Hooker Odom: under her, LME's are whipping boys and spankers simultaneously: Mistress of the sly, chaotic statements

There is something pornographic about this kind of manipulation. Pornography : the hidden, the subterfuged, out of sight-- coupled to S & M pain. This is abusive treatment, to my mind, by DHHS, and it needs to be recognized as such.

I had a conversation with the woman who is head of NAMI NC this afternoon ("Ms Nihoff" <ddihoff@naminc.org> regarding whether there are 12 or 15 hours available of Community Support. You have to return to the Implementation Update #27 and look at it very carefully in order to see just how sly DHHS, under Hooker Odom, has become. The document is signed by Allen Dobson, MD and Mike Mosley, Director of MH. http://www.ncdhhs.gov/mhddsas/servicedefinitions
/servdefupdates/dmadmh4-24-07update27.pdf

This kind of confusing chaos eats up tons of time for mental health providers: calling, asking, trying to read between the lines. I'm sick of it. As Mr. Richard, Director of A.R.C. in NC (drichard@arc.nc.org) stated last Wednesday evening at a meeting for people concerned about Development Disabilities (DD) services stated: 'mental health reform shouldn't be this complicated.' Amen, brother.

DHHS under Hooker Odom creates nothing but constant confusion re rule changes such as who can provide CS services ; CS companies believed it completely acceptable to use the workers they did : "Tanner said when state definitions for personnel changed in March, allarea providers panicked because they wanted to apply the changes thecorrect way."We called the state, we couldn't get answers from the state, so wedid the very best we could to read them and make what we could of themand put these things in place.".....
.http://www.rrdailyherald.com/articles/2007/04/29/news/news.txt

On page 3 of the Update #27 document, under 'Review of the initial person-centered plan':
"Initial benefit may be authorized up to 780 units for a 90 day period based upon judgment of PCP and supporting documentation submitted. " (note: 780 units of 15 minutes each = 15 hours).

However, like some Nazi character out of the movie, The Night Porter, http://www.dvdmoviecentral.com/ReviewsText/night_porter.htm, the LME's are put into the position of reviewing post-payment associated with Community Support (CS) "in excess of 12 hours per week....These reviews, which will be triggered by authorization data (Note: Value Options authorizes CS) and paid claims data maintained by the Department, will begin May 1, 2007...Effective immediately, ValueOptions wil lflag for further clinical review any requests for increase of hours of Community Support....."

Go ahead: go for that 15 plus hours of Community Support. (Note: prior to this reduction in CS, 28 hours was the maximum number of hours; utilizing 'medical necessity, Endorsed Provider companies could sometimes ask for more; many children in school have commonly been receiving 25 hours.)

Go for it, Endorsed Provider. And then you can expect a flagging by not only the LME, who would probably like to see you be able to provide the services, but then by 'The Department.'

LME's are already stretched thin and trying to get an answer to a complex question gets you passed from person to person at the LME: again, very time consuming for the provider. Yvonne Copeland, Executive Director of NC Council Executive Director stated: (April 30 newsletter)"...The post-payment clinical review activity conceptually falls under the purview of the LME although this level of review is not factored into the cost model nor is it in the current DHHS/LME contract. LMEs are already stretched thin as expectations seem to mound and funding is uncertain.

And Verla Insko seems concerned that the LME's don't spend the money they have---and so why do they need more---as associated with their stockpile set aside in order to reportedly treat state-funded consumers?

Reported to me by another mental health provider, admission to the Endorsement process has been closed. If you were a new provider you might risk going for the hours, but the Endorsed Providers who have been endorsed have a great deal to lose if the LME flags the 'over 12 hours', and then 'The Department' will have a go at the review which has been flagged by the local LME.....looking, perhaps at all their records....some of which may not be in order as DHHS did not teach CS workers how they had to document their records as associated with skill-building.

But hey, consumers/ clients : "Recipients whose community support services are reduced, terminated or denied will be notified of their Medicaid appeal rights." (If you can find an Endorsed Provider who is inviting an audit).

Endorsed Providers cannot engage a Medicaid appeal---only consumers can. Even if Endorsed Providers apply to Value Options for authorization, they can be flagged and then investigated. Endorsed Providers will not apply; consumers will have no opportunity to make a Medicaid appeal as they have not been denied the services.

