GA's Republican Gov heads for the bottomless pothole of privatizing all of GA's mental health hospitals: no one learns

November 29, 2008

RE:

Mental health plan is big shift to privatization
Atlanta Journal Constitution - GA, USA

(cut and paste):

http://www.ajc.com/metro/content/
metro/stories/2008/11/30/
mental_health_privatization.html

"North Carolina auditors said that state wasted $400 million after allowing unqualified private companies to perform many psychiatric treatment functions. ..."


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Dear Mr. Judd and Mr. Miller, reporters at the Atlanta Journal Constitution (AJC):

I read w/ interest your article which outlines a great deal of hesitancy as expressed by various mental health advocate groups re: the complete privatization of GA's public mental health hospitals.

I would like to submit an Opinion piece about these matters. To whom should that be addressed? Thank you for this information.

Privatization of the public psychiatric hospitals will not work and here is why:

1. as stated by one observer in the article, you cannot make money off of mental health. The chronicity of illnesses prohibits financial success.

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2. Without the addressing of the outpatient services matter, closely aligned to keeping people out of the hospital, there will simply be more of a fierce round-robin of admitting and discharging which will be destabilizing to people having serious mental health issues. The private companies will want to get people out of the hospital as quickly as possible in order to create revenue.

To suit, as evidenced by NC mental health reform:

"The state’s mental health system has been in chaos since state lawmakers passed legislation in 2001 to revamp it. While their goals of privatizing services to give consumers more choice and of getting people out of state-run hospitals and back into their communities were laudable, underfunding, poor planning and mismanagement utterly undermined the effort.

In fact, the exact opposite of the objectives has resulted. Records show that the number of mental patients checking into state hospitals for short visits grew by 83 percent from 2001 to 2005 as a result of dwindling local services and treatment space at community hospitals...."

(cut and paste):http://www.citizen-times.com/apps/
pbcs.dll/article?AID=200881127014

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3. The notion of privatization as being useful----specifically privatization without overviewing operations----a devil's brew or private and public interests all competing---seems to have been debunked by the recent cascade of bank failures and auto maker failures. Why GA DHHS and state legislators would fall for this is simply representative of their inability to consider anything more than the short term gain (or loss), which, specifically, is their avoidance of fixing the public psychiatric hospital system in GA.

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4. I have been carefully following NC mental health reform for almost two years now as per my blog.

I am a clinical psychologist offering services under this system and I understand it better than most. Your article stated, "North Carolina auditors said that state waste(d) $400 million after allowing unqualified private companies to perform many psychiatric treatment functions."

The 'wasting' took place at the direction of NC DHHS just as the building of those psychiatric hospitals in GA is to take place vis a vis GA DHHS. The Secretary of NC DHHS for 7 + years, until she resigned amidst a clamouring for her head, was Carmen Hooker Odom, who was well supported by Dem Governor Easley for all that time.

Practitioners' hearts sank at her barrage of disorganized outlines of changes within the various Service Definitions which outlined services. Her disorganization w/ no basis in any actuarial research started in 2002 and continued thru August, 2007.

Hooker Odom did not do the actuarial studies in order to understand whether the usage of Community Support Service (CSS), a Service Definition outlining services associated with rendering in the homes of clients, mental health-oriented services, in order to improve their lives by teaching them skills as well as doing things like getting them to doctor's appointments, etc.

In reading your article what I hear is a lot of people who should know better alluding to a suspicion that should not just be bounced around to each other like a ball but rather someone needs to do the leg work to figure out if such a privatization would work.

However, just like in NC, no one wants to be the one to point to the Emperor's new clothes but would rather say, 'I told you so', when the matter fails----which it will----on some other person's watch.

Sincerely,

Marsha V. Hammond, PhD

Privatization of all things public, including social services & mental health, increasingly seen as hazardous

Seems we haven't gotten to the end of this road aka 'privatization will get you worse services and you'll lose your experienced leadership and what will you get in substitution?'

NC's mental health system was privatized with big fanfare at the beginning of the Easley administration in 2000 and look where we are now.

NC privatized its mental health system (HEY: was that why it was picked? by Dr. Richard Visingardi, Director for MH/DD/SAS, coming from MI from another failed mental health reform project---- as easy prey?) when the state was flush w/ money).

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+ side re: privatization: bigger pool of providers, some with more expertise than could have been had at the local community mental health center (if you can find them)


- side re: privatization:

lost money and degraded services (where did all our Community Service Support $$ go to?)

weak oversight (inability of NC DHHS to demand that LME's provide certain basic services as associated w/ how law was written such that LME's could determine how they wanted to allocate their monies leaving entities like Smoky Mountain Center LME as nixing Basic Services and therefore losing experienced, professional providers)

lost expertise (thus the purported 'shortage' of professional providers being 'documented' by western NC news services

assets sold off for short-term gains but long-term loss

lost democratic accountability (elected county commissioners of western NC counties clearly lost their umph re: being able to impact mental health care vis a vis their citizens)

the corruption of the political process (Carmen Hooker Odom, for 7 long years Secretary of NC DHHS, appointed by Easley: need we say more)

Certainly, no money has been saved and wasn't that the main argument in favor of mental health privatization?

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from Stateside Dispatch:

http://www.progressivestates.org/
content/100/stateside-dispatch-archives

Privatization Update: Recent News from across the Country

As states face mounting deficits, corporate lobbyists have been promoting the idea that privatization of public services and assets is a free lunch -- services can be delivered more cheaply than by public employees and public assets like highways can be sold or leased for a hefty return to the taxpayer. As PSN has detailed in our December 2007 report Privatizing in the Dark: The Pitfalls of Privatization & Why Budget Disclosure is Needed, the promises of privatization too often yield to a reality of lost money and degraded services, weak oversight and lost expertise, assets sold off for short-term gains but long-term loss, lost democratic accountability, and the corruption of the political process......


Lost Benefits in Indiana: In Indiana, local and state human service leaders criticized the privatization of the delivery of welfare benefits in 59 (of Indiana's 92) counties and called for the return of traditional caseworkers to Indiana's welfare system. Advocates for elderly, disabled, and low-income individuals claim that difficulty navigating the new welfare system has led to the loss of benefits for many vulnerable citizens. In 2006, Governor Mitch Daniels' administration awarded a $1.16 billion privatization contract to a team led by IBM to take over the processing of applications for Medicaid, food stamps, and Temporary Assistance for Needy Families.

After listening to months of complaints from constituents and health care providers, two committees of state lawmakers - the Medicaid Oversight Commission and the Health Finance Commission - called for a temporary halt in the privatization of social services until problems are resolved. Representative Suzanne Crouch and Senator Vaneta Becker (both Republicans) have drafted legislation to be considered by the General Assembly when it meets in January. The legislation will prevent Indiana's Family and Social Services Administration from extending the welfare privatization into the remaining 33 counties until a complete review of existing services in conducted.....
Costly Privatized Medicare Plans: According to two new studies mentioned in the New York Times, private Medicare plans cost more than traditional Medicare without adding comparable value to patients. According to Marsha Gold of Mathematica Policy Research, one-third of Medicare beneficiaries with Part D get coverage through Medicare Advantage, which adds to Medicare's complexity and costs but does not result in any noticeable improvement in quality. In another article, Carlos Zarabozo and Scott Harrison of the Medicare Payment Advisory Commission state that the government pays private companies 13% more on average than what it would spend for the same beneficiaries in traditional Medicare. Zarabozo and Harrison acknowledge that higher payments finance extra benefits for some enrollees, but these payments create a greater burden on beneficiaries and taxpayers and do not lead to improved quality of services.

