Thursday, August 16, 2012

Why ALL the NC LME's Will Suffer Shortfalls: the Private MH Companies Creates by NC Mental Health Reform are STACKING SERVICES

I posted this as re: my comments associated with the article associated with Forsyth County commissioners being asked to cough up some more money for that part of the state as associated with the Medicaid Waiver.  Sorry: don't do it.  Until the commissioners figure out that it is the STACKING OF SERVICES BY THE PRIVATE COMPANIES which was allowed by NC DHHS, each one of the LME's is going to ask each county's commissioners for a 'loan' re: this Medicaid Waiver.  These are my comments and this information is anchored by the article associated with the 'reason' that was given as to why WHN LME was $3 million in the hole pertaining to the firing of the CEO for 12 years, Arthur Carder.

Here is the news article and below that is my comment which was posted:

UPDATE: Backers of CenterPoint Human Services ask Forsyth County Board for $1.5 million

"The LME's are suffering a shortage of money due to the process that NC Mental Health Reform put into place, as deemed by the NC state legislature, which was to create private companies (the argument was that competition was 'good' for the business: nevermind that mental health consumers have no money and it is public money e.g., medicaid, medicare).

These private companies STACK SERVICES which is to say that if a Medicaid consumer is referred to a company by the LME, which they always are (I have not been allowed, as a solo provider to work as an In Network Provider for Western Highlands Network LME in western NC), the clients/ consumers are given the following services by such a company: CST (Community Support Team: enhanced beneficts); therapy; PSR (Psychosocial Rehabilitation; the client attends 'classes' 5 days/ week, 9 to 3 pm, as associated with a more or less cognitive rehabilitation model), etc..

Arthur Carder, CEO of WHN LME for about 12 years now, was fired about two weeks ago as WHN LME had a shortfall of $3 million and the reason given in the well written news article (see my blog: google up: Marsha Hammond Madame Defarge: if I put the URL in here, this will not post) was that STACKING of services had caused the shortfall.

So, NC DHHS, in conjunction w/ NC State Legislators, have created the mini-monsters which are the private companies which stack services.

I have several clients who continue---as they have for some time---to receive therapy services from me (they are dually eligible clients, w/ Medicare always being primary and paying the bulk of the fee and medicaid being primary) who receive Medicare services from me and these stacked services which are paid for by Medicaid ONLY.

This is idiocy.  I am a doctoral level psychologist, who knows well my clients, is able to render an array of services for clients, and yet these private companies, put into action by NC Mental Health Reform, are going to bankrupt Medicaid as associated w/ mental health services in NC due to the STACKING OF SERVICES.

This asking for money will not stop until this STACKING OF SERVICES matter is tackled.

Oh, did I mention that we need a ONE PAYER SYSTEM which would collapse Medicaid and Medicare into one entity such that these kinds of duplicitous services could not take place. "


Blogger James Sidney Hare said...

Marsha: I am a frequent reader of you blog which is very informative, and, for the most part, "right on the money." I've worked for 3 private MH/SA agencies since MH reform began. I've been doing this 25 years. Just FYI, we often ask for multiple authorizations for services, indv therapy, group therapy, and med management,but usually only ONE of those services is used frequently. I clearly do not think "service stacking" is the culprit. Jimmy Hare, MSW/LCSW, Candler

10:02 PM  
Blogger dog-inheaven said...

I don't know Jimmy... I think that may have been the case but I'm seeing now, one or two agencies we both are familiar with are "stacking services". For example, SAOP, Basic Benefit client (substance abuse out-patient client)...attending group therapy and individual therapy can also attend a mental health group, let's say "anger management" and be authorized for it. In addition they can also receive CST and med. management at the same time. So we have conceivably, 1.SAOP group ($19.00 per event) 2.Individual therapy (56.00 per event, not really sure about the reimbursement rate) 3. Med management (not sure what this is billed but they do see the NP once a month ),CST (not sure what that is billed per event but it is enhanced service) and anger management group (19.00 per event). Now...they can only come to one of those group events (Anger Management or SAOP twice a week. The agency doesn't make a lot of money off the basic benefit group, only 39.00 a week per client, not counting the individual sessions which they can have 2 a month. Let's say with one client, the agency can be reimbursed 116.00 for individuals, 39.00 per group x 2 times a week = 78.00 per week = 312.00 x 15 clients = 4,680 a month + whatever charge to see the NP once a month and what ever can be billed for CST services. What I'm seeing is a move to push a lot of smaller private practices out of the picture. One of the down sides of being CARF agency who receives money from the LME is that they also are expected to provide 24/7 crises management (remember too that many of the chronically mentally ill clients, high acuity and case management needs will be referred to you by the LME. You become their provider home and responsible for the majority of their care). This is one reason many smaller agencies have chosen not to become involved with the LME. Now…there is also the enhanced service, Intensive Outpatient Clients...the reimbursement rate for them is about 140.00 per event. This includes individual therapy, case management, and crises management. They too can see the NP but not receive CST. If there are 12 attending an IOP group (enhanced benefit) that is 3 groups a week (3 events-140.00 per event x 3 events per week = 420.00 x 12 clients = 5,040.00 per week x 4 weeks = 20,160.00. That is if everyone shows. To make sure you actually schedule so that you earn about that amount consistently you keep your group size at about 16 people. Add NP visits at one a month but not CST. I didn't include the amount of money earned from substance and mental health assessments which runs about (100.00 to 120.00 per event). My math might be off. It is 4:30 AM. The positive thing about being involved with the LME is the referral piece and the given reimbursement (if your agency is billing correctly). The agencies we are familiar with have at least two on going IOP groups and about 6 SA Basic Benefit groups. They recently have added an assortment of mental health groups like anger management, seeking safety, etc which do not seem to be getting off the ground but their substance abuse groups are soaring. In the last year since they took over one agency , they've cut their staff from 13 SA counselors to 2 and recently added a third. They have always had 4 mental heath counselors who have carried huge client loads and now they have cut that to 3 counselors. I know of three other big agencies in town who work with WHN and see smaller agencies being totally pushed out of the picture when it comes to IPRS and Medicaid monies.

4:24 AM  
Blogger dog-inheaven said...

I didn't mention burn out, burn out, burn out... these are large companies great expectations regarding money. They micro manage and burn their staff out. There is high turnover with both clinicians and administrative support staff. When a large cooperation took over a smaller provider two years ago they began cutting staff by 35% and then over the past year cut staff by at least 80%. Who is making the money?

4:44 AM  
Blogger shi zhan said...

モンクレール レディースが大人気なブランド品です!2012 年 5 月 9 日に、アメリカ合衆国で彼女は東南アジア初の旗艦店をオープンしたことを伝えました!旗艦店が設計して、衣料品ブランドは東南アジアで画期的な一歩を立ちました!オープンするとモンクレール ベストが大きな話になりました!人気が高いです!

3:21 AM  
Blogger shi zhan said...

モンクレール レディースが大人気なブランド品です!2012 年 5 月 9 日に、アメリカ合衆国で彼女は東南アジア初の旗艦店をオープンしたことを伝えました!旗艦店が設計して、衣料品ブランドは東南アジアで画期的な一歩を立ちました!オープンするとモンクレール ベストが大きな話になりました!人気が高いです!

3:21 AM  

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