Friday, July 06, 2012

Medicaid Waiver: Vastly Different Strategies Between WHN LME and SMC LME: One Blocks Providers While the Other Invites Them In

Here is the letter I just received from the WHN LME Provider Relations Director, Melissa Faulkner, restricting me to seeing the Medicaid consumers that I currently have and no others:

"July 4, 2012

Marsha V. Hammond, PhD

Dear Status Provider Enrollment Application Request:

We would like to thank you for your interest in enrolling with Western Highlands Network (WHN). Your request has been approved for Client Specific Applications. The enclosed application allows you to request client specific agreements to serve WHN enrollees.  The award of a client specific contract does not permit you to serve any additional enrollees of the WHN Network.  At present, WHN is aware of the following enrollees in your care:------------Please do not admit any new WHN enrollees without prior approval from WHN....."

Contrarily, SMC LME seems to be moving, even though chaotically, towards enrollment of all legitimate providers (best I can tell) and as per my phone conversations with Patty Wilson, Senior Provider Relations Manager.

Why is this? If I were paranoid I might think they were trying to shut me up.

So, here is my letter back to Melissa Faulkner:


Dear Ms. Faulkner, Director of Provider Relations WHN LME:
Thank you for your reply. 
May I inquire as to your rationale regarding your non-desire to allow me to be an In-Network Medicaid Provider when I have 40 years of working in health care settings, w/ over 15 of them as a doctoral level psychologist? 
I have no ethical violations, no violations of any kind and am better trained than most of the mental health providers in the area. 
Moreover, because of my advanced training, I have expertise in working w/ people w/ severe persistent mental health issues and as you know, the ACT teams provide no therapy for these seriously mentally ill people-----the ACT teams being a source of referrals for me as those people become more stabilized such that they can benefit from therapy. 
Thank you in advance for your reply. 
Marsha V. Hammond, PhD, Licensed Psychologist, NC
cc: Ryan Whitson, Board SMC LME; Arthur Carder CEO;
Ureh, Lekwauwa, MD, NC DHHS; Sally Cameron, Executive Director NC Psychological Association


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