What NOW from the Haywood Cnty Comm & SMC LME re: some new company to take over direct mental health care services?

"...The unsuccessful journey has now made a full circle, and the system will basically be returned to the way it was..."

MY WORD, what a statement.

If you fold two recent articles together, what you come up with is that SMC LME is intending to create ANOTHER 'shadow' company (as is Meridian Behavioral Health a shadow company associated w/ the LME, having spun off via Joe Ferraro, former SMC administrator, and Tom McDevitt, about to be the former Director of SMC LME.)

I KNOW, I KNOW: TOM MCDEVITT IS GOING TO TAKE A JOB W/ MERIDIAN NOW.

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

Article one, FINALLY explaining Tom McDevitt's 'operation' as associated with having created Meridian Behavioral Health as Joe Ferraro spun out of SMC when it was morphing into an LME: (GEE, Tom: if we'd have known about what your intentions and plans were, many of us providers would not have bothered to drive all the way to Sylva in order to sit through useless Provider meetings for all those years, with you pretending to create a mental health provider network when in fact you were sending all the state funded clients to Meridian and THAT is why the Utilization Review Department and Clinical Direct Steve Puckett, PhD, refused to allow state funded clients----other than those that were held by Meridian----to get services---using the excuse that 'all outpatient services must fall under Community Support Services----which was constantly being defunded).....:

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

Mental health reform fails to empower
New mental health system wasting taxpayers’ money
By Quentin Ellison: qlellison@hotmail.com

(cut and paste):
http://www.thecherokeescout.com/articles/2008/10/28/
news/doc4907666404198494162565.txt

"To avert a total crisis, McDevitt said that a spin-off nonprofit organization – then Mountain Area Support Services, today called Meridian – was formed. Ferrara became chief executive officer of that group, while McDevitt stayed with Smoky Mountain..... “We basically split Smoky into two different organizations, with quality leadership and quality board members,” McDevitt said...."

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

Article 2: Mental health reforms are on the way

Vicki Hyatt - Editor

"....The unsuccessful journey has now made a full circle, and the system will basically be returned to the way it was.

During a work session last week, Haywood County commissioners met with representatives from the Smoky Mountain Center to learn more about the coming changes. At stake is the status of Medicaid reimbursement funds, which will no longer be given to a third-party contractor as of September 2009, and instead will be provided directly to the local management entities.

The switch means SMC must get out of the business of providing direct services, such as operating the crisis management unit at the Balsam Center in Waynesville.

One option for a new model provides a way the transition can be relatively seamless and use basically the same health care providers that are now in place within the community.

Under the new structure, Haywood County leaders are faced with the choice of forming a new agency operating in the seven western-most counties to handle mental health services or contracting with a separate entity to address the needs. A third choice is to continue the present system and refuse the state funding available to implement the new required system, but Steve Puckett, with Smoky Mountain Health, told commissioners that was not a feasible option. ..."

*******************
Here is the comment I wrote to Ms. Hyatt, the author of Article no 2:

"Ms. Hyatt: I know this arena pretty well but most everything in your article seems to be referring to some clandestine activity for which SMC LME is already well known for in terms of not speaking directly to what they have planned. Who is the company that you are alluding to?

You stated, Ms. Hyatt:"...While no decisions can be made at a work session, county leaders generally expressed support for forming the new organization, which would be governed by a board of directors separate from the board now overseeing operations at the Smoky Mountain Center...."

WHAT is the name of the company and WHO is organizing it?

Thanks for your response.

So $10 million of sorely needed mental health money will go to PAY FOR INPT PSYCHIATRIC CARE at NC State Hospitals who LOST THEIR ACCREDITATION

ANYONE WHO PAYS TAXES TO THE STATE OF NC SHOULD BE INCENSED ABOUT THE BELOW. This is money that NC DHHS was beholden to 'watch over' in terms of securing and keeping accreditation at the state psychiatric hospitals rather than mis-managing.

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

State To Reallocate Mental Health Money
(RALEIGH)— The Department of Health and Human Services must reallocate $8 million to $10 million in its budget to cover expenses associated with treating some patients at one of the state's four psychiatric hospitals.
From The North Carolina News Network - http://www.ncnn.com/

********

(cut and paste):

http://www.ncnn.com/content/view/3499/26/

"Dr. Michael Lancaster, co-director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services, said Wednesday the state is expected to pay an estimated $800,000 a month over the next year as Cherry Hospital works to regain its certification to be reimbursed for treating any new patients on federal insurance programs.

The Centers for Medicare & Medicaid Services last month revoked the Goldsboro facility's certification following the death of a patient who died after choking on medication and being left sitting in a chair unsupervised for nearly 24 hours.


Lancaster says the hospital will continue to treat patients and won't cut services associated with patient care, but he would not specify where the money would come from within the $14 billion DHHS budget.


In addition, DHHS will pay Compass Group Inc. more than $400,000 to help restructure Cherry Hospital's management team and to help get it reinstated.


In a report released earlier this month, the independent consulting firm said that fixing the dysfunctional organizational culture will require time, attention and additional resources. "

Hey Perdue: did you think that Steven Sabock who sat dying in his chair at Cherry Hosp needed MORE CASE MANAGEMENT?

October 29, 2008

Dear ctimes@roxboro-courier.com, Letter to the Editor re: this article: Perdue campaigns in Person - 10/29/08

(cut and paste):
http://www.roxboro-courier.com/
newsnowstories/ts102908-4.htm


Its not very comforting to know that Bev Perdue, running for NC Governor, is indicating that 'I'm going to be very tough' when she does not realize that the matter which she has been advocating as necessary to bolster, specifically, case-management, is nothing more than (more) organizing of the paperwork. Bev Perdue has repeatedly suggested that what NC Mental Health Reform could stand a good does of would be 'more case management.'

Overwhelming paperwork is PRECISELY the problem w/ NC mental health reform. The system is awash in paperwork.

No, Ms. Perdue: what NC Mental Health Reform needs a good case of is the removal of barriers which keep professional mental health providers from working efficiently with people w/ mental health challenges. Case management does not involve the direct care of the client.

Marsha V. Hammond, PhD

The data is in re: what the problems are w/ mental health reform but the LME's and NC DHHS do not act on the problems

The answers are all fairly well understood now but the lack of solutions continues and that means that the LME's and NC DHHS are not doing their jobs as they see how the landscape is unfolding re: mental health care in NC. There is nothing special or exceptional about my responses. The same would be stated, I believe, by any provider who has been trying to function under the severe restrictions associated with the providing of mental health care in NC.

The below questions are extracted from a survey monkey document forwarded to a mental health listserv in NC the third week in October, 2008. I made the responses below.

The survey was sent by this woman in Wilson county: Jennifer Hancock, Executive Director The Mental Health Association in Wilson County 106 East Vance Street, Wilson , North Carolina 27893 Mailing Address: P. O. Box 652 , Wilson , North Carolina 27894 Phone: (252) 243-2773 mhawilson@embarqmail.com

Here is the link to the survey should you be interested in participating: (cut and paste):

http://www.surveymo nkey.com/ s.aspx?sm= 0AS4PS17FZbi7qHY 3CuvPA_3d_ 3d

Marsha V. Hammond, PhD
********************

Mental Health Services in Wilson County Solutions
Responses from a Buncombe and Haywood County Provider

1. In January 2009, the State of North Carolina will have a new governor. Many of the lead positions at the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; Division of Medical Assistance; etc. are appointed positions. This means that our new governor will fill these positions after taking office. What are the core values that the individuals appointed to these positions MUST possess (i. e. personal conviction in the value of all humans regardless of their disability(ies))?

Response: Both staff at psychiatric hospitals and patients should be treated w/ Dignity. This means that there is enough staff to take care of anticipated & possible problems. This means that patients can expect to be paid attention to if they appear ill and unable to function. This is simply the basics.

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

2. In January 2009, the State of North Carolina will have a new governor. Many of the lead positions at the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; Division of Medical Assistance; etc. are appointed positions. This means that our new governor will fill these positions after taking office. What are the core values that the individuals appointed to these positions MUST possess (i. e. personal conviction in the value of all humans regardless of their disability(ies))?

Response: I do not live in Wilson county. However, what appears to be taking place in Buncombe county and Haywood county (more rural) is that well qualified mental health providers are presented w/ a series of Barriers which cannot be circumvented, in order to offer mental health care to people. What are these Barriers?

A. If providers do not provide CSS, then they should not have to participate in needless and time-consuming training which is not paid. This should clearly be stated by NC DHHS instead of providers having to move up the chain of LME administrators, hoping that someone can find Dr. Lancaster or Leza Wainwright and get an answer.

B. The massive paperwork associated with the providing of mental health care for state funded clients is serving no known purpose; there is no data to be obtained via NC DHHS and so why all the paperwork----unless it has been put into place in order to prevent the utilization of services. Thus, NC DHHS should make a determined effort to minimize paperwork and be clear about how the paperwork is to be used rather than obscure issues by insurmountable truckloads of paperwork which serves as nothing more than a Barrier to services.

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

3. Providers of mental health services "cherry pick", providing services to consumers who are easier to serve and rejecting consumers who have more complex and challenging needs. How can we ensure treatment and services for individuals living with complex and challenging mental health issues in Wilson County, and statewide?

Response: Providers only cherry pick clients in order to stay financially viable. This, indeed, is the problem w/ privatizing mental health services in NC. If CSS is only allowable to the tune of no more than 8 hours/ week/ client---and if the client is schizophrenic, then savy providers will avoid these clients and they SHOULD in order to protect their continued ability to provide services.
******************

4. Case managers and qualified professionals have far too many individuals on their caseloads, even though there is to be a certain ratio. This prevents them from doing their job well. What measures, penalties, incentives, etc. can we take to ensure that case managers and qualified professionals have balanced case loads allowing for quality services and service monitoring?

Response: If you insist on the providers carrying the clients who are very ill e.g., schizophrenic, or with many behavioral symptoms associated w/ other illnesses such as some of the personality disorders, then you should be prepared to allow them to carry more clients that will allow them to remain financially viable. You cannot complain about them carrying too many clients when the system creates the scenario of disallowing enough care for time-consuming clients such that the provider works for free, in an attempt to take care of that client.


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

5. The mental health system if full of political jocking, and political practices, which takes the focus off the populations the system is designed to serve. How do we take the politics out of human services?