Consumers don't get services; Endorsed Providers don't get audited (neither do they get paid); DMA does not have to deal with Medicaid appeals. Man, that's clean, I'm telling you. A clever head wove this. Is it Allen Dobson's? Surely Hooker Odom is not this clever.

Carmen Hooker Odom : you do Karl Rove proud.

Hooker-Odom sends destructive mixed signals to the public & gullible press : WHERE'S MY COPY OF HOOKER ODOM'S AUDIT??

Upon the release of George Tenet's book on his years at the CIA, CIA employees have this comment: http://www.afterdowningstreet.org/?q=node/21888

"You helped send very mixed signals to the American people and their legislators in the fall of 2002."

I don't know if there is anything as debilitating to the public as this phenomenon of 'mixed signals.' It leaves the public in the place of figuring everyone is somehow to blame, in some way, when, in fact, if you 'follow the money'---or, in this case----'follow the mixed signals'----you will come upon a perpetrator or set of perpetrators----in this case Tenet and Bush----each trying to prop the other up.

Carmen Hooker Odom, with Mike Mosley by her side as director of Mental Health, has mastered the 'confusing signals' scent-thrower maneuver. And most every journalist takes the hook. The public reads the articles put out by the NC press and concludes that while Hooker-Odom may be an idiot administrator, the Community Support (CS) providers have attempted to game the CS lynchpin service.

This is not true.

First , the LME money is sitting there, unspent, meant to be applied to assisting consumers/clients ("However, a substantial amount of the money that has been sent to the LMEs -- approximately $93 million -- will not be spent this year." http://www.newsobserver.com/681/story/568491.html

Why isn't any reporter asking about THAT? Isn't it a little suspicious that there is this pool of money that is untouched? Three theories come to mind for me: 1. the Easley administration wants mental health reform to fail 2. Easley doesn't pay any attention to mental health reform and it crashes under Hooker Odom 3. there is such a mishandling that the 'left hand' of the LME's cannot get into sync with the 'right hand' of DHHS.

Secondly, the Service Definition of CS does not specify that CS workers can't 'take little Joey swimming', when swimming is skill building at various levels. NC Policy Watch overviews this : "Advocate David Cornwall, head of the group N.C Mental Hope, points out that Hooker Odom’s anecdotes border on offensive. The state definition of community support services includes services like taking children swimming or to see friends and that those are exactly the kinds of activities that are so important in the lives of children with mental illness." http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servicedefinitions2-22-06update.pdf

Thirdly, Hooker Odom's staff taught CS providers and their workers how they were supposed to keep notes and they did not say anything about being specific to the degree that would have derailed an audit. (see page 6 for documentation requirements) http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/CS%20childadolesendorsementinstructions4-5-07.pdf

"....Raymond Turpin, president of Jackson County Psychological Services, said he took the required training, but it consisted of two days of talking about delivering services to substance abusers, and his agency serves children with mental illness. “What training we got was purely philosophical,” he said. “There was no practical information. ... I just wish somebody would step in and stop these destructive decisions.” http://citizen-times.com/apps/pbcs.dll/article?AID=200770411177


Fourthly, 'The Department' complained that 'high school graduates' which were 'unintended' were being used as paraprofessionals to do the hands-on CS work. Not only was there nothing in the Community Support Service Definitions that stated that they could not, but "The Department" 's response made it even more probable that this would happen: 'Even if the $52 rate is sufficient for some, it may not be sufficient for others - especially those who hire large numbers of well-educated, experienced workers with high salaries.' http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FMGArticle%2FWSJ_BasicArticle&c=MGArticle&cid=1173350971886&path=%21localnews&s=1037645509099

This is Rove strategy fully incorporated by Easley Dem administration under Hooker Odom: don't tell them what they can't do but set it up so they cannot do what they are contracted to do.
Corollary: tell the LME's that they are supposed to be administering mental health reform money and make the DHHS memos so vague that its not clear what is desired; gig the Endorsed Providers providing CS, who then complain to the LME's, who are left holding the bag of failed mental health reform, thus destroying their credibilty.

For the most part, except for Chris Fitzsimmons at NC Policy Watch, the online and papers journalists are merely scribes and they seem satisfied to give us disjointed pieces with the public writing Op-Ed rebuttals. they don't do the background work which is associated with looking at the documents put out by DHHS. The citizens who do the work need to be the journalists who weild the weight of the published pen.

