Sunday, February 26, 2012

Lanier Cansler, Secretary NC DHHS, leaves to 'start a little consulting business': WHO'S IN CHARGE AT NC DHHS?

Does anyone know who is (very) temporarily taking Lanier Cansler's place while NC Medicaid rolls down the hill, crashing into everything and everyone?

Here is a fairly new to the scene mental health reporter who interviewed Mr. Cansler who indicated he was going to 'start a little consulting business'----ahem----like the one he had before that serviced NC Medicaid. See:

This is what Cansler stated are his intentions now that he's a free agent (again: cycling in and out of the public and private health care worlds, over and over again):

"NCHN: You left state government last time and you started a consulting firm. What happens now?

Secretary Cansler: I’ll set up a little consulting firm, same kind of thing. I hope…"

Hey: maybe he'll take a key position w/ Piedmont Behavioral Health that is hoisting the Medicaid waiver onto all the LME's.

Here is my response to that reporters interview w/ Mr. Cansler prior to his last day on February 1, 2012 and it was a rebuttal of another poster who just had to get in their little comment about how those 'big entities' have to be smothered and washed down the drain:

"Big, omnibus systems work way better than small, omnibus systems as associated with privatizing Medicaid and giving the LME's massive money to simply manage Medicaid money. As it stands, now the LME's, utilizing the demanded PBH (Piedmont Behavioral health)-initiated Medicaid waiver, providers who have been providing Medicaid services in western NC are being buried under paperwork barriers due to the mismanagement of the small, omnibus system when in fact for this professional psychologist provider, the CENTRALIZED NC MEDICAID WORKED JUST FINE.

Now, I cannot even get thru the additional tier of applying to request to be able to send in the paperwork to continue to be a Medicaid provider as per Western Highlands Network LME when I have been a provider for Medicaid clients in NC for 7 years.

So, all the talk about those terrible big systems simply is not true.

Everything is now splintered into smaller barrier-creating systems that whoopee! will save Medicaid $$ and the reason is associated with the providers not being able to do the work and get paid.

So, its an illusion, my friend, all your talk about these nasty big systems taking all your tax-payer money. It is the PRIVATIZATION of health care that is taking your money. And part of that privatization is associated with splitting all the mental health (formerly) community mental health centers into entities that only manage and only create paperwork which has nothing to do w/ seeing people who need mental health services.

Marsha V. Hammond, PhD, Licensed Psychologist, NC

Sunday, February 12, 2012

State Funded Mental Health Care Clients Wait Times for Inpt Treatment DAYS and DAYS

This blog response is created as pertaining to Richard Craver's excellent and detail article associated with the wait time for state funded mental health care clients for inpatient hospitalization. 'State funded clients' are those who have no insurance: no Medicaid, no Medicare, nothing. The original purpose of NC mental health care reform, lest we forget what a fine incentive it has become, was to provide mental health care for ALL citizens of NC and thus the category of 'state funded client' was created. The other agenda was to 'privatize' mental health care, because, dontchaknow, there's lots of money to be made doing this and of course that will create competition and then voila the best (read: the biggest company paying their workers the least money) will win out.

Here is Craver's article and below is my comment. You have to be on facebook to create a comment. It would be nice if people would.


As associated with the massive paperwork for Western Highlands Network (WHN) LME in western NC, I stopped seeing state funded clients over 5 years ago. Now, WHN LME is participating (they are demanded by NC DHHS) in yet another tier of paperwork barriers as associated with mental health care, this time, pertaining to Medicaid clients.

To be truthful, provider applications for being 'in-network' essentially----THOUGH I HAVE BEEN A MEDICAID PROVIDER FOR 10 YEARS IN NC-----were to have been into the Provider Relations Department at WHN LME by the end of December. How I dreaded all those pages of paperwork. I had filled in provider paperwork for WHN LME back when I was seeing state funded clients but of course none of that paperwork could be used though it is completely duplicitous except for the matters of updating one's malpractice insurance coverage.

So, now we have been requested to submit a request to create a request to become an 'in-network' provider as per WHN LME. The first Friday I called about this, two weeks ago this past Friday, I was passed around 7 times until I finally called Arthur Carder's (the CEO) office. I simply had a question about a form.

Then, I was required to turn in my tax return, a page indicating 'who I was servicing' in terms of Medicaid clients (an indication of 'need'), as well as other paperwork. This was ONLY the request to get to the reqesst of the larger body of paperwork. This past week I called the Director of Provider Relations at WHN three separte days, leaving 3 polite messages. Then I decided I would take a go at it again this coming Tuesday, which will be 2 weeks since I turned in the request to get to the request to be an in-network provider----though I have worked w/ NC Medicaid clients and billed and contract completely independently via NC DHHS.

This multi-days wait time in order to get in-patient mental health treatment for state funded clients----which most all providers rid themselves of years ago----even though that was the original intention of NC Mental Health Reform, is simply a preview of the similar treatment now that the LME's have been fully funded, with their waivers, to manage Medicaid $$---LME by LME.

The state legislature should have given the money to the providers in order that we create efficient, motivated, research-driven outpatient therapy. Instead, we now have multi-million $$ funded LME's who cannot answer their phone calls or get their paperwork done.