Response: You put someone who knows MH at the top. And that's not Dempsey Benton.
**************

6. When an individual with a mental illness presents at our local emergency room they are moved around and then are transferred out of the area to a state hospital. How can we develop resources in Wilson to provide a stable inpatient treatment service, preventing out of area transfers? or What can we do to decrease the need for hospitalization?

Response: The LME should participate w/ the local hospitals in order to set up psychiatric beds at that local hospital. In Haywood county, as associated with Haywood Regional Hospital, SMC LME obtained a grant in order to create those beds which are to open this week, the last week of October, 2008.
*********

9. It has been identified as a system problem with mental health services in Wilson County that there is a lack of mental health services for uninsured/underinsured who are not eligible for Medicaid. Who will provide services for those who have no means to pay, and what sources of payment are available for these services? If you list a source of payment please provide any restrictions or a link to a web based application with the restrictions spelled out.

Response: That's why you are supposed to have a functioning LME that creates funding for the treatment of state funded clients.

Lack of Mental Health Care has EVERYTHING to do w/ Poverty: US rank: 28/31 counties' expenditure on social issues

"According to OECD statistics for 2003, the United States ranks 28th out of 31 countries in the percentage of GDP devoted to social spending such as healthcare, education and pensions."

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

How is poverty measured? In two ways: (1) Poverty Level and (2) Living Income Standard

POVERTY LEVEL

"Mollie Orshansky, an employee of the Social Security Administration, developed the poverty level based on the “economy food plan,” the cheapest of four family food plans devised by the Department of Agriculture. A survey from 1950’s found a family spent about a third of its after-tax income on food. So, Orshansky multiplied the economy food plan by three to estimate a budget under which a family could not live. Orshansky did not intend this to measure an adequate income, but rather to serve as a baseline under which a family could not economically sustain itself. While FPL does increase with size of family, there are no adjustments made for variations in cost in different geographic areas of the country.

By 1969 the federal government adopted this poverty measure as its official definition of poverty—since there was no other available gauge. Unfortunately, the poverty level is now used to measure the number of poor based on their pre-tax income, not as it was intended, and other costs have been added to the average family budget, such as childcare, that were not considered in the 1960’s and housing costs have risen at a faster pace than food prices. For these reasons and others, the poverty level is severely outdated and inaccurate. Those up to 200-300% of federal poverty level are often still unable to meet basic household expenses...."

(cut and paste):http://www.nccouncilofchurches.org/
areasofwork/issues/economic_justice/
Poverty_%20Level_%20Vs_Living_Income_Standard.html

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

LIVING INCOME STANDARD

And then there is the more practical, modern Living Income Standard (LIS: which does not matter because nothing is calculated off of this but it SHOULD be):

"A bare-bones budget indicating how much families in North Carolina must have to meet their basic needs, the Living Income Standard (LIS) covers seven basic items: housing and utilities; food; health care; transportation; miscellaneous expenses like clothing and cleaning products; and taxes. It does not include: money to be put away for savings; consumer loans like car or lending company or mortgage loans; meals out, entertainment, birthday presents, videos, etc. Therefore, the Living Income Standard is still a very conservative, low indicator of actual cost for a frugal standard of living.

The Living Income Standard is a more realistic gauge than the federal poverty level of the earnings needed by a family to avoid actual, functional poverty. It is an income level below which a family would need public benefits or private financial assistance to pay bills for essentials. That is, the LIS is now what the federal poverty level was intended to be, but never truly was—an approximation of the lowest income it takes to make a family economically “self-sufficient.”

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

The explains why we have such odd descriptions like '200% of poverty level' for determination of such things as sliding scales for state funded mental health services.

***

NC DHHS is supposed to be keeping statistics on matters but you can't get any information on that important matter and so let's make some approximations here.

So, we have health insurance slipping away from working class families; we have 'thinner' insurance; and in the US, we have over 75 million people working at or below the minimum wage of %5.85/ hour which is $6000 below the yearly poverty level.

So, we have accelerating poverty and an accelerating need for state funded mental health services or more people to move into Medicaid.

How many people are we talking about?

*****

The approximate population of the USA is: 301,139,947 (July 2007 est.)

How many people work in the USA?

They are reported below. The figures show the percentage of people in the 25-54 (termed the 'prime working age population') age group with jobs.

1995 2000 2005

All Men Women All Men Women All Men Women

U.S 79.7 87.6 72.2 81.5 89.0 74.2 (this is 2005): 79.3 86.9 72.0

So, in 2005, approximately 80% of adults between the ages of 25-54 were working. This is also supposed to include the self-employed as per census figures.

http://norris.blogs.nytimes.com/
2006/10/01/how-many-people-do-work/

**************
What is population of NC? approximately 8.5 million people live in NC.

Approximately 36% of those 8.5 million people are: under 18; over 65. Those are not the working people. So, you have approximately 3 million working people.

********

(In NC): "27 percent of workers earn less than $9.28 per hour, the amount needed to lift a family of four above the federal poverty line.[2]"

http://www.ajf.org/Fastfacts.pdf

So, you have approximately 800,000 people who are the 'working poor.' When mental health providers see state funded clients one of the things (they used to do) was calculate their sliding scale and most 'working poor' people who were state funded clients were within 200% of the Poverty Level. This does not include their children.

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


In terms of mental health in NC, these people living below the poverty level would be the 'state funded clients' and those are the clients who are blocked from efficient treatment vis a vis the LME's creating Barriers to mental health care.

We are, indeed, in BIG trouble.

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

THE INVISIBLE AMERICANS

http://www.smirkingchimp.com/thread/18150

"....One of the measures related to poverty is the unemployment rate which is much lower in many OECD countries than in the United States where it is 6.1% , although it is important to bear in mind that the unemployment statistic itself is very flawed, for example treating the working poor as if they earn a sufficient income to support their families. According to the OECD, in August 2008, the U.S. has an unemployment rate of 5.68% compared to Austria at 3.30%, Denmark at 2.9%, the Netherlands at 2.60%, Korea at 3.2%, Japan at 4.15%, Australia 4.08%, Luxembourg at 4.2%, and the Czech Republic at 4.30%.

Hidden behind these statistics on unemployment are the 75,873,000 (Bureau of Labor Statistics, 2007) people who are working at or below the minimum wage. Since the recent increase to $5.85 per hour, the minimum wage had been stuck at $5.15 an hour since 1997 which adds up to $10,712 a year or $6,000 below the poverty line. In fact, the minimum wage lags far behind cost of living increases given that the current minimum is $3.50 lower in purchasing power since 1960.

One of the critical explanations for the depth of poverty in the United States is the ideological opposition to transfer payments for individuals who are struggling. This opposition is a consequence of the religious commitment to Neoliberalism which encourages each individual to maximize his wealth to benefit society as a whole. It must be noted that there is no similar anathema to transfers to defense industries or to corporations in the form of tax breaks, subsidies, deregulation, guaranteed loans, and bailouts. Adam Smith’s invisible hand seems to slap those in need and reward those who are wealthy while applying the dogma adhered to rigidly by the disciples of Milton Freidman.

According to OECD statistics for 2003, the United States ranks 28th out of 31 countries in the percentage of GDP devoted to social spending such as healthcare, education and pensions. Only Ireland, Korea and Mexico spent a lower percentage of GDP on social spending. On the other hand, Sweden spent 31.3%, France 28.7%, Germany 27.3% and Belgium 26.5%. Low social spending explains the high poverty rate in the U.S. as well as the very high infant mortality rate. Out of 18 European countries, Japan and Canada, the U.S. had the highest number of deaths per 1000 live births (OECD, 2007). The U.S. had 6.9, Finland 3, France 3.8, Germany 3.9, Norway 3.1, Portugal 3.5 and Sweden 2.4.

Despite the statistics exposing the severity of poverty in the United States and an understanding of the unconscionable mental, physical and emotional consequences of poverty, not to mention the long-term costs to society, past presidents and the two candidates for the next presidency seem to assign a very low priority to this tragic problem.

Obama’s solutions to reduce poverty include raising the minimum wage to $9.50 by 2011. First of all, $9.50 will mean that a minimum wage worker will still be below the poverty line as well as falling further behind the cost of living for three more years. It seems that when the financial and banking sector are in a state of crisis, it only takes weeks to agree to a $700 billion package but when the problem is poverty there doesn’t seem to be enough money to fund the necessary programs and the poor will just have to wait until 2011 to scrounge around for the few crumbs that Obama can scrape together.

Obama promises to reform the Child and Dependent Care Tax Credit but families that pay almost nothing in taxes because their income is too low will barely benefit. His promise to give families up to 50% credit for their child care expenses is too vague to offer any hope. Many European countries and several provinces in Canada pay close to 100% of day care expenses for those who need it.

The real problem is that the government has no real intention to redistribute wealth in any meaningful way. Redistribution of wealth is well beyond the boundaries of legitimate economic policy in American political culture. It’s radical, extreme and subversive. It’s probably a threat to the security of the United States...."

State of Darkness: US Complicity in Genocide since 1945
http://www.stateofdarkness.com

NC Families last 8 yrs: health care premiums inc 74% while average earnings rose 14%:McCrory would recommend 'thinner' coverage & thus more RISK

Note how the Republicans running for office in NC have frequently been gunning for 'thinner' coverage e.g.,"coverage that offers fewer benefits and/or that comes with higher deductibles, copayments, and co-insurance."

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

WHAT McCrory has stated:

(cut and paste: http://www.ncjustice.org/
assets/library/1304_nchac13oct08.pdf

".....In other words, McCrory would allow insurance companies
to sell health plans that do not meet the minimum standards
currently in place. The theory McCrory is pushing is that
insurance companies could sell cheaper policies that do not
include “luxuries” such as hospital care for pregnant women.
With less expensive options available more people could then
buy health insurance.

But there are several problems with this argument. There is
little evidence that minimum standards add much to the price
of insurance. A recent Massachusetts study concluded that
the net cost of standards adds about three to four percent to
the cost of premiums...."

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

Premiums vs Paychecks: A Growing Burden for North Carolina’s Workers
Families USA September 2008
(cut and paste):
http://www.familiesusa.org/assets/pdfs/
premiums-vs-paychecks-2008/north-carolina.pdf


"....Over the past eight years (2000 through 2007)..... On average, health care premiums for families rose by 74.7 percent, while median earnings rose by only 14.0 percent.

