It's Prety Bad when you have to COMPLAIN ABOUT THERE BEING NO COMPLAINT FORM
Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC
Mailing address: Asheville, NC 28806
Cell: 404 964 5338 fax: 828 253 2066
E mail: hammondmv@netzero.com
November 16, 2007
RE: formal complaint pertaining to administrative policies of Smoky Mountain Center LME
Dear Bill Hambrick:
This is a formal complaint related to an administrative procedure being followed by SMC LME. I wrote an e mail re: this matter this past week to you; Marsha Coe; Steve Puckett, PhD, Charles Barry. I am following it up w/ a formal letter of complaint posted to the SMC US Mail address. I wish that I could say that it is my understanding is that this must be attended to by the LME within a time-frame. However, in that there is no formal policy for providers to utilize for complaints about the LME, its hard to tell how far this will go or if it will go anywhere at all. Therefore, the co-chairs of the Joint Legislative Committee for NC Mental Health Reform (Insko; Nesbitt) are cc'd.
The (Bulletin 7#77) ‘LME Complaint Reporting’ http://www.ncdhhs.gov/mhddsas/announce/commbulletins/commbulletin77/lmecomplaintreporting8-07.pdf appears to be the most recently revised information (Revised August 13, 2007).
I believe it is an administrative issue complaint in accord w/ the information associated with Bulletin #77: “Administrative Issues Any concerns regarding administrative issues such as compliance with rules, paperwork, facility-related (not incident or safety concern), etc.”
As background associated with my complaint which I have reiterated many times : I do not provide CSS. I provide Individual Therapy. I am affiliated w/ Direct Care, LLC, an Endorsed Provider. In several telephone conversations, Individual Therapy, CPT code 90808, is what was approved by the ACCESS lead care manager, Marsha Coe for two state funded clients. CPT code 90808 is what was submitted via the BUI electronic authorization web page associated with www.smokymountaincenter.com. The authorization request for 90808 was apparently changed by SMC LME to a CSS coding and/ or stream of money. I do not know the reason and neither is it my business.
Charles Barry, Quality Control Manager at SMC LME, then required me to have 20 hours of CSS training in order to receive and keep my money paid to me by SMC LME for servicing the two clients in agreement w/ phone conversations w/ Marsha Coe.
Barrance Robert, who heads up Direct Care LLC has returned the money paid to me as Charles Barry’s office threatened Direct Care LLC w/ an audit if I did not go through CSS training. I am not going to go through 20 hrs/ CSS training when I do not provide CSS. I want to be paid the money I earned. This is the background of this complaint.
Bulletin 77, DHHS NC, concerns itself with ‘complaints.’ I cannot use the complaint form associated with that bulletin, specifically, The Customer Service Form (ACS01): http://www.ncdhhs.gov/mhddsas/announce/commbulletins/commbulletin77/lmecomplaintreporting8-07.pdf, as the form is to be used by LME staff. That form states at the top: “Purpose: This form is to be used by Local Management Entity (LME) staff to document customer service issues such as concerns, complaints, compliments, investigations, and requests for information involving any person requesting or receiving publicly funded MH/DD/SA services from a LME or a MH/DD/SA services provider.”
The form appears to assume that private providers will not have complaints about the LME and/ or the private provider will deny services to the consumer, the consumer will make a complaint, and the LME will then address the issue. If the private provider is ethical, the private provider cannot in some cases withdraw from the client. Not only would this create a therapeutic impasse, but it could create a serious ethical dilemma for the private provider.
Neither does this Bulletin appear to be associated with a complaint against an LME; it is the consumer who makes the appeal:
Bulletin #067 Update to Bulletin #063 Non-Medicaid Appeal Process
12-18-06
http://www.ncdhhs.gov/mhddsas/announce/commbulletins/communicationbulletin67-12-19-06.pdf
Neither does this Bulletin appear to be associated with a provider making a complaint about an LME:
Bulletin #063 Memo re: Non-Medicaid Appeal Process
10-9-06
Neither does this bulletin allow providers to complain about the LME:
Bulletin #056 Memo re: LME Complaint Reporting
6/12/06
That takes us back to August, 2005 and I did not continue to look for ways to formally complain about the LME as it would be out of date and certainly not considered as on the correct form.
