Medicaid Waiver & Its Permutations as the State Legislature Changes the Language Associated w/ Using Piedmont Behavioral Health LME's Medicaid Model

Meantime, the Medicaid Waiver continues to roll out across the state.

Sure, we want to save money. Everyone gets that and the premise is that locally the Medicaid money can be managed more efficiently and there is some sense to this.

The problem is that the LME's, that manage state funded mental health care and have done this since 2002, are now being demanded by the NC State Legislature to oversee their catchment area's Medicaid. Those LME's are going to---and already have---- created a mountain of unnecessary paperwork when what is currently in place is an efficient authorization mechanism vis a vis Value Options (for more than 8 outpatient therapy sessions for adults; for more than 26 outpatient therapy sessions for adolescents/ children).

Whenever you see that someone has suicided or killed someone in the NC newspapers, and they talk about that person having a mental health challenge, know that the most important question to ask in order to understand what didn't take place in terms of their mental health care is: was the person a 'state funded mental health' client. I'll eat my hat if this isn't true of every single story I've seen over the past year regarding these kinds of events. No reporter ever asks the question, either, for to ask the question is to reveal the failure of NC Mental Health Reform. The purpose of NC Mental Health Reform, in part, was to provide mental health care for EVERY citizen. Thus, the 'state funded' mental health care category was created and that has been what the LME's have been doing for the past 10 years: managing state funded clients. For, you see, the paperwork created by the LME's in order to work w/ people who had no Medicaid or other health insurance, was this 'state funded' avenue and it does not work because no provider is willing to fill out reams of paperwork and not be paid. NC Mental Health Reform was a well intentioned idea that has been very poorly planned and diminishing paperwork is part of the planning and NC DHHS and the LME's can't or won't do anything about that matter.

Thus, a tremendous barrier to outpatient treatment by professionals, such as this psychologist, is waiting in the wings and the name of that is the Medicaid Waiver. Its the outpatient treatment that keeps people out of the hospital and saves taxpayer money. When you create a massive barrier to that, guess what: more people will go into the hospital and more money will be spent. Additionally, no patient I have ever known has wanted to go into a psychiatric unit; they simply get so ill that there is no other choice. This matter is true for ANY mental health professional working in an outpatient setting.

Moreover, the paperwork for Enhanced Services, the Service Definition that has sunk NC Mental Health Reform, requires even more paperwork. Rather than NC DHHS having created that Service Definition in 2000, they might have more carefully PLANNED how money was going to be spent by all the private companies that understandably sprung up to 'catch the wave' of the Enhanced Services monies. The lack of planning is evident to providers and Medicaid consumers and their families and that is what all the complaining is about from the public: once again, another major shift in Medicaid funding and its management is being created and we can already see the places that the planning is absent. Our comments are ignored.

Why is the Medicaid waiver a problem for Medicaid recipients and their families as it is being launched, with the NC Legislature pushing this, from the loins of Piedmont Behavioral Health LME? Because there is no transparency to Medicaid recipients/ their families as per the Non-Disclosure Agreement created by Piedmont Behavioral Health (pbH, their logo), an LME in eastern NC. pbH attempted to hoist onto Western Highlands Network (WHN) LME that agreement during the WHN LME board's May, 2011 meeting (see this link for that document:: http://madame-defarge.blogspot.com/2011/05/watergate-ii-or-borg-public-funds-being.html. The WHN LME Board voted the acceptance of that document down, against the advice of their attorney and the CEO of WHN LME.

So, NC DHHS has not done its job regarding how to utilize already Medicaid certified mental health providers as per this waiver and rather than do their work, has allowed the LME's to simply demand that providers spend hours and hours of unpaid work, filling out forms and gathering up unnecessary information, in order to continue to work w/ Medicaid clients. The CEO of WHN LME, when I queried him about the 18+ page form to be filled out, indicated that CMS (Centers for Medicaid/ Medicare Services) demands such. I have asked the legislative arm of the American Psychological Association to find out whom I can speak to at CMS in order to revamp this matter.

As re: psychologist mental health providers (and others), don't ask the NCPA for help: the public mental health committee members of that organization are salaried psychologists working in state mental health hospitals and do not function independently and do no billing and therefore have no horse in that race. Been there, done that.

And, the NC State Legislature has not done their work re: the Medicaid Waiver as they hem-haw around the language in the various bills outlining the Medicaid Waiver as they attempt to demand that 'fealty' (they have now changed that word to 'kind of looks like' or something akin to that) to the pbH Medicaid Waiver model be adhered to. It is clear that the complaining of providers, citizens, and county commissioners is impacting how the NC State Legislature writes the bills outlining the implementation of the Medicaid Waiver.

Yes, it is clear that there is no reason for each LME to re-create the wheel re: the management of Medicaid monies since the state legislature is so damned intent on hoisting this Medicaid Waiver on all the LME's----if they can keep standing. However, there is no good reason why public monies supplied to pbH to create their Medicaid Waiver beginning in 2005, should cause pbH to act like a private enterprise and send mental health reform right back to 'where we were 7 years ago' (the statement of the Chair of the WHN LME Board during the May, 2011 meeting of that board).

On the 2nd Friday of June, at 9:30 am, the Western Highlands Network (WHN) LME Board will meet; they administer state mental health and will soon administer Medicaid for 7 counties in Western NC. You can bet there will be a great deal of talk about the Medicaid Waiver matter.

Over the past several weeks since the May, 2011 WHN LME Board meeting, there has been a great deal of complaining about the arm twisting associated w/ the Medicaid Waiver matter and I suspect that the county commissioners have done their fair share of that complaining as they had to have voted to allow the Medicaid Waiver to move towards adoption by the LME. (I bet they recognize that as a Trojan Horse now).

