Thursday, March 26, 2009

Why Mental Health Providers keep sinking like rocks: NC DHHS couples w/ Value Options to write confusing memos: HELLLOOO Secretary Cansler

Medicaid authorizations are not difficult to obtain for a simple service such as therapy rendered by a Licensed Psychologist (LP), such as myself. It entails the filling out of a one page form which is faxed or mailed and usually the therapy is re-authorized after the basic 8 sessions are utilized.

However, this is completely NOT true as related to the Enhanced Services such as Community Support Services.

And let's not forget this fact. Secretary of NC DHHS, Cansler, worked as a private lobbyist to assure that Value Options got the multi-million $$$$$$ gig doing authorizations for NC Medicaid clients. Prior to that, he worked as second in command at NC DHHS from 2000-2006. Now, he's back at NC DHHS and gee, I wonder how it is that Value Options NOW works to limit the $$$$ utilized for Community Support Services.

Is that a coincidence?----this ever diminishing Community Support Services $$ or are there surreptitious intentions here?

Which reminds me, I have not yet heard from Secretary Cansler regarding the 'private' minute meetings associated with the removal of 50 Broughton (Western NC public psychiatric hospital) to be consumed by the private, free-standing, 14% only Medicaid beds psychiatric hospital in Winston Salem being built by Old Vineyard Behavioral Health (OVBH).

OVBH had private meetings starting in early 2008, as per the Centerpoint LME notice put out 2.20.2009 , with Centerpoint LME as well as NC DHHS. IN that memo, Cansler was stated as heralding this creation of cooperation in order to create hospital beds within a facility that could only have 14% Medicaid beds as per the Centers for Medicaid and Medicare Services (CMS) IMD exemption rule. That rule requires that psychiatric hospital beds for Medicaid clients be in general hospitals in keeping with CMS belief that psychiatric patients also much of the time could have or do have physical difficulties that could need attending to.


So, how does Value Options destabilize Endorsed Provider companies?

Remember: NC Mental Health Reform was supposed to be about: privatizing and making more competitive! mental health services.

However, there are multiple newspaper articles from every newspaper in NC, over the past several years, documenting that mental health providers have dropped like flies leaving consumers w/ no services and the reasons can be pinned directly onto Value Options and how they interpret the confusing memos created by NC DHHS.

Basically, here's the gig: the Endorsed Provider companies operate to some extent on faith in terms of providing Community Support Services to clients who have serious mental health challenges and are attempting to upgrade their skills which is the agenda of CSS.

The Endorsed Provider companies put their necks out in providing CSS to clients. CSS must be re-approved every 90 days. New signatures of the client/ the client's guardian must be re-obtained. Recently NC DHHS created a new "Update/ Revision Signatures' page. However, they were not clear as to WHEN this new signature page had to be used. Additionally, Value Options takes months to provide a written authorization for services. This results in the Endorsed Provider company being squeezed from both ends: they have employees who see their CSS clients and they must be paid but then VO shuffles the cards always in their favor.

You might think that the 'wrong form' is not such a big deal but this would be incorrect. If the wrong form is turned into Value Options, the client can have a 'gap' in services which means that ALL of their services can be cut.

Most importantly, if there is a 'gap in service' , it counts as a NEW APPEAL and the services are not guarantees under Maintenance of Service.

Indeed, it appears that VO employs this 'you turned in the wrong form' as an opportunity to remove CSS Medicaid services.

This is not to even mention the yearly update of the Person Centered Plan (PCP) form and all of its issues.

CSS requires reauthorization every 90 days. If, CSS are cut by VO, the Medicaid client can appeal. The client can continue to receive the same CSS during this period identified with "Maintenance of Service." However, again, the Endorsed Provider company has to put its neck out, assuming that VO will continue the same level of CSS, usually 8 hours/ week/ client.

Unlike what the Endorsed Provider companies and their employees are required to do which is to not allow a gap of services to take place, VO can take months---from the time that the authorization request is submitted by the Endorsed Provider company----to give a written authorization. This means that for that period of time, the Endorsed Provider company is counting on the continuation of services.

This loss of money as related to employing CSS workers and paying them on a regular basis----when the CSS may be cut significantly to 1 or 2 hours/ week (which is now not uncommon)---- discourages companies from providing continuous Community Support Services as they have to go out on a limb in terms of 'having faith' that the CSS will be authorized.

That is one significant reason for a loss of mental health services in NC.

More recently, in 2009, NC DHHS created this new 'Update / Revision Signatures page'

Here is an example of how this has played out recently as pertaining to this new 'Update/ Revision Signatures page':


Medicaid client living in a Family Care Home (where tens of thousands of mental health challenged clients live in NC) has been in Medicaid appeal for over a year. OVER A YEAR.

This means that the Endorsed Provider company has been operating on faith for OVER A YEAR.

Client has been covered by 'Maintenance of Service' (Medicaid pays for his Community Support Services while it is in appeal). Client had a mediation hearing one month ago; his services were extended for one month at the same rate so that he could obtain a neuropsychological assessment (he has a head injury). He obtained this assessment.

The Endorsed Provider company QP (supervisor) sent in the 'signature page' associated with the Maintenance of Service. VO maintains that the WRONG signature page was sent in which will create a gap in service which means that the Endorsed Provider company will suck wind.


Here is the NC DHHS memo explaining WHEN to use WHICH signature page:

NOTE: Implementation Update #51 indicates that, “The revised documents will have an effective implementation date of January 1, 2009; this means that any PCP annual review that is due in January of 2009 will need to be updated on the new forms. Revisions will not be subject to the new forms, only the annual plan.”

• The new documents are now effective March 1, 2009.

• Any Introductory PCP, Complete PCP or PCP annual review that is due in March of 2009 will need to occur using the new format.

• It will also be necessary to use the new Update/Revision form for any reviews taking place in March 2009. The only significant change to this form is the signature page. If a new service is added to a PCP as a result of a review and update/revision to the plan, Part 1, Section A of the Signature Page, with the new check boxes must be used.

PROBLEM: Used old signature page as no new services added on this review (3/17/09) as per Implementation Update #54;


Was it clear to you WHEN and WHICH form you were supposed to use?

NC DHHS needs to employ some English majors to overview their publications as they appear to not be able to write them clearly----if that is what they are trying to do----which is an assumption in itself.

Here is the e mail to VO as associated with the turning in of the wrong signature page:

PSDCustomerService ( : Ryan N. is identified as the VO provider liaison employee:

"We apologize if DMA’s Implementation Update led you to believe that the new PCP signature page was not needed for this review, unfortunately, per DMA any review that takes place after 3.1.09 does need to be performed on the new signature pages. The signature pages included in your request are signed on 3/16 and 3/19 by QP and member and the PCP itself shows the reviewed data as 3/17/09. As per another of DMA’s policies we will only be able to grant authorization as of the date of updated corrected request if received so there will be a gap in services due to this. "

Basically, VO interprets NC DHHS memos in such a way that mental health services are removed and there is very little that the Endorsed Provider companies can do other than just go broke.


Blogger dwil said...

Just came upon some of your writing...I like the way you think.
Well informed on the issues, and, not hesitant to call as you see it. A good advocate for us providers. Be nice to chat sometime

12:37 AM  

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