When it is seen that NC Medicaid has 'saved' all that money----it will be because the providers have sucked wind, gone under, and generally been unable to call day after day, fill in ream after ream of paperwork----to simply see a client for outpatient mental health.

As is true for any health care in the US, it is idiocy to spend much of the health care money for the purposes of administrating something that could be centrally managed.

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

Thursday, February 09, 2012

Federal Hlth & Human Services Allows States to 'Select' Coverage of Services, Thus Allowing Entities Like BCBSNC To Be In Control

"....One must ask whether it's a good use of resources to have 50 individual states analyze the relative merits of 10 different options for EHBs ..."

Or, one might ask what is the point of having various LME's in the state to manage Medicaid when I called 7, yes 7, times Friday a week ago trying to get an answer to a Western Highlands Network form which is online re: Provider privileges.....and have called the Director of Provider Relations three days in a row now, asking for a response which I submitted 9 days ago in order to request to request to be on the provider network for WHN so that I can be paid for my NC Medicaid work.

Yes, indeed, who profits by divying up all this administrative work? Not the providers; not the recipient of services. But rather the insurance companies and entities that act,look, and smell like insurance companies, such as the LME's in NC. Who profits when tort reform takes place such as was voted in by Republicans in TN, allowing physicians to form their own internal malpractice network? Not the citizens of the state.

Who is speaking---in a phrase----and as per French philosopher Michele Foucault's query: WHO IS SPEAKING------ when these kinds of actions take place?

In TN, it would be the insurance companies again...they are the ones that drive tort reform. And as re: NC mental health reform, it would be----again----entities that act or are insurance companies with all their inefficient management that creates barriers to care for both citizens--the insured---and the providers.

Follow the money.

The Value of Federalism in Defining Essential Health Benefits:

New England Journal of Medicine, February 8, 2012

"The promise of nearly universal health insurance coverage embodied in the Affordable Care Act (ACA) has meaning in part because it is tied to a minimum set of covered services called essential health benefits (EHBs). Health and Human Services Secretary Kathleen Sebelius surprised the health care community when, on December 16, 2011, she announced that there would not be one single national definition for EHBs.1 Rather, each state will have 10 options to choose from in defining the EHBs, 7 of which are tied to existing coverage in that state's small-group, state-employee, and health maintenance organization markets.

Although critics of this decision grudgingly acknowledge that it was good politics to avoid a high-profile national battle over benefit design, they generally see little substantive merit in the secretary's approach. Yet her decision is sound public policy and capitalizes on the strengths of American federalism that run throughout the new health care reform law

......Of course, federalism has some costs as well. The primary weakness of the secretary's approach is its potential inefficiency. One must ask whether it's a good use of resources to have 50 individual states analyze the relative merits of 10 different options for EHBs while also considering the very complex matter of the fiscal liability that those options will create for the state.5 And in the current political environment, giving states yet one more choice creates yet another opportunity for opponents of the law to delay its implementation....."

Tuesday, February 07, 2012

Why Veterans in NC Don't Get Outpatient Mental Health Care

Well, this is reminescent of what is taking place re: Medicaid clients under Western Highlands Network LME which manages many of western NC counties, including Buncombe county, where Asheville is. I have had to send in a request to request getting on the provider network. And that takes days, or weeks....and so we go round and round...every single mental health provider regarding inability to get authorization so we can get paid to see patients.

This is the situation re: Tricare which insures veterans. This is my letter to MHN, Mental Health Network, which credentials and sets the reimbursement rate for providers. This is only the initial letter . There's pages and pages to be filled out after this...and months and months to wait....
FROM: Marsha V. Hammond, PhD, Licensed Psychologist, NC
Mailing address: NPI: 1194700591

TO: Michelle Barselo, Manager MHN, credentialing & reimbursement for in-network Tricare Fax: 1 877 821 8215 phone: 1 800 888 4024, x 4517

RE: recommendation by MHN employee to contact you regarding in- network PhD, Psychologist reimbursement rates and CPT coding

February 8, 2012

Dear Michele Barcelo:

