Sitting for portraits while Central Reg.Hospital endangers employees & patients lives due to poorly designed hospital

I'm beginning to suspect that the reason that the NC Psychological Association won't comment on mental health reform is because some of their 'leading lights' are critical, key people associated with the state hospitals.
*****************

Portrait won't grace hospital

"In a rebuke to director Patsy Christian, (DHHS chief Dempsey Benton says no to her canvas and to the state's paying for it"

http://www.newsobserver.com/2771/story/1090119.html

***********************
Biesecker's article indicates that there is to be a State Board of Investigation regarding Dr. Christian's use of public $$ to pay for a deeply discounted portrait, to hang in the foyer of the new Central Regional Hospital.

Admirable, Mr. Benton, this whopping savings of $500: but what about the premature opening of the hospital? The employees and the psychiatrists are against it; the NC Psychological Association sits on its hands (Osberg is a member of NCPA).

It plays well in the papers, I know.

Christian is not listed in the US News & Report (see below, Items) as Director of Dix, but rather Osberg is listserv as Director.

In the May 30, 2008 letter (see below, Items) from Wolfe, Champion, and Rumer who are elected officers of the Dorothea Dix Hospital Psychological Staff, Osberg is listed alongside Christian as a Director of Dix Hospital.

Osberg is a psychologist who is licensed in NC. He is also a member of the NC Psychological Association. (see below, Items)

Christian is not listed as a psychologist or a member of NCPsychological Association.

Dempsey Benton nixed the payment, though small it was at just over $500 (discount from an employee, it seems; psychologists are warned about bartering but since she isn't a NC licensed psychologist, I guess this won't stick to her).

And Mr. Benton was not on board when the Central Regional Hospital was in the designing stages.

But if you know anything about heavy-duty psychiatric hospitals, and how every thing is always locked up and down, then you will find yourself laughing or maybe crying at the ludicrousness of the Freelon architectural firm's design wherein the employees have to either run through the forensic unit, where the murderers stay, in order to get from the Adult to the Child unit---should you be called to assist when a patient is out of control, or you key out, run outside of the building, key back in, in order to move from one part of the hospital to the next. See the architectural rendering of the hospital here: http://www.freelon.com/portfolio/167

Heckuva job, Govna.

Marsha V. Hammond, PhD: Registered Dem

**************************************
Items used for this post:

Item 1:

Letter from Dix Medical-Psychological Staff to Secretary Bentonhttp://www.newsobserver.com/content/news/health_science/story_graphics/ 20080531_doctors.pdf

Item 2: http://health.usnews.com/listings/hospital-directory/north%20carolina/dorothea_dix_hospital

Administrator:
JAMES OSBERG, DIR

Item 3:
0897 Osberg III James W. Psychologist Current. http://www.ncpsychologyboard.org/search.htm

Item 4: architectural rendering of Central Regional Hospital:
http://www.freelon.com/portfolio/167

HELLO NC Psychological Association : will you weigh in? : Dix closes / Regional Central Hospital opens as THEY RENOVATE EVEN BEFORE MOVING IN

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC e mail: hammondmv@netzero.com cell: 404 964 5338 fax: 828 254 2013 NC Mental Health Reform blogspot:

May 30, 2008

Dear Richard Rumer, PhD
(Licensed Psychologist : Dorothea Dix Hospital 820 S. Boylan Ave., Raleigh NC 27603-2176 )

Thank you for standing behind the important letter written on May 30, 2008 by yourself, Dr. Margaret Champion,MD and Dr. Nicole Wolfe, MD, affiliated w/ Dorothea Dix Hospital.

Here is a copy of that letter which is online in pdf file format:

Letter from Dix Medical-Psychological Staff to Secretary Benton

http://www.newsobserver.com/content/
news/health_science/story_graphics/ 20080531_doctors.pdf

Having worked at the Alabama State Mental Hospital in Tuscaloosa, which once had a building second only to the Pentagon, I realize the procedures one has to utilize in order to move from one psychiatric unit to another. The age of that hospital was such that there was an entire sound-track associated with the large skeleton keys I carried in my pocket as I moved from one locked unit to the next.

The purpose of my letter and posting on my NC mental health reform blogspot, as well as circulation amongst concerned citizens in NC, is an attempt to bring forward a comment by the NC Psychological Association which has had very little to say about NC mental health reform.