So, my complaint is also about not having a complaint form to complain upon.
I am not willing to risk harm to the state funded clients I see because there is no appropriate complaint form as associated with the notion that there is no need to complain. If there is a complaint form buried in the NC DHHS bulletins, if someone will kindly point it out, I will be glad to fill it out.
In speaking to SMC employee Shelly Lackey today on the phone as associated with this process and bringing my complaint before the SMC LME board, SMC Human Rights Committee, and SMC CFAC, she agreed to pass my name to the two Haywood citizens who serve on that committee. I have also contacted Haywood County Commissioner Mary Ann Enloe.
Thank you for taking the time to read this letter of complaint and I am happy to provide you w/ any information which may not be clear.
Sincerely,
Marsha V. Hammond, PhD: Clinical Licensed Psychologist
Cc:
Chris Fitzsimmons, NC Policy Watch
DMH/DD/SAS Customer Service Office
DMH/DD/SAS Customer Service and Community Rights Team
Phone: (919) 715-3197 Fax: (919) 733-4962 dmh.advocacy@ncmail.net
DMH/DD/SAS Customer Service and Community Rights Team
Phone 919-715-3197 FAX: 919-733-4962
Glenda Stokes or Cindy Koempel
Customer Service and Community Rights Team
Advocacy and Customer Service Section
Division of MH/DD/SAS
North Carolina Department of Health and Human Services
3009 Mail Service Center
Raleigh, NC 27699-3009
FAX: 919-715-3197
Phone: 919-733-4962
CoChairs of the Joint Legislative Oversight Committee: Verla Insko; Martin Nesbitt
Tara Larson, DHHS NC
Shelly Lacky; Charles Barry; Steve Puckett; Bill Hambrick; Tom McDeviltt; Doug Trantham: Marsha Coe: SMC LME
NC Advocacy MH listserv
NC Psychological Association
Madame Defarge: NC Mental Health Reform blog
Mailing address: Asheville, NC 28806
Cell: 404 964 5338 fax: 828 253 2066
E mail: hammondmv@netzero.com
November 16, 2007
RE: formal complaint pertaining to administrative policies of Smoky Mountain Center LME
Dear Bill Hambrick:
This is a formal complaint related to an administrative procedure being followed by SMC LME. I wrote an e mail re: this matter this past week to you; Marsha Coe; Steve Puckett, PhD, Charles Barry. I am following it up w/ a formal letter of complaint posted to the SMC US Mail address. I wish that I could say that it is my understanding is that this must be attended to by the LME within a time-frame. However, in that there is no formal policy for providers to utilize for complaints about the LME, its hard to tell how far this will go or if it will go anywhere at all. Therefore, the co-chairs of the Joint Legislative Committee for NC Mental Health Reform (Insko; Nesbitt) are cc'd.
The (Bulletin 7#77) ‘LME Complaint Reporting’ http://www.ncdhhs.gov/mhddsas/announce/commbulletins/commbulletin77/lmecomplaintreporting8-07.pdf appears to be the most recently revised information (Revised August 13, 2007).
I believe it is an administrative issue complaint in accord w/ the information associated with Bulletin #77: “Administrative Issues Any concerns regarding administrative issues such as compliance with rules, paperwork, facility-related (not incident or safety concern), etc.”
As background associated with my complaint which I have reiterated many times : I do not provide CSS. I provide Individual Therapy. I am affiliated w/ Direct Care, LLC, an Endorsed Provider. In several telephone conversations, Individual Therapy, CPT code 90808, is what was approved by the ACCESS lead care manager, Marsha Coe for two state funded clients. CPT code 90808 is what was submitted via the BUI electronic authorization web page associated with www.smokymountaincenter.com. The authorization request for 90808 was apparently changed by SMC LME to a CSS coding and/ or stream of money. I do not know the reason and neither is it my business.
