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.