Medicaid consumers have no Due Process Rights re: defunding of Community Support Services: WHAT GIVES?

When DHHS began outlining Community Support, how did they speak about it?:
FROM: Allen Dobson, MD Mike Moseley SUBJECT: Enhanced Services Implementation January 19, 2006 MEMORANDUM These new services become effective Monday, March 20, 2006. ".....Medicaid eligible consumers are entitled to due process rights. Medicaid eligible consumers must receive a formal notification, including notification of their appeal rights, for any services that Medicaid continues to cover that are removed from the plan through this procedure. See the discussion of due process notices later in this document.] ... Subjects for Future Updates: Due Process Issues As noted earlier in this correspondence, many Medicaid eligible consumers will need to receive formal notification of service changes and their associated appeal rights as a result of implementation of the new services. We will distribute to LMEs and providers in the next few weeks a standardized letter to be used in those required notices. "
http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/
servdefimplementation1-19-06dmadmh-memo.pdf
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Just how was Community Support envisioned in May, 2007 as per document from DHHS? (bold is mine)
http://www.ncdhhs.gov/mhddsas/servicedefinitions/commsupports/csservdef-referencesheets5-07.doc
"Community Support – Children/Adolescents (MH/SA)Key Elements
Service Definition and Required Components
rehabilitative, and recovery goals.
psychoeducational and supportive in nature .
consists of a variety of interventions: Education and training of caregivers
Preventive and therapeutic interventions
Assist with skill enhancement or acquisition, and support ongoing treatment and functional gains.
Assist the recipient in accessing benefits and services.
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And so can someone tell me how DHHS and by proxy, the LME's, gotten away with limiting ---across the board------Community Support to 12 hours/ week/ consumer WITHOUT advising Medicaid consumers of Due Process Rights?
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Medicaid Appeal cases: http://www.nls.org/conf/dueprocess.htm
MEDICAIDDUE PROCESS ISSUES - NOTICE AND HEARINGS
III. Case Law Concerning Medicaid Fair Hearing
A. Denial, Suspensions, Terminations & Reductions, i.e. Changes in Care
C. Across-the-Board Changes (Sole Issue of Federal or State Law)
Eder v. Beal, 609 F.2d 695 (3d Cir. 1979), cert. Denied, 444 U.S. 950 (1979). Notice required to implement various across-the-board reductions in Medicaid benefits.
****************************************
FACT SHEET
MEDICAID’S AMOUNT, DURATION AND SCOPE REQUIREMENT:
CHALLENGING CUTS TO SERVICES FOR ADULTS
Prepared by:
Sarah Somers, Staff Attorney
National Health Law Program
March 31, 2004
"...Beneficiaries have challenged the sufficiency of Medicaid services numerous times over the past thirty years, however, no concrete rule has emerged as to what constitutes a sufficient amount of services.....“the Medicaid agency may not arbitrarily deny or reduce the amount, duration or scope of a required service under §§ 440.210 and 440.220 to an otherwise eligible recipient solely because of the diagnosis, type of illness or condition.”36"

DHHS continues to create barriers to mental health delivery in NC

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC email: hammondmv@netzero.com

Ms. Galloway, (DHHS employee: Leesa Galloway ):

I challenge you to evidence the e mails from mental health providers who stated that your new PCP forms 'were wonderful.' LAST YEAR's or actually EARLIER THIS YEAR'S PCP (Person Centered Forms) were easily manipulatable by simple double clicking. Not only are the forms CHANGED but they are running on software so new that mental health practitioners, instead of working with clients, are sitting here typing complaints to you and others at DHHS.

Accordingly, you stated this in your e mails to me: "The reason I said "it was wonderful" was based on the feedback other providers has sent to us." (as regards the mandated, as of July 15, 2007, PCP short form----yet another form that DHHS is requiring----in order for consumers to receive services).

