Tuesday, October 30, 2007

US Broken Non-one-payer Med. System: 2 Hours To (Maybe) Send a Change of Address Form to Medicare

My purpose is to document the problems encountered by this one psychologist as associated with the profound disorganization of the US non-one payer piecemeal system. This post is associated with the 2 hours it (may have: don't know yet) took me to fill out correctly a simple change of address for Medicare services. If you think you can call up and change one's address (even using an efficient system w/ a password) you'd be dead wrong. This is the trajectory to changing a professional address so that you can simply get paid.

1. simply find the correct form online. Why do I need this? Because I cannot get paid otherwise. in order to do this, you have to call until you don't get a busy signal (took me 20 times) in order to be put on hold x30 min, in order to speak to someone who can direct me to the correct online place for the change of address form, CMS 8551. Also need to file an electronic funds transfer form CMS 588. As of 2006, you can no longer receive a check; the funds must be electronically transferred. There is no information on the forms indicating where you are supposed to send them...thus, the search.

2. fill out the forms (approx 30-45 min to pull together all the information). Unlike all other Medicaid/ Medicare information, the form CMS 588 is supposed to be filled out w/ blue ink.

3. EVen though I call the Bank of America local number in order to find out the 'dspository contact person', I get a phone calling system who then has to route me back to my local bank so I can get a name required for the form.

4. Where to send the information? As directed by the form, I go to a CMS website. There is a list of people, 3 sites in NC, to be exact, and one that looks like it pertains to my forms. However, he is not at his phone. Go back to computer to look for further information associated with CMS/ Medicaid/ Medicare. Turn up the DMA person, Brenda Reid, in Raleigh. She states that today, "I received a form 8551 but its not supposed to come here...I don't know why we are getting these forms." She tells me that one form goes to EDS and the other to a person, Lisa Webb, Provider Enrollment Specialist for Clinical Psychologist. I get her secretary; then hit the wall of no one at her desk. Is she the one who needs to get the form 8551 or should I make out several copies and send them in every direction? Do I need to fill out all the form 8551 as in one place online under CMS I see that if you are submitting a new 588 form that you should fill out ALL of form 8551 even though one is only changing one's address.

5. Now I go back to yet another arm of Provider Relations, the one that has to do w/ where my Medicare 'pending' check is, in order to see how long it is going to take for any (correctly delivered) change of address is going to take. Since I have been waiting x 6 mos now to get paid since filing my paper Medicare claims and then electronic via Medicare Claims Express, claims-----what's a few more weeks? I can continue to plough thru my savings waiting to get paid.

6. I sent in these 2 sets of paperwork earlier this year and it apparently went nowhere.

You can explain the high cost of medical care in this non-one-payer system of a country by simply documenting the time it takes to simply get one's office address changed. You have to stand on your left foot, cross your left arm over your right shoulder, make sure you're facing Raleigh, blink 2 times exactly, no more------and then maybe, just maybe, you can get your paperwork through.

Tuesday, October 16, 2007

NC DHHS : creation of job coaches (who will be quickly removed) in order to destroy sheltered workshops : ARBEIT MACH FREI

"State should rethink closing sheltered workshops published October 9, 2007

"North Carolina appears poised to dismantle another successful program for an uncertain and highly suspect alternative that will surely fail, just as mental health reform has failed, without adequate funding and community alternatives.

The state is moving toward closing sheltered workshops such as Haywood Vocational Opportunities that employ people with developmental disabilities.

The objective is to move people out of workshops and into jobs at retail stores, restaurants and other businesses.The Department of Health and Human Services, though, is moving toward what it calls "supported employment," in which people would be placed in jobs in the community. Sheltered workshops apparently would be phased out."

“This is the wave of the future,” said Lisa Jackson, program manager at the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. “Other states have done this, and we’re moving toward it.”

I have something to say about how difficult it is to provide job coaching and jobs for disabled people away from a formal structure like a sheltered workshop (e.g., HVO in Waynesville, NC, which has been around for some decades). When the main sheltered workshop in Atlanta, Atlanta Rehabilitation Center, was closed, some employees sought to create another sheltered workshop. We even had the fairly lucrative contracts transferred (in that particular case it was a putting together of plastic pieces which were the electrical harnasses for cars). We were certainly naive.

And so now we have NC DHHS attempting to outsource all the disabled people into the community-----where they are not wanted; not appreciated; are ill-prepared to work in acompetitive environment; and will (you can bet your bottom $$) will have the job coaching removed as soon as they are in a job for a period of time. For, you see, DHHS NC is utilizing a rehabilitation model which does not accommodate anyone with a life-long mental challenge, be it mental illness or developmental disability.

This will not work and it particularly will not work under NC DHHS as the agenda is to pull the rug out from under the services after a period of time. You've used up all your points, DHHS, and now we truly do not trust you to do whatever it is you think we're believing. Every single DHHS agenda since mental health reform began in 2001 has been predicated on creating a service in order to eventually dismantle it.

Research indicates that this is necessary: http://psych.iupui.edu/users/gbond/pdfs/99%202002%20bond%20qseis%20jvr.pdf

Journal of Vocational Rehabilitation 17 (2002) 239–250 239
IOS Press A scale to measure quality of supported employment
for persons with severe mental illness

"...Follow-along supports are continuous: Individualized supports to maintain
employment continue as long as consumers want the assistance...."

This will lead to time and again losses of jobs; accelerating depression on the part of the clients; and collapse of the sheltered workshop industry which has been carefully put together over decades.

Over and over I have seen clients placed in the community, in low-paying jobs. The first supervisor who hires them on likes them well enough and understands them. That person leaves. Another supervisor comes on and knows little about the person and the person gets fired. End of story. Recreate the wheel time and time again.

Extremely depressing to the disabled person to the point that they simply will not try to work after a time. So what are DHHS's plans then? To tell them to work or receive no disability pay?

The system will not be able to accommodate this given what we know about DHHS incompetence. There will be mounds of paperwork to fill out re: this illusive 'job coach'; the pay will be poor; no Endorsed Provider company will want anything to do with it unless they can re-create another---yet another----sheltered workshop which will run nothing like the sheltered workshops already in place.

While the supported workshops would not be places where most of us would willingly work related to 'widget production' (putting items into bags; creating surgical sterile trays, etc.) it is work that disabled people commonly find satisfactory. They get away from home (where they become depressed and isolated); earn some money; make some friends.




Under the Nazis, over the entrance to the Dachau Concentration Camp, was this expression: Work Makes you Free. People interned in Dachau didn't get freed by their work; the Russians, part of the Allied Forces, freed them. And work is not freeing if you struggle endlessly to maintain it and have had your job coach pulled. And there is no reason to think that NC DHHS is going to act any differently re: this matter than it has about all other matters under its malfeasant purview.

Just as in the dismantling of the community mental health centers we now face the dismantling of workshops which have been carefully put together over decades. Who runs this state anyway?