Your letter, dated May 30, 2008, addressed to Patricia Christian, PhD, RN and James Osberg, PhD (both assumably psychologists) has been sent to psychiatrists and psychologists throughout NC.

You have outlined a grim scenario wherein the opening of the new Central Regional Hospital will stand as another monumental 'moment of legacy' for Governor Easley and Dempsey Benton.

The NC Psychiatric Association has stated clearly that they think that the opening of the hospital is very premature.

Will the NC Psychological Association speak up about these important matters?


"...Our concerns extend beyond issues of paperwork and prcedures. The new facility will open with a proximity (key-card) system that neither DDH nor JDH staff have ever used before, and with a duress (safety) alarm system that is likewise new to us. We have yet to receive any training, or review procedures manauals, regarding these or any such basic life--safety matters as fire drills or medical codes. Even the list of staff offices that was received yesterday is incomplete, apparently because of the pending renovation of what will be the new Child and Adolescent Center...

The Medical-Psychological Staff also noted that certain sensitive emergency response issues raise troubling questions. For example, in order to respond in a timely manner to a medical emergency in the Child/Adolescent unit (in a separate building) medical staff will have to exit the CRH through a door in the Forenseic Service Unit. This would seem to compromise the safety and security of the Forensic Service Unit, which arguably will house some of the most potentially dangerous patients in the hospital....(see the architectural rendering, online, of the new hospital built by the firm who has never designed a hospital before here: http://www.freelon.com/portfolio/167. It is evident from the pic that the buildings are set up such that in order to move from a proximal unit to a distal one, you have to go thru one building and then another one.....)

As you know, hospitals are requied to have an organized and self-governing medical staff, with thorough bylaws and precedures regarding credentialing and privileging. As of this writing, we have not yet seen such bylaws for CRH, we have not see the credentialing and privileging procedures, and there has been o vote to adopt thes bylaws. We have asked Mr. Raynor, our acting director of standards, to contact JCAHO to seek consultation regarding the proper procedures when opening a new hospital, as credentialing and privileging of licensed healthcare providers is an essential element to proper patient care....."

(I'm betting that the new hospital, not yet open, is about to be shut down by JCAHO).

I'm looking forward to that article, Michael Biesecker, mental health reporter for the Raleigh News & Observer.

Maybe Dr. Lancaster and Leza Wainwright, to whom the letter it also addressed, the co-directors of the Department of Mental Health, under NC DHHS, should re-impose Carmen Hooker Odom's gag order placed on DHHS employees back in 2002....seeing how they now are free of Debbie Crane, the Information Officer of NC DHHS, who was fired by governor Easley for pointing out that his throwing away of his e mails was not in keeping with the standard held by NC state government.

Heckuva job, Mr. Easley. This hospital will never get off the ground if the architectural rendering (see http://www.freelon.com/portfolio/167) is true to the purpose of this mental hospital which will presumably service 24 NC counties.

*********************************************************************************
Materials utilized as background to this post:

Item 1: architectural firm hired by the state had never designed a hospital before:
http://www.dhhs.state.nc.us/MHDDSAS/centralhospital/news_faqs.htm
Who designed the new hospital?It was designed by The Freelon Group, a North Carolina architectural firm based in the Research Triangle Park.
**********************
Porfolio of The Freelon Gp: http://www.freelon.com/
(search by 'project type' reveals no hospitals)
***********************
Item 2: Dempsey Benton was the former CEO of the City of Raleigh x 17 yrs prior to his appointment as Secretary of NC DHHS:
City of Raleigh Environmental Programs: Benton Water Treatment Plant
Apr 11, 2007 ... The new plant is named for Dempsey E. Benton, who served as Raleigh’s city manager from 1983-2000 and as chief deputy secretary of the N.C. ...www.raleighnc.gov/
**********************
Item 3: what did the new hospital cost?
http://www.dhhs.state.nc.us/MHDDSAS/centralhospital/news_faqs.htm
How much does the new hospital cost?The construction contract, with change orders is $111,956,970. The funding available for construction, design, medical equipment, furniture and associated components, telecommunications and data equipment, computers, etc, is $130,000,000 in Certificates of Participation (COPs). All of these funds are expected to be expended by the time the CRH is fully operational.
********************
FAQ's re: hospital: http://www.dhhs.state.nc.us/MHDDSAS/centralhospital/news_faqs.htm
****************
http://www.ncdhhs.gov/mhddsas/DIX/
The transition from John Umstead and Dorothea Dix Hospitals to Central Regional Hospital (CRH) will begin in early June and be completed by July 1, 2008. The CRH-Dix Unitwill be operational upon the closing of Dorothea Dix Hospital.
*********************
What item is missing? http://www.freelon.com/portfolio/167
"How do you get from the Adult unit to the Adolescent Unit without having to run through the Forensic Unit?"