In addition to higher premiums, working families faced higher out-of-pocket health care costs,such as deductibles, copayments, and costs for services that were not covered by their insurance plans. As a result, health care costs are absorbing an ever-larger portion of family budgets, and it is clear why many North Carolina families feel worse off economically than they did eight years ago.....

Over the past eight years, North Carolina’s working families have seen their
health care costs go up faster than their earnings. As a result, the cost of health insurance premiums now imposes a greater burden on family budgets than ever before.

....Some employers have concluded that they can
no longer afford to offer health insurance to their workers and have dropped coverage, driving an increase in the number of uninsured workers. The proportion of Americans covered by employment-based insurance dropped by more than 5 percentage points between 2000 and 2007 (from 64.2 percent of adult Americans in 2000 to 59.3 percent in 2007)....

Other employers continue to provide coverage, but they now ask their workers to pay a greater share of the premiums. In addition, a growing share of employers are lowering their health costs by providing “thinner coverage”—coverage that offers fewer benefits and/or that comes with higher deductibles, copayments, and co-insurance.4

Humana refuses to pay mental health costs, driving up mental health care, w/ telephone operators in India who ask for duplicate paperwork

I'm sorry. I just do not believe that the poor poor insurance companies are experiencing difficulties w/ not getting information.
I have yet to work out---for the THIRD TIME why Humana keeps asking me for a tax form and the last time I called some person in India associated w/ their provider relations wanted yet the same tax form again. I'll have to devote an hour or two to calling them, getting no one, or the information will not be there, or basically I will just sent the information out into the fax ethersphere and they'll call me again.

Humana is also the same Medicare Advantage company who will not pay for anything other than 90806 CPT code.

I hope that 'fair and balanced!' Humana will have some of its corporate welfare removed w/ the next prez gets in as re: welfare so that the poor poor insurance company could outbit Medicare.

********************
"Insurers question or reject claims "when we don't get full information or
when we get duplicate bills," said Karen Ignagni, president of America's Health
Insurance Plans" (see below, LA Times series on insurance problems: cut and paste:

*********
http://www.latimes.com/business/
la-fi-insure23-2008oct23,0,442561.story

From the Los Angeles Times
The battle of the medical bills
Doctors and insurers blame each other for an administrative headache that is driving up the nation's healthcare costs.

By Daniel J. Costello, Lisa Girion and Michael A. Hiltzik

October 23, 2008


"..."Insurers have found a very creative way of denying, delaying or slowing payments in a way that is having a real impact on patient care and some of our survival," said Von Crockett, Centinela's chief executive. "Every single doctor and hospital is writing off money they are legally owed but don't collect. It's an insane situation.....

Doctors and hospital executives say collecting payments from insurers has become an
expensive headache that is driving up the nation's healthcare costs.

Billing disputes and protracted payment delays are one consequence of a massive
consolidation among health insurers that has created de facto monopolies in much of the country, the Los Angeles Times found.

Two decades ago, the top 10 insurers covered about 27% of all insured Americans. Today,four companies -- WellPoint Inc., UnitedHealth Group, Aetna Inc. and Cigna Corp. -- cover more than 85 million people, almost half of all those with private insurance.

A 2007 survey by the American Medical Assn. found that in two-thirds of metropolitan
areas, one health insurer controlled at least 50% of the market. In the Los Angeles area, two companies dominate -- Kaiser Permanente and WellPoint's Anthem Blue Cross.

As a result, doctors and hospitals have little negotiating power and few options when an insurer rejects a bill. Some physicians are dropping out of insurance networks or turning away new patients. Others have moved to cash-only practices. Some smaller hospitals and solo-practice physicians say they are being driven out of business entirely.

The insurance industry lays much of the blame for billing problems on doctors and
hospitals. Insurers question or reject claims "when we don't get full information or
when we get duplicate bills," said Karen Ignagni, president of America's Health
Insurance Plans, the industry's lobbying arm in Washington. "Efficiency is a two-way
street....."

ALL Insurance dropping out from under NC Citizens, including mental health (& the LME's continue to blockade care for the 'working poor')

And the LME's continue to block professional providers ability to work w/ state funded clients.

Specifically:

1. Smoky Mountain Center (SMC) LME, the largest LME in NC, has NO Outpatient therapy available except under the Service Definition of Community Support Services (CSS) which blocks professional providers from providing what their licenses allow them to do, specifically, assess and provide therapy UNLESS the professional provider is willing to sit thru untold dozens of hours of unnecessary 'trainings' which have been demanded by NC DHHS, as associated with the Service Definition, CSS.

What needs to happen? SMC LME needs to allow Basic Services for state funded clients, the 'working poor', in order that mental health services are available. There is no indication that this is changing.

2. Western Highlands Network (WHN) LME, the other LME administrating mental health services in western NC (the two LMEs together oversee 25% of NC mental health services) Director of Provider Relations, Donald Reuss (donaldr@westernhighlands.org) has obtained information from NC DHHS, assumably Dr. Lancaster or Leza Wainwright, the directors of MH services associated w/ NC DHHS, indicating that professional providers can operate within their license and provide outpatient therapy and do not need to go thru the endless trainings if they are not providing CSS, which they do not and would not.

How common these difficulties are in the rest of NC, I do not know.

And it really does not matter if there is Mental Health Parity if there is no insurance coverage at all.

And it really does not matter if there 47 different Heinz varieties of insurance models (a matter alluded to by some people running for public offices in NC) available if there is no insurance at all.


*********************
Report: N.C. children losing health coverage faster than rest of U.S.
By Scott Nicholson

http://www.wataugademocrat.com/
2008/1020/1020reportncchildren.php

"North Carolina’s children are losing health coverage faster than in any other state, and Tarheel workers are also near the bottom in coverage, accoding to one group.

A study released last week by the Economic Policy Institute showed North Carolina families are about 150 percent more likely than the average American to have lost medical care offered through the workplace.

For the seventh straight year, the portion of Americans covered through work fell while health-care costs continued to have double-digit annual increases.

In North Carolina, the number of insured dropped 5.4 percent since 2001. “This continues an alarming trend that shows no signs of stopping,” said Adam Searing, director of the N.C. Health Access Coalition at the North Carolina Justice Center.

“More and more North Carolina families find themselves without health care, and it seems like new studies sounding the alarm about this crisis come out every day.”

Nationally, 3.4 million fewer children had employment-based coverage in 2007 than in 2000, which Searing said was not just a result of the tough economy but also from the pressures placed on small businesses.

The types of available jobs also factored into health-care coverage. People among the bottom 20 percent of household income were the least likely to have employer coverage.

Searing said the N.C. Health Access Coalition recommended six specific steps toward covering everyone with affordable care.

“We also recommend a big change in what we pay for because a lot of what costs in health care are certain drugs and procedures that haven’t proven to be effective,” he said.

“We don’t want to just cover more people, we want to lower costs. We have these big, major medical research centers in North Carolina, and they should establish an institute for effectiveness and cost control in health care,” Searing said.

“There’s a tremendous amount of research for what works and what needs to be done better, and these institutes would have the respect needed.”....."

Professional Mental Health Providers : we have been blocked from providing services while the LME's complain about having no providers

EXCUSE ME: If the LME's would remove the barriers for the professional mental health providers, you would, I believe, see the state's money more efficiently spent.

WHY does Smoky Mountain Center LME, the largest LME in NC, utilize the more expensive Endorsed Provider service Community Support Services in lieu of Basic Services? There are no Basic Services at SMC LME. All outpt therapy is included under the Enhanced Services Service Definition, Community Support Services.

This disallows mental health providers from providing outpatient therapy.

The only purpose it serves is to shunt services towards Meridian Behavioral Health Services, which was created as Smoky Mountain Center moved away from being a community mental health center to administrating mental health services in western NC.

Is this WHY SMC LME disallows Basic Services inclusive of outpatient therapy?

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

There is no place within NC Mental Health Reform for mental health providers to submit input. Not via NAMI; not via the LME's; nowhere. And you cannot get answers to your questions unless you can convince someone at the LME to go and get the answer.

Donald Reuss of Western Highlands Network LME thought my question about outpatient therapy merited a response and got the answer. THANK YOU.

Harold Carmel, MD, of the NC Psychiatric Association, has indicated over the past several days that NCPA is going to be submitting some suggested changes to NC mental health reform law.

Let's hope that this includes some feedback from professional mental health providers who have had very little ability to provide feedback into NC's failing mental health reform. Let's hope that outpatient therapy, utilized in the way that it could be, is paid attention to.

HOwever, psychiatrists do not generally do outpatient therapy and there is no indication that NC Psychological Association understands what has been going on.

I have a lot of clients who would have been in the hospital w/o my support, rendered on a 24/7 basis. They can call me anytime...and they do. They are my outpatient therapy clients and I treat their needs seriously and listen to them.

It would be nice to be LISTENED TO for a change, by people who tinker w/ mental health reform.

When I went to the Haywood NAMI meeting on Thursday, October 16, 2008, Meg Hudson, part-time employee for Smoky Mountain Center (SMC) LME and part-time employee for Meridian Behavioral Health, run by a retired SMC LME employee, gave a talk on the new beds being opened at the end of October at Haywood Regional Hospital just outside of Waynesville, NC.

SMC LME's Doug Trantham, Director of Emergency Services, has worked hard to put this into place.

I spelled out for Meg Hudson, who is to be one of the social workers on the new behavioral health unit at Haywood Regional Hospital, as well as the members of NAMI there, and Dr. Ardeman, the new psychiatrist for that behavioral health unit at Haywood Regional Hospital, that SMC LME has ALL of its outpatient therapy under the Service Definition, Community Support Services, and that professional mental health providers who are unwilling to sit thru 20+ hours of CSS training, as required by the Utilization Review Department of SMC LME, headed by Charles Barry, are unable to provide outpatient therapy services at SMC LME.

So please do not complain about the lack of mental health providers when I have told you exactly what the problem is. I cannot be the only professional mental health provider who is unwilling to sit thru 20+ hrs of unpaid, unnecessary CSS training.

I had last week asked WHN LME's Director of Provider and Consumer Services, Donald Reuss, if he could get an answer to the matter of 'whether professional mental health providers who render outpt therapy have to go thru the 20+ hours of CSS training for Western Highlands Network (WHN) LME in order to be 'employees' (the only status that psychologists have as associated w/ NC Mental health reform' and he came back w/ an answer from someone---Lancaster or Wainwright----an answer that I have been trying to get from Lancaster & Wainwright over the past week.

