Tuesday, May 29, 2007

Energy and private Medicare are heavily subsidized by gov't: HEALTH CARE 4 ALL SHOULD BE SUBSIDIZED

A reposte to Peri Morgan's group NC100----a group which is whittling away at mental health parity in the NC Legislature:

Bill Franklin bought forward the following important point: "... business is frankly
subsidized, particularly medicine, health care, drugs, hospitals, etc. by government,
the people, than is commonly realized...."

I would hope, Ms. Morgan, that NC100 would respectfully admit to benefiting from subsidies like the below-----as do we all. American business in particular is heavily subsidized but the minute you start talking about universal health care, they drag out the very defunct 'socialized medicine' argument.

I tell you what: the citizens won't subsidize business and business can pay the full price of what it is attempting to do and the citizens will shut up about universal health care.

I would like to suggest that business would benefit from people having efficient, one-payer, Medicare-like health insurance which would be a 'subsidy' as associated with having a health work force. We can have a win-win solution only if business will cooperate in order that we all can work together for common solutions----NOT if business attempts to twist our arms and steal from our pockets at the same time.


Respectfully, Marsha V. Hammond,PhD


Lawmakers Push for Big Subsidies for Coal Process

Published: May 29, 2007
WASHINGTON, May 28 — Even as Congressional leaders draft legislation to reduce greenhouse gases linked to global warming, a powerful roster of Democrats and Republicans is pushing to subsidize coal as the king of alternative fuels.

Prodded by intense lobbying from the coal industry, lawmakers from coal states are proposing that taxpayers guarantee billions of dollars in construction loans for coal-to-liquid production plants, guarantee minimum prices for the new fuel, and guarantee big government purchases for the next 25 years.

The Medicare Privatization Scam

April 21, 2007, Saturday
(NYT); Editorial Desk
Late Edition - Final, Section A, Page 14, Column 1, 488 words
DISPLAYING ABSTRACT - If private health plans are supposedly so great at delivering high-quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program?

H973 mutilated: The NC state Senate finishes the damage to H973 by trying to privatize Medicaid: WE NEED A ONE PAYER SYSTEM

My letter to Susan Fisher, one of the (better) representatives in the NC State Legislature re: what a botched and mostly useless mess is H973 and why Medicaid should not be privatized:

Dear Susan Fisher (Fisherla@ncleg.net), one of our representatives in the NC State Legislature:

You stated in your newsletter that came out today, Monday:

"Health :
_ North Carolina took a step this week toward giving those who suffer from mental illness the same level of insurance coverage available for physical illnesses. The bill (H973) would bring North Carolina in line with many other states in the region. It exempts companies with 25 or fewer employees from the expanded requirement and many companies with 100 or more employees would be exempt because they are self-insured. That means the change will apply initially only to about one in six workers in the state. Thirty-four states already have mental-health parity. The bill now goes to the Senate. Senate leader Marc Basnight (Marcb@ncleg.net) says members of his chamber support expanding private mental health coverage.

Ms. Fisher: First of all 38 states have mental health parity. Only two have excluded Substance Abuse. The program above is not mental health parity and the name should be changed to something like, "NC State Legislature idea of what mental health parity should look like." Leave the citizens out of this, would you? Its what the legislature and the lobbyists want----not the people who elected you.

This does not even tackle parity as associated with Medicaid or Medicare. This bill has become a joke.

And the matter about supporting the privatization of Medicaid??
Shall I tell you what that would look like, speaking from the provider end of things and as associated with having to deal with the authorizations associated with state funded mental health clients??

Instead of being able to fax in an efficient one page sheet of information to Value Options and receive a letter back authorizing that within 1 week to 10 days, what I will have to do (as there will be more middle men and women to be paid) in order to obtain more sessions for my psychotic patients who threaten homicide and cut themselves is to go through tiers of authorization, calling people on the phone, to be put on hold, to be given to someone who has no idea what they are doing.

PLEASE DO NOT PRIVATIZE MEDICAID. The NC State Legislature has done quite enough damage already and is not even able to mandate that people like Hooker Odom pay attention to the recommendations of the Joint Legislative Committee. STOP: GO HOME: while we still have some shreds of mental health still hanging around.
Another swell Buncombe county representative who is priding himself on taking an ax to H973: Mr. Thomas:

Recently, as in last week, a first term Republican NC Senator was stated by local news services to have had a 'sucess' in terms of limiting mental health parity. He claimed the trophy of preventing companies with fewer than 25 employees from having to be 'mandated' as re: mental health parity as associated with H973, the mental health parity bill that was just massacred by the NC Senate.

And large companies typically have their own insurance. So, who does that leave as having been served by mental health parity: VERY FEW. Success my ass: this is blood money...off the back's of NC citizens. This is blood money: the lobbying money from the insurance industry and the likes of NC100-----an organization watching over private dollars of ignorant people who have not done their homework.


Indeed, American business cannot even compete any longer as the private sector is shackled with the leg-irons of having to create insurance for its employees (when they can be held to doing such; its evident that most of them want nothing to do with it):

A Katrina Health Care System
By ATUL GAWANDEThe New York TimesMay 26, 2007
"...the costs of our job based healh insurance system---costs adding $1500 to each car Chrysler builds here, but almost nothing to those built in Canada or Europe----have so broken the automaker's ability to compete that giving it away became the smartes thing Daimler could do....Daimler Chrylser sold off its Chrysler division for three pebbles and a piece of string...for an 82 year old company that built more than two million cars and trucks last year, took in $47 billion in revenue, and owns 64 million square feet of factory real estate in North America alone...analysts say it was a great deal for Daimler. Why? Because the buyer, Cerberus Capital Management, agreed to absorb Chrysler $18 billion in health and pension liability costs." http://greenpagan.blogspot.com/2007/05/katrina-health-care-system.html

Tuesday, May 22, 2007

Can the LME's be trusted?:the tale of Jay Laurens and specially sanctioned Piedmont Behavioral Health LME

This is the tale of Jay Laurens, the Executive Director of Rowan Homes, who apparently decided to speak up re: the way was being spent by Piedmont Behavioral Health, and therefore incurred the disfavor of this LME----who punished him by removing him as an appropriate provider. This should make everyone sit up and wonder: can it happen with the LME with which I am involved? This is a recipe for currying favor, licking boot, and obsequious/fake/ fawning behavior by such inclined Endorsed Provider companies when presented with the opportunity by so-inclined LME's. And it certainly is not out of the realm of possibility. This is yet another argument for the creation of a ONE PAYER SYSTEM wherein everyone would be created as equals----or unequals. Such behaviors could more easily take place with an isolated LME than at the state level. REMEMBER: the profit margin of Medicare/ Medicaid is 5%: this is a very efficient system. What do you think the profit margins of companies such as NC BC/BS are?

associated article: http://www.salisburypost.com/area/309271306692634.php
".....In spite of all that, a judge ruled the Concord agency had theauthority to contract with whomever it wanted — and didn't have tokeep doing business with Rowan Homes.That authority puts Piedmont Behavioral in a unique position.Around the state, organizations like Piedmont Behavioral — called"local management entities" under the state's mental health andsubstance abuse treatment structure — are required to contract withany Medicaid-eligible agency that shows itself "willing and qualified"to provide services, such as Rowan Homes.Since 2005, however, Piedmont Behavioral has been exempt from thatrule as the site of a pilot program state officials hoped would provea more efficient, cost-effective way to deliver mental health care....

Critics, including Rowan Homes Executive Director Jay Laurens, say the state has concentrated too much power at Piedmont Behavioral, which oversees mental health and substance abuse services in five counties, including Rowan and Cabarrus, and required too little accountability in return.

Advocates, including state legislators and executives at the state Department of Health and Human Services, say the pilot program is working and may be expanded later this year. ..."

Monday, May 21, 2007

Emerg psych serv; clear perception diff between Legis/ DHHS vs consumers as to success;H973 will pass;11th Dist Dems note ment. hlth care issue

NC Policy Watch & NAMI luncheon: Raleigh: 5.21.07: 11:30 – 1:30 pm : long applause was for NAMI-Wake former director, Ann Akland: her statements that ‘the system is not working’ were well received.

"“Getting or changing services is a lengthy, confusing, complicated, bureaucratic process,” explained Ann Akland, a panelist at the forum who also has an adult-aged child suffering from mental illness. She added the intricate system leaves “patients and families to fend for themselves.”http://news14.com/content/headlines/582673/north-carolina-s-state-of-mental-health/Default.aspx You can play the video of the meeting by accessing that web page.

