Monday, May 19, 2008

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:

************************ materials used for this post: Item 1:, 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 ************************************* Item 3: 2007: 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: )


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