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Bush Labor Department misled Congress in effort to privatize jobs
John Byrne
Published: Tuesday November 25, 2008

President George W. Bush's Labor Department misled Congress in an effort to prove outsourcing jobs to private companies was more efficient than assigning the jobs to government employees, according to a Government Accountability Office report released Monday.

The report (pdf here http://www.gao.gov/new.items/d0914.pdf ) found that the Department used fictional projected numbers to improve "savings reports" -- even when real numbers were already available. And when the government did find private firms to take a government job, that employee generally was either reassigned to another task with the same title or promoted.

The effort was called "competitive sourcing," aimed to increase government efficiency by having federal and private organizations compete for providing services. While part of a federal government approach since 1955, the Bush Administration has made the approach a key element of the President's Management Agenda under the Office of Management and Budget.

An investigation revealed, however, that the Labor Department -- under direction from Bush budget officials -- deliberately withheld information about true costs.

'Fixing Hell' author provides direction for how to fix the night shift at Butner Central Hospital re: patient tied face down in order to draw blood

I was a Registered Respiratory Therapist for almost two decades prior to becoming a psychologist. I have drawn blood on literally thousands of people. I do not understand why you have to put someone face down in order to draw their blood. You can use tape to immobilize any one's body----inch by inch----if necessary. Unless someone has been an IV drug abuser, you can get blood out of them, somewhere. And there's no advantage on the back side of their body, either.

This being said, I never had to draw blood on someone as combative as this.

But I've worked plenty of night shifts and indeed the hardest I EVER worked in my life was at 2 am at Grady Hospital in Atlanta in the ICU's.

Additionally, you might imagine that there it was, the end of the tiresome night shift, the client was combative and would not stay still in order to get the blood drawn and so you have to come up w/ a solution unless you are going to take an ax and just lob off a limb in order to 'do what the doctor said.'

Moreover, its not cool to pass the task to the next shift. However, if you had a supervisor, they could make this happen when there would be more staff during the day.

A supervisor, I would think, would have interceded and talked w/ the physician in order to perhaps come up w/ a time later in the day instead of 6:30 am, right in the middle of the big change of the shift starting to crank. Later you would have had more staff, a refreshed staff, not the tired night shift, and things would have turned out differently.

This is what the psychologist, Colonel Larry C. James, PhD, is talking about in his book, Fixing Hell, as regards 'what goes on during the night shift' at GITMO and Abu Ghraib. Anything that is going to go wrong, is going to happen on the night shift due to the lack of supervision.

Excerpt, Fixing Hell, pgs. 50,51:

"That night at about 1 am I was making my rounds in the building that housed most of the interrogation booths....As I walked toward the observation room with its one-way mirror that would allow me to peek into the interrogation boothsw, I heard lots of yelling, screaming, and furniture being thrown around. I saw Luther and three MPs wrestling with a detainee on the floor. It was an awful sight. I wanted to run back to my room and wash my eyes with bleach. The detainee was naked except for the pink panties I had seen hanging on the door earlier. He also had lipstick and a wig on. The four men were holding the prisoner down and trying to outfit him with the matching pink nightgown, but he was fighting hard.

My first instinct was to rush in and start barking orders at the men, demanding they stop this ridiculous and abusive wrestling match. But I managed to quell that urge and wait. .....Someone is going to get hurt, I thought. I need to stop this right now. I knocked on the door and stepped in, trying hard to look like this crazy scene didn't bother me in the least. 'Hey Luther, you want some coffee?" I asked ina calm, low voice. Luther, who looked like he'd been wrestling a pig and wasn't coming out ahead, got up off the floor and walked over to me. "I sure do , Colonel,", he said, breathing hard. "I'll take you up on that, sir."

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And so, Mr. Benton: are you going to make sure that there is a supervisor available on the night shift which can settle matters like this?

Not if you do not understand the hospital milieu of shift work and what happens during those dark hours in the middle of the night, come 4 am. Try working it yourself: you'll see just how tough it is and why the available, well-trained 24/7 supervision needs to be functioning, as Dr. James outlines in his book as associated with another version of hell.

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http://www.wral.com/news/local/story/4016955/

Workers speak out about patient abuse claims

Posted: Today at 5:53 a.m. : 11.24.08


".....Butner, N.C. — Poor training, understaffing and confusing work policies were to blame for an incident in which a patient was improperly restrained at the state's newest psychiatric hospital in Butner......

The workers said a doctor ordered them to do a forced blood draw on an aggressive and combative patient and that although they did not want to, they felt obligated to follow orders.

"He wasn't in any danger at any time," said Patricia Swann, a nursing supervisor involved in the incident. "We had staff sitting with him at all times."

The employees involved and the union representative representing them said Monday management is making the employees out to be scapegoats.

"Nothing ever comes around until something goes wrong," said Bernice Lunsford, the union representative for the Central employees. "It seems like, to me, around here, you're damned if you do and damned if you don't......"

NC mental health hospitals lose Medicare/ Medicaid funding for deaths while CA private psych hospitals receive $25,000/ death in penalties

Thank god for the investigative reporters in NC.

"In December 2005, Ramona Knapp, 51, was left fatally brain damaged after hospital workers restrained her improperly, pinning her to the floor."
PSI private psychiatric hospital, Sacramento, CA

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cut and paste: http://www.charlotteobserver.com/
breaking/story/369795.html
by Michael Biesecker at the Raleigh News/Observer

"RALEIGH Internal records show workers at a state mental hospital in Butner strapped a patient to a bed facedown for more than an hour this week, violating proper procedures and endangering the patient."

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Amazing. Don't tell NC DHHS about this. They'll be importing some of these kinds of swell services.

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"(PSI) : It has twice been fined $25,000 for endangering patients ."

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Let's see: that's $2.5 million re: 3/4 NC public psychiatric hospitals losing Medicare/ Medicaid payments associated with significant problems x 12 months = (oh let's cut them a break): $20 million paid for by NC taxpayers associated w/ mismanagement by NC DHHS

VERSUS

Two $25,000 fines.

OH, did I tell you? IN CA, "Roughly two-thirds of the care is paid for by taxpayers. PSI collected about $900million through state and federal programs in 2007, the company's SEC filing suggests."
cut and paste:
http://www.propublica.org/feature/
psychatric-cares-peril-and-profits-psychiatric-solutions-inc/

Gee, I'd call that corporate welfare. They wolf down the profits while the public pays the bills.

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

"....In a challenging field with a troubled history, PSI hospitals often fare worse than comparable private hospitals in meeting government standards for patient care, according to an analysis of state and federal inspection reports.

See how PSI facilities compare to 10 similar hospitals Since 2005, the 10 hospitals PSI has owned longest have compiled almost twice as many patient-care deficiencies as 10 similar hospitals owned by its closest competitor, Universal Health Services Inc.

The PSI hospitals were cited in three patient deaths and for placing patients in immediate jeopardy four times, the inspection records show. The UHS hospitals received no equivalent citations.

Among private psychiatric hospitals in California, Sierra Vista had the single highest rate of state and federal deficiencies – about eight times the statewide average.

It has twice been fined $25,000 for endangering patients – accounting for the only such penalties levied against psychiatric hospitals under a 2006 state law establishing the sanctions. PSI executives declined to be interviewed for this article and, citing privacy law, would not discuss individual patients.

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Mario Vidaurre, 41
Died after a struggle with a West Oaks staffer. Video of detective interview with staffer.

Steven Burton, 55
Failed to receive adequate doctor's care at Sierra Vista Hospital. Audio slideshow of 911 call ; "When Steven Burton, 55, checked in for treatment of alcohol abuse and depression in February, he complained of chest pains. The intake nurse didn't notify a doctor because, as she later told regulators, "he didn't look sick."

