Saturday, June 30, 2012

I Will Be Eligible for Medicaid (But the Devil's in the Details): Obamacare: An Act of Human Decency that Is also Fiscally Responsible

There's great coverage of all the points on the two Op-Ed pages of the Friday, June 29, 2012, NYT. 

If you've thought that obtaining health care was tatamount to taking 60+  $100 bills and running out into the street and letting the wind carry them away, and if you're self employed and have all those tax deductions like self employed people do, then if your Adjusted Gross Income (AGI) on your tax forms is within 138% of the Federal Poverty level, then YOU WILL BE ELIGIBLE for Medicaid IN 2014.

How do we get to 138% of the Federal Poverty Level?

".....The ACA expands Medicaid to a national floor of 138% of poverty ($15,415 for an individual; $26,344 for a family of three). The threshold is 133% FPL, but 5% of an individual’s income is disregarded, effectively raising the limit to 138% FPL. The expansion of coverage will make many low-income adults newly eligible for Medicaid and reduce the current variation in eligibility levels across states. To preserve the current base of coverage, states must also maintain minimum eligibility levels in place as of March 2010, when the law was signed. This requirement remains in effect until 2014 for adults and 2019 for children. Under the ACA, states also have the option to expand coverage early to low-income adults prior to 2014. To date, eight states (CA, CT, CO, DC, MN, MO, NJ and WA) have taken up this option to extend Medicaid to adults. Nearly all of these states previously provided solely state- or county-funded coverage to some low-income adults. By moving these adults to Medicaid and obtaining federal financing, these states were able to maintain and, in some cases, expand coverage. Together these early expansions covered over half a million adults as of April 2012...."

Here is a snapspot of what is taking place currently, in 2012, across the 50 States, aggregated data:

8326_Figure 1

Here is a great site for all the bits and pieces of information:

Right now, for NC, you must be within 49% of Federal Poverty Level (looks like I need to re-do my Federal Income Taxes perhaps).  However, as associated with the matter of 'the devil's in the details', does NC have a category for me delineated as: "Working Parents"? Dunno.  And what is the age of the person to be considered 'Elderly'?

According to the Feds, age 60 or older is 'Elderly':

"Who is Elderly?A person is elderly if he or she is 60 years of age or older."

In looking at NC Medicaid charts, there appears to be no categories for "Working Parents":

Here info for current yea re: all the various statesr:

Here is info re: Federal Poverty Level:

These are some of the more salient points across the editorials:


".....How many people are we talking about? You might say 30 million, the number of additional people the Congressional Budget Office says will have health insurance thanks to Obamacare. But that vastly understates the true number of winners because millions of other Americans — including many who oppose the act — would have been at risk of being one of those 30 million...."


"......And here’s the biggest gift that Roberts gave to the nation: By restraining the power of the court to shape health care policy, he opened up space for the rest of us to shape that policy through the political process. By modestly refraining from rewriting health care laws himself, he has given voters and politicians more room to be audacious....."

3.  THIS is the Editor(s) of the NYT outlining the entire matter and its a worthwhile organizing the more subtle points:

".....THE PRACTICAL IMPACT In general, the decision means that tens of millions more Americans will have access to affordable health insurance and that reforms in how medical care is delivered and paid for can be aggressively pursued to bring down the cost of health care. Most of the changes will take effect in 2014, like coverage for adults with pre-existing conditions. Many popular provisions are already in effect, including mandated coverage of pre-existing conditions in children and allowing parents to keep their children on their coverage until they are 26.

The law covers preventive care without cost-sharing by Medicare patients and improves preventive care coverage in private plans. It bans insurers from imposing lifetime limits on how much they will pay for an individual’s care. The law is already providing grants to carry out demonstrations and pilot projects to encourage hospitals, physicians and insurers to coordinate care, eliminate waste and reduce medical errors. These initiatives will now be accelerated in coming years.
The major exception to the strong legal endorsement of the law involves Medicaid. The law called for states to expand their Medicaid coverage to virtually everyone earning up to 133 percent of the federal poverty level, or up to $25,390 for a family of three. It encouraged states to expand their programs by having Washington pay 100 percent of the cost of newly eligible enrollees for three years, with the subsidy decreasing after that to 90 percent. But it also contained an implied threat to withdraw all federal financing for Medicaid if a state refused to expand. By a 7-to-2 vote, the court said that was too coercive and upheld only the provision of additional funds.

We disagreed with the court’s legal reasoning on this point and believe that without the possibility of withdrawing federal funds, the reform law may fall short of ensuring near-universal coverage....."

Thursday, June 28, 2012

This is What Smoky Mountain Center LME Requires for Medicaid Providers to Fill Out so THEY CAN CONTINUE BEING PAID TO SEE THEIR MENTALLY ILL MEDICAID CLIENTS

These are the items that are required by SMC LME in order that one CONTINUE to be paid to be a Medicaid Provider, which I have been for about 10 years.  Read the list and understand why Medicaid will have few providers. I don't know of another psychologist under SMC LME.  Not ONE. The only one I knew, upon hearing about mental health reform back in 2003 or so, explained to me that she was "moving back to Florida....I can see where this is going."

1. 20 page form associated with items you already inserted on the demanded CV; you have to type in "N/A" about 100 times. This is expected as per the directions to the darn thing.

2. copy of your psychologist license, current
3. copy of any other psychologist licenses you have had
4. your college transcript
5. CV
6. 2 letters of reference from 'similar' professionals
7. 2 page checklist that MUST be filled out
8. W-9 IRS form
9. face page of malpractice insurance.

Medicaid already has all this information on me, either directly or indirectly, as associated with being a licensed psychologist. So WHY do these LME's have to recreate the wheel in this hellish manner, over and over again?

But WAIT: this is the good news.....that you get to fill out all these forms at one time. 

For, in order to CONTINUE TO BE A MEDICAID PROVIDER for Western Highlands Network LME, you have to jump thru one hoop of forms.....wait....wait....fingers drumming on the table.....wait....

I still haven't moved through all the steps at WHN LME in order to be an 'In Network' provider. 

So, I ask you: as the LME's eye each other, salivating on eating each other alive, which LME do you think will consume the other?  I'm betting that SMC LME will consume WHN LME for at least we only had to turn in the forms one damn time. 

Wait, that's not true: when mental health reform started in western NC, we did all of this SEVERAL YEARS AGO in order to see state funded clients. 

You think they kept that paperwork? Naw.

Western Highlands Network LME Removes Sign Prohibiting Recording of Board Meetings From Entrance

"Arthur Carder  3:09 PM (6 hours ago)

The sign was removed a few days ago.

Also Board meetings and Board Committee meetings are open to the public. They may be recorded by anyone; audio and or video.

Arthur D. Carder, Jr. MSW

Chief Executive Officer

Western Highlands Network"

State Budget For Addiction Treatment Defunded by $8.5 Million by NC Republican Led State Legislature

This was sent to me by a mental health practitioner.  

Gee: I just had someone tell me yesterday that they thought that their 16 yr old grandson who is in repeated legal difficulties needed some extended Alcohol and Drug (A & D) Treatment.  

Good luck. 


Dramatic Reduction in Funding for Substance Abuse Services in NC

Please be aware that the state budget includes a reduction of substance abuse funding of $8.5 million dollars beginning July 1, 2012. Advocates, persons served, providers and other stakeholders are strongly encouraged to contact their legislators immediately. Ask them if they are aware of the ramifications of this in their communities.
 What does this mean? 
Untreated addiction will result in:

Increased emergency room visits
Increased admissions to psychiatric hospitals
Increase in the prison population
Increased homelessness

Reductions to an already fragile substance abuse treatment system will result in:

Decreased choice for individuals and their families seeking treatment options
Lost jobs for providers
Programs will close their doors

 What action can you take? 
The Substance Abuse Prevention and Treatment Block Grant (SAPTBG) reduction will not impact the Medicaid shortfall and no one anticipated the dire consequences that will result in these budget reductions. This will immediately become a crisis for individuals, families, communities and services.
  Please contact at least one of your Senators or Representatives on the Appropriations Committee by Monday, June 25th  to express your concerns regarding the impact these reductions will make.
Contact information can be found below:

 Senate Appropriations / Base Budget 
 House Appropriations  
 Senate Appropriations on Health and Human Services 
 House Appropriations Subcommittee on Health and Human Services

What The Buncombe County Attorney Has to Say RE: Recording of Public Meetings of the WHN LME Board: No Useful Information

On Mon, Jun 25, 2012 at 10:28 AM, Michael C. Frue wrote:
> Dear Dr. Hammond -
> County ownership of buildings is not determinative of whether recording of public meetings is allowed or not.  Generally speaking, however, such recordings of public meetings is permissible.  The sign at 356 Biltmore you mention is not a County sign nor does it express County policy. I understand the sign is left over from a former tenant.
> You should direct your specific questions to the Western Highlands Network LME and its attorney, Vic Buchannon.
> Thank you.
> Michael C. Frue
> Buncombe County Attorney
> 205 College Street
> Asheville, NC  28801
> p.  828-250-4121
> c.  828-231-1572

Mr. Frue, Buncombe County attorney:

thank you for your note.  I will ask the WHN LME operator tomorrow for the e mail address of the WHN LME attorney as you have advised.  

