Smoky Mountain Center LME's 'perfect storm': the big pile-on: YOU SHOULD HAVE LISTENED SOMETIMES TO THE PROFESSIONALS

my comments to Julia' Merchant's article on mental health care problems in western NC:

The state of mental health careA fractured system is in danger of breaking down completely, leaving officials wondering — how did it get this bad?By Julia Merchant • Staff Writer
http://www.smokymountainnews.com/issues/01_08/01_16_08/fr_mental_health.html
*****************************************************
Smoky Mountain Center LME Could Have Done a Better Job with Outpatient Services

I have seen clients for 4 or 5 years associated with the catchment area of Smoky Mountain Center (SMC) LME.

In the article by Julia Merchant, the Director of SMC LME, Tom McDevitt, a very bright, capable man, acknowledged that it has been much more difficult over the past year or two, to get people admitted into the psychiatric hospitals. It is inferred and assumed that outpatient therapy, if rendered dependably and by professionals, will address issues that might have lead to hospitalization. NC DHHS formally created these services, Basic Level Services, consisting of psychiatric medication and follow-up and outpatient therapy, in June, 2007. SMC LME does NOT offer Basic Level Services.

Why?

Mr. McDevitt outlined the notion of outpatient therapy as being perceived as the stop-gap measure such that people would require less inpatient treatment.

Bear in mind that SMC LME, like the other LME's in NC, does not deal with Medicaid or Medicare clients in terms of authorization and payment. They attend, mostly, to state funded clients.

I know the people who work for the LME and have observed them for a few years now, as NC mental health reform came on board. They are hard working people who care deeply about mental health matters.

This is not intended to slander their good efforts; however, I would like to state that SMC LME has morphed into an entity that has irresponsibly managed its state funded clients, the 'working poor' (those w/o Medicare/ Medicaid/ or third party insurance) as regards outpatient services.

Some of the 'why' as regards this matter appears to be associated with the strategy that SMC LME adopted several years ago which was to create a capitated contract (I assume it is capitated which means that the agency is paid a certain amount and no more, regardless of how many patients are seen) with Meridian Behavioral Health Services.

Meridian was founded by a retired, former employee of SMC LME. Meridian created cohort (similar people, not professionals) driven services called WRAP services for state funded clients.

Its a great idea! It allows the sharing of information and the upgrading of psychosocial skills for those with mental health challenges. It takes place in a group therapy format. This being said, neither is it a substitute, when necessary, for professional intervention on an outpatient basis.

My speculation is that because of this relationship with Meridian, providers, such as myself, who were referred state funded clients by the ACTT team (the most severely, persistently mentally ill clients are seen by the travelling ACTT team, which has a psychiatrist)---who were perfectly willing to work with state funded outpatient clients---- even to the point of seeing them in their homes----were locked out of being able to provide outpatient services as SMC LME's Clinical Director, Dr. Puckett, kept trying to drive the state funded clients into Meridian's Recovery Education Program----the group therapy format, managed by non-professional, minimally trained, cohorts.

Why did he so persistently try to drive the clients away from outpatient therapy, causing me to write into the Person Centered Plan, even though not requested by the client and even though the client couldn't even get to Meridian?

Specifically, SMC LME has made it so difficult for providers such as myself to work with state funded clients, providing outpatient therapy, that I, for one, have simply thrown in the towel and will not work w/ their state funded clients-----which is the population which they assumably manage.

When I attempted to hammer on the matter of the difficulty of working with state funded clients in terms of rendering outpatient therapy, in the client's home, far away from any town or city, I received nothing but requests to submit more and more paperwork. Not just a little paperwork but Person Centered Plans whose usual length is 15-20 pages. There is no pay for creating this paperwork.

I was threatened with audits. It was suggested by Charles Barry, the Quality Management Director, that I was acting 'unprofessionally.'

When I was able to obtain outpatient therapy authorization (read: I could get paid) , a brief burst of outpatient therapy services would be authorized; then one or two months later, I'd have to do the whole thing again: calling up the ACCESS Center, speaking to a particular person who was frequently not available (no point in talking to anyone else as they would simply direct me back to that person).

Our relationship became so contentious that it was wiser to simply stop seeing any SMC LME state funded clients.

When I attempted to inform the SMC LME CFAC (Consumer and Family Advisory Committee composed of consumers and/ or family members of consumers) of the difficulties of working with SMC LME pertaining to my state funded client, they told me to send my comments to a staff member who would give these to the SMC LME CFAC members. I was able to find the business address of the chairman of the board of SMC LME and I sent him my concerns.