You guessed it, key-card to get out, run outside, key-card to get back into the Child/ Adolescent unit so you don't have to run through the Forensice Unit where the murderers are interned.

Someone will be dead before that series of events can transpire.

NC Psychiatric and Psychological Associations Have Avoided Mental Health Reform Tragedies

As a clinical psychologist, it pains me to no end to hear the deafening silence associated with----so far---the NC Psychological Association and NC Psychiatric Association.

As noted in a recent article about the concerns of the NC Psychiatric Association, as pertaining to the premature opening of Central Regional Hospital (Gov Easley has to try and redeem himself in some way for all the failures of NC Mental Health Reform), Dr. Stephen I. Kramer, president of the NC Psychiatric Association, stated: ".... to his knowledge, the group has never before felt the need to voice its members' concerns to the state...."

The NC Psychiatric Association finally had something to say, issuing a concerned statement as per its 900 members in NC, as pertaining to the danger of opening the new Central Regional Hospital on the heels of closing two other psychiatric hospitals.

While I have gotten used to professionals simply avoiding confrontations or pointed statements, it still amazes me. I sometimes wonder if we live on different planets.

Last week, in Haywood County in Western NC, under the jurisdiction of Smoky Mountain Center (SMC) LME, the largest LME in terms of geographic area in NC, four mentally ill patients sat in the local emergency room for DAYS as there were no psychiatric beds for them.

The Balsam Center, the small, temporary, psychiatric emergency hospital in Waynesville, NC, is the smartest thing that SMC LME ever did. Though managed by the very competent Doug Trantham, it is no substitute for mental health care being available in the community----as was promised by NC Mental Health Reform.

Instead, SMC LME utilizes one private Endorsed Provider, Meridian Behavioral Health, headed up by a retired SMC LME employee, Joe Ferraro.

Such patients' mental health concerns could be addressed if professionals were encouraged and indeed, allowed (read: paid), to work with mentally ill clients under SMC LME.

Instead, several years ago, a unique contract was created between SMC LME and Meridian. All SMC jurisdiction clients are encouraged to move into Meridian's Recovery Education Center (REC), which is run by non-professionals, rather than be accorded the necessary, bedrock mental health services of therapy and psychiatric follow-up, made available by well-trained mental health professionals.

I struggled for almost two years to provide mental health services to a state funded client under SMC LME, with the Clinical Director, Dr. Puckett, again and again directing me to funnel the quite ill client into Meridian's REC.

There was no pay for me, the clinical psychologist, who was seeing the client at the client's home, deep in rural NC.

Instead, what SMC LME created was barrier after barrier to therapy, something which had been requested by the client. I gave up and dissassociated myself from SMC LME when the Utilization Management Director, Charles Barry, threatened the company with which I am associated with an across the board audit if I attempted to utilize Community Support Services for therapy.

The client awaits mental health services. The client continues to cut and take pills after years of sexual and physical abuse.

Seeing that SMC LME was never going to pay me for any of the services which I had provided and was willing to provide, I directed the client to file for disability (SSI) and Medicaid, not the best of choices as this precludes the client from working any more than $200/ month of earned income. I was trying to avoid moving the client into that direction but it was move towards disability and Medicaid or simply write off the client.

The client is waiting for a Medicaid appeal which will take several more months after a Medicaid denial (the usual).

But there was sure money for Meridian.

Marsha V. Hammond, PhDClinical Licensed Psychologist
hammondmv@netzero.com

Where have all the mental health professional providers gone?