Other people across NC have asked me about this matter of recording the LME meetings.  Therefore, perhaps it is a state rules and regs matter.  I am asking for clarification re: this from you, please.

I do not believe that the sign is 'left over' from a former tenant of 356 Biltmore Avenue.  I have never seen it before.  Neither has the board member, listed below, noted it before.

Can you please give me a link to any legal information as associated with your statement: "Generally speaking, however, such recordings of public meetings is permissible. "

 I expressed my concern to Arthur Carder, CEO of WHN LME last week when I saw the sign-----told Nettie Jones, a Board Member of WHN LME of my concern who is the Buncombe County Rep.  I have heard nothing from Mr. Carder.

I appreciate you sending me any rule and regs info re: this important public matter.


Marsha V. Hammond, PhD

> -----Original Message-----
> From: Marsha Hammond,PhD []
> Sent: Friday, June 22, 2012 2:25 PM
> To: Michael C. Frue
> Cc: David Gantt
> Subject: WHN LME: No More Public Recordings in Public Building
> FROM: Marsha V. Hammond, PhD
> Clinical / Health Psychology
> NC Licensed Psychologist
> cell: 828 772 1127
> e mail:
> NC Mental Health Reform blogspot, since 2007:
> TO: Michael Frue, JD, Buncombe County Attorney
> RE: sign posted at 356 Billtmore Avenue, Asheville, NC 28801, Buncombe County owned building, rented by Western Highlands Network LME
> Date: June 22, 2012
> Dear Mr. Frue:
> Thank you, in advance, for your response. I asked Wanda Greene and Mr.
> Israel and they referred me to you.
> Can you tell me where to find the rules and regulations as associated with Buncombe County Buildings---public buildings-----that forbids the public recording of public meetings?
> Unlike in the past, and as associated with increased pressure to be accountable to the public, at 356 Biltmore Avenue, the entrance to Western Highlands Network LME, there is posted in large letters an admonition that no public recording may take place in meetings in the building.
> Until recently, there was a gentleman----you may know him----I call him 'Citizen Jerry' who dresses up in a clean shirt and tie and records all of Buncombe County public meetings.  I arrived belatedly at the budget meeting today for WHN LME so I do not know if he was there but I was there and I was going to digitially record the meeting.
> Please advise me what the rules are as associated with buildings which are property of Buncombe County and its citizens as pertaining to this matter.
> thank you.
> Respectfully,
> Marsha V. Hammond, PhD
> cc: David Gannt; Nettie Jones

Who Needs This?: Flow Diagram for How To Get Paid for Rendering Outpatient Mental Health Services at WHN or any Other LME in NC

This is the procedure, as per WHN LME, in order that Medicaid clients receive outpatient mental
health services:

1. Provider submits Enrollee 
registration Form (ERF)
and faxes to WHN

2. WHN 
e-mails WHN Client ID
(and Referral Number, if
requested) to provider

3. Provider completes/submits
STR, LCAD, TAR, & Tx Plan*
to WHN (within five days of first
contact with client)
electronically (CCIS)

4. WHN 
UM Staff manages

5. Provider receives authorization 
approval or denial (via LON)
and initiates services if approved.


Who needs this?


Sunday, June 24, 2012

Now, Late in the Day, the Director of Provider Relations at SMC LME, Indicates that the Re-credentialing Materials from WHN LME Can be Used for Recredentialing w/ SMC LME

The following is correspondence between myself and Patty Wilson, Director of Provider Relations at SMC LME:


Dear Patty Wilson, Director of Provider Relations at SMC LME:

I appreciate your note. It does not help, however, that you are now directing me to change the materials you have insisted I submit as per your 'check-list' at this late stage of the game.

As per your demand on your check list, I have already sent off for my 'Official College Transcript' and will be submitting this to the SMC LME Provider Relations Department---as you requested on your official check-list. A point to be noted: there will be no Licensed Independent Practitioners who will not have gone thru credentialing / licensure processes that would have required this and so WHY did you ask for this to begin with? Did you now think thru this matter?

Additionally, it does not make any sense to have two separate provider credentialing application processes as per WHN and SMC LME. How is it that your two LME's are able to pull up an a la carte menu of things that you demand from LIP's? ---that are completely different?.

As you have alluded to below, I 'may'---as you say----- send my WHN LME application to SMC in lieu of what SMC has asked for. However, I frankly would not trust that this would suffice given the difficulty I have experienced in getting some word----from you-----that this could be so.

And as you know, we are up against your July 1, 2012 deadline .

Is there no standardization of this re-credentialing process for Licensed Independent Practitioners or do we have to clue you----the Provider Relations Departments----as to what makes common sense?

You seem to be inferring that I do not need to send in to the two 'letters of recommendation'p; however, I have already obtained them. And so, it is late in the day for you tell me that I can now just use the WHN LME credentialing process which does NOT require the two lettters of recommendation.

Didn't any of the LME's THINK about this process prior to demanding providers to do all this work? Didn't any of the LME's standardize this re-credentialing process, using the CAQH credentialing process, for example, which NC DMA has suggested to begin with?

I find it distressing to think that most of the Medicaid money is being spent on recreating the wheel over and over again rather than being applied to the needs of Medicaid recipients.

I am afraid that I do not trust that if I send in my SMC LME re-credentialing application which is to have included:

1. CV
2 two letters of recommendation
3. 'official college transcript'

----a process which is completely different from that of WHN LME----- that I will get anything back but a certified letter that you have not received the correct materials---even though you suggest that the materials for re-credentialing for WHN LME is the same as that for SMC LME.


Thanks again, for your reply, Ms. Wilson, but I am sending in to SMC LME what your official check list has stated I must send in.

I don't trust anything else given the difficulty in working w/ SMC and WHN LME regarding this Medicaid Waiver re-credentialing process otherwise.

Marsha V Hammond, PhD
On Thu, Jun 14, 2012 at 4:29 PM, Patty Wilson wrote:

> Dear Ms. Hammond,

> Thank you for your request for information/clarification regarding required elements of the LIP application.

> I am sorry you were unavailable to receive my two phone calls yesterday (6-13-12), or my phone call today. As I indicated in my voicemail to you today, in follow up to the two yesterday, I am responding by email.

> Your point that transcript submission is redundant since you are already licensed is well made. As such, please feel free to omit that document from your application when it is submitted. Additionally, in terms of standardization, you may simply make a copy of the application you submitted to Western Highlands Network, and send it to the Provider Network Department at Smoky Mountain Center. The only caveat is that original signatures are required at points of signature.

> Our records of paid claims for behavioral health services for consumer's whose Medicaid originates in the SMC catchment, do not include payments to you. We know that these records can be incomplete. Remittance Advice documents of paid claims to you, for services rendered since January 1, 2012 to SMC consumers, may be submitted as proof that you have provided such services in the timeline specified for admission to the SMC Network. Please be sure to conceal any Personal Health Information if you submit such documentation.
> Again, thank you for your inquiry. If I can be of further assistance, please do not hesitate to contact me.

> Thank You,

> Patty

Saturday, June 23, 2012

How SMC and WHN LME's Could Improve Their Relations with Providers: ANSWER THE QUESTIONS AND THE PHONE, PLEASE

This is a correspondence between myself and Stephanie Gibson of SMC LME.  She clarified that she did not hang up on me but that there was a snafu in the SMC LME phone system.

Unfortunately, both WHN and SMC LME's have phone systems such that the operator at both places has NO IDEA how to turn up a live human. 

Here is what we talked about as per e mail.

On Fri, Jun 22, 2012 at 3:34 PM, Stephanie .. Gibson wrote:
> Hi Marsha,
> I apologize you were not able to speak to someone. I did not hang up on you, the operator called me and I told her to forward the call to me and a staff member came in my office so it went to voicemail, the call was never picked up on my end. The operator called back saying you were on the line and I was talking with the staff member so I asked that she send your call to my supervisor, Patty, to see if she might be available. I did not realize that Patty was in a meeting.