Marsha V. Hammond, PhD, Licensed Psychologist

NC DHHS : Please Do Your Work Re: the Medicaid Waiver Prior to Giving Everyone Else the Work To Do

In Mr. Cansler's 'Medicaid Waiver' presentation to state representatives in 2009, he mentioned, on page 4, that one thing that could be expected would be 'frequent billing and payment difficulties." Here is that information that Mr. Cansler gave out in 2009: www.ncdhhs.gov/dma/legis/071009MedicaidWaiverLME.pdf

Does the below lack of regard for provider's time come under that heading? And I really cabnot understand why is it acceptable to not anticipate these kinds of issues PARTICULARLY if one of the LME's, specifically, Piedmont Behavioral Health (pbH; their logo) 'has gone through' the Medicaid Waiver process since 2005.

Thus, I have written to the following representatives associated with these matters:

"Rep. Jeff Barnhart" ,
"Rep. Harold \"Bru\" Brubaker" ,
"Rep. Justin P. Burr" ,
"Rep. Nelson Dollar" ,
"Rep. Verla Insko" ,
"Rep. Darren Jackson" ,
"Rep. Beverly Earle" ,
"Rep. David Lewis" ,
"Rep. Bill Current" ,
"Rep. Fred Steen" ,
"Rep. Hugh Blackwell" ,
"Rep. Jean Farmer-Butterfield" ,
"Rep. Jennifer Weiss" ,
"Rep. Jim Crawford" ,
"Rep. Julia Howard" ,
"Rep. Mark Hollo" ,
"Rep. Pat Hurley" ,
"Rep. Rayne Brown" ,
"Rep. Shirley B. Randleman" ,
"Rep. Tom Murry" ,
"Rep. Tricia Cotham" ,
"Rep. William Brisson" ,
"Rep. William Wainwright" ,
"Rep. Garland Pierce" ,
David Gantt



Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 5197
e mail: chomskysright@gmail.com


May 16, 2011


Dear State Representatives and County Commissionersi:


I am in receipt of advocates' concerns re: the Medicaid Waiver . Providers have concerns also. I voiced these to Secretary Cansler as re: the Western Highlands Network (WHN) LME meeting last week during which they voted NO to the "Non-Disclosure Agreement" sent to them by Piedmont Behavioral Health (pbH; that's their logo). That means, that they are voting NO to the Medicaid Waiver . He wrote me back via his assistant 5.9.2011 and indicated that they were 'working on it.' That 'working on it' should precede the doing of the waiver. (you can see that letter at my blog: http://madame-defarge.blogspot.com/)


My concern, which I presented to the Executive board of WHN LME on 5.6.2011, was the 18+ pages of 're-certification' to render Medicaid Services. I am a licensed psychologist; I am a Medicaid provider; I am a Medicare Provider; I am a provider on most insurance panels. I have an NPI number (national provider number which was supposed to have taken the place of Medicare/ Medicaid numbers).


WHY can't NC DHHS work w/ CMS (Centers for Medicare/ Medicaid Services) to seguae this Medicaid Waiver thru the LME's if they are so intent on making it happen? Why leave it to the providers to do the work that NC DHHS should have done, this in addition to my work as a psychologist? Why am I having to ask the American Psychological Association's CMS liasons about what to do here? These are long processes, that of working with CMS and NC DHHS should have done this prior to hoisting this Medicaid Waiver which they have been doing since 2005 vis a vis pbH.


I would ask you to slow down this Medicaid Waiver matter until NC DHHS does its footwork and homework which has now become my work, unless I want to fill out 18+ page applications LME-by-LME. The concerns of the advocates and families of consumers has been exactly the same: please stop railroading this Medicaid Waiver prior to having done your work.


Sincerely,


Marsha V. Hammond, PhD, Licensed Psychologist

Secretary Canlser Responds to Medicaid Waiver Provider Request to Please Save Us From the Unnecessary 18+ Page Re-certification of Medicaid Provider

I'm already a Medicaid provider. Now the LME's vis a vis this Medicaid Waiver, are insisting that all the providers re-certify themselves LME-by-LME as re: this Medicaid Waiver.

They blame it on CMS. Sure. I mean, I know from sitting and listening at APA to Tony Puente's talks re: CMS and psychologists who work in public mental health that there is the necessary creation of 'avenues' regarding psychologists' reimbursement fees, and all that kind of thing. However, if NC DHHS wanted to prevent a further deterioration of public mental health, they would have gone and talked to CMS.

I'm soliciting help from the APA CMS liasons. I'll be back w/ info as I get it.
______________________________________________________

Marsha V. Hammond, PhD, Licensed Psychologist, NC
Member, American Psychological Association
Mailing address: Asheville, NC 28806
Cell: 828 772 5197 e mail: chomskysright@gmail.com

May 15, 2011

RE: 18 page + application forms for already licensed & Medicaid certified psychologists as re: Medicaid Waiver process in NC/ public mental health