About 300 people attended; Western NC continues to be under-represented, it appears. As noted by District 11 Dems pertaining to District meeting this past Saturday held at Pisgah High School:

"...We passed resolutions on our forests, universal health care and mental health care issues. This last one is becoming a serious issue in western North Carolina, since the state has turned it into all private providers and then really messed with the providers...."

MAIN POINTS TO CARRY AWAY: (see below for details)

Item 1: a great number of the concerns had to do w/ lack of crisis care: INSKO stated that the reform never intended to take away crisis care and stated she was working on making this clear again. (see below); she stated that this was also true re: case-management : (thus, there is some real backing up here and our complaints are being heard , in part, related to emergency psychiatric services)

I walked over to Verla Insko's office and she indicated that this is being augmented in order to make more clear the point that indeed, the LME's are responsible for emergency services. That which is in bold, immediately below, is what is new and Insko indicated that she expects this to be passed this legislative season:

"115.4. Functions of local management entities. (a) Local management entities are responsible for the management and oversight of the public system of mental health, developmental disabilities, and substance abuse services at the community level. An LME shall plan, develop, implement, and monitor services within a specified geographic area to ensure expected outcomes for consumers within available resources.
(b) The primary functions of an LME are designated in this subsection and shall not be conducted by any other entity unless an LME voluntarily enters into a contract with that entity under subsection (c) of this section (skipping down to section c) ....(c) Subject to subsection (b) of this section and all applicable State and federal laws and rules established by the Secretary (the following is being struck through) , an area authority, or county program or consolidated human services agency.

My understanding is that the LME's MUST provide emergency services or see that it is reliably provided. This will effect, for instance, the mobile crisis unit in Western Highlands re: inability to cover all the needs associated (in particular) with children/ adolescents. (good person to talk to about this is Diane Bauknight, who is the mother of a consumer: "Diane Bauknight" dianebauknight@gmail.com

State Legislator, who is the co-chair of Joint Mental Health Reform Committee Verla Insko is at: 919-733-7208; "Verla Insklo" Verlai@ncleg.net.

It is problematic that the LME’s have no formal links in order to do their work e.g., links with counties/ county commissioners; Insko stated legislatively they are attempted to improve the relationship s and linkages that LME's have in the community and counties (see below)

All in all, audience, and consumers, were making very vigorous points how the system is not working and is indeed broken.

H973 will pass thru both houses; substance abuse has been taken out and there is some other dumbing down re: the mental health issues (per Tote, Mental Health Alliance; last legislative year, a full mental health parity bill passed through NC House, but then stalled out in the Senate)

Per Wainwright,DHHS, the new Service Design will address the transportation issue associated with clients who cannot get to appointments re: mental health care : (this is in direct contrast to Steve Puckett’s statement at the Smoky Mountain Center provider’s meeting less than 10 days ago/ re: there is no payment for transporting clients.

Mental health care reform is a recovery model NOT a rehabilitation model (how did that term come into usage? I don't know. They are different in that rehabilitation is a medical model term; Insko was clear about mental health reform was not intended to be a medical model).

Item 7. Wainwright of DHHS makes point that Feds were slow re: Service Definitions and that ACT team, as it is now in NC, has been a rejected model, by Feds, in NM (see below),

My notes taken during this meeting (yes, I am typing that fast but you'll notice it's in outline form)

VERLA INSKO (NC STATE LEGISLATURE, ORANGE, DEM) : I use a systems overview as associated with all the pieces / partners re: mental health reform; mental health reform not intended to be a copy of medical model; ‘recovery’ model, not rehabilitation model: ‘what went wrong’: a waste of time to begin blaming any of the partners in the system; inadequate planning: actually needed a full year of planning; should have outlined a planning process; state was supposed to write a business plan and LME to write theirs; LME plans were insufficient; oversight committee should have laid out guidelines; when governor had to tap 2001 mental health funds, that should have been a signal to slow down; we removed certain functions that we had expected the LME to perform: assessments; when they were removed, since we wanted the LME’s to manage the matter locally, there was nothing put back into place; relationship between DHHS & LME, tensions; these have to get down to a manageable level; 1 of biggest problems: no one is serving our most seriously mentally ill and they end up in jails; solutions: don’t go into any other changes until system is stabilized: no big changes now; another model: child developmental assessment agencies; move toward the agencies that are successful already.

LEZA WAINWRIGHT (cohort of Mike Mosley, Department of Mental Health: DHHS): what was necessary re: mental health reform was comprehensive approach; addressed governance; prior to reform we didn’t even have a term called target population. As re: old system, there were problems: 1. over-reliance on state system 2. conflict re: manager being service deliverer. We didn’t pilot this reform; we took it state-wide at the same time we were identifying target pop; all of this change has served to destabilize the system. These are some of our successes: more oriented towards the consumer: consumer and family advisory committees: we have tried very hard to give consumers a voice; its not where it needs to be yet but at least there are formalized mechanisms. There is another partner in this whole equation who is playing a more service role: the federal government: other states are currently unsuccessful using our identical ACT bill information (New Mexico is unsuccessful) We have to recognize the role of federal government; we have implemented crisis intervention teams; particularly successful in Wake County. Another challenge which has been taking place, happening at the same time is that changes were being made in the private sector; Also parity is a critical matter which we do not have in NC. 200 community hospitals closed over the past several years; they were picking up psychiatric consumers; clearly that has had the effect of putting more of a strain on the state hospitals. What we have seen is a large spike in short term stays, primarily due to substance abuse; again, all of this is taking much longer than we would like; all of us underestimated the skill set it would take in order to manage this massive change

JOHN TOTE: Mental Health Association in NC: oldest advocacy group in NC: we are also providing services; looking back at old system: clearly our system needed some tweaking. Mental health reform and what has taken placed is not just a paradigm shift but a completely new experience: clearly we have not hit the mark: some services have done well and so this is not just an abject failure: there are some things that are now in the system that were not. Clearly, however, this is not where we need to be; its not good that we have to keep changing the system every other week. We do need to let local communities to get a handle on where they are. The legislative oversight committee came up with some recommendations; thus far the general assembly has not hit the mark; there must be policies that drive funding; we do need new money. Local money level, per Fitzsimmons, is lacking at the local control level. Again it comes back to policies. We do need to take of the people who are in the most severe need. Parity addresses this issue. Where can we do a better job at early intervention. There are not a lot of officials here today, Gov Easley, most of all. Where are the state legislators?

ANN AKLAND: NAMI-Wake; retiree from EPA; has schizoaffective daughter; prisons house many more people with mental health issues than psychiatric hospitals. Used daughter as example; it was obvious that this mental health reform was doomed for failure; I sent e mails to Verla: we’re moving too fast, we need to slow down; the focus was on the closing of hospital beds: you know why?: because they wanted the money; we had to have that money to put the services in place; there was not much money to be had from the closing of hospital beds. We need to delay the closing of Dix until we have the services. Another reason that the system is not working is that the services have to be delivered by private providers. Now I just heard what Verla said, that this isn’t so. The LME’s should not have to ask for waivers as their staff does not know if they are going to stay or go. What is it about the LME’s not able to spend 93 million dollars. Verla says we need to keep things like they are. Yes, we cannot afford to keep things like they are. Maybe some things need to be stabilized but we sure need to change some things. I don’t see the progress; I don’t feel the progress. I’m here to say that the system is off track. I have been my daughter’s case worker. My daughter now has the services from the ACT team. The idea is to help them reduce stressors in order to keep from hospitalization. Even the ACT team is not working to keep Kristen safe. There is not any money to be made. There is not a big economic incentive to give her the support she needs. The idea of 24/7 from an ACT team is only a dream. I am my daughter’s crisis line; we are tired and we are getting older. We worry that Kristen will become another nameless person in this system. When we’re gone, will she find herself in prison. Will she just give up, take her own life. Deputies have been to Kristen’s house 3x / past month. Multiple hospitalizations. Her ACT team leader thinks she is receiving adequate services. It won’t be long until she will need a long term commitment. I don’t see the progress. Everyone is chasing a buck. Most local mental health officials are afraid to speak out; that’s where they get their funding. Just like an addict until we admit we have a really serious problem, we won’t get better until we admit to the problem. Keep Dorothea Dix hospital open. Please keep that safety net in place. LME’s should have flexibility to administer money. Until NC has a governor who pays attention to this, this will not happen.

RUTH SHEEHAN: reporter: Raleigh News & Observer : (200,000 reader circulation) has written repeatedly about one person w/ serious mental health issues: Phil Wiggins . she stated, there’s lots to be commended about a well maintained community care. The promise of that care was not always in place; cuts came; he went to psychosocial rehab; now, there is a question as to whether this can continue as the community support is being cut to 15 hours/ week. The individual stories are what we all care about. I am sorry that the members of the legislature are not here; the governor is not here. I wish each of them had a family member with mental illness so they could understand what is going on.