> I will ask for clarification on the communication, the communications are originated in Provider Network and sent to me to email and post on the website.

Thank you. 
Stephanie Gibson


I appreciate this clarification, Stephanie. If you had been on the receiving end of this Medicaid Waiver business, I assure you that you would be as paranoid as I am-----given how I detail the matters on my blog----and will continue to do so. I stand corrected and will correct it on my blog right now.

I did not know that I was 'shooting the messenger', w/ you being the messenger.

Whoever is constructing these posts could benefit from having them proofread by someone w/ a degree in English or at least a good writer to go over it. They are confusing, utilize acronyms that I have no idea what they refer to, and are generally unhelpful. And they come at the providers almost everyday.

I can appreciate that someone is trying to keep us informed but creating confusion should not be confused w/ informing the providers.

If it is true what you are saying, then I might suggest that your phone system, just like the phone system of WHN LME----wherein the operator has absolutely no idea if anyone will ever answer the phone or if one will simply get endless voicemails----needs some kind of system such that the person one is trying to reach is AVAILABLE.

The ONLY person at SMC LME that was ever immediately reachable was Doug Trantham and he went away and started Appalachian Counseling Services.

He had a system that if he was not at his desk, it would ring over to his cell and you could almost always talk to him. It not like I am calling up to talk about the weather. I have no intention on bugging you people.

I greatly admire that man, Doug Trantham, for that very reason. .

marsha hammond, phd

Friday, June 22, 2012

Western Highlands Network NEW RULE: No Recording of Board Meetings: $1.8 Million Projected to Rent/ Clean/ Maintain 356 Biltmore Avenue

I went, belatedly, to the WHN LME board meeting today.  It was basically an approval of the budget and ended early.  I nevertheless obtained a copy of the budget and will put it into pdf form (I have no idea if the LME puts this online or not). 

I have not looked at it in detail yet. 

However, what caught my eye, as I entered the building, which was NEVER THERE BEFORE was a statement on the glass that stated that there was to be no public recording of the meetings in the building. 

This is odd as there has been an audio recording of the Board's meetings for years by Citizen Jerry, a man who dresses up in a tie and clean shirt, and tapes the meetings for all of Buncombe County public meetings, be they City Council meetings, or whatever.

So, I called up Arthur Carder, CEO, of WHN LME and left him a message asking him why this has been changed. 

I used to have an office in that building and now 356 Biltmore Avenue is ONLY rented by WHN LME.  NAMI was in there about a year ago. What happened to them? Heath Shuler moved his office about 1.5 years ago.  The two story building with about 50 offices in it is owned by Buncombe County. 

So, I went over the City Manager's office, Wanda Greene.  Her secretary referred me to the General Manager of Buncombe county buildings, Mr. Israel. He indicated that it had been completely rented by WHN LME and had, basically, no comment about the big wording next to the entrance that no recording of meetings could take place. 

So, then I have set the following letter to the Buncombe County attorney, Michael Frue. 

As it turns out, as per the Financial Statements today given out at the Board meeting, under "Current Operating Expenses Subtotal 3xx, with 3xx referring to 3 confusing Descriptors, specifically:

1. FY 2013 MCO Budget State/ Federal total   2. FY2013 MCO Budget Medicaid Total   3. FY2013 MCO Budget Combined (I assume this is the grand total associated with state and federal Medicaid matters.  In any case, the rent for 356 Biltmore is $648,328/  year.

Also under that header the most costly item is an additional $435,000 for "Service Maintenance Contracts" (picking up trash and vacuuming costs that much)?

The "Rent and Occupancy Subtotal" is $1,811,328 projected for the year 2013.

So, almost 2 MILLION $$ of Medicaid money is being used to rent and clean up and maintain WHN LME at 356 Biltmore Avenue. 

This isn't even anything about salaries.

Here is my letter to the Buncombe County Attorney, Michael Frue:

FROM: Marsha V. Hammond, PhD  Clinical / Health Psychology  NC Licensed Psychologist
cell: 828 772 1127 e mail:

TO: Michael Frue, JD, Buncombe County Attorney (

RE: sign posted at 356 Billtmore Avenue, Asheville, NC 28801, Buncombe County owned building, rented by Western Highlands Network LME

Date: June 22, 2012

Dear Mr. Frue:

Thank you, in advance, for your response.

Can you tell me where to find the rules and regulations as associated with Buncombe County Buildings---public buildings-----that forbids the public recording of public meetings?

Unlike in the past, and as associated with increased pressure to be accountable to the public, at 356 Biltmore Avenue, the entrance to Western Highlands Network LME, there is posted in large letters an admonition that no public recording may take place in meetings in the building.

Until recently, there was a gentleman----you may know him----I call him 'Citizen Jerry' who dresses up in a clean shirt and tie and records all of Buncombe County public meetings. I arrived belatedly at the budget meeting today for WHN LME so I do not know if he was there but I was there and I was going to digitially record the meeting.

Please advise me what the rules are as associated with buildings which are property of Buncombe County and its citizens as pertaining to this matter.

thank you.

Marsha V. Hammond, PhD

cc: David Gannt; Nettie Jones

Medicaid Waiver under Smoky Mountain Center LME: Confusion re: already authorized Medicaid Services

Here is my letter to the Director of Provider Relations at SMC LME-MCO regarding an announcement today sent out by Stephanie Gibson at SMC LME-MCO:

FROM: Marsha V. Hammond, PhD Clinical / Health Psychology  NC Licensed Psychologist
cell: 828 772 1127  e mail:

TO: Patty Wilson, Director of Provider Relations, SMC LME-MCO

RE: Stephanie Gibson's announcement re: continuation of authorizations for Medicaid clients

Date: July 22, 2012

Dear Patty Wilson:

Stephanie Gibson sent out this e mail a moment ago. I called her; she hung up on me after I stated my name and nothing else; I called back; the operator told me she wanted me referred to you, Patty Wilson.

Here is the e mail Stephanie Gibson just sent out and my questions are below the e mail. Thank you for your reply.

The memo is confusing to me and this is compounded by the matter that I have Medicaid patients who are already authorized by Value Options to receive services, pretty much, through the end of this year. Her memo is, I believe, an attempt to speak to this matter but it is confusing.

"Stephanie .. Gibson

12:48 PM (30 minutes ago)

TO: SMC Providers

RE: I. ATTENTION ICF/MR Providers: Utilization Review Information

DATE: June 22, 2012
__________________________________________________________________________________________________________ ATTENTION ICF/MR Providers: Utilization Review Information

As previously communicated to providers, SMC is required by DMA to honor authorizations completed by VO that extend beyond June 30, 2012.

ICF-MR providers do not complete the UR--utilization review--process (have their services authorized) through VO. However, SMC wants to honor the end dates of the current URs for ICF-MR residents. To do this, we are asking the ICF-MR providers to send in a copy of all current UR forms for residents whose Medicaid county of eligibility is one of the 15 SMC counties. We will use this as the end date of the “authorization”. We will need you to send an updated UR AT LEAST 10 days prior to the expiration of each resident’s current UR.

The NC Innovations LOC Determination is to be utilized when ICF-MR agencies submit UR under the Innovations Waiver. This form is to be utilized at the next UR submission for an individual served in the ICF-MR facility. Additionally, this form will be utilized by ICF-MR facilities for initial UR submissions as well."
Here are my questions:

1. What does ICF refer to?

2. I ask this question as I have several Medicaid patients who received extended authorizations from Value Options earlier this year; they have mental illness diagnoses; they are not MR; does this announcement pertain to these patients?

3. If so, the above statement, specifically: "we are asking the ICF-MR providers to send in a copy of all current UR forms"----are you asking for me to print out from the Medicaid website the authorization for the patient? If so, Stephanie's additional statement that, "We will need you to send an updated UR AT LEAST 10 days prior to the expiration of each resident’s current UR."----does this mean that you do not need the authorization printed out from NC Medicaid UNTIL the authorization is about to expire? If so, how is the Medicaid Waiver going to overlap in terms of SMC LME assigning some kind of number to the billing process which now takes place via the HP Webclaims Portal.

4. Who do I send this authorization to, if it is so that you need a print out of the Medicaid authorization?

5. Are there any additional numbers that need to be attached to Medicaid billing as per the Medicaid Waiver going into effect July 1, 2012, as re: these already authorized sessions?----or do I simply continue to bill utilizing HP Webclaims portal as before.