I have never heard a single thing from SMC LME CFAC or the chairman of SMC LME Board, and when I pressured Leza Wainwright. Mike Moseley's deputy in the Division of Mental Health, she was able to finally get SMC LME to post on their website minutes from the CFAC meetings. What was revealed was that very few members of the CFAC even attended meetings.

Admittedly, SMC LME serves a very wide geographical area. However, by law, the LME must create a system such that the CFAC is functional. A few people showing up does not look very functional and moreover, absolutely no response from 10 plus mailings to various members of the SMC LME CFAC is evidence that the SMC LME CFAC basically does not function.

This means that the LME does just as it pleases.

Forgive me if I am a little irked by SMC LME's personnel statements about how difficult it is to get consumers mental health beds when they decompensate without access to outpatient services.

What I would really like to know is just how much money in terms of contracts has been consumed by Meridian Behavioral Health Services as associated with their (assumably) capitated contract to service state funded clients under SMC LME catchment area? How does that amount of money compare to funds that Western Highlands LME (there are only 2 LME's in western NC) utilizes to provide Basic Level Services to state funded clients?

If you want my opinion, SMC LME chose a format to address state funded consumers mental health concerns via its (assumably) capitated contract with Meridian which, while neat and tidy and in accord with Mr. McDevitt's accountant training, was not a substitute for professional outpatient services and now that the 'perfect storm' of Broughton's difficulties are upon them, they want to pile on regarding NC mental health reform's tawdry performance record.

You should have listened to the mental health professionals, SMC LME. Ditto for NC DHHS.
Marsha V. Hammond, PhD: Clinical Licensed Psychologist

Part B Medicare (mental hlth): collapsing and defunded

Many citizens of NC utilize Medicare as their primary health care provider.

This post is a documentation of the difficulties of interfacing with this primary health care agency and it is intended to portray the severe problems experienced by providers who are attempting to provide mental health services for clients who have Medicare.

First of all, in NC, Medicare has for 2008 discontinued Behavioral Health CPT codes which placed mental health care rendered by a PhD psychologist into the 'medical' column of reimbursement which is 80%. No more. There is now only CPT codes associated with mental health which means that providers can expect no more than 62.5% payment for services.

The American Psychological Association worked a long time in order to put forward Behavioral Health Codes so that psychologists could be reimbursed in a professional manner.

You wonder why providers will not accept Medicare?

In 2008, Medicare reimbursement for therapy has been slashed by about 15% or more. A CPT code of 90808 (bill too many of these and you will certainly be audited) which is therapy for 70-90 minutes or more LAST YEAR was billable at $145.

THIS YEAR, 90808 is billable at $125.

90808 CPT code is not what most mental health care people will utilize as the top 10% of providers will receive a 'congratulatory' letter from Medicare telling them that they have to submit all of their paperwork, including patient notes, and if everything is not in order, then the provider has to re-pay Medicare.

So, without the Behavioral Health codes, which were an efficient mechanism for clients who had physical illnesses which were addressed in therapy, the provider is now stuck w/ the lesser paying, non-medical, mental health therapy codes which are paid at 62.5%.

You wonder why providers will not accept Medicare?

Not only that, but the North Carolina Psychiatric Association has 'discovered' that NC Medicaid (if the patient has dual eligibility which is very common, Medicare is billed first and then Medicaid picks up the rest) is not making up the difference and according to a NC Psychiatric Association member "this is legal." Its reportedly not done in any other state but 'it's legal.'

You might collect a few more cents off of the client in terms of their co-pay, which is not demanded by Medicare (you cannot avoid asking for the co-pay from clients but neither must you demand it from every client either)-----if you have the heart to try and squeeze that out of people who cannot feed themselves.

When a provider enrolls with Medicare, and pertinent to mental health services (Part B Medicare), you are given a 'Performing Provider Number.' This comes to you on a piece of paper which is your initial credentialing document. Psychologists are exempt from a UPIN number which physicians utilize. No other numbers are listed on this initial document. Over the course of billing and exchanging information with CIGNA Government Services, one is assigned, in no particular order, the following descriptors unique to the provider:

1. identifer #
2. Billing ID
3. Payor ID

This does not take into account any other identification sets which might be utilized by a billing entity (when the provider throws up their hands and cannot negotiate Medicare Claims Express software). The billing agency takes another chunk of the provider's money.

This does not take into account Medicaid identification data. Or Medicaid webclaims identification data. Or state funded clients identification sets of information. Or BCBS identification sets. Or any other third party payment identification sets.