This is, in my opinion, yet another misleading article related to these 'bad apples' CS providers (from NC Mental Hope's writer, David Cornwall): "Jane Ferguson, the CEO of Appalachian Counseling, wrote in a guest column Thursday that the agencies that were billing incorrectly represented only about 16 percent of the state's more than 1,000 providers. ....Instead, the state chose to punish everybody for the sins of the few. Although this week's new rate may ease the pain some, it still punishes the entire system instead of just the wrong-doers. " http://mentalhopenews.blogspot.com/2007/04/new-rate-doesnt-go-far-enough.html

Repeat it, repeat it, repeat it, repeat it, repeat it....until it is believed:

Bad apples: "....Easley : … We’re finding a lot of them are gaming the system — those are her words. My words are ripping off the taxpayers..." http://carolinamountains.com/apps/pbcs.dll/article?AID=200770420130

Bad apples: "...The state, responding to what it says is widespread misuse of community-support services, also said yesterday that it is tightening the rules for how those services are provided and reviewed..." http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FMGArticle%2FWSJ_BasicArticle&c=MGArticle&cid=1173350971886&path=%21localnews&s=1037645509099

Bad apples: ""That reduction was made based on the best available data we had at the time, which showed that those 167 providers were billing for services that were almost totally provided by people with high school degrees or less," Hooker Odom said. http://www.hendersonvillenews.com/apps/pbcs.dll/article?AID=/20070427/NEWS/704270348&SearchID=7327979535264

Bad apples: "..1) the possibility that unscrupulous providers would abuse the system by using unqualified individuals to deliver services;\..." http://www.newsobserver.com/681/story/568484.html

Bad apples: "Audit: Mental health providers cheatDHHS says some companies billed the state for suspect services or none at all. Gov. Easley wants an investigation" http://www.newsobserver.com/150/story/566059.html

Bad apples: "Secretary Hooker Odom was quoted in the Raleigh News and Observer as saying, "The results of (our) clinical audit were deeply disturbing. We are concerned that the problem may not be limited to just those 167 providers." She has also put in a request to the Attorney General’s Office to expedite the suspected cases of fraud and abuse found in the first audit. It is understood that Governor Easley is supporting the Secretary’s decision and believes that fraud and abuse in the mental health system is a serious issue. .." North Carolina Council Community News, April 30, 2007

Bad apples: Eureka C. Daye of Behavioral Health Link; NC Council Community News, April 30, 2007: "I also believe that there are those providers who are skimming merely for profit."

Bad apples: Audit of 167 companies finds "many examples" of abuse (PDF)
http://www.newsobserver.com/114/story/566059.html (half way down the URL)

Bad apples: "...Jane Ferguson, the CEO of Appalachian Counseling, wrote in a guestcolumn Thursday that the agencies that were billing incorrectlyrepresented only about 16 percent of the state's more than 1,000providers."Those providers could have been put on a corrective action plan orprobation or both," she wrote, echoing exactly what we said in thisspace April 13..."http://www.hendersonvillenews.com/apps/pbcs.dll/article?AID=/20070429/NEWS/704290355&SearchID=73279778992413

**********************************************************************
from Bill Moyer's recent PBS special: http://www.pbs.org/moyers/journal/btw/transcript1.html
"BOB SIMON: Just repeat it and repeat it and repeat it. Repeat Al Qaeda, Iraq. Al Qaeda, Iraq. Al Qaeda, Iraq. Just keep it going. Keep that drum beat going.
And it was effective because long after it was well established that there was no link between Al Qaeda and the government of Iraq and the Saddam regime, the polls showed that an overwhelming majority of Americans believed that Al Qaeda-- that Iraq was responsible for September 11th. ..."
****************************************************************************

THERE ARE NO SINS OF THE FEW. Yes, all professions have incompetents in them; mental health is NO different. However, there is a distinct smell associated with unwittingly tripping-up the public's understanding of what is taking place here by assigning a bigger stink here. Skipping over the mixed signals trash talk will take you straight to Hooker Odom and her mismanagement of mental health reform.

