Thursday, March 08, 2012

Soliciting Contact w/ the Federal Centers for Medicare & Medicaid Services (CMS) re: Inability to Be Paid to Work w/ Medicaid clients under WHN LME

Marsha V. Hammond, PhD Clinical / Health Psychology NC Licensed Psychologistcell: 828 ---------e mail: NC Mental Health Reform blogspot, since 2007:

March 7, 2012

Dear Dr. Diane Pedulla of the American Psychological Association Practice Directorate:

I left a message for you today. Thank you for your hard work re: psychologists in the US.

First of all, there is no point in me contacting the NC Psychological Association as they pay no attention to Medicaid matters in NC. I have joined twice and resigned twice over the past 10 years re: inability to engage them on these important public mental health care matters.

I am contacting you because although I have been a Medicaid provider in NC for the past 7 + years, I am being denied the ability to continue to do this under the Medicaid waiver that is wrecking Medicaid in NC. I am given no reason; I get no calls back from the Provider Network of the local LME/ MCO which is managing mental health care for Medicaid clients in western NC, specifically, Western Highlands Network (WHN) LME. This puts me in a clear ethical dilemma as my therapeutic relationships are long-term and with seriously mentally ill clients.

Here is the issue grossly outlined and more detail information is at my blog as listed above. NC has been undergoing a very, very challenging mental health reform over the past 12 years. It has not gone well; it has decimated the public mental health care system. The original design was two-fold: 1. to privatize mental health care, including Medicaid, so that there would be 'competition' which would diminish the $$ spent 2. to allow choice for patients regarding health care providers.
First of all, this is a very poor way to make money; competition does not work well within a system in which there is little money to be made and that includes Medicaid which is associated with impoverished clients with significant mental health challenges. Secondly, there is less and less choice as providers are collapsing from the duress related to NC mental health reform. Thirdly, the co-chairs of the legislative oversight committee, a free-standing committee, have completely changed members since Republicans took over the NC State Legislature. Thus, there is no continuity re: what has happened and where we were headed.

This is all related to a Medicaid Waiver which was hoisted onto the local LME/ MCO, specifically Western Highlands Network (WHN) LME/ MCO---the old community mental health center which for the past 7 + years has functioned as an administrative only entity. The LME/ MCO which created the Medicaid wavier, in eastern NC, far across the state, is Piedmont Behavioral Health (PBH LME/ MCO). The PBH LME/ MCO is leading the charge, if you will, across NC, re: this Medicaid waiver which appears to be a clear attempt of NC DHHS to rid itself of monitoring Medicaid----a federally mandated service. This Medicaid waiver includes a non-disclosure agreement which was basically a hostile take-over of the WHN LME Board which was signed, under duress, by the WHN LME/ MCO Board in June, 2011.

Prior to this Medicaid waiver, many companies and providers collapsed, including the loss of a major company under WHN LME about 7 years ago which covered 10,000 lives. WHN LME/ MCO now oversees 80,000 Medicaid eligible patients and in January, 2012, less than 5% of those patients received any mental health services. There is thus a very significant attempt to curtail Medicaid services utilizing the non-use of mental health providers, including psychologists.

There is no reason given to me by the Provider Network of WHN LME/ MCO as re: denying my continuing to provider Medicaid services. I have never had a charge leveled at me; I have no ethical violations; I have not been accused of Medicaid fraud. I do have my mental health care reform blog which has documented many injustices associated with Medicaid services over the past 7 years.

Moreover, I am advised by NC DHHS psychologist Bert Bennett, PhD that the LME/ MCO must allow in-place mental health Medicaid providers at least one year during which the LME/ MCO may evaluate who it wants to continue to allow to see Medicaid patients. I have presented these issues to the WHN LME Board, called dozens of times the Network Provider people at WHN LME/ MCO. I receive no information back. I have seriously mentally ill clients and I take seriously my therapeutic relationships with them.

Medicaid is a federal/ state joint enterprise, as I understand it. It is sustained by public tax dollars. I do not understand how such an arrangement allows a health care maintenance organization, in this case, the LME/ MCO, to decide, on the basis of comraderie with the LME/ MCO----as to who it will allow to be paid to see tax-payer supported patient care.

My query here is thus: given the importance of this matter re: Medicaid services, and given the useful track record APA has associated w/ working with CMS (Centers for Medicaid and Medicare Services), who can I speak to at CMS in order to bring forward these difficulties as associated with federal tax dollars associated health care?

I thank you in advance for your assistance and direction, Dr. Pedulla.

Sincerely, Marsha V. Hammond, PhD


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