Hooker Odom: under her, LME's are whipping boys and spankers simultaneously: Mistress of the sly, chaotic statements
I had a conversation with the woman who is head of NAMI NC this afternoon ("Ms Nihoff" <email@example.com> 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
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 (firstname.lastname@example.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.".....
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.