Sunday, June 08, 2008

NC Psychological Association : dying to take your $$ but you better write your own letters

Marsha V. Hammond, PhD
Clinical Licensed Psychologist, Asheville & Waynesville, NC
E mail:
Cell: 404 964 5338
Mailing address: POB 16974 Asheville, NC 28816

June 8, 2008

Dear DHHS Secretary Dempsey Benton:

It has come to my attention, as a doctoral level psychologist, that LME’s across NC are authorizing vastly different rates and kinds of therapy services for state funded clients in need of mental health services.

I am therefore writing this letter in order to ask you to address the significant discrepancies between the authorization of therapy services across the LME’s of NC.

I specifically am asking about the barriers to therapy services created by Western Highlands Network LME and Smoky Mountain Center LME.

I have asked NC Psychological Association about this matter.

In association with the June 6, 2008 meeting with the Executive Board of NC Psychological Association, a member of that board indicated that that centrally located (in NC) LME’s utilize the same standard as Medicaid in terms of authorization of services.

This is not true of SMC LME and WHN LME, which, combined, oversee 25% of NC counties.

This has created significant barriers to the providing of professional services in western NC.

SMC LME, for instance, does not allow for any therapy outside of Community Support Services (CSS) as per Stephen Puckett, PhD, Clinical Director of SMC LME. As you undoubtedly know, 20 hours of CSS training has been written into the Service Definition by NC DHHS as mandatory. This was created, I believe, as NC DHHS allowed the utilization of high-school graduate CSS workers.

I do not believe it was the intention of NC DHHS to mandate that doctoral level psychologists go through 20 hours of unnecessary, unpaid training in order to continue to do what they do quite well, specifically, provide professional therapy services.

I am asking if you can please address this specific issue and remove the requirement for mental health professionals as this training is not necessary and has resulted in myself, for instance, not working with mentally ill citizens in rural NC.

WHN LME, the other LME in western NC, has a similarly restrictive requirement as pertaining to the rendering of professional mental health services. Marsha Ring, the manager of Utilization Management, has indicated to me, as well as to Dr. Rumer, that 8 therapy sessions is the absolute maximum number of sessions/ year. After this, only clients with diagnoses of Personality Disorders (PD’s) can be advanced to additional therapy, and the further restriction is that group therapy utilizing the well-known, cognitive therapy format known as Dialectical Behavior Therapy (DBT) must also be in place in order for there to be more than 8 therapy sessions/ year.

I agree that DBT provides useful information for clients who have difficulties associated with PD’s.

However, I would like to advocate, that in keeping with other LME’s in NC, that the standard of authorization be similar across the LME’s and that the standard that is utilized be in keeping w/ Medicaid criteria.

As regards Medicaid criteria, and as you may know, after 8 visits, the clinician must obtain authorization from Value Options, for therapy.

The authorization request is not limited to Personality Disorders but includes other diagnoses such as Major Depression, etc.

This is an acceptable manner of authorization and it would be in keeping w/ Medicaid, providing uniformity to services.

Thank you for addressing these concerns, Mr. Benton. I look forward to hearing from you.

Sincerely, Marsha V. Hammond, PhD

cc: Leza Wainwright; Mike Lancaster; NC Psychological Association; Western NC Psychological Association; CPSYLink listserv; Insko, Nesbitt; Douglas Sea, attny; David Janowsky, MD; Donald Reuss, WHN; Marsha Ring, WHN Network; Diane Bauknight, MH advocate; Bill Franklin, MH advocate, Almance county; Dan Cogswell, PhD, WNCPA; Elizabeth Huddleston, co-chair, Public Sector, NCPA; Bill Barley, PhD, WNCPA


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