Saturday, December 06, 2008

Specific barriers to working w/ state funded mental health clients in western NC's two LME's

Verla Insko indicated she would try and get answers to the questions re: problems w/ authorization of state funded clients at Smoky Mountain Center (SMC) LME and Western Highlands Network (WHN) LME. I have indicated to her that given the incredible difficulty of working w/ the LME's re: getting authorization (read: get paid) for seeing state funded clients, I am completely aghast at the possibility, indeed, the certainty, of the LME's picking up the management of NC Medicaid clients.

Will the LME's fall down on the job like they have re: state funded clients?

Rep Insko indicates the following:

"When area programs ran everything, they were able to co mingle the funds and make all the money go a lot further. Now, some providers - not you - are willing to see only Medicaid patients. We need to have all providers in the public system willing to take both Medicaid and state paid patients.

The hardest to serve mh patients are often not Medicaid eligible. If we can't integrate them into the system, they end up in EDs, jails and our state institutions. "

My Response: then the LME's should have been able to remove the following barriers which preclude professional providers from servicing the state funded clients. And the NC State Legislative Oversight Committee could have made that possible, I imagine. And the NC State Legislature should have made that happen as re: the Oversight Committee's recommendations.

Money is money. I fail to see how the LME's with their 'culture' of 'you can't find us' is going to change re: Medicaid and indeed I might speculate that they will be overwhelmed and that THEN sure enough, there is going to be complaining by providers.


Specifically, these are the provider BARRIERS to rendering mental health care at these two LME's, who administer 25% of NC's 100 counties.


1. BARRIER #1: MY PSYCHOLOGIST LICENSE DOES NOT 'WORK' AS RE: STATE FUNDED CLIENTS UNDER NC MENTAL HEALTH REFORM. A doctoral level psychologist functions independently. A master's level psychological associate in NC functions under the supervision of a doctoral level psychologist. A doctoral level psychologist bills independently. However, as re: state mental health clients, a doctoral level psychologist cannot do this. This creates a barrier to mental health care re: the extensive paperwork associated with matters which should be protected and made possible on the basis of the license of the professional provider.

2. BARRIER #2: ACCESS CENTERS WHICH ARE SUPPOSED TO LINKS PROVIDERS TO AUTHORIZATIONS SIMPLY DON'T WORK. The ACCESS centers at both of these LME's, which create the authorization so that the professional provider can get paid--- at both LMEs---- require an enormous amount of follow-up by providers to simply get thru an authorization. You can call/ e mail/ DRIVE UP THERE and you will still not be able to get things taken care of.

3. BARRIER #3: NC DHHS CONTINUES TO CHANGE MAJOR PIECES OF PAPERWORK AND THERE IS NO OBVIOUS REASON FOR THIS: PCP forms are changing in January. whoopee! get to do them all over again. WHN LME does utilize a truncated version of PCP for basic level services. Smoky Mountain Center LME does not offer Basic Level Services; all outpatient therapy goes under CSS which is constantly being defunded.

4 BARRIER #4: THESE TWO LME'S HAVE TWO DIFFERENT AGENDAS RE: WHAT SHOULD BE A BASIC SERVICE THAT IS CONSISTENT ACROSS NC: HAfter the limited 8 sessions/ year/ state funded client, the Utilization Review Department of WHN LME, headed by Marsha Ring, has stated that if further therapy is in order, the personality disordered (I guess the others get no follow-up), then DBT training must also be available. WHERE IS THIS DBT TRAINING?

SMC LME has all the outpatient services under the Service Definition, Community Support Services, which is constantly being defunded. In order to utilize CSS, one must undergo, per NC DHHS criteria, 20+ hours/ of CSS training even if one is not providing CSS BECAUSE CSS is demanded to have this. How is it that this 'everything in the kitchen sink' service definition is allowed to be utilized and thus create a barrier for professional providers? How is it that there is such inconsistency across the LME's in terms of such fundamental services??


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