I challenge the news services to do more than be mere scribes. If there are 'bad apples' then please pay attention to the background information, namely, the Community Support Service Definitions (yes, you have to dig and look at that) that allowed the use of high school paraprofessionals and also pay attention to the poor training that DHHS provided as associated with record keeping.

Journalist David Halberstam stated : "You have to keep digging...keep asking questions, because otherwise you'll be seduced or brainwashed into the idea that it's somehow a great privilege, an honor, to report the lies they've been feeding you." Working the Truth Beat By BOB HERBERT Published: April 30, 2007

'When Journalism Became Transcription and Reporting Disappeared': BRING ON THE OP-EDS

"....To call the media's complicity in the Iraq War a conspiracy is an insult to conspiracies, because it wasn't hidden - as Moyers shows, it was all out there for everyone to see. The problem was, Beltway reporters didn't want to see it. As New York Times White House correspondent Elisabeth Bumiller famously admitted, in the lead up to war most self-respecting Washington journalists who wanted to stay on the White House Christmas card list refused to ask tough questions because "no one wanted to get into an argument with the president...." ( as associated with Bill Moyer's special: APRIL 25, 2007: "Buying the War"
http://www.workingassetsblog.com/2007/04/when_journalism_became_transcr.html ; http://www.pbs.org/moyers/journal/btw/transcript1.html

To paraphrase the matter : To call the news services coverage of Hooker Odom's defunding of Community Services shallow, poorly researched, and one-sided does not capture what has taken place. Journalists have given 'frequent flyer' bonus points to repeat sources throughout NC news services, in particular a range of state officials all serving Hooker Odom. The tough talk of 'we'll get those bad apples' is repeated by every source---and wolfed down by journalists. Mental health emergency services never gets any coverage, though it is part of the defunded Community Support lynch-pin service. (Apparently, recent mass murdering is already yesterday's news). Determinations of Community Support hours (understandably) reflects the models of the companies represented by the '20 Community Support Providers' invited to sit and sup with Mosley and Hooker Odom at the table of determining their own companies compensation and needs---as well as ours. This is just as revealing at this state level as the media's complicity in covering the run-up to the Iraq War.

(I smell Karl Rove): Will the news services fall for the red herrings and mis-information? It seems so....

Mr. Rosomer:

I left you a message on your office mail. Thank you for your coverage of this very pressing matter. This, your article, is the one to which I am alluding:

Friday, April 27, 2007
Service providers, state compromise
Medicaid reimbursement rate set at $52 By James Romoser JOURNAL RALEIGH BUREAU
http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FMGArticle%2FWSJ_BasicArticle&c=MGArticle&cid=1173350971886&path=%21localnews&s=1037645509099

First of all, there is an innacuracy which is important in your article. Or, better stated: the state has told you that 15 hours of (Community Support) CS is available in one place and then 12, to us. So, which is it? Perhaps you can get the straight answer. To see the confusion, see these two memos from the state:

http://www.dhhs.state.nc.us/pressrel/4-26-07.htm in contrast to this 4.24.07 North Carolina Department of Health and Human Services : Implementation Update #27: Revised Community Support Authorization Criter and Utilization Review http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdates/dmadmh4-24-07update27.pdf (12 hours will red flag you as per this memo, only two days before)

If we assume the earlier memo is true (they seem to cancel each other out re: this agency), then that potentially includes 6 hours of paperwork. Thus, face to face work is actually---or could be----6 hour/ week/ client. Please see: ‘State Sets Final Community Support Services Rate’ : http://www.dhhs.state.nc.us/pressrel/4-26-07.htm

Secondly, I think most people would agree that using one provider from Western NC, specifically, Dan Zorn, from Families Together, in Asheville, to represent all of Western NC, is not 'fair.' You stated: "Bob Hedrick, the executive director of the N.C. Providers Council, said he thinks that the state did a good job in working with the groups who provide community support.We think the process was open and fair. We think that they accurately considered the factors in the cost,” Hedrick said.'

Thirdly, the corollary information on the web page associated with the story, pertaining to critical matters relating to mental health, is very very old...as in years old. The situation has changed so quickly, and so detrimentally, that this is not reflective of reality any longer.