Crystal Marshall, 17
Died of a rare blood disorder after Cumberland Hospital delayed calling 911

Alan Chambers, 42
Asphyxiated himself at West Oaks Hospital

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"Dying for profits - PSI psych hospitals neglect patients (cut & paste):
http://www.dailykos.com/story/
2008/11/23/235743/35/818/661243

by FishOutofWater
Sun Nov 23, 2008 at 08:57:43 PM PST
The only ways to increase profits in a hospital business that has fixed payment rates are to cut costs or increase utilization of available beds. PSI - the fastest growing for profit chain of psych hospitals - has cut staffing costs to increase profits. Low staffing levels have led to patient neglect, abuse and avoidable death in multiple cases. Despite multiple avoidable patient deaths PSI strongly continues the business model that led to those deaths.

Increased "privacy" protections, the low credibility of the mentally ill and lax government regulation have created conditions where large profits can be made at the small expense of the occasional avoidable death of a psychiatric patient. Profit maximization is incompatible with patient safety.

FishOutofWater's diary :: ::
Psychiatric Solutions Incorporated has bought up psych hospitals across America. Their business model is simple. Cut staffing costs to increase profitability. Have fewer staff care for more patients. Replace staff with higher qualifications with lower paid staff with minimum qualifications...."

How NOT to change NC Mental Health 'operational problems' at the public mental health hospitals sucking dry taxpayers $$$$

YIPEE! It took Cherry Hospital about 7 months to look at the filming of the dying of Steven Sabock who choked on medication, hit his head, and died while the staff was playing cards.

There should literally be rioting in the streets around NC DHHS re: this and other kindred matters.

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http://www.foxnews.com/story/
0,2933,455106,00.html

FOXNEWS.COM HOME > HEALTH

Three Employees Fired After Patient Chokes on Medicine, Dies
Thursday, November 20, 2008

GOLDSBORO, N.C. — North Carolina officials have fired three employees and disciplined others in the death of a patient who was neglected for more than 22 hours at a state-operated mental hospital.

The employees at Cherry Hospital in Goldsboro were fired over the death of Steven H. Sabock, 50, of Roanoke Rapids, who had a bipolar disorder and died April 29 after choking on medication and hitting his head.

Surveillance video shows employees playing cards and watching television and ignoring Sabock as he slumped in a chair.

State officials said 10 other employees were disciplined. One received a five-day suspension, four others were suspended for three days and five received written warnings, The News & Observer of Raleigh reported Thursday.

Federal regulators withdrew Medicare and Medicaid funding worth about $800,000 a month after the death.

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This is right up there w/ the Big Three auto-makers flying their private Lear jets to D.C. in order to beg for money from the American people. (see: ABC News: Big Three CEOs Flew Private Jets to Plead for Public Funds Auto Industry Close to Bankruptcy But They Get Pricey Perk By BRIAN ROSS and JOSEPH RHEE
November 19, 2008: http://abcnews.go.com/Blotter/
WallStreet/story?id=6285739&page=1 )

Broughton has not regained its accreditation re: Medicare/ Medicaid. Cherry Hospital has not regained its accreditation re: Medicare/ Medicaid. The new Central Hospital in eastern NC has not been able to take in patients due to safety issues.

Unbelievable. And since these hospitals cannot utilize Medicare/ Medicaid $$, every patient that is admitted is utilizing NC citizens' taxpayer $$ during a time when services are being shut-off and trust me, its going to get much worse.

It makes me ill to think that we would support and condone behaviors of people like this and its no different than continuing to keep the head administrators on at NC DHHS. With statements and continuing behaviors like these, I bet the administrators of Cherry Hospital and Broughton Hospital could 'see their way' to quickly re-inventing the functioning of the hospital if they were threatened w/ a pink slip.

I think they should be in their offices 24/7 until they fix this. And then they should have $$ extracted from their future salaries for being so slow to do their jobs.

***********


VideoDHHS to update lawmakers on state mental hospitals
Related StoriesWidow: Cherry Hospital patient should still be alive

DHHS to update lawmakers on state mental hospitals

http://www.wral.com/news/local/story/3992911/


Posted: Nov. 19 7:45 p.m.

Raleigh, N.C. — Officials with the Department of Health and Human Services will provide an update to lawmakers Thursday on the status of the state's mental health hospitals.

The four facilities have come under scrutiny in the past two years for a variety of issues related to patient care and safety.

Most recently, the federal Center for Medicare and Medicaid withdrew federal funding from Cherry Hospital in Goldsboro following the death of Steven Sabock. Workers neglected the 50-year-old as he sat in the same chair for 22 hours before his April 29 death.

Three workers were fired and two others resigned as a result. Four other employees were fired in August and two were charged with assault in connection with the beating of another patient.

The state's newest psychiatric facility in Butner, Central Regional Hospital, opened years later than expected. And workers at Dorothea Dix in Raleigh have long complained about unsafe working conditions.

Broughton Hospital in Morganton temporarily lost federal funding after a patient died last year. It also lost its accreditation for federal funding.

"We feel like we have competent staff," said Dr. Jims Osbert, chief of State Operated Services, which oversees mental health services. "The issues really were in changing some major cultural and operational kind of problems that have been in existence at Cherry, frankly, for many, many years."

Reporter: Bruce Mildwurf
Photographer: Edward Wilson
Web Editor: Kelly Gardner


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Unbelievable.

Western NC might as well secede: all of Perdue's meetings are in eastern NC, including the one on mental health

This is yet another reason to have had someone from Charlotte elected governor. At least that was more centrally located. Legislators and the governor seem to have no concept of the existence of western NC. We might as well secede.

For whatever its worth, Governor-elect Perdue: we don't need any more case management, just another form of spending money without providing face-to-face, direct services to citizens of NC. Case management, which has been touted by Perdue as one of the ways to 'fix' NC's failed mental health reform, is simply another way of organizing the paperwork which has very little to do w/ the services.


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“These advisory groups will provide valuable feedback to Governor-elect Perdue and are a tool to open up government to North Carolina’s citizens,” said Perdue’s Communications Director David Kochman.

Transition Advisory Groups include:

Aging: November 19

Western Wake Tech Community College
Millpond Village
Kildare Farm Road
Cary, NC 27513
Room 101

Commerce: November 19

DOT Chapanoke
313 Chapanoke Road
Raleigh, NC 27603
Room 203/204

Corrections: November 21

DOT Chapanoke
313 Chapanoke Road
Raleigh, NC 27603
Room 203/204

Crime Cont rol/Justice: November 25

NC Rural Center
4021 Carya Drive
Raleigh, NC 27610

Cultural Resources: November 20

DOT Chapanoke
313 Chapanoke Road
Raleigh, NC 27603
Room 203/204

DENR: November 21

Western Wake Tech Community College
Millpond Village
Kildare Farm Road
Cary, NC 27513
Room 101

Education : November 25

Western Wake Tech Community College
Millpond Village
Kildare Farm Road
Cary, NC 27513
Room 101

Energy: November 20

Western Wake Tech Community College
Millpond Village
Kildare Farm Road
Cary, NC 27513
Room 101

Health: November 20

NC Rural Center
4021 Carya Drive
Raleigh, NC 27610

IT/ DOA: November 25

Western Wake Tech Community College
Millpond Village
Kildaire Farm Road
Cary, NC 27513
Room 118

Mental Health: November 24

Western Wake Tech Community College
Millpond Village
Kildaire Farm Road
Cary, NC 27513
Room 118

Military: November 21

NC Rural Center
4021 Carya Drive
Raleigh, NC 27610

Revenue: November 21

NC Rural Center
4021 Carya Drive
Raleigh, NC 27610
;
Transportation: November 24

Western Wake Tech Community College
Millpond Village
Kildare Farm Road
Cary, NC 27513
Room 101

You can thank Doug Trantham for the new Haywood Reg Hosp Behavioral Health Unit for mental health services

I'm not on the inside of SMC LME but from what I witnessed for 5+ years at meetings and as associated with correspondence and phone calls, there is one man in particular, who deserves the lion's share of thanks for the moving forward of these emergency psychiatric beds, namely, Doug Trantham (doug@smokymountaincenter.com; and you can get him as easily on his phone at work as you can e mail him), Direct of Emergency Services.

