Tuesday, October 21, 2008

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.


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


"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.”....."


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