Fourthly, Hooker Odom has presented no evidence of misuse of Community Support (CS). I would hope that a journalist covering this matter would go beyond a statement assumed to be true, just because Odom states it: "The state, responding to what it says is widespread misuse of community-support services, also said yesterday that it is tightening the rules for how those services are provided and reviewed." I contend, that the audit that was done revealed that 'taking little Joey swimming' and other scandalous behaviors, was not documented in such a way that the social skills learned and other skills e.g., swimming, such that Odom could comment in such a disingenous way. We did not game the system: we applied our traning to the upgrading of psychosocial skills teaching and since the mandated CS training offered by the state did nothing to specify how much detail we had to give in our notes, when we were audited, they saw what they wanted to see, namely, that we had merely 'taken little Joey swimming.' Why do journalists make such a big deal about querying me in terms of 'what I know' and yet they accept carte blanche the statements of the likes of Carmen Hooker Odom??

Fifthly, there is nothing in the CS Service Definition or associated documents that precludes the use of 'high school graduates' who have been screened by the Endorsed Provider companies. (see: http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servicedefinitions2-22-06update.pdf ; http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/csadult4-5-07.pdf

Sixthly, vague phrasing like 'actual cost' ("...The state said that a review of companies’ financial data showed that the $52 rate reflects the actual cost of providing community-support services...") is something I don't understand. What is 'actual cost'? Is this the salaries of the QP's, the people who manage the Endorsed Provider companies and all the paperwork that they manage along with the management, clinical supervision of their employees? Does this also include the payment to the workers? Does this also include the office rent and associated utilities that Endorsed Provider's office must pay?

Seventhly, the more 'intense reviews' that the state could make if Endorsed Providers utilize more than 12? 15?---we don't know----hours/ week---is a threat to take legal action. "see: http://www.dhhs.state.nc.us/pressrel/4-26-07.htm: "The state has tightened up the way use of CS will be reviewed. Those changes include:
Post-payment reviews will be conducted for all CS recipients who receive more than 12 hours of service a week. Findings that services have been provided improperly could result in legal action. The claim of any recipient for an increase in CS will be flagged and reviewed for clinical appropriateness. "

Eighthly, Hooker Odom has effectively disallowed consumers from persuing a Medicaid appeals if they are displeased with having less than 12? 15?---we don't know----hours of CS, for the denial of services. These appeals, which are made by consumers, and which is administered by the Hearing Office within DMA, are ONLY made at the behest of the consumer. Without a consumer complaint and a Medicaid appeal, no appeal cannot be made. Endorsed Providers cannot make an appeal. You can well imagine that Endorsed Providers will not be willing to provide more Community Support hours for consumers as they will not have the capacity to legally challenge NC DHHS. Endorsed Providers will be made out to be the ‘bad guy’ by consumers, thus carving the way for the collapse of mental health reform. Is Karl Rove around here somewhere? Oh, I forgot: he's at West Henderson High School tomorrow at 2 p.m.

Thanks for your coverage, Mr. Rosomer.

Marsha V. Hammond, PhD

Hooker Odom blocks Medicaid appeals and threatens Endorsed Providers with 'legal actions'

To: Debbie Crane, Director Public Affairs Office Public Affairs 101 Blair Drive, Raleigh NC 27603 919 733 9190 FAX: 919 733 7447

RE: Solicitation for feedback regarding 4.26.07 DHHS release: ‘State Sets Final Community Support Services Rate’ : http://www.dhhs.state.nc.us/pressrel/4-26-07.htm

April 27, 2007

Dear Debbie Crane; Smoky Mountain Center LME Board; Lieutenant Governor Perdue; Governor Easley; Chairman of Western Highlands LME Board, Senator Nesbitt, and Verla Insko (Co-chairs of the Joint Legislative Committee associated with mental health reform) :

I include all these parties in that the feedback and implementation of Community Support (CS) is enacted at the level of the LME boards and overviewed by the Joint Legislative committee. Administratively, this has been approved as per the assignment of Carmen Hooker Odom as DHHS Secretary, via the Office of the Governor.

Comments Number 2 & 3, below, are a response to the specific solicitation for comments. Comments 1 & 4 are statements requesting that confusion and chaos be attended to and minimized. DHHS, under the direction of Hooker Odom, is a vindictive agency making thinly veiled threats towards Endorsed Providers who seek to provide mental health services to consumers in NC.