A couple of years ago, providers were told they had to have an NPI number, which is a descriptor that is SUPPOSED to be usable across Medicare/ Medicaid. You might suspect that it takes a few years for this simple little NPI number to move into their process, but the real dilemma is that you can never get CIGNA GOVERNMENT SERVICES on the phone. NEVER.

You can, as I have done, enlist the assistance of Repeat Dialer software. Won't get you through. Someone from Medicare might even call and leave a message. You can't call them back. You are stuck trying to move through their system the best you can.

Upon the 7th set of faxes and correspondences re: simply trying to change my address and set up the automatic deposit, which they demand, I resorted to creating 'options' for the person on the other end. I sent CIGNA a multiple choice formatted selection of paperwork with the explanation that they could throw the useless paperwork out.

Dear CIGNA GOVERNMENT SERVICES:

I am enclosing 4 possible selections of paperwork as associated with the descriptor 'Medicare Identification Number' (something I have never been given though you have paid me for services) and the way I figure it, it must be a,b,c, or d (which is all the permutations of what this exchange-a-term Medicare Identification Number) must be.

If I could get you on the phone I could ask you what that number is. However, what I get is 'courtesy calls' telling me that I simply need to resubmit the paperwork.

PLEASE DISCARD THE PAGES YOU DO NOT NEED.

Your (some kind of ) Medicare Provider, Dr. Hammond

MEDICARE: they may have single digit administrative costs BUT THAT'S BECAUSE YOU CANNOT GET THEM ON THE PHONE

Marsha V. Hammond, PhD: Clinical Licensed Psychologist e mail: hammondmv@netzero.com

Dear CIGNA Medicare Services:

You stated on your web site:

"If you do not receive a response to your Web site inquiry within 45 days, please call your CIGNA Government Services Customer Service Contact."

I would like an answer to 2 questions and really, 45 days is waaaayyy too long for a provider to await an answer. I cannot get you on the phone (as usual), even utilizing a repeat dialer software.

1. I would like to know if my change of address form which has taken 5 permutations of (mostly) writing out 'CIGNA Government Services' on a one inch line has finally been accepted. I first submitted 'CIGNA'; that wasn't right. Then I submitted 'CIGNA Gov't Services' and THAT wasn't right. As per what the person who leaves me messages "Dr. Hammond, this is just a courtesy call from CIGNA Government Services...." I have now SPELLED OUT in very tiny script 'CIGNA Government Services.' I hope this will suffice and that we now, 5 months later, have a change of address.

2. You owe me several thousand dollars, up into the 5 digits. Is that money forthcoming into my account?

Sincerely, Marsha V. Hammond, PhD

Why are Endorsed Provider companies being audited when Value Options, contracted by DHHS to create authorizations, gave the green light to services?

TO: Cullen Browder
WRAL TV station: Raleigh/Durham/ Fayeteville: NC
P.O. Box 12000, Raleigh, N.C. 27605

January 7, 2007

Dear WRAL TV of Raleigh/Durham/ Fayetteville (wral.com):

I read with interest the 2005 piece on, 'Audit Questions Whether State Overpaid On Medicaid Claims" by your reporter Cullen Browder. I know that this is some time ago; however, the matter of auditing is here yet again and I thought you might be interested in some new information as associated w/ NC mental health reform.

Value Options, the company appointed by Carmen Hooker Odom, who OVERBID and obtained the opportunity to create authorizations for Medicaid clients, authorized millions of mental health provider authorizations----SOMETIMES EVEN WHEN THE PATIENT/ CLIENT WAS NOT A MEDICAID CLIENT.

Value Options thus has a contract w/ DHHS NC in order to create authorizations. If Value Options has the contract w/ DHHS in order to create authorizations, and if 'authorization' is what is utilized within the health care industry as the 'green light' for services, then why are Endorsed Provider companies being audited and demanded to pay back millions of dollars----for services which VALUE OPTIONS AUTHORIZED?

It would be great if you could cover such a story as NC mental health reform is quite a hot topic at this time.

Thanks very much for your coverage.

Marsha V. Hammond, PhD

Endorsed Provider companies flounder under weight of post payment audits, penalties, payback: JUST WHO GET AUDITED?

Mr. Benton is on record this week as stating this as pertaining to the closure of public psychiatric hospitals, w/ Broughton having lost its ability to admit Medicare and Medicaid patients since, August, 2007, costing the NC taxpayers over one million dollars/ month in extra fees :'"We have to restore the public's faith in our facilities,"

Community Support Service (CSS) include emergency services and everything from counseling to skill building.

