Sunday, March 08, 2009

NC DHHS Sec Cansler asks for double+ salary while provider companies collapse & NC DHHS plots to diminish Medicaid mental health bed #'s

ONLY 14% OF THE BEDS IN THE FACILITY BEING HERALDED BY SECRETARY CANSLER (He stated on February 20, 2009: We need the, ".....establishment of increased numbers of short-term acute inpatient care beds for psychiatric services in our community hospitals..." See announcement below put out by Center Pointe LME on 2.20.2009) ----only 14% OF THESE BEDS WILL BE AVAILABLE TO THE LARGEST GROUP OF MENTALLY ILL PATIENTS, SPECIFICALLY MEDICAID PATIENTS.

The announcement doesn't mention that little fact.

See here NAMI policy paper:

"Current Medicaid LawInstitutions for Mental Disease (IMDs) are inpatient facilities of more than 16 beds whose patient roster is more than 51% severe brain disorders by primary admitting diagnosis. Federal Medicaid matching payments are prohibited for IMDs with a population between the ages of 22 and 64. IMDs for persons under age 22 or over age 64 are permitted, at state option, to draw federal Medicaid matching funds."

NAMI, it appears, has reasons for having what is known as the IMD exclusion, repealed. These are not clear to my mind in reading over the above paper.

As a mental health provider in western NC has stated: "Free standing psychiatric facilities can not have more than 16 beds and still bill Medicaid. This limits their size and feasibility, since you must have all the same services available for a 16 bed unit, that you do for a 50 bed unit."

And try as they may, the mental health advocates in eastern NC are experiencing extreme difficulty in getting anyone to attend to this elephant in the room, namely, the IMD Exclusion which is in place and has been in place for decades.

CMS (Centers for Medicaid & Medicare Services) basically, does not like the idea of free standing psychiatric hospitals as associated w/ a lack of access to extended hospital facilities and therefore limits the number of beds in such free standing facilities.

The question is simple: Why is NC DHHS under Cansler, Center Pointe LME, and Old Vineyard Behavioral Health so intent on creating private, free standing psychiatric beds that most of the psychiatrically ill can't use?

Admittedly, the developing of this private, free standing psychiatric hospital, began before Cansler took over this job.


But where was the Center Pointe CFAC (Community & Family Advisory Council) during all of this? They are to act as advisors for the LME and one would speculate that they would have had something to say about all of this----if they had been told.

However, mental health advocates have stated this as re: the CFAC of Center Pointe LME as per a mental health advocate in eastern NC:

"The original CFAC was disbanded by the LME Board. They have a new CFAC and it was appointed by LME leadership. The LME controls it"

The renegades on the CFAC must have been thrown off prior to August, 2007, because there are NO MINUTES older than this and then the CFAC minutes stop again mid-2008. So, what did the CFAC members speak about for the rest of 2008? No idea.

And when you look at the CFAC minutes, you read alarming Stepford-wife-like statements like this:

March, 2008:

group continues to learn
more and more each month
as the group develops."

April, 2008:

"Gladys Christian updated the group on
the approaching Community Fun Day
event schedule for May 23 in Stokes
County. This will be an opportunity for
consumers to join together and have a
good time."

June, 2008:

(Note: significant matter which the CFAC is just now, mid 2008, being let in on):

"Kevin told the group that FY09 will be our 1st
year of single stream funding. We will start
FY09 with a plan that predicts that same budget
as last year as the allocation for FY09 has not
been received from the state. Single-stream
means that we will get state dollars in one lump
sum as opposed to age/disability-specific
designations. A concern with single stream
funding has been how equitable distribution of
dollars will be ensured. With single stream,
money can be put where it is most needed and
respond more flexibly to local needs."

And THAT'S IT as per the CFAC---a group of mental health advocates who are supposed to provide guidance to the LME.


This is a terribly important matter because most people who have Severe and Persistent mental illness (SPMI) are Medicaid clients. Why are they mostly Medicaid clients? Because they get SSI, a form of social security disability payments, for those who have not (been able to) vest(ed) into the Social Security System. SSI is linked to Medicaid. How much is this year's SSI check? About $680/ month. What else do these people get? Some food stamps and Section 8 housing.

Here's a marvel: I have an extremely frugal SSI client w/ a SPMI who is able to save more/ month than most middle class families. He eats one meal/ day at the local soup kitchen. Why does he save? In order to set money aside for his nieces whom he loves dearly.

However, Cansler, the Secretary of NC DHHS, Old Vinehard Behavioral Health, and Center Pointe LME, are avoiding public scrutiny and waves of disatisfaction from the local mental health advocates in Winston Salem, NC, by having a meeting tomorrow at 1 pm at the Winston Salem library, which few will attend, undoubtedly, due to working.

There's 'dark plot' written all over this.

Moreover, why should Mr. Cansler receive a $300K salary, which he apparently has requested (he now earns approx $120K/ year (gotta get more than Dr. Lancaster, you know, clocking in at $280 grand) when:

1. mental health provider companies continue to collapse

Mental health providers struggling:

"ARP Phoenix, which operates substance abuse treatment centers and the new 16-bed mental health crisis unit, no longer will be funded by Sisters of Mercy. ASHEVILLE – Another provider of vital mental health services is in danger of closing as of June 30."


