Value Options, the Authorizing Company for Outpatient Mental Health Care in NC, Creates Barries for Citizens w/ Severe Persistent Mental Health Dx
Cell: 828 ----------- e mail: Chomskysright@gmail.com
March 22, 2012
RE: the company Value Options (authorized by NC Medicaid) creating barriers for mental health care for NC citizens with SPMI (Severe Persistent Mental Illness) having Medicaid insurance
Dear Nelson Dollar, Chairman of Health & Human Services Committee and Member, Health and Human Services Subcommittee on Mental Health (307B1 Legislative Office Building; Phone: 919-715-0795Email:Nelson.Dollar@ncleg.net; Legislative Mailing Address:
NC House of Representatives300 N. Salisbury Street, Room 307B1 Raleigh, NC 27603-5925:
Thank you for reading this letter. I would like to bring to your attention problems I am experiencing w/ Value Options, the company who, for years, and until recently----- has been efficiently managing outpatient mental health service authorizations for NC Medicaid citizens having SPMI (Severe Persistent Mental Illness e.g., Schizophrenia; Schizoaffective Disorder, etc.).
As a pertinent point, commonly, citizens who experience symptoms associated with a diagnosis of schizophrenia benefit more from medication management rather than therapy and medication management. This is not true of people having ‘lesser’ diagnoses, if you will, that is, SPMI diagnoses such as Schizoaffective Disorder. There are quite a few diagnoses associated with the SPMI category. Mental health issues such as these are CHRONIC, like diabetes---and they don’t go away after two years----which is why Value Options has stated to me they are sending ‘for review’ my request for more than 8 outpatient therapy sessions for the client of which I am speaking here. Apparently, if you are not cured in two years, they balk at the continuation of outpatient mental health care for NC Medicaid citizens.
The DSM (the psychiatric manual which outlines mental health issues) outlines Schizoaffective Disorder in such a way that it is, to my thinking, ‘in the middle’ or on a continuum between Schizophrenia and Bipolar Disorder. In other words, it is something of a psychotic disorder and something of a mood disorder. Medications assist with the maintenance of the symptoms but do not make them go away.
More specific to this letter, I have a client who for 6 years has received weekly outpatient mental health therapy for 45 minutes/ visit who has benefited greatly from this therapy. His social skills are much improved; he is generally happier; he adheres to his medication; he is not paranoid when he goes into a store; he lives independently and manages his own affairs. Contrarily, he could live in a family care home, which would cost Medicaid many more thousands of dollars / year than living independently----a matter which I believe is made possible, in part, due to careful follow up by mental health providers in Haywood county.
When I met him, he had a knife in his pocket when he visited me. He has beaten a man almost to death. He still threatens to kill his father due to neglect he experienced as a child due to the father. He continues to experience auditory and visual hallucinations on a daily basis; he is intermittently depressed. He is followed by a psychiatrist and this is as good as he gets, basically.
NEVERTHELESS, today, a Value Options ‘case manager’, specifically, Mary (Value Options tel number: 1 888 510 1150, x 292604) has informed me that upon my submission of the ORF2 authorization request which has been approved for the past 6 years for outpatient mental health care, that for this man w/ SPMI, it is being referred to ‘a doctor’ and I will have waited for over two weeks to receive information as to whether I can be paid to continue to see my not infrequently homicidal client.
I think you can understand why I am concerned. I have an ethical obligation to continue to see him. It would be tragic if he acted on his homicidal ideations. He is able to call me late at night---which he does on a regular basis when he is depressed. He also calls the emergency hot-line in Haywood county. I consult with his Primary Care physician (the private company psychiatric nurse who carried an enormous patient load, has quit in Haywood county as has a psychiatrist due, I believe, to their work load) in order that his medications be continued.
Public mental health care is collapsing in western NC and we do not need more barriers being created by Value Options. We simply want to do our work and be paid by NC Medicaid. We do not need more paperwork and more phone calls from Value Options. We need to be able to efficiently do our work.
As associated with the neighboring LME, Western Highlands Network, there are over 80,000 Medicaid eligible patients. I have no idea how many there are for Smoky Mountain Center with its additional 7 counties (15 total counties for SMC LME). We are undoubtedly talking about at least 150,000 Medicaid eligibles and it is simply not tenable to have Value Options nickel and diming providers in this manner. Please, please address this issue.
As you perhaps know, there are 8 automatic outpatient mental health therapy sessions automatically available to NC citizens who have Medicaid insurance. After that point, Value Options must give authorization via the ORF2 form (in use for years, but now since October, 2011, must be filed electronically, a much more time consuming process) in order that the mental health provider be paid for his/ her work.
I wanted to advise you of the current difficulties I am experiencing from Value Options, as pertaining to this intermittently homicidal client in Haywood county, who is a Medicaid recipient, as associated with the creation of barriers to outpatient mental health care which has, in the past, greatly assisted this citizen. When I asked the Value Options ‘case manager’, Mary, today, if I should have checked the “3” as associated with the ORF2 form, as pertaining to ‘homidical tendencies’, she indicated that this would imply that the citizen is walking around with a gun and killing people. I do not believe that we want to go in that direction and that this citizen merits persistent follow-up and that Value Options needs to pay attention to the diagnostic categories of the NC citizens’ mental health diagnoses severity. Instead, I checked a ‘1’ but this was before our therapy session during which the client advised me that he wanted to ‘beat the brains out of my father.’ I advised Value Options of this matter. I found them most unhelpful.
Thank you again for reading this letter and I look forward to hearing from you. Please feel free to circulate this letter as you see fit.
Marsha V. Hammond, PhD, Licensed Psychologist NC