Drugging Up the Family Care Home Residents : NC vs NY

Just who are the prescribers that allow the developmentally disabled to have their anti-psychotic medications tripled without the approval of the family? That's the key to this story and hopefully the NYT reporter will address the issue.

What I have noticed as re: family care home residents in NC, where there has been marked improvement over the past couple of years for the most part, there is a a 'set' provider group that prescribe the medications for the residents of the family care homes. In other words, one practice will service dozens of residents of a family care home.

This, of course, makes sense as the family care homes are expected to provide visits to physicians. What happens is that a medical provider comes around to the family care home about once/ month in order to update medications. There is very little time spent w/ the resident, best I can tell. It is not like going to see your doctor; you don't even get ten minutes.

Is that in itself following Medicaid guidelines which require face to face meeting with clients for a set period of time?

It is usually rather large psychiatric/ medical groups who manage the medications and it is very difficult to get in touch w/ them if there are medication issues. You either catch them when they come around or forget it.

See today's article in the NYT:
Potent Drugs, Few Rules, as State Treats Disabled

http://www.nytimes.com/2011/12/23/nyregion/potent-pills-few-rules-in-states-treatment-of-the-disabled.html?pagewanted=all

Just As Predicted by UNC Chapel Hill School of Law Expert, Piedmont Behavioral Health is Attempting to Confuse, Obfuscate, & Shred Public Records Law

Here is the background information as associated with this critically important matter.

Moreover, this was predicted and outlined by Mark Botts, professor at UNC Chapel Hill's School of Law as associated with a memo handed out by Arthur Carder, CEO of Western Highlands Network LME (WHN LME) during the WHN LME Board meeting in June, 2011. I simply took what Mr. Carder handed out to the audience and copied it and posted it here, previously, at Madame Defarge. Here is Mr. Bott's letter. http://madame-defarge.blogspot.com/2011/06/whn-lme-goes-its-own-way-re-medicaid.html

At that WHN LME June, 2011 meeting, you could have cut the air with a knife for the WHN LME Board knew EXACTLY what was being proposed and what power Piedmont Behavioral Health LME-----the first LME to eagerly obtain a 'Medicaid Waiver' from NC DHHS several years ago----was attempting to establish. What had been driven into that board meeting room in June, 2011, was a Trojan Horse that was The Borg (for you people that watched, Star Trek, The Next Generation w/ Jean Luc Piccard).

During that meeting, what became apparent was that PBH was attempting to develop a position of being able to call the shots for the other LME's and launch their 'methods' for organizing Medicaid mental health at that LME-----with an eye towards being able to commandeer the other LME's and demand that they 'GIVE UNTO CAESAR THAT WHICH IS CAESAR'S' or another way to say it, is 'you can kiss my ring now and by the way hand over the money we demand of you (the other LME's) and allow us to dictate to you just how you will run your LME that is eager and being demanded by NC DHHS to launch into Medicaid Waiver mode'.

I suspect that citizens do not understand why in the world it would matter why one LME dictates to another one how to do their work. But plainly put, PBH has the apparent intention of shredding NC Public Records Law which means that people attempting to obtain Medicaid, such as this child as outlined by David Cornwell, will simply be given----FOR YEARS ON END----the run around as re: denial of services. And if you cannot obtain the records about WHY you are not being given services, then you don't get any services and you cannot find out WHY you cannot get any services.

As Mr. Cornwell clearly outlined, PBH simply told the court to go take a hike and were given yet another opportunity----with the Medicaid child sitting in the background----still with no services. This is, indeed, amazing.

As outlined by Mr. Cornwell re: this court appearance by the PBH CEO, PBH has indicated that it has 'sovereign immunity' as associated with Medicaid Waivers and that it is an 'independent contractor.'

They want the whole cake and they want to eat it all, too. And they want to tell YOU how much cake you can have, when you can eat it, and if you want to know what the ingredients are in the cake, well you can't have the recipe----or the public records.

WE TOLD YOU SO. The WHN LME Board members balked----at least as much as they could----from inviting the Trojan Horse shredding public documents into the lives of western NC citizens. If this is allowed to stand as per the courts, citizens will not be able to know why they cannot obtain Medicaid services.

Here is the link to Mr. Cornwell's excellent outline of the court room travesty that just took place. http://ncmentalhope.org/commentary/2011/compliance/

"PBH: Compliance and Contempt"

Incredible.

Will There Be Any Reason to Have Massively Funded MH LME's to Manage Medicaid When There is no Medicaid?

oops. Seems like the $1 million slotted for the LME's to manage Medicaid is going to be a challenge if there is massive defunding of Medicaid. You can thank the Republican driven NC State Legislature.

