Value Options, Medicaid authorizing agent for NC: continued Barriers to services re: constant changes in paperwork
I've documented this before. And its still a problem. And I do not anticipate any relief from this because it is not an important agenda, this diminishment of paperwork for the people working hands-on w/ the clients.
Value Options (VO) is the authorizing agency for Medicaid clients in NC. They have a contract w/ NC DHHS.
Endorsed Provider companies or private providers, such as myself, send them paperwork in order to ask for services beyond the basic services. For outpatient adult therapy, after 8 sessions in a calendar year, authorization must be obtained from VO in the form of a simple, appropriate, one page form. YOu fax it in or mail it in, and more or less, the authorization is forthcoming within a couple of weeks. No sweat.
HOWEVER, re: the constantly defunded Community Support Services (CSS), there has to be a very lengthy (we are talking 20 pages of very carefully written treatment plan) document entitled the PCP.
This appears to be the flow associated w/ VO re: the PCP's which allow the 8 hours/ week/ CSS/ client which is provided by CSS workers; now 25% of those face-to-face services must be provided by the supervisory QP rather than the CSS workers who undergo very frequent, non-paid, upgrading of their skills----like the vastly important----CPR (Cardiopulmonary Resuscitation) last week which took about 4 hours for an Endorsed Provider company which I know.
(I am demanded, as a private doctoral level psychologist to have associated with an Endorsed Provider company in order to be able----should I choose to----provide outpatient psychotherapy to state funded clients). This demanded association is, in itself, a Barrier re: all the paperwork that has to take place between ME and that company e.g., the assigning of passwords in order to submit the paperwork to the LME, etc.
You guessed it: its not worth it to me, the doctoral level psychologist, to provide outpatient therapy to the state funded clients. Too many barriers.
But I digress.
As associated with the PCP, the 20 something page document, is apparently scanned by VO. There are certain section that have to be filled out in an appropriate manner.
Recently, as re: PCP's associated w/ CSS, rom the time that the QP submits the PCP to VO, the requirements of the document keep changing and thus the PCP keeps getting kicked back and thus the client continues not to get services.
An example: VO has changed the dating of the PCP to be the 'last time that the document was changed' vs the usual 'the original submission date of the PCP.'
ONLY AFTER THE DOCUMENT HAS MOVED THRU THIS SCANNING MESS CAN IT FINALLY BE SEEN BY A HUMAN REVIEWER. Who knows how long that takes...
No company is ever advised about the changes. It simply happens and remember: no services are available UNTIL the CSS are approved.
I had a similar complaint re: Western Highlands Network LME document change last fall when I submitted the 10 pages of paperwork on a state funded client....waiting...waiting....and finally between the time it had been sent to WHN to the time it was disapproved, which was over a month, sure enough a section in the document had been upgraded by either NC DHHS or WHN LME and instead of grandfathering the change in the document, they simply rejected the submission of the paperwork.
Its a year later. I have yet to turn up the energy or time to send in more paperwork to WHN on this one state funded client that I have.
Its easier just to see him for free.
HEY! Maybe that is what NC DHHS was counting on!
Value Options (VO) is the authorizing agency for Medicaid clients in NC. They have a contract w/ NC DHHS.
Endorsed Provider companies or private providers, such as myself, send them paperwork in order to ask for services beyond the basic services. For outpatient adult therapy, after 8 sessions in a calendar year, authorization must be obtained from VO in the form of a simple, appropriate, one page form. YOu fax it in or mail it in, and more or less, the authorization is forthcoming within a couple of weeks. No sweat.
HOWEVER, re: the constantly defunded Community Support Services (CSS), there has to be a very lengthy (we are talking 20 pages of very carefully written treatment plan) document entitled the PCP.
This appears to be the flow associated w/ VO re: the PCP's which allow the 8 hours/ week/ CSS/ client which is provided by CSS workers; now 25% of those face-to-face services must be provided by the supervisory QP rather than the CSS workers who undergo very frequent, non-paid, upgrading of their skills----like the vastly important----CPR (Cardiopulmonary Resuscitation) last week which took about 4 hours for an Endorsed Provider company which I know.
(I am demanded, as a private doctoral level psychologist to have associated with an Endorsed Provider company in order to be able----should I choose to----provide outpatient psychotherapy to state funded clients). This demanded association is, in itself, a Barrier re: all the paperwork that has to take place between ME and that company e.g., the assigning of passwords in order to submit the paperwork to the LME, etc.
You guessed it: its not worth it to me, the doctoral level psychologist, to provide outpatient therapy to the state funded clients. Too many barriers.
But I digress.
As associated with the PCP, the 20 something page document, is apparently scanned by VO. There are certain section that have to be filled out in an appropriate manner.
Recently, as re: PCP's associated w/ CSS, rom the time that the QP submits the PCP to VO, the requirements of the document keep changing and thus the PCP keeps getting kicked back and thus the client continues not to get services.
An example: VO has changed the dating of the PCP to be the 'last time that the document was changed' vs the usual 'the original submission date of the PCP.'
ONLY AFTER THE DOCUMENT HAS MOVED THRU THIS SCANNING MESS CAN IT FINALLY BE SEEN BY A HUMAN REVIEWER. Who knows how long that takes...
No company is ever advised about the changes. It simply happens and remember: no services are available UNTIL the CSS are approved.
I had a similar complaint re: Western Highlands Network LME document change last fall when I submitted the 10 pages of paperwork on a state funded client....waiting...waiting....and finally between the time it had been sent to WHN to the time it was disapproved, which was over a month, sure enough a section in the document had been upgraded by either NC DHHS or WHN LME and instead of grandfathering the change in the document, they simply rejected the submission of the paperwork.
Its a year later. I have yet to turn up the energy or time to send in more paperwork to WHN on this one state funded client that I have.
Its easier just to see him for free.
HEY! Maybe that is what NC DHHS was counting on!
posted by Marsha V. Hammond, PhD at 1:53 PM
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