Monday, August 20, 2012

Defunding of Sheltered Workshops is Surely Related to Stacked Services Consuming Most of Medicaid $$ as the LME/ MCO's refer Medicaid Patients for Yet More Stacked Servies

This is my reply to a long article by the fine mental health writer/ journalist, Richard Craver:

This is a bit of what he was writing about, which it a picture of 75 families of undoubtedly mostly Developmentally Disabled children/ adults, who are begging for services to continue and I will eat my hat if these people are not the ones who are massively benefiting from the stacked services that the private mental health care companies are servicing.  I'm not trying to get on the wrong side of these families, but they do not seem to realize what is taking place re: tax payers' money re: the stacking of services within these private companies.  What has happened, in part, re: this population, is that all the funding for JOBS---remember those?-----and sheltered workshop jobs at that----has been cut----such that these people are left w/ few options as to what to do w/ their time.  So, they go to the private mental health care companies who stack services.

Relatedly, I had a call from a woman from HVO this past week, re: me trying to get a Cerebral Palsy client of mine into HVO in Waynesville, ,which employees disabled people, under the CAP plan, which SMC LME administers.  What SMC LME tells me is that they give HVO a fixed (and diminishing) amount of money for these positions and so you are back to the mental health care companies being the care-givers for these people when what would be so much better for them would be to have a sense of self accomplishment/ working/ and being around other people.  The HVO woman begged me to call my state representatives re: the defunding of these positions.

Here is what Craver wrote, in part:

"....Whisenhunt said she is opposed to CenterPoint's request because $1.53 million is a lot of taxpayer money to tie up in a sour economy.

She also said she's put off by CenterPoint's unwillingness to search deeper for internal solutions. CenterPoint's budget for fiscal 2012-13 is $93.2 million, according to its website.
"$1.5 million is a small percentage of its overall budget," Whisenhunt said. "Surely to goodness they could come up with that amount through cutting their expenses rather than cutting consumer services.
"The county has had to make due with what we have for years now. Why can't CenterPoint?"
CenterPoint officials have been putting pressure on Forsyth commissioners, telling them that without their action, local residents will lose services. At last week's Forsyth commissioners meeting, about 75 people lobbied the board to provide the allocation. Several speakers shared poignant stories of dealing with behavioral-health issues, whether their own or those of family members...."
Here is my comment to his article: 
"Western Highlands Network (WHN) LME/MCO in western NC will, undoubtedly, also be asking for 'loans' from the local counties.  The CEO for 12 years, Arthur Carder, was fired about 3 weeks ago because of this shortfall which featured, in addition, to the sound of the screen door slamming as he walked out, the Chief Financial Officer claiming she had 'no idea.'  Right.

So, why are these LME's plowing thru so much money re: this Medicaid Waiver.  Well, first of all, they have limited the independent practitioners from becoming In Network Providers (I have been denied access to this and my 45 PAGE---yes, you heard right----application is still awaiting approval and I have been trying to get approved since 1.23.2012).  Either that, or given the 45 page application process, many independent providers have simply said, 'NO THANKS."

Why are independent providers, such as myself, a Licensed Psychologist, useful for Medicaid clients?  Because we are the well trained mental health providers.  We are the little people who do not work for the private companies who are STACKING SERVICES which is causing these over-runs.  We follow our chronically ill patients for years or for as long as it takes until they are considerably better which would mean that they seldom go into a psychiatric unit which costs thousands of dollars/ admission-----for they are able to call upon us when a mental health emergency takes place.

What am I paid to see a client for 45-50 minutes, one session? As a doctoral level psychologist, for a CPT code of 90806, mostly what Medicaid will approve, WITH ME SEEING THE CLIENTS IN THEIR HOMES which is never done by these companies, I am paid approximately $80/ session.  We are paid what we are worth whileas the companies hire people who are lesser trained and an hourly fee, with the profit going to the founder(s) of the company.  Capitalism at its best!

Returning to the matter of the private companies, and the billing by them which is causing these over-runs, what does 'stacking services' mean? It means that when a Medicaid client is 'admitted to a company, to whom they have been referred by the LME/ MCO (I never get referrals from either WHN LME or Smoky Mountain Center LME), they are then able to receive an array of Enhanced Benefits Services such as PSR (Psychosocial Support) which can meet 5 x/ week, for 5 hours/ day; additionally the client can have a 'therapist' (not a psychologist) via that agency; additionally, the client has a Community Support Team, which refers to all the other ancillary services.

All these services are then billed to Medicaid and the LME's allow this massive, inefficient, in my opinion, expenditure because of the model that was proposed as associated with NC Mental Health Reform which was one associated with REHABILITATION.  Chronic mental illnesses, which the people have who receive treatment by these companies which were created when the NC State Legislature created mental health reform in 2000, are CHRONIC ILLNESSES and there is little point in throwing megatons of money at the issue for 3 month spurts at a time, only to find that the chronically ill person has---surprise-----residual symptoms.

Do you 'rehabilitate' diabetes? Do you 'rehabilitate' HIV? Do you 'rehabilitate' hypertension? You know the answer and the answer is the same re: people who have SPMI,Severe Persistent Mental Illness.

Until the MODEL is changed and it is recognized that these are chronic illnesses (OMG: mental illness is not spotty and intermittent), the LME/ MCO's who refer patients to the companies, will continue to come around to the county commissioners with their hands out.

Good luck.  Meantime, you might consider allowing the well trained mental health providers to do their jobs instead of creating massive barriers to their functioning.  That way, you would save money.

And the county commissioners might even puzzle over just how much money is being wolfed down by the LME/ MCO who is strictly an administrative paperwork machine.  All they are doing is managing paperwork.  I would be very interested in knowing how many Medicaid $$ are going towards the usual 50+ grand/ year salaries plus benefits for the employees of the LME/ MCO's.  And how many $250,000 'medical directors' there are.  And how many $150,000/ year CEO's there are.  And how many ignorant Chief Financial Officers pulling down at leats $100,000/ year----there are.

Oh, did I mention that we need a ONE PAYER SYSTEM and Medicare is the model for that? With its 5% administrative overhead (the paperpushers), and with the private insurance companies or 'Medicare Advantage' (oxymoron if there ever was one) companies like Humana/ United Health Care, etc and their 15%+ administrative overhead-----what do you bet that the LME/ MCO administrative overhead is approaching 25% of NC Medicaid money----for the delivery of mental health services to VERY FEW PEOPLE.

Marsha Hammond, PhD, Licensed Psychologist, Asheville, NC
see my blog which can be found using my name and its title 'Madame Defarge'; if I print it here, this page will not publish w/ a URL. "


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