6. I ask that question as HP lost its contract and some other company, landed by Lanier Cansler prior to he becoming Secretary of NC DHHS, is to sometime become the agency that handles the billing for Medicaid patients.

7. Do you know how much longer the HP Webclaims portal will be in effect?

8. As associated with that portal, which I know well from having used it efficiently for years, there is no place for any SMC LME number. When I bill there, I simply put in the Medicaid number of the patient. So, if SMC is going to require a number as re: this Medicaid waiver, assuming that I will be allowed to be an In-Network provider as I continue to work with Medicaid patients under SMC LME, how is this going to be handled?

thanks for your reply.

Marsha V. Hammond, PhD

cc: Ureh Lekwauwa, MD, DMA

Thursday, June 21, 2012

FRESH AIR: HELLO: Here is the Model to Pay Attention to: an LME in Eastern NC Understands the 'Emergency' Nature of Mental Health Crises & Creates a 24/7 Free-standing Clinic to Address Challenged Citizens Issues

I'm dying for some fresh air re: this Medicaid Waiver. 

Here it is and as I tell my clients: take advantage of the breaks and revel in them.

Thank you, Richard Craver, Reporter.

"A big boost for behavioral health

The new Forsyth Behavioral Health Outpatient and Assessment Center in Winston-Salem features a multifamily group room for therapy and seminars. The 24/7 center, which opened Wednesday, offers services designed to relieve the Forsyth Medical Center Emergency Department from the 5,000-plus behavioral health patients it sees every year. Outpatient services include programs to help treat substance abuse and mood and anxiety disorders.

The center also has a 24/7 call center for community members, doctors and first responders facing behavioral health issues...."

Wednesday, June 20, 2012

Lanier Cansler, Months Ago Secretary of NC DHHS, Lobbied for Company that Scoops Efficient HP Medicaid Billing and NC Citizens Pay $495 Million+ for Cansler's Influence and Pull

Just when I think I have pulled every hair out regarding this Medicaid Waiver mess, here comes something else even more shocking:  Lanier Cansler, Mr. Revolving Door (He has done this twice now, going in and out of DHHS, to work as Secretary of the entire thing, and then out again, as a lobbyist so he can make the BIG BUCKS BABY).

Medicaid Webclaims was COMPLETELY EFFICIENT re: Medicaid Billing.  Everything ran like clock-work.  I logged on, put in my ID, pulled up my client's names, put in the necessary data, all of which took about 1 minute to do / client for a number of Medicaid sessions. 

Now, we've got Mr. Revolving Door Cansler who yanked this contract from HP PRIOR to being assigned the position by Perdue (I can still hear her now assuring the public that 'he's a public servant now' as people made inquiries about his lobbying jobs) and we have now idiotically spent millions of dollars to create this (oh yeah) state of the art computer system for billing Medicaid.

This is every bit as idiotic as re-credentialing Medicaid providers by the LME's. 

WHO WILL STOP THIS MADNESS? Why the hell do we need another company spending all our money to write computer code that was in place and running very well by another company?

Here is the article:

"......The contract sparked a fierce fight. HP, which runs the 1980s system, was a bidder on the new contract and protested on technical and political grounds: CSC had retained former DHHS Deputy Secretary Lanier Cansler as a lobbyist. Weeks after the contract award, Cansler was named DHHS secretary by Gov. Bev Perdue.

Stewart denied the protest.

In its bid documents, CSC estimated that 90 percent of the millions of lines of computer code needed could be copied from its New York Medicaid program. CSC later revised that to 73 percent; in the end, because of big differences between the New York and North Carolina Medicaid programs, only 32 percent of the New York code was used....

The program soon fell behind, and in the summer of 2010 CSC asked for an extension. Following a lengthy negotiation, the state granted an 18- to 22-month extension and raised the contract price to $495 million.

CSC celebrated the amended contract with an invitation to a July 28, 2011, picnic at Umstead Park: “Please plan to join us for BBQ and Indian Cuisine! It will be a great time to get to know your co-workers as well (as key CSC and DHHS) executives. You might even have the chance to challenge them to a game of bean bag toss or horseshoes!”

Delia, who became DHHS secretary in February, says CSC added six months of delay by overestimating how much code it could bring from New York. The company agreed to pay the state $10 million in damages, an amount criticized as unsubstantiated and low in a subsequent state audit.

The rest of the delay, Delia said, stems from changes in federal and state laws and regulations, and was out of the control of DHHS...."

Read more here:"

Read more here:

Forget All the 'Medicaid Only' Clients or Anyone Having Medicaid as Secondary Without Medicare: THIS Should Finally Deal Some Kind of Death Blow to the Medicare Advantage Companies due to Management Nightmares

Well, let's start off with the good news, shall we?  The blasted LME's are not managing the Medicare primary/ Medicaid secondary funds for those clients.  Those are most of my clients. 

They ARE managing the Medicaid for people who ignorantly sign onto some other Medicare Advantage Plan, it appears.  So, if you have clients who have Humana as their Medicare, w/ a wrap-around to Medicaid, you'll have to have the Medicaid dollars managed by the LME. 

AND, there's now no longer any 365 days to submit Medicaid billing.  There's 90 days under the Medicaid Waiver. 

So,that makes it simple: I simple advertise myself as a Medicare/ Medicaid provider but not Medicaid alone. And no Medicare Advantage plans clients. 

So, just as I have been telling my clients for years: DON'T GO OFF YOUR MEDICARE PLAN.

So, to add tothe list of problems with the oxymoronic Medicare Advantage companies:

1. you commonly have to get authorizations somewhere along the way to continue to see the patients.

2. you not uncommonly have to send in all your notes in order to get paid (I had to do this many times w/ Humana but they stopped that about a year ago but who knows they could start again)

3. they have a 15% administrative cost whileas Medicare has about a 5% administrative cost (in other words, some fat cat is not earning a sky is the limit salary which is what is being proposed by the bill which was to be voted on yesterday by the NC State Legislature turning the LME-MCO's into mini-hospital authorities wherein they could create their own salaries and avoid having any consumers on their boards and not report to the county commissioners).

4. there is no wrap-around in terms of billing, to Medicaid, as this administration has to go through the LME whileas w/ a client with primary Medicare and secondary Medicaid, there continues to be a wrap-around.

This is sheer idiocy.  How many pieces are we trying to carve this mental health care into, anyway?

Here is my e mail to Donna at Western Highlands Network LME and below it is her reply. She's a helpful woman working in a blown-up system.

Marsha Hammond,PhD

Jun 14 (6 days ago)
to Donna

thanks for your reply, Donna.

I have several questions as associated with it and a comment: there
was an automatic wrap around from Medicare to medicaid previously.

Now, I have, or my biller has, the additional step of turning in the
EOB from Medicare to WHN, so that WHN can figure out how much is to be
paid as associated with the client's Medicaid account. Correct?

I want to make sure that I understand this correctly: there is now no
samless way to have an automatic wrap around to Medicaid for dually
eligible clients utilizing this Medicaid waiver. Correct?

If so, I find this exasperating. It just adds work for me or for the
biller and is ludicrous. Is there any plan to CREATE a seamless way
to do this -----like it has always been done before?

You indicated that there is '90 days', I assume, from date of service.

That was not associated with Medicaid in the past. I believe it was
a year. I would have to check on that but it certainly was not 90
days. Is this as associated with the Medicaid waiver? If so, where
are the rules/ regulations associated with the Medicaid waiver? Please
don't tell me to go wander around in the DHHS/ DMA web pages. Surely,
the guidelines must be in a discrete place and I would so much
appreciate it if you could simply give me the URL.

Thirdly, I do not understand your sentence below: "Mcare/Mcaid does
not enter a managed period."

thanks for your hard work.

Donna Baker Oliver

3:58 PM (23 hours ago)
to me

Yes there used to be what is known as the "crossover" from Mcare to Mcaid. In the current Waiver system through out the State there is not a "crossover" process. From what I understand it would be very complicated to achieve with a federal system like Mcare. Other providers have been frustrated by this as well. Regarding the managed question: when a consumer has third party insurance like BCBS, Aetna etc plus Mcaid, the Mcaid is managed by WHN UM once the session limit has been used or the provider goes to managed. ********Mcare/Mcaid is the exception in that the secondary Mcaid is not managed by UM.

You are correct the "90 days to bill" is associated with the Waiver. Previously providers who have since come under Waiver sites had 365 days to bill the Mcaid vendor. Providers not yet under Waiver sites (ie. not seeing consumers whose Mcaid are under Waiver sites) still have 365 days from what I understand.