As far as I am concerned, and as associated with other mental health providers, DHHS continues to create barriers to care for NC citizens. Not only was the training for the new PCPs held 2 days prior to its launch but you are utilizing software which many of us are unfamiliar with, namely a sophisticated version (it appears) of Windows Office. Elsewhere in the state the training was held after the mandated launch date. AND the instructions on the PCP tips site do not include all the steps. If the purpose of mental health reform is (lest we forget the original agenda) to get the services to the citizens, DHHS continues to create barriers to this taking place in terms of:

1. training that is right up against a launch date

2. constant changing of the forms such that providers have to throw out what they have and recreate it into yet another form

3. (not to mention the non technical side of the matter): having the LME's investigate mental health providers who have given the allotted more than 12 hours of Community Support last year to NC Medicaid citizens to THIS YEAR be told that their Diagnostic Assessments---which was not required last year----is required. LAST YEAR, the recent DSM, psychiatric diagnosis, rendered by a qualified mental health provider was sufficient. THIS year, and after the rendering of the Community Support services were given and paid for, a rubric has been post facto created associated with judging the quality of the Diagnostic Assessment which LAST YEAR was not required and so was therefore UNTETHERED to the Community Support Services which were rendered LAST YEAR. And so when the now required Diagnostic Assessment does not meet the criteria related to the need for the Community Support, (because the provider did not have to create the Diagnostic Assessment as part of the Community Support hours requested LAST YEAR), the administrative, master's level LME person THIS YEAR is telling the clinical doctoral psychologist that indeed the Diagnostic Assessment does not indicate that Community Support services were merited.

As far as I am concerned, the ongoing incompetency of DHHS continues and that agency is running mental health reform straight into the ground. It is obvious that DHHS is either completely unconscious of the effects pertaining to this lack of stability in terms of these kinds of issues----OR you simply want mental health reform to fail OR you simply do not want NC citizens to have these services as associated with these concocted barriers. None of these reasons is OK.


Feel free to pass this to anyone you like.

Sincerely, Marsha V. Hammond, PhD: Licensed Clinical Psychologist



At 12:41 PM 7/20/2007 -0400, Leesa Galloway wrote:


The reason I said "it was wonderful" was based on the feedback other providers has sent to us.

>12 hours of Community Support for Medicaid clients, even though they have this covered service, WILL NOT BE TOLERATED BY DHHS

Here's the rub RE: anyone nervy enough to utilize more than 12 hours of Community Support for Medicaid clients (and this is their right and part of their coverage):

NOW ONLY 12 hours of Community Support will be gone after by ANY mental health practitioners/ sets of practitioners. PERIOD. This is what you get when you go beyond 12 (see below): (it does not matter that DHHS cannot deny Medicaid citizens from having Community Support the PLAIN FACT OF THE MATTER is that no set of providers wants the hassle of this kind of perusal/ follow-up/ challenge/ expending time to go thru the DHHS memos to prove that what they said a few months ago is now what they say NOW. We only have so much energy and we are careful, if we are smart, to expend in a useful fashion. Taking on the LME's who are the whipping boys of DHHS is not a good expenditure of energy.

As associated with an organization with which I work, 35 plus charts of any consumer receiving more than 12 hours of Community Support in Smoky Mountain Center and Western Highlands LME (and none for community support less than this) has been pulled for going over by a fine tooth comb. This means that every document must be 'perfect copy' (no mistakes); every document must match up to each other; any assessments must support the Community Support (an important point: it does not matter that diagnostic assessment was NOT required when the services were rendered but are NOW required post rendering of services; since it is NOW required it has to match the Community Support services that were made available even though NO assessment was required; thus, the practitioner, though the client had a legitimate DSM diagnosis, and this was acceptable re: DHHS implementation guidelines at the time, as associated with this post review which is detailed in the below URL, the providers are now gigged associated with requirements which were not in place when the Community Support services were rendered). This is nothing different than what we knew was about to happen when Hooker Odom gigged all the mental health providers re: post payment reviews. It is only taking time to move to fruition.