NANCY RYAN, NC NAMI: state board: the services are a very mixed bag across the state, county to county: poor counties, rich counties; rural and not so much so; If things were really good before, then they quite probably look bad now, she suggested, in terms of how people view mental health reform; if they were bad previously, then things have improved.

HEALTH CARE ADVOCATE: Paperwork overload: psychiatrists crying to me everyday dying because they can’t get care.
INSKO: there are some things that we have to put back in place which we never intended thru the statute to take away from LME’s: crisis services/ crisis functions. If they can’t contract it out, we should require the LME’s to provide this themselves. Also, case management might be necessary. We did not intend to give these services away. MIKE NELSON: county commissioner Orange County: in my county, we’re a fairly affluent county; even here it feels like the system is near total collapse. Clinic in operation for 38 hears, closing to 2 days/ week; 110 clients have to find new care; many of the clients do not have cars. What can we do at the county level INSKO: when we initially proposed reform, we were going to move the matter to the counties; this was roundly refused by the county commissioners. LME’s have no real linkage thru a formal established relationships; they are an odd beast. Counties had a lot on their plate, so the next step was to look at the LME’s . If counties would pay some of the administrative dollars, they would get involved. This is a real disconnect in this system. County managers have a way of strengthening this linkage. We are talking about this at the state level, how to make these administrative linkages better. WAINWRIGHT: part of the new service design is to address the transportation issue (this was exactly contrary to what Steve Puckett, PhD, said at the SMC provider meeting less than 1 week ago). SHEEHAN: Very sick people need stability. Area programs need to be our safety net again. TOTE: County commissioners stated upon reform that they would stand behind this reform. This has not played out. For valid reasons and not valid reasons, the counties have not stepped up. The counties do have responsibility now. What we said in this reform effort, these people in this target population; people outside target pop would be taken care of by the counties in order to keep them out of the target population. INSKO: (she stated that she did not remember anything about the counties volunteering to become active as associated with mental health reform; quite the contrary).
SCHIZOPHRENIC CLIENT: Give us back our day hospital. We need it: INSKO: about 22 LME’s have something like this. I hope that there will be a renewed effort to put facilities in Wake county. If we can authorize to the LME’s and give them more flexibility that may be one way to address this problem. PHYSICIAN: In 1960’s, we had a model system. There seems to have been a concerted effort to destroy this. ADVOCATE COMMENT: If you had been working for a corporation, you would have been fired. People should be able to keep their mentally sick children on health insurance. Tax relief for families taking care of mentally ill children: housing, health care; food, so that we families can take back the power of the state and not have to wait for decades for state government to get right. INSKO/ TOTE: Alexander has agreed to remove Substance Abuse provision; mental health parity will pass thru both chambers.

Saturday, May 19, 2007

More on Community Support audit; Medicaid 101;New DHHS director,Benton;

Larson is the person who was in charge of the Community Support audit which caused a significant reduction in both the rate numbers of hours:

Marsha V. Hammond, PhD e mail: http://webmailb.netzero.net/webmail/8?folder=Inbox&msgNum=0000rN00:0016JVhY000028tz&block=1&msgNature=all&msgStatus=all&count=1179604485# RE: your below e mail associated with Community Support audit

Ms. (Tara) Larson: Tara.Larson@ncmail.net

Thank you for your clear letter regarding the Community Support audit. I can understand that the agenda of CMS is an over-riding need for the checking of the boxes vis a vis 'the paperwork', associated with the 4 items which were overviewed pertaining to the audit. Those items were: Valid Service Order: Valid Service Plan; Valid Authorization ; Valid Service Note.

I can also appreciate that many of the Endorsed Provider companies are novices at the level of Medicaid 101 'paperwork.' We will do better. North Carolina Mental Health Care reform has not been easy for any of us.

Accordingly, can you provide me with the dates and locations of Medicaid 101 aka paperwork training, that is available in the near future in Western NC? I would hope that there is one in Asheville, it being the largest city in Western NC.

Basically, I have 3 points. I put these forward in the spirit of creating collaboration, rather than sparring. It may very well be that Medicaid providers---none of them----of whatever ilk----are seen as anything other than creators of paperwork as regards CMS. However, overseeing CMS is Mosley's MH and then sitting alongside that is DMA, and above that is DHHS. It appears that the 'paperwork people' are not in conversation with the others (perhaps):

1. the DHHS audit does not take into account the work---the actual doing of the task---by the Endorsed Providers and their employees, as associated with the 4 items.

2. DHHS mislead the public and the press with statements that indicated that this was a review of the actual work done by the Endorsed Provider companies. Contrarily, this was a review of the paperwork which was not accorded the above, No 1, matter.

3. DHHS does not appear to be listening at any level to the Endorsed Provider companies and their representatives at all. DHHS does not appear to be listening to the LME's, either, or the Joint Committee on mental health reform (Insko and Nesbitt, chairs).

Unlike the NC State Auditor's overview of the collapse of New Vistas/Mountain Laurel which occurred in October, 2006, and impacted 10,000 lives, your audit, which impacts millions of lives, did not take into account anything other than paperwork.
Please feel free to pass this on to anyone that would be interested in this.
Respectfully and sincerely,
Marsha V. Hammond, PhD
cc: my colleagues in the mental health care advocacy groups
the below is Ms. Larson's e mail letter to me:

Dr. Hammond, I have reviewed your email, read your response to the State Auditor's report and am also aware of your emails regarding the rate process as well. I understand your opinions. CMS is very clear in case after case, state after state reviews, that they deem items to be of equal importance when it comes to medical record documentation. The CS providers were not held to any different standard as any other Medicaid provider. The items that were the most problematic are not new to Community Support and have been around for years. There must always be a valid treatment plan, an order for the service, progress notes, etc. We thought that the all or nothing approach did not accurately represent provider performance since it didn't recognize providers who were basically doing well but had some missing or incorrect items. We devised the alternative approach to concentrate on just the most objective yes/no items. Those items that are essential to all medicaid providers, not just mental health.

When we began the reviews, we too thought we would be dealing with issues that were very related to the new service definitions and issues of transition. That was not the case. We too were surprised at the level of noncompliance being found. I personnally reviewed some of the charts to check validation of the findings by the auditors. Christina attended one of the on site reviews for the same reason. We both conducted and attended the Medicaid 101 training - the findings were complaince with or lack of understanding of basic medicaid. The questions during the trainings were very, very basic. Many of the providers had not attended any of the trainings since March 30, 06, didn't know basic treatment methodologies, nor understood why medicaid didn't pay salaries of staff rather than paying units on billable time. Thanks for keeping us in the loop of your issues, solutions and concerns.
New DHHS director:
Ex-Raleigh city manager to lead N.C. health services agency
(Raleigh) News & Observer
Dempsey Benton, a former chief deputy in the state environmental department and Raleigh city manager, was appointed late Friday to lead the $14 billion state agency that operates psychiatric hospitals, regulates nursing homes and runs foster care programs across North Carolina.
Benton, 62, who oversaw Raleigh's efforts to keep up with rapid growth in the 1980s and '90s, will head the state Department of Health and Human Services. It's a Cabinet post in the administration of Gov. Mike Easley and is likely to last only through the 2008 elections.

Thursday, May 17, 2007

HOW ALL ENDORSED PROVIDER COMPANIES ARE AFFECTED: state auditor report re: collapse of New Vistas/ Mountain Laurel Endorsed Provider in Oct, 2006

Marsha V. Hammond, PhD: Licensed Psychologist, NC
Asheville, NC
Fax: 828 253 2066 cell phone: 404 964 5338 e mail: hammondmv@netzero.com

May 17, 2007

RE: NC State Auditor report on New Vistas/ Mountain Laurel collapse in October, 2006: 10,000 lives provider associated with Western Highlands LME

Dear Governor Easley; Lt Governor Perdue; Mike Moseley (MH); Carmen Hooker Odom (DHHS); (DMA); Attorney General; NC NAMI; Western Highlands Board of Directors; colleagues and state legislators:

I would like to make some formal comments associated with the NC auditor’s report on the matter of the collapse of New Vistas/Mountain Laurel (NVML) Endorsed Provider company. I have never been affiliated with that company. I do live in Buncombe County and am thus quite aware of the effect this has had upon the community of citizens as well as the community of providers. I am speaking to this matter as a licensed psychologist who has overseen the providing of Community Support, the creation of Service Plans, and a significant amount of knowledge about how mental health reform has played out, so far, in NC.