"Mental health staffing suffers acute shortage"

http://www.citizen-times.com/apps/pbcs.dll/article?AID=200880522002

Western NC has two LME's that oversee all the state funded clients. These two LME's may be attempting, as per Easley's early 2008, Mercer report, to authorize and oversee Medicaid in the near future.

Currently these two LME's oversee the authorizations and reimbursement associated with state funded clients. They also perform post-payment reviews on private Endorsed Provider companies as associated with Medicaid clients.

They are: Smoky Mountain Center (SMC) LME and Western Highlands Network (WHN) LME. These LME's oversee 20% of NC counties. That's a chunk of control.

Provider loss and burn-out has been outlined in Leslie Boyd's good overview article.

As a doctoral psychologist, and as someone who has some significant knowledge of both LME's, here is a gross outline of the difficulties and therefore, the background information on why NC is losing mental health workers and why it will continue to lose them.

Authorizations for services as regarding state funded clients are extremely time-consuming, voluminous, and have nothing to do with why the client needs services. This authorization process is simply a gate-way in order to access services and so that the LME's have some handle on the money they must pay out.

So, given the difficulties with this state funded system, let the clients who need mental health care go and get Medicaid, you say.

Not so easy, my friend.

In order to apply for Medicaid, you must:

1. file for Social Security Disability (you won't get it but you must file; its a lot of paperwork)

2. fill out paperwork for Medicaid (you won't get that either and so you must create an appeal, depending on your providers to spend more unpaid hours assisting you).

3. wait for some months for your appeal to come up.

4. you can sometimes get 'medical medicaid' but not full Medicaid. This will pay for therapy and medications, amongst other health related services. This does not even address the matter of the disability payments or other kinds of Medicaid, for example, Domicilliary Medicaid.

But, back to state funded clients---which is what NC mental health reform was supposed to be about in the first place---that and taking mental health care into the community---oops: that was Community Social Services which have steadily been defunded over the past year.

In that there are only 8 therapy sessions available to state funded clients----and that's only as associated with Western Highlands LME---its not worth it to providers to create a massive amount of paperwork for therapy which over the course of a year nets the provider about $600.

While a WHN LME provider services director recently indicated to me that more therapy could be obtained via a Dialectical Behavior Therapy (DBT) platform,as writtin into the Person Centered Plan paperwork (10-20 pages of repetitive paperwork, asking the same thing in about 10 different ways, as noted by Boyd's article; NC DHHS created this mess) the Utilization Management Director of WHN LME indicated that more than 8 sessions of therapy was not available except as associated w/ DBT group therapy.

It is terribly time consuming to try and figure out who knows what they're talking about as regards the LME's. You could spend hours on the phone as associated with one client. That's not to even mention the paperwork. More unpaid time for the provider.

The confusion that is rampant appears not to be just within the LME but was originally created by NC DHHS. The LME's have attempted to come up w/ solutions in order to live within the guidelines of NC DHHS Service Definitions. However, these two LME's have done it in vastly different ways.

In order to obtain authorization to see a state funded client (sure: you can see them and never get paid) five to six forms, of some length, have to be submitted. And then you wait for weeks to hear what has happened. If there was a problem, they do not inform you but you continue to see the quite ill client, expecting to be paid. Its either that or the client waits around or suicides or simply attempts to exist until something can be put together in terms of authorizations.

Boyd's article did a good job of outlining the horrific paperwork. It doesn't work. There is nothing in the IPRS paperwork that is creative or useful as associated with the care of the client. It is simply an attempt to move the client into a category deemed as 'serviceable' as pertaining to severity of symptoms.

SMC LME owes me over $1200 re: a mentally unstable state funded client. The hang-up re: that matter was associated with this doctoral psychologist not being willing to sit thru 20 hours of unnecessary and un-pertinent Community Support Services (CSS) training as SMC LME decided that they do not 'do' out-patient therapy for clients.

There are no 'Basic Level Services' at SMC LME. 'Basic Level Services' are the most commonly utilized services, specifically, therapy and psychiatric meds. Rather, at SMC LME, therapy falls under CSS.

However, there is no reason under the sun to go thru (yet more unpaid) 20 hours of CSS training if all you are doing is therapy----which of course is why you went and became a psychologist.