"Budget shortfall could mean catastrophic Medicaid cuts after allWRAL.comRaleigh, NC — North Carolina Department of Health and Human Servicesofficials said Monday that state lawmakers have changed their tune aboutfinding funds to fill a projected $139 million Medicaid budget shortfall,forcing them to consider making ...<http://www.wral.com/news/state/nccapitol/story/10466208/....."

The below is from the article at the above URL:

"....Unless lawmakers find more money for Medicaid, many adult services, like hospice care and mental health care, could be on the chopping block. The state could also reduce reimbursements to physicians who treat Medicaid patients by up to 20 percent, DHHS officials have said.

They say lawmakers publicly pledged to help fill the shortfall in October after it became clear that the agency couldn't make the $356 million in cuts required in the state budget....."

WaPo:Senate Panel (Senator Burr-R, NC) Calls for Probe of VA MH Services: Providers Tangled in Red Tape Trying to See Vets for Outpatient MH Care

Senate Panel Calls for Probe of VA Mental Health Services

"After hearing testimony about the continued long waits faced by veterans seeking mental health care, a Senate committee Wednesday called for an investigation of the problem and an audit of the Department of Veterans Affairs’ $5.7 billion mental health care budget.

“Especially at a time when we are seeing record suicides among our veterans — we need to meet the veteran’s desire for care with the immediate assurance that it will be provided — and provided quickly,” said Sen. Patty Murray, (D-Wash.), chairman of the Senate Veterans Affairs Committee, who asked the VA’s Office of Inspector General to examine the issue....."

http://www.washingtonpost.com/politics/senate-panel-calls-for-probe-of-va-mental-health-services/2011/11/30/gIQA1AtHEO_story.html

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As per a handout from Reverend Scott Rogers, Executive Director of Asheville buncombe Community Christian Ministries, presented at the Western Highlands Network LME Board on May 6, 2011,

'VETS WHO HAVE A 100% DISABILITY CAN BE ELIGIBLE TO RECEIVE MH TREATMENT SERVICES FROM A PRIVATE COMMUNITY PROVIDER." Otherwise, you're outta luck soldier; go to the VA.

And how many VA sites are there that might even offer mental health care in western NC?

1. Asheville VA Medical Center 2. Community Based Outpatient Clinic, Franklin 3. Rutherford County Community Based Outpatient Clinic (I don't know if outpatient Mental Health is being offered at the latter two sites, neither which are in Haywood County which has more veterans than any other county in NC.

I did my internship at the VA in Birmingham. Do you know how difficult it is for a vet to get 100% Service Connection, approximately 36 grand in tax free monies IS? I may have seen one person at the VA with this. Service Connections are calculated in terms of percentages depending on the impairment of the vet and I have seldom seen someone w/ a mental health diagnosis w/ a 100% Service Connection.

This is the primary reason why it does not make any sense for any private provider to try and see veterans via Tricare. There are next to no vets with 100% Service Connections. Even though I worked in the VA System, this entire area of outpatient MH Services is a complete enigma to me in terms of where do I fit in it; how do I get clients; how do referrals get made, etc.

No wonder Senator Burr is investigating the matter.

I don't know if it is standard for each of the DSS (Department of Social Services) to have a 'liason' person but Buncombe County DSS does and have my more recent complaint about how I could not get onto the panel at Tricare in order to offer vets outpatient Mental Health Services got his attention and he referred me to Senator Burr's office as there apparently has been quite a lot of talk about how services are not getting to vets. Moreover, reportedly, Western Highlands Network LME has a veteran's liason: julie@westernhighlands.org

Having started the long long process of being able, as a PhD/ doctoral level psychologist offering services to vets (only doctoral level internship sites are at the VA and the one in Birmingham is where I did my internship)-----over two years ago, I sighed and recently called Tricare again to see what the hang-up is. I looked at my notes I had taken during a Tricare presentation given via MAHEC training up at Mission Hospital, Asheville, NC, 2.5 years ago. The presenter gave a number, 336 607 8300, which was supposed to take you to MHN or the company which Tricare has apparently outsourced to. When you call it, all you get is a fast busy signal indicating a non-functional number .

One of the first things this provider had to do over two years ago was to sign up w/ a service called CAQH (Council for Affordable Quality Healthcare), a clearinghouse, which takes all the information about the provider e.g., training, internship, license number, and in NC, malpractice insurance---and keeps it updated----a matter which the provider is demanded to do every 90 days. You go online and 'attest' that the information is the same, if it is. I understand that BCBSNC also uses this CAQH mechanism and for the life of me I cannot understand why the LME's must have pages and pages of paperwork filled out when there is CAQH that does this. If someone knows the answer to this question, please tell me (chomskysright@gmail.com).

