Thursday, February 14, 2008

Dear Gubernatorial Candidate: Endorsed Provider companies collapsing across state under duress of post-payment reviews and CSS $$ reduction

Dear Fred Smith, gubernatorial candidate, NC:

I would like to comment on some of your recents points pertaining to NC mental health reform. You're on the right track. Specifics as to where you might like to head are in order. They are alluded to in the statements attributed to you, below. I would like to provide you with information from an 'on the ground' mental health practitioner who has seen from the beginning just what mental health reform appears to be about.

Quite pointedly, I would like to put forward that the non-inclusion of providers to any significant degree has hampered NC mental health reform efforts. Providers have been relegated to 'those who need to be watched', lest we make off with the $$$. This continues to be true, PARTICULARLY as associated with western NC---more rural and dispersed.

The problem has not been one of a lack of desire to participate; rather the problem is associated with DHHS NC determinedly persuing their own direction, the mental health delivery system be damned.

You stated, Mr. Smith, as per information passed to me in conjunction with a conversation with MHA/NC and the ARC of NC, that these are some of the overarching problems :

"The lack of consistent structure, processes, and application of rules across the State and among LME's.... · A provider reimbursement and regulatory system that fails to adequately promote the development of the necessary community service capacity. ....Failures in the implementation of the reform plan have resulted in: · Inconsistencies and loss of services to some of our most fragile citizens. ·

A substantial loss of public confidence in the reform effort especially among consumers, their families, and care providers. ·

A current service delivery system that is extremely fragile and incomplete. ...

... Since long promised reforms have failed to meet the needs of our mental health care delivery system, it is important that we move forward with a plan that creates a structure of clarity, certainty, and confidence, providing appropriate leadership and a plan that more clearly identifies the roles and responsibilities of the State, the Local Management Entities (LME's), and the care providers.

To accomplish this we must: Place clear responsibility on the State for providing care for the long-term and more difficult chronic cases of mental illness and disabilities that cannot be appropriately served in the community and require the expertise and services provided through our state psychiatric hospitals and facilities for the developmentally disabled.

Develop the community capacity for short-term acute psychiatric care by working with our LME's, community hospitals, and other providers to establish and reinforce our abilities to serve consumers in crisis, providing a hub around which to build community services while reducing dependency on the State's psychiatric hospitals.

Develop the community capacity to provide individuals with mental illness, developmental disabilities, and substance abuse with appropriate on-going assistance and services necessary to provide the greatest opportunity to live a productive and quality life."
These are my specific comments and please do consult my blogspot, Madame Defarge, for specific details and a time-line of malfeasant efforts by NC DHHS as re: mental health reform in NC.

(1) The STATE, as per your item above, does not need to take 'more responsibility' in terms of a move back to the LME's of associated care as pertaining to the care of the 'most fragile.'----if by 'take responsibility' you mean they should revert to their old selves, Community Mental Health Centers.

NC Mental Health Reform was moving right along until Hooker Odom, seeing that the services were being utilized, pulled the brake and threw all the passengers up against the walls of the train and sometimes out the window by first of all, reducing Community Support Services $$, and THEN, something which is continuing into Dempsey Benton's time, bit by bit, post-payment review by post-payment review-----reduction of CSS hours from 'whatever the client deemed to be useful' to the NOW 3 hours/ week. IF CSS is one of the lynchpins of NC Mental Health Reform, then instead of vacillation about just what it entails (mastered by Hooker Odom) and continued massive reduction of use of this service which includes everything from skills training to emergency services----then NC mental health reform has ALREADY failed.

A case in point: state funded clients' services associated with Smoky Mountain Center LME and Western Highlands Network LME are:

**difficult to obtain in terms of the authorization process e.g., the paperwork is massive as associated with Person Centered Plans (15-20 pages of non-paid, non-reimbursed, time-consuming paperwork which must be frequently updated in order to move through blocks of psychotherapy sessions which interface with psychiatric mental health care); the authorizations are time-consuming in that you cannot speak to the person who creates the authorization; you have to call and call or e mail and e mail----- causing providers to simply want to avoid the MAIN clients that NC Mental Health Reform is supposed to attend to.

While the money is so tightly controlled as pertaining to state funded clients that you might as well say that there are no services available, as regards Medicaid services, the post-payment reviews, which are an attempt to push back the Person Centered Planning----WHICH THE STATE DEMANDS----and which is a consensus between the client, pertinent family members or community members, and the provider------finish off what is left of the Endorsed Provider companies.

I am frankly amazed that more Endorsed Provider companies have not collapsed. And indeed, it is only as associated with the Endorsed Provider companies obtaining of attorneys (yet more of their money gone awway) that there are any left. Gather some information about the use of attorneys to push back on the LME's in terms of these post-payment reviews and you will witness a system which is imploding under the weight of malfeasant post-payment reviews by the LME's, and by default, NC DHHS.

If you couple that morass of paperwork associated with authorizations for state funded clients to an overly zealous Quality Management team, such as is commandeered by Smoky Mountain Center's LME's Charles Barry, the director of QM there, you have the boondoggle of not only the required massive paperwork but the ensuing post payment reviews which suck the very life out of the Endorsed Provider companies.

Witness the recent collapse in Orange and Chatham county as reported on this week by the Raleigh N & O. Witness the collapse just over a year ago of the exact same kind of large provider, overseeing 10,000 lives in Western Highlands LME, just over a year ago.

If NC DHHS keeps it up, and by default, the LME's keep up their aggressive, mega paperwork agenda----coupled to the reduction in Community Support Services dollars----coupling THAT to the post payment reviews which causes the companies to pay back the services that they have ALREADY offered-----then you will have a continued recipe for failure----county after county----LME after LME----across the state.

Marsha V. Hammond, PhD: Clinical Licensed Psychologist


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