NO, stated Mr. Reuss: if you do not provide CSS training, then you do not have to go thru the 20+ hrs of CSS training. Here is his response and I believe this is useful for other professional providers who also have been unable to render outpt psychotherapy for state funded clients:

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

Dr. Hammond,
You do not need to have the 20+ hours of training for enhance services to do basic outpatient services. Your license is evidence enough that you have the appropriate training to provide that outpatient therapy.
Donald


Donald Reuss
Director of Provider and Consumer Relations
Western Highlands Network
356 Biltmore Avenue, Asheville NC 28801
(828) 225-2785 x2969
Fax- (828) 225-2784
donaldr@westernhighlands.org

******

To suit, more indicators of increased hospitalization when, frankly, the professional mental health providers could be utilized.

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

Lawmakers to weigh mental-health funding during tough economy

By Vicky Eckenrode
Staff Writer

(cut and paste):
http://www.starnewsonline.com/article/20081018/
ARTICLES/810182957?Title=Lawmakers_to_weigh_mental_
health_funding_during_tough_economy

“When the General Assembly comes back into session in January, and the new governor takes office in January, they’re going to be faced with an awful lot of need and I’m afraid less money than now,” she said.

Coupled with overall money concerns, state lawmakers also will be bombarded with a number of issues plaguing the state’s mental health system. .....

Since legislators left Raleigh this summer, Broughton Hospital, a state mental facility in Morganton, lost its accreditation, meaning it might lose payments from private insurers.

Another state facility, Cherry Hospital in Goldsboro, lost its certification for federal Medicare and Medicaid payments after complaints about patient abuse and safety. Part of the hospital closed where a patient died after not being attended to for more than a day...."

Mental Health professionals continue to be dismissed : non-accreditation of Broughton; professional committees dismissed at new Central Reg. Hospital

Broughton continues to bleed the tax-payers because NC DHHS cannot get it re-accredited as associated w/ all of its problems.

And has been the continued theme, specifically, the providers who are directly doing the work are not consulted but rather the administrators' advice is used, NC tax payers continue to pay for the lack of regard for the work of the professionals on the part of NC DHHS.

State was warned on mental health billing
Biesecker: http://www.newsobserver.com/news/
story/1254221.html


"In meetings and e-mail messages last summer, Dr. Michael Lancaster, co-director of the state mental health division, and Jim Osberg, director of all state mental hospitals, were told that using Dix's number at Central Regional would potentially be a violation.

The warnings were summarized in a June 16 e-mail message from Dr. Susan Saik, then the medical director at Dix: "Changing to Dix's provider number while Dix is still operating leaves a number of problems that could lead to serious issues with regulatory agencies," Saik concluded in the lengthy and highly technical message.

Saik and others recommended using John Umstead's provider number at Central Regional instead. The move would avoid confusion and simplify the transfer of patients and staff from Dix, they argued.

Staff overruled

Lancaster and Osberg overruled them."

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

Additionally, the committee of professionals, inclusive of psychologists, who attempt to guide the actions of the mental hospital, has been dismissed and one committee has been created THOUGH THE BILLING, which was incorrect and caught the eye of the federal regulators, was done as if TWO HOSPITALS EXISTED.

*****

And Broughton continues to be paid for by NC Tax Payers as NC DHHS is not able to utilize the skills of the professionals at Broughton who oould, it is assumed, be put to work in order to regain its accreditation.

http://www2.hickoryrecord.com/content/2008/oct/09/
broughton-loses-accreditation-appeal/

Broughton loses accreditation appeal
By Sharon McBrayer | The News Herald
Published: October 9, 2008


I think the whole of NC DHHS administration needs to go away. They won't listen to the people on the ground.

New Medicaid services appeal for Medicaid consumers: everything has moved to OAH as of 10.1.2008:but WHERE IS V.O. IN THE MIX?

There's a very slick sleight of hand being outlined here. Listen carefully:

The law offices associated w/ Douglas Sea, in Charlotte, NC, is interested in obtaining information about Medicaid appeal complexities as associated with MOS matters e.g., diminishment of services w/o client being able to appeal the matter.

Indeed, Mr. Sea's office was instrumental in guiding an Endorsed Provider company in western NC as associated with information pertaining to the OLDER, ORIGINAL MOS----rather than the newer MOS.

Why would there be two sets of authorization requests for CSS? As in the case of the clients' cases described here, many Endorsed Provider companies crashed as NC DHHS diminished CSS hours. They were left in the place of having delivered the services and paying their employees but then were gigged by NC DHHS as associated with paperwork problems and then demanded to payback to NC Medicaid. They simply went under.

HOWEVER, the original appeal made by the crashed company, linked to the request for services, WERE STILL IN EFFECT. THIS is what Mr. Sea's office has been able to highlight re: reduction in CSS which has never moved thru the informal appeal/ mediation/ formal appeal process.

So, NC DHHS set into motion events that they then not legally deal w/ re: the legal demand that a reduction in Medicaid services have a process----which was never gotten to----re: the avalanche of appeals.

He can be reached at: "Douglas Sea" . I am told that a class action lawsuit is in development.

Website for Legal Services of Southern Piedmont:

http://www.lssp.org/staff.html

FAMILY SUPPORT AND HEALTH CARE PROGRAM
Douglas Sea, Attorney and Senior Program Director
Dorothée Alsentzer, Attorney
Robert Davis, Attorney
Ellen Hamilton, Paralegal Advocate
Alison Hartman, Paralegal Advocate

**************
THIS IS THE INFORMATION THAT MR. SEA IS ACCUMULATING RE: MEDICAID APPEALS:

Informal Medicaid service appeals ended September 30. No informal hearings were held after that date (although some decisions may have been issued on hearings held before October. Anyone with informal appeal still waiting for a hearing as of Oct 1 was supposed to be informed of option to have case transferred to OAH. DMA still has put nothing on its website yet about the changes and has issued no written info to providers that I have seen. I have three questions for all of you:

1) Do you have or know of any clients with pending informal appeals where hearing was not held by September 30? If so, has your client received a notice about transferring the case? If so, what does the notice say? Please fax it to me after marking out client identifying info. Be aware of a possible 30 day deadline for client to respond in writing to that notice.

2) Do you have or know of any clients who received a notice of denial or termination of Medicaid services since September 19? If so, did that notice include informal appeal rights or only formal appeal rights? Please fax it to me, again after removing client info.

3) If your client got a notice including informal appeal rights recently and tried to request an informal appeal on or after 10/1, what happened to that appeal? What was client told?

AGAIN, CONTACT HIM HERE: dougs@lssp.org

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


Legislatively created back in June, 2008, by the NC State Legislature, as associated with an avalanche of CSS Medicaid appeals as NC DHHS cut Community Support Services (CSS), the Office of Administrative Hearing (OAH), is now handling Medicaid appeals. Paperwork associated with this matter appears to be the key H-06. The form is here:

(cut and paste):
http://www.ncoah.com/hearings/h06.doc

NC DHHS scrambled to have hearings on denial of Community Support Services prior to the October 1, 2008 deadline as evidenced by telephoning Endorsed Provider company representatives in order to set up a time for informal appeals for their Medicaid clients who had commonly been denied CSS, prior to even the delivery of letter to the Endorsed Provider company representatives. In some cases, the clients never have received any paperwork about their informal hearings from NC DHHS.

In that Value Options (VO) is the authorizing agent for Medicaid Services for NC DHHS, how is VO going to tackle this matter of the interfacing of OAH w/ DHHS? Can we expect more of the same lack of timely f/u as re: VO?

And to whom will these problems be reported? To NC DHHS?----who has been allowed to wash its hands of the appeals matter re: their inability to deal w/ the avalanche of Medicaid denials associated w/ NC DHHS diminishing CSS hours----or the Office of Administrative Hearing----who has no interest in mental health matters and/ or the delivery of services other than to deal w/ the informal appeals/ mediation/ formal appeals of the denial of services?

It seems to me that once again we have 'progressed' to the place of no-one-knows-what-to-do-because-they-are-not-the-responsible-party which has become a well honed skill in NC mental health reform.

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

Here is the outline of a telephone conversation w/ personnel at Office of Administrative Hearing.

Telephone conversation 10.14.2008 2 pm, approx:

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

DHHS Hearing Office, Yvette Young, indicated that DHHS is in the process of forwarding informal appeal documents to OAH.

Laura Brown, Supervisor on the Administrative side of Hearings (this is how she stated her title is: 919 855 4260), referred the caller to Jane Plaskie.

Jane Plaskie, Appeals Coordinator, Clinical Policy within DMA: 919 855 4260

She stated: the General Assembly passed into law on July 1, 2008, that informal appeals thru the DHHS Hearing office would no longer be available to recipients, effective October 1, 2008. From that date all appeals would go to the Office of Administrative Hearing. Ultimately, clients could have a formal hearing in front of a judge at various locations around the state.

Before the judge’s decision, they would be offered the opportunity for mediation involving DMA staff, the vendor that made the decision e.g., Value Options, and the recipient. At that point, the recipient could accept the mediated offer or elect to still go before the judge.

Plaskie stated that MOS still applies. This means that the client can continue with the ORIGINALLY obtained services (for instance, more than the 8 hours/ week/ client/ CSS) until the matter is settled.

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

That sounds organized, right? NC DHHS has called the Endorsed Provider companies to let them know of the possibility of taking care of the Medicaid appeals prior to the matter being forwarded, as was legislatively determined, to the OAH.

PRIOR TO this legislatively determined matter, there were 11 days (now 30 days under OAH) to make an appeal about the reduction of services.

Over the past year or so, as CSS have been denied and severely diminished, when Medicaid appeals were made to NC DHHS, it was not uncommon for NC DHHS to have the NEWER Medicaid appeals paperwork----put together by the newer, non-crashed Endorsed Provider company who took over the clients from the crashed company----before them---but not OLDER appeals paperwork created by the crashed Endorsed Provider company.

So, unless the newer Endorsed Provider company realizes it, the non-challenged, never having moved fully thru the appeals process consisting of: informal/ mediation/ formal before a judge---appeals (in that order) MOS remains in effect IF the reduction in services was appealed to begin with----as CSS were being defunded and diminished.

