Saturday, July 30, 2011

NC Disability Rights' Vicki Smith: NC Mental Health Mess: With Disappearance of Republican Driven De-Funding, NC Moves FURTHER Away From Law

Vicki Smith, who is Executive Director of Disability Rights, undoubtedly a 501c3 entity (nonprofit) has to adhere to certain standards----as in it cannot be partisan, or coming down on the side of one political party or another. The same is true of another organization, NC Hope, which is a mental health consumer-driven group.

Here , in Adam Linker's online post, Vicki Smith is speaking about how the Department of Justice has determined that keeping people with mental health challenges in family care homes is cruel and ridiculous. It is. I've had plenty of clients in these family care homes where the only entertainment or things to do with your life is to smoke cigarettes, watch endless re-runs on TV, and take your psychiatric meds that hammer your head to your pillow. (see page 8: Policy and Progress: NC Justice Center:

In that the Republicans are cutting Medicaid funding, does anyone really think they are going to CREATE funding for this to happen? So, you can bring lawsuit after lawsuit and even fine NC DHHS, etc. etc. etc. Until you get the Republican Party out of control at the state and federal level, nothing will happen.

Non-profit groups such as these serve useful functions, obviously. However there is a very large rogue elephant walking around in the room, disrupting all of their attempts to do anything and it is called the Republican Party. And that party is in control of the NC State Legislature at this time.

Indeed, that party is in such control that they just cut Asheville out of the District 11 map which means that next time we vote,unless the NC Democratic party wins its suit in court, we will vote with the more conservative Gastonia, NC, and have absolutely no ability to choose or keep a Democrat in the US Congress or the State Legislature.

So, talk on, non-profit groups. Until you can get the Republicans out of the catbird seat, nothing good will happen.

Friday, July 29, 2011

Small 'Ahem' re: Department of Justice's Federal Investigation of NC Mental Health Services, Particularly Family Care Homes:Republicans Must Go

The Department of Justice (aka 'the Feds') have, as we knew, begun an investigation of NC Mental Health Reform. The Feds, have most specifically as re: this investigation, surveyed the family care homes and the 'institutionalization' of people w/ mental health challenges in those family care homes----- of which there are many in the Asheville area.

Indeed, this psychologist has formally complained about the family care homes to the point of risking arrest by the Buncombe County Sheriff who 'accompanied' me off the campus of one family care home in Leicester, NC (I am glad to say that this home has improved and shaken its old owner; its problems remain, however, due to how rural it is, and thus isolated; so the Feds can talk on and on but unless there are mechanisms and money to put what they would like to happen into effect, well, little is going to change).

Here is that Madame Defarge matter from several years ago. I went to Buncombe DSS and had a meeting w/ the personnel at DSS and the thankfully long-gone owner, a meeting which I walked out of, as I said I would, because DSS could not keep the owner from attacking and dennigrating me:

In any case, the DOJ letter posted July 28, 2011, kindly made available by NC Mental Hope's David Cornwall is here and will not be posted by the DOJ until 10 days from July 28, 2011, on the Civil Rights webpage of the DOJ:

What this July 28, 2011 document argues is that a lawsuit will be pressed if NC DHHS does not clean up its act re: people who have mental health challenges who are interned in family care homes. Specifically, in the last part of the letter and Section E, it outlines that mental health care in NC must 'devlop sufficient supportive housing' at 'scattered sites' and 'connect to an array of services' people w/ mental health challenges and that moreover, there must be 'quality management' of those services.

Sure. Better go tell that to the Republicans who are driving all the cuts to human services.

Where does the DOJ think that these services are going to be turned up? 'Scattered site' housing': you bet. There is no more Section 8 housing available in Haywood or Buncombe county (or more coyly and correctly stated, 'there's a waiting list.')

Thus, they can talk and talk but money talks, bullshit walks----and this DOJ threatened lawsuit is therefore bullshit against the backdrop of a Congress that is being held hostage by a bunch of tea-baggers whom are giving the rest of us migraine headaches.

Or as Edgar Allen Poe said, this is all a dream within a dream. Sure, bring a lawsuit, DOJ. The little man or woman might best spend their time highlighting how the Republican agenda is to cut more services than are at this time in place.

J. J. Cale CD, "#8": "Money Talks":

"Money talks, you'd better believe it......
You'd be surprised the friends you can buy with small change...."

