Friday, July 27, 2012

Medicaid Waiver: Emergency Board Meeting for WHN LME re: 3$ Million in Red & Damning Mercer Report

I received an e mail from the CEO's Executive Secretary yesterday indicating there would be an 'emergency meeting' of the WHN LME Board re: the $3 million short-fall.  The agency is only 6 months into its Medicaid Waiver.  There is no more money available; that is part of the Medicaid Waiver. When its gone, its gone, lest the LME turn to the counties.  You think they're going to come up w/ money? I don't think so.

And, I still sit and wait to get my Out of Network (OON) Provider application through.  Since WHN LME will not be satisfied w/ 2 letters or recommendation (from this Medicaid provider who has been in the system for over 10 years) on company letterhead, I have to get my two references to fill in a form.  I dare not have them send the information to WHN LME untethered from my OON application for it will get lost.

And I just went over the 10 page form for my Medicaid client w/ a severe sexual abuse history who dissociates.  Prior to the Medicaid Waiver, I had no paperwork to turn in except for the one page Value Options 'Request for Reauthorization.'

So, now what we have is an LME consuming most of the Medicaid money, going broke, greatly diminished services to Medicaid clients and the specter of a SMC LME take-over. WHN LME is sandwiched in between the two regions of SMC LME. 

With this continuing kind of management, that is undoubtedly what will happen. 

This is not particularly a good thing either.  SMC LME may be better organized (there is a lot to be said for that) but they are requiring webinars re: the clinical and billing issues which is 8 hours of unpaid provider time.  Plus, the person who organizes that at SMC LME failed to put me into last week's classes though she said she would and so now I have to wait until August 8th which means that I have no ability to bill for my Medicaid clients under SMC LME which started its Medicaid waiver on July 1, 2012.

And, to my mind, a sad note: here is a video of SMC LME employees tauting the joys and benefits of the Medicaid Waiver on you-tube.  Maybe some of them are in hoodies because they do not want to be identified:

Oh, gee: 'this video has been removed by the user'

Well, to describe it would be difficult but basically it was the IT/ Utilization Management Departments of SMC LME dancing around, whooping joyously about the benefits of the Medicaid Waiver. 

I guess the CEO nabbed it before it went viral but unfortunately for him, plenty of people saw this silly video which outlined an LME's employees, pulling down 50+ grand/ year w/ benefits, w/ time to make a goofy video about a subject which has done nothing but shortchange providers and citizens of NC who have mental health challenges.
Whoopee! Let's hear it for the Medicaid waiver.

WE NEED A ONE PAYOR SYSTEM not all these bits and pieces scattered everywhere.


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