Dear American Psychological Association_____________________________

I am a licensed psychologist in NC; I am a member of APA. I am certified by NC Medicaid to provide services to Medicaid clients; I am certified by Medicare to provide Medicare Services; I have an NPI number which was reportedly to have taken the place the Medicare & Medicaid numbers.
The Medicaid Waiver program is being advanced by NC DHHS in a most unprepared manner, and even though I have been for years a Medicaid provider, I am being required to re-apply for certification vis a vis this Medicaid waiver process as associated with an 18 page+ application, assembling of items like a ‘sealed college transcript’, etc., in order to be certified to provide Medicaid services for an LME (mental health administration government entity) in NC which is under the administration of NC DHHS. Why, I ask? Why not just disband the licensing board, please, and save me and the taxpayers some money.
I enclose a letter from Dr. Beth Melcher, PhD, Asst Secretary for MH. DD./ SA Services of NC DHHS, dated 5.9.2011.
In that letter, she explains:
“….Secretary Cansler requested that I respond to your letter dated May 1, 2011. In this letter you raise concerns regarding the process for becoming a credentialed Medicaid provider within the Western Highlands Network LME provider network. The process you have outlined is approved by the federal Center for Medicaid/. Medicare Services (CMS). As additional LMEs become waiver sites the provider application process is one of the areas to be standardized across the Managed Care Organizations (MCOs). While licensure is a critical piece of the certification process additional information is required. There is discussion about whether information from licensure boards could be shared for verification information which would streamline this process. …”
As you probably know, any citizen can go onto the internet and discern as to whether I, or anyone else, is a licensed psychologist. It is public information. Why can’t NC DHHS utilize the licensing board information in order to curtail this unnecessary recreation of the wheel, LME by LME?
In order to render services to Medicaid eligible clients (and most of my clients are either Medicaid clients or dually eligible Medicare/ Medicaid clients), I am being required to create paperwork-----LME-by-LME-----in order to continue to work as a Medicaid provider. Why?
NC Mental Health Reform, as administrated by NC DHHS, has destroyed the provider network and this kind of paperwork, surely to be succeeded by reams of paperwork on each and every Medicaid client, session by session, is a very very serious matter which will contribute to more mental health crises, as was outlined today in a Raleigh newspaper regarding a woman who quite obviously was supposed to have received mental health services and was kept in the hospital two days (I assume she was a ‘state funded client’; this means that no private provider would render services for any period of time due to the paperwork involved with such a client; NC Mental Health Reform, started about 10 painful years ago now, was to have made mental health services available to ALL citizens), was released to a group home, which she left, and then she proceeded to jump off the local hospital’s parking deck (she was not a patient there!), killing herself.
Can someone from APA please address this issue? I am forwarding this to Division 42, Division of Independent Practice, of APA, of which I am a member, in the hopes that someone has an idea as to how to inform CMS that it is not necessary for Medicaid providers to be re-approved by each and every LME as the Medicaid Waiver is unjustifiably hoisted onto the LME’s in NC----by the NC State Legislature and as per NC DHHS.
Thanks for any assistance and attention you can give to this matter.

Sincerely,

Marsha V. Hammond, PhD
Licensed Psychologist, NC; certified Medicaid & Medicare provider

Cc: Beth Melcher, PhD, Asst. Secretary for MH./ DD/SA Services
Secretary Lanier Cansler
Arthur Carder, CEO WHN LME
David Gantt, Chair Buncombe County Commissioners; members of the Buncombe
County Board of Commissioners
Representative Verla Insko, Co-Chair Joint Legislative Oversight Committee for MH
Reform, NC
Senator Martin Nesbitt, Co-Chair Joint Legislative Oversight Committee for MH
Reform, NC
NC Mental Health Reform blogspot maintained by Marsha Hammond, PhD:
http://madame-defarge.blogspot.com/

Watergate II or The Borg?:Public Funds Being Used to Create Private Wealth? per NC Medicaid Waiver as Western Highlands Network is Bullied by pbH LME

The document below almost caused me to weep for the citizens of NC.

Here's the outline of what I think is taking place:

Piedmont Behavioral Health (pbH, as they so cutely call themselves), which is an LME, or public mental health agency under NC DHHS---just like Western Highlands Network LME or Smoky Mountain Center LME-----covering all of western NC re:Medicaid and state funded mental health services----is twisting,big time, the arm of WHN LME. Who cares,you say?

Well, pbH is funded by tax-payers as is WHN and SMC. pbH wants to own WHN LME, hook, line, and sinker. If you don't believe that, simply read the public document below.

And from WHN LME, they will simply move on to their next conquest w/ a similar arm-twisting 'Non-Disclosure Agreement.' I assume that SMC LME is next.

Unless I am badly mistaken, sitting behind pbH is Daymark Recovery, a private, for profit company in eastern NC (I do have one client in western NC, whom receives psychiatric services from a Daymark Recovery psychiatrist via a modality here which I will not describe as I do not want to be sued, and I wrote him/ her a letter re: his medication which caused her to go to jail; that psychiatrist, duh, denied that). So much trouble ensued, that the client and talked about the possibility of suing that psychiatrist.

Maybe some activist has the information linking Daymark Recovery to pbH?

Daymark Recovery insures 38,000 lives in terms of mental health services. I'm betting that they are the largest private mental health company in this state.

Yesterday, the Executive Board of WHN LME met and one of the public documents given to anyone that was there was the pbH 'Non-Disclosure Agreement' (see below; I copied the entire thing and nothing is changed except for underlining and bolding some of the headers: this is what the WHN LME looked at and voted down yesterday----God bless those brave people).

pbH was able to 'offer' this 'Non-Disclosure Agreement' as they (pat on the back, boyo) have been in the Medicaid Waiver business a la NC DHHS/ NC Medicaid since 2005. Therefore, they are now acting like they can very exactingly tell everyone else what to do, how to do it, and how long they are going to do it.

Its a very , very scary contract which is being hoisted onto the backs of NC citizens in order that public monies be used to line private pocket. (there will be no justice in the land until medical care is non-profit)

If this isn't Jean Luc Picard's (see Star Trek) Borg experience, I don't know what is. I'm looking around to see if I should be meeting someone in a garage a la Watergate but hey, folks: this is a public document. I simply copied it.

