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.”
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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.”
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