REMEMBER to figure out WHEN the original appeal to NC DHHS was created. THAT will determine the services that are currently in place as associated with a continuation of MOS until the appeals process moves its way thru the OAH system.

However long that takes.

Both gubernatorial candidates look lame re: health reform----for different reasons

Neither one of them is in touch w/ the real world of the lower & middle income citizens.

(cut and paste):
http://www.reuters.com/article/domesticNews/
idUSTRE49D5PU20081014

Growing number of workers are poor: study
Tue Oct 14, 2008

"One-third of all (U.S.) children reside in low-income working families," said Roberts.



Perdue's problems re: what she states about health reform:

1. Perdue thinks that kids should be able to get to health insurance. What she doesn't know is that kids can get to Medicaid, trust me, regardless of how many adults are in the household and how much they make; moreover kids get 28 mental health visits/ year w/o any further authorization requests whileas adults get only 8; thus, Perdue's desire to get more kids on insurance is a moot point. Moreover, kids ability to get to Medicaid is increasing as associated w/ the diminishing of family incomes (see above Reuter's article). Kids have the least of the problems re: medical and mental health care.

2. Perdue would like to see a healthier bunch of citizens; so I want to know how she is going to trim back big burley in this Duke-funded state.

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

McCrory's problems re: what he states about health reform:

1. he wants to offer 'incentives for businesses'; I'd like to see proof that this would work. I don't think that people who are just making enough to put food on the table and pay the rent are particularly interested in advancing their skills such that they figure out how to get to McCrory's 'child health care tax credit'

2. McCrory would like to do away w/ mandates associated with the floor level of what insurance companies are demanded to offer to their customer. He himself must have some pretty damn good insurance for which he does not pay very much if he figures that the 650,000 people w/ crummy BCBSNC health insurance to the family tune of $700/ month----a policy that does not offer screening colonoscopies after age 50----are somehow going to get to any kind of insurance that is of any use for something less.

3. McCrory says he'd rather people have 'some insurance than no insurance.' I don't see the difference in terms of the disaster that would befall you if you had a catastrophic occurence such that you had to be hospitalized for some time or have extensive surgery. Catastrophe insurance vis a vis massive hospital bill can be purchased for the price of filing for bankruptcy if push comes to shove. Oh, and you can get to Medicaid for 6 months at a time if you meet a deductible against what is coming into the household----which, if you have a catastropic event-----will be no money coming in weighed against massive hospital bills. Yes, Medicaid will pick those up.

4. McCrory sings the same sad song re: the attorney costs associated w/ malpractice suits. I have not heard any support for this actually being a matter which is important to pay attention to.

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


Gubernatorial candidates discuss health care reform
October 13, 2008 - 9:11PM
Barry Smith
Freedom Raleigh Bureau

(cut and paste)
http://www.enctoday.com/news/
health_50313_kfpress__article.html/
insurance_perdue.html

RALEIGH - Democrat Bev Perdue has a goal of having health insurance for all kids who don't already have insurance.

Republican Pat McCrory wants to give more incentives to the private sector to provide health insurance for their employees.

Perdue, the state's lieutenant governor, and McCrory, the mayor of Charlotte, are vying for the governor's race in North Carolina. Voters will elect North Carolina's next governor on Nov. 4.

"The goal I have of providing health insurance for all kids who don't have health insurance I believe is a critical goal of the 21st century," Perdue said. "It will take us a while to get there."

She said that if kids aren't provided health insurance, we will pay for them when they make emergency room visits.

"We'll be much better off having a healthy and well kid going to school or coming to daycare so that they become healthy and well workers," Perdue said.

In addition to incentives for businesses to cover their employees with health insurance, McCrory supports offering child health care tax credits and tax credits for the uninsured.

He said that he would like to do away with a lot of the health insurance mandates now required by state law.

"It's making it unaffordable for young people," McCrory said. He said doing so would allow customers to pick from a menu of health care options.

McCrory's campaign says that the state's 47 private insurance mandates are estimated to cost increases in insurance premiums of about 41 percent.

"I'd rather them have some insurance than no insurance," McCrory said.

Perdue disagreed. She said that there are certain minimum requirements that health insurance plans should offer.

She said that she supports efforts to get the families of poor people insured as a means to getting parents to enroll their children in health insurance programs.

Perdue also supports attacking health care costs by promoting healthy lifestyles, such as reducing obesity.

Along that line, Perdue says that she is proud of her work chairing the Health and Wellness Trust Fund, particularly when it comes to smoking.

"Now you can't find a tobacco user while he's sitting on state property, or on school property or in a state vehicle," Perdue said. "We've outlawed it."

McCrory seeks to attack health care costs by curtailing non-economic damages, such as punitive damages, in malpractice lawsuits. Such efforts could lower costs by reducing the amount of "defensive medicine" practiced. His campaign says that lowering such legal damages could also result in lower health insurance premiums.

He also supports changes in the mental health system, including the establishment of citizen panels to review contracts. He opposes the closing of Dorothea Dix Hospital in Raleigh.

"The last thing we need to do is reduce the number or rooms," McCrory said.

Perdue supports extending the safety net for mental health patients and establishing mental health courts, with judges and other judicial officials who have extensive training in the subject.

Barry Smith can be reached at bsmith@link.freedom.com.

SMC continues its nepotistic past by having part-time Meridian employee, Meg Hudson, acting as the Director Soc.Wrk team@Haywood Reg psychiatric unit

I would like to know how it is that Meridian Behavioral Health's part-time employee, Meg Hudson, is going to act as the Smoky Mountain Center Director of Social Work at Haywood Regional Hospital's new psychiatric unit w/o feeding patients and money to Meridian Behavioral Health which is directed by Joe Ferraro who is a retired SMC LME employee?

The speaker this coming Thursday at the Haywood NAMI meeting (see information below) is Meg Hudson speaking about the matter of the new psychiatric inpatient unit which is a very needed thing. And Doug Trantham, Director of Emergency Services at SMC LME is an honorable man w/ a good reputation.

Nevertheless, just a couple of weeks ago SMC LME Director Tom McDevitt, was removed as associated w/ his daughter and wife working at SMC LME and in particular, his wife was a real estate agent and SMC LME had real estate interests.

We've ALWAYS had Meridian right in the middle of SMC LME's business.

And now, as per the NAMI Haywood newsletter which came out October 12, 2008, I understand that a person whom I don't know and have nothing negative or positive to say about at this point in time-----is working part-time for Meridian and part-time for SMC LME and is going to be in the key position of creating referrals.

NAMI Haywood meeting is Thursday, October 16, 2008, 7:30 pm, at a local church in Waynesville, NC, one block down the street, going towards Frog Level, from the main Waynesville library (same side of the road). You go into the glass doors on the side street of that church and meander around and listen for voices.

Yes, I know, terribly vague. I can give directions if people want them: 404 964 5338 or I'm quite sure that the president Suzanne Gernandt (sgernandt@earthlink.net) would be glad to give them to you or the vice president, Patricia Meyer (pameyer01234@yahoo.com)

To have a provider company's employee acting as the main interface for an inpatient psychiatric unit is no different than having BCBSNC 'liason' employees who are SUPPOSED to interface w/ the state legislature standing committee that oversees BCBSNC----but who in fact simply report back to BCBSNC w/ 'insider' news----best I can tell from trying to understand why BCBSNC will not pay for any screening colonoscopies in western NC except for one office based practice in Boone, NC.

I'll be at that NAMI Haywood meeting to ask Meg Hudson how she intends to deal w/ this matter. I do not interface w/ SMC LME anymore and so I have nothing to gain as re: this question.

It appears that SMC LME continues to have as an agenda the furthering and protection of Meridian Behavioral Health Services while diminishing the ability of other professional providers to work w/ clients within the catchment area of SMC LME as associated with no outpatient therapy except as associated with Community Support Services which is constantly being defunded.

You guessed it: that's why I am no longer affiliated w/ SMC LME in terms of attempting to work w/ their state funded clients via the Endorsed Provider company that I was demanded to affiliate with in order to be able to do such----as associated w/ NC Mental Health reform requirements.

GOSH! What happened to our appeal rights?! : how NC DHHS screwed Medicaid consumers of their mental health appeal rights

Bring on the attorneys.....

Here's the lowdown on what has taken place re: Medicaid appeals as associated with the cutting of services by NC DHHS:
***********************

I have a client who has been receiving 3.5 hours/ week of Community Support Service (12 hours/ week/ max/ client is what NC DHHS states it will cover; I did not offer the CSS; I did a psychological assessment on him; he is a dually eligible client e.g., both Medicaid and Medicare; all CSS comes via Medicaid).

He had a head injury and thus his diagnosis is Cognitive Disorder NOS, the 'head injury' diagnosis. Yes, head injured people can learn new skills in order to circumvent head injury difficulties and you would be surprised at the level of head injuries amongst the indigent population.

The purpose of CSS is associated with 'rehabilitation' and the learning of new skills as associated w/ that 'rehabilitation.'

NC DHHS via Value Options, the authorizing agent for NC DHHS and by default, Western Highlands Network (WHN) LME, lowered his CSS available hours to 1.5 hours/ week from 3.5 hours/ week.

This is hardly enough for a company to even bother with the matter, given the cost of gasoline re: seeing the client who has no transportation----and most Medicaid clients have no transportation and there is little public transporation outside of Asheville in western NC.

This is what the Value Options letter stated to the Endorsed Provider company representative (the client has not received his letter). I am posting the pertinent information from the Value Options letter to the representative of the Endorsed Provider company who has been doing CSS work w/ the client:

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

Value Options letterhead: 'Improving Behavior to Improve Health'

"Informal appeals are decided by a hearing officer at DHHS....

How to file a formal appeal:

Formal appeals are before a judge from the Office of Administrative Hearings (NOTE THE DIFFERENCE FROM HEARING OFFICER AT DHHS: see below for importance of this matter)

An administrative law judge will make a decision in your case. The agency then reviews that decision. Further appeal to court is allowed after the agency decision. ....

If you appeal and remain otherwise Medicaid eligible for the service, Medicaid will continue to pay for the services you now receive until the final agency decision, unless you give up that right. IF YOU LOSE YOUR FORMAL APPEAL, YOU MAY BE REQUIRED TO PAY FOR THE SERVICES THAT CONTINUE BECAUSE OF THE APPEAL.

lET'S SAY IT AGAIN, SAM: If you lost your formal appeal, you may be reequired to pay for the services that continue because of the appeal...."