26 inpatient psychiatric beds are now open for adults w/ primary mental health issues, both in Clyde, NC (the location of Haywood Regional Hospital, right next to Waynesville and 25 min from Asheville) as well as Linville, over an hour from Asheville.

If the other departments of SMC LME worked as well as this one managed by Mr. Trantham, citizens of western NC would have an amazing array of mental health services.

See the article in the Citizen Times today re: this matter.

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http://www.citizen-times.com/apps/
pbcs.dll/article?AID=2008811170327

New HRMC psychiatric unit is a joint effort

by Andre A. Rodriguez • arodrigue@gannett.com • published November 17, 2008

".....State initiative

In 2007, the state legislature provided funding to create local service capacity to reduce use of the overburdened state hospital system. Smoky Mountain Center was one of four Local Management Entities selected to participate in this program.

Haywood Regional's Behavioral Health Unit and Cannon Memorial Hospital in Linville in Avery County are inpatient units opened in Smoky Mountain Center's coverage area through this public/private partnership.

With a total of 26 new adult psychiatric inpatient beds, Smoky Mountain Center is the only Local Management Entity in the state creating new inpatient capacity through the hospital pilot.

“This is part of a legislative initiative that brings some local services for mental health out into the region,” state Sen. Joe Sam Queen said. “The legislature puts great hope in this pilot.”

Recovery

The Behavioral Health Unit will be staffed by psychiatrists, psychiatric nurses, clinical social workers and community mental health assistants, also known as peer support workers.

“These peer support workers are people who have gone through some special training who have had some mental health and substance abuse problems and have been trained to be able to talk about that with other people about their recovery,” said Carl Losacco, a licensed clinical social worker with Smoky Mountain Center.

The idea behind the recovery model is to minimize alienation felt by people who have mental and substance abuse problems, he said.

“The part of the problem that is a barrier to recovery is feeling separated from the other people who are part of the community,” Losacco said. “A lot of it has to do with language particular around labels — labels that we will use, and labels that we want to avoid. For instance we don't want to say, ‘This person is a schizophrenic,' rather ‘This is someone with schizophrenia.'

“It may seem like semantics, but it becomes very important to people because we all are sensitive to the words that are used to describe us.”

Patients

The Behavioral Health Unit will admit patients ages 18-65, and older than 65 when appropriate, who have a primary psychiatric diagnosis requiring an inpatient level of care....."

What other LME's have Basic Level Services?: Five County LME: no one available to answer a ?

The same thing happens when you call Western Highlands Network LME. The operator sits in the front of the office, behind a window, and has no idea who is around. Just another barrier to finding cures for NC's mental health care woes:

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

Marsha V. Hammond, PhD: Licensed Psychologist: NC
fax: 828 254 2013 e mail: hammondmv@netzero.com

November 13, 2008: 1:35 pm, Thursday afternoon

Hi and thanks for your article, specifically, "Local legislators prepare to balance budget."

http://www.enctoday.com/news/state_50949_kfpress__article.html/braxton_wainwright.html

In particular, my internet bot picked it up re: mental health, which I write about at my blog, http://madame-defarge.blogspot.com/.

I wanted to ask someone at the LME associated w/ your area if there are Basic Level Services but alas, after 3 tries via the operator, I could speak to no one at the LME.

$$$ can be saved if Basic Level Services, such as is used by Western Highlands Network LME, authorizes. The other LME in western NC, Smoky Mountain Center LME, does not have Basic Level Services and there are all kinds of holes in mental health due, in part, to that matter. Please see my blog for more info.

The same thing happens when I call Western Highlands Network LME. Its easier to get in my car and drive up there than it is to find a live person when you call the operator.

24 Hour Helpline 1-877-619-3761 : nope: no one available to answer my question.

Thanks for your reporting.

Marsha V. Hammond, PhD

Macon County Mental Health 2008 Report : surmountable barriers but will the Macon County Mental Health Task Force tackle them?

Macon County Mental Health Task Force, June, 2008:

http://www.maconnc.org/healthdept/pdf/
Mental_Health_Taskforce_Final_Report.pdf

What are the Barriers to mental health care in very rural Macon county in western NC?

"Barriers identified during this survey included: Stigma, income/poverty, lack of integration of mental and physical health services, shortage of mental health professionals, need for funding of community based prescription medications and psychological service programs regional disparities, and cultural diversity."

All of these Barriers can be tackled fairly quickly but I guess it means they have to get into a fight w/ SMC LME because SMC LME does not offer Basic Level Services. I submit that SMC LME does not offer Basic Level Services as they want to protect Meridian from an influx of other professional mental health providers.

The main complaint from any and all non-Meridian providers under the SMC LME catchment area is that the paperwork is killing them. Of course its killing them. that's because SMC LME must require professional providers to submit the 5x lengthier Person Centered Plan instead of the Basic Level Services Person Centered Plan.

see WHN link, cut and paste:

http://www.westernhighlands.org/SARP/
bulletins/Communication_Bulletin_73.doc :

Western Highlands Network
Communication Bulletin #73
January 11, 2008

Basic PCP Usage

Western Highlands Local Management Entity (LME) has modified its current policy around the use of the Basic Person Centered Plan (PCP). With this change individuals that receive only Basic Benefit services require only the 4-page Basic Benefits Service Plan. Should the individual's needs warrant utilization of Enhanced Benefits Services, the 13 page Person Centered Plan (PCP) must be completed by the Qualified Professional (QP) through a person centered process.

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An associated article on that Macon County task force matter:

http://www.cherokeescout.com/articles/
2008/11/11/news/doc4919fd67618bf763873663.txt

Funding, local control needed
Snow: State needs to stay the course of mental health reform

By QUINTIN ELLISON
Special to the Cherokee Scout

Tuesday, November 11, 2008 8:05 PM CST

"Local control

However, Macon County Commissioner Ronnie Beale, also a Smoky Mountain Center board member, remains concerned that there isn’t adequate local control.

“The system needs to be less complicated and have more local involvement,” Beale said. “Our needs may be different from Rutherford County, which may be different from Wake County. And with local input and local control, you have to have the local funding.”

In a unique move, Macon County took aggressive steps this year to help ensure its involvement in the state’s mental health system. In June, a commission-appointed board, formed at Beale’s request, released a report by the Mental Health Taskforce on Mental Health Services in Macon County....."

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

These are the Barriers as outlined by the Macon County Mental Health Force Task, summarized in June, 2008:

1. shortage of mental health professionals : (they had 26 mental health professionals show up for a meeting in January, 2008, as associated with their concern; imagine all the others that did not come to the meeting wwwaaaayyyy out in rural Macon county).

2. psychological service programs regional disparities : this is associated w/ the numbers of professional mental health providers. I imagine that it was proclaimed to be a separate category, for instance, in that substance abuse, in particular, seems to be dependent on an organized program which is probably in short demand in this very rural county w/ a spread out populace.

