Monday, June 22, 2009

Time to unjoin NC Psychological Association: no attention paid to public mental health concerns at any level

Its uncanny how NCPA and APA are enantiomers (mirror images) of each other pertaining to simply pretending that the sky has not been falling for quite some time. Time to UNJOIN and UNSUBSCRIBE and go get some different, activist mental health colleagues.

My letter of 'thanks but no thanks' re: my hundreds of $$ of dues to NCPA:

FROM: Marsha V. Hammond, PhD Licensed Psychologist, NC
E mail: cell: 404 964 5338
Fax: 828 254 2013

TO: NC Psychological Association
1004 Dresser Court Suite 106
Raleigh, NC 27609

June 22, 2009

Dear NCPA:

Thank you for the recent materials associated w/ rejoining. However, I will not be re-joining for NCPA has had nothing productive to say about the problems that psychologists and psychological associates have experienced regarding NC Mental Health Reform. And it has nothing to say about health reform except for vague comments regarding parity which are not true----as per the recent NCPA newsletter.

Let me be specific about what would have been useful to take place:

1. The Public Psychology people associated w/ NCPA were said by Sally Cameron to be ‘very busy’, thus, they did not answer my e mails. I work mostly w/ Medicaid & Medicare clients. That is whom they work with. I would have appreciated some communication between myself and psychologists doing similar work. It would have been useful to have an item in the NCPA newsletter regarding public practice.

2. NC Mental Health Parity is a joke for BCBSNC was allowed to opt out. BCBSNC insured over 50% of insured people in NC. The recent article in the NC Psychologist newsletter heralded parity as something whose time has come. Would that this was true.

3. You seemed to think that my concerns re: NC Mental Health Reform were simply a litany of complaints as made clear by assigning Dave Weiner, former NCPA president to ‘address your concerns.’ He did not address my concerns and I was frankly offended that you seemed to think I was a novice intern who had no experience and needed ‘guidance.’

The picture that was painted in the NCPA newsletter has been one of giving out awards and talking about what a swell place NCPA is. Thus, there is little of substance pertaining to the public face presented by NCPA and next to no information about the problems psychologists have practicing in NC.

Oh, there were admonitions to get involved in being a ‘rescue psychologist’ for disasters----something which pays nothing. I am suggesting that NCPA is less of a guild (for guilds concern themselves with protecting the interests and livelihoods of their members) than a good ole boy & girl club where is celebrated----just like w/ APA over the past 10 years-----what a swell bunch of people we are and hey, let me give you a gun so you can shoot at the people outside the circle.

What are some of the specific problems of NC mental health reform?

a. Under NC Mental Health Reform, those w/o Medicare or Medicaid and who need mental health care are defined as ‘state funded clients.’ The LME’s, which administer state funded clients, are completely varied in terms of the criteria necessary to obtain authorization for these services.

There is no standardization anywhere as regards those Utilization Review Departments within the LME’s. The original thinking was assumably associated with ‘every part of NC needs to determine what it needs.’ However, what happened simply was that the paperwork became and is so overwhelming that psychologists are loathe to see state funded clients.

Additionally, as Dick Rumer, PhD, a member of the NCPA board a year or so ago, discovered, in central NC around Charlotte (this is what he stated to me, I believe, during the NCPA board meeting which was held in Asheville, NC about a year or so ago) that an LME he contacted, utilized criteria for state funded clients which was similar to Medicaid.

Contrarily----as I have reiterated many times to Sally Cameron, the Executive Director, and other people associated w/ NCPA----Smoky Mountain Center LME, one of the two LME’s in western NC, utilizes only Meridian Behavioral Services for state funded clients and no individual therapy is provided. Meridian has as CEO a retired employee of SMC LME. To say that they are one and the same is completely true. And so what happened to the private psychologist providers? Their concerns were certainly not addressed by NCPA or even WNCPA. I do realize that WNCPA serves as a point of social contact and I have appreciated this in the past.

Western Highlands Network LME, the other LME in western NC, allows, as per Marsha Ring the Utilization Review Department Manager, authorizes only 8 therapy sessions for state funded clients and they could continue in individual therapy---perhaps----if they could turn up group therapy in DBT format----if anyone knew where that was----as all the pieces of mental health are everywhere & scattered and cannot be found. –

If the purpose of NCPA is to address public concerns vis a vis psychologists, related to mental health, you have not done that and here are the particulars:

b. Medicare ‘Advantage’ Plans (I call them ‘pretend Medicare), specifically, Humana, will only pay for 90806 which is 45-50 min of therapy. That pays me, the doctoral psychologist, $55 for seeing the client in their homes (oh: western NC has no public transportation infrastructure). It has become very obvious that as re: health care reform and national health care, that there needs to be an option for Medicare or government sponsored health care. Medicare does not have the stipulations that Humana has: nothing but 90806; must send in your therapy notes or they will say give us our money back; endless beauocratic difficulties associated w/ the simplest of matters like they registering one’s professional Tax ID. NCPA has had nothing to say about these kinds of difficulties.

c. I am happy to say that MEDICAID works pretty well. If NCPA had anything to do w/ this, I would like to hear about it. What makes NC Medicaid work well is: streamlined & efficient authorizations for therapy and webclaims billing which is a snap.

However, when it comes to Enhanced Benefit Services such as Community Support Services, a valuable service which supplements what psychologists do, particularly for Medicare & Medicaid clients----NCPA has had nothing to say about continuing it as the NC State Legislature has slashed its budget. Not a word.

I have spent hours writing letters of complaint to the Department of Health Service Regulations and the NC DMA Medicaid Investigations people associated w/ improper use of Medicaid funds outside of Medicaid clients’ Person Centered Plan.

d. Many publicly funded clients live in Family Care Homes. There are over 700 of these homes in Buncombe county alone. Across NC, there are tens of thousands of disabled clients who live in these homes.

These are regulated by the Department of Health Service Regulation or DHSR. I have an almost 2 inch thick file now associated w/ complaints associated with my clients who are residents in these homes. These complaints include: 1. not enough food 2. badgering of clients by the administrations 3. administrations colluding with exterior private mental health provider companies and demanding that residents attend Enhanced Benefits programs such as Psychosocial Rehabilition Services rather than what is in their Person Centered Plans as signed off by the psychologist who helps to create medical necessity 4. threatening mental health workers w/ arrest if they do not kowtow to the unreasonable demands of the administration.

There has been no attention paid to public health matters by NCPA. As the Obama administration hopefully moves forward---without the support of the Republican Party----a public health option such as Medicare----you might reconsider the knowledge base of your former members who work with the Medicare & Medicaid clients.


Marsha V. Hammond, PhD


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