So, the client is left believing that the Endorsed Provider company may sue them (ridiculous to sue a Medicaid client; they don't have anything) and so the client relinquishes the CSS as s/he believes the Endorsed Provider company----who basically EATS THE COST of providing the service, if they be so naive, will turn around to gig the client.

Check. And mate.

The Endorsed Provider company will not provide the service as they figure they will eat the cost and the client relinquishes the CSS as they do not want to be sued by the Endorsed Provider company who has eaten the cost.

Fun's only beginning.

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

Background information necessary for understanding what is taking place here:

Recipients of Medicaid services receive a 'MAINTENANCE OF SERVICES' unless---unless---unless----they move from an Informal Appeals Process and into a Formal Appeals Process before a judge.

If a Medicaid client moves through the below enumerated Level One of the appeals process----which appears at this time to be the only process which is still in place----though in a phantom-manner-----given that the Level Two appeals process, specifically, Office of Administrative Hearing, and Level Three appeals process, specifically, the Clinical Policy & Program Section of NC Medicaid tell one to go back to the original DHHS Hearing Office----and IF- IF- IF the NC DHHS Hearing Office, the Level One appeal process 'cannot mediate the appeal' (per Lavette Young of the NC DHHS Hearing Office), then the appeal process goes before a judge at which time the Medicaid recipient loses rights associated with a 'Maintenance of Service'---because NOW the informal appeal process has become a FORMAL appeal process.

***************************
LEVEL ONE APPEAL PROCESS for denied Medicaid services:

Through September 30, 2008, the NC DHHS Hearing Office (919 647 8200) was 'officially' attending to the Medicaid appeals, specific to Recipient Appeals (there are also provider appeals but that is not what we are talking about here).

When 919 647 8200 was called, we were told to call the next level of appeal:

LEVEL TWO APPEAL PROCESS for denied Medicaid services:

This first week of October, 2008, SUBSEQUENT TO SEPTEMBER 30, 2008, the next tier of appeals, specifically, THE OFFICE OF ADMINISTRATIVE HEARING (919 431 3000) was 'supposed' to be doing appeals according to the NC DHHS Hearing Office. When this office was called the first week of October, 2008, the person stated: "We're not doing Medicaid appeals yet. Try calling this number for the Clinical Policy and Program Section of NC Medicaid: tel 919 855 4260.'

lEVEL THREE APPEAL PROCESS for denied Medicaid services:

'Jane' at this office of Clinical Policy & Program Section of NC Medicaid, told us to call 'Laura Brown' within the same office We called her: no answer and no return call. Then someone at the switchboard for Clinical Policy & Program Section of NC Medicaid sent us back to the beginning, specifically, to LEVEL ONE APPEAL PROCESS for denied Medicaid services.


BACK TO LEVEL ONE APPEAL PROCESS WITH AN ADDITIONAL CAVEAT: If no mediation can resolve the matter, THEN the Medicaid consumer move from an Informal Appeal Process to a Formal Appeal Process---at which point s/he loses their rights to Maintenance of Service.

DISABILITY RIGHTS : the non-timid organization who is going to right the wrongs of NC Mental Health Reform

They're not in anyone's pocket and they're ready to rumble and they have sharpened their tools and they're loaded w/ lawyers.

The same is not true of any of the other mental health advocacy groups or surveillance groups: this includes NAMI NC; Mental Health Association (MHA); the various county and city NAMI chapters dispersed across NC; free-wheeling MH advocates, such as myself; and, the Joint Legislative Oversight Committee for Mental Health REform of the NC State Legislature.

The rest of us, including me, are just all talk compared to this group.

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

A new watchdog shows its teeth
Saturday, September 27th, 2008

http://www.ncpolicywatch.com/cms/2008/09/27/
a-new-watchdog-shows-its-teeth/

By Rob Schofield


"Dix TRO heralds a welcome sea change in the debate over mental health, developmental disabilities and substance abuse

There are a lot of wonderful groups and individuals in North Carolina who work in the world of mental health, developmental disabilities and substance abuse. For decades, a variety of doctors, nurses, therapists, family members of patients, care providers, housing providers, advocacy groups, journalists and patients themselves have worked hard to reform and modernize our public systems for serving these vulnerable populations.

Unfortunately, despite their many successes through the years in eliminating at least some of the more ghastly practices that once were common in the past century, some basic, unpleasant and vexing truths remain:

#1 - People with mental illness, mental disabilities and substance abuse problems remain an unpopular and weak constituency......

#2 - The nonprofit MH/DD/SA advocacy community is not well-equipped to aggressively confront the established powers that be......"

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

Here is Disability Rights stated agenda:

1. Investigate claims of abuse, neglect and exploitation of any person with a disability.

2. Investigate, and where appropriate, provide representation to persons with disabilities who have experienced discrimination.

3. Protect individuals with disabilities through age 21 who experience disability-related exclusion from services and ensure a free appropriate public education in the least restrictive setting.

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


What have they done so far: they noted the most pressing issues and acted boldly:

1. They've noted the critcal matter of closing psychiatric emergency beds in mental health hospitals: they legally halted the evacuation of Dix Hospital which was moving all of its patients into the new problematic Central Regional Hospital.

2. In accord w/ their statement of what they will be attending to, "Earlier this month, the group brought suit against the Wake County schools seeking access to information over alleged mistreatment of autistic children at a middle school."

Western NC leads the way in law enforcement officers' training who interface w/ citizens w/ mental health challenges

Yes, indeed: this is what is important.

*****************************
http://www.smokymountainnews.com/issues/
10_08/10_08_08/fr_briefs.html

Local officers trained in mental illness awareness

Fourteen law enforcement officers from the Franklin Police Department and the Macon County Sheriff’s Office attended a workshop, “Recognizing the Warning Signs of Mental Illness and Strategies for Effectively Dealing with it”.

The workshop was held at Southwestern Community College Public Safety Training Complex on Oct. 1 & 2. This training was made possible through a partnership between Smoky Mountain Center, the Mental Health Association in North Carolina, Southwestern Community College, and NAMI Appalachian South (National Alliance on Mental Illness); and was partially funded by a grant from Macon County Community Foundation.

The training provided information to assist with recognition of mental illness and tactics to use in effectively and safely deal with individuals suffering from major mental illness. Members from Smoky Mountain Center provided information on resources and services available in Macon County. NAMI Appalachian South gave a presentation, “In Our Own Voice: Living with Mental Illness”, to help understand persons with mental illness.

This is a first step by this partnership in bringing CIT training to law enforcement officers in Macon and surrounding counties. The CIT (Crisis Intervention Team) program is a nationally recognized training program developed by the Memphis Police Department in 1988.This unique and creative program was established for the purpose of developing a more intelligent, understandable, and safe approach when an officer is called upon to deal face-to-face with the complex issues of a mental illness crisis.

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


What It Is: "IN OUR OWN VOICE"

A presentation by consumers that creates awareness about what is involved in recovery from mental illness.

(cut and paste)

http://www.nami.org/Content/NavigationMenu/
Find_Support/Education_and_Training/
Education_Training_and_Peer_Support_Center/
In_Our_Own_Voice/In_Our_Own_Voice.htm

NAMI Wake-county rebutts NC NAMI patina of NC Mental Health Reform success, as per NC NAMI silence on the matter

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC : Asheville/ Waynesville, NC
e mail: hammondmv@netzero.com

October 8, 2008

Dear NAMI Wake President, Kathy Smith (ksmith@nami-wake.org); Past President, Frank Edwards, (fhe@nc.rr.com), and Kent Goddard, Vice President (kentgoddard@aol.com) (with cc to NAMI NC):

Ann Ackland sent me a copy of the Wake NAMI statement and evaluation as regards the status of NC Mental Health Reform.

I was pleased to see that you are speaking in no uncertain terms about the challenges and difficulties as contrasted to the upcoming 2008 NC NAMI meeting which has one mention vaguely associated w/ NC Mental Health Reform as associated with its more than 23 meetings over the course of three days the end of October, 2008, to take place in Raleigh, NC.

Moreover, there was no mention, as per NAMI NC, in terms of any meetings or concerns associated with the interface of officers of the law and people w/ mental health challenges.

The NAMI-Wake report is here: (cut and paste) http://www.nami-wake.org/

The NAMI-Wake findings and recommendations are HERE (cut and paste):
http://www.nami-wake.org/files/
NAMI_Wake_Indicators_Summary_Findings.pdf

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I read w/ some considerable exasperation the fact that, "The state has very limited data about how, and even if, those patients not being admitted are being served."

And I would like to therefore know why mental health providers are required to accumulate vast amounts of information on state funded clients---to the tune of 30+ pages associated with putting into place a Person Centered Plan and authorization for services?

To my mind, if they are not going to use the data, then let us disband w/ the accumulation of useless information.

Indeed, the 'standing on the head' of psychologist Carl Rogers' notion of 'person centered therapy', morphed into 'Person Centered Plan', as per NC DHHS, is an abomination.

As further indication of the lack of attention paid to data that seems to be ceaselessly and endlessly accumulated, you stated this: "Data about those discharged within 30 days from a psychiatric hospital are not available."

This matter, which the NAMI-Wake report stated, seems to outline the entire failure of NC Mental Health REform: (NC has 100 counties) "Fifty eight counties have a suicide rate above the national average of 11.01. Twelve of 25 LME’s had suicide rates above the nationalaverage."

If SUICIDE can be deemed to be the final statement on the lack of availability of mental health care, then, to be sure, NC Mental Health Reform has failed.

Along with the lack of training,surely suggested by the COMPLETE LACK of attention to this matter as per the 2008 NAMI convention the end of October, 2008, is this fact, which your report stated:

"The number of transports for involuntary commitment is increasing. The number of hours law enforcement officers spend on involuntary commitments is skyrocketing, seriously impacting small sheriffs’ departments across the state."

But the state of NC seems to be SAVING MONEY as re: this matter which your report stated:

"State and county funding for mental health services to consumers has declined since 2001 despite a significant increase in the population of North Carolina."

IN CONTRAST to the NAMI 2008 meeting, which pays no attention to the matter of training of officers of the law who necessarily engage with, and impact, citizens w/ mental health challenges, you indicated these as pressing concerns:

State Sheriff’s Offices

􀂾 Set up a uniform procedure throughout the state that allows deputies to drop off
patients at hospitals, transferring custody to the hospital security. .

