment, both individual and in group; Meication; 12 bed psychiatric unit; 4 bed detox; SA residential program; large homeless program in cooperation with Asheville Buncombe Community Christian Ministries (ABCC)

If someone figures out how to crack the code to offer professional services for veterans suffering from PTSD, head injuries, depression, etc., let me know, would you? Meantime, all these homeless vets are just sitting at the Asheville Buncombe Community Christian Ministries site....just like all the non-vet homeless people are sleeping at The Mission on Patton Avenue in Asheville. And when they have to leave during the day, they simply go around the corner to A-Hope and last week the interior of that building was full of THRONGS of homeless, mostly male, citizens.