In any case, I carved out an hour to try and talk to Tricare again last week. This is what I found out and its just more of what I found out 2.5 years ago and I still cannot get onto the provider panel for Tricare to see vets in a timely manner. Even though I have twice before interfaced in terms of application as provider to Tricare, I still have to wait 90-120 days to get some paperwork from someone leading to being 'on the panel' which as I stated above, does not lead anywhere, because there are no vets with a 100% Service Connection.

This time around I was told that though they have my application materials from before, every six months, if the provider has not seen a client from their roster, the application is 'inactive' and you have to restart the entire process again. There is NO health care company that does anything like this. If you decide you do not want to be a Medicare provider any longer after having signed up, you have to tell the in writing. Ditto re: Medicaid.

So, Tricare was long ago out-sourced to a company called MHN (1 800 541 3353). You have to go to their website and have sent in paperwork to create a pin number, etc. CAQH gives you a provider number which you will also need to use vis a vis MHN (to sign up as a provider go to: www.mhn.com/provider/start.do) .

There are three tiers, if you will, associated with outpatient mental health care. And you can get entangled at any point in trying to understand where you are supposed to fit if you merely want to provide and get paid for providing outpatient mental health services to vets.

One tier is a 'Family Service' which involves going to military bases and providing psychoeducation to families and service-people. I'm not sure how this works, exactly, but I did go through the interview process back in May, 2011. Somebody calls you up on the phone and grills you for over an hour (though you are licensed as a psychologist) asking you questions about various vignettes and 'what would you do.' What I wouldn't do is go to live on a military base, far away from my home, for long weekends of such. So, that didn't go anywhere.

Prior to that, over two years ago, I had signed up as an 'Out of network" provider for what Tricare/ MHN (you can't tell them apart) calls their 'Standard Program.' I have no idea why a service-person would use this program, which undoubtedly causes them to pony up more money in order to see a professional, than the next program which is the "Tricare Provider In Network" program.

Though I had received in November, 2009 "Notification of Provider Certification Action" from 'Health net' (who knows how they fit in w/ Tricare and MHN and they sure do not tell you) with a checked box indicating that I was a designated provider---along with having sent in an Electronic funds Transfer completed form; a Provider's Notarized Facsimile or Stamp Signature Authorization completed page; License Number and training completed page; Criminal Records check; W-9 Form; Tricare Non-network Individual Clinical Psychologist Application, I still could not interface w/ seeing clients.

All my calls to the Haywood county veteran's liason person sitting on the bottom floor of Haywood Regional Hospital----who was at the MAHEC Tricare presentation over two years ago---- were never returned even though she had been a presenter at the dog and pony show along w/ the Tricare Northern Region (NC is in the Northern Region of Tricare).

To make it even more confusing, the conversations re: the above paperwork was with a company called PGBA, LLC Provider Data Management POB 870156 Surfside Beach, SC 29857-9756 (you can only talk to them 10-2 PST), and under that header was the Tricare 1877 874 2273 number.

When I went to the Western Highlands Network LME Board meeting May 6, 2011, ReverendScott Rogers, Executive Director of Asheville-Buncombe Christian Ministries, who was apparently there due to all the homeless vets he comes into contact with, gave out the following information.

Most notably, in his one page of handout notes he gave to anyone who asked for them at the WHN LME meeting, "Dave Wright, the supervisor in the MY Clinic at the VA Medical Center in Oteen (the Asheville VA)....advised against trying o access MH services by phone---saying the process is slow, frustrating and sometimes unreliable. " DUH.

Mr. Wright, the director, indicated that the following MH services are available for vets: psycho-education; MST (I have no idea what this is and I hate acronyms that are untethered); PTSD treatment, both individual and in group; Meication; 12 bed psychiatric unit; 4 bed detox; SA residential program; large homeless program in cooperation with Asheville Buncombe Community Christian Ministries (ABCC)

If someone figures out how to crack the code to offer professional services for veterans suffering from PTSD, head injuries, depression, etc., let me know, would you? Meantime, all these homeless vets are just sitting at the Asheville Buncombe Community Christian Ministries site....just like all the non-vet homeless people are sleeping at The Mission on Patton Avenue in Asheville. And when they have to leave during the day, they simply go around the corner to A-Hope and last week the interior of that building was full of THRONGS of homeless, mostly male, citizens.