Most importantly, providers can only receive reimbursement for services provided to WHN consumers (whose Mcaid is with our counties) when they have a fully executed contract with WHN.

Thank you,

Big Shake-Up at NC Medicaid: (I Wondered Why No One Would Answer my Letters But Then Again That's What I Expect From These People)

I guess its Michael Watson that I need to ask the questions to re: the travesty regarding re-credentialing of already credentialed and licensed Medicaid Providers. 

So, here is my e mail to Michael Watson w/ a cc to DMA physician .nc.and the Secretary of NC DHHS.

FROM: Marsha V. Hammond, PhD
Clinical / Health Psychology  NC Licensed Psychologist
cell: 828 772 1127 e mail:

TO: Michael Watson, Chief Division of Medical Assistance

RE: Provider Re-credentialing Difficulties at WHN LME and SMC LME

Date: June 18, 2012

Dear Mr. Watson:

Congratulations on your new job. As the former CEO of Sandhills LME, perhaps you know something about how the LME's work.

As a Medicaid provider for over 10 years, working with the SPMI,Seriously Mentally Ill Population, as associated with both WHN LME and SMC LME, these are the difficulties I have (so far) encountered in trying to CONTINUE to see my seriously mentally ill patients for outpatient therapy-----something which keeps them out of the psychiatric hospital and saves the state of NC thousands of dollars every year.

WHN LME has asked for my 'Request' to be considered to continue to be a Medicaid provider twice now: once in January, 2012, and now again. They lost all my paperwork the first time and/ or they just want to ignore me. They asked for: tax return; attestation as to how I handle my emergency calls; an outline of the kind of people that I see (the SPMI population, including expertise w/ DID and personality disorders). I gave them all of that in January. Nothing has happened. I have been to the WHN LME Board meeting several months ago, complaining. I am getting ready to go again on Friday as the CEO and the Board's attorney are asking for a raise when WHN LME's own paperwork in March, 2012, indicated that they had served just 5% of the 80,000 Medicaid recipients under their catchment area. Why should they get a raise when most of the Medicaid providers have bailed and this one----a licensed psychologist----cannot even get her paperwork through?

SMC LME has asked for: CV; two letters of recommendation; A COLLEGE TRANSCRIPT (the NC Licensing Board saw this years ago). I have until July 1 to get this together. After that, their web page indicates that the provider network will be closed. How can that be when I was informed by a psychologist in DMA that the network, under Medicaid guidelines, must remain open for 'at least a year' as associated with this Medicaid waiver?

As per DMA notices posted, you have been considering using CAQH credentialing, which is online, paperless, and no a la carte menu of LME choices and providers have been using CAQH for years as associated with working w/ other insurance companies such as BCBSNC.

Can you PLEASE end this re-credentialing boondoggle so that I can continue to work with and be paid for working with my patients?

Marsha V. Hammond, PhD
Secretary Delia Announces Reorganization of State Medicaid, DHHS Leadership Team

State Medicaid office will now report directly to Secretary

Raleigh– North Carolina Department of Health and Human Services (DHHS) Secretary Al Delia today announced that he is reorganizing the leadership teams that oversee the state’s Medicaid division.

The changes come after careful evaluation of the Department’s management, said Delia, who was named acting secretary in February.

Michael Watson, DHHS chief deputy secretary, will become the new head of the state’s Medicaid office, the Division of Medical Assistance (DMA). That position will be elevated to serve on the Secretary’s executive leadership team. Watson joined the Department in 2009 as an assistant secretary. He is the former CEO for Sandhills Center for MH/DD/SAS, with more than 20 years of experience and leadership in developing and operating mental health, developmental disabilities and substance abuse services on a local and regional level. His salary remains $160,000.

Watson replaces Dr. Craigan Gray, who served as director of DMA since April 2009 at a salary of $270,000.

Beth Melcher, assistant secretary for mental health, developmental disabilities, and substance abuse services development since August 2010, will become chief deputy secretary. Melcher, a licensed psychologist, is the former president of Recovery Innovations North Carolina. She was clinical director of The Durham Center, and also worked with the National Alliance on Mental Illness North Carolina as its executive director and as public policy director. Her salary will be $141,797.

John Dervin, the secretary’s senior policy adviser since March 2012, will step into a newly created role as chief of staff. Dervin previously served as policy adviser for health and human services for Governor Perdue. His salary will remain $84,000.

“After nearly six months in this role, my first priority for strengthening our management team is to elevate the state Medicaid office to play a more prominent role in the Department’s decision-making process,” said Secretary Delia. “Medicaid is not a stand-alone division. It touches not only multiple DHHS divisions but also plays a huge part in shaping the state budget. We need better communications and stronger oversight of this $12 billion program. I believe these changes will accomplish that.”

These staff changes are effective immediately.

Monday, June 18, 2012

NC State Legislature Proposes Bill to allow LME's to Completely Avoid Oversight, USING YOUR TAX $$, In Order to Give LME CEO's Whatever Salaries They Want

If you want to post a comment to Richard Craver's article below associated with this extremely important matter, you must be: 1. logged onto facebook (which the paper is using) 2. wait 5 minutes after posting  3. refresh your computer to see if your post is there  4. If it is not, take out any links as facebook requires someone at the paper to allow you to post if you have links in your post 5. when all else fails, call this nice woman at that paper: 336 727 7338

1. "The bill removes the requirement that county commissioners approve the hiring of an MCO director, giving that responsibility to the MCO board. Advocates say many LME boards already operate as rubber stamps for their executive directors."

2. The LME's need no longer have anyone w/ mental health challenges or associated family member present on the LME Board.

3. It would eliminate tops on executive salaries THUS USING FEDERAL AND STATE DOLLARS TO PAD THE POCKETS OF CEO'S OF PUBLIC ENTITIES. (It's Wall Street----and its with your tax $$)

4. The LME's would act completely like private enterprises, all the while taking Federal and State Tax dollars and doing whatever the hell they wanted to with that money. It would excempt the LME's from ANY OVERSIGHT AT ALL.


Changes to bill would give more power to groups overseeing mental health services

Behavioral health authority powers

The new language to House Bill 1075 allows a behavioral health authority to operate similarly to a hospital authority or UNC Board of Governors, including:

Winston-Salem Journal

Published: June 18, 2012

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A late change to a bill giving more power to groups that oversee behavioral-health services in the state is raising concerns among advocates because the new language allows oversight groups to gain even more authority than the initial bill did.

The changes to the bill would create a new category of oversight group — a behavioral health authority. A BHA could borrow money and buy or sell property, would have no limits on executive salaries and would not be required to have any advocacy group members on its board.

The new language was inserted into N.C. House Bill 1075 on June 11 — five days after the bill had passed the House.

The substitute bill has been put on the Senate's agenda for Tuesday. If approved, the bill would return to the House for review and potential passage.

The changes would allow a local management entity (LME), such as CenterPoint Human Services, to become a behaviorial health authority after three years of serving as a managed-care organization (MCO) under the Medicaid waiver program being rolled out in the state.

The waiver program is intended to combine the management of Medicaid and state funds at the community level to reduce costs and add more accountability. MCOs would operate with fewer restrictions on how they manage the mental-health, developmental-disability and substance-abuse providers and services they oversee.

Becoming a behavioral health authority would take the oversight groups' level of independence to a higher level since public authorities can borrow money and buy or sell property. Authorities have limited or no local government oversight on their overall operations. They are allowed to file lawsuits and have a legal staff.

The initial bill already shifted much of the oversight of an MCO from county commissioners to the N.C. Department of Health and Human Services. The DHHS secretary would be required to approve a group's change to a behavioral health authority.

Local and statewide advocates expressed exasperation when informed of the new language. They worry that past mistakes in state mental-health reform will be repeated, hurting patient care and costing the state tens of millions of dollars in wasted spending.

David Cornwell, executive director of N.C. Mental Hope, said the proposals before the latest change already gave MCOs the best of being a private and a public entity.

"I don't see how it's conscionable for largely clueless legislators to consider such far-reaching changes to an already shattered system at a time the state faces multiple lawsuits over its (behavioral-health) services," Cornwell said.

Controversies over care

The bill is the latest development in the controversial recommendations submitted in September by Piedmont Behavioral Healthcare and the N.C. Council of Community Programs.

The bill's primary sponsors are state Reps. Nelson Dollar, R-Wake, and Justin Burr, R-Montgomery. The bill has bipartisan co-sponsor support.

