Wednesday, May 07, 2008

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,..."


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