Monday, November 28, 2011

Medicaid Waiver Double Talk Straight from the Horse's Mouth : NC Mental Health Reform Was Supposed to Be About Choice (Until PBH Got Involved)

Here is my response to Betty Taylor's (Betty Taylor is the CEO and area director of CenterPoint Human Services) article re: the Medicaid Waiver which is about to sweep across NC re: trying to reduce the cost of NC Medicaid. It won't work and the reason it won't work is that it is predicated upon issues that don't have to do w/ the cost of mental health care vis a vis the quality of services-----for NC medicaid clients.

Here is the NC DHHS outline of how this wholesome waiver is gaining ground across the state:

The private health care companies will simply not offer services (hey: it looks cheaper on paper) and it will appear, in terms of accounting (REMEMBER: Lanier Cansler who heads up NC DHHS is an accountant not a mental health person) that things are improving. One of the primary tenets of NC Mental Health Reform was to offer CHOICE to clients/ consumers. And I challenge ANY mental health care company to offer high level outpatient mental health services in the homes of clients like I do. I'm not necessarily bragging about this but it does get the services to the clients and I have a zip no-show rate.

And so, what is being proposed as per this article and as re: the Medicaid Waiver, is a 'CLOSED NETWORK' which will necessarily drive the quality of care down and the cost UP. You'll have less qualified people offering less professional services and you can bet my bottom dollar it won't be in the homes of the clients.

Here is the article from the Winston Salem Journal and below that is my comment.

Betty Taylor: Waiver changes will impact consumers and providers

"....On Oct. 31, 2011, CenterPoint Human Services received approval to be a 1915(b)/(c) waiver site. As CEO of CenterPoint, the Managed Care Organization or "MCO" that will implement the waiver for Forsyth, Stokes, Davie and Rockingham counties, I want to share with you what this means for our community.

Your first question may be what is a "waiver"? The Social Security Act sets out requirements that must be satisfied before Medicaid will pay for services unless the state has federal approval to "waive" them. North Carolina received federal approval to "waive" two sections of the act in its provision of Medicaid-funded mental-health, substance-abuse and intellectual/developmental-disability services. Waiving §1915(b) allows North Carolina to implement managed-care delivery systems for these services while waiving §1915(c) allows long-term care services to be delivered in community settings instead of institutional settings.

Most of us agree that receiving care near home instead of in distant state facilities is a good thing. Unlike concerns with commercial, for-profit managed care, implementing a publicly managed care-delivery system also has benefits. Access to services is increased, quality is continually assessed and stakeholder input and education is key. It is up to the MCO in our community, CenterPoint, to assure these results. With wise management of funds, any remaining funds will be reinvested in the community to create additional services.

There are changes under the waiver that impact consumers and providers. Without a waiver, the Social Security Act requires that any "willing and able provider" be allowed to deliver and bill for Medicaid-funded services. This is called an "open network." Under waiver the MCO is not required to contract with all providers and a "closed network" can be created. The MCO is charged with analyzing local needs and designing its provider network to address those needs. In the closed network, consumers still have choice, although it is not unlimited. CenterPoint will maintain an open network in the first year of waiver operation allowing providers the opportunity to demonstrate their value in being included in the closed network in the second year.

North Carolina has toyed with expansion of waiver for several years as a way to contain Medicaid costs and to raise the bar on service quality. PBH, a MCO serving Cabarrus, Davidson, Rowan, Stanly and Union counties, launched its publicly managed waiver in 2005. The state watched closely and asked questions about outcomes, efficiencies, access to services and consumer responses. During this period, North Carolina experienced multi-million dollar Medicaid cost overruns for a service called Community Support. At the same time, PBH had no such economic issues and legislators noticed...."


(Here is my comment place in the paper):

What a lot of double talk is being foisted on the public here.

First of all, let's write in clear English and/ or use an editor at the paper please. Is the Medicaid waiver associated w/ only substance abuse and developmental disabilities ONLY? I declare: this is news to me and its a very important point I might expect that this is not MOST of the people with Severe Persistent Mental Health challenges aka Medicaid consumers.

Secondly, there is no longer, for the most part, since 1970, as associated w/ Wyatt v Stickney (see FRIDAY, NOVEMBER 18, 2011: Ricky Wyatt of Wyatt v. Stickney Passes:Wyatt v. Stickney 1970 Case Discharged Thousands of Patients to Community Mental Health: mental health care at a psychiatric hospital far removed from the residence of the citizen seeking mental health services. Outpatient Mental Health Care is where we've been heading and utilizing for the past 30 years.

Thirdly, re: the matter of 'open network', excuse me, but NC Mental health Reform was supposed to be about CHOICE and this provider, for one, provides services IN THE HOME of the client. So tell me, CenterPointe, that you can improve on that. I am a solo independent psychologist and I make a decent living doing just that.

Fourthly, the need for the waiver is not 'intensified.' See above.

Fifthly, (this seems silly: Point Number 5 and proceeding): show me the stats on the 'over-run' re: Medicaid services. What I suspect is being alluded to is Lanier Cansler's predecesor's 'over-run' re: the poorly planed Community Mental health Services. What i see taking place now is an appropriate use of Case Management, for the most part. This being said, most case management which is paid for by Medicaid NC/ NC DHHS is mostly paperwork and is not face to face contact hours w/ the client. That's what I DO.

Point Number 6: How nice to acknowledge the following: "Waiver changes will impact consumers and providers" (see: TUESDAY, OCTOBER 18, 2011: Piedmont Behavioral Health (smack! slurp!): How Can We Help You Out re: Collapsed New River LME (AND SHRED YOUR PUBLIC RECORDS LAWS; )

Point Number 7: my grammatically tuned ear is wincing under the statements like "...Now waiver will be in operation..."

Marsha V. Hammond, PhD, Licensed Psychologist, NC
NC Mental Health Reform blogspot since 2007:


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