Thursday, July 28, 2011

NC Medicare Transfer Confusion: It Does Not Matter That You Sent In Your Palmetto NC Medicare Paperwork Ages Ago

When CIGNA Government Services assumeably lost its bid to continue managing NC Medicare, it was transferred to PalmettoGBA (whatever that stands for: here is their home page:

I sent in all my paperwork to Palmetto months ago, transferring my Medicare provider information. At least they send you paper remittances which CIGNA stopped doing about 8 months ago which was really unhelpful because then you could not see, easily, if some of your claims had problems and address the issue. Instead, you had to go online and peck around.

Even though there are paper remittances, there is still massive confusion in the system due to the transfer between CIGNA and Palmetto.

As per the personnel on the phone at Palmetto a moment ago, they have been managing NC Medicare for over 30 days now. However, when you call up the IT - Tech Services arm of the company, make note that of the 8 options, for there is not one referring to 'NC' as per that tel number: 1 866 749 4301. So, pick any one of them; I picked the 1st one' Trailblazers.' That will take you to an IT person who, if you're lucky, will tell you that your registration that you just created at the home page in order to access documents to do business w/ Palmetto, 'does not work' or there is some problem and that he will 'send it back to provider services and they should send you an e mail within 24-48 hours.'

Great. There's nothing like the ease of doing one's work.

These are all just barriers to health care. We need a ONE PAYER SYSTEM.

The IVR (automatic voice response system: I haven't even tried that yet to see if anything works) is: 888 414 8592.

More Confusion for Medicare Providers With Unprocessed Claims From CIGNA Gov't Services Transfer to Palmetto GBA Managing NC Medicare

If you had any unresolved claims left in the lurch, as I did (gee: wonder why I never heard back from CIGNA Government Services in the 30 days they stated they would contact me) when CIGNA Government Services lost their contract earllier this year (did I say this before: We need a ONE PROVIDER SYSTEM) to process Medicare Part B Claims for Mental Health, make note that Executive Kay Cretch (the only number you can find on the internet associated w/ CIGNA Goverment Services for NC anymore), after asking 'how did you get this number', states that all this information was 'supposedly' 'given' to Palmetto GBA which now process NC Medicare claims.

So, don't bother calling the old CIGNA Government Services tel number which is on the paperwork of your non-processed claim (866 238 9651), for its been disconnected. You can read Kay Cretch of CIGNA whom will 'walk upstairs' (no, I'm not kidding; her number: 615 782 4525) your question so that someone can call you back and the machine will tell you only that OH and KY providers need bother calling.

For NC Providers, as regards Medicare claims, you now call
Palmetto GBA
J11 Mac
Mailcode GM-215
POB 100238
Columbia, SC 29202-3238

at the 866 830 3043.

Have your NPI, PCAN (Medicare Provider Number) and ever other piece of paper you can think of ready.

Saturday, July 23, 2011

With the Loss of Teachers in NC, We're Going To Need More Mental Health Grants for Kids in School

Gee: wouldn't it be great if other counties had such a program. This one is associated w/ Henderson County in Western NC.

The loss of teachers next year is exemplified here re: Cateret County in eastern NC.

What I know is that 'the best' school counselor at Asheville High School left for a Texas job; the dance teacher has been 'ushered out' after 30 years; and, the American history teacher took a hike also. This is just details from what I know as re: my 16 yr old son at Asheville HS.
The 'hit' to NC public education as associated w/ the Republican driven NC state legislature is massive. See, for example:

".....Using an N.C. Public Instruction PowerPoint presentation, Dr. Novey outlined the effects on the school system of a projected $3.7 billion state budget shortfall and the loss of more than $1 million in federal stimulus funds.

The bottom line would be the loss of 92 positions, of which about 80 are teachers and teacher assistants. This would result in larger class sizes and possible loss of programs.

Dr. Novey has posted the PowerPoint presentation on the school system’s website:
. He also urged citizens to contact their state representatives to urge them to retain education funding....."


Grant establishes mental health wellness program for North Carolina students
JULY 19, 2011
New program investigates students' mental wellnessFor academic success to occur, it sometimes becomes necessary to meet the emotional needs of students first. According to the Citizen-Times, Henderson County schools in North Carolina recently received a federal grant that will establish mental health counseling for local students.

"I think a lot of kids wouldn't seek services outside of school," Tammy Greenwell, chief operating officer for Blue Ridge Community Health Services, told the media outlet.

The Henderson County grant, which totals $160,000, is part of a $95 million mental wellness program established by the Affordable Act, reported the news provider.

For some students, it may be difficult to speak their minds. Accordingly, counselors may want to engage them in innovative ways and use educational technology, such as a mental wellness computer program, a therapeutic robot or a DLP projector, to make them feel comfortable.