Senate sponsors of the new language are not identified. Dollar and Burr could not be reached for comment about whether they approve of the new language.

Piedmont Behavioral Healthcare is the only local management entity operating as an MCO, but 11 MCOs, including CenterPoint, are supposed to be operating statewide by Jan. 1.

The council, led by CenterPoint executive director Betty Taylor, wants to eliminate limits on top executive salaries because MCOs compete with private-sector insurance companies for staff with specific expertise. Salary proposals would not require the approval of the DHHS secretary.

The bill removes the requirement that county commissioners approve the hiring of an MCO director, giving that responsibility to the MCO board. Advocates say many LME boards already operate as rubber stamps for their executive directors.
The benefit for county governments, particularly those with tight budgets, is that the changes could limit their liability for MCO overspending and put it on DHHS.

The new language represents substantial additions to those recommended by a 24-member General Assembly subcommittee before the legislative session began in May.
For example, advocates and analysts said they are concerned that although membership on a BHA board is expected to reflect expertise on local needs and priorities, including at least one family member or individual from an advocacy group is suggested only "when possible."

"There appear to be no absolute compositional requirements for the board of a behavioral health authority," said Mark Botts, an expert on mental health records and confidentiality at UNC Chapel Hill School of Government, in an email to advocates.

The initial bill required MCO board seats for a county commissioner, individuals or family members of those with behavioral-health issues, a member of the general public and professionals with expertise in health care.
Botts' email said a behavioral health authority would have even fewer requirements for board composition than in the current statutes or the previous version of the bill.

Laurie Coker, a local advocate who served on the General Assembly subcommittee, said a major concern is whether MCOs will be more responsive to customer demands.

"There have been troubling additions to the original bill on MCO governance," said Coker, who also serves director of the N.C. Consumer Advocacy, Networking and Support Organization.
"We could move toward much more privatized system management, in that public input and responsibility through counties could be cut out altogether from local management. Yet we supposedly are to have a public managed-care system, and not a private one."

Coker said the initial bill reflected agreements derived from "a level of critical discussion rarely had in committee meetings that involve such a variety of perspectives.

"North Carolina doesn't need further complication and confusion added to our already substantial system change. We need the inclusion of consumers, family members and county officials to ensure best outcomes locally."

Worries about unknowns

Al Delia, acting DHHS secretary, acknowledges that patients and caregivers are worried about the unknown. He said LMEs must clear several hurdles with state regulators before managed care is instituted, and mistakes are being fixed.

"DHHS believes this amendment represents a substantive change and that it deserves more thorough discussion," said Julie Henry, DHHS' acting director of public affairs.

"We are concerned about the limits the measure places on DHHS' authority and oversight. The amendment would exempt BHAs from provisions of the state mental health statute."

In an exchange reported by the Associated Press, Sen. Jim Davis, R-Macon, said "this whole thing scares me to death" during a discussion of the House bill before it was referred to the committee on mental health and youth services. The discussion, which lasted several hours, appears to have taken place before new language was inserted.

If lawmakers struggle with this bill, Davis asked, "How are we going to take care of the folks that this governance is supposed to be protecting?"

Sunday, June 17, 2012

Smoky Mountain Center LME has a LOBBYIST: Using Federal and State Monies to Pay for a Lobbyist, Intended for Medicaid?

What sleight of hand is this? Here is the lobbyist for SMC LME:

2012 Active Nelson Mullins Riley & Scarborough, LLP

Lobbyist Information...
Name: Joseph H. Lanier
Address: PO Box 30519
Raleigh, NC 27622-0519
Phone: (919) 329-3871

Gee, I wonder where they bury the cost of paying for the lobbyist in their accounting numbers?
So, Medicaid funds and/ or state funded client funds are being used to pay for a lobbyist to protect the interests of an LME that manages state and federal funds.

                                                            How can this be?

Medicaid Waiver: Western Highlands Network Provider Relations Employee Asking for Submission of Quality Management Plan Which is No Longer Required for Licensed Independent Practitioners

June 16, 2012

Dear Ms. Donna Oliver:

I sent the Provider Enrollment Application Request Form to Ms. Stein in Provider Relations last week. She came back to me in an e mail and told me to resubmit : my tax return (I sent it to Ms. Faulkner in January, 2012); my Market Analysis (I sent that to Ms. Faulkner in January, 2012); my Emergency Response System statement (I sent that to Ms. Faulkner in January, 2012). She also asked for a Management Plan.

I don't know if she realizes this or not, given that she is working in Provider Relations, but that was taken off as an item to be submitted by LIP's sometime ago. Therefore, I am not sending that.

I am resending all of these documents to you, personally, as apparently Ms. Stein does not know that the Quality Management Plan is no longer necessary, as per your own Provider Enrollment Application Request Form.

Please let me know what else you need.

Sincerely, Marsha V. Hammond, PhD
Here is Ms. Stein's e mail to me:

June 14, 2012

Marsha V. Hammond, PhD

Re: Status of In Network Agreement

Dear Dr. Hammond,
The In Network Agreement submitted by Marsha V. Hammond, PhD was received on June 14, 2012.  The following required materials were not included with the Application:
·          Copy of your emergency response plan - (i.e., plan you have in place for clients in crisis, when you are unavailable)
·          Market analysis demonstrating need for services (this could be information on the need for the type of services you provide in your service area)
·          Copy of most recent tax return
·          Copy of Quality Management Plan

Please submit the materials listed above within five (5) business days so that your request may be processed in a timely manner.  No further action will be taken until all of the documents requested are submitted, reviewed and approved.

Should you have any questions, please contact me at 828-225-2785, ext 2979.


Kelley Stines
Provider Network Operations
The old Provider Enrollment Application Request Form did require a Quality Management Plan, whatever that is for a solo, Licensed Independent Provider.

The new form states specifically that this is not required: here is the link:

Well, my goodness, since Friday of last week, WHN LME has removed all its links to Provider enrollment and stated this:

"Notice: As a waiver site WHN is no longer offering contracts to all interested providers, but will enroll providers based on the needs of the local recipients and on provider network performance. WHN became an operational waiver site as of January 3, 2012. WHN held its open enrollment period during the implementation of its 1915 b/c waiver, from April 2011 through December 2011". 
Does the right hand know what the left hand is doing? 

The above is a puzzle given that DMA is stating that the enrollment period continues for 'at least a year.'  

Avoid Working w/ United HealthCare, Medicare Advantage Plan, unless you are an IN-NETWORK PROVIDER: Refusing to pay When Medicare Clients Transfer On their Own

Well, I've got nothing better to do than to organize a bunch of paperwork to send to United HealthCare Appeals Department which entails printing out all of the patients' outpatient psychotherapy notes, creating a face page, sending a copy of it to the NC Insurance Commissioner as the client did not understand that a Medicare Advantage company can be an oxymoronic term. 

Almost one-half year's worth of weekly billing had been rejected x2 (it takes time to wind thru their system while I continue to honor my relationship w/ the client and see her) on the basis of:

                          Error Code: 0979: Member Self Directed Out of Network

So, for United Healthcare, if the Medicare provider is not 'in network' to that company, if the client picks that company as their Medicare Provider, you will not be paid. 

The woman on the line at United HealthCare, as she tried to talk the client out of switching back to Medicare insisted, "You could have seen oe of the providers we have" to which the client stated, "But I've been seeing Dr. Hammond since my husband died"-----indicating that the administration of United Healthcare has no idea of the nature of outpatient therapy. 

Hey: just switch over to that fella down the road.  Right.

She called them the other day to switch back to regular Medicare-----where I recommend ALL my clients to stay. 

I haven't had any recent trouble w/ Humana but two years ago they insisted I send all of my patients' session notes in order to pay me.  And by the way, that reminds me that the company that Humana had outsourced the outpatient mental health care only authorized until mid-year.

Whoopee!  More paperwork to create for Humana. 


Friday, June 15, 2012

Medicaid Waiver: Western Highlands Network Lost My Previously Sent Paperwork

This is recent correspondence w/ the Provider Relations Department at WHN LME:

Dear Ms. Stines associated with Provider Relations at WHN LME:

I advised you as per e mail, when I sent you that information, Ms. Stines, that I had sent the below enumerated materials to Melissa Faulkner back in February as she, at that time, requested them----APART from any form such as you just received .

Ms. Faulkner requested the tax return, the attestation of who I see, a list of my Medicaid clients, and my emergency response plan at that time-----before she would consider me being able to continue to provide Medicaid services. She did not ask for the form which you have in your hand. I assume there is a file somewhere on me at WHN LME.

