Madame Defarge

Drugging Up the Family Care Home Residents : NC vs NY

2011-12-23T14:52:00.004-05:00

Just who are the prescribers that allow the developmentally disabled to have their anti-psychotic medications tripled without the approval of the family? That's the key to this story and hopefully the NYT reporter will address the issue.

What I have noticed as re: family care home residents in NC, where there has been marked improvement over the past couple of years for the most part, there is a a 'set' provider group that prescribe the medications for the residents of the family care homes. In other words, one practice will service dozens of residents of a family care home.

This, of course, makes sense as the family care homes are expected to provide visits to physicians. What happens is that a medical provider comes around to the family care home about once/ month in order to update medications. There is very little time spent w/ the resident, best I can tell. It is not like going to see your doctor; you don't even get ten minutes.

Is that in itself following Medicaid guidelines which require face to face meeting with clients for a set period of time?

It is usually rather large psychiatric/ medical groups who manage the medications and it is very difficult to get in touch w/ them if there are medication issues. You either catch them when they come around or forget it.

See today's article in the NYT:
Potent Drugs, Few Rules, as State Treats Disabled

http://www.nytimes.com/2011/12/23/nyregion/potent-pills-few-rules-in-states-treatment-of-the-disabled.html?pagewanted=all

Just As Predicted by UNC Chapel Hill School of Law Expert, Piedmont Behavioral Health is Attempting to Confuse, Obfuscate, & Shred Public Records Law

2011-12-14T18:09:00.003-05:00

Here is the background information as associated with this critically important matter.

Moreover, this was predicted and outlined by Mark Botts, professor at UNC Chapel Hill's School of Law as associated with a memo handed out by Arthur Carder, CEO of Western Highlands Network LME (WHN LME) during the WHN LME Board meeting in June, 2011. I simply took what Mr. Carder handed out to the audience and copied it and posted it here, previously, at Madame Defarge. Here is Mr. Bott's letter. http://madame-defarge.blogspot.com/2011/06/whn-lme-goes-its-own-way-re-medicaid.html

At that WHN LME June, 2011 meeting, you could have cut the air with a knife for the WHN LME Board knew EXACTLY what was being proposed and what power Piedmont Behavioral Health LME-----the first LME to eagerly obtain a 'Medicaid Waiver' from NC DHHS several years ago----was attempting to establish. What had been driven into that board meeting room in June, 2011, was a Trojan Horse that was The Borg (for you people that watched, Star Trek, The Next Generation w/ Jean Luc Piccard).

During that meeting, what became apparent was that PBH was attempting to develop a position of being able to call the shots for the other LME's and launch their 'methods' for organizing Medicaid mental health at that LME-----with an eye towards being able to commandeer the other LME's and demand that they 'GIVE UNTO CAESAR THAT WHICH IS CAESAR'S' or another way to say it, is 'you can kiss my ring now and by the way hand over the money we demand of you (the other LME's) and allow us to dictate to you just how you will run your LME that is eager and being demanded by NC DHHS to launch into Medicaid Waiver mode'.

I suspect that citizens do not understand why in the world it would matter why one LME dictates to another one how to do their work. But plainly put, PBH has the apparent intention of shredding NC Public Records Law which means that people attempting to obtain Medicaid, such as this child as outlined by David Cornwell, will simply be given----FOR YEARS ON END----the run around as re: denial of services. And if you cannot obtain the records about WHY you are not being given services, then you don't get any services and you cannot find out WHY you cannot get any services.

As Mr. Cornwell clearly outlined, PBH simply told the court to go take a hike and were given yet another opportunity----with the Medicaid child sitting in the background----still with no services. This is, indeed, amazing.

As outlined by Mr. Cornwell re: this court appearance by the PBH CEO, PBH has indicated that it has 'sovereign immunity' as associated with Medicaid Waivers and that it is an 'independent contractor.'

They want the whole cake and they want to eat it all, too. And they want to tell YOU how much cake you can have, when you can eat it, and if you want to know what the ingredients are in the cake, well you can't have the recipe----or the public records.

WE TOLD YOU SO. The WHN LME Board members balked----at least as much as they could----from inviting the Trojan Horse shredding public documents into the lives of western NC citizens. If this is allowed to stand as per the courts, citizens will not be able to know why they cannot obtain Medicaid services.

Here is the link to Mr. Cornwell's excellent outline of the court room travesty that just took place. http://ncmentalhope.org/commentary/2011/compliance/

"PBH: Compliance and Contempt"

Incredible.

Will There Be Any Reason to Have Massively Funded MH LME's to Manage Medicaid When There is no Medicaid?

2011-12-08T19:58:00.003-05:00

oops. Seems like the $1 million slotted for the LME's to manage Medicaid is going to be a challenge if there is massive defunding of Medicaid. You can thank the Republican driven NC State Legislature.

"Budget shortfall could mean catastrophic Medicaid cuts after allWRAL.comRaleigh, NC — North Carolina Department of Health and Human Servicesofficials said Monday that state lawmakers have changed their tune aboutfinding funds to fill a projected $139 million Medicaid budget shortfall,forcing them to consider making ...<http://www.wral.com/news/state/nccapitol/story/10466208/....."