"The school and family health program allows the students and members of the community in those areas access to primary family care they would not have had access to otherwise," Chuck Shelton, Bakersville Community Medical Clinic administrator, told the Citizen Times.

Friday, July 08, 2011

NC Medicare Providers' Outpatient Therapy Problems w/ Palmetto (Which We Never Had With CIGNA Government Services Who Used to Manage Medicare in NC)

Palmetto has been 'managing' NC outpatient Medicare for the past several months (CIGNA Government Services which used to manage Medicare must have been out-bid, resulting in a company that can no longer function efficiently, apparently).

This is what my biller, whom has done an excellent job for a couple of years advises me:

"....This new Medicare company (Palmetto) obviously does not send out denial EOB's before the 13 day pay drop as Cigna did so there was no reason to assume a problem. For some reason, Palmetto wants to see Box 32 (Facility Location were services rendered) completed with your information. This is not the norm since it is typical reserved for hospital, nursing facility, etc. info...."

These are all just barriers to mental health care in NC. This is just going to put more and more mental health providers out of business and these kind of 'glitches' seem to be epidemic now.

NC Medical Schools 'Area Health Education Centers' Mention That NC Has Mental Health Reform Challenges/ Circle Game of Value Options & HP Enterprises

Ya think?

These kinds of things just make me want to cry. The medical schools 'education centers' (in Asheville, NC, its 'MAHEC' or Mountain Area Health Education Center') which must fell more trees than Planned Parenthood or the ACLU (yes, I'm glad to support them but give me a break w/ the US mail barrage please)---makes mention that 'NC Mental Health Reform is under way.'

Really? See here their challenging information:

NC Mental Health Reform: Facing the Challenge of Reform

When the associated NC Medical Journal published a piece of mine about a year and a half ago, they ran it as 'Reader's Forum.' I guess I should be satisfied w/ having made some small statement regarding the mess that NC Medicaid has become.

I wrote in the NC Medical Journal, p. 574 NC Med J November/December 2009, Volume 70, Number 6, the following:

"....."....North Carolina mental health reform was instituted
in 2001, with implementation starting in the furthermost
point from Raleigh in western North Carolina where it was
created......Individual therapy and assessment becomes formatted group therapy
rendered by lesser qualified mental health professionals......"

Mark that last line and juxtapose it next to this sad matter re: state of affairs of one of the largest mental health providers in western NC as associated with one of the mental health 'providers' having an affair w/ an underage male and then running off to Florida with the child when the police came to investigate:

"......With barely any work history to boast of, she turned to her one and only employment asset: a psychology degree from those years at UNC. Mills applied for, and got, an entry-level position at Meridian Behavioral Health Services, a multi-county nonprofit mental-health provider......Joseph and some of the other kids from Meridian were soon “working” at Mills’ home, Petty said, cutting grass and painting walls. His daughters told him of parties, and he and his new wife, Meg, started witnessing the same behaviors firsthand...."

So, you see, it is upsetting to this professional, licensed, doctoral mental health care provider to have to call back and forth between Value Options, the authorizing agent (for outpatient therapy of more than 8 sessions/ year for Medicaid adults) and HP Enterprises (who creates the paperwork re: billing) in order to see where my professional money has gone.

So, today, while I am supposed to be on vacation, I needed to look at my NC Medicaid paperwork to see why in the world my bank account was so low given that I had done all of this Medicaid billing in the last month. Until recently, NC Medicaid webclaims was a dependable way to get paid....that is, perhaps, until HP (yes, that Hewlett Packard) Enterprises took over the 'remittances' arena----or is it Value Options, the authorizing agency that is to blame?

For, its become a circle game and you cannot pin the tail on the donkey anywhere....if you can even find the donkey.

For, you see, neither one of these businesses offers any more paperwork that one can quickly scan. Instead, for the 'remittances' (to understand if there are any billing errors that one needs to address) you go online to the 'remittance' arena at NC Medicaid webclaims which makes managed by HP Enterprises----but then, HP Enterprises (aka "we-can-help-you-with-three-patients-only-but-we-can-put-you-back-in-the queu") cannot tell you anything about how many sessions the 'cousin' Value Options has authorized. Thus there is no ability of the provider to easily match up the authorizations and the payment system (everything has been outsources and made piece-meal, including Humana's outpatient therapy to a company in Texas named 'LifeSynch).

Unless, of course, you want to spend your vacation calling back and forth to HP Enterprises and Value Options----the functional arms of NC Medicaid outpatient mental health services.