As per the enclosed NC DHHS release, specifically this section, I am making formal comment. The appeals process in which a consumer engages, has been confirmed in a telephone call to the DMA Hearing Office on 4.27.07. Specifically, that telephone call verified that consumers can only make appeals upon the rejection of a request for more Community Support hours which can only be made upon rejection (a matter of chasing one’s tail without ever catching it, if you will):

Comment 1: This sly and stealthy memo completely disallows any Medicaid appeal by consumers; they have been stripped of their rights to appeal. This is, I believe, illegal. Medicaid appeals, for the denial of services, which are made by consumers, and which is administered by the Hearing Office within DMA, cannot be made, as Endorsed Providers will not be willing to provide more Community Support hours for consumers as they will not have the capacity to legally challenge NC DHHS. Endorsed Providers will be made out to be the ‘bad guy’ by consumers, thus carving the way for the collapse of mental health reform.

Comment 2: Community Support is no longer associated with emergency services mandated in contracts with Endorsed Providers vis a vis the LME’s: please remove this service of providing care 24/7/365 from the contracts between the Endorsed Providers and LME’s. Please revise the CS Service Definitions guide document in order to reflect this ‘new’ interpretation: http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servicedefinitions2-22-06update.pdf No Community Support is available until the service has been approved by Value Options, subsequent to the 8 approved hours for the creation of paper work to be sent to Value Options. Therefore, there is no more emergency services that Endorsed Providers can make available. Endorsed Providers will be made out to be the ‘bad guy’, but also the skeletal emergency services provided now by the LME’s will be unable to provide adequate services as the LME’s have now eschewed the keeping of any pertinent psychiatric information on clients, with ‘homes’ with Endorsed Providers.’ These skeletal emergency services will have no access to any psychiatric records and will not be able to treat clients. In other words, with the Endorsed Providers effectively providing no (paid) emergency services, the consumers will be sent to emergency psychiatric services associated with the LME’s (in the case of Smoky Mountain Center, the under-funded Balsam Center) or to local hospital emergency rooms, unqualified to care for such patients. Relatedly, the Service Definition of Community Support should be revised to reflect the impossibility of Endorsed Providers providing these emergency services. The Service Definition currently states: “The service includes providing “first responder” crisis response on a 24/7/365 basis to consumers.experiencing a crisis.” http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servicedefinitions2-22-06update.pdf (page 2).

Comment 3: The available hours for Adult Community Support is confusing: are there 12 or 15 hours available? A DMA memo sent out earlier in the week stated that for adults 12 hours of Community Support/ week/ consumer is allowable. This memo indicates that 15 hours are available. Please advise as Endorsed Providers will not be willing to attempt to red flag their administration of CS hours pertaining to a 3 hour discrepancy.

Comment 4: Please revise the Service Definitions for Community Support, the formal template guiding Endorsed Providers, so they can accurately, and without fear of legal retaliation, provide CS services to consumers. There is nothing in the Service Definition that indicates the ‘intensity’ of the services. Accordingly, please revise the following documents in order to minimize confusion and so that they are in keeping with this ‘new’ interpretation of Community Support : http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/csadult4-5-07.pdf; http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servicedefinitions2-22-06update.pdf

Below are the specific sections of the 4.26.07 document upon which these comments are based.

The damage that these sly, sleuthful, threatening memos has done to mental health reform in NC cannot be underestimated.

Sincerely, Marsha V. Hammond, PhD: NC Licensed Psychologist
“…The state has tightened up the way use of CS will be reviewed. Those changes include: Post-payment reviews will be conducted for all CS recipients who receive more than 12 hours of service a week. Findings that services have been provided improperly could result in legal action. The claim of any recipient for an increase in CS will be flagged and reviewed for clinical appropriateness. The state has proposed other changes that are currently out for a 45-day comment period. Those proposed changes include:
• Prior approval will be required for all CS services, except for an initial 8-hour review by a qualified professional such as a psychologist to ensure that CS is the proper service.
• For adults, the maximum amount of CS that will be approved is no more than 15 hours a week.
Community support services, which are part of a range of new services, are supposed to be a relatively low intensity service for people in need of clinical services to live successfully in the community. Examples of CS include: case management functions to link consumers to other services, including physical health services, clinical counseling to address issues of symptom monitoring and behavior management, and skill building activities to help the consumer master the skills needed to live independently and function in their environment.”





