Monday, December 08, 2008

Even the Co-Chair of the Joint Legislative Oversight Comm on Mental Health cannot get a straight answer from SMC or WHN LME's in western NC

NC State Representative Verla Insko graciously volunteered to ask questions to Smoky Mountain Center (SMC) LME (don't know who she talked to) and to Western Highlands Network (WHN) LME. Even the co-chair of the Joint Legislative Oversight Committee cannot get a straight answer.



"Dear Verla:

SMC LME stated this, as per your e mail:

"Smoky - Dr. Hammond has not been a provider in their area for for 2 1/2 years. She is disputing old cases that she appealed, and went through the review process with no changes to the decision."

Verla: Perhaps I didn't ask if you would ferret out the information in a manner which would not have gotten you a pat answer and completely dismissed your inquiry. I am not disputing old cases. I would like to know why there are no outpatient therapy benefits except under the constantly defunded Community Support Services given the restrictions in terms of funding and as associated w/ NC DHHS requiring that if services are under the Service Definition CSS----then the person associated w/ that----regardless of what they do----has to undergo CSS training----when that has nothing to do re: outpatient therapy and psychological assessment.

Would you mind re-asking the question? Why are there no outpt therapy services under SMC LME except under CSS---with all of its restrictions?

thanks for letting me know if you can ask it. God knows I am not going to shut up.


Marsha V. Hammond, PhD: Licensed Psychologist: NC
e mail: cell: 404 964 5338

December 7, 2008

Dear Mr. (Donald) Reuss (

Verla Insko volunteered to get some information re: my inability to get authorization or even get a response re: client 4------. This is what she wrote me today.

"Western Highlands - Dr. Hammond is a Medicaid provider and not authorized under WH. She billed for services but is not part of the provider panel. The case is over a year old. She could possibly request authorization in the future from WH but they really didn't need any therapists and it wouldn't change the status of these old cases."

I am confused.

First of all, at one of the very first WHN LME provider meetings about five years ago, where I met -------------- I signed up as a provider. However, I am a Licensed Psychologist (LP) and I bill independently to Medicare/ Medicaid/ 3rd parties. The only thing I cannot bill independently for are the state funded clients. Thus, all this massive confusion. .

Secondly, the 'provider panel' associated w/ WHN LME---- you yourself told me about a week ago----are people who must utilize WHN LME's Medicaid billing number because they cannot bill Medicaid independently. I know of this as about a week ago I asked you why their names were there as it appeared to me to be a nice bit of free advertising. You told me that they cannot bill Medicaid independently and you advised me that if/ when the LME's take over management of Medicaid that perhaps I could put my name there.

Relatedly, the LME's only manage state funded clients at this time. The private Endorsed Provider companies are the only banners under which the providers operate as associated w/ state funded clients. Thus, what does this mean, "Dr. Hammond is a Medicaid provider and not authorized under WHN. She billed for services but is not part of the provider panel."?

I originally submitted the paperwork for client 4------- in October, 2007; again in April, 2008; again in September, 2008. I talked to people on the phone at WHN each time. That there is no record of this is concerning to me.

It is true, as per our previous conversations, that WHN LME did not have paperwork associated w/ my formal contract via ----------(Endorsed Provider company) because I had balked at the unnecessary training associated with that being demanded of 'employees' of the private Endorsed Provider companies. Indeed, it is not even a contract; I was required to submit 15 pages of employee paperwork in order to merely be able to do therapy w/ state funded clients. I do specific tasks, namely, assessment and therapy. My license covers this.

Specifically, I had asked you if I had to go and sit through 20+ hours of unpaid, unnecessary CSS training; you graciously went and got that info (and I finally got a call back from Dr. Lancaster a couple of weeks ago). You stated I did not have to have that training as I do not provide CSS. I appreciated that.

This 'missing' piece of paperwork formalizing----for your benefit---my relationship w/ --------------(Endorsed Provider company) was sent to you by the owner of -------------(Endorsed Provider company), -----------, a couple of weeks ago, unless I am mistaken.

And so, in an attempt to again move forward the authorization for outpt therapy on client 4--------, I last week I turned in to you ---by hand----the one page of information outlining all of this. Kimberly Kuhn, whom, I am advised is the intake person, told me last week that you would be getting in touch w/ me re: this client 4--------.

I assume that the person that Verla talked to was someone other than you and maybe that person does not realize the contract that is between myself and -----------(Endorsed Provider company).

Otherwise, is there some reason that -----------(Endorsed Provider company) is not able to obtain authorization consideration for WHN state funded client # 4-------? WHN LME is in receipt of my contract w/ ---------- or at least ------------ tells me this. This means that the authorization proceeds via --------------(Endorsed Provider company).

Can someone explain this statement to me which seems to be associated w/ me not being on some panel? : "She could possibly request authorization in the future from WH but they really didn't need any therapists and it wouldn't change the status of these old cases." This has nothing to do w/ anything. My work w/ the state funded clients (the one I have; anymore work like this would kill me) proceeds via (Endorsed Provider company). 'We', assumably is associated w/ providers who cannot independently bill Medicaid.

Verla Insko seems concerned that psychologists (not you, she stated) are not willing to work w/ the state funded clients. Is it any wonder that this is so? Is this going to happen for every Medicaid client?

I'd appreciate some clarification. I'm completely lost on what is being said here.

Forward this to any pertinent party.


marsha hammond, phd


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