>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
****************************************************
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
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
*********************************
".....I had a conversation with the woman who is head of NAMI NC this afternoon ("Ms Nihoff"
/servdefupdates/dmadmh4-24-07update27.pdf
****************************************************
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
posted by Marsha V. Hammond, PhD at 10:17 PM
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