A caveat as re: Boyd's article: Joe Ferraro's company, mentioned in Boyd's article, specifically Meridian Behavioral Health Services, whose main office is in Waynesville, NC, does an admirable job of wrapping people back around to working with cohorts who have mental health challenges themselves. Thus is a community of caregivers created.

However, it is the ONLY model as associated with SMC LME.

Moreover, as related to Meridian's Recovery Education Center, as as pertaining to the aforementioned employees earning a whopping $10/ hour, most are part-time and therefore most do not receive benefits. These are people who have attended a series of classes associated with W.R.A.P. training. That training has been created by Meridian. They are, in every sense of the word, paraprofessionals.

However, the CSS paraprofessionals, who operate under the private Endorsed Provider companies, are dissed on the basis of being 'high school graduates'(high school graduates was acceptable as associated with the Service Definition, created in 2005 by NC DHHS). Many of Meridian's 'paraprofessionals' are also simply high school graduates who have made significant investment in their own mental health.

And Joe Ferraro is a retired SMC employee.

While Tom McDevitt, Director of SMC LME, has been quoted in another news source as indicating that these paraprofessionals are no substitute for professionals, in reality, profesionals cannot be utilized by SMC LME as pertaining to state funded clients as Steve Puckett, the Clinical Director of SMC LME, insists that state funded clients wrap around to Meridian's program as soon as possible.

SMC LME has taken care of its problem in terms of a lack of mental health services by funneling state funded consumers into a secretive contract (yes, Dr. Hammond: you can come to Sylva, NC, and look at the minutes associated with the meeting of the SMC LME Board) with Meridian Behavioral Services. However, I understand that now they are wondering where all the professionals went to.

We went away. Just like many other mental health professionals are doing---and will continue to do---until you can relieve us of all this paperwork and very significantly streamline the authorization process.

Contrary to the $750,000 'independent' Mercer report, demanded by Governor Easley, I see absolutely no reason why the LME's should take on Medicaid authorizations and payment. Its the ONLY system that works efficiently.

Dempsey Benton is worried that Feds will demand back $175 million Community Support Services $$ : will he try and blame the providers (again)?

NC DHHS Secretary Dempsey Benton has expressed concern regarding the possible paying back of federal $$ associated with Community Support Services (CSS).

CSS is a skills based modality offered to some NC Medicaid clients; a very small number of hours are available for state funded mental health clients.

It is the lynchpin service under NC mental health reform as it has attempted to 'bump up' the skills of those w/ mental health challenges in order to improve their lot in life.

The Service Definition for CSS was outlined by NC DHHS in 2005. If the feds are wanting $175 million back, NC DHHS best look to itself and how it outlined CSS as per their own Service Definitions, rather than dragging out the 'bad apples' argument as associated with the private, Endorsed Providers.

You screwed up, NC DHHS. Now you figure out how to pay back the feds other than creating more stringent standards for post-payment reviews----standards other than the original ones under which the private, Endorsed Provider companies operated.

The Raleigh News/Observer could be commended if they could find out just what are the questions that the federal visitors are asking about the CSS $$ expenditure.

Marsha V. Hammond, PhD
NC Mental Health Reform blogspot: http://madame-defarge.blogspot.com/

************************ materials used for this post: Item 1: http://www.dhhs.state.nc.us/dma/bulletin/Enhanced%20Benefits.pdf, p. 2 "Service Definitions1. Community Support Adult – H0036 HB (Individual) H0036 HQ (Group)This service is available to adults and will become the “clinical home” of the adult.(PAY ATTENTION, BEV PERDUE: there are already 'clinical homes', something you think needs to be created) The interventions include training of the care giver, preventive, developmental and therapeutic activities that will assist with skill building, development of a person centered plan, relational skills, symptom monitoring, therapeutic mentoring and case management functions of arranging, linking, referring to services and monitoring of provision of services. The providers of this service will also serve as a first responder in a crisis situation. The service must be ordered by a physician, licensed psychologist, physician’s assistant, or nurse practitioner prior to or on the day that the services are to be provided. The Community Support provider organization will be authorized by the LME for an initial thirty (30) days in which the Diagnostic Assessment and PCP (person centered plan) will be completed. Subsequent authorizations will be required by the approved LME or the state vendor. The Community Support provider organization will be identified in the PCP and is responsible for obtaining authorization from the LME for the PCP. Prvider and Staffing Requirements:The service will be provided as an agency based service with qualified professionals, paraprofessionals and associate professionals who must have 20 hours of training specific to the requirements of the service definition within the first 90 days of employment. The provider qualifications for the AP (Associate Professional), Paraprofessional, and Qualified Professional may be found in the NC Administrative Code T10A 27 G."

