Monday, May 07, 2007

Mental Health Reform Activities on May 7, 2007 : the 'quality review' tool is law October 1, 2007: SO WHAT'S THE RUSH, LME'S?

There is no mental health reform bills to be discussed on Tuesday, May 8th. We have less than 2 weeks to get a 'reading' of H973 Mental Health Equitable Funding (the mental health parity bill). I've heard from only 2 state legislators today----of the approximate dozen plus necessary to move this things forward. The Speaker's secretary, Emily : <>, I thought, tried to e mail me today but then I got a response that her computer had glitched. hmmmm. I guess I'll be calling quite a few people tomorrow. Again, the list of people that are necessary to contact is below in May 5, 2007's blog.

The below is what took place today, in various stages of the bills being 'read' and voted on. I have presented what appear to me, to be highlights, below. And of course, as you might expect, I have made comments. :
H.B. 627 Extend Pilot/Clarify LME Functions/LME Admin.
H.B. 1522 Local Mgmt Entity/Board Membership.
H.B. 1541 LME Providers/Accept Non-Medicaid.
H.B. 1557 LME Restructing Pilot/Funds.
H.B. 1654 Clarify MH/DD/SA Rule Making Authority.
H.B. 1784 Improve MH/DD/SA Quality Control - LMEs


"...An individual that contracts with a local management entity (LME) for the delivery
of mental health, developmental disabilities, and substance abuse services may not serve
on the board of the LME for the period during which the contract for services is in
effect." Gee, if this has been in place associated with Western Highlands LME, there would probably be an emergency psychiatric center for children and adolescents. So, this gets a thumbs up.

5 The General Assembly of North Carolina enacts:
6 SECTION 1. Local management entities providing mental health,
7 developmental disabilities, and substance abuse services under contract with a provider
8 shall require under the contract that the provider also provide services to LME clients
9 who are not Medicaid eligible, who are part of the target population, and whose services
10 are paid for using State funds. The contract between the LME and the provider shall
11 also require that the provider's services under the contract shall be composed of seventy
12 percent (70%) Medicaid-eligible clients, and thirty percent (30%) non-Medicaid eligible
13 clients in the target population whose services are paid for with State funds...."
Well, blow me down. Then how is Smoky Mountain (SMC) LME (7 western NC counties) going to deal with this? All the state clients in the SMC catchment area are mandated to go to Meridian---to peer groups----and its not uncommon for people do refuse this offer----and so how will this LME come into compliance with this bill? Its a matter of 'choice'----what mental health reform was (1000 years ago) about. State clients have no choice.

".....the sum of one million four
12 hundred ninety-two thousand dollars ($1,492,000) for the 2007-2008 fiscal year, and the
13 sum of one million nine hundred thirty thousand dollars ($1,930,000) for the 2008-2009
14 fiscal year. These funds shall be allocated as nonunit cost reimbursement funds for the
15 Albemarle Local Management Entity (LME) to design and implement the business
16 structure for a five-year pilot program...."
Albermarle county gets special Rx for some reason....perhaps someone knows...

"It shall
12 also include post-payment clinical reviews of targeted consumers
13 utilizing a standardized quality review tool....
This act becomes effective October 1, 2007"
So, I want to know this: why are the LME's so hot to start this post-payment clinical review of targeted consumers (everyone is targeted) if it does not become the law until October 1, 2007??
Get a load of the all the groovy new paperwork DHHS has thought up for providers re: this 'clinical review'(as per the above): There's going to be a non-stop chain of letters crossing each other. This should work very well:

1st Written Request to Provider for Medical Record
(Allow 7 business days from the date of the letter)

Request to Provider for Record OR for Missing documents
(Allow 5 business days)

LME notifies DMA that record has not been submitted and payments from DMA will be suspended until complete record is received at the LME
This is what is taking place as a result of the flimsy, non-transparent, audit that Hooker Odom cooked up. I still have no information about the details of the audit. I want to know why Endorsed Provider companies are being demanded-----about to be law!!----re: this post-payment clinical review WHEN THE DETAILS OF THE AUDIT HAVE NOT BEEN MADE PUBLIC: the hallmark of quality research is the release of raw data so that other researchers may look it over. WHERE'S MY AUDIT INFORMATION??
Here is what I asked via Verla Insko in terms of the audit which is driving the above paperwork which is drowning Endorsed Provider companies:
1. How many Endorsed Providers are there in NC? (in other words, what is the overall 'n' or number of Endorsed Providers from which the 167 were gathered.
2. Were the 'passpoints' of 50% and 75% as associated with Gps 1,2,3 set:
a. arbitrarily?
b. norm-referenced? (there is no normative data and so that is not possible; in other words, this matter has not been studied before and a set of data carefully created in order to evaluate subsequent behaviors is not in existence)
c. criterion referenced? If so, what were the criteria utilized in order to make the judgments and render the percentages? In other words, how was it that 50% and 75% were chosen? There is no clear reason to do this. It is assumed to be arbitrary. And that does not suffice.
3. What were the target measures associated with rendering the scores, the percentages, the cut-offs? What did the raters look at besides the fact that these were the 167 heaviest billers in NC?
4. What is the impact of having chosen this skewed population of 'heaviest billing' Endorsed Provider companies? One might assume that Endorsed Providers who heavily bill might make more errors related to volume of paperwork. IN that case, the notes of '4 or more notes missing' would not have much meaning as against the volume of billing that was taking place. They chose this population in order to see what they wanted to see.
5. Who were the raters?
6. 6. What was the problem w/ the other 7 providers in Category 3 (as associated with missing data e.g., no information about 'missing notes and/ or what the criterion measures were).
This returns us to the question of what were the target measures? It looks to me like the target behaviors associated with this aqudit were two things and TWO THINGS ONLY: the percentage of paraprofessionals and how many notes did these heavy billing agencies miss of those perused. The Service Definitions associated with Community Support do not forbid the use of paraprofessionals so tell me what the purpose of the audit is other than to make Governor Easley "look like" he is keeping an eye on the utilization of Medicaid Community Support Services (and any other kind of Community Support services e.g., state funded clients) .


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