Ann Ackland, former board member for NC NAMI outlines how her daughter needs CSS but how it has failed: "“The plan sounds really good when you talk about being able to have people have services they need to stay in the community,” Ann Akland said. She added, however, “The execution is abysmal. It is failing.”

If you think CSS is failing now, just wait until more companies collapse under the weight of post payment reviews,audits, and paybacks---- commonly for inappropriate reasons.

Here is a case in point: the company with which I am affiliated offered 15 hrs/ week of CSS to a schizophrenic client, a Medicaid recipient. With this support, the client was able to obtain a GED and at least apply and go off to college----only to not be able to cope with campus life. The client is fortunate given the educated status of his parents and their relative wealth.

The CSS were begun in thet fall of 2006, prior to DHHS's demand that a Diagnostic Assessment be in place. Clearly in place in the medical records prior to the utilization of CSS was: my assessment; the psychiatrist's assessent; and, the psychiatric nurse practitioner's assessment.

As a person who had attempted to render therapy to the client I rather quickly noted that it was not very helpful and that what would be appropriate would be CSS in the form of someone younger, who could relate to the client in a more meaningful fashion and create a sense of ease , or more ease, in terms of interpersonal skills. CSS was the perfect remedy!

Almost one year after the beginning of CSS, SMC LME's Quality Management department, headed by Charles Barry, told the company with whom I am affiliated that there was no 'medical necessity' for the CSS and that the company needed to pay back $24,000 as associated w/ the CSS.

As associated with SMC LME Quality Management Department, a LPC (Licensed Professional Counselor : no diagnostic skills are part of the training for an LPC; I know: I used to be one) rendered the judgment and under the space soliciting the reviewer to recommend what services would be useful, she stated, "I don't know."

The penalty associated with post payment review paybacks is NOT part of the money to be paid back. Rather it is a penalty placed on the Endorsed Provider company which stays in place, eating their revenue, until all the money is paid back. Ten percent every month is extracted as a penalty on the money owed pertaining to the audit.

Endorsed Provider companies are given 15 days to come up with evidence that in fact the reviewer was mistaken. In the case of this client, the evidence is easily turned up given the electronic nature of the medical records and how well known the client was to the company and how many psychiatric contacts the client had throughout the system. .

The company with which I am affiliated is already reaping the 'benefits' of other Endorsed Provider companies crashing re: post payment reviews. The paybacks, legitimate or not, are sinking the companies.

You might say: well, but that's the penalty for not doing the work correctly----be it paperwork or what.

I'd ask you this: and so WHO are the companies that are being audited? The companies that spun out of the LME's e.g., retired employees or people who needed a job after the Community Mental Center morphed into an LME, are not being audited at the same rate.

So, you tell me: what is the purpose of the post payment reviews and the payback and penalties? I am currently turning up the information as re: specific companies and will be back w/ that information across various LME's.

Marsha V. Hammond, PhD

Dempsey Benton gets DHHS to actually answer pertinent questions! Smoky Mountain Center LME actually put CFAC minutes online !

State DHHS secretary announces changes to fix state hospitals
by Leslie Boyd
http://www.citizen-times.com/apps/pbcs.dll/article?AID=/20080103/NEWS01/80103084

RALEIGH – , N.C. DHHS Secretary Dempsey Benton announced at a press conference Thursday afternoon that he would remove management of the four psychiatric hospitals – Broughton, Cherry, Umstead and Dorothea Dix – and 10 other state facilities from the Division of Mental Health, Developmental Disabilities and Substance Abuse Services and take direct responsibility for their operations.
******************
Dempsey Benton has sent a clear message to consumers, citizens, and providers: the Department of Mental Health under Mike Moseley and Leza Wainwright, Moseley's deputy, is on the carpet.

He has taken over the management of the state psychiatric hospitals from the Department of Mental Health, which is under DHHS. This is a positive step.

DHHS and the Department of Mental Health, actually answers my letters and e mails now!

Benton directed Wainwright to answer my e mail associated with my concerns about not being able to get in touch w/ any of the Smoky Mountain Center LME CFAC. Shortly after my letter was received by Mr. Benton, SMC LME set up an e mail address with which to correspond w/ the CFAC and they placed more recent minutes online.

You will notice that Western Highlands LME CFAC minutes have been online since 2005. They can be obtained here: http://www.westernhighlands.org/cfacminutes.htm

What is the CFAC (which is associated w/ every LME) ? : Consumer and Family Advisory Committee.