Its as if an alien, for profit, out only for themselves------ empire swooped down on a public entity and said sign this or we throw you off the train with an 85 pound bag of concrete tied to you-----and this is exactly what the WHN LME attorney said would happen if the Board did not approve this 'Non-Disclosure Agreement.'

When I digitalize the film given to me by Jerry Rice, simply a private man who states that his 'ministry' is to record every single Buncombe County public meeting since 1999----for no pay, he states-----it will be seen what took place yesterday during that WHN LME meeting.

Read it in its entirety below. Even Jean Luc Picard weeped when he was overtaken by the Borg (but he got his identity back-----eventually) . The section on "Moral Rights", in particular, made me shudder. But then, even that shudder was offset by the knife that I personally felt in my own back re: the 'we've signed this voluntarily.'

______________________________________________________________
pbH

NON-DISCLOSURE AGREEMENT

This Non-Disclosure Agreement (“Agreement”) is effective as of May 2, 2011 (“Effective Date”) by and between PBH, a Managed Behavioral Healthcare Organization, having its principal place of business at 245 LePhillip Court, Concord, North Carolina 28025 (“PBH”)) and Western Highlands Network a Local Management Entity, having its principal place of business at 356 Biltmore Avenue, Asheville, NC 28802 (“WHN”)

In consideration of the mutual covenants and agreements hereafter set forth, the parties agree as follows:

Relationship of the Parties. WHN desires to operate North Carolina’s 1915 (b) and 1915(c) Medicaid waivers and to contract with the North Carolina Division of Medical Assistance to manage behavioral health benefits for Medicaid consumers. PBH has operated the 1915(b) and 1915(c) waivers since 2005. PBH has agreed to share with WHN Proprietary Information which PBH has developed during its five years of operating the waivers. WHN will contract with various contractors who may have access to and utilize PBH’s Proprietary Information as part of the business relationship ship between WHN and its contractors. This agreement addresses the desire that Proprietary Information shared with WHN will be used exclusively to prepare WHN to operate the waivers and for no other purpose. Specifically, PBH and WHN desire that Proprietary Information which is shared may not be used, sold, licensed, or any way offered for the benefit of any party other than WHN. WHN agrees to require any contractor who may have access to the Proprietary Information to be bound by the terms of this Agreement.

Term/ Termination. This Agreement will commence on the Effective Date and continue, unless terminated earlier pursuant to this Section 2, until 5( five ) years thereafter. This Agreement may be terminated by either party at any time by giving written notice of termination to the other party. In the events of such termination, WHN will be obligated to return to PBH all Proprietary Information and to destroy any copies of the Proprietary Information, whether it is in hard copy, electronic, or any other form, whether in the possession of WHN or a WHN contractor, with 7 (seven) days of the date of the written notice of termination.

Confidentiality

a. Proprietary Information. WHN understands that PBH possesses and will possess Proprietary Information that is important to its business. For purpose of this Agreement, “Proprietary Information” is all information that is disclosed to WHN by, or on behalf of PBH, and that is developed at PBH’s facilities or with use of PBH’s equipment and/or personnel. Proprietary Information includes, but is not limited to, information (and all tangible items in any form incorporating, embodying or containing information) relating to (a) all client, customer, vendor, and contractor lists and all lists or other compilations containing client, customer, vendor, or contractor information; (b) information about products, proposed products, research, product development, know-how, techniques, processes, costs, markets, marketing plans, strategies, forecasts, sales, and unpublished information relating to technological and scientific developments; (c) plans or ideas for future development and new produict concepts; (d) all techniques or processes,documents, books, papers, drawings, schematics, models, sketches, computer programs, data bases, and other data of any kind and descriptions including electronic data recorded or retrieved by any means; (e) the compensation, performance and terms of employment of PBH employees; (f) software in various stages of development, and any designs, drawings, schematics, specifications, techniques, models, data, source code, algorithms, object code, documentation, diagrams, flow charts, research and development, processes and procedures relating to any software; and (g) all other information that has been or will be given to WHN in confidence by PBH (or any affiliate) concerning PBH’s actual or anticipated business, research or development or that is received in confidence by or for PBH from any other person or entity. Proprietary Information does not include information that WHN demonstrates, by written documentation created in the ordinary course of business, (i) is in the public domain through lawful means that do not directly or indirectly result from any act or omission of WHN in breach of its obligations hereunder; (ii) was already rightfully known or available to disclosure to WHN; (iii) is independently developed by WHN; (iv) is disclosed under operation of Law, provided WHN has promptly notified PBH of any legal process requiring production of Proprietary Information prior to compliance and has taken all reasonable precautions to ensure confidential treatment of any information so disclosed; (v) is disclosed by WHN with PBH’s prior written approval.

Non-DisClosure. WHN understands that this Agreement creates a relationship of confident and trust between WHN and PBH with regard to Proprietary Information. WHN will at all times, both during and after the term of the Agreement, keep the Proprietary Information securely in confidence and trust. WHN will not without the prior written consent of an authorized representative of PBH (i) copy, use of disclose any Proprietary Information, (ii) remove any Proprietary Information from the business premises of WHN, or (iii) deliver any Proprietary Information to any person or entity outside WHN. Notwithstanding the foregoing, WHN may use the Proprietary Information (and disclose and deliver same to WHN’s contractors, if applicable, who have a need to know, provided such contractors have previously entered into written agreements protecting third-party proprietary information received by WHN and containing provisions at least as restrictive as those set form in the Section 4) as may be necessary and appropriate for WHN to operate North Carolina’s 1915(b) and 1925(c) Medicaid waivers and to contract with the North Carolina Division of Medical Assistance to manage behavioral health benefits for Medicaid consumers.

