Wednesday, November 21, 2007

Will The Commission overseeing NC Mental Health Reform act on these Barriers to MH Care in NC?

Marsha V. Hammond, PhD: Clinical Licensed Psychologist : Asheville, NC E mail: cell: 404 964 5338 fax: 8282532066

November 21, 2007

RE: rules query; complaint against Smoky Mountain Center LME

Dear Floyd McCullouch, Chair of the Rules Committee of The
Commission for Mental Health, Developmental Disabilities, and ubstance
Abuse Services (MH/DD/SA); Pender McElroy, Chairman of the
Commission (MH/DD/SA); and, other members of The Commission:

I am writing you as associated with several matters. All of these concerns are associated with the barriers to providing mental health services in NC by myself, a doctoral level psychologist licensed in NC.

I understand that the Rules Committee, of which Mr. McCulouch is chair, meets at the Clarion Capitol Hotel in Raleigh on January 16, 2008, 9:30 a.m. Subsequent to that, as per my telephone conversation w/ Rose Ann Forbes of Asheville, a member of both the Rules Committee as well as the Commission itself, there is a meeting of the full Commission on February 14th, beginning at 9:30 a.m., at the same location. I would like to have these issues entertained at those meetings. Thank you so much for your kind assistance.

I will highlight some general comments as well as some specific ones in the following. Then, I summarize the points at the end of this letter.

First of all, there are 1300 outstanding complaints which are being not addressed by OAH. This matter can be verified by listening to the latest meeting (online at the state website) of the Joint Legislative Committee of Mental Health Reform, chaired by Verla Insko and Martin Nesbitt.

I note on your website that you declare The Commission to be the place where the buck stops prior to going to the General Assembly (“The RRC is the last place a rule goes before going to the General Assembly.”

I know that there are rules associated with such a process and I am appreciative of your guidance about how to efficiently take care of business. Please advise me as to how these complaints will be more efficiently addressed. It is not enough to say that DHHS has hired some temporary employees to do what should be a core process of NC Mental Health Reform. In general, citizens and providers see very little of their input being admitted into the mental health reform process. Can you comment as to the permanence of NC DHHS in terms of addressing the complaints issue? Can more resources be assigned to this complaints process so that NC Mental Health Reform can work?

Secondly, that matter is related to this matter: consumers, citizens, and providers are noting that the CFAC’s (Consumer and Family Advisory Committee) of the LME’s are commonly not functional. In part (and I am still educating myself as re: this), it may due to the lack of teeth (the CFAC is advisory only) as per the NC Mental Health Reform law which seems to be allowing DHHS to simply ignore the feedback that comes up through the LME CFAC’s at the LME level on through to the state CFAC.

For instance, some LME’s have determined that they need to appoint members of the CFAC and that appears to predjudice such appointees to favoring the LME. Also, I assume that the rules that are associated with the state CFAC are applicable to the LME CFAC. Can you make clear in the rules which you oversee if this is true or not? The law is clear, I believe, as to what the purpose of the state CFAC is:

The State CFAC shall undertake all of the following:
(1) Review, comment on, and monitor the implementation of the State Plan for Mental Health, Developmental Disabilities, and Substance Abuse Services.
(2) Identify service gaps and underserved populations.
(3) Make recommendations regarding the service array and monitor the development of additional services.
(4) Review and comment on the State budget for mental health, developmental disabilities, and substance abuse services.
(5) Participate in all quality improvement measures and performance indicators.
(6) Receive the findings and recommendations by local CFACs regarding ways to improve the delivery of mental health, developmental disabilities, and substance abuse services.
(7) Provide technical assistance to local CFACs in implementing their duties.
(d) The Secretary shall provide sufficient staff to assist the State CFAC in implementing its duties under subsection (c) of this section. The assistance shall include data for the identification of service gaps and underserved populations, training to review and comment on the State Plan and departmental budget, procedures to allow participation in quality monitoring, and technical advice on rules of procedure and applicable laws.

I might speculate that SMC LME does not have enough personnel to put the minutes onto the SMC LME web page. If so, is not the law that states:

"....(d) The Secretary shall provide sufficient staff to assist the State CFAC in implementing its duties under subsection (c) of this section. The assistance shall include data for the identification of service gaps and underserved populations, training to review and comment on the State Plan and departmental budget, procedures to allow participation in quality monitoring, and technical advice on rules of procedure and applicable laws...."

also applicable to the LME CFAC site? Without information, citizen participation languishes.

As specific evidence, in the case of SMC LME, there is no information about what takes place at the CFAC, a very critical citizen watchdog group that sees to it, according to the law, that the LME admits into its procedures feedback that comes to the CFAC. Please note this site as being devoid of information in terms of minutes:
Content goes here.

Please advise me as to how the LME CFAC’s can be nudged to perform their mandated duties. I have written Shelly Lackey of SMC LME ( as well as Bill Hambrick, the key administrative person ( and I have no replies to my queries. I am regretful that I am such a pest on this matter but I am afraid it is very important.

Thirdly, again as associated with SMC LME, I have asked for months, since the beginning of the summer, via a dozen or more e mails, a question about the matter described immediately below. Specifically, I have asked Bill Hambrick; Steve Puckett, PhD (Clinical Director) and Charles Barry (over Quality Management) a question associated with providing services to a state funded MH client that I see. Moreover, this is not unassociated with the lack of ability of providers to bring forward a formal complaint to the LME. Specifically, I have sent a letter to Bill Hambrick asking he and SMC LME to address the matter of why providers have no evident process associated with bringing forward their complaints against the LME. There appears to be no formal mechanism for doing such.