<

CHAOS REIGNS: Give your requested feedback to Carmen Hooker Odom & Mike Mosley

Some people think that students no longer learn to write right. Hooker Odom and Mosley prove the point that these difficulties have been in place for a long time.

They are soliciting YOU for your feedback as per the anxiously awaited
'State Sets Final Community Support Services Rate' http://www.dhhs.state.nc.us/pressrel/4-26-07.htm. Comments can be sent to: Debbie Crane, Director, Public Affairs Office 101 Blair Drive, Raleigh, NC 27603(919)733-9190 FAX (919)733-7447

(Seriously) : If you really want them to receive the feedback, contact Mike Arnold, the liason at Lt Gov Perdue's office: mike.arnold@ncmail.net (my comments in bold/ in parentheses). Will she run for governor with the millstone of Odom around her neck? Naw: that's Easley's legacy:

"......The state has tightened up the way use of CS will be reviewed. Those changes include: * Post-payment reviews will be conducted for all CS recipients whoreceive more than 12 hours of service a week. Findings that serviceshave been provided improperly could result in legal action. (yeah, we're all eager to run toward that) .....

The claim of any recipient for an increase in CS will be flagged and reviewed for clinical appropriateness. The state has proposed other changes that are currently out for a 45-day comment period. Those proposed changes include: Prior approval will be required for all CS services, except for an initial 8-hour review by a qualified professional such as a psychologist to ensure that CS is the proper service. (1. my fee 'as a psychologist' is $100/hr; that's what Medicaid pays me; 2. that means no emergency services as they are part of Community Support; 3. to the LME's: please release the Endorsed Providers from their 24/7/365 contracts)

For adults, the maximum amount of CS that will be approved is no more than 15 hours a week. (wait a minute: I sense the hand of fate upon us: 15 hours is 3 more than 12: that gets you some 'legal action')

Senator Nesbitt and Lt Gov Perdue: Tell me what to do with my suicidal/ homicidal client

Senator Nesbitt and Lt Gov Perdue: Please tell me what to do with my homicidal/ suicidal client
Marsha V. Hammond, PhD e mail: hammondmv@netzero.com cell: 404 964 5338 April 26, 2007

Dear Senator Nesbitt and Lt Governor Beverly Perdue:

I want to briefly relate to you what happened to my client on Tuesday of this week re: (essentially) no more Community Support. I see him again today. Fortunately, he is a Medicaid client. If he were a state funded client, I would simply eat the cost of this necessary second session.

He is 35, w/ a serious (**non-rehabilitateable mental illness: he cannot be fully 'fixed' under the constraints of Odom's medical model imposed on NC citizens**). He takes his meds dutifully. He gets homicidal and suicidal about 1/ yr re: stressors. He is much better than he was 2 yrs ago. He is a big man. I have seen him regularly for 2.5 yrs. He should perhaps go into the hospital but refuses to go (willingly) into a locked ward. If I turned him over to the more acute care ACTT team, he would no longer see me, something he refuses to do (**he cannot have 2 services at once**). If I call the sheriff, he WILL, believe me, take several deputies down in the ensuing fight.

My best option is (read: WAS) to use Community Support (CS). He needs human company such as WAS available IMMEDIATELY via CS. As you have heard from many providers, the company with which I am affiliated is downsizing, like all other CS providers under Mosley edict of 4.24.07 limiting CS and threatening providers with auditing if they use more than 12 hours/ week. More pressingly, under the 4.24.07 edict, there is no immediate move into CS. One has to wait for the paperwork to be processed by Value Options.

PLEASE TELL ME WHAT TO DO WITH THIS HOMICIDAL/ SUICIDAL CLIENT.
Marsha V. Hammond, PhD

Does the NC Dem Party have any idea how the next Dem person running for governor is going to be hoisted on the petard of the chaos that Carmen Hooker Odom and Mike Mosley have created? Is it Perdue? Can her office not do something about this woman who narcisstically mismanages the doman of DD/MH/SA?