The below is from the article at the above URL:

"....Unless lawmakers find more money for Medicaid, many adult services, like hospice care and mental health care, could be on the chopping block. The state could also reduce reimbursements to physicians who treat Medicaid patients by up to 20 percent, DHHS officials have said.

They say lawmakers publicly pledged to help fill the shortfall in October after it became clear that the agency couldn't make the $356 million in cuts required in the state budget....."

WaPo:Senate Panel (Senator Burr-R, NC) Calls for Probe of VA MH Services: Providers Tangled in Red Tape Trying to See Vets for Outpatient MH Care

2011-12-04T12:01:00.005-05:00

Senate Panel Calls for Probe of VA Mental Health Services

"After hearing testimony about the continued long waits faced by veterans seeking mental health care, a Senate committee Wednesday called for an investigation of the problem and an audit of the Department of Veterans Affairs’ $5.7 billion mental health care budget.

“Especially at a time when we are seeing record suicides among our veterans — we need to meet the veteran’s desire for care with the immediate assurance that it will be provided — and provided quickly,” said Sen. Patty Murray, (D-Wash.), chairman of the Senate Veterans Affairs Committee, who asked the VA’s Office of Inspector General to examine the issue....."

http://www.washingtonpost.com/politics/senate-panel-calls-for-probe-of-va-mental-health-services/2011/11/30/gIQA1AtHEO_story.html

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As per a handout from Reverend Scott Rogers, Executive Director of Asheville buncombe Community Christian Ministries, presented at the Western Highlands Network LME Board on May 6, 2011,

'VETS WHO HAVE A 100% DISABILITY CAN BE ELIGIBLE TO RECEIVE MH TREATMENT SERVICES FROM A PRIVATE COMMUNITY PROVIDER." Otherwise, you're outta luck soldier; go to the VA.

And how many VA sites are there that might even offer mental health care in western NC?

1. Asheville VA Medical Center 2. Community Based Outpatient Clinic, Franklin 3. Rutherford County Community Based Outpatient Clinic (I don't know if outpatient Mental Health is being offered at the latter two sites, neither which are in Haywood County which has more veterans than any other county in NC.

I did my internship at the VA in Birmingham. Do you know how difficult it is for a vet to get 100% Service Connection, approximately 36 grand in tax free monies IS? I may have seen one person at the VA with this. Service Connections are calculated in terms of percentages depending on the impairment of the vet and I have seldom seen someone w/ a mental health diagnosis w/ a 100% Service Connection.

This is the primary reason why it does not make any sense for any private provider to try and see veterans via Tricare. There are next to no vets with 100% Service Connections. Even though I worked in the VA System, this entire area of outpatient MH Services is a complete enigma to me in terms of where do I fit in it; how do I get clients; how do referrals get made, etc.

No wonder Senator Burr is investigating the matter.

I don't know if it is standard for each of the DSS (Department of Social Services) to have a 'liason' person but Buncombe County DSS does and have my more recent complaint about how I could not get onto the panel at Tricare in order to offer vets outpatient Mental Health Services got his attention and he referred me to Senator Burr's office as there apparently has been quite a lot of talk about how services are not getting to vets. Moreover, reportedly, Western Highlands Network LME has a veteran's liason: julie@westernhighlands.org

Having started the long long process of being able, as a PhD/ doctoral level psychologist offering services to vets (only doctoral level internship sites are at the VA and the one in Birmingham is where I did my internship)-----over two years ago, I sighed and recently called Tricare again to see what the hang-up is. I looked at my notes I had taken during a Tricare presentation given via MAHEC training up at Mission Hospital, Asheville, NC, 2.5 years ago. The presenter gave a number, 336 607 8300, which was supposed to take you to MHN or the company which Tricare has apparently outsourced to. When you call it, all you get is a fast busy signal indicating a non-functional number .

One of the first things this provider had to do over two years ago was to sign up w/ a service called CAQH (Council for Affordable Quality Healthcare), a clearinghouse, which takes all the information about the provider e.g., training, internship, license number, and in NC, malpractice insurance---and keeps it updated----a matter which the provider is demanded to do every 90 days. You go online and 'attest' that the information is the same, if it is. I understand that BCBSNC also uses this CAQH mechanism and for the life of me I cannot understand why the LME's must have pages and pages of paperwork filled out when there is CAQH that does this. If someone knows the answer to this question, please tell me (chomskysright@gmail.com).

In any case, I carved out an hour to try and talk to Tricare again last week. This is what I found out and its just more of what I found out 2.5 years ago and I still cannot get onto the provider panel for Tricare to see vets in a timely manner. Even though I have twice before interfaced in terms of application as provider to Tricare, I still have to wait 90-120 days to get some paperwork from someone leading to being 'on the panel' which as I stated above, does not lead anywhere, because there are no vets with a 100% Service Connection.

This time around I was told that though they have my application materials from before, every six months, if the provider has not seen a client from their roster, the application is 'inactive' and you have to restart the entire process again. There is NO health care company that does anything like this. If you decide you do not want to be a Medicare provider any longer after having signed up, you have to tell the in writing. Ditto re: Medicaid.

