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: RE: your below e mail associated with Community Support audit

Ms. (Tara) Larson:

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.


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