I would like to first of all make the point that what has taken place as associated with that Endorsed Provider is simply the matter ‘writ large.’ All other Endorsed Provider companies and thus all providers of mental health care in NC have suffered the same problems. At the end of this letter, I would like to propose some possible solutions.

It was a quality audit, unlike the DHHS audit on Community Support providers. As pertaining to the DHHS April, 2007 Community Support audit, DHHS personnel have refused to answer my questions about the methodology associated with that audit which utilized four criterion, all weighted the same, which are all quite different in terms of time utilized by Community Support Endorsed Providers. In that DHHS audit, ‘Service Plan’ was given the same weight as ‘Authorization’(which is nothing but a signature). A ‘Service Plan’ is a very time-consuming venture, taking place between the Endorsed Provider and the client as well as significant others associated with the client. The usual amount of time consumer is 10-15 hours. I am positing that the methodology is unsound and the results are therefore dismissable. This means, essentially, that there is no basis for the defunding of Community Support.

In any case, returning to the matter of the NC auditor’s report: the auditor interviewed a range of impacted individuals over 2-3 months in order to gather his data points. New Vistas, which combined with Mountain Laurel (NVML), under Western Highlands LME, was noted by the auditor as having continued with ‘business as usual’, as they began to move forward, in fact wisely taking advantage of their connections within the community. Financial stability linked to state-funded mental health clients, a problematic matter. These clients, the auditor noted, necessitate ‘double’ authorizations, a matter which is time-consuming for both the Endorsed Provider company as well as the LME. Additionally, the amount of work per state funded client is the same in terms of Service Plans (as mentioned above) and the allowed services is much, much less than for Medicaid/ Medicare clients. Thus, the Endorsed Provider works hard to put together the services and receives minimal compensation in return.

In the beginning, as mental health reform created Endorsed Provider companies across NC, New Vistas was viewed and mandated to be a ‘safety-net’ provider, and so they continued to see clients who were non-revenue-making, such as state clients (non-revenue making also refers to the problem with the ‘double’ authorizations as associated with state-funded clients). Additionally, there was no emergency psychiatric facility to take state-funded clients save Broughton Hospital, two hours out of Buncombe County. Children are not taken there. Contrarily, Smoky Mountain Center LME, has utilized The Balsam Center, located in Haywood County, for this purpose. In the eastern end of the state, indeed, the psychiatric facilities have been closed. Testifying to the difficulty in keeping these emergency psychiatric centers up and running, I am advised by Doug Trantham, the Director of Services at the Balsam Center, that it has been very difficult to keep services available due to lack of funding by the state and shifting of funding mandated by the state. A year or so ago, The Balsam Center was ready to go ahead with a children’s psychiatric in patient center but then DHHS shifted the funding which pulled the rug out from under this. Adding further to the burden borne by The Balsam Center, until recently, no Medicaid/ Medicare client could stay at Balsam Center, but only state funded clients (paying less money as per funds). This was undermining of the functioning of that emergency psychiatric center. There continues to be NO child psychiatric emergency services. Instead, Western Highlands LME thought it better to have one company which has provided mobile crisis care. This has not worked well as one company does not sufficiently provide the range of services which is necessary.

The auditor outlined major revenue stream loss as associated with no-shows by clients associated with appointments with providers within NVML. The auditor did not address the difficulty with transportation or child-care. He simply noted that they did not come in for appointments. To underline this matter and what has not been done in order to address it, when the Smoky Mountain Center LME had its provider meeting on May 12, 2007, administrators further underlined that no Community Support monies could be used for transportation of clients to necessary meetings. Thus, the Endorsed Providers are expected to bear this expense without compensation or even acknowledgement by the auditor that this is perhaps problematic.

The auditor acknowledged that DHHS implemented Service Definitions in March, 2006, as a key factor associated with confusion within NVML. Having been a recipient of this, I can testify to the difficulty of attempting to ‘read between the lines’ of DHHS Service Definitions and their memos which go out to providers via the LME’s. As associated with those specific Service Definitions of March, 2006, DHHS first put them out as salient and usable to providers, then DHHS put the Service Definitions on hold, leaving providers with no ability to plan treatment, pay employeed, or maintain their businesses.

The auditor goes on to speak about the critical matter of ‘insufficient operating capital’ as re: NVML. I find this puzzling when I am advised that LME’s will be sending back millions of dollars in un-used funds to the state. This causes the state legislature to assume that since they are sending money back, they must not need it. I am informed by Bill Hambrick, administrator at Smoky Mountain Center, that the funds are being sent back as associated with the inability to find providers to do the work that has been mandated per the Service Definitions by DHHS. As pertaining to NVML, job stressors began to effect the very functioning of the company. As the Service Definitions became an unknown factor in terms of what would be paid for---with DHHS putting them out and then putting them on hold----employees began to look for other jobs. This snowballed into many people looking for other jobs.

These are my recommendations as re: the above matter which I believe I understand at least as well as most Endorsed Provider companies associates (which is what I am):

1. Give the LME’s a block of money and allow them to use it as they find necessary as associated with mental health care needs in their catchment area. This is also in keeping with earlier assumptions that this is what was going to take place. This addresses the matter of ‘double authorizations.’ DHHS would be useful in a role as organizer of information. However, what appears to have taken place is that not only has DHHS attempted to do this, and has done it badly, but they have attempted to mandate pockets of money and authorizations which was not in accord with their knowledge base of what the communities needed. Include funding for the care of state-funded clients within that block of money. This will also circumvent the return of monies to the state, causing the state legislators to assume that since the money was not used, no additional legislation associated with funding is necessary.

2. Fund and create emergency psychiatric services throughout the state, paying particular attention to the lack of child psychiatric services which has caused consumers’ parents to have placed their young children in other states for care.

Sincerely and respectfully,
Marsha V. Hammond, PhD: Licensed Psychologist, NC

Bad appples argument resurfaces: NC state auditor reveals 25% fee reduction as 1 culprit; DHHS Service Definition see-saw also critical

The NC State Auditor has finished his report outlining the collapse of a '10,000 lives covered' Endorsed Provider company, specifically, New Vistas/ Mountain Laurel, overseen by Western Highlands LME in Buncombe County:

These issues are not unique to this Endorsed Provider agency. The problems are simply 'writ large' and every single Endorsed Provider agency struggles with moving forward as pertaining to the incompetent management of DHHS which mandates what Endorsed Provider companies can do---or not.

And related to the news coverage of that matter by the Asheville Citizen-Times, can someone tell me why the news-services can't be bothered to look at the details of official documents, like Service Definitions (created by DHHS in order to guide such things as Community Service) or 'small' details like '25% fee reduction' as associated with the NC Auditor's report which outlines matters associated with the collapse of the largest mental health provider in Western NC in October, 2006 (New Vistas/ Mountain Laurel). You would think that a journalist could at least think around the issue and posit it as something to ask questions about---to at least make an educated guess as to how this might impact a fledgling company??

In the 5.15.07 article http://www.citizen-times.com/apps/pbcs.dll/article?AID=200770515113 by Nanci Bompey at 828-232-6003, via e-mail at mailto:nbompey@citizen-times.com?subject=Reader%20Feedback , that reporter outlines the following matter (a continuation of the 'bad apples' gigging of the Endorsed Providers so mastered by Hooker-Odom, and then underlined by Easley):
".....They did not have the business experience to manage their private shop,” said Chris Mears, a spokesman for the state auditor’s office...."

Bad apples; bad apples; bad apples; bad apples; bad apples; bad apples. (See April archives of Madame Defarge: Sunday, April 29, 2007: Hooker-Odom sends destructive mixed signals to the public & gullible press : WHERE'S MY COPY OF HOOKER ODOM'S AUDIT?? )

Here is the link to the audit of the provider associated with '10,000 lives' pertaining to mental health coverage, which collapsed on the eve that Mike Moseley, Director of Mental Health, under DHHS, spoke to a shockingly respectful room of providers and consumers 50 plus miles away in a hard-to-find-auditorium at Western Carolina University:
http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2007-7225.pdf (you cannot cut and paste anything from this document and so you will have to look at it yourself)

My comment to the Asheville Citizen-Times writer was the following:
The Performance Audit, conducted by Mr.Merritt, The State of NC Auditor, noted, as re: New Vistas collapse, that the following occurred: "a 25% fee reduction." (page 1).
I would like to know what fledgling business would be able to handle that. I would like to know why DHHS, The Department of Health and Human Services, continues to mismanage funding----and moreover why the state legislature and the governor and the LME's continue to put up with it."

Here are my comments on the audit:

This was a quality audit. If only we could have been accorded the same respectful and thorough analysis by DHHS as associated with Community Support. They interviewed a range of impacted individuals in order to gather the data points (p. 9).