3. cultural diversity: professional mental health providers supposedly have some significant training as associated w/ the matter of cultural diversity. Certainly for psychologists and the American Psychological Association, you cannot pick up a publication without running into matters associated with this issue.

4. income/ poverty: this was supposed to be what the state funded client system and NC mental health reform was about. In that it is not attending to these people, I'm afraid I lay the blame squarely at the feet of SMC LME and its clinical arm, (since McDevitt spilled the 'official' beans---as he's leaving anyway)Meridian Behavioral Health, headed by retired employee SMC LME, Joe Ferraro. Meridian contracts w/ SMC LME to provide ALL the state funded clients' mental health care. Sad fact is, they do not. There are many providers, such as myself, who have fought tooth and nail to obtain authorizations and reimbursement (read: get paid) to see state funded clients. That's right: the professional mental health providers who VOLUNTARILY and WILLINGLY went to the houses of the state funded clients----for no extra money than the regular pay for a therapy session----threw in the towel after years of trying to weave our way thru the morass of the SMC LME authorization trivia. We gave up!

5. need for funding of community based prescription medications : there are several ways to tackle this:

a. Meridian houses a company associated w/ obtaining discounted bulk medications which may or may not be part of Meridian but is frequently used by patients. These are MAILED to the house of the patient.

b. Every medication is associated with a pharmaceutical company. Every pharmaceutical company has a service---online---wherein one can print out a document which can be sent to the pharmaceutical company so that the patient can receive deeply discounted medications. This must be signed by the prescribing provider.

c. India and Canada have discounted medications to be had, in bulk.

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

SMC LME's Utilization Review Department, headed by Charles Barry, requires, as per SMC LME non usage of Basic Level Services e.g., therapy/ medication management----and instead their usage of Community Support Services (CSS), which is constantly being defunded----that mental health providers sit thru 20+ hours of unpaid, unnecessary training in order to offer professional mental health services in accord with their licenses.

If you want to remove the biggest barrier to professional mental health care under the SMC LME catchment area, this matter MUST be tackled. These are some suggestions:

1. Ask NC DHHS's Department of Mental Health, co-directors, Mike Lancaster or Leza Wainwright, to allow SMC LME to release professional mental health providers from having to go thru 20+ hrs of CSS training----when they are not offering CSS.

Tip: SMC LME will not allow this to happen. Why not? Because they have a 'special relationship' between themselves and Meridian which effectively blocks professional mental health providers from working w/ state funded clients within SMC LME's catchment area.

Tip: Western Highlands Network saw the need for Basic Level Services (duh)and therefore created a much smaller amount of paperwork.

*************
2. Ask NC DHHS's Department of Mental Health, co-directors, Mike Lancaster orf Leza Wainwright, to make SMC LME offer Basic Level Services.

Tip: this won't happen either. Why? Because by putting all the therapy services into the CSS basket, professional mental health providers outside of Meridian are blocked from working w/ state funded clients. Besides, this, as per mental health reform (law or not, I do not know; I suspect law), the LME's have been allowed to tailor their services as associated with what they perceive to be the demands of the populace of their catchment area. Maybe this will change w/ McDevitt gone. Maybe this is an extension of the 'conflict of interest' waaaayyy beyond any real estate matters associated w/ his wife or the hiring of his daughter by SMC LME. If I were a good reporter, I'd want to know how someone had profited from this 'special relationship' w/ Meridian, headed by the retired SMC employee, Joe Ferraro.

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

3. OR, the various counties associated and stuck w/ SMC LME could DEMAND that Basic Level Service be made available in order to free up professional mental health providers.

Tip: Guess what will happen. Steve Puckett, PhD, the Clinical Director at SMC LME, will then go over all the Person Centered Plans, as he did w/ mine, in an attempt to keep throwing back the plans so that the state funded clients do not get services and thus Meridian will be protected.
**********

GET THE PICTURE?

One in Five Hospital Admissions are for people w/ mental health diagnoses

If one wanted to diminish this statistic, it would seem that one would beef-up outpatient services. Instead, under Smoky Mountain Center LME, what has happened, is that outpatient therapy can only be had under Community Support Services, which includes all other services, and is constantly being defunded and collapsed due to massive paperwork demands.

Western Highlands Network has attempted to diminish paperwork for Basic Level Services, as associated with truncated versions of paperwork for state funded clients.

Not so at SMC LME for any provider attempting to work outside of Meridian Behavioral Health Services which IS essentially the clinical arm of SMC LME.

I do not see why NC citizens should continue to put up w/ this kind of mis-treatment. I don't see why jotting the t's and dotting the i's should preclude efficient mental health care treatment. But that is what NC DHHS has created in an attempt to reign in the expenditure of money. And some of the LME's have expanded that notion to the extreme.

It seems that there should be another way to keep the brake on the outflow of cash. They could have started with an accurate actuarial picture of services instead of Carmen Hooker Odom's throwing a dart at the side of a house.

Such 'braking' might include utilizing professional mental health care providers which are at this time not allowed to function within the SMC LME catchment area. They are good value for the money and they keep people out of the hospital if they are authorized to treat patients.
**************************
1 in 5 Hospital Admissions Are for Pts w/ Psychological Disorders


The Agency for Healthcare Research and Quality (AHRQ) released the
following announcement:

One in Five Hospital Admissions Are for Patients with Mental Disorders

About 1.4 million hospitalizations in 2006 involved patients who were
admitted for a mental illness, while another 7.1 million patients had a
mental disorder in addition to the physical condition for which they
were admitted, according to the latest News and Numbers from the Agency
for Healthcare Research and Quality.

The 8.5 million hospitalizations involving patients with mental illness
represented about 22 percent of the overall 39.5 million
hospitalizations in 2006.

AHRQ's analysis found that of the nearly 1.4 million hospitalizations
specifically for treatment of a mental disorder in 2006:

- Nearly 730,000 involved depression or other mood disorders, such as
bipolar disease.

- Schizophrenia and other psychotic disorders caused another 381,000.

- Delirium -- which can cause agitation or inability to focus attention
-- dementia, amnesia and other cognitive problems accounted for 131,000.

- Anxiety disorders and adjustment disorders - stress-related illnesses
that can affect feeling, thoughts, and behaviors - accounted for another
76,000.

- The remaining roughly 34,000 hospitalizations involved attention-
deficit disorder, disruptive behavior, impulse control, personality
disorders, or mental disorders usually diagnosed in infancy or later
childhood.

This AHRQ News and Numbers is based on data from Hospital Stays Related
to Mental Health, 2006 (HCUP Statistical Brief #62) found at
.

The report uses statistics from the 2006 Nationwide Inpatient Sample, a
database of hospital inpatient stays that is nationally representative
of inpatient stays in all short-term, non-Federal hospitals. The data
are drawn from hospitals that comprise 90 percent of all discharges in
the United States and include all patients, regardless of insurance
type, as well as the uninsured.

Blame Smoky Mountain Center LME policy for not enough mental health providers

(letter to editor submitted as a response to 'Cherokee Scout' article on mental health):

Reform: Therapeutic services at risk
Not enough providers in western North Carolina

By QUINTIN ELLISON
Special to the Cherokee Scout
(cut and paste):

http://cherokeescout.com/articles/2008/
11/05/news/doc491134b1f0605836623280.txt

Wednesday, November 5, 2008

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

Blame Smoky Mountain Center LME policy for not enough mental health providers

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

Contrary to the article, which indicated that there is a lack of providers in western NC, specifically, as pertaining to the counties who have Smoky Mountain Center (SMC) LME as a mental health administrator, please bear in mind that there are no Basic Level Services authorized by SMC LME. Basic Level Services include outpatient therapy.

