State funded mental health client plan didn't work in NC and neither will HB 212 health Insurance Pool Pilot Program proposed by NC Hse of Represent.
Marsha V. Hammond, PhD: Clinical Licensed Psychologist: Asheville, NC e mail: hammondmv@netzero.com cell: 404 964 5338
re: proposed HB 212, health Insurance Pool Pilot Program
March 27, 2009
Dear Representative Fisher: As you are one of the primary sponsors of this HB 212, I would like to know how this insurance pool pilot program might play out given the massive problems w./ the state funded mental health pool project otherwise known as 'state funded clients.'
I overview below the problems providing care to these people which I am very familiar with as I tried again and again to obtain authorization in order to see them. It sounds like a good idea; but then state funded mental health care sounded like a good idea. And it wasn't.
In western NC these are the specific problems:
1. Smoky Mountain Center LME had an employee retiring spin out of SMC, Joe Ferraro, and he created a company called Meridian Behavioral health Services and they see all the state funded clients and they provide peer support services---which has no professional linked to it except in terms of supervising paperwork and running groups some of the time----not even most of the time. I hammered and hammered on the Utilization Review Department of SMC LME in order to provide me w/ authorization and payment for seeing two state funded clients. I lost thousands of dollars re: my work.
2. Western Highlands Network LME based in Asheville, NC, has only 8 sessions available/ client/ year. this is not even once/ month. Moreover, the CPT code which can be utilized is only 90806 which is 45-50 min of therapy. This really does not work and frankly it would be better NOT to see clients, IMO. As per Marsha Ring, the Utilization Manager of WHN LME, IF the client can find some group therapy oriented in terms of Dialectical Behavioral Therapy (DBT) then MAYB the client will be forwarded to more individual therapy. One cannot even find out where/ when/ IF groups meet in Asheville much less the rest of western NC. Therefore, there are 8 sessions/ 45 minutes long/ client/ year. I would like to know how there are different plans for this proposed pilot.
The last one, I think we can safely say, DIDN'T WORK. Moreover, in perusing the document, this is what I see which is very concerning to me:
http://www.ncleg.net/Sessions/2009/Bills/House/PDF/H212v2.pdf"
43 SECTION 5.(c) The Department of Insurance may adopt rules concerning the44 collection of pertinent data from all insurers covering small and large employer groups in the45 State, whether through a Demonstration Project or through the traditional small and large group46 markets, to conduct the evaluation authorized by this act. Data collected pursuant to this section47 shall be the minimum that the Department deems necessary to perform its evaluation, and data48 collection shall not occur more frequently than on an annual basis during the life of the49 Demonstration Project authority.
What does the above 'say' to me? That there will be created a massive amount of paperwork associated w/ seeing these clients and that means that providers will avoid these citizens....just as providers avoid state funded mental health clients.
Thank you for your response. Marsha V. Hammond, PhD
********************************************
sent to me by Representative Fisher's office in Asheville, NC:
"HealthCounties interested in establishing health insurance pilot demonstration projects to provide a model for affordable employer-based health insurance would be authorized to do so under a bill that passed the House this week (HB 212).
The bill will now go on to the Senate. 2009-2010 SessionHealth Insurance Pool Pilot Program.here is link: http://www.ncleg.net/gascripts/BillLookUp/BillLookUp.pl?Session=2009&BillID=H212
************************************
What might be the problem w/ this pilot program? If its anything like the state funded client matter associated w/ mental health services, this is what can be depended upon to happen:
1. minimal services will be available (for state funded clients it is 8 psychotherapy sessions/ year, of the shorter version, 45 minutes that is available)
2. any Enhanced Services such as Community Support Services (CSS) will be essentially non available; 2/ hrs/ week were available and no company can afford to see someone for less than 1 hour/ week or less given the massive paperwork associated w/ CSS).
3. smart LME's (I guess they're smart; they certainly kept me from seeing my state funded clients) will simply create shadow companies that scoop up all the clients and give them inferior services e.g., peer group support, no professionals present, and get paid a capitated amount for the numbers of lives served.