􀂾 Set up an alternative mechanism (such as a state-wide contract) for transporting
involuntarily committed patients when they are discharged from the hospital.

􀂾 For counties with fewer than 5 deputies on duty at a time, establish an alternative
mechanism for transporting patients under involuntary commitment procedures.

􀂾 Develop stronger ties between the sheriffs’ offices and the LME so that issues
related to people with mental illness can be addressed before they become
problems.

􀂾 Continue to encourage Crisis Intervention Team (CIT) training for all law
enforcement across the state.

THANK YOU !!----NAMI-Wake for your detail, committed report as pertaining to the mental health challenges of the citizens of NC.

Obama & McCrory are going in : be you Dem or Republican, w/o the ability to act on feedback, we can't move forward

My response to the posting which is below:

As a registered Dem, I agree w/ McCrory in terms of the sitting on the hands re: Easley/ Perdue. Whether an administration is Dem or Republican, if they sit in power w/o any real ability to take in feedback and change the system, poor progress is made as associated with a malfunctioning system.

The problem, Mr. McCrory, is not associated w/ the 'training' of the mental health workers. We have master's degrees; doctoral degrees; medical degrees. THE PROBLEM is created by NC DHHS who appears to have a limited capacity to do something as minimal as come up w/ an efficient way to diminish the paperwork and move forward.

Obama's going in and you got my vote, Mr. McCrory, at the state level. Perdue seems to think we need 'more case management'; nothing could be further from the truth. We do not need case managers, who do no actual work in terms of working w/ the client to move forward, but who organize the information----as this was SUPPOSED to be something that COMMUNITY SUPPORT SERVICES DID.

Marsha V. Hammond, PhD, Clinical Licensed Psychologist, Asheville/ Waynesville NC

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The above is associated w/ a reply to the following post which is an outline of McCrory's statements on metnal health:


(cut and paste)
http://www.carolinapoliticsonline.com/2008/10/07/
mccrory-easley-perdue-administration-accountable-for-mental-health-crises

New leadership needed to correct problems

Charlotte, N.C. – The following is a statement from Mayor Pat McCrory, the Republican nominee for governor, in response to news that employees at Cherry Hospital accepted money from drug companies and foreign medical schools to visit destinations such as Hawaii and Hungary:

“The Easley-Perdue administration continues to lurch from one crisis to another in mental health care. In the latest scandal, managers at Cherry Hospital took money from a nonprofit foundation created to benefit the hospital’s patients to spend on catered meals and a staff retreat. This follows the director of Central Regional Hospital stepping down after using money intended for patients use to have her portrait made. In typical administration fashion, the former Central Hospital administrator was sent to Cherry Hospital to help correct problems there.

“The mismanagement in mental health is so systemic that it will require a complete change of attitude and management to solve the crisis. While both Gov. Easley and Lt. Gov. Perdue sit in silence, patients are in danger, hospitals are losing accreditation, and taxpayer’s dollars are being misspent.

“Over the last year, Broughton Hospital lost and regained accreditation, Cherry Hospital lost accreditation and the new Central Regional Hospital is about to lose accreditation. At the same time, administration officials have been unrelenting in their drive to close Dorothea Dix Hospital which may cause it to lose accreditation. Loss of accreditation at Broughton cost taxpayers $1 million a month and the loss of accreditation at Cherry Hospital is costing taxpayers $800,000 a month. In addition, over $400 million has been misspent in reform efforts.

“In order to improve our mental health system, we must hold people accountable for mismanagement and scandal. Second, we must change the culture of striving for minimum standards and set the goal to achieve excellence. Third, we must admit mistakes and not continue down the wrong road simply because some people are stubborn. Fourth, we must improve the caliber of training for mental health care workers. Most importantly, we need the leadership of a new administration.

“It is obvious that reform of our mental health care system must come from outside the present administration. Lt. Gov. Perdue is part of the problem and should not be entrusted with the major task of correcting a broken Mental Health system.”

NAMI 2008 : avoiding the difficult topics: Annual State Conference w/ not one single mention about NC Mental Health Reform

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC: Asheville/ Waynesville, NC
e mail: hammondmv@netzero.com

October 7, 2008

Dear NAMI NC: Debra G. Dihoff, MA Executive Director (ddihoff@naminc.org); Brenda Piper, Family-to-Family Education Program Director (bpiper@naminc.org); Jennifer Rothman, Young Family Program Director (jrothman@naminc.org) :


I just received my brochure for the October 31-November 1, 2008 NAMI state/ annual conference.

Of course its held in Raleigh. Has it ever been somewhere else closer to western NC?

I was glad to see this session: Expanding Supportive Housing Opportunities, given the problems w/ that with which I am aware as associated w/ western NC families.

Additionally, this is a very important topic about which I have written, specifically, ICARE: Integrating Mental Health Services into oPrimary Care.

There is to be a great deal of peer support information, it seems. That's a good idea given how NC mental health reform is collapsing in terms of providers.

Of the 23 courses/ workshops/ talks at luncheons, only ONE came close to addressing matters associated w/ the problematic NC Mental Health Reform, specifically:

10:15-11:45: Public Policy Update-Panel Discussion
Michael Lancaster, MD, Director, NC Depart. of Health and Human Services, Div MH/DD/SAS
Bonnie Schell, Chief of Consumer Affairs, Piedmont Behavioral Health
Andre Sperling, JD, Director of Legiszlative Affairs, NAMI

Additionally, I was very disappointed not to see something about training of law enforcement as associated with a series of beatings and deaths of mentally ill people in NC.

And hospitalization-----as associated w/ the non-ability of Cherry Hospital and Broughton Hospital to take Medicare and Medicaid patients-----most of the NAMI constituents in terms of mental health challenged people-----was not mentioned.

You play it pretty safe, NAMI NC.

Sincerely,

Marsha V. Hammond, PhD

The maddening JOKE of Federal Mental Health Parity: out of pocket Deductibles Went Up 4 surgical/medic./mental hlth/ substance abuse

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC

RE: H.R. 6983

October 7, 2008

Dear Representative Patrick Kennedy (Patrick.Kennedy@mail.house.gov):

I appreciated the talk you gave at APA/ Boston. And while MH parity may be an improvement over what was-----actually, scratch that: its not an improvement because the insurance companies have now simply raised the deductibles for everything: surgical/ medical/ mental health/ substance abuse.

I would appreciate hearing from you re: this important matter.

What a grim world we inhabit.

Sincerely,

Marsha V. Hammond, PhD

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HERE is the Act information, specifically, H.R. 6983: Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

(cut and paste):
http://www.govtrack.us/congress/
billtext.xpd?bill=h110-6983

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"....The parity law prohibits group health plans from imposing limits on inpatient days or outpatient visits and from requiring higher deductibles or cost sharing for mental illness or addiction treatment. These changes will make coverage for mental illnesses and addictions at an equal level as medical-surgical coverage...."

(cut and paste):
http://www.packetonline.com/articles/2008/10/06/
the_princeton_packet/your_views/
doc48ea90af6c20d924533813.txt

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

"...the financial requirements ....and the treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan (or coverage) and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits."

(cut and paste)
http://www.govtrack.us/congress/
billtext.xpd?bill=h110-6983

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BOTTOM LINE: the insurance companies just made money off of American citizens associated with increasing the out of pocket deductible paid in order to get to the 'non-restricted' medical/ surgical/ mental health/ substance abuse benefits!

And they did it one year prior to the actual enactment of this Act!----which means
they are already pocketing the profits from the increased deductibles!

*********

Testimony from child psychologist posting on an APA listserv:

"Parity in Washington turned out to be a joke, and a money maker for the
insurance industry. What it did for my patients was raise their deductible. So prior to parity, their deductible may have been $500 for the year. Now with parity for mental health, their deductible is now $2000 per year. Many can never use their
benefits, as everything is going to deductible. And the deductible is based
on one person. So if you have a family of 4 who all need treatment, it's
$2000 deductible per person, per year. So in January, they start all over
again with the $2000 deductible."

***********

MORE EGREGIOUS DETAILS:

**IF the insurance company experiences an "increase for the plan year involved of the actual total costs of coverage with respect to medical and surgical benefits and mental health and substance use disorder is more than:

‘(i) 2 percent in the case of the first plan year in which this section is applied; and
‘(ii) 1 percent in the case of each subsequent plan year.

the company may opt out of providing mental health parity.

*****

**It does not go into effect for another year (and yet the insurance companies are raising their deductibles already):

Effective Date-
(1) IN GENERAL- The amendments made by this section shall apply with respect to group health plans for plan years beginning after the date that is 1 year after the date of enactment of this Act

Rich people get concierge service; mental health challenged get Community Support Services

What is Community Support Services (CSS) supposed to be about? Essentially, the purpose of CSS is to improve the lives of disabled people who are on Medicaid in order to ADDRESS HIS/HER EDUCATIONAL, VOCATIONAL, HOUSING NEEDS.

Enhanced Benefit Services for Mental Health and Substance Abuse
Effective March 20, 2006

"Service Definition and Required Components

Community Support consists of mental health and substance abuse rehabilitation services and supports necessary to assist the person in achieving and maintaining rehabilitative, sobriety, and recovery goals. The service is designed to meet the mental health/substance abuse treatment, financial, social, and other treatment support needs of the recipient. The service is also designed to assist the recipient in acquiring mental health/substance abuse recovery skills necessary to successfully address his/her educational, vocational, and housing needs. The Community Support Professional provides coordination of movement across levels of care, directly to the person and their family and coordinates discharge planning and community re-entry following hospitalization, residential services and other levels of care. The service includes providing “first responder” crisis response on a 24/7/365 basis to consumers experiencing a crisis...."

(p. 1): http://www.dhhs.state.nc.us/MHDDSAS/servicedefinitions/
servdef3-27-06rev.pdf

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What do rich people's kids get at North Carolina's High Point Unversity's 'Club Ed': essentially the purpose of Club Ed is to 'come up with ways to please current and prospective students" so that they will be inspired to make better grades and assure the university of more donors and more students :

"....To that end, he (President of the university, Nido R. Qubein) hired a director of WOW! The holder of that illustrious title is Roger D. Clodfelter, and it's his job to come up with ways to please current and prospective students. The ice-cream truck that circles the campus doling out free frozen treats (more than 500 to choose from!) is but one example.
....

