Saturday, May 28, 2011

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:: 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


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