Yeah: if that's happening w/ this (again), someone better ALERT THE PUBLIC.
re: proposed HB 212, health Insurance Pool Pilot Program
March 27, 2009
Dear Representative Fisher: As you are one of the primary sponsors of this HB 212, I would like to know how this insurance pool pilot program might play out given the massive problems w./ the state funded mental health pool project otherwise known as 'state funded clients.'
I overview below the problems providing care to these people which I am very familiar with as I tried again and again to obtain authorization in order to see them. It sounds like a good idea; but then state funded mental health care sounded like a good idea. And it wasn't.
In western NC these are the specific problems:
1. Smoky Mountain Center LME had an employee retiring spin out of SMC, Joe Ferraro, and he created a company called Meridian Behavioral health Services and they see all the state funded clients and they provide peer support services---which has no professional linked to it except in terms of supervising paperwork and running groups some of the time----not even most of the time. I hammered and hammered on the Utilization Review Department of SMC LME in order to provide me w/ authorization and payment for seeing two state funded clients. I lost thousands of dollars re: my work.
2. Western Highlands Network LME based in Asheville, NC, has only 8 sessions available/ client/ year. this is not even once/ month. Moreover, the CPT code which can be utilized is only 90806 which is 45-50 min of therapy. This really does not work and frankly it would be better NOT to see clients, IMO. As per Marsha Ring, the Utilization Manager of WHN LME, IF the client can find some group therapy oriented in terms of Dialectical Behavioral Therapy (DBT) then MAYB the client will be forwarded to more individual therapy. One cannot even find out where/ when/ IF groups meet in Asheville much less the rest of western NC. Therefore, there are 8 sessions/ 45 minutes long/ client/ year. I would like to know how there are different plans for this proposed pilot.
The last one, I think we can safely say, DIDN'T WORK. Moreover, in perusing the document, this is what I see which is very concerning to me:
http://www.ncleg.net/Sessions/2009/Bills/House/PDF/H212v2.pdf"
43 SECTION 5.(c) The Department of Insurance may adopt rules concerning the44 collection of pertinent data from all insurers covering small and large employer groups in the45 State, whether through a Demonstration Project or through the traditional small and large group46 markets, to conduct the evaluation authorized by this act. Data collected pursuant to this section47 shall be the minimum that the Department deems necessary to perform its evaluation, and data48 collection shall not occur more frequently than on an annual basis during the life of the49 Demonstration Project authority.
What does the above 'say' to me? That there will be created a massive amount of paperwork associated w/ seeing these clients and that means that providers will avoid these citizens....just as providers avoid state funded mental health clients.
Thank you for your response. Marsha V. Hammond, PhD
********************************************
sent to me by Representative Fisher's office in Asheville, NC:
"HealthCounties interested in establishing health insurance pilot demonstration projects to provide a model for affordable employer-based health insurance would be authorized to do so under a bill that passed the House this week (HB 212).
The bill will now go on to the Senate. 2009-2010 SessionHealth Insurance Pool Pilot Program.here is link: http://www.ncleg.net/gascripts/BillLookUp/BillLookUp.pl?Session=2009&BillID=H212
************************************
What might be the problem w/ this pilot program? If its anything like the state funded client matter associated w/ mental health services, this is what can be depended upon to happen:
1. minimal services will be available (for state funded clients it is 8 psychotherapy sessions/ year, of the shorter version, 45 minutes that is available)
2. any Enhanced Services such as Community Support Services (CSS) will be essentially non available; 2/ hrs/ week were available and no company can afford to see someone for less than 1 hour/ week or less given the massive paperwork associated w/ CSS).
3. smart LME's (I guess they're smart; they certainly kept me from seeing my state funded clients) will simply create shadow companies that scoop up all the clients and give them inferior services e.g., peer group support, no professionals present, and get paid a capitated amount for the numbers of lives served.
Yeah: if that's happening w/ this (again), someone better ALERT THE PUBLIC.
posted by Marsha V. Hammond, PhD at 12:56 AM
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