If you cannot find those documents, please advise me and I will reassemble them.

A question:  I was under the impression that LIP did not have to provide a Quality Management Plan.  Why would they?  Its only me that is associated with my practice.  PLEASE ADVISE.  Thank you

Your credentialing process is piecemeal and frustrating. Using CAQH, as recommended by DMA, would put a stop to all of this. 


Marsha Hammond, PhD
cc: Dr. Stein, Medical Director, WHN LME

Arthur Carder; Nettie Jones, Buncombe Board Member (I will talk to her this weekend as she does not really utilize e mail)

On Thu, Jun 14, 2012 at 2:21 PM, Kelley Stines wrote:

June 14, 2012

Marsha V. Hammond, PhD

Re: Status of In Network Agreement

Dear Dr. Hammond,

The In Network Agreement submitted by Marsha V. Hammond, PhD was received on June 14, 2012. The following required materials were not included with the Application:

· Copy of your emergency response plan - (i.e., plan you have in place for clients in crisis, when you are unavailable)
· Market analysis demonstrating need for services (this could be information on the need for the type of services you provide in your service area)
· Copy of most recent tax return
· Copy of Quality Management Plan

Please submit the materials listed above within five (5) business days so that your request may be processed in a timely manner. No further action will be taken until all of the documents requested are submitted, reviewed and approved.

Should you have any questions, please contact me at 828-225-2785, ext 2979.

Medicaid Waiver under SMC LME: Does Anyone Know How to Get in Touch w/ People Writing the Mercer Report Overviews of the LME's?

Here is recent correspondence between myself and an official, with an unstated job title, at Smoky Mountain Center LME.  Oh, and by the way, the Medical Director of SMC LME never contacted me. :


Dear. Mr. Martin:

May I ask what your position is at SMC LME?

AS re: your below e mail indicating that 'many stakeholders' engaged in the credentialing process, did you ever ask any provider(s) about credentialing at all?
Or are providers not a 'stakeholder'?

I would like to know the answer to this question, if you would. I want to know if providers advised you that it was necessary to ask for 'Official College Transcripts." And I want to know how it is that up and down the chain of command of DMA, including you, the LME, not one person remembered that CAQH was a credentialing process already in place that providers have engaged in for years-----when it was stated by DMA to be a possible avenue.

Why are your organizations so slow? Millions of Medicaid $$ are being used up re: man/ woman hours processing piece by piece these credentialing applications---all asking for slightly different versions from the a la carte menu created by someone, somewhere, in DMA.

I believe that any provider who was a professional would have advised you that asking for the "Official College Transcript" was pointless as one's licensing board would have already have reviewed that matter.

You may think I am making a pretty big deal of this but the fact of the matter is, is that your LME has hundreds of provider credentialing packages to address in less than 2 weeks.

And according to the Mercer Report you were supposed to have been fast-tracking that matter. And you were behind in April, 2012, according to the Mercer Report.

But instead, what I get, is non-responses to my questions. So, somebody/ somewhere, perhaps as associated w/ my blog, will know how to get in touch w/ the people who do the Mercer reviews and I will tell them just how your credentialing process is going so that they will have some data from some entity other than the LME who undoubtedly paints a cherry picture of things.

You're failing at your credentialing. WHN LME failed/ is failing at its credentialing process.  They can't even keep my pieces of paper together but lose them and ask for them again.  If you were using CAQH, none of this would happen.  And it would all be paperless. 

I still have no response from the Provider Relations Department, either by e mail or phone (I approached it from both of those) and it is 3 business days hence.

I will fax to my doctoral degree university, University of North Texas, which is clearly indicated at CAQH and probably at the NC Licensing Board website, a request for an Official College Transcript so that my package will be complete. And I will go over and ask Matt Holmes, MD, psychiatrist of the ACT team, and Sandy Howard, PNP, for letters of reference. I have no psychologists to ask as there are no psychologists working under SMC LME catchment area that I know of.   

Feel free to pass this e mail on to anyone you like.  Its on the public domain at my blog, in any case.  My intention is to documents for providers and reporters and anyone else who is concerned, just how badly this Medicaid Waiver matter is going. 


Marsha V. Hammond, PhD

cc: DMA ; blog

On Thu, Jun 14, 2012 at 8:25 PM, Craig Martin wrote:

> Good evening Dr, Hammond.

> Thank you for taking the time to reach out to us about the way credentialing has been so problematic for our network LIP's. I do apologize  to you for this.

 As I imagine you've heard from others, it took work on the part of many stakeholders to move to more standardization by LME/MCO's in the credentialing process.

> SMC's LIP's will benefit from this in the future.....and I regret the approval for  this change came so late in the game.

 I spoke with Dr. Wilson who has contacted you today.

Thank you for your patience as we work to implement the changes in Medicaid benefit management that will over time help improve provision of needed services for those we mutually serve.

> Kind regards,

> Craig


> Sent from my iPhone

Thursday, June 14, 2012

To the Medical Directors of Western Highlands Network and Smoky Mountain Center LME's: Please allow Licensed Providers to Use What Already is in Place & STOP RECREATING THE WHEEL

FROM: Marsha V. Hammond, PhD  Clinical / Health Psychology  NC Licensed Psychologist

cell: 828 772 1127  e mail:

TO: Medical Directors of SMC and WHN LME's

RE: credentialing boondoggle at both LME's re: Medicaid waiver: CAN WE PLEASE USE THE CAQH CREDENTIALING SYSTEM as recommended by your own DMA?

Date: June 14, 2012

Dear Dr. Stein (, Medical Director for Western Highlands Network LME and Dr. Patty Wilson, Medical Director for Smoky Mountain Center LME:

Why recreate the wheel over and over again, LME by LME, across the state, in terms of credentialing if there is already something in place? Your own DMA has recommended the use of the CAQH credentialing process. All the providers have submitted all the information you need to CAQH----YEARS AGO.

There is a July 1, 2012 deadline for credentialing for SMC LME. Thus, my questions. The credentialing process for both LME's is unweildy, has different requirements, requires 'Official College Transcripts', letters of reference (for one, not the other LME), tax returns (for one, not the other LME), etc. It is very obvious that the entire credentialing process is a complete mess: I seldom calls returned from Provider Relations; I get no answers to my e mail; I cannot turn up a live person when I call.

Under the Medicaid Waiver, your credentiailing process IS NOT WORKING.

As you know, I spoke with Dr. Lekwauwa who is in the Mental Health Division of DMA this afternoon. She indicated to me she would speak with the medical directors of both LME's to see if we can't cut to the chase here re: this vastly inoperable credentialing process w/ both these LME's re: Licensed Independent Providers (LIP) who have been Medicaid providers FOR DECADES.

All LIP's utilize the CAQH credentialing system which is demanded by other insurance companies. DMA, according to its web page, is interested in utilizing CAQH for credentialing.

Here is the CAQH web page:

Here is what the DMA webpage states:


LIP (Licensed Independent Practitioner) Credentialing

As noted in the last March Special Medicaid Bulletin, LME-MCOs have been working with
stakeholder groups on streamlining the enrollment process. As of this date, the following LMEMCOs will be using the Council for Affordable Quality Healthcare (CAQH) to gather credentialing data for Licensed Independent Professionals (LIP):
• CenterPoint Human Services

• CoastalCare (Southeastern Center and Onslow Carteret)

• The Durham Center/Cumberland/Johnston/Wake


• Partners for Behavioral Health Management (Pathways, Crossroads and Mental Health



• Sandhills

• Smoky Mountain Center

• Western Highlands Network

DMA will publish updated CAQH information as other LME-MCO make decisions about
working with enrollment and credentialing vendors.

The contracts between CAQH and the LME/MCOs listed above are being currently developed.

Future Medicaid Bulletins will notify providers when they can begin using the CAQH on-line enrollment process.

CAQH provides a streamlined, secure method for electronic data collection – at no cost to the
provider. Providers keep total control of the data, authorizing access only to the participating
LME-MCOs of their choice. Revisions made by the provider are available instantly to
authorized LME-MCOs.

CAQH is a national provider credentialing process that providers update every 3 months. As associated with that process, the CAQH people had to have received one's licensing information, etc.

Do you really want the entire batch of NC LIP's to have to complain about this impossible credentialing process which has been hoisted by the LME's undergoing the knife of this Medicaid Waiver?

Do you really want Medicaid patients to be without care----in the hospital, spending Medicaid dollars because the LIP's could not get their paperwork thru the LME's? Because this is what is going to happen and HAS been happening.