2. NC DHHS and the administration of Central State Hospital in Butner, NC, cannot even spot the 'how to hang yourself' cords in the rooms of the psychiatrically ill

3. this plotting is taking place which excludes the advocates and has been taking place since early 2008 re: this menage a trois; and apparently the CFAC knows nothing about it or they do, no one knows because there are no CFAC minutes since mid-2008


4. Center Pointe LME has a very sour relationship w/ local mental health advocates and instead of attempting to mend this, they persist in dissing the mental health advocate community. And yes, it had a lot to do with the dismissal of the CFAC prior to August, 2007. These are the kinds of comments that are in the local press 'comments' re: mental health advocates' comments:

"Yet once again, the so called local mental health advocates find something to complain about. Typical."Poster: 'foxmulder':

5. the transfer of the 50 beds from Broughton, 'paper beds', makes western NC advocates nervous (though Doug Trantham, Emergency Services director at Smoky Mountain Center LME in western NC, has stated that there are quite a few more 'paper beds' associated w/ Broughton Hospital in Morganton, NC, in western NC). However, will western NC be found wanting for psychiatric beds that have moved east, is the question.



Here is the notice that was put out by the LME as pertaining to heralding the new inpatient psychiatric beds that will have only 14% medicaid beds:

24/7 Psychiatric Emergency Department, Additional Hospital Beds Coming
DHHS Secretary Commends Local Partnerships

Contact: Michael Cottingham
Marketing & Public Relations Officer
Office: 336.714.9132 Cell: 336.287.8739

"Winston-Salem, NC (February 20, 2009) - Through the collaborative efforts of CenterPoint Human Services, Old Vineyard Behavioral Health Services, Forsyth Medical Center and the Division of Mental Health Developmental Disabilities and Substance Abuse Services, much needed psychiatric services are on the way.

In collaboration with CenterPoint, Old Vineyard recently submitted a non-compete Certificate of Need to the Division of Health Service Regulation for the transfer of 50 unused beds from Broughton Hospital to the agency's Winston-Salem facility. The Division of Mental Health, Developmental Disabilities and Substance Abuse Services (Division) has already approved the transfer of these beds from Broughton.

Old Vineyard will also construct a free-standing (24/7 psychiatric emergency department as a part of this initiative. Old Vineyard's parent company, Universal Health Services, is exclusively providing the funds for expansion and development of these projects which are estimated at $12-13 million.

CenterPoint and Old Vineyard have been working on this project since early 2008.
"The increase in local bed capacity and the ability to better serve the mental health population through a 24/7 psychiatric emergency department drastically increases the service array for Forsyth County and beyond," says Rob McCartney, Old Vineyard CEO.

In addition, CenterPoint Human Services, Forsyth Medical Center, and the North Carolina Division of Health and Human Services have entered into a three-party contract to expand local access to short-term acute inpatient care for CenterPoint patients. Under the contract, the organizations will work collaboratively to treat in the local community patients whose mental health needs can be addressed during a short hospital stay of less than seven days, Up to eight additional beds are available to manage these patients locally. This will allow the state hospitals to focus on managing the more complicated patient cases that require much longer hospital stays.

Forsyth Medical Center is the fifth hospital in North Carolina to enter into a three-party contract.

“We anticipate that this new process will mean fewer patients waiting for hours in local emergency departments to be transported and admitted to a state hospital,” said Jo Haubenreiser, vice president of Forsyth Medical Center Behavioral Health Services. “This collaboration will assure patients are proactively managed throughout their stay in the local hospital and then are re-connected to a broader pool of resources in the local community. In addition, the process prioritizes transfers to the state hospital in the event the patient is found to need a longer, more intensive hospital stay.”

"North Carolina Department of Health and Human Services Secretary Lanier Cansler, during a recent visit with CenterPoint board members and leadership team, said “The key to building a strong system of community mental health services is the establishment of increased numbers of short-term acute inpatient care beds for psychiatric services in our community hospitals. This provides the core for building community mental health care capacity and expanding access to care closer to home, to family,to friends. As CenterPoint has shown, we can work together and create good partnerships that will successfully advance the development of increased access to care in our communities.”

CenterPoint Human Services is the Local Management Entity responsible for overseeing Mental Health, Developmental Disabilities and Substance Abuse Services in Forsyth, Stokes and Davie Counties. Being a Local Management Entity means we work closely with service providers and community partners on a daily basis to address the needs of all people in our communities.

"These initiatives are the culmination of efforts spanning years of stakeholder work and input defining the critical needs of consumers, families, hospitals, magistrates and law enforcement," says Betty Taylor, CenterPoint Area Director/CEO.

Old Vineyard Behavioral Health Services provides services for children, adolescents, and adults on its 16-acre campus located at 3637 Old Vineyard Road in Winston-Salem. Its parent company, Universal Health Services, Inc. (UHS), is a Fortune 500 company and one of the nation’s largest and most respected healthcare management companies.


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