Currently, SMC LME, as well as all the LME's in NC, oversee only state funded clients, the 'working poor.' Soon, however, as per NC mental health law, the LME's will be managing Medicaid.

You heard me right: there are no outpatient therapy services except under the Service Definition associated w/ Community Support Services (CSS) which is being constantly defunded.

What does this mean in terms of mental health services and the numbers of providers?

Well trained doctoral psychologists are not willing to sit through 20+ hours of unnecessary, unpaid CSS training. Neither are well trained providers willing to submit 20+ pages of paperwork in order to obtain authorization for one client session.

In that SMC LME uses the vehicle of CSS, licensed providers are not able to utilize their licenses in order to practice but must submit to these additional barriers. This does nothing more than create a barrier to care for citizens of western NC under the SMC LME catchment area. That's why you don't have enough providers. Remove the barriers, and the providers will come.

Without the undergirding of Basic Level Services, this means that more citizens, unable to obtain state funded services due to barriers, go into Broughton Hospital, which has not had its Centers for Medicaid and Medicare Services accreditation re-established since August, 2007.

The cost of running Broughton, in Morganton, NC, the main psychiatric state hospital for western NC, is approximately $1,000,000/ month.

Moreover, to exacerbate the situation, there is a shortfall as associated w/ the NC state budget and this is one main reason why this is so. Thus, mental health $$ are about to be pulled.

This is not even to speak to the de-accreditation of Cherry Hospital in eastern NC where Steven Sabock was found dead after being unattended for dozens of hours.

Contrarily, under Western Highlands Network (WHN) LME, which is the other administrator of mental health services in western NC, there is no such requirement in terms of the CSS training barrier and the excessive paperwork.

The Utilization Review Department of SMC LME, headed by Charles Barry, has blocked attempts by doctoral level psychologists to provide outpatient mental health services.

If you want to do something about the lack of mental health providers in western NC, as administered by SMC LME, you need to find out why SMC LME will not allow Basic Level Services. Basic Level Services and the diminished paperwork would allow professional mental health providers to see clients and diminish psychiatric inpatient time which would save the state money.

Or would this have something to do w/ the protection of Meridian Behavioral Health Services which was created by a retiring employee of SMC LME and Tom McDevitt, who has been relieved of his director's position by the SMC LME Board?

Meridian has a contract w/ SMC LME to service all the state funded clients. And soon, the LME's will be overseeing Medicaid.

Will SMC LME continue to play favorites w/ Meridian in order to shore up an insistently collapsing provider network who cannot support themselves due to diminished work----- in order to bolster Meridian which spun out of SMC LME?

Federal Mental Health Parity law outlined by American Psychological Association's Jeff Cook,Direct. Field & State Operations

Just remember: prior to the utilization of the 80/20 fee structure associated with mental health / CPT codes which will begin 1.1.2010, the Behavioral Health Codes e.g., 96152 series, provide practitioners w/ a way to bill for 15 min increments (Medicare NOT Medicaid), providing an interface w/ primary care physicians.

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

The Wellstone-Domenici Mental Health Parity Act

Frequently Asked Questions

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted into law on October 3, 2008. This publication provides answers to questions from psychologists about the new Act and what it means for professional psychology.

Q1. What does the new federal parity act do?

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (The "Wellstone-Domenici Parity Act") will end health insurance benefits inequity
between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees.

Under this new law a group health plan of 50 or more employees that provides both
physical and mental health/substance use benefits must ensure that all financial
requirements and treatment limitations applicable to mental health/substance use disorder benefits are no more restrictive than those requirements and limitations placed on physical benefits.

This means that equity in coverage will apply to all financial requirements, including lifetime and annual dollar limits, deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of
treatment, number of visits, days of coverage and other similar limits.

Q2. What does "mental health and substance use parity" mean?

Mental health and substance use parity means that benefits coverage for mental health and substance use benefits must be at least equal to that coverage provided for physical health benefits. In other words all of the financial requirements and treatment limitations applied to mental health and substance use benefits may be no more restrictive than for physical health benefits. Historically health plans have applied higher patient cost-sharing and more restrictive treatment limitations to mental health and substance use benefits than for physical benefits. This new law ends this practice.

Q3. How is this new law different from the 1996 federal parity law?

The Wellstone-Domenici Parity Act amended and substantially increased the mental health benefits protection afforded under the federal Mental Health Parity Act of 1996, which only required parity coverage for lifetime and annual dollar limits and did not apply to benefits for substance use disorders.

Q4. When does this new parity law take effect?

The Wellstone-Domenici Parity Act will apply to health plans beginning January 1, 2010. (The effective date is slightly different for labor union plans pursuant to collective bargaining agreements.) This will give health plans the time necessary to redesign their coverage to come into compliance with the new law. The current 1996 parity law will remain in effect through 2009.

Q5. Which health plans will have to comply with the new parity law?

The Wellstone-Domenici Parity Act applies to all group health plans with 50 or more
employees, whether they are self-funded (regulated under ERISA) or fully-insured
(regulated under state law), that provide mental health or substance use benefits. About 97 percent of these plans provide some mental health or substance use benefits now.

Those health plans with 50 or fewer employees that must meet state mental health parity requirements will continue to do so. The new law does not apply to the individual health insurance market. Under this new law, 113 million people across the country will have the right to non-discriminatory mental health coverage, including 82 million individuals enrolled in self-funded plans (regulated under ERISA), to which state parity laws do not apply.

Q6. Does the Wellstone-Domenici Parity Act apply to Medicare and Medicaid patients?

The new law does not apply to Medicare patients. This past July, however, Congress
provided for Medicare coinsurance parity for Medicare patients when it enacted the
Medicare Improvements for Patients and Providers Act (MIPPA). Currently, Medicare
beneficiaries are responsible for paying 50 percent of the approved amount for outpatient mental health services, but only 20 percent for other services. Under MIPPA, mental health services will enjoy the same 80-20 percent split in coinsurance by 2014. This phase-in to coinsurance parity for outpatient mental health services begins in January 2010, when beneficiaries will pay 45 percent coinsurance; the figure drops to 40 percent in 2012, 35 percent in 2013 and 20 percent in 2014.

The Wellstone-Domenici Parity Act, however, does apply to Medicaid managed care health plans. Medicaid enrollees in these plans will have better access to mental health and substance use services once the new parity law takes effect.

Q7. What diagnoses are included for parity protection?

Just like the Mental Health Parity Act of 1996, the Wellstone-Domenici Act covers all diagnoses for mental disorders. It goes beyond the 1996 Act and some state parity and mandated benefit laws by also requiring parity for substance use disorders. There are no exclusions. In effect, whatever a plan covers must be at parity.

As in the current system, a health plan may deny coverage based on medical necessity or under the terms of its coverage contract with an employer just as under the 1996 Act. It is important to note, however, that health plans have not dropped coverage of diagnoses or services as a result of the 1996 Act or of enactment of the many state parity laws across the country.

Q8. Can a diagnosis be excluded from coverage under the new law?

Though employers are not prohibited from dropping coverage for a diagnosis, experience suggests that this will not happen. The Wellstone-Domenici Parity Act broadly defines mental health and substance use disorder benefits to mean benefits with respect to services for mental health conditions and substance use disorders, as defined under the terms of the plan and in accordance with applicable federal and state law.

Most plans in the market today provide for comprehensive coverage. Such coverage will continue under this new law, and Congress will be closely watching the impact of the new law on coverage of diagnoses. The new parity act requires the U.S. General Accountability Office (GAO) to conduct a study that analyzes the specific rates, patterns and trends in coverage, any exclusion of specific mental health and substance use diagnoses by health plans, and the impact of this Act on such coverage and costs. GAO will provide a report to Congress within three years (and an additional report after five years) on the results of these studies.