Do you really need to spend all the administrative $$ that the LME's are utilizing to put into place each LME's credentialing process when there has been one in place for years, namely, CAQH?


Marsha V. Hammond, PhD, Licensed Psychologist, NC

Ureh Lekwauwa, MD, at NC DMA is e mailing Directors of Medical Services at SMC & WHN re: Possible Use of CAQH instead of Credentialing Nightmare Currently in Place

I called Steven Jordan's office (Director of Mental Health) in Raleigh re: the absolute travesty associated with being credentialed by the petty fiefdoms also known as Western Highlands Network and Smoky Mountain Center LME-MCO.

Thank God I was passed to Ureh Lekwauwa, MD, a medical director there in his office and she indicated she was going to e mail the Medical Directors of the two LME's to see about putting more quickly into place the CAQH credentialing process which would dead stop all of these shenanigans immediately.  She is at:; tel: 919 733 7011.

CAQH has ALL the data re: credentialing of providers and we, as citizens of the state, could save MILLIONs of dollars by utilizing what is already there instead of petty beaurocrats telling us to send in this piece of paper, and then that one.

I told her it was a complete nightmare out here.  She said, 'I know.'

Godalmighty: will not someone relieve us of this troublesome credentialing process?

Here is the letter I sent to her and mental health reporters and activists:

Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 1127
e mail:
NC Mental Health Reform blogspot:

June 14, 2012

RE: credentialing nightmares at SMC and WHN LME

Dear Dr. Lekwauwa in Mental Health at DMA/ NC:

I was so relieved to find someone who understands the massive impossibility of this credentialing nightmare taking place.  SMC LME states online in its FAQ's that was trying to process 600 applications MONTHS AGO.  If I sound a little agitated it is because I have spent dozens of hours trying to move this credentialing process forward----going to board meetings, driving to board meetings, asking for assistance, calling up Provider Relations for assistance---seldom getting any useful information back.  I have to see my clients, not blog-on about this hopeless system.

I've been a Medicaid provider for over 10 years.  I have kept people out of the hospital thru outpt therapy and saved the state thousands of dollars over that period of time.  My clients can call me anytime of the night or day.  I save the state $$$$$$$$$$.

We are now up against a July 1, 2012 deadline as re: SMC LME and I have CRITICALLY ILL patients who will could into the hospital if they cannot be seen on an outpatient basis.

PLEASE allow the LME's to utilize the CAQH credentialing in lieu of their demands of sending in 'official college transcripts' and 'letters of recommendation' and 'CV''s' , etc.

*WHN requires a tax return; SMC does not

*SMC requires a CV; WHN does not

*SMC requires two letters of recommendation from 'like' mental health providers; I don't KNOW any psychologists under SMC LME catchment area. I cannot even get the question answered by anyone in provider relations as to 'will a psychiatrist do' re: this letter.

*SMC requires an 'Official College Transcript'; WHN removed that rule when I challenged them last year.

We are DYING out here re: this Medicaid waiver.  There is no standardization anywhere.  All the Medicaid providers have thrown up their hands and run away.

Here is a list of the posts on my blog over the past year re: this mess.

PLEASE help us.  PLEASE.

All professional providers, known as LIP, Licensed Independent Practitioners, have been on CAQH FOR YEARS.

Why Did NC Medicaid/ DMA Not Require LME's to Utilize Already in Place CAQH Provider Credentialing Process?: WHY?

2. WEDNESDAY, JUNE 13, 2012
Smoky Mountai Center LME Sets Medicaid Waiver Deadline of July 1, 2012 and Yet Providers Cannot Easily Communicate with the Provider Relations Department
FROM: Marsha V. Hammond, PhD

3. Under Medicaid Waiver, Smoky Mountain Center LME Requires Different Items to be Submitted vs WHN LME, Including an 'Official College Transcript'

4. Under Medicaid Waiver, Western Highland Network's Piecemeal Provider Application Process

5. WEDNESDAY, JUNE 06, 2012
NC Department of Medical Assistance (Medicaid) indicates Open Enrollment for Providers for 1 year but LME's Say Something Else

The Medicaid Waiver is Failing Miserably at the Level of Services and Costs to Taxpayers
Richard Craver who writes regularly on NC mental health issues, wrote the following article at the Winston-Salem Journal recently:

6. 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

7. TUESDAY, MARCH 06, 2012
Letter to NC Comm Co-Chairs:WHN LME Medicaid Providers Being Denied Access to Medicaid Authorizations: URGENT

The Emperor Has No Clothes: Medicaid Waiver Managing only Citizens 18 and over When Bulk of Medicaid Recipients are 18 and Under

The Medicaid Waiver being hoisted upon providers and clients (some call them 'consumers') alike is only associated with ADULT Medicaid Services and/ or I cannot discern how many 'Health Choice' Medicaid youth consumers are folded into the population numbers from the DMA information below. 

What a sleight of hand!  It looks like all these Medicaid consumers are about to be serviced by these LME-MCO's, wolfing down the money for administrative purposes, when, in fact, Health Choice consumers are OUTSIDE of this management. 

See below the chart from a NC DMA website indicating consumers within the 4 age categories (you can click on the link and get a better view but I cut and pasted it also).

Here is how NC DMA describes Health Choice, which is part of NC Medicaid:

North Carolina Health Choice (NCHC) for Children is a free or reduced price comprehensive health care program for children. The goal of the NCHC Program is to reduce the number of uninsured children in the State to ensure that the population served will be healthy and ready to learn and work. If your family makes too much money to qualify for Medicaid but too little to afford rising health insurance premiums, your child(ren) may qualify for NCHC.

If a youth has 'Health Choice', this is not being monitored by the LME-MCO's as associated w/ this Medicaid waiver. 

Notice below how that the bulk of the population across the LME's is in the population aged 0-17+ (meaning anyone less than 18 years of age).

Thus, all this Medicaid Waiver money flooding into the administration coffers of the LME-MCO's----all those new hires w/ fat salaries of 50 grand/ year plus benefits-----is mostly going towards administration.

Gee, what does this remind me of?

I know! I know!

The matter of the Medicare Advantage Plans (Humana; United Health, etc) having administration overhead of 15+% with Medicare having administration overhead of 5% or less. 



page 15:

Table 2. Medicaid Eligible Individuals September 2010 for RFA Waiver Application

Minimum Requirement #1  Source: DMA’s management information system, DRIVE Client-Population table, report date Jan. 12, 2011  LME cod e LME Name

age=0-2    age=3-17   age= 18-64   age= 65-200  Grand  Total

101 SMOKY_MTN 11,060 36,002 34,018 13,069 94,149 83,089

102 WESTERN_HIGHLANDS 10,691 33,437 31,396 10,556 86,080 75,389

108 PATHWAYS 9,053 29,529 29,070 7,890 75,542 66,489

109 CATAWBA 5,783 17,800 14,106 4,436 42,125 36,342

110 MECKLENBURG 21,674 61,024 44,748 9,572 137,018 115,344

112 PIEDMONT 16,040 48,574 37,453 10,531 112,598 96,558

201 CROSSROADS 5,700 18,129 14,679 5,038 43,546 37,846

202 CENTERPOINT 12,327 37,401 29,731 8,568 88,027 75,700

204 GUILFORD 10,788 32,063 25,821 6,871 75,543 64,755

205 ALAMANCE_CASWELL 4,308 12,452 9,863 3,315 29,938 25,630

206 OPC 3,716 10,716 8,677 2,979 26,088 22,372

207 DURHAM 6,905 17,852 14,496 2,948 42,201 35,296

208 FIVE_COUNTY 6,008 20,425 21,500 6,906 54,839 48,831

303 SANDHILLS 13,964 43,983 35,369 10,795 104,111 90,147

304 SOUTHEASTERN_RE G 9,054 30,277 29,933 8,702 77,966 68,912

305 CUMBERLAND 7,681 24,344 23,035 3,893 58,953 51,272

307 JOHNSTON 4,142 12,670 10,008 2,841 29,661 25,519

308 WAKE 14,924 40,437 27,235 6,726 89,322 74,398

401 SOUTHEASTERN 6,654 20,689 19,908 4,815 52,066 45,412

402 ONSLOW_CARTERET 3,769 11,108 10,734 2,533 28,144 24,375

405 BEACO N 7,346 23,388 20,983 6,797 58,514 51,168

407 ECBH 13,182 42,287 41,025 13,631 110,125 96,943

413 EASTPOINT E 8,933 27,914 23,081 7,700 67,628 58,695

Total 213,702 652,501 556,869 161,112 1,584,184 1,370,482