This is a longer letter outlining matters which is being sent to Senator Burr’s office in keeping with his interest in the difficulties of mental health providers being able to work with veterans. I also am sending you, as requested, three separate letters as associated with the three different query items, which you could perhaps present to the Tricare liason working at MHN, which coordinates Tricare reimbursement rates and credentialing. This information is also forwarded to the Practice Directorate at the American Psychological Association with a membership of 150,000 psychologists throughout the US. The Military Psychology Division of APA is also receiving this important information, given that the VAMC trains more psychologists than any other site in the US. I did such training at the Birmingham, AL, VAMC.
Today, after looking at the significantly less than Medicare/ Medicaid reimbursement rates---about 30-40% less---- for MHN in-network contracted doctoral psychologists and Tricare contracted in-network reimbursement for doctoral level psychologists----- in order to work with (my intention) veterans, I recontacted a helpful gentleman at MHN, Gus X. Riddles. Mr. Riddles called me several weeks ago as Senator Burr’s (NC) office had contacted me several months ago related to persistent problems in being able to become in-network with Tricare in order to work with veterans in rural western NC. In that Mr. Riddles advises me that there are a total of
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less than 175 insured parties in Buncombe and Haywood county, where I work, I am not asking about MHN clients but rather about Tricare matters---
-which MHN coordinates----including the fee structure, according to Mr. Riddles.
I would hope that Tricare could at least pay as much as Medicare/ Medicaid but obviously this is not true per the data at the Tricare page ( ProcedurePricing/ProcPricing.aspx.
He advised me to send you separate faxes requesting a review/ negotiation regarding these issues which are barriers to providing outpatient mental health care to veterans in rural western NC. As you perhaps do not know, the county in which I do most of my work, Haywood County, has more veterans than any of the other 100 counties in NC. I have been trying to move into becoming a provider with Tricare for at least two years now, having submitted a variety of pieces of paperwork, attended a MAHEC mental health conference in Asheville 2.5 years ago, and having been called by various people, and now, thankfully, stumbled upon the helpful Mr. Riddles through no effort of my own but in association with Senator Burr’s office. I thank you in advance for your kind assistance. Mr. Riddles advises me that up to 30 days are required for you to interface with the Tricare liason. Then it is 30-45 more days when I put in my application in order to be an in-network provider. As I have indicated above, I am a Medicare provider, NC Medicaid provider, a BCBSNC provider, a Humana provider, etc.. I find it extremely disheartening to have to spend a great deal of my time writing these letters and creating this paperwork in order to re-create the wheel time and again. If NC Medicaid was not collapsing, I would not be trying to become in-network with Tricare.
These are the three areas outlined which are problematic regarding the 70+ page contract which Tricare, via MHN, who handles the credentialing and fee structure for Tricare, that I have noted. This request here is submitted prior to even submitting the 10+ pages of paperwork being requested by MHN and is even in addition to the CAQH ‘attestation’ pages which is required and which has all the information about my license, etc., online.
Specifically, these are the issues and I will create three more letters faxed to you in order that you could perhaps present them to the Tricare liason:

(1) as a general point, the doctoral level rate at the Tricare TMAC
reimbursement rate site is the same as the master’s level rate. Given the
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severity of the issues of returning veterans and the extent of my training
clinical/ health psychology training which includes an internship at the VA in
Birmingham, AL, I would like to maintain that a doctoral level psychologist
be paid more than the master’s degree person. All doctoral level NC psychologists have such training though a modest number train at the VAMC. The master’s level practitioners are not psychologists; they may be Licensed Professional Counselors or in NC, one of about five states, the master’s level people are supervised by the doctoral level people. I realize this is a bigger issue than can perhaps be taken into account regarding my own contract but I want to put this out there so you understand the difference between a master’s level mental health practitioner and a doctoral level psychologist that can provide assessment and more in-depth and thorough outpatient treatment.

(2) Many clients benefit from an extended therapy session, specifically, 70-90 minutes. This would particularly be so since I see many of my clients in their homes and transportation is a very significant issue in rural western NC where there is mostly no public transport. Also, I am not willing to travel to see someone for a 45 minute session. And so, is there a code that would increase the psychologist’s reimbursement re: the rural area and in-home? I also would suggest that when someone is utilizing therapy in order to overcome PTSD (documented one-third of returning veterans) and perhaps associated closed head injury trauma, that an extended session is recommended. I have enough experience now to be wary of my initial request for these longer sessions, a CPT code associated with 90808---given that insurance companies balk at using this code. Is this a ‘stable’ Tricare code?

(3) Most importantly, as regard how I maximize my billing and
reimbursement via Medicare/ CMA, at the Tricare website, the reimbursement for a ‘non-facility, non-physician 90808, 70-90 minute session is $96.72. I do not like to use 90808 as this CPT code pays at the undesirable 50% mental health rate (yes: mental health, regarding of all the talk about parity, is paid at 50% of the ‘Total Maximal Allowable Charge’ whileas non-mental health is paid at 80%). Therefore, I use the Health & Behavior CPT code series, put into place at Medicare/ CMS (Centers for Medicare/ Medicaid Services) back in 2000 by efforts by the American Psychological Association. This 96152 CPT series bills in 15 minute increments. Medicare pays approximately $25/

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15 minute increment for my service and the Tricare page indicates a pay of $16.25. As you perhaps know, in addition, most Medicare patients have
Medicaid and NC Medicaid picks up what Medicare does not. Thus, dually eligible patients, having both Medicare and Medicaid, have no co-pay. Given the dire economic circumstances which are even more dire in rural western NC, I think you might see the logic of ‘no co-pay’ for veterans who cannot find jobs except perhaps at the local WalMart for $7.25/ hour (yes, I know a 4-tour veteran who is working at the Waynesville, NC WalMart for exactly that). So, as I said, I typically see people for, as I said, the 70-90 minutes. You can see the difference in the reimbursement rate.

I look forward to speaking and/ or hearing from you at your earliest opportunity and thank you for reading this information. Enclosed or attached please find three separate letters associated with each item outlined above.


Marsha V. Hammond, PhD