Friday, April 27, 2007

(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

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: 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 (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’ :

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 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: ;

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: "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


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