New Vistas (then combining with Mountain Laurel: NVML) proceeded as they had before, providing services to state funded clients as well as emergency psychiatric services (state funded clients receive a great deal less in services than Medicaid/ Medicare clients do) and Buncombe county has only adult psychiatric emergency services for Medicaid/ Medicare clients ONLY at Copestone/ St. Joe's. Buncombe is utilized as a reference point as this is the most populous county as associated with Western Highlands LME. (p. 12-13)

New Vistas was created as a 'safety net'; it was assumed that providers care for state-funded and non-Medicaid/ non-Medicare clients----or those w/o any mental health insurance or insurance period. (p. 13)---as they had in the past.

Major revenue stream loss was associated with no-shows by clients. (no information was given by the auditor as associated with matters impacting clients like: no transportation; no childcare, etc.; p. 13)

The new Service Definitions implemented in a haphazard manner by DHHS, March, 2006, was noted by the board of the company ot have been a key factor in the collapse of the company (p. 15). At the same time, DHHS---in its typical confusing fashion---put its Service Definitions OUT and then placed them ON HOLD, leaving al the Endorsed Providers, include NVML, in limbo. The LME's or boards governing the Endorsed Provider companies such as this one, have only been able to try and interpret these DHHS edicts as best they could----with the suggestion to the providers that they should call DHHS in order to obtain some clarity. This is really really not helpful.

The audit goes on to speak about 'insufficient operating capital.' So, tell me: how is it that the LME's will be sending back to the state millions of unused mental health dollars while the Endorsed Provider companies such as this one go wanting? Talk about famine during a time of plenty.....

Job stress associated with job instability began to take its toll on the company (p. 18); people quit as associated with the stressors of the job, causing even more people to quit. This was not unrelated to DHHS unfolding edicts, then putting them on hold, leaving everyone in a Catch22 non-man's land. Recently, Community Support providers have been gigged, as associated with a crappy audit (see previous Madame Defarge posts for specifics) , Hooker Odom cranks up her 'bad apples' machine; Easley, parrot-like echos this sentiment; news-services talk about the 'bad apples'----with no one taking the time to do the work as associated with looking at the details of the matter.

The audit made note (DUH) that state-funded clients require dual, time-consuming authorization. (p. 23)

(My comments as pertaining to desire on part of providers for standardization): There has been absolutely no progress made on the matter of standardization of methods associated with authorization as pertaining to providers indicating to DHHS that this was, in many cases, their number 1 priority. (p. 24).

The matter that there is a severe lack of emergency psychiatric services was expressed as a critically important matter many times by NVML personnel, to the auditor (p. 21)


Tuesday, May 15, 2007

Update on H973: still hung up in Insurance Comm. of NC House;Jeb Bush now@Frye Hosp;

I talked to Ann, Representative Martha Alexander's assistant earlier this afternoon (Alexander is the main sponsor of H973). She was present during the 11 a.m. Insurance Committee (NC House) meeting. She painted a picture of a less confrontational set of representatives as re: H973. She stated she did not know if this was associated with them 'having made their minds up', or not. She stated that there were 3 'experts' associated with support of the bill, one of them being the head of psychiatry at UNC Chapel Hill Medical School; another a consumer's parent. On the opposing side were 2 lobbyists: 1 representative of a group with the descriptor of NC100 (if this isn't a Republican non-think tank, I'll eat my hat: http://www.nc100.org/?page_id=13); the other associated with representation of a group of health insurance companies (not BCBS; she remarked that their lobbyist had presented in opposition to H973 last week).

I told her that certainly instead of the entire matter crashing, mental health practitioners and consumers would want mental health to have parity. Ann stated, when I asked her, how did Representative Alexander feel about this, "We haven't discussed that yet." She advised me, when I queried her, that Ms. Alexander is in frequent conversation with NCPA, North Carolina Psychological Association.

The bill is to be entertained----yet again---next Tuesday, 11 a.m., in the Insurance Committee of the house. It will have very few days after that to move thru its trajectory in any other committees and then the NC Senate. I'll be back in a few minutes after I have gotten some more specific feedback from Ann, at Representative Alexander's office.
"A man with a briefcase can steal millions more than any man with a gun." Don Henley, of The Eagles, from: "Gimme what I want"
I would personally like to know why the Republicans of NC are running this Dem state (Dem governor, in name only, I know) :

RE: the citizens of NC want H973, mental health parity bill, passed

May 16, 2007

I would personally like to know why the Republicans of NC (NC100) are running this Dem state (Dem governor, in name only, I know) :

RE: As per the lobbying against H973, the mental health parity bill, stuck in the maelstrom, sucked down by faux-Dems posing as Republicans in the NC House Insurance Committee, as lobbied against by a stealth group known as NC100 http://www.nc100.org/: Perry Morgan perri.morgan@nc100.org, lobbyist: every one of your points can easy be rebutted :

Mr. Perry, you stated:
Item 1: "The problem of mandating health insurance coverage and benefits really revolves around affordability and fairness - affordability by those who must pay the premium cost and fairness to all kinds of North Carolina businesses and their employees."

Let's have a little discussion about 'corporate welfare' and 'corporate malfeasance', Mr. Morgan.

Yes, indeed: this is what private, for-profit insurance companies have in store for us; an 19% 'corporate welfare' support system for non-Medicare 'Medicare' insurance like HUMANA and let me advise you that, as a provider, if you want to have nothing but paperwork---and no $$$$ as associated with payment due----coming at you as associated with these private, 'non-medicare'/Medicare/ HUMANA kinds of companies, then absolutely, you are correct and your mission as an 'administrator' has absolutely
BEEN MISSION ACCOMMPLISHED (and spare me w/ the talk about the NYT being a left-wing rag; what is very much true is that there are so few papers now that do anything except just synchophantically 'scribe away' that the number of newspapers with an IQ of greater than 80 can be counted on one hand).

item 1: The New York Times > MedicareInsurer Faces Reprimand in Medicare Marketing CaseROBERT PEAR The New York Times"Some agents for Humana have enrolled Medicare recipients in products that "they did not understand and did not want," an official said.....

Item 2: http://www.timegoesby.net/2007/05/the_fraud_of_me.html
"....Some physicians will not accept fee-for-service plans and some co-payments are shockingly higher than with traditional Medicare...."

Item 3: Mission accomplished on Medicare "reform":
http://www.needlenose.com/node/view/4018By SwopaMay 7 2007 - 1:22pmFrom the New York Times today:
"...federal officials said that the fastest-growing type of Medicare Advantage plan generally does not coordinate care, does not save money for Medicare and has been at the center of marketing abuses.... the cost to the government is also higher because it pays the private fee-for-service plans, on average, 19 percent more than the cost of traditional Medicare

Item 4:
OPINIONChildren Versus Insurers PAUL KRUGMAN The New York Times40 days agoUniversal health care may happen one of these years, but the choice between providing health care to uninsured children and subsidizing insurance companies is playing out right now.

Item 5:
Senate Bars Medicare Talks for Lower Drug Prices ROBERT PEAR The New York Timeselap('1176951003');27 days agoRepublicans in the Senate argued that private insurers were already negotiating large discounts for Medicare beneficiaries.

Item 6:
EDITORIALThe Medicare Privatization Scam THE EDITORS The New York Timeselap('1177127403');25 days agoIt is time to level the playing field and force private plans to really compete with traditional Medicare.

The sooner that the citizens of NC realize that their state legislators have been bought and paid for by the likes of NC100 and BCBS, the better will be their ability to tackle the problem. Yes, let's throw open that moldy old trunk.

To suit, take a look at Senator Martin Nesbitt's son's NASCAR hauling truck : http://www.martnesbitt.com/photo%20truck.jpg sponsored by Blue Cross/ Blue Shield/ NC.

I like Senator Nesbitt and admire his candor. However, its his problem that he has chosen to be affiliated with BCBS/NC. Their representative argued against mental health parity, H973, LAST WEEK, as associated with the insurance committee where H973 is STUCK.

Here's an item that made me nauseous (bear in mind that Frye Hospital in Hickory, NC, is associated with one of a handful of psychiatric units in Western NC)
Tenet hands Jeb Bush a big windfall
Jeb Bush will get over $450,000 in the next year from Tenet for being a board member -- about three times what the average director makes at major U.S. corporations.