Ownership and License.

a. Assignment of Proprietary Information. All Proprietary Information covered by this Agreement and proprietary rights of any kind that pertain to the Proprietary Information, which currently exist or may exist in the future (collectively, the “Rights”), shall be the sole property of PBH. WHN hereby irrevocably assigns and agrees to assign to PBH, without further consideration, any and all Rights that WHN may have or acquire in the Proprietary Information, except as is otherwise agreed to in writing by the parties.
b. Cooperation. WHN agrees to perform, during and after the term of this Agreement, all acts deemed necessary or desirable by PBH to permit and assist it, at WHN’s expense, in evidencing, perfecting, obtaining, maintaining, defending and enforcing Rights and/ or WHN’s assignments herein. Such acts may include, but are not limited to, execution of documents and assistance or cooperation in legal proceedings. If WHN is unable or unwilling to perform the acts required by this provision, WHN hereby irrevocably designates and appoints PBH and its duly authorized officers and agents, as WHN’s agents and attorneys-in-fact, with full power of substitution, to act for and in behalf and instead of WHN, to execute and file any documents and to do all other lawfully permitted acts to further the above purposes with the same legal force and effect as if executed by WHN.
c. Moral Rights. Any assignment of copyrights hereunder (and any ownership of a copyrights as a work made for hire) includes all rights of paternity, integrity, disclosure and withdrawal and any other rights that may be known as or referred to as “moral rights” (collectively, “Moral Rights”). To the extent such Moral Rights cannot be assigned under applicable law and to the extent the following is allowed by the laws in the various countries where Moral Rights exit, WHN hereby ratified and consents to any action of PBH that would violate such Moral Rights in the absence of such ratification/ consent. WHN will confirm any such ratifications and consents from time to time as requested by PBH.
d. Interference With PBH Business. WHN agrees that for the term of this Agreement as described in Section 2 and for a period of six (6) months following any termination of the Agreement, WHN shall not, for itself or any third party, directly or indirectly divert or attempt to divert from PBH (or any affiliate of it that might be formed) any business of any kind in which PB H is engaged including, without limitation, the solicitation of or interference with any of its customers, clients or vendors. WHN understands that none of the foregoing activities will be prohibited if WHN can prove that the action was taken without the use in any way of Proprietary Information.
e. Privacy. WHN recognizes and agrees that it has no expectation of privacy with respect to PBH’s telecommuncations, networking, or information processing systems (including, without limitation, stored computer files, e mail messages and voice messages( and WHN’s activity, and any files or messages, on any of those systems may be monitored at any time without notice.

Independent Entities. The Parties shall act as independent entities and not as an employees or authorized agents of each other. The Parties have no authority to enter into contracts or binding commitments in the name or on behalf of the other. The Parties will not use each other’s logos or marks without prior written approval, and then such use shall be only for the benefit of the other Party and the at the direction of the other Party. The Parties shall not be, nor represent themselves as being, authorized to bind the other Party.

Representations and Warranties. Each Party represents and warrants that, as of the Effective Date and at all ties during the term of this Agreement: (i) this Agreement will not breach any agreement that either Party has with any other party including, without limitation, any agreement to keep in confidence proprietary information acquired in confidence or trust prior to the executive of this Agreement; (ii) neither Party is, nor will be bound by any agreement, nor will they assume any obligation, which would in any way be inconsistent with this Agreement; (iii) neither Party will disclose to, or induce the other Party to use, any confidential or proprietary information of any person or entity other than themselves; and (iv) each Party’s employees and contractors, as applicable, have executed written non-disclosure, assignment of rights, and other appropriate agreements sufficient to protect the confidentiality of the Proprietary Information, and sufficient to allow the Parties to grant the assignments and licenses as provided herein.

Indemnity. Each Party agrees to defend, indemnify and hold the other Party and their affiliates (and their respective employees, directors and representatives( harmless against any and all losses, liabilities, damages, claims, demands and suits and related costs and expenses (including, without limitation, reasonable attorneys’ fees and court costs (arising or resulting, directly or indirectly, from (i) any act or omission or breach of any representation, warranty or covenant of this Agreement of the indemnifying Party, or (ii) infringement of any third-party intellectual property rights by the indemnifying Party.

Limit of Liability. NOTWITHSANDING ANYTHING ELSE IN THIS AGREEMENT OR OTHERWISE, NEITHER PARTY WILL BE LIABLE WITH RESPECT TO ANY SUBJECT MATTER OF THIS AGREEMENT UNDER ANY CONTRACT, NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL OR EQUITABLE THEORY FOR ANY INCIDENTAL, SPECIAL, EXEMPLARY OR CONSEQUENTIAL DAMAGES, THE FOREGOING LIMITATION DOESNOT APPLY TO EITHER PARTY’S OBLIGATIONS OF CONFIDENTIALITY UNDER SECTION 3, ASSIGNMENT AND DISCLOSURE UNDER SECTION 4, OR INDEMNITY UNDER SECTION 7.

