Wednesday, August 22, 2007

So NOW the LME realizes there's a problem as providers stop providing Community Support Services

Marsha V. Hammond,PhD, Clinical Licensed Psychologist

'urgent' CSS problems

August 21, 2007

Dear Bill and colleagues at SMC and SMC afffiliated providers:

For the past 6 mos I have sent Bill Hambrick (Smoky Mountain Center LME key administrator) e mail which is part of my documentation of the defunding of CSS at my blogsite, Madame Defarge,which concerns itself with NC mental health reform. I like Bill and I have admired many people part of SMC LME administration. But let me say, my friends, that there is no use in you alerting us NOW at this late point in time to the problem with CSS. You've been given information about the affect on providers and you chose to look the other way or at the very least you never responded to this vexed provider pertaining to what is now becoming 'urgent.'

I would have hoped that you would have leaned on DHHS to let them know just how concerned providers have been. Now you appear to be leaning on providers as you have not listened to them.

You stated that you are concerned about CSS and that you want to: "listen to not only what barriers you are finding, but hear your creative ideas and recommendations as to how such barriers might be resolved. "

I have been telling you since April, 2007 what the barriers are. To put it in a nutshell,these are the barriers:

1. post payment review threats issuing from DHHS and then at the behest of the LME's who carry out DHHS's whims

2. Charles Berry's (your quality control person) gigging of the providers in terms of post payment reviews. Specifically, Mr. Berry's punitive demeanor as associated with post payment review pertaining ONLY to clients receiving 12 hrs/ week/ CSS(contrarily, Tara Larson of DHHS last week stated in Asheville 'there is no magic number of hours' when in fact we know that there is). CSS services were provided in good faith prior to Hooker Odom's vindictive and destructive defunding of CSS in April, 2007. Mr. Berry has applied standards to the post payment review which were not in place prior to the utilization of the CSS which were given in 2006 and early 2007. Yes, quite probably DHHS has 'trained' Mr. Berry and yourselves to do this.

The fact or assumption that you did not attempt to vigorously admonish DHHS about the ramifications of this as associated with this now 'crisis' could have been anticipated months ago.

Mr. Berry is: hard to get in touch with; does not respond in a timely manner; has attended to details that were not his business (e.g., my contract with ------------ went back and forth to him, trying to please him with the right wording, until he finally dropped the ball and I got tired of trying to find him); uses his position to lay into providers who have worked hard to provide services in good faith.

In summary, providers cannot work in this kind of vindictive environment wherein standards that were created by DHHS in 2006 no longer apply in 2007 and indeed standards have been 'value added' subsequent to the services which were rendered in good faith.

Your problem, to my mind, is with DHHS and if you cannot argue with DHHS the affect that their instability in terms of procedures, then really there is nothing to tell or ask providers. If you are in control of monies untethered to DHHS then you better tell us now.

Creative recommendations?

No 1: Give us a quality control person that is amenable to working with the providers that the LME has endorsed. You could benefit from a spokesperson who treats providers as if they are colleagues rather than entities to be disciplined. We do not respond well to threats which would destabilize our companies. We simply will not provide the services.

No2: it would be useful if DHHS heard from YOU as to the above matters. Tara Larson, a key person in DHHS, simply submits that 'I don't know what you're talking about.' If you can't convince them, then no one can.

No 3: make EVIDENCE rather than hearsay that you will support providers who have moved through your endorsement process that you want to work with them as you realize that DHHS shifts criteria and demands. All the SMC LME meetings I have been too hint at the difficulties of working with DHHS but I suppose you are unwilling to speak pointedly to the matter as you are beholden to DHHS. This leaves providers with the feeling that you are simply unwilling to go to bat for us. Moreover, we have to figure out which of what you are saying is true and dependable by endlessly cross-referencing with DHHS/ SMC/ Value Options.

No 4: it was useful to have had the rather recent table from SMC comparing what USED to be acceptable for PCP's , etc., and what is now required. Clear, concise, thoughtful information to providers is always appreciated. This is in contrast to what is stated by DHHS. That information is: backtracking; untethered; confusing; non-overlapping; and hieroglyphic in terms of 'wonder what they mean by that.'

No 5: any well managed ways of creating online (that means we don't go 2 hours round trip to Cullowhee) training such as the refreshingly launch of BUI, is to be commended and recommended. Rick, the BUI guy, was: easy to reach; knew what he was talking about; stayed on the task until it was figured out when the provider called him up.

Please Let me know if someone takes notes from the meeting. I'd be interested in coming to meetings if there is evidence that something is actually being attended to in terms of what concerns the providers. Please do circulate these comments to any pertinent person, including Mr. Berry.

We have all moved to 'no more than 12 hours/ week/ CS' for ANY CLIENT as no one can afford all the time that Mr. Berry demands re: post payment review. Rather than endure that travail, we simply will not go there. So, if your intention was to create that, then you've succeeded.

Additionally, companies find it harder to keep workers as associated with the complete instability of the mental health reform that DHHS has enacted. Thus, you have hold-ups in terms of services. We cannot give workers CSS hours and then pull the rug out from under them several months later. That lends itself to an unfocused, untrained, unappreciated and unappreciative CSS workforce. And they simply quit rather than starve.

To my mind, DHHS has destabilized mental health reform significantly and the LME's have colluded with that.

Sincerely, Marsha V. Hammond, PhD

This is the e mail letter sent to SMC providers alerting them to the problems with Community Support Services (CSS):

To: Community Support Providers Southern Region (Cherokee, Clay, Graham, Haywood, Jackson, Macon, and Swain counties) Date: August 21, 2007

We have an urgent need that necessitates a meeting with Community Support providers from the Southern Region. In recent weeks a number of providers have decided to cease provision of Community Support Services or have limited capacity to receive further referrals, while others wish to select the type of consumer they will serve. This puts consumers in our community at risk. It is our responsibility to ensure consistent availability of services within established standards. We plan to meet that obligation. However, before we take steps to resolve these concerns, we want to meet with you and listen to not only what barriers you are finding, but hear your creative ideas and recommendations as to how such barriers might be resolved. This must be done quickly as the need is urgent and has significant impact on consumers. We plan to host this important problem-solving meeting next Thursday, August 30thth at 4:30 p.m. at the Area Office (following the DVIP training for those providers involved with this). This is your opportunity to have input and be a part of the solution. We appreciate your constructive and resourceful thinking as we move forward with a plan.


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