Proof? (yada yada, SMC personnell will tell you that 'all' Community Support hours are perused but this document tells a different story and all that would need to happen is to gather the statistics associated with the edict prior to Hooker Odom telling all the Community Support providers that 'you're being investigated -----April, 2007-----, and POST to that date); all you need to do is look at this online training given in May, 2007, to the LME administrators, re: 'what we do with people who ask for more than 12 hours of Community Support.' (referring to Implementation Memo No 27: http://www.ncdhhs.gov/mhddsas/servicedefinitions/commsupports/dhhs-lmepostpayreview5-07training1.ppt#258,5,Implementation Memo #27; this is reiterative of the information at my blog, Madame Defarge: (April 30, 2007: http://madame-defarge.blogspot.com/2007_04_01_archive.html

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".....I had a conversation with the woman who is head of NAMI NC this afternoon ("Ms Nihoff" regarding whether there are 12 or 15 hours available of Community Support. You have to return to the Implementation Update #27 and look at it very carefully in order to see just how sly DHHS, under Hooker Odom, has become. The document is signed by Allen Dobson, MD and Mike Mosley, Director of MH. http://www.ncdhhs.gov/mhddsas/servicedefinitions
/servdefupdates/dmadmh4-24-07update27.pdf

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You cannot cut and paste this document (http://www.ncdhhs.gov/mhddsas/servicedefinitions/commsupports/dhhs-lmepostpayreview5-07training1.ppt#258,5,Implementation Memo #27). Go to the site and see what the LME personnel are being told to do to the providers. more than 12 hours of Community support provided over the past year? OFF WITH YOUR HEAD: the post review assessments are being given poor marks, even though the diagnosis was in place and this was the requirement of DHHS at the time; the records are being sent to DHHS so that the providers can then be subjected to payback re: community support that was rendered in good faith to citizens, with DHHS then changing the rules.

Godalmighty: somebody sue these people. All this paperwork and no care of the clients.

marsha hammond, phd

DHHS paperwork created by incompetents: no services by default: ANYONE SEEN KARL ROVE?

Marsha Hammond, PhD: Licensed Psychologist

e mail: hammondmv@netzero.com

July 19, 2007

RE: non usability of forms necessary for clients to receive services

Hello:

I want to illustrate just what practitioners have to put up with on a regular basis from DHHS. By that I mean every time you interface with DHHS. This is not unusual.

Not only do they change the forms, willy-nilly, for no apparent good reason other than they have re-invented, yet again, a concept associated with paperwork pertaining to the care of clients, but their methods and forms do not work. I cannot begin to describe how exasperating it is to work with DHHS and by default, the LME's.

When the reporters write about the clinicians who do not seem to want to see indigent clients, be sure and include these kinds of difficulties and see just how many business people would put up with this.

Take for example this form, the PCP short form. This must be submitted if a client is to receive Community Support Services and some other Medicaid services. When you open the form, you can fill in the first page of information at the top e.g., the name, Medicaid number, etc. But then if you proceed to pages 3,4,5, you cannot 'open' the top of the document which means that you have to hand-write the information which one might assume is unacceptable to DHHS.

Yes, this is the level of problems at this agency. Not only do they constantly change the forms, but they are incompetent at creating them.

I guess I am resigned to embarassing them in front of the citizens in order to get something done.

argh.

marsha hammond, phd

Go ahead: try it for yourself. Try to put anyone's name at the top of page 3,4,5. yes, I know: you'd think it wouldn't matter, that you don't have to type it in. You'd be wrong.

http://www.ncdhhs.gov/mhddsas/training/access-care/introductorypcp7-11.07.doc

ELEPHANT TALK:DHHS only cares about the paperwork; torpedo-ing Carl Rogers 'client centered thinking',humanistic psychologist of great fame

Dear Jennifer (Hancock: of MHA , Mental Health Association, in Wilson County):

I appreciate your thoughts below re: the value of person centered thinking as associated with perhaps shaping DHHS protecol. I think you're barking up the wrong tree.