************************************ Item 2: 10A NCAC 27G .0202 PERSONNEL REQUIREMENTS http://qmhsite.com/personnel.requirements.pdf ************************************* Item 3: 2007: http://www.dhhs.state.nc.us/pressrel/10-30-07.htm State upgrades Community Support programfor mental health and substance abuse patients "Earlier this year, internal reviews indicated problems with the new program — ranging from widespread paperwork errors to overuse of the program and underqualification of many service providers." (If NC DHHS had wanted to limit CSS hours, then they should have stated this limitation in the Service Definition; if NC DHHS had wanted for the CSS paraprofessionals to have something more than a highschool education, then they should have stated this in the CSS Service Definition. CSS began in the fall of 2006 and it took a year for NC DHHS to outline these understandable improvements: )

Have psychologists lost or won re: NC Mental Health Reform?

Just the Facts: Have Psychologists lost or won re: NC Mental Health Reform?

In review, the purpose of mental health reform in NC was to advantage non-insured (state-funded; the ‘working poor’) clients to ‘choice’ associated with mental health care. This ‘choice’ was reflected in the creation of private companies, Endorsed Providers, who have moved through stages of an accreditation process put together by NC DHHS. Thus, mental health reform was private whereas community mental health centers had been public.

Secondly, the Joint Legislative Oversight Committee for Mental Health Reform, chaired by Martin Nesbitt (D-Buncombe) and Verla Insko (D-Orange), intended for mental health care to be more engaged at the community level. Thus, the lynchpin modality of Community Support Services (CSS) was created.

CSS is distinct from Community Based Services (CBS), the previous (public) mental health services which allowed for interactions between CBS workers and clients without a specific skills-based training purpose.

Bear in mind that at this time, the LME’s are only responsible for the state funded clients. A recent ‘independent’ report to the tune of three-quarters of a million dollars, instituted by Governor Easley, was an attempt to estimate whether the LME’s are ready to manage Medicaid.

Under Secretary of NC DHHS, Carmen Hooker Odom, who resigned in August, 2007 after seven years of unique guidance, CSS was heavily utilized to the point that NC DHHS and Governor Easley paired up to campaign about the ‘abuses’ of the Endorsed Provider companies vis a vis CSS.

Within six months of creating CSS, and upon an after-the-fact reviewing of expenditure of funds, vigorous post payment reviews were instituted by the LME’s at the request of NC DHHS and this resulted in the loss or downsizing of Endorsed Provider companies.

One repetitive criticism leveled at the companies was their utilization of ‘high school graduates’ as the face-to-face paraprofessionals teaching skills to clients, under the supervision of professionals. The Service Definition for CSS, which outlines the parameters of the services which was created by NC DHHS, allowed for these high school graduates. Additionally, there was no limit to the number of hours as CSS was originally instituted.

This left NC DHHS in the position of creating more restrictive (and thus punitive) criteria as associated with these post-payment reviews in order to recover monies spent, a significant chunk which was federal dollars. Providers were scapegoated and clients received services which were then jerked back.

So, in judging the success, or not, of NC mental health reform, and as per the creation of ‘choice’ and the skills based training CSS, has NC mental health reform been a success of failure?

The devil's in the details................

....... as regards the two LME’s in western NC, Western Highlands Network (WHN) LME and Smoky Mountain Center (SMC) LME. Together these two LME’s are responsible for 20% of the 100 counties in NC.

Such an appraisal is not separate from this evaluation which is associated with the bread and butter of most psychologists’ work, specifically, psychotherapy. SMC LME has a rather unique relationship with Meridian Behavioral Health care.

Managed by a retired, former SMC employee, Meridian absorbs most of the state funded clients, utilizing a W.R.A.P. model, taught by mostly minimum wage paraprofessionals. Outpatient psychotherapy for state funded clients is available only under CSS.