Monday, May 14, 2007

H973: save our Senator Nesbitt:the ballad of Nesbitt Jr.'s BCBS ADVANTA race car :PLEASE DON'T MAKE ME SPILL MY MACHIATO w/the clock runnning out

In the Ballad of Ricky-Bobby, 'Taladega Nights', a movie about NASCAR racing (how much more NC can you get), Sasha Baron-Cohen plays a suave, gay racer who, while handling the steering wheel, reads books on existentialism while drinking his machiato----over the deafening sound of hellbent NASCAR drivers. Yes, it was filmed in NC.

Accordingly, this post is not going to make me better friends with Senator Nesbitt, who is the co-chair of the Joint Legislative Committee on mental health reform. I like him, his candor, and the way he helped shove Hooker Odom out the door. He stated that she would not listen to the Joint Legislative Committee which is chaired by he and Verla Insko.

I had to step very carefully today when I called Nesbitt's office and talked to Janlee, his mental health legislative person, as I tried to ask if perhaps Senator Nesbitt could call on some of his colleagues in order to slide H973 thru the Insurance Committee of the House. I am admittedly a novice about just how much arm-twisting is too much. Unfortunately, we don't have any time left and so instead of letting the opportunity slip away, I thought maybe the ADVANTA car picture could cause the BCBS vampire to throw up the cape and run back into the tomb from which it came.

Contrarily, Representative Alexander's office legislative aide, Ann, as well as Rep Goforth's aide, Ann Jordan, thought the picture of Nesbitt Jr's ADVANTA car was pretty funny: SEE IT HERE, while its still on the internet. http://www.martnesbitt.com/Photos.htm

I can't seem to get a screen capture to pick it up. You'd better hurry; it may be like that screen saved OH vote during the 2004 presidential election which was made by Mark Crispin Miller: one minute its there, and then 1.5 hrs later, the other guy won

H973 is not even in the Senate yet---where Nesbitt is. There are


to move this mental health parity bill thru both houses. Tomorrow, at 11 a.m., it goes to the Insurance Committee of the NC House.

Rep Goforth, from Asheville, via his assistant Ann, has stated that she has placed the following information forward to me by Cook, JD, working mental health parity at the American Psychological Association, in the folders of each of the NC House representatives serving on the Insurance Committee:

"What have States Done to Ensure Insurance Parity?"

I asked her if she was also going to place in the Insurance Committee members folders the picture of Nesbitt, Jr's ADVANTA race car.

According to this map with some significant detail, only 2 states have parity that does not cover substance abuse, specifically, NM and WA. Others have addressed concerns about funding by placing various caps in coverage.

This comes on the heels of Chris Fitzsimmons TODAY, of NC Policy outlining the gnarly visage of Blue Cross / Blue Shield (BCBS) stealth behind the scenes as re: parity and the passage of this specific bill and particularly as associated with this Insurance Committee which has a record, apparently, of blocking bills that will cause the insurance industry to spend money. Remember, it was Verla Insko who has stated that 'the insurance companies have too much power in this state":

".....Any hopes, however, that the Health Committee vote had sent the long sought measure on its way toward swift passage were quickly dashed last week by reports emanating from the House Insurance Committee (the bill’s next stop on the legislative carousel). Like a lot of “business” committees in the General Assembly, the Insurance Committee has traditionally been viewed as a place in which the insurance industry will almost always get its way. It appears to be living up to its reputation.

According to the reports from advocates and observers, the parity bill has run into strong opposition from the health insurance lobby, which almost always chafes at any effort by public officials and institutions to regulate the terms and conditions of the services it sells – even when the requirements apply to the entire industry or, as in the case of the state’s biggest health insurer, Blue Cross Blue Shield (BC/BS), profit is not an issue.

Though unwilling to publicly admit their opposition or spell out their concerns for fear of negative PR, the industry appears nonetheless to have forced a halt to the bill’s progress while it draws up and puts forward a “compromise” version. With the legislature’s so called “crossover deadline” just 10 days away (after a one week extension last week), proponents are concerned that the industry may be attempting to “run out the clock.” "

. Moreover, H973 now has the backing of now only the NC Psychological Association but Western NC Psychological Association----amongst many other groups.

Its the 11th hour....the foam on my machiato has dissipated. Will the Insurance Committee of the NC House pass H973??

Here are the people on that committee; it might be best to call your own representative also:
HERE ARE THE E MAIL ADDRESSES OF THE MEMBERS OF THE INSURANCE COMMITTEE FOR THE NC HOUSE. The mental health parity bill is: H973. All the members of the committee's e mail addresses are below. http://www.ncleg.net/gascripts/Committees/Committees.asp?sAction=ViewCommittee&sActionDetails=House%20Standing_28
Rep. Goforth
Rep. Holliman
Vice Chairman
Rep. Bryant
Vice Chairman
Rep. Dickson
Vice Chairman
Rep. Dockham
Vice Chairman
Rep. Setzer
HERE ARE THE E MAIL ADDRESSES OF THE MEMBERS OF THE INSURANCE COMMITTEE FOR THE NC HOUSE. The mental health parity bill is: H973 davida@ncleg.net, johnbl@ncleg.net, brub@ncleg.net, angelab@ncleg.net, nelsonc@ncleg.net, billcu@ncleg.net, margaretd@ncleg.net, jerryd@ncleg.net, billf@ncleg.net, bruceg@ncleg.net, hughh@ncleg.net, juliah@ncleg.net, davidl@ncleg.net, garlandp@ncleg.net, drews@ncleg.net, mitchells@ncleg.net, williamw@ncleg.net, trudiw@ncleg.net, tomw@ncleg.net

Saturday, May 12, 2007

Substance Abuse: 20% of mental hlth parity ; Insko on overwhelming #'s of non-Medicaid clients& what this means

If the NC Insurance Committee of the House sinks mental health reform by dragging out the substance abuse red herring, it will be because they have not done their homework. 38 states have mental health parity and those state legislatures' have created various means to cap matters such that the spending does not get out of control.

See: What have States Done to Ensure Insurance Parity?

Of the 38 states that have parity laws, ONLY 2 HAVE EXCLUDED SUBSTANCE ABUSE: KENTUKY AND WASHINGTON: Report from American Psychological Association's (Practice Directorate):
Jeff Cook, J.D.Director of Field & State OperationsAmerican Psychological Association Practice Organization750 First Street, NEWashington, DC 20002(202) 336-5875 (Office)(202) 336-5797 (Fax)202) 336-5797 (Fax)jcook@apa.org

Mr. Cook states , "Our actuary, Ron Bachman, has told us that the cost of the substance use disorder portion of a parity law that includes both mental health and substance use disorder is typically about 20%." Ron Bachman: rbachman@apa.org


davida@ncleg.net, johnbl@ncleg.net, brub@ncleg.net, angelab@ncleg.net, nelsonc@ncleg.net, billcu@ncleg.net, margaretd@ncleg.net, jerryd@ncleg.net, billf@ncleg.net, bruceg@ncleg.net, hughh@ncleg.net, juliah@ncleg.net, davidl@ncleg.net, garlandp@ncleg.net, drews@ncleg.net, mitchells@ncleg.net, williamw@ncleg.net, trudiw@ncleg.net, tomw@ncleg.net


Raleigh N&O:
How can we make sense out of recent conflicting comments on thestate's mental health system?

One writer says North Carolina is near the bottom among the states infunding for mental health -- we need more money. Another writer saysit would be wrong to put more money into the system when the localmental health agencies are unable to spend $93 million.

Another personpoints to the recent overspending for Community Support services.First, an important fact: People between the ages of 19 and 64 don'tqualify for Medicaid no matter how poor they are or how sick they areunless they are disabled or have minor children.

It follows then that few people with mental illness qualify forMedicaid. So, while it is true the Medicaid budget for mental healthis overspent, what that means is that the relatively few people withmental illness who qualify for Medicaid are receiving substantialservices.

The many people with mental illness who are not Medicaid-eligible mustwork with providers who are willing to be paid 100 percent withlimited state dollars or to provide services pro bono.

Many Medicaidproviders are unwilling or unable to see state-supported or indigentpatients.

We need more state dollars to support these consumers andkeep them out of our jails, emergency rooms and state institutions.Local agencies spending all their service dollars receive their moneyfrom the state in block grants before the services are provided ratherthan through billings after the services have been provided.

We couldaddress the problem of unspent funds by allocating most or all of thestate service dollars in block grants. Once we spend all the currentservice dollars, we would have a better idea of how much more money isneeded to serve all the mentally ill who do not qualify for Medicaid.

All the writers are correct, but they are each describing only onepart of the elephant.

Verla InskoState House of RepresentativesChapel Hill(The writer, a Democrat, represents the 56th House District. Thelength limit on letters was waived to permit a fuller discussion.)