Carl Rogers, a famous humanistic psychologist, invented this over 50 years ago. He was a gentle soul, this creator of client centered thinking but his simple and elegant application is simply lost to this system.

More recently, the DHHS crowd has simply been skimming the web or hanging out in Minnesota so they can launch this 'person centered thinking' to the ooh/ aah of the less well educated crowd who will surely remark about the fine weave of the Emperor's New Clothes:

"Person-Centered Planning has distinctive practices, but all share a common foundation of beliefs: The person at the focus of planning, and those who love the person, are the primary authorities on the person’s life direction."
http://rtc.umn.edu/docs/pcpmanual1.pdf

WHOOPEEE!!

King Crimson - Elephant Talk Lyrics
http://www.seeklyrics.com/lyrics/King-Crimson/Elephant-Talk.html

(Belew/King Crimson)
Talk, it's only talk
Arguments, agreements, advice, answers,
Articulate announcements
It's only talk

Talk, it's only talk
Babble, burble, banter, bicker bicker bicker
Brouhaha, boulderdash, ballyhoo
It's only talk
Back talk

Talk talk talk, it's only talk
Comments, cliches, commentary, controversy
Chatter, chit-chat, chit-chat, chit-chat,
Conversation, contradiction, criticism
It's only talk
Cheap talk

Talk, talk, it's only talk
Debates, discussions
These are words with a D this time
Dialogue, dualogue, diatribe,
Dissention, declamation
Double talk, double talk

Talk, talk, it's all talk
Too much talk
Small talk
Talk that trash
Expressions, editorials, expugnations, exclamations, enfadulations
It's all talk
Elephant talk, elephant talk, elephant talk

How about some person centered thinking as pertains to the mental health practitioners? That might include mechanisms like: decide on a route and think about it carefully enough that you don't change in several months OR when you determine that you want to provide consumers services like Community Support, you don't turn around 1 yr hence and then state that records will then be inspected for services e.g., Community Support, for over-use----when the use hours were available at the beginning of the agreement OR stop torturing the providers of Community Support to the extent that the citizens simply will not, under any circumstance, obtain more than 12 hours/ week re: intensive overview. It reminds me of being out the other night, dropping the outgrown clothes over at the Goodwill, and being stopped by the police who thought I was looking for crack because I was driving past Deaverview housing projects in West Asheville. I don't need that kind of scrutiny. They searched my car for 45 minutes and got very excited about my orange enteric coated aspirin.

Until DHHS, and the LME's in association with DHHS, stops creating confusion via an uninterrupted flow of paperwork changes (we now have as of July 15th, a short version of the PCP, which means we have to take our long versions, reformat it, send it back in, along with an ITR, to Value Options, in order to obtain Community Support service.....(not thru yet) .....and then within 30 days create the fuller PCP (15 plus pages) and an assessment (we now have a menu of choices all the same in terms of more work and no new information) and then we turn that into the LME.

It appears that these people have nothing to do but create some new way of thinking about matters WHICH MATTERS NOT A WHIT RE: PATIENT CARE.

We do not have time to see the clients. However the paperwork looks GREAT.

And you don't dare ask for more than 12 hours of Community Support or your case, whether well put together or not, will then be sent by the LME to DHHS whereupon, undoubtedly, they will gig you and ask you to pay back money.

Enough already. This state is lucky to have ANY mental health providers other than those who prescribe meds----and there are way too few of those. I have become more and more pessimistic and am actively seeking ways to disengage myself from any of this.

And don't get me started on the additional paperwork for state funded clients. The news services and their commentators will wax on, as did recently a Greensboro woman, reporter even! about how providers seem to avoid the more difficult, indigent clients. My dear: that is only because the paperwork will drown the most determined practitioner.

Marsha Hammond, PhD, Licensed Psychologist, buncombe and haywood county