Q9. Does this new parity law have any impact on benefits management and medical
necessity criteria?

Just as under the 1996 Mental Health Parity Act, under the Wellstone-Domenici Parity Act, a health plan may manage the benefits under the terms and conditions of the plan. The new law goes beyond the 1996 law by requiring a plan to make mental health/substance use disorder medical necessity criteria available to current or potential participants,beneficiaries or providers upon request. A plan must also make reasons for payment denials available to participants or beneficiaries on request or as otherwise required.

Q10. Does the Wellstone-Domenici Parity Act apply to the out-of-network (OON) services that I provide?

Yes. Under the new law, if a health plan provides both OON physical and mental/substance use disorder benefits, these services must be provided at parity. If a plan currently provides only OON physical benefits, this new law will require it to add OON mental health/substance use disorder benefits, at parity.

A few health plans, typically referred to as "closed panel or staff model"
HMOs, do not provide for any OON coverage. Since these plans do not provide OON physical coverage, they are not required to provide OON mental health/substance use coverage.

Q11. How will the new parity law financially help patients who use OON providers and can psychologists continue to "balance bill" for OON services?

Patients choosing mental health or substance use providers OON will see that their health plan pays a greater portion of the cost.

Example 1: A psychologist provides psychotherapy office visits on an OON basis for a patient whose health plan currently excludes OON mental health and substance use coverage but provides OON medical office visits with 80 percent of the visit paid by the plan. The psychologist charges $100 per session. Prior to the new parity law, the health plan paid $0, while the patient paid $100. Under the new law, the plan must now cover the OON psychotherapy visit at parity with OON medical office visits. The plan will now pay $80 for the visit, while the patient is responsible for $20.

Example 2: A psychologist provides psychotherapy office visits on an OON basis for a
patient whose health plan currently reimburses 50 percent of its payment for OON mental health services, but reimburses 60 percent of its payment for OON medical office visits.

Assuming a plan pays $100 for a mental health psychotherapy visit, prior to the new
parity law the health plan paid $50, while the patient paid $50. Under the new law, the plan must now cover OON psychotherapy visits at parity with OON medical office visits. Therefore, the plan now pays $60 for the psychotherapy visit, while the patient is responsible for $40.

The new law does not affect "balanced billing." A psychologist may continue to
charge more than the health plan reimbursement rate for OON services and balance bill the patient for any amount of his or her charge beyond the plan rate.

Q12. Will the new parity law financially help patients who use network providers?

Yes. Patients who use in-network services will benefit from the new law as well. For example, if an in-network plan payment for psychotherapy services is currently 50 percent, while the plan payment for physical health services is 80%, the new law will require the plan to increase the psychotherapy payment to 80%.

Q13. Does the Wellstone-Domenici Parity Act have an impact on network reimbursement?

No. Reimbursement rates for services rendered by network providers are mutually
negotiated between the providers and the health plan. The new law does not address
reimbursement rates.

Q14. Will health plans drop their OON coverage completely to avoid the new parity law?

No. Dropping OON coverage is not a viable option for a health plan. A plan now
providing OON services would have to fundamentally restructure itself into a closed-panel plan that does not offer any OON services, either for physical or mental health/substance use benefits. Plan enrollees expect choices and options in choosing their service providers, and the cost of meeting the new parity requirement is very low. Taken together, enrollee dissatisfaction and the cost associated with such a fundamental restructuring would far outweigh the very low cost associated with simply complying with the new parity law.

Q15. Can health plans drop mental health and substance use benefits coverage completely in order to avoid the new law?

The Wellstone-Domenici Parity Act does not require a health plan to provide mental health and substance use benefits. But if the plan does provide such coverage, it must be at parity with physical health coverage. Health plans are not going to drop this coverage to evade the new parity law.

The 2006 Kaiser Family Foundation Annual Survey of Benefits showed that 97 percent of plans already provide mental health and substance use benefits. It is now well accepted that mental health and substance use treatments are an integral part of treating most medical conditions. Effective treatment of most illnesses like diabetes, asthma, and congestive heart conditions requires a full recognition and treatment of co-morbid mental health and substance use disorders.

The Congressional Budget Office (CBO) has estimated that the Wellstone-Domenici Parity Act will raise health plan premiums by an average of about 0.4 percent (four-tenths of one percent), to be split between employers and their employees. Due to this very low cost, health plans will continue to provide mental health and substance use benefits-now at parity-and make minor benefits adjustments throughout the plan benefit to make up this very slight cost.

Q16. My state already has a parity law. How will this new federal law affect the state law?

Forty-three (43) states have enacted parity laws. While some of these laws provide for strong parity protections, most are not as comprehensive as the new federal law. Nevertheless, the Wellstone-Domenici Parity Act is extremely protective of state law, since the Health Insurance Portability and Accountability Act (HIPAA) of 1996 preemption standard applies. This HIPAA preemption standard has applied to the federal parity law since 1996 and will continue to apply under the new law.

Under the standard only a state law that "prevents the application" of the
federal law is preempted. This means that if a provision in a state parity law provides for less protection than the federal law, it is preempted. If the state law provides for more protection than the federal law, it is not preempted. In essence, the Wellstone-Domenici Parity Act is a "floor" from which states may provide for greater protection.

Q17. Overall, how will the Wellstone-Domenici Parity Act affect my practice?

Beginning on January 1, 2010, under the new parity law more patients in employer health plans in need of mental health and substance use services will be better able to afford the treatments that psychologists provide. With mental health and substance use benefits coverage equalized with physical benefits under the new law, treatments will no longer be cut off due to arbitrary financial requirements or visit or other treatment limits.

Unless a diagnosis is specifically not covered by a health plan, the new law provides for parity coverage for all diagnoses. As under the 1996 law, a health plan may exclude a diagnosis under the terms and conditions of the plan. However, experience has shown that health plans are unlikely to drop coverage for diagnoses due to the new law.

While health plans may continue to manage benefits, patients and providers will benefit from the greater access to information about plan medical necessity criteria and reasons for payment denials that the law requires.

The Wellstone-Domenici Parity Act mandates that a health plan must provide OON mental health and substance use services at parity when it provides OON physical health services. This means that patients will have greater access to the OON services that psychologists provide. With equalized financial requirements and treatment limitations,the new law also promotes the use of in-network services.

Under parity, a psychologist is free to continue to develop his or her practice and
business model. Whether a psychologist is a network provider, accepts out-of-network patients, or seeks only non-insured private pay patients, his or her practice will benefit from the overall increased affordability of mental health services, the equal treatment of services, and the reduction of stigma and discrimination for those needing care.

Q18. Where can I take a look at the bill myself?

(cut and paste): http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h1424enr.txt.pdf
begins on page 117. The bill can also be found at www.thomas.gov

Q19. How will the new parity law be enforced?

As with the 1996 parity law, the U.S. Departments of Labor (for ERISA-regulated health plans), Health and Human Services (for all other health plans), and Treasury (for tax penalties for noncompliance) will jointly enforce the law. Prior to the January 1, 2010 enforcement date, these departments will be creating a regulation to enforce the law.


The APA Practice Organization's answers to the questions presented here are based on the statutory provisions of the Wellstone-Domenici Parity Act, as enacted on October 3, 2008,as well as regulatory experience with the 1996 parity law and the Health Insurance Portability and Accountability Act. The APA Practice Organization will update these questions and answers, particularly with publication of the implementing regulations for the new law expected in 2009.



