Tuesday, December 16, 2008

NC Senator Martin Nesbitt's talk to Buncombe NAMI summarized: mental health moving back towards professional providers

Mr. Nesbitt gave Buncombe NAMI an informative, open-minded talk this evening at the Buncombe NAMI meeting. I am summarizing below what I heard him say (and if he wants something changed, he can tell me and I'll do it).

What he has to say is important as he is the co-chair, along w/ Verla Insko, of the Joint Legislative Oversight Committee for Mental Health Reform. He stated that he and Rep Insko are, 'like Frick and Frack', indicating that they see eye to eye on most matters. At least they get along.

Senator Nesbitt suggested that if we could all work together on mental health reform, that he believed we could move the matter along. He stated that he sees dysfunction in all parts of 'the system.' (this lead me to a new definition of systemic dysfunction: its when all the associated parties to not agree on the important components of the goal; more on that later).

As is prevalent within the legislative circles, it appears that the mantra about those 'bad apple' Endorsed Provider companies, greedily lapping up the Community Support Services $$$---continues to be a popular story.

Mr. Nesbitt did indicate that the former Secretary of NC DHHS, Carmen Hooker Odom, put that into play, however. The fact is that the Service Definition associated w/ Community Support Services ENDORSED the usage of lesser qualified CSS workers. It was written INTO the Service Definition. Additionally, Hooker Odom doled out the Medicaid management to Value Options (and we may never know just whose pockets got padded re: that matter, will we).

If you are using a business model which includes competition and privatization, then don't turn around and bemoan the entrepreneurial greed. The mental health 'industry' is not composed of saints, you know.

And while we're talking about business models, the mental health industry is the only one that entails you fixing up your customers so they no longer need or want your services.

Think about it: you go to the bank: they treat you well; you want to stay w/ them. You get a cell phone, it works or not, and you stay---or not w/ the company. You go to the bakery; you enjoy the muffin...you'll be back. You go to your physician: he's a nice guy and listens to you..you'll go back.

BUT: you go to the mental health provider----they treat you for mental illness----and then you understood yourself so well that you never needed to go back: NOT SO FAST, says the mental health provider who just spent 10 hours filling out all the forms and getting the signatures and faxing all the stuff and talking to all the Value Options people and the LME's support staff.

If the advocates/ the families/ the LME's/ the Legislative Oversight Committee/ the Providers/ the warehousers of people having mental illness e.g, the personal care homes: IF you want the people to get BETTER, then you need to have the same GOALS.

Distinctly, the providers----due to their investment in non-paid/ exasperating paperwork---and the personal care home warehousers otherwise known as the personal care homes----who VERY MUCH do not want their inhabitants to get better---very much have a vested interest in people not getting better.

I told Mr. Nesbitt: Value Options has a one page form that I sent in re: request for observation. The LME's have SIX FORMS, all w/ significant pieces of information to be filled in. Remove the paperwork problems and you will get the providers functioning efficiently.

I don't know what you do about the warehousers. The Departments of Social Services pay a large amount of money---in addition to the Social Security Disability checks that are received by the inhabitants of these fairly sub-standard houses----for warehousing. The warehousers give them back pocket change. These are some of the main consumers of CSS. It would be very interesting to know how many Medicaid clients are warehoused in this manner. My understanding is that its their Medicaid funds that are plumbed.

So, if all the entities involved w/ making mental health care work are going to AGREE on a goal----which seems to be critical----then the addressing of the very significant barrier to care, namely the PAPERWORK,

Mr. Nesbitt indicated that the CSS definition was being massively re-worked. And he indicated that the matter of 'standardization of paperwork' across the LME's, he thought, was one of the top matters to be addressed by the new Secretary of NC DHHS (whoever that is).

This does not, however, address the matter of the 30 pages of paperwork required by the LME's associated with obtaining services for state funded clients and for Medicaid clients receiving CSS.

Standardization will not diminish the paperwork, in and of itself, Mr. Nesbitt.

He reminded me that 2-3 years ago, the LME's were managing Medicaid. But then, Medicaid management got farmed out to Value Options---a national company---which caused the LME's to get rid of quite a few of their employees----only to find out that come 2009 they are to begin picking them up again.

What a lot of wasted effort/ heart-ache/ problems.

AYE: but here's the rub: there will be NO MONEY coming to the LME's in order to manage the 30% of Medicaid (which 30% are we talking about, I asked Verla Insko in an e mail earlier: is it CSS? what is it?: this is important in terms of Endorsed Provider businesses being able to plan but heck, this is mental health and you don't/ can't plan).

So, this means that the LME's which cannot even do the management of the state funded clients will take on the additional burden of managing 30% of NC Medicaid.

I pointedly asked the question----my perennial question: "Why doesn't Smoky Mountain Center LME, the largest LME in NC, and one of two in western NC, have any Basic Level Services (which include outpatient therapy)?" (I know the answer to that but no one's talking: its because SMC LME favored Meridian Behavioral Health Services, its spin-off company, which necessarily excluded all the other professional providers: WHERE, oh WHERE, have our professional providers gone?)

Mr. Nesbitt stated, basically, "I don't know the SMC system that well, not as well as Western Highlands Network LME system. You know, there's been problems down there recently."

That still does not answer the matter of why aren't there any basic level services for state funded clients under SMC LME.

No one wants to answer that question.

And it reminds me of how I felt like banging my head on the table when I talked to one of the CFAC people associated w/ SMC LME, as I told them that I had been the one to ask Mike Moseley, Director of Mental Health (I bet he is glad to retire, man alive) why SMC LME did not have the CFAC minutes on their web site?

BANG. BANG. BANG. The CFAC committee could not have asked to have their minutes put up on the SMC LME website?

YIKES! For God's sake, don't ask for what you want!


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