Friday, March 02, 2012

My Questions to the Western Highlands Network LME Board This Morning and WHAT THEY DID and How They Responded

The below was stated at the Western Highlands Network (WHN) LME Board meeting today, March 2, 2012. It was recorded by hard-working citizen Jerry who selflessly records, on his own dime, every single Buncbome County official meeting-----be it the School Board or the City Council, or the LME. I imagine that recording could be you-tubed with some translating.

This past week, about 5 days ago, I asked CEO Arthur Carder's secretary if I could use an MP4 player to record this meeting----as does citizen Jerry (he has a tiny set-up, goddess bless him). Surprise: I didn't get an answer and today when I saw her (she is a nice woman) she indicated that Mr. Carder had not gotten back w/ her. Gee, I wonder why?

Today, when I addressed the board in my allotted 5 minutes, the Board's attorney cut me off at exactly 5 minutes. Bear in mind that there are some helpful people on the WHN LME Board. So, one of them, good soul, asked if I could not finish what I was saying. I finished my last paragraph.

The attorney interrupted me earlier when I mentioned a name that he obviously is unfortunately not familiar with, specifically, Vicki Smith, Executive Director of NC Disability Rights. He doesn't wait to interrupt: he just butts in, lawyer-style. (Hi, there, you reading this blog)

Uh, well, Vicki Smith is not employed by WHN LME, Mr. WHN LME Board attorney, I more or less said.

"Well, we can't be pulling up personnel issues", he said.

Uh,I wasn't pulling up personnel issues. I was simply describing how I could not get any response from Provider Relations and asking the Board to help me out here.

This is what I said and it should be you-tubed---not because I am someone special but because I am just oe little indication of the problems here. A lot of members of the board looked sad as I talked. Remember: this is more or less the same board that kicked dirt up in the air prior to being taken over by The Borg, oh, excuse me, Piedmont Behavioral Health (PBH)'s Medicaid waiver.

The board's attorney at that time practically shoved them into the pit mid 2011 (see Defarge blog on this re: "I think to be in a witness protection program). Same attorney, yep.

After the CFAC (family advisory council much-nicer-than-me) lady presented her spiel, another good soul on the Board who was last year the Chairman asked if they could not convene away from the prying eye of citizen Jerry's recording device. It was a secret meeting and I can understand why they do this and that they do it not infrequently.

However, when can I get an answer back to what is going on re: my 'request to send in an application' to the WHN LME Provider Relations?

Citizen Jerry suggested the information could be opened up after the meeting, or next month, or next year.

Great. This is what I said, more or less today ("shoot me if I play too long" said Steely Dan):

"I am Marsha Hammond, PhD, first Licensed as a Psychologist in 1995. For the past 7 years I have worked with NC DHHS, seeing Medicaid clients . The authorizations were organized, easy to obtain from NC Medicaid and the payment was efficient and simple. There was no paperwork on my end except for the once/ year, one page authorization form. In addition to my professional work, since 2007 I have maintained a blog under the moniker Madame Defarge , outlining mental health care issues in western NC. This makes me distinctly a challenge to the local LME’s.

In 2011, WHN ‘s Board decided to utilize the PBH waiver, thus declaring to current Medicaid providers the need for paperwork submission. It did not matter that I was already a Medicaid provider; it did not matter that I had submitted a similar set of paperwork several years ago to work with WHN state funded clients. I admittedly did not find the time to submit the paperwork prior to the January 3, 2012 deadline.

Then, when I did my Medicaid billing in January, 2012, I was reminded of the necessity of doing this. I initially contacted WHN Provider Relations Department Thursday, 5 weeks ago. 7 calls that day to Provider Relations, culminating in a call to Arthur Carder’s secretary to get a response finally outlined for me that I had to fill out a face page that was not easy to find on the WHN webpage. I turned it in the next day.

A week later I called Provider Relations several times to see what the next step was. I was then asked to turn in paperwork not connected to being a provider but a pre-step re: that process. The paperwork demanded was: my current tax return; a statement of what services I offered; a list of my clients; their Medicaid numbers; the date I had started seeing them; an attestation as to my availability. All this was turned in within one week.

After about 5 calls to Provider Relations, the director indicated to me that I was in a line with ‘2 other similar cases’ and was being considered ’in the order in which they are received.’ I have heard nothing. I have continued to call WHN Provider Relations. I ask that the Board obtain an answer to what is the next step as I cannot pry the answer out of Provider Relations.

As a bit of connected history, in 2006,under the WHN LME catchment area,the newly established private mental health care company, New Vistas/ Mountain Laurel collapsed suddenly; it had 10,000 mental health patients associated with it. WHN LME was left to pick up the pieces.

In 2011, New River LME was accused by SMC LME of ‘Medicaid fraud’ which was never fully explained anywhere in the press. Smoky Mountain Center (SMC) LME (who you can bet has its eye on WHN LME screwing up) did a hostile take-over of that LME.

Currently, as related to either paperwork chaos reigning at WHN and/ or the paperwork load demanded by WHN LME, there are private companies here that commit Medicaid fraud every working day. I have it from the horse’s mouth. I do not work for any agency. I am a solo provider.

The explanation from them is that ‘we have to make the money’ and it was outlined to me that the paperwork demands and short-deadlines----created by WHN in order to stay on top of Medicaid expenditures, I assume----is what is drowning the companies. Will the lack of paperwork efficiency create another collapse when this Medicaid fraud is discovered, if it is discovered?

When I asked Vicki Smith, ("whoa, stop right there, said the WHN LME Board attorney: see above) Executive Director of NC Disability Rights in Raleigh what she knew about the LME closing its provider network, as I queried her as to whether the PBH Support Needs Matrix, developed by PBH, was being used to exclude current Medicaid providers at WHN, she informed me that the LME’s who have signed on to the waiver are obligated to maintain “fidelity” to the PBH model. Upon asking her if PBH’s Support Needs Matrix, not dissimilar to other rubrics or a matrix that have been used in the past in order to obtain state funded client services---did she think that this Support Needs Matrix was possibly being utilized to limit mental health care. I am concerned about this due to the question that the WHN LME Provider Relations Department asked me, specifically, 'what services do you offer. Vicki Smith indicated that this Matrix has been determined to be used w/ the (primary diagnosis) DD population. So, it appears that WHN LME is not using this matrix in order to rule out the use of Medicaid monies for people with a primary Mentalo Health (MH) diagnosis (god help the DD population).

When I asked Dr. Bert Bennett of the Behavioral Health Unit of NC DHHS about whether WHN had closed its Medicaid provider network, he told me that WHN is expected to keep its doors open to all current Medicaid providers for at least one year; “During that year, the LME/MCO has the ability to evaluate thecapacity of their network and, after a year, they do have the ability to choose which providers will be in their network.”

I would like to know what is going on related to this current Medicaid provider’s WHN application to continue to provider Medicaid services in this catchment area. Thank you."

I am sorry to put you on the hot seat, Vicki Smith and Bert Bennett, but I simply want to know what is going on re: continuing to be a Medicaid provider----what I have been doing for years---re the Provider Relations Department at WHN LME.


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