TALKING POINTS FOR A LETTER TO GOVERNOR EASLEY AND LT GOV. PERDUE, WHO HAS EVERYTHING (ASSUMABLY) TO LOSE:

Mosley threatens Mobster Action on Endorsed Providers:

In reviewing the April 24, 2007 Memo from Mike Mosley and Allen Dobson, MD, the following salient points are introduced from the perspective of a provider working with a company who has successfully utilized Community Support Services for the past year:
#1. Threats: Providers of Community Services who provide more than 12 hours/ week for a client will automatically trigger a review which could involve ‘further review and investigation.’ No agency, particularly now, with more time demanded to manage paperwork, will have any clients that receive more than 12 hours/ week of Community Support. The norm was more than 12 hours/ week. Thus, a significant cut-back in Community Services, at a reduced rate, is now what we have. NOTE: Community Support Services include emergency health services.
#2. No immediate services available: As associated with both children and adults, ‘ No 30 day pass through period’ is allowed, as before. This initial 30 days was associated with delivering immediate services to client who could be suicidal and in immediate need of assistance. So, if one has a suicidal client who could benefit from Community Support and contact, that client will either have to be: committed to a locked-down ward or sent to overburdened ACTT, which provides no therapy and lose current therapist. Such a scenario presented itself to me just yesterday.
#3 Consumers are demanded to fit into a rehabilitation model which does not accommodate chronic mental illness: The Diagnostic Assessment and corollary paperwork must reflect that Community Support will: “correcxt or ameliorate a defect, physical or mental illness…”
#4. Hope is for the Future: ‘…the Department will further refine and modify the plan on a quarterly basis….’
To summarize the matter, no Endorsed Provider is going to risk all the difficulties of being ‘investigated’ by DHHS for more than 12 hours/ Community Support / week and emergency psychiatric services are effectively thrown back to the LME emergency services (for Smoky Mountain Center, this is the Balsam Center) as Endorsed Provider companies cannot provide the demanded 24/7/365 services required for their very existence and endorsement.

3 Good Reasons to Can Carmen Hooker Odom and Mike Mosley

Reason #1: (they have no idea how to manage this agency): If Odem and Mosley had a problem with the Service Definitions that they created which guide the Endorsed Providers, they should have at least politely and humbly suggested that they 'mis-spoke.' In distinct contrast to this, they slit the throats of the Endorsed Providers with the explanation that they were trying to protect the public against the 'bad apples.'

Reason #2: There are not enough of the sought-after, highly trained people whom Odum and Mosley have evidently been pining for in the mental health care community. Not by a long shot. Thus, they have created Community Support which is considerably truncated in its vision, to be administered by people with considerably less time to devote to it as more highly trained inviduals will not be willing to work for such a poor hourly rate. If the Endorsed Provider agencies get $40/ hour for Community Support, just how much do you think the hourly wage is going to be for a highly trained master's level mental health worker? How much running around to various clients houses do you think such a worker is going to be able to do? Bear in mind that under mental health care reform, individual providers, such as myself, a psychologist, cannot work with the clients. Oh no: you have to fly under the protective wing of the Endorsed Provider entity.

Reason #3: (Odum and Mosley play charades with disabled people's lives): The Supreme Court's Olmstead decision and the American Disability Act mandates that people with disabilities are to be given the resources to live within their communities. By cutting Community Support by one-third, Odum and Mosley have put at clear risk the continues existence of the fragile Endorsed Provider system and accordingly, disabled people's ability to continue to live in their communities

Just Who Was Madame Defarge?

Cold, confident, vengeful, broad (who has watched too much Stephen Colbert):
".....Dickens notes that Madame Defarge’s hatefulness does not reflect any inherent flaw, but rather results from the oppression and personal tragedy that she has suffered at the hands of the aristocracy.." (http://www.sparknotes.com/lit/twocities/canalysis.html)...."
".....Possessing a remorseless bloodlust, Madame Defarge embodies the chaos of the French Revolution. The initial chapters of the novel find her sitting quietly and knitting in the wine-shop. However, her apparent passivity belies her relentless thirst for vengeance. With her stitches, she secretly knits a register of the names of the revolution’s intended victims. As the revolution breaks into full force, Madame Defarge reveals her true viciousness ..."(http://www.sparknotes.com/lit/twocities/canalysis.html)
".....In the 1981 Mel Brooks film, History of the World, Part I, Mme Defarge (played by Cloris Leachman) is the chief conspirator in the plot to overthrow King Louis. She has become so poor, she has run out of wool, simply rubbing her knitting needles together..." (http://en.wikipedia.org/wiki/Madame_Defarge)