By law, the LME must assist the CFAC to function.

While mental health advocates have sighed and assumed that the LME CFAC's are toothless, perhaps we are moving into a new era wherein they are functional and responsive.
Each LME has a CFAC and it is a formalized group of consumers and family members appointed in accordance with the requirements of NCGS 122c-170.

VOLUNTEERS ARE FREQUENTLY NEEDED!

And if you look at the SMC LME CFAC minutes, you will see that volunteers who can make the meetings are needed!

The purpose of the CFAC is to ensure meaningful participation by consumers and families in shaping the development and delivery of public mental health, developmental disabilities and substance abuse services for each LME.

You can contact the state CFAC here: state.cfac@ncmail.net

IF ONLY THE LME'S WOULD PROVIDE ACCURATE INFORMATION ABOUT AVAILABLE SERVICES......What happens if you hold a CFAC meeting and nobody comes?

Marsha V. Hammond, PhD Clinical Licensed Psychologist, NCe mail: hammondmv@netzero.com

January 2, 2008

Dear Mr. Benton and Ms. Wainwright:

Thank you, Ms. Wainwright, for forwarding to me this information (see below this e mail for I have enclosed your response re: the CFAC question I had).

I have another question and I will put it in writing to Mr. Benton as he seems to be able to get people to answer questions : can you ask SMC LME to state clearly on their website as to their not providing Basic Level Services for state funded clients rather than misleading providers and causing providers to spin their wheels for a long time as they attempt to find out how to obtain Basic Level Services-----which SMC LME does not offer?

As it turns out, I have recently severed my relationship w/ SMC LME as they will not provide Basic Level Services for state funded clients and I do not provide Community Support Services.

Ms. Wainwright informed me of this herself, specifically, you indicated, Ms. Wainwright, in a recent e mail to me that SMC LME was within their right to not provide Basic Level Services. This is quite out of keeping w/ the other LME's, I believe.

Additionally, as pertains professional participation in mental health reform, I would submit that the relegation of psychologists to being demanded to squeeze into the CSS format is a clandestine attempt to dumb down therapy for state funded clients (QP's and CSS personnel are being painted as offering 'therapeutic' services as per the new CSS Service Definitions; I sent in my comments).

Though DHHS has stated that Basic Level Services are to be available, SMC LME, instead, decided that it did not offer Basic Level Services. This is a puzzle to me as one would think that this would be cheaper than the costs of CSS.

Dr. Puckett stated to me a few months ago:

"....Since 7/1/06 it has been SMC’s policy to utilize state funds only for enhanced benefit services for target population consumers. Exceptions are made when it is clearly demonstrated that *****appropriate enhanced benefit services are not available***** to meet consumers’ needs. If you believe that this is the case for a consumer you are serving you may submit a PCP or PCP-Lite via SMC’s Communication Center with clear justification for a basic benefit service better meeting the consumer’s needs for review by a Care Manager.Steve PuckettSteve Puckett, Ph.D.Clinical Operations Director"

Puckett would insist that I refused to keep re-submitting PCP's for state funded client 040974 and Mr. Barry stated as pertaining to my too many conversations associated w/ state funded client 040974, that I was acting 'unprofessionally' and had a 'great deal of trouble writing PCP's' (e mail 12/07).'

They implied that if I just kept submitting version after version of PCP's that I could get authorization for state funded client 040974 who specifically requested outpatient therapy from me-----something I struggled to make available to her for over 2 years. I grew very weary of doing a paper chase about a matter which SMC LME had no intention of attending to. I therefore severed my relationship w/ SMC LME.

In 2003 or so, SMC LME created a contract w/ Meridian Behavioral Health Services in order to offer WRAP training and cohort driven services for state funded consumers. No therapy can be provided for state funded SMC LME clients unless it is associated w/ CSS. This effectively blocked providers, such as myself, from being able to work with state funded consumers even if the clients did not want WRAP training and did not want CSS. Meridian Behavioral Health Services was founded by Joe Ferraro who retired from SMC LME sometime earlier this decade.

As re: the Basic Level Services, I provide outpatient therapy in keeping with my doctoral training. I am not willing to go through 20 hours of CSS in order to work w/ SMC LME who demands that all outpatient therapy be contained within CSS. I therefore am not available to work w/ state funded clients as per SMC LME. I continue to see Medicare and Medicaid clients in this area.