The Utilization Management Department of SMC LME demands that in order to obtain authorization for psychotherapy under CSS, the person providing the therapy has to obtain 20 plus hours of non-paid, irrelevant (to psychotherapy) training. Additionally, when PCP’s are submitted, they are reviewed by the Clinical Director who apparently has as an agenda the non-authorization of state funded clients outpatient psychotherapy services. You guessed it: send them to Meridian Behavioral Health services.

As is standard, I believe, across NC, under WHN LME, there are no more than 8 psychotherapy sessions available/ year regardless of severity (the most severe are managed by the mobile ACTT team, with a psychiatrist). Pre-authorization is necessary; five forms have to be processed.

The Provider Relations Director advised me that after these 8 are used up, more psychotherapy sessions could be obtained as associated with a Service Definition associated with DBT for clients with personality disorder diagnoses. Contrarily, the Utilization Management Director advised me that if the individual psychotherapy/ DBT was utilized, group therapy also had to be utilized.

Additionally, the UM Director stated to me that as per ‘research’, public mental health clients (state funded) utilize an average of 4 sessions/ year. I advanced the notion that I supposed that these were ‘sessions’ associated only with checking to be sure the patient is still alive.

In a nutshell, as per psychologists, and as related to their bread and butter duty of psychotherapy, the resounding answer to the question: “Has NC mental health reform benefited psychologists or not?” is ‘No’ as related to the state funded clients.

Moreover, I fear that if the LME’s are advanced to managing Medicaid, that easily negotiated system will be corrupted by the chaos already very evident in attempting to engage with the local LME’s.

Now, tell me where the NCPA has been over the past 7 years in terms of watching out for psychologists and their ability to administer clinically relevant services. Psychologists are not able to provide clinically necessary treatment and it is therefore hazardous to take on state funded clients.

As regards one of the two main tenets associated with NC mental health reform, ‘choice’ has been severely truncated. Endorsed Provider companies have collapsed as related to punitive post-payment reviews as CSS was poorly planned and severely under-finances and un-monitored.

Without a massive infusion of monies based on ‘sin taxes’ e.g., tobacco and alcohol tax, with an incoming non-responsive governor, and with the ever-present, unassailable chaos evident in the two LME’s in western NC (something I assume is repetitive across NC) , I think you can pretty much sum it up and say that psychologists best avoid the state funded clients and carve out their earnings from other paying sources.

Ah, see? NCPA actually realized this and so cut to the chase. What’s that? You think that NC mental health reform was all about bringing more appropriate, relevant, community based, services to the mentally ill?

Community Support Services (12 hours/ week/ $52/ hr = $2496/ month) VERSUS Inpatient psychiatric hospitalization: $21,000/ month minimum

Community Support Services are a bargain compared to inpatient psychiatric hospitalization

by Marsha V. Hammond, PhD: Clinical Licensed Psychologist

Phil Wiggins, the 64 year old schizophrenic followed by Raleigh News & Observer reporter, Ruth Sheehan, who has been hospitalized for all of his life until NC DHHS created Community Support Services (CSS) several years ago, is assumably about to move back into the psychiatric hospital.

Why should this matter to citizens of NC? Besides the fact that his existence will consist of the same four or so walls every day of his life, what is the cost of a psychiatric hospitalization versus CSS, as made possible by Endorsed Provider companies, created by NC mental health reform?

Medicare information indicates that at a minimum, psychiatric inpatient hospitalization is $615/ day (see: October 2007 information: http://www.medpac.gov/documents/MedPAC_Payment_Basics_07_psych.pdf)

Medicare indicates that as people age, this increases, assumably as associated with other health problems.

So, let's assume that Phil Wiggins, 64 years old, is hospitalized at a NC inpatient public psychiatric hospital for $700/ day.

That's 2007 $$. A usual month consists of 30 days. That's $700 x 30 = $21,000/ month for Mr. Wiggins to stay in an impoverished environment, where there is little to do, an environment in which his mental illness undeniably worsens or at the very best, is stabilized.

Community Support Service (CSS), that bane of NC DHHS, and by default, its authorization agency, Value Options, pays approximately $52/ hour.

In April, 2007, courtesy of then DHHS Secretary Carmen Hooker Odom, appointed by Governor Easley, cut the hours of CSS to no more than 12/ week.