Friday, May 11, 2007

MH Reform update;Moseley protects unlimited stream of MH funding;NC state legislators beholden 2 BC/BS re: parity bill

Chris Fitzsimmons of NC Policy Watch has stated the following re: the insurance lobby in NC,in particular, Blue Cross / Blue Sheild(BC/BS): http://www.ncpolicywatch.org/

".....Insurance companies have ferociously fought parity for years, claiming that the mandate would dramatically increase the cost of insurance and may result in businesses dropping coverage for their employees. The evidence from national studies and the state employee health plan proves that the claims are not true. Insurance costs do not rise significantly when mental health is covered and national studies have shown that the lack of parity costs $110 billion a year in absenteeism, lost wages, and more claims for disability and unemployment.
But it is not just a matter of economics. It is a civil rights issue. Insurance companies are allowed to discriminate against people with mental illness and it appears they want to keep discriminating against them."


Donations to NC State Legislators:

BLUE CROSS AND BLUE SHIELD OF NC PAC (Year 2006):142,600 (Year 2002): 69,250

Item 1: BCBS refuses to pull $ fm surplus account to help poor people, though it was founded on the principle of doing such:

A bill that would pull millions from the surplus account of Blue Cross and Blue Shield of North Carolina into a trust fund to provide heath coverage for low-income North Carolinians drew immediate fire from BCBSNC on Thursday.

Item 2: BCBS NC has a history and an associated lawsuit re: accumulating too much of a surplus, which is illegal in terms of statutory limits:
What does Hooker Odom have in common with Bill Frist, MD, who had to pay back Medicare re: fraud:
"Just two days before Sen. Trent Lott (R-MS) stepped down as Majority Leader in 2002, the company Frist's father started quietly settled a massive Medicare fraud lawsuit for $630 million. The eleventh-hour deal -- brokered with Justice Department attorneys after a seven-year court battle -- was made as Frist (R-TN) secured the necessary votes to assume the Senate's top post. "


SEE LETTER SUBMITTED TO ALL THE MAJOR NC NEWSPAPERS, WRITTEN TO : Mr. Les Merrittt N.C. Office of the State Auditor 2 South Salisbury St.20601 Mail Service CenterRaleigh, NC , May 3, 2007

BY: (704)633-7370 Jay Laurens Executive Director Rowan Homes, Inc.

RE: UNLIMITED STREAM OF MENTAL HEALTH FUNDING FOR PIEDMONT BEHAVIORAL HEALTH CARE managed by Hooker Odom buddy who is 'on leave' ("he's out for a couple of weeks", was the explanation when I asked if hehad taken a leave, as per his secretary when I called today, May 11, 2007) . Here is Mr. Laurens' letter to the NC State Auditor:


"If PBH looks bad, Mike Mosleye looks bad. If Mike Moseley looks bad, Secretary Hooker Odom looks bad. If Secretary Hooker Odom looks bad, Governor Easley looks bad. "

High Points of Mr. Laurens letter:

Item 1: Hooker Odom had no legislative approval to create this relationship: without legislative approval, Carmen Hooker Odom, Secretary of Health and Human Services has allocaed approximately $90 million to Piedmont Behavioral Healthcare (PBH) ......

PBH does not have to submit detail information like the Person Centered Plan, the authorization, the session notes----but the other LME's Endorsed Providers do:>Note that this session law allows for the transfer of up to only 15% from one disability category to another but does not allow for the total de-categorization of these funds. Rather thatn actually billing the state through IPRS for actual services provided like other LME's must do, PBH simply submits 'encounter data"

There is a suspicious difference between the services which are presumably being given----related to the millions of dollars being utilized----and the lack of documentation: PBH is only reporting enough total units of service to draw down federal funding since they receive all of their state funding up front." Also, in another recorded statement,a representative with the state controller's office, whose identity Iwill also reveal if necessary, has indicated that the encounter datasubmitted to his department from PBH and the Division "includes the number of units and the rate of payment per unit, but no information as to what service was actually provided or to whom."

(So, the audit of Endorsed Providers Community Support work was done at the level of eye-balling every single note, evern authorization, every piece of paper.....but these people do not even sign-off for their funds).

PBS has had a very dramatic increase in funding from NC DD/MH/SA, state funding to PBH has increased drmatically. IN fiscal year 2003-2003 PBH received $18,076,235 ..... The following year, in fiscal year 2003-2004, PBH received $36,081,977 in non-Medicaidfunding or double the amount received the previous year. ....No other LME's fund balance had grown by anywhere near that measure.

One might presume that this fast moving river of funding was associated with the loss of large mental hospitals; however, this is not true: "....BUT NO STATE HOSPITALS OR INSTITUTIONS HAD BEEN CLOSED.

A slush fund was created with the name: Fund 1590: Fund 1590--$33.716,448 (93.44% of all the total allocation. Fund 1590 was created by DHHS and DMHDDSAS for the allocation of all de-categorized, non-Medicaid dollars allocated to PBH, to be used at PBH's total discretion.

What might be the basis for this strange funding?: . One must question why the state has allowed PBH to continue to operate with a single funding stream agreement, inspite of these same concerns. Secretary Odom currently has no valid legal contract or memorandum of understanding with PBH defining this agreement.

The writer of this letter mentioned the discrepancies in the services provided and the funding being utilized and was punished by DHHS: It is important to note that shortly after PBH and DHHS entered this unusual agreement, representatives of Rowan HOmes, Inc., a provider in PBHY's network, expressed concerns that the agreement seemes to be in the best interest of PBH but not in the best interest of consumer it serves.

Hooker Odom has been caught in similar circumstances before when her husband was on the board of advisors of associated entity, Carolinas Health Care Systems: . As you know, Secretary Hooker Odom is no stranger to questionable contractual arrangements. Following an audit by your predecessor, Mr. Ralph Campbell, the state had to pay back %151.5 million to the federal government because a group of NC hospitals, led by Carolinas Medical Center (Carolinas Healthcare Systems) had overbilled Medicaid At the time this agreement was entered, Carmen Hooker Odom, who would later become the Secretary of Health and Human Services, was the Vice President for Governmental Affairs for Carolinas Healthcare Systems. Also, the Secretary's husband, T.L. "Fountain" Odom, was, and is, on the Board of Advisors for Carolinas Healthcare Systems.

Yet more suspiciousness: The Secretary selected ValueOptions even though this company's bid was $18 million more than the lowest bid and 9 million more than the next lowest bid! N.C. Representative Verla Insko, co-chair of theLegislative Oversight Committee for MH/DD/SAS even described it as a"total shock."

Easley, who appointed Hooker Odom, stood to gain: *ValueOptions has been regular contributor to the Democratic Governor's Association, including a $75,000 donation in 2006.

Dr. Michael Lancaster of NC DMA, stood to gain: . *Dr. Michael Lancaster, Chief of Clinical Policy for the NC Division of MHDDSAS was previously the Regional Medical Director for Value Options.

DHHS personel such as Tara Larson, have refused to respond: Tara Larson, Manager of Medicaid Policy at the Division of Medical Assistance (DMA) PBH has colluded has engaged in the following to increasepayments from Medicaid: * billing for services not rendered * billing for more services than actually provided * billing for more staff than are actually care providers * understaffing relative to service definition requirements and billingI can provide you with a copy of the entire letter and all relatedattachments upon request. It substantiates improprieties on the partof PBH and the provider mentioned above, with whom they have signedmultiple lucrative contracts. I firmly believe that theseimproprieties meet the definition of Medicaid fraud. Though it may bea coincidence, it worth pointing out that the Executive Director forthis contract agency also previously lived in New York.I am concerned that DMA may not investigate the matter fully. While Ms. Larson's assistant did confirm receipt of the packet, I have since left four phone messages with Ms. Larson, but have received no return calls. If PBH looks bad, Mike Mosleye looks bad. If Mike Moseley looks bad, Secretary Hooker Odom looks bad. If Secretary Hooker Odom looks bad, Governor Easley looks bad.

Thursday, May 10, 2007

More info on audit fm DHHS ALSO H973, parity bill, moved to TUESDAY, 11am, May 10th: Insurance Committee of NC House

I just talked to Ann, the NC House clerk who was taking notes during the Insurance Committee meeting this morning. There were 2 bills to be discussed this morning, Thursday, May 10th. The one concerned with chiropractic 'took the whole meeting', she stated.

Here is info on the mental health parity bill, H973, which is to be attended to on May 15, 11 a.m., by the Insurance Committee of the NC House:

This gives time to strategize and contact these important representatives who are members of the Insurance Committee of the NC House. Verla Insko has stated that much of mental health bills and associated fuding is impacted (detrimentally) by the powerful insurance lobby in NC. It is critically important that they realize that we know this.

