Tuesday, May 08, 2007

Rep. Alexander's office: H973 just passed Health committee today; headed to Insurance committee; ALSO, Verla Insko responds re: post payment reviews

People have been telling me that the online color palette I have chosen is not particularly helpful. Let's see if these are OK. I am a persistently (too) colorful a person, it seems.

I just called Rep. Alexander(Dem106) Martha B. Alexander Mecklenburg 919-733-5807 Marthhaa@ncleg.net. She is the main sponsor of H973 Mental Health Equitable Funding (the mental health parity bill). Ann, her secretary, told me that the mental health parity bill has just passed through the HEALTH committee of the state legislature and will now move to the INSURANCE committee. I'm doing what I can to follow it. It seems to me that if mental health parity goes into place, a lot of piddly arguments will have to cease. It will be a whole new ball game. Maybe there's some way they can screw it up, but I do not see it at this point in time.

Related to the previous day's post querying why were LME's NOW in such a hurry to do post payment reviews, Verla Insko wrote me and stated:
"The Dept/Division has the authority to order post payment clinical reviews anytime it deems them necessary. These are taxpayer dollars we are using to buy services. The GA wants to make it clear, the LMEs also have the authority to do post payment clinical reviews even when they are not ordered by the Dept. We have a minority of providers who are gaming the system; but if we don't have effective monitoring tools that apply to everyone and that are used judiciously, the providers who game the system will drive everyone to the bottom because they will make a lot of money and the Dept will be forced to lower rates or reduce hours and then only the low quality providers will be able to stay in business. I assume when you say this bill goes into law on Oct 1, you are referring to the bill clarifying that the LMEs also have this authority. It doesnt' apply to the Dept. and the Dept has ordered the post payment reviews. "
RE: the state funded clients (my concern is at the level that as per Smoky Mountain Center, all state funded clients have been required to go to Meridian Behavioral Health as associated with a contract that SMC has with Meridian; I have been able to keep my 2 state funded clients and this has rewarded me with a great deal of paperowork, telephone calling, etc):
"The bill that requires providers to take non Medicaid patients is not intended to require the LMEs to send them any. Once this bill comes into the public eye as it has with you, it will get more scrutiny." In other words, the LME's may continue to make their decisions about how they take care of state funded clients in a manner in keeping with their catchment area (that's one of the criteria, I guess).


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