Wednesday, February 10, 2010

NC Medicaid Moves to Disenfranchise Rural Citizens with Mental Health Needs using LME's as authorizing agents

Marsha V. Hammond, PhD Clinical / health PsychologyNC Licensed Psychologiste mail: cell: 828 772 1127

February 11, 2010

Dear Cheryl Brimage of Centers for Medicare & Medicaid Services (; direct line: 404 562 7116 ):

I understand that you are the the CMS coordinator as associated w/ the proposed Medicaid waiver vis a vis the Piedmont Behavioral Health model which would demand that the LME's oversee Medicaid authorizations. Certainly, efficiency and cost containment is important, even critical.

Unfortunately, the LME's are not efficient and mental health care patients as well as providers will be severely affected if the LME's are allowed to drive mental health care completely in the direction of favoring large mental health care companies. And that will be the agenda. And with that agenda will come mountains of paperwork which only a large company can create. And they will not be creating superior mental health care but simply massive amounts of paperwork that give some illusion that mental health care is taking place.

I work w/ many indigent Medicaid patients. NC Medicaid is very simple to work with: billing is easy; authorizations go thru seamlessly. I follow my clients carefully; they can call me anytime of the night or day; I see them in their homes.

Do you think that a large provider------which is what this Medicaid authorization process will give incentive to------will see the patients in their homes? Western NC, outside of Asheville, NC, has no public transportation to speak of.

Contrarily, my experience w/ the LME's, inclusive of Western Highlands Network LME and Smoky Mountain Center LME has has been exactly the opposite. I do not mean to imply that they are not well meaning people. I mean to clearly state that these two LME's, which cover over 25% of NC 100 counties have created such mountains of paperwork that I refused to work with state funded clients over a year ago. I don't think they concocted the paperwork; I think it was demanded by them as per CMS and NC DHHS.

A system that allows small providers to function is a system that provides efficient mental health care to rural Medicaid clients.

State funded clients, as you may or may not know, are the patients that NC Mental Health Reform was supposed to cover and these clients were to have had access to their choice of health care providers. Those notions flew out the door several years ago related to the mountains of paperwork and impossible authorization process demanded by NC DHHS and created by the LME's, the managers of mental health care in NC.

Now I hear that these LME's are going to oversee Medicaid authorizations. The only money that will be saved will be associated with strangling the health care providers by demanding umpteen requirements to be on a panel when all that should be necessary to know is that I am licensed as a psychologist in NC.

I simply cannot do my work which is to treat people w/ serious persistent mental health challenges and do the paperwork which the LME demands which is nothing more than a strategy to cut out the services and severely truncate my ability to make a living.

I left you a message today on your phone and I look forward to hearing from you soon. If you want an efficiently operating system associated with RURAL mental health care in NC, you will see to it that the small providers are allowed to continue to work efficiently.

Please feel free to pass this to pertinent person or entity. It has been posted on my NC Mental Health Care reform blog.

Please see my recent publication at the NC Medical Journal on exactly this topic.

Marsha V. Hammond, PhDLicensed Psychologist,


Post a Comment

<< Home