Sunday, July 01, 2012

Why Did WHN LME Hand Out Paperwork at the June 22, 2012 Board Meeting Indicating that the NC Council of Community Programs Which Oversees the LME's Has Created a 'Central Repository' for Provider Re-Credentialing When It Does Not Exist?

FROM: Marsha V. Hammond, PhD, Licensed Psychologist, Asheville, NC e mail: cell: 828 772 5197

TO: The Two Board Officers for the NC Council of Community Programs, overseeing the LME’s in NC:

1. Betty Taylor, Area Director President CenterPoint Human Services 4045 University Parkway Winston-Salem, NC 27106 (336)714-9118

2. Ken Jones, Past President , Area Director Eastpointe 100 South James Street Goldsboro, NC 27530(919)731-1133

AND, Regional Representative for the Western part of NC:

3. Ed Tarleton Area Board Member Smoky Mountain Center PO Box 183 Glendale Springs, NC 28629 (336) 973-8618;

4. Arthur Carder Area Director Area Director Pathways Western Highlands Network 356 Biltmore Ave Asheville NC 28801;

5. Rhett Melton Gastonia, NC 28054 Asheville, NC 28801 (704) 884-2501 (828) 225-2785

DATE: June 28, 2012

RE: NC Council of Community Programs Handout at the June 22, 2012 WHN LME Board Meeting indicating there to be a ‘Statewide Issues Resolution’ re: Provider Credentialing

Dear Ms. Taylor, Mr. Jones, Mr. Tarleton, Mr. Carder, and Mr. Melton:

I am writing to inquire about the matter associated with a hand-out at the June 22, 2012 WHN LME Board meeting. It is on the NC Council of Community Programs letterhead. On page 2, it indicates that there has taken place a “Statewide Issues Resolution” as associated with the very pressing issue of “Need standardized application process for providers across all LME-MCO’s. ” Moreover, on page 2, in the same box, the memo states that there has been the creation of a “Central repository established for provider application.”

I am currently engaged in provider credentialing for SMC LME and WHN LME . The applications are completely different. Therefore, there is obviously no ‘Central Repository’ or even a similar application process.

For WHN LME, the provider re-credentialing takes place in poorly planned stages with the first stage being the submission of one’s tax return; statement of what will occur if there is a patient emergency; a declaration of what kind of expertise/ patients one has been seeing. Then one waits for months to hear an answer. I have been trying to be re-credentialed by WHN LME for over 6 months.

For SMC LME, there is one stage of re-credentialing which includes the following: 20 page form associated with items which one has already outlined in the demanded CV; copy of my psychologist license; copy of any other states’ psychologist license; my doctoral university transcript; CV; 2 letters of recommendation from ‘similar’ practitioners’; 2 page checklist which must be filled out; W-9 IRS form; face page of malpractice insurance.

Do you see any similarities between those two re-credentialing processes?

This is a massive hardship for providers. It is therefore an injustice as per NC citizens. If you need details on that, please see my blog which has been documenting this:

So, why does your paperwork indicate that this ‘Central Respository’ has been created----- when it has not? And moreover, why didn’t your organization consider the difficulties that providers would experience as associated with the a la carte method which has been utilized by the various LME’s in order to re-credential already Medicaid credentialed providers?

It appears that your organization is simply a lobbying mechanism (you state you have 2 lobbyists: for the LME’s. And, the LME’s appear to have massively failed regarding their No 1 mission which is to smoothly transition this Medicaid Waiver. Since 2002 the LME’s have simply been managing state-funded clients (those who cannot qualify for Medicaid and have no other health insurance). That is ALL the LME’s have been doing, to the tune of millions and millions of $$.

There is no standardization for the re-credentialing of providers and by your non-fulfillment of what you state you have done e.g., “creation of Central Repository”, your continued existence appears to be simply a mechanism to create work for the LME’s who continue to absorb most of the Medicaid money rather than it being employed for the treatment of NC citizens.

I am thanking you in advance for your response. I want to know why your letterheaded statement indicates that there is a ‘Central Repository’ when obviously there is not one. If there is a ‘Central Repository’ for re-credentialing, a matter which was suggested by NC DHHS as regarding the use of the CAQH credentialing process----which providers have been using for years----then someone needs to inform SMC LME and WHN LME that it’s there.


Marsha V. Hammond, PhD, Licensed Psychologist, NC


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