APA Practice Organization

Government Relations Office

October 2008







Jeff Cook

Director, Field and State Operations

APA Practice Organization

750 First Street, NE

Washington, DC 20002

(202) 336-5875 (Office)

(202) 336-5797 (Fax)

jcook@apa.org (Email)

Will NC's county commissioners do the right thing in terms of monitoring mental health services in NC?

Article sent as letter to editor by Mary Annecelli associated with her experience as a mental health advocate under Centerpointe LME, in eastern NC:

LETTERS TO THE EDITOR Winston-Salem Journal Published: November 1, 2008
and footnote below letter.

**********

Passive

Long before the election mantras about "change," our Forsyth County commissioners were presented detailed information regarding issues with CenterPoint, the Local Management Entity (LME) that functions like an HMO. It assesses, refers and approves payment for mental health, developmental disability and substance abuse services for Forsyth, Stokes and Davie counties.

The Mercer Report, along with the state Department of Health and Human Services report of May 2008, confirmed that CenterPoint spent over $8 million, a whopping 23.7 percent of its $34,681,146 budget, just for administration -- while those in need in our community were denied critical medical services.

Concerned citizens weren't asking for new money, but seeking accountability for tax dollars. Concerned citizens asked commissioners to exercise their legally mandated oversight of funds already allocated, to ensure critical medical services for eligible citizens and responsible CenterPoint board-member selection.

Forsyth County commissioners are integral to any solution and have been passive thus far. The local election really matters. Let's elect new commissioners -- Nancy Young, John Gladman II and Dave -- and send a message to all commissioners: failure to be responsive to local taxpayers is not acceptable.

MARY L. ANNECELLI

Winston-Salem

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



Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville/ Waynesville, NC
e mail: hammondmv@netzero.com cell: 404 964 5338

RE: county commissioners interfacing w/ the LME boards (and being on the LME boards) and what this means

November 3, 2008

Dear Mary Annecelli (mental health advocate in eastern NC associated w/ Centerpointe LME):

Thank you for your outline of problems associated with encouraging the county commissioners, associated w/ counties in easterh NC associated w/ Centerpointe LME, to do something about the 24% administrative costs (what the LME employeese are paid) associated w/ that dysfunctional LME.

IN other words, your point seems to be that the commissioners of those counties are refusing to look at the conundrum of high LME salaries as against the backdrop of severely curtailed services to the citizens who receive (or not) mental health services living in the catchment area associated w/ Centerpointe LME.

I would like to suggest that county commissioners in Haywood county are experiencing some of the same challenges in terms of understanding what to do about a lack of providers and problematic delivery of mental health services.

Recent e mail exchanges about difficulties of the Haywood county commissioners seems to be associated with they having a different set of information about providers under SMC LME----than the providers have.

I assume that SMC LME has never indicated to them that providers in western NC have been trying to provide services for state funded clients----what the LME's have so far been authorized to oversee-----but rather the information created by SMC LME---- which created Meridian Behavioral Health Services---- is that the 'next plan' is to continue to utilize the same providers (Meridian Behavioral Health Services providers). The Haywood county commissioners do not seem to understand that other providers have experienced great difficulties in providing services. There are providers here; they simply cannot work w/ SMC LME when SMC LME has created a privileged position for Meridian Behavioral Health Services which necessary excludes providers not working for Meridian.

Ms. Enloe, a good commissioner in Haywood county, and also on the Board of SMC LME, stated this past week in an e mail to several people, concerned about these issues, suggested that I involve SMC LME administration, specifically, Bill Hambrick, a nice man to be sure, as pertaining to her suggestion that I 'let him know how you feel.'

I told her I had made suggestions and complained FOR YEARS re: the lack of well qualified providers being allowed to obtain authorization for services for state funded clients. SMC LME refuses to have Basic Level Services (no outpt services) except under the Community Support Services service definition. And, as you know, CSS, is being constantly defunded.

I surmise that the reason that SMC LME has all of its state funded clients, the 'working poor'-----remember, the ones that mental health reform was supposed to be about----being served under the Community Support Services service definition, is in order to preserve what they saw as fleeting mental health care services as mental health reform moved into western NC and as SMC LME divested of all of its clinical people.

And so, SMC LME worked with former SMC LME employee Joe Ferraro, in order to create Meridian Behavioral Health Services in 2001 or so and Meridian picks up all the state funded clients and has a privileged seat at the table re: mental health services under SMC LME.

The nature of this privilege is just now being revealed as Tom McDevitt finishes his tenure, having been removed by the SMC LME Board, as associated w/ conflict of interest pertaining to real estate matters (his wife is a real estate agent; I do not know the details re: this) and his daughter was working at SMC LME. Tom was quoted this past week in a newspaper article that the reason that Meridian was 'created' by SMC LME was because the LME was afraid that there would be no mental health services available in western NC.

Mr. McDevitt, an accountant by trade, did, to my mind, a good job of managing SMC LME. The REAL conflict of interest is associated with SMC LME determinedly continuing to give Meridian Behavioral Health Services a special position----the direct result which is other mental health care providers cannot work in the environment when the struggle to give mental health services to clients is so time-consuming.

Here is an overview of 2 recent news articles which give indication that:

1. I was correct re: SMC LME's persistent support of Meridian Behavioral Health, a matter which had never been spelled out.

2. Haywood county commissioners do not understand that Meridian has had a privileged position and seem to believe that all that is necessary is for providers to inform SMC LME administration, specifically, Bill Hambrick, about their concerns.

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

Friday, October 31, 2008
What NOW from the Haywood Cnty Comm & SMC LME re: some new company to take over direct mental health care services?
".....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.)

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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: ****************

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...."

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Article 2: Mental health reforms are on the way

Vicki Hyatt - Editor: The Mountaineer (Waynesville, NC)

....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.

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....."

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Unfortunately, mental health providers not associated w/ Meridian Behavioral Services, will not be able to work w/ SMC LME, due to the privileged position given to Meridian Behavioral Health Services.

McCrory will go in on the basis of Perdue constantly talking about the need for MORE MENTAL HEALTH PAPERWORK

You're going down, Perdue. And this should make the NC Dem party think long and hard about how to reign in a governor who can't do his work----which was the case w/ Easley and MH Reform. Perdue didn't listen and gave no indication of any flexibility re: what needed to take place other than she would act like a CEO and give us some more paperwork in the form of case-management. Woooweee: we've got plenty of those CEO's around.

Surprise, surprise: NC voters can think for themselves and outside the boxes associated w/ political parties.

Here's one hard left Dem who voted for McCroy.

It'll be Obama; Hagan; McCrory. Nesbitt will stay in but R.L. Clark, who late at night walked the halls of Broughton Psychiatric Hospital in Morganton----but who is sorely lacking in social skills----would have been a good candidate.

I suggest to the NC Dem Party that they pay attention to mental health reform and its progress or lack thereof.

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Tight races draw high interest
CharlotteObserver.com - Charlotte,NC,USA

http://www.charlotteobserver.com/
politics/story/294497.html

“I've never seen a paid staffer for any national campaign in Yancey County,” says Paul Feldman, 46, a mental health counselor in Burnsville. ...
See all stories on this topic

"....Real Clear Politics, a polling clearinghouse, shows Democrats Obama and Hagan with slight leads, though both within the margin of error. But it also shows McCrory, the Republican, with a slight edge over Perdue.

“Given the nature of the year, which is clearly Democratic, and given that the governor's mansion has been Democratic for a long time, it's very surprising to see Lt. Gov. Perdue in such a tight race,” says Debnam, of the Democratic-leaning Public Policy Polling....."