Beyond the 12 hours, the Endorsed Provider company would be very subject to a post payment review which would break the company. Thus, no more than 12 hours/ week/ CSS is available.

That's 12 hours/ week/ $52/ hr = $2496/ month.

Yes indeed: let's compare the very minimum of CSS hours permitted by NC DHHS per month, specifically, $2496, versus $21,000/ month for inpatient psychiatric custodial care.

The public can do math: can the Governor and NC DHHS?
Marsha V. Hammond, PhD

****************

"....While fiscally conservative lawmakers continue to count the monetary cost of adding new beds at state mental hospitals, who will be responsible for counting the enormous social costs that come with a broken system that currently tolerates far too few beds?..." http://psychlaws.blogspot.com/2008/03/real-cost-of-psychiatric-hospital-beds.html

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Psychiatrichospital servicespayment systemFor rate year (RY) 2008 (beginning July 1, 2007), the base payment rate is $615 per day. http://www.medpac.gov/documents/MedPAC_Payment_Basics_07_psych.pdf

What did NC DHHS ---DO---in order to have to pay back Feds $130-170 million $$$

Citizens merit answers to these important mental health reform questions

Several good, salient suggestions have issued from the joint mental health oversight committee which has recently met in order to determine what changes need to occur in order to 'right' NC mental health reform.

This being said, God, or the devil, is in the details.

These are some questions that bear answering for NC citizens:

1. what were and are the criteria associated with Community Support Services (CSS) as determined by the federal government---which fairly obviously was overlooked by NC DHHS (otherwise, why are the feds asking for their $130-170 million back)-----and why didn't NC DHHS pay heed to those criteria prior to launching CSS? In other words, why are the Endorsed Provider companies responsible for NC DHHS's mismanagement?

2. what are the disadvantages of single-stream funding as re: the Local Management Entities (LME's)? The advantages seem obvious in terms of flexibility for the LME's and their idiosyncratic needs.

3. What matters are to be 'streamlined' as re: the post-payment review appeals process ? Relatedly, a NC gubernatorial candidate has stated that the issue is not to create 'perfect paperwork' (which is mostly the reason that the appeals are in place; its not that the work has not been done) but better mental health services.

What is the relationship of this 'streamlining' and the impending class action lawsuit by a Charlotte law firm pertaining to denial of CSS by NC DHHS?

4. How much money would be saved by NC if Value Options, the company that NC DHHS former Secretary Carmen Hooker Odom chose to review Medicaid authorizations and payments, even though they were a high bidder, were to be replaced by the LME's?

Relatedly, a recent 'independent' report, advocated by Governor Easley, to the tune of $750,000, obviously had as an agenda to move the LME's towards Medicaid authorization and management.

There are distinct problems with this.

The LME's are not all on the same page as re: how they utilize mental health dollars.

Specifically, Smoky Mountain Center LME, the largest of the LME's in NC, which, along with Western Highlands Network LME, oversee mental health services in one-fifth of NC counties, has, as an agenda, the funding of Meridian Behavioral Health Services, an Endorsed Provider company which spun out of SMC LME, which utilizes a 'WRAP program manned by non-professionals.

If SMC LME is refusing therapy services to state funded clients, how can they be trusted to not do the same re: Medicaid consumers?

Marsha V. Hammond, PhD

(referencing this article):

Officials discuss mental health concerns
By Matthew WhittlePublished in News on May 6, 2008 01:46 PM


"....The community support network is still facing scrutiny after the state found last year that more than $400 million in improper Medicaid services had been authorized, with the federal government looking to recoup between $130 million and $170 million. ..."

" single-stream funding for the local management entities ..."

"streamlining of the appeals process for providers who are being required to make repayments or whose endorsements have been pulled. ..."

"keep Dorthea Dix open for overflow mental health patients from Cherry and the new Butner hospitals, as well as funds to provide incentives for community hospitals to accept more acute psychiatric patients and to increase mobile crisis units. ..."

"need more money to pay their employees, especially those nurses and others who are making little more than when they started. ..."

"....Other proposals included in the bill are ones to take the Medicaid payment authorization authority away from the private vendor Value Option, and put it back in the hands of the LMEs by June 30, 2009,..."

http://www.newsargus.com/news/archives/2008/05/06/officials_discuss_mental_health_concerns/index.shtml