Charles Barry, Quality Control Manager at SMC LME, then required me to have 20 hours of CSS training in order to receive and keep my money paid to me by SMC LME for servicing the two clients in agreement w/ phone conversations w/ Marsha Coe.
Barrance Robert, who heads up Direct Care LLC has returned the money paid to me as Charles Barry’s office threatened Direct Care LLC w/ an audit if I did not go through CSS training. I am not going to go through 20 hrs/ CSS training when I do not provide CSS. I want to be paid the money I earned. This is the background of this complaint.
Bulletin 77, DHHS NC, concerns itself with ‘complaints.’ I cannot use the complaint form associated with that bulletin, specifically, The Customer Service Form (ACS01): http://www.ncdhhs.gov/mhddsas/announce/commbulletins/commbulletin77/lmecomplaintreporting8-07.pdf, as the form is to be used by LME staff. That form states at the top: “Purpose: This form is to be used by Local Management Entity (LME) staff to document customer service issues such as concerns, complaints, compliments, investigations, and requests for information involving any person requesting or receiving publicly funded MH/DD/SA services from a LME or a MH/DD/SA services provider.”
The form appears to assume that private providers will not have complaints about the LME and/ or the private provider will deny services to the consumer, the consumer will make a complaint, and the LME will then address the issue. If the private provider is ethical, the private provider cannot in some cases withdraw from the client. Not only would this create a therapeutic impasse, but it could create a serious ethical dilemma for the private provider.
Neither does this Bulletin appear to be associated with a complaint against an LME; it is the consumer who makes the appeal:
Bulletin #067 Update to Bulletin #063 Non-Medicaid Appeal Process
12-18-06
http://www.ncdhhs.gov/mhddsas/announce/commbulletins/communicationbulletin67-12-19-06.pdf
Neither does this Bulletin appear to be associated with a provider making a complaint about an LME:
Bulletin #063 Memo re: Non-Medicaid Appeal Process
10-9-06
Neither does this bulletin allow providers to complain about the LME:
Bulletin #056 Memo re: LME Complaint Reporting
6/12/06
That takes us back to August, 2005 and I did not continue to look for ways to formally complain about the LME as it would be out of date and certainly not considered as on the correct form.
So, my complaint is also about not having a complaint form to complain upon.
I am not willing to risk harm to the state funded clients I see because there is no appropriate complaint form as associated with the notion that there is no need to complain. If there is a complaint form buried in the NC DHHS bulletins, if someone will kindly point it out, I will be glad to fill it out.
In speaking to SMC employee Shelly Lackey today on the phone as associated with this process and bringing my complaint before the SMC LME board, SMC Human Rights Committee, and SMC CFAC, she agreed to pass my name to the two Haywood citizens who serve on that committee. I have also contacted Haywood County Commissioner Mary Ann Enloe.
Thank you for taking the time to read this letter of complaint and I am happy to provide you w/ any information which may not be clear.
Sincerely,
Marsha V. Hammond, PhD: Clinical Licensed Psychologist
Cc:
Chris Fitzsimmons, NC Policy Watch
DMH/DD/SAS Customer Service Office
DMH/DD/SAS Customer Service and Community Rights Team
Phone: (919) 715-3197 Fax: (919) 733-4962 dmh.advocacy@ncmail.net
DMH/DD/SAS Customer Service and Community Rights Team
Phone 919-715-3197 FAX: 919-733-4962
Glenda Stokes or Cindy Koempel
Customer Service and Community Rights Team
Advocacy and Customer Service Section
Division of MH/DD/SAS
North Carolina Department of Health and Human Services
3009 Mail Service Center
Raleigh, NC 27699-3009
FAX: 919-715-3197
Phone: 919-733-4962
CoChairs of the Joint Legislative Oversight Committee: Verla Insko; Martin Nesbitt
Tara Larson, DHHS NC
Shelly Lacky; Charles Barry; Steve Puckett; Bill Hambrick; Tom McDeviltt; Doug Trantham: Marsha Coe: SMC LME
NC Advocacy MH listserv
NC Psychological Association
Madame Defarge: NC Mental Health Reform blog
posted by Marsha V. Hammond, PhD at 9:05 PM
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