Miscellaneous.

a. Governing Law. WHN agrees that any dispute in the meaning effect or validity of this Agreement shall be resolved in accordance with the laws of the State of North Carolina without regard to the conflict of laws provisions thereof. If any provision of this Agreement is held to be illegal or unenforceable, such provision shall be limited or excluded from this Agreement to the minimum extent required, and the balance of the Agreement shall be interpreted as if such provision was so limited or excluded and shall be enforceable in accordance with its terms.
b. Assignment. This Agreement (together with all attached exhibits) shall be binding upon WHN, and inure to the benefit of the parties hereto and their respective heirs, successors, assigns, and personal representatives; provided, however, that WHN shall not assign any of its rights or delegate any of its duties hereunder without PBH’s prior written consent and any attempted assignment or delegation will be void.
c. Entire Agreement/ Modifications. This Agreement (together with all executed Work Statements and attached exhibits( contains the entire understanding of the parties regarding its subject matter. This Agreement may only be modified by a subsequent written agreement executed by authorized representative of both parties.
d. Notice. All notices required or given under this Agreement shall be deemed given upon receipt or upon deposit in the US mail, postage pre-paid; by facsimile; or by commercial overnight delivery service with tracking capabilities.
e. Remedies. WHN recognizes that nothing in this Agreement is intended to limit any remedy of PBH under the Uniform Trade Secrets Act and other trade secre laws and that WHN could face p0ossible criminal and civil actions, resulting in substantial monetary liability if WHN misappropriates PBH’s trade secrets. In addition, WHN recognizes that a violation of this Agreement could cause PBH irreparable harm, the amo0unt of may be extremely difficult to estimate, thus making any remedy at law inadequate. Therefore, WHN agrees that PBH shall have the right to apply to any court of competent jurisdiction for an order restraining any breach of threatened breach of this Agreement and for any other relief PBH deems appropriate without being required to post any bond or other security. This right shall be in addition to any other remedy available to PBH in law or eq1uity.
f. Survival. The provisions of this Agreement that may be reasonably interpreted as surviving its termination shall continue in effect after termination of this Agreement. PBH is entitled to communicate WHN’s obligations under this Agreement to any customers, clients, vendors, or contractors of WHN.
g. Time. TIME IS OF THE ESSENCE INTHIS AGREEMENT, AND THE TERMS HEREOF SHALL BE SO CONSTRUED.

WHN HAS READ THIS AGREEMENT CAREFULLY AND UNDERSTANDS AND ACCEPTS THE OBLIGATIONS WHICH IT IMPOSES UPON WHN WITHOUT RESERVATION. NO PROMISES OR REPRESENTATIONS HAVE BEEN MADETO WHN TO INDUCE WHN TO SIGN THIS AGREEMENT. WHN SIGNS THIS AGREEMENT VOLUNTARILY AND FREELY.

In witness whereof , THE PARTIES HERETO HAVE EXECUTIED THIS Agreement as of the first day above written,

For PBH

By: __________________________________
Daniel R. Coughlin
CEO

For Western Highlands Network

By: ___________________________________
Arthur D. Carder, Jr.
CEO

I Think I Need To Be In a Witness Protection Program After that Western Highlands Network LME Board Meeting Today

I understand that Burnsville, NC (sssssshhhhhh) is the area to be if you're in the Witness Protection Program. Its a nice city; they even got liquor there now.

There is a saintly citizen, Jerry, whom records w/ a videocam every single Buncombe County public meeting and has created a giant library since 1999. He taped the WHN LME Board meeting today and I'm gonna see if I can get it you-tubed (digitalized) which is why I think I need to be in the Witness Protection Program.

The CFAC representatives stood up while the sharks swam around them; I stood up and was stupidly ignorant about the sharks; Jerry, the recorder guy, stood up for the little guy and has seen lots and lots of sharks. The head of DSS Buncombe, a board member, sighed and pushed for a letter to the governor; a board member commented that pbh seems to be acting like a private enterprise instead of a government entity; others commented that it seemed like a really really bad idea to sign it as completely obliterated any transparency as re: impacted citizens (and citizens in general).

So, you might say that in a hostile take-over attempt, Piedmont Behavioral Health (PBH, though on their letterhead----this was public information----it's little 'pbh'---how modest; this reminds me of the French vs the British at Agincourt: you guess who's playing the French) sent a 'Non-Disclosure Agreement' to be signed by the WHN LME Board.

That's right about when I figured out that the dark shadow of the shark the size of the Titanic on the other side of that rock was pbh aka NC DHHS Medicaid and I tried to swim for shore without flailing too obviously.

(Its pretty weird? crazy? to be writing about a 'Non-Disclosure Agreement' and therefore disclosing it but I always did love that White House Correspondent's dinner talk by Stephen Colbert; no Laura Bush did not shake his hand after that even though he smelled nice and was wearing a tuxedo).

The pbh Non-Disclosure Agreement states, in part:

".....effective as of May 2, 2011.....Relationship of the Parties. WHN desires to operate North Carolina's 1915 b and 1915c Medicaid waivers and to contract with the North Carolina division of Medical Assistance to manage behavioral health benefits for Medicaid consumers. PBH has operated the 1915b and 1915c waivers since 2005. PBH has agreed to share with WHN Proprietary Information which PBH has developed during its five years of operating the waivers. WHN will contract with various contractors who may have access to and utilize PBH's Proprietary Information as part of thet business relationship between wHN and its contractors. This agreement addresses the desire that Proprietary Information shared with WHN will be used exclusively to prepare WHN to o[erate the waivers and for no other purpose......continues for 5 years......"

And then there's 3 more legal pages with the last one being a blank line (the WHN LME board swam with the sharks and tried not to bleed which is to say they voted 8 to 6 NOT to accept this; they needed 9 votes to pass it) with the signature awaiting the pen of CEO of pbh, Daniel R. Coughlin. The WHN LME attorney took a very careful count of the people who voted.

Oh, by the way: all the LME's will be MCO's by 2013 and Magellan was discussed as a fall back position if the LME's put up too much of a fight re: these Medicaid waivers and hostile take-over maneuvers.

And so I pulled someone aside afterwards and asked, 'why is everyone so afraid of pbh?' to which s/he replied: 'Cabarrus county has two Republicans that are in cahoots w/ pbh and also they're pushing against (Martin) Nesbitt (Buncombe; head of NC Senate).