To some significant degree I severed my relationship w/ SMC LME as I could not get them to tell me the straight story : is there or is there not Basic Level Services?

I corresponded w/ Charles Barry, manager of QM, Dr. Puckett, clinical director, and Bill Hambrick, director. No one ever provided me with the answer to my question and indeed the staff there seemed to think I was trying to pull some wool over their eyes as re: not wanting to waste my time obtaining training I did not need.

Here is the information from the SMC LME website re: their statement that they do provide Basic Level Services----which they stated to Ms. Wainwright that they do not. It would be useful to consumers and providers to have the correct information rather than having to ask many times and finally contact Mr. Moseley in order to get the answer about whether Basic Level Services for state funded consumers were available.

Here is what the SMC LME manual states (website states this was updated in November, 2007):

SMC online manual: http://www.smokymountaincenter.com/documents/provider/OperationsManual_2007-11-"BASIC SERVICES Mental health, developmental disability or substance abuse services that are available to North Carolina residents who need them whether or not they meet criteria for target or priority populations."

In the spirit of providing accurate information to both consumers and providers, and in that SMC LME does not want to offer Basic Level Services to state funded consumers, could you ask them to correct their web page?

An observation: The members of CFAC are many as associated w/ SMC LME. In reviewing the notes on the SMC LME website, http://www.smokymountaincenter.com/partners/cfac_notes/SR_2007-04-2007-09.pdf five or fewer members from this list are in usual attendance.

'Self governing' doesn't work if no one attends. I had been trying to get in touch w/ SMC CFAC members in order to state to them my concerns about this client, 040974. I contacted by US mail the chairman of the SMC LME board and several of the CFAC members. I had to send the letters to the CFAC members via Shelley Lackey in that there was no way to get in touch w/ them: no telephone numbers ; no mailing address.

I have never received any information back from my query and this CFAC and board has met since my inquiry. The December minutes of the CFAC meeting are not online at this time and so I do not even know if any of my mail was received or noted.

Moreover, the general consensus amongst mental health providers, consumers and their families is that the CFAC's are toothless and under the thumb of the LME's. This, certainly, is supported by the efforts I had to put forward in order to even get ANY CFAC notes or information.

Therefore, anything related to 'quorum'-----if that is what permits the CFAC to function, is never available. I might surmise that given the area of SMC LME, many people simply cannot make the meetings and therefore a more efficient mechanism in order to create consumer participation would be in order.

Thank you again, Ms. Wainwright and Mr. Benton, for this information. I appreciate being able to participate at least to the point in being able to advantage the community to some online information as associated with such a large geographical area.

Here is the CFAC list from the SMC LME webpage.

Sincerely, Marsha V. Hammond, At 01:53 PM 1/2/2008 -0500, Leza Wainwright wrote:
Dr. Hammond:Secretary Benton requested that I respond to your inquiry to him regarding the Smoky Mountain Consumer and Family Advisory Committee (CFAC). Your correspondence with Secretary Benton indicated concerns that the Smoky Mountain CFAC minutes were not available on the web and that Smoky Mountain staff had not given you contact information for two CFAC members, as you requested.I am pleased to tell you that the Smoky Mountain CFAC has now chosen to have the minutes of their meetings posted on the Smoky Mountain Center website.

The minutes are available at http://www.smokymountaincenter.com/partners/cfac.asp by clicking on the hyperlink labeled "meeting notes" on the right hand side of the page. Minutes for all meetings thus far this state fiscal year have been posted and future minutes will also be posted.

As you know, CFACs are by state statute designed to be a "self- governing and a self-directed organization" (G. S. 122C-170 (a)) so the decision to post the minutes on the Internet had to be made by the CFAC.

As for your request to be given contact information for specific Smoky Mountain CFAC members, I am told that the membership of the Smoky Mountain CFAC have decided that they do not want their individual contact information distributed.

Instead, there is a dedicated e-mail address at The Smoky Mountain Center (smcfac@smokymountaincenter.com) that can be used to contact CFAC members.

Of course, employees of The Smoky Mountain Center cannot compel volunteer CFAC members to respond to inquiries, but I have been assured that any inquiries received are passed along to the appropriate CFAC members.I hope this information is helpful. If you have further questions regarding the roles and responsibilities of CFACs or any specific CFAC, please contact Ann Remington in the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services central office.

Ann is the team leader for a team of state employees who provide support to CFACs statewide. Ann can be reached at Ann.Remington@ncmail.net or via telephone at 919-715-3197.

Leza WainwrightDeputy DirectorDivision of MH/DD/SAS