So, this hiatus also gives time for the powerful insurance lobby create problems for the passage of this important bill. One way in which they might do this is purportedly related to pulling the red herring of 'substance abuse treatment would break us.'

First of all, as associated with substance abuse diagnoses, they are secondary to the diagnosis which is 'driving the car' in terms of mood disorders, psychotic disorders, or other mental health diagnoses. This is why there is the term 'dual diagnosis' ,as associated with a DSM diagnosis, and along side it, a DSM substance abuse diagnosis. Substance abuse may look to be the primary problem as pertaining to the havoc of the associated behaviors ----and there is no denying that one has to treat substance abuse in a vigorous manner-----but the other diagnoses have to be addressed also or the client/ consumer will undoubtedly fall prey to the substance abuse again. It is, after all, (under DHHS): DD/MH/SA. There's a reason for that. They sit together, these matters. That is because they impact each other.

Also, as associated with mental health parity laws in 37 plus states, as well as mental health parity at the federal level, substance abuse is not 'extracted', best I know.

Talking points re: parity , might include:
Item 1: Insurance costs have decreased as regards utilization of mental health: (from the American Psychological Association, Russ Newman, JD, PhD: http://www.apa.org/monitor/mar02/pp.html

Item 2: ""This is a public health crisis that in some way impacts every family in America. It's time to break down the barriers to good mental health and addiction treatment." http://www.upi.com/Health_Business/Briefing/2007/05/02/push_for_

Item 3: personal and professional antedotal information that 'puts a face' on the importance of mental health parity.

Item 4: Multiple items here to take into consideration: http://www.ncpsychology.org/html/PARITY%202007.htm

May 10, 2007
Mr. Jarrard (of DHHS; Dr. Puckett, Clinical Operations Director sent me to you):

Thank you for your quick response. You stated I should speak with Tara Larson and Christina Carter; I assume that their e mail addresses are: tara.larson@ncmail.net and Christina.carter@ncmail.net. I am sending these questions over to them. Please advise me if their e mail addresses are something else.

This e mail may be perceived as heavy handed but frankly when DHHS attempted to apply faulty methodology on the matter of Community Support and put at risk the livelihoods of Endorsed Provider agencies, you merited a thorough critiquing----rather than the press just rolling over and playing dead----which they did---mentioning the 'bad apples' providers over and over.

Re: this, which you just stated, as associated with my questions:

"....However, I would respond in general to your inquiry by saying that CMS deems all of the items to be equally important and requires the entire record to be considered out of compliance if any of the required items are missing or incorrect. We thought that "all or nothing at all" approach did not accurately represent provider performance since it does not recognize providers who were basically doing well but had some missing or incorrect items. We devised this alternative approach to concentrate on just the most objective, yes or no, items...."

WHOOAAA and wait a minute: the basic question that this audit/ research was to have answered, I had believed, was whether the Endorsed Providers were providing Community Support (CS) in keeping with the Service Definition. That's where all the 'bad apples' talk came from (see earlier Madame Defarge post). (We also realize that the key reason for the audit was in order to staunch the flow of Medicaid dollars...something that had not been anticipated due to the mis-management under Hooker Odom).

The methodology wisely avoided a forced choice format (yes or no: accept or reject). Such would have indeed aroused the ire of many more of the Endorsed Providers in that it would have been an absolute standard; moreover, it would not have been an appropriate standard by any reasonable person's standard.

In my opinion, Mr. Jarrard, neither was it appropriate to utilize an approach which weighted equally the 4 criterion measurements. Those 4 criteria were, as per the 30 plus slides associated with the Powerpoint presentation which Dr. Puckett forwarded to me as associated with your 'OK' that this take place (as per your e mail statement to me):

Valid Service Order: Valid Service Plan; Valid Authorization ; Valid Service Note

As I mentioned on the blogspot, each of these is different in terms of time spent by the Endorsed Provider. Why does this matter? It matters at the level of the work that DHHS and thus the LME's have demanded of the Endorsed Provider companies. We check our boxes in terms of completion. However, not all the boxes are equal in terms of our effort and a dismissal of this matter is disrespectful and what we have come to expect under the DHHS administration of Hooker Odom.

Valid Service Order: a Valid Service Order is easy to obtain. It is merely a signature from an approved person e.g., psychologist, psychiatrist, psychiatric practitioner (as associated with a relationship arrived at vis a vis the Endorsed Provider. Time expended: less than one hour.

Valid Service Plan: difficult, time consuming (time expended: 10-20 hours) inclusive of interviewing face to face, probably more than once, the consumer (gathering the data); inputting the data; proofreading the data; sending the data off via HIPAA guidelines.

Valid Authorization: This takes about 1 hour of work on the part of the provider. You fill in the form after looking at and/ or digging up the information, you fax it,and then you wait for ValueOptions to send you the paperwork back. The work may also include calls you have to make to Value Options to see what is hanging up the authorization.

Valid Service Note: The Community Support hands-on workers do the notes. For each note, they probably spend 15-30 min/ day, handwriting the note. At the end of the week, this person gives the notes to the supervisor, QP, associated with the Endorsed Provider Organization. That person looks at the notes, consults with the hands-on person if corrections are necessary, in order to come into compliance; there may be necessary corrections made. Per client/ week of notes: 2-3 hours of work combined between the hands on worker and the supervisor.

Why should the 10-20 hours of a valid Service Plan have the same weight as a Service Order?
This is not to mention the problem with the non-direct perusal of the behaviors of the hands-on Community Support person. You used an indirect measure of the work.

If the Person Center Plan (PCP) which sits at the core of this paperwork, is required to be associated with the interviewing of not only the client but of significant others, then I want to know why did not DHHS evaluate the performance of the Endorsed Providers from the stance of the impacted parties, namely, the consumers and in association with that, their improved performance, pertaining to Community Support----or not. If we can do it: you can.

Maybe the problem is ineptitude (the optimistic amongst us might say). However, I speculate that the reason that this audit was done in the manner that it was pertains to Hooker Odom's and DD/MH/SA, 'The Department's' desire to frighten Endorsed Providers and make sure their paperwork is straight----beyond any services that might be rendered to the consumers/ client.

The American Psychological Association has worked for a long long time to create an accurate system which reflects the amount of time that psychologists utilize in order to do things like write a report or organize an assessment. (see: Ratio Value Factor) The end product, for instance, a psychological assessment, was not being accorded the 'relative factor unit' or time necessary in order to create the end product, for instance, the psychological assessment.

Information re: 'relative value factor' or 'relative value unit' is what we are talking about here. Again, why should these 4 criteria be accorded the same value? They do not require the same in terms of input for the Endorsed Providers and so why should DHHS impose (we already know that under Hooker Odom there is no collaboration) this invalid design as associated with our work?

In any case, the matter of evaluating 'ratio value factor' has been used for some time in order to map out just how much work takes place with, for instance, a CPT code. To suit:

"What is the Relative Value Unit of a Code?

The relative value unit (RVU) of a CPT code is one factor that determines what Medicare will pay for the service described by that code. HCFA multiplies the code’s RVU by a monetary conversion factor and the result is essentially the amount Medicare will pay for the service. (There are some adjustments made for geographic differences in resource costs.)"http://www.resna.org/taproject/goals/other/healthcare/CPTcodes.htm

The creators of this methodology might benefit from taking into account the difference in time as associated with each of these 4 criteria. And they might make measurements based on the outcomes of the interventions, rather than reviewing the paperwork, an indirect assessment of the intervention.

You would have been better off if you had listenedto the Joint Legislative Committee (Nesbitt and Insko) who suggested----as you saw how much money was being spent on community support----to have based the matter on the qualifications of the people doing the hands-on work. The audit seems to have been desperately driven by the need to staunch the flow of Community Support dollars. So, you gigged the providers.

So, we have an invalid piece of research which does not assess what you were (assumably) trying to assess and that was: what is the quality of the work being done by the Endorsed Providers as associated with Community Support......

....and the taxpayers paid for this invalid piece of research. I would like to know how much the tax payers paid.

At the most basic level, this audit has no validity. The gigging of Community Support providers has no validity because the severe reduction in hours and the diminishment of the hourly rate was stated to be based on the audit:

1. DHHS did not even bother to consult with the providers who do the work in terms of the creation of the items (all those 20 Community Support people either sat on their hands or you did not ask them and you already had your instrument in place prior to 'pretending'? to be working with them. )

2. ....which led you to create an invalid tool.

You have skewed the data and your research has no merit. Statistics is black and white with few shades of gray. If you were a dissertation student of mine, you would have been sent back to 'go.'

I would like to hear from Ms. Larson and Ms. Carter, please.