...now, I think I'll take a little drive over to Burnsville......

What To Expect Per the Medicaid Waiver Endorsed by NC DHHS and In Place at WHN & PBH LME's

I was curious if the other LME whom is engaged in the 'its a done deal' NC DHHS Medicaid Waiver, Piedmont Behavioral Health----all the way over in eastern NC (you don't want people to be able to organize and riot together due to their physical proximity)-----also had an 18 page provider application.

They sure do! But its not the same 18 pages! They require different information than the 18 page WHN LME network!

Moreover, here's something I bet providers over there may or may not know and this portends what is to happen here: its a closed network and as it is right now, as per Haley, in administration at PBH, they don't want no more stinkin' LCSW's (to use film-maker John Houston's phrasing). They sure want psychologists but do psychologists want them?

Moreover, as per my question to Haley, about things like, "Why are you asking me to fill out paperwork about my internship and post-doctoral work", etc., etc., etc.,----when the NC Licensing Board would not license me if I had not had those things: she stated, "well, the licensing board indicates that you're licensed but we don't know if you had the internship because they won't answer that question."

Great! Mounting piles of duplicitous paperwork and no hand looking to see what the other one has or does. It sure looks like it makes jobs for the LME's that have no contact w/ the patients though!

Can we PLEASE have a uniform application for professional providers as per this Medicaid Waiver process?

As one of my supervisors of my documented 2000 hour INTERNSHIP, prior to my 2000 hour POST-DOC year----- said as I exited my experience there: "Pray for your Profession." That was 15 years ago. I think initiating blood sacrifice rites would be in order now.

Resolution Regarding the Western Highlands Network 1915 b/c Medicaid Waiver Project.....

....it was signed by all the associated county commissioner chairmen and declares that 8 county managers will be part of the WHN LME Board (best I can understand the document) . This being said, all the counties had something slightly different to say re: their support of the Medicaid Waiver.

Here is the person to contact about the document: Rhonda Mckee, Human Resources Director, WHN LME.

For instance, a funny thing is that it is indicates that 'it will support our federally qualified health clinic (FQHC), Minny Jones Health Clinic", the largest integrated provider in our county....." (ahem: Minny Jones, I assume the same person, is on the WHN LME Board).......

It doesn't say HOW it is going to create that support and in that there are lots of health clinics in Asheville, and in that Minny Jones is on the WHN LME Board, I'm scratching my head.....

Maybe I'm out of the loop, but I don't know anything about the Minny Jones Health Clinic. When I google it up, this is what I get: 264 Haywood Road, Asheville, NC (that's around the corner from me); its a 'permanent health services provider'

WHY, I want to know, is this stipulation sitting in the
Buncombe county 'sign off' vis a vis this
WHN LME Executive Board Member?

Inquiring minds want to know.......Let's ask the chairman of the County Commissioners, David Gannt, whom signed off on the document.......

Chair of WHN LME Board Did NOT Support Medicaid Waiver: WHN LME Board Meeting 9:30 am, 5.6.2011

I spoke w/ the Chairman of the WHN LME Board, Ryan Whitson, tel 894 3301, x 8, a moment ago. He indicated, very clearly, that he did not support the Medicaid waiver 'because I don't trust the state of NC.' He reported that 3 other of the 16 members did not support the waiver.

There is a meeting of the WHN LME Board this Friday, 9:30 am. Providers may make public comment, something he indicated he put into place, by 'signing in' at 9:15 am, in order to speak before the board . I will be there.

A helpful woman at Western Highlands Network LME, Rhonda, in Human Resources (rhonda@westernhighlandsnetwork.org) indicated to me that there are 16 members of the WHN LME board and amongst those 16 are 8 county manager, one of whom is Ryan Whitson. She was not able to tell me who the other managers were who voted against the Medicaid wavier (she simply did not recall but perhaps she could tell me later when I send her an e mail)

Rhonda explained that prior to the WHN LME Board acting on the matter, that the resolution was approved by each of the county commissioner boards. She indicated she would scan that resolution and send it to me and then I will place it on this blog.

THUS, THE BOTTOM LINE IS THIS: IF PEOPLE BEING SERVICED BY AN LME DO NOT WANT THE MEDICAID WAIVER, THEY NEED TO MAKE SURE THAT THE COUNTY COMMISSIONERS, WHOM VOTE ON THE MATTER FIRST, ARE INFORMED.

I don't know if this ridiculous waiver is a 'done deal' or not but I intend to drag my fingernails across the chalkboard the entire time.

The current members of the WHN LME Board are:

Ryan Whitson, chair
Mandy Stone
Minny Jones
Steve Wyatt
Abigail Karroubi
Steve Garriso
Carolyn Moser
Charles Vines
Keith Holtzclaw
Barbara Trumble
John Coudrey
Susan Hendrick
Arthur Wilson
Steven Smith
Mason Bennett
Joe Martin

Letter to Lanier Cansler re: Medicaid Waiver Program of Western Highlands Network LME

Marsha V. Hammond, PhD Licensed Psychologist, NC
Billing address:
Cell phone: 828 772 5197 e mail: chomskysright@gmail.com

DATE: May 1, 2011

RE: Medicaid Waiver for WHN LME

Dear Lanier Cansler, Secretary of NC DHHS:

Thank you for reading this letter. I know you are an extremely busy man and I don’t mean to maintain that I have some special status re: my questions here. Nevertheless, I must say something about this ‘Medicaid Waiver’ program as prescribed by Western Highlands Network (WHN) LME. I must say something as the other LME’s are poised to utilize a similar strategy. I have no idea if the outline of this ‘application’ is being issued from NC DHHS but I would beg you to consider the time that providers are utilizing to do hours and hours of work which is unpaid and has absolutely nothing to do w/ patient care.
The NC Psychology Licensing Board has given me a license to practice as a fully-fledged psychologist in this state and so why is this LME asking all of these duplicitous questions? I wish I could say that the NC Psychological Association concerns themselves w/ these important issues but alas their behavior is indicative of a dysfunctional system that has no idea what is taking place re: the practice of public mental health services.
Sir, if you simply take a look at the WHN LME webpage outlining the ‘application’ for being a Medicaid provider under WHN LME, I think you might ascertain that all of that information is included under the rubric known as my license as a psychologist in the state of NC. Here is that website: http://www.westernhighlands.org/images/stories/4contractapplicationforlicensedindividualpractitioners.doc
I am admittedly very perturbed at being asked to provide the following kinds of information if for no other reason that I have clients to attend to---and Medicaid clients are usually more ill and challenging that other insured clients (I stopped working w/ state funded clients years ago re: the paperwork log jam created by the LME’s):
1. a sealed transcript associated w/ my PhD (the NC Psychology Licensing Board did this years ago; that is why I have a license here)
2. references from my colleagues (the NC Psychology Licensing Board did this years ago; their recommendations allowed me, in part, to have a license here)
3. a demand to submit ‘2 evaluations’ (the NC Psychology Licensing Board, in addition to my doctoral program, internship, and post-doctoral year did this)
4. my ‘Physician Coverage’ (if I did not work w/ these helpful colleagues, I could not care for my clients)
5. what kind of ‘approach’ do I use in my work (the NC Psychology Licensing Board is associated w/ my training as was my doctoral program, internship and post-doc training)
6. ‘Exclusion Sanction Information’ (the NC Psychology Licensing Board has a record of any complaints or associated information or they would not grant me a license every two years & any judgement is public information at the Board’s website)
7. “Electronic Claims Submission” (I have been successfully utilizing NC Webclaims for my NC Medicaid clients for years w/o difficulty and so why are we creating all this paperwork other than to bury the few remaining providers?)
8. my NPI certification (this can be determined by going to the online NPI site)
9. my Medicare certification (the NPI number was to have supplanted the Medicare & Medicaid provider number)
10. my Medicaid provider certification (surely NC DHHS whom manages NC Medicaid has this information??)
11. my previous license as a psychologist in another state many years ago (the NC Licensing board has this information)
12. my malpractice insurance limits ( this is one matter I can understand that the LME might be interested in re: any 'deep pockets' that an insured might go after as associated w/ a malpractice suit)

Mr. Cansler: Can you please explain to me why I should use my time creating reams of paperwork in order to continue to service my Medicaid clients under this Medicaid Waiver program? If my license as a psychologist does not evidence my expertise, then why not ask the Secretary of State of NC to just disband the NC Psychology Licensing Board? That would save me over $200 every couple of years and would fully employ a host of people at the LME’s who utilize their time shuffling, needlessly, in my opinion, reams of paperwork.
I would like to call you and speak to you about this. I am very disturbed by this Medicaid Waiver plan and see no sense in it.
Thank you for your time, Mr. Cansler. I mean you no disrespect by this letter.

Sincerely,
Marsha V. Hammond, PhD, Licensed Psychologist

I'll Be Calling Lanier Cansler, Secretary of NC DHHS, re: the WHN LME 'Medicaid Waiver' Application Process, Tomorrow

Well, I'm fit to be tied re: this WHN LME 'Medicaid Waiver' application process.

It has taken me over an hour to fill out pages and pages WHICH SHOULD BE ASSOCIATED WITH MY LICENSE AS A PSYCHOLOGIST IN THE STATE OF NC. This should be true of any professional whom is licensed in this state. Otherwise, please tell me why I pay over $200 every couple of years to have my license continued? Why not just get rid of the licensing board and let every little LME gather up every little piece of paper from every single professional?

They want:

*a sealed transcript from the university that gave me my PhD! (the NC Psychologist licensing board has this)

references from colleagues! (the NC Psychologist licensing board has this)

my address! (which they darn better not release to the public, as I have specified repeatedly over the 10+ pages...so far)

2 EVALUATIONS! (what's an 'evaluation'?: is that the same as a psychological evaluation and why do they need such if I am verified by the State of NC to be licensed as a psychologist?)

Hellooooo, Mr. Cansler..........

Western Highlands Network LME Buries Providers With New 'Medicaid Waiver' Paperwork (and that's not even associated w/ anything related to clients)

Amazing! "Who will rid me of these troublesome mental health providers?"

Where is the NC Psychological Association (nowhere in sight).

See this link for the massive amount of documentation being provided by the 'new & improved' Medicaid waiver process associated with any Medicaid mental health under Western Highlands Network catchment area:

http://www.westernhighlands.org/images/stories/4contractapplicationforlicensedindividualpractitioners.doc

What the first round of mental health reform didn't do, this Medicaid waiver mess surely will----in terms of finishing off the mental health providers. There's 18 items associated w/ paperwork such as one's authorization to provide Medicaid services, etc., which you'd think NC DHHS could validate.

Now NC DHHS is attempting to have all the LME's create this massive boondoggle/ paperwork log jam. Its not enough to already be a Medicaid provider as per NC DHHS: now we have to submit individual massive packages to the various LME's.

What's money saving about this? There will simply be more homidical/ suicidal people who do not receive services, spending more expensive time in psychiatric units----unless they are thrown out 'prematurely' and kill someone on their way down (as happened about a month ago in eastern NC).

So, we are demanded to submit all this duplicitous paperwork and then attend a mandatory meeting for which we will not be paid.

Heckuva job, Brownie!