There is written into law consumers’ formal complaint process (as evidenced by the existence of Quality Management Offices such as Charles Barry at SMC LME heads up), but there is no formal procedure for providers to utilize in order to make their own complaints about the LME.

This is also why I believe it is critically important to have representatives on The Commission which reflects the various LME’s. SMC LME and WH LME are associated with 19/100 of NC counties; yet, less than 5% of the members of The Commission are associated with western NC as associated w/ SMC LME and WH LME. Please advise me as to whether this can be remedied.

Ms. Rose Ann Forbes was of the mind that issues are common across the state; however, I am advocating that circumstances are unique and therefore require adequate representation. I am volunteering myself as a potential member of The Commission should that be something to be entertained as people serve their 3 year stint. I enclose my vitae.

In other words, unless the consumer complains about not receiving services, which I, as a provider am ethically beholden to deliver, the provider can simply carry on seeing the consumer and never be paid as associated with no formal process which advantages providers to interfacing with the LME about these barriers to providing treatment to consumers, in particular, state funded consumers which is the primary bailiwick of the LME.

I am not willing to stop seeing my state funded client and endanger her mental health just because there is no process for me to utilize and I have been completely ignored by the administration at SMC. I enclose my letter to Bill Hambrick. This was after many e mails on the same matter.

I have also asked Tara Larson of DHHS specifically about this matter. I have received no answers for my persistent questioning---nothing at all. Not a suggestion about whom to ask or where to go.

Please help me. The matter is this: I, as a doctoral psychologist, provide psychotherapy. I do not provide Community Support Services (CSS). Yet I am demanded by Charles Barry of SMC LME to attend 20 hours of CSS training in order to be paid for the work I do w/ my state funded client. As per SMC LME’s choice of funding streams, the funding for psychotherapy comes from a CSS funding source. That is not my affair. I have had specific, documentable conversations with the ACCESS care manager, Marsha Coe, about the services I provide to state funded consumers; the services we discussed were psychotherapy services, not CSS. Yet, SMC LME demands that I use my professional doctoral time in order to sit in 20 hours of training rather than treat clients. This appears to be a mis-use of my time. Please tell me where I should take this complaint so that I might efficiently serve my state funded client and be paid.

Please enlighten me as to where in the rules, regulations, or statutes as to how I can formally bring a complaint against SMC LME as associated with their lack of feedback pertaining to my persistent questioning. There appears to be no process associated with bringing a complaint about the functioning of the LME vis a vis the provider.

Additionally, I am alerting you to the barrier associated with the very long period of time it takes to have an authorization request attended to by this provider as pertaining to WH LME. The problem is this as associated with authorization requestions (for mental health treatment): if the LME denies the services which I have requested, if I am continuing to treat the client, as is appropriate and is associated with my psychologist ethical guidelines, I may not be reimbursed.

In summary, can you address the issues outlined above at the meetings on January 16th (Rules), January 17th (Advising) and February 14th (full meeting of The Commission):

1. How can consumer complaints be processed in an efficient manner by OAH? Can a time limit be created so as to improve the efficiency of this process?

2. Is the law associated with the functioning of the state CFAC pertinent to the individual LME CFAC’s or not? (Corollary): How can the CFAC’s of the LME’s be nudged to do their jobs more efficiently?

3. Is it not appropriate to have representative members of The Commission from the various LME’s and specifically, is not Western NC under-represented?

4. Where is the law which is associated with the (assumed to be in existence) procedure associated with the formal complaint process that a provider can utilize in bringing a complaint against the administrative process of an LME? (Corollary): (as per the attached letter to Bill Hambrick re: client 040974, state funded client): Where is the rule/ statute/ or regulation associated with DHHS NC creating a Bulletin which advises providers about this formal complaint process; (Corollary): Who can address my ignored concern about being required to obtain 20 hrs CSS when I do not provide that service?

5. Would you consider my application as a member of The Commimssion? (I am easily reached@: & my vitae is enclosed to Mr. McElroy & Mr. McCullouch in a US Post letter to them)

Thank you so much for addressing these matters. I look forward to your comments.


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

Please feel free to pass this e mail to any pertinent party.

attachment to this e mail: hammond cl 040974 SMC LME
Enclosed Hammond vitae to : Floyd McCullouch,CHAIR, Rules Committee of The Commission; Mr. McElroy, Chair of The Commssion
(US Post letter sent to McElroy and McCullouch)
also, e mail to:
1. members of The Commission, inclusive of:
Rose Ann Forbes
PO Box 8511
Asheville, NC 28814
hm: 828-253-2501

Floyd McCullouch, CHAIR (Rules Committee) 120 Livingston Dr. Goldsboro, NC 27530 hm: 919-734-9046 fx: 919-735-6064 cell: 919-920-9046 email:
Pender McElroy, CHAIRMAN 600 S. College St. Charlotte, NC 28202 wk: 704-335-3880 fx: 704-350-9369 email:
2. SMC LME: Bill Hambrick, SMC LME: ; marsha coe: Steve Puckett, PhD; Charles Barry; Tom McDeviltt, Director:

3. NCAdvocacy Listserv (w/ over 130 providers and consumers across NC)
Moderator: David Cornwall: NC Mental Hope: ,"David Cornwall" <>: & associated concerned citizens and providers in NC

4. Chris Fitzsimmons, NC Policy Watch

5. Adam Searing, NC Justice Watch

6. DHHS: Tara Larson; Mike Mosley; Leza Wainwright

7: joint legislative committee: Insko; Nesbitt

8. NCPA: Sally Cameron

9. Madame Defarge: NC Mental Health reform blogspot

10: Direct Care, LLC personnel: Barrance Roberts; Anthony Jones


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