Near the entrance to the cafeteria is the concierge desk. The chief concierge, Leslie Smith, takes care of maintenance requests, gives restaurant recommendations, and sends out dry cleaning, among other services. Students can also sign up for automated wake-up calls. Right now the voice is generic, but there is talk of adding a recording of the president himself urging students to get out of bed.

The list of frills goes on.....

If it sounds like too much, well, maybe it is. But it's in keeping with the president's philosophy, as summed up in the university's slogan: "At High Point, every student receives an extraordinary education in a fun environment with caring people."

His strategy for High Point has so far been a success. Since Mr. Qubein took over, freshman enrollment has tripled, even though the university is charging more. He's raised more than $100-million, mostly by tapping the wallets of wealthy friends.

Seven buildings have been torn down, 12 new ones have been built, and six more are under construction. One of those new buildings, informally dubbed "The Multiplex," will house a movie theater, a sports bar, and a steakhouse.

..... some seniors and recent graduates complain that the new students are lazy and feel entitled. One possibly apocryphal story involves a freshman who opened his fridge (the freshman accommodations are two-person suites with kitchens) and asked: "Where's the food?" Someone had to explain that he needed to purchase his own supplies.....

Mr. Qubein is acutely sensitive to the suggestion that High Point emphasizes goodies over substance. Even the silliest-seeming extra, he contends, has a larger purpose. "When the students know you care, they reward you by doing well in the classroom," he says. "Then they reward you by telling their friends and by their parents' becoming your donors."

.....Another way of making students happy is by prettifying the campus. Six fountains have been added in the last two years (with six more on the way.....
--------------------------------------------------------------------------------
http://chronicle.com
Section: Short Subjects
Volume 54, Issue 43, Page A1

GEE, I HOPE THEY DON'T GET FAT ON ALL THAT ICE CREAM: that could lead to some real eating disorder problems.....

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This is what NC DHHS has in store re: CSS upgrade:

"The activities of the initial plan included additional training for providers, clinical post payment reviews on all recipients receiving an average of 12 or more hours of Community Support a week, revisions to the endorsement checklists used by the Local Management Entities to determine that providers have the necessary qualifications to deliver the service, and some changes to the Community Support service definition."

READ: training in terms of paperwork for providers (the trainings are only about paperwork)

post payment reviews (looking at the paperwork, which is assigned to the LME's)

perusing the paperwork associated w/ the LME's vis a vis the Endorsed Provider companies

http://www.dhhs.state.nc.us/dma/csupport/
dhhsplantoimprove.pdf

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Ahem: Where's the NC DHHS concierge who can address the matter of the paperwork? I don't feel AT ALL like doing it.

Federal mental health parity: again, the problem is w/ the UTILIZATION REVIEW departments

Bailout Provides More Mental Health Coverage

By ROBERT PEAR
Published: October 5, 2008
WASHINGTON — More than one-third of all Americans will soon receive better insurance coverage for mental health treatments because of a new law that, for the first time, requires equal coverage of mental and physical illnesses.

http://www.nytimes.com/2008/10/06/washington/
06mental.html?_r=1&ref=us&oref=slogin

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Fewer and fewer people have insurance thru their companies.

"The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 59 percent in 2006. This is the lowest level of employment-based insurance coverage in more than a decade."

National Coalition on Health Care:
http://www.nchc.org/facts/coverage.shtml

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Here's the rub re: federal mental health parity and its the same problem re: mental health parity in NC, which just a couple of months ago passed mental health parity.

NC State Legislature is run by Democrats. Bear this in mind as you consider the matter of 'free enterprise run amuck' and its apparent appeal beyond the confines of the Republican party.

The state legislature has liasons between BCBSNC, a non-profit, overseen by a standing committee of the state legislature. However, those liasons are employees of BCBSNC and my fierce conversations w/ them indicate that basically BCBSNC does what it wants to do. Moreover, BCBSNC was allowed to opt out of NC mental health parity or mental health parity was not going to go forward. Period.

The model which was held as sacrosanct, namely Reaganesque 'let competition create better services' is what undergirded NC mental health reform.

My goodness, that sounds familiar.

These are the following populations served re: mental health services:

**state funded clients (overseen by the LME's; the working poor, w/ no health insurance; providers have to complete reams of paperwork and several forms )

**medicaid (authorizations are obtained via Value Options who is under thumb of NC DHHS; Medicaid recipients receive SSI and as associated w/ that more restrictions re: working vis a vis Ticket to Work work incentives program should they want to work)

**Medicare/ medicaid dually eligible (unlimited authorizations, basically; recipients receive SSDI; many have to pass thru 'doughnut hole' re: medications which is problematic; if they want to work, they must utilize the PASS program which is very very confusing)

**Medicare-like Advantage plans: (Humana is the only one I have attempted to work with and this is the only insurance company I will not do business with; only outpatient therapy available is 90806; pays doctoral psychologist about $50/ 90806 session; no 90808; no H & B codes, 96152; requires session notes for frequent billing; creates endless hurdles; appear to have their provider services people in India who excel at another level of creating paperwork barriers)

**Private insurance plans

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The purposes of NC mental health reform had to do with:

1. allowing 'choice' for the consumers (this went away a long time ago as private Endorsed Provider companies failed or moved out of areas re: barriers created by LME's and by default, NC DHHS; Carl Rogers notion of 'person centered' was stood on its head as NC DHHS utilized 'Person Centered Plans' which are outlines of services which are usually 20 pages in length and require numerous 'wet' signatures, all of which is sent to the LME's for them to sit on it for a few weeks----or a few months; no services prior to authorization. You guessed it: go to the emergency room and get admitted to psychiatric hospital because there is no way to get to outpatient services otherwise; ka-ching: spend the tax-payers $$ related to the closing of Broughton Hospital and Cherry Hospital to Medicaid/ Medicare $$ due to the mismanagement of these hospitals by NC DHHS)

2. the tired old beliefs about competition which assumes that competition will create more services and better services. This notion was assumed to be applicable to NC mental health reform. Whoops: we forgot: no one can make money on clients who need such intensive supports.

3. taking mental health into the community vis a vis workers, Community Support Services workers, who would work fairly intensely w/ Medicaid consumers (only these get these services; state funded consumers get so little that they get none at all and this does not apply to Medicare or dually eligible clients or private insurance clients). Ah, you say that the difficulties with the Work Incentive Programs (e.g.,: PASSS for SSDI clients and Ticket to Work for SSI clients) makes it difficult to actually put into practice CSS: you'd be right. Additionally, another problems w/ use of CSS for impoverished Medicaid consumers is that there are so many basic matter lacking in their lives e.g., no transportation; lack of money for food, etc., that CSS $$ are spent trying to deal with THAT rather than the returning to work. There is some benefit to Medicaid recipients being able to work and sheltered workshops can hire them, via Voc REhabilitation Services, but the slots are few. It is not true that it is easy to lose your Medicaid if one works; it is not. However, this notion has been fostered for decades by Vocational Rehabilitation Services and so the belief is embedded within this population and even some of the people who work w/ this population.

4. saving money was in there somewhere but that got lost a long long time ago as more money was spent and the culprit was deemed to be Community Support Services (those intensive services for the Medicaid clients) and the private Endorsed Provider companies were highlighted as greedy entrepreneurs and while there was some truth to this, mostly it was not true but the statements were turned to the advantage of NC DHHS, in particular. NC DHHS, under Carmen Hooker Odom, Secretary of NC DHHS, who was moonlighting at another gig in NYC when she was supposed to be working here for 7 years, did not have a fiscal plan down and became basically horrified when she realized that Endorsed Provider companies were taking NC DHHS up on their invitation to extend Community Support Services to citizens. She's gone; we're left w/ her mess; new governor coming forward and may be REpublican basically as associated w/ the mess the NC Dems have created re: NC mental health reform.

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Here is the problem w/ federally mandated mental health parity:

Utilization Review departments can declare that what is available is a very basic level of services and create barriers associated with further services. Thus, it does not matter that the co-pays are less as associated w/ mental health parity.

For instance, in western NC, as associated with Western Highlands Network LME (the old community mental health centers morphed into administrators), there are 8 outpatient therapy sessions for people w/ 'legitimate' mental health diagnoses e.g., depression, PTSD, etc.---the restriction does not sit there.

WHN LME has declared, as per Marsha Ring, the manager of its UR Department, that if the diagnoses include a personality disorder, more therapy sessions can be obtained if group therapy associated w/ DBT is made available. While this is a useful idea, the privatization of mental health care in NC has dismantled the mental health centers and creating group therapy is not possible, particularly as associated with a rural, rather poor population. They can't even get to their appointments.

Oh, I see: you think that CSS $$ should be used to provide transportation. We're back to the matter of lives so basically impoverished that food and transportation are not easily available. Whoops: more defunding of CSS by NC DHHS.

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Another model of Utilization Review, with which I am familiar, is associated w/ the other LME in western NC, Smoky Mountain Center LME, the largest LME in NC. Together the 2 LME's oversee 25% of NC 100 counties.

There is NO outpatient therapy available under SMC LME. Outpatient therapy sits under Community Support Services which has been constantly defunded. Besides this, the agenda of this LME appears to be associated with creating tiers of paperwork barriers vis a vis the Utilization Review Department run by Charles Barry who threatened the Endorsed Provider company with which I am required to work re: state funded clients that I could not utilize CSS hours to get to therapy because I had refused to sit through unnecessary 20 + hours of required (by NC DHHS and thus the LME) training; I could dare them or the company would 'be audited. '

More barriers associated w/ SMC LME were associated with the Clinical supervisor, Stephen Puckett, PhD, who decided he has nothing better to do other than to go over the PCP's with a fine-tooth comb and then send them back, over and over, for revisions.

I gave up working w/ SMC LME. I managed to obtain Medicaid for my state fund client by sending all my therapy notes to the Social Security Administration adjudicator. It took 3 months to get Medicaid for her; I had been fighting w/ SMC LME over payment for services rendererd to this client, so seriously mentally ill that she had been referred to me by the intensive ACTT team, for 2 plus years.

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These are the two models with which I am most familiar as re: Utilization Review and they do not function. The scary part is that the NC State legislature and via them, the NC DHHS, has has an incipient vision to have the LME's manage Medicaid. Given that Medicaid pays the best for psychologists and given that the authorizations are fairly forthcoming from Value Options, I can envision a system that implodes into a black hole rather than the merely current exploding death star.