So, Tricare was long ago out-sourced to a company called MHN (1 800 541 3353). You have to go to their website and have sent in paperwork to create a pin number, etc. CAQH gives you a provider number which you will also need to use vis a vis MHN (to sign up as a provider go to: www.mhn.com/provider/start.do) .

There are three tiers, if you will, associated with outpatient mental health care. And you can get entangled at any point in trying to understand where you are supposed to fit if you merely want to provide and get paid for providing outpatient mental health services to vets.

One tier is a 'Family Service' which involves going to military bases and providing psychoeducation to families and service-people. I'm not sure how this works, exactly, but I did go through the interview process back in May, 2011. Somebody calls you up on the phone and grills you for over an hour (though you are licensed as a psychologist) asking you questions about various vignettes and 'what would you do.' What I wouldn't do is go to live on a military base, far away from my home, for long weekends of such. So, that didn't go anywhere.

Prior to that, over two years ago, I had signed up as an 'Out of network" provider for what Tricare/ MHN (you can't tell them apart) calls their 'Standard Program.' I have no idea why a service-person would use this program, which undoubtedly causes them to pony up more money in order to see a professional, than the next program which is the "Tricare Provider In Network" program.

Though I had received in November, 2009 "Notification of Provider Certification Action" from 'Health net' (who knows how they fit in w/ Tricare and MHN and they sure do not tell you) with a checked box indicating that I was a designated provider---along with having sent in an Electronic funds Transfer completed form; a Provider's Notarized Facsimile or Stamp Signature Authorization completed page; License Number and training completed page; Criminal Records check; W-9 Form; Tricare Non-network Individual Clinical Psychologist Application, I still could not interface w/ seeing clients.

All my calls to the Haywood county veteran's liason person sitting on the bottom floor of Haywood Regional Hospital----who was at the MAHEC Tricare presentation over two years ago---- were never returned even though she had been a presenter at the dog and pony show along w/ the Tricare Northern Region (NC is in the Northern Region of Tricare).

To make it even more confusing, the conversations re: the above paperwork was with a company called PGBA, LLC Provider Data Management POB 870156 Surfside Beach, SC 29857-9756 (you can only talk to them 10-2 PST), and under that header was the Tricare 1877 874 2273 number.

When I went to the Western Highlands Network LME Board meeting May 6, 2011, ReverendScott Rogers, Executive Director of Asheville-Buncombe Christian Ministries, who was apparently there due to all the homeless vets he comes into contact with, gave out the following information.

Most notably, in his one page of handout notes he gave to anyone who asked for them at the WHN LME meeting, "Dave Wright, the supervisor in the MY Clinic at the VA Medical Center in Oteen (the Asheville VA)....advised against trying o access MH services by phone---saying the process is slow, frustrating and sometimes unreliable. " DUH.

Mr. Wright, the director, indicated that the following MH services are available for vets: psycho-education; MST (I have no idea what this is and I hate acronyms that are untethered); PTSD treatment, both individual and in group; Meication; 12 bed psychiatric unit; 4 bed detox; SA residential program; large homeless program in cooperation with Asheville Buncombe Community Christian Ministries (ABCC)

If someone figures out how to crack the code to offer professional services for veterans suffering from PTSD, head injuries, depression, etc., let me know, would you? Meantime, all these homeless vets are just sitting at the Asheville Buncombe Community Christian Ministries site....just like all the non-vet homeless people are sleeping at The Mission on Patton Avenue in Asheville. And when they have to leave during the day, they simply go around the corner to A-Hope and last week the interior of that building was full of THRONGS of homeless, mostly male, citizens.

Medicaid Waiver Double Talk Straight from the Horse's Mouth : NC Mental Health Reform Was Supposed to Be About Choice (Until PBH Got Involved)

2011-11-28T23:10:00.002-05:00

Here is my response to Betty Taylor's (Betty Taylor is the CEO and area director of CenterPoint Human Services) article re: the Medicaid Waiver which is about to sweep across NC re: trying to reduce the cost of NC Medicaid. It won't work and the reason it won't work is that it is predicated upon issues that don't have to do w/ the cost of mental health care vis a vis the quality of services-----for NC medicaid clients.

Here is the NC DHHS outline of how this wholesome waiver is gaining ground across the state: http://www.ncdhhs.gov/dma/lme/MHWaiver.htm

The private health care companies will simply not offer services (hey: it looks cheaper on paper) and it will appear, in terms of accounting (REMEMBER: Lanier Cansler who heads up NC DHHS is an accountant not a mental health person) that things are improving. One of the primary tenets of NC Mental Health Reform was to offer CHOICE to clients/ consumers. And I challenge ANY mental health care company to offer high level outpatient mental health services in the homes of clients like I do. I'm not necessarily bragging about this but it does get the services to the clients and I have a zip no-show rate.

And so, what is being proposed as per this article and as re: the Medicaid Waiver, is a 'CLOSED NETWORK' which will necessarily drive the quality of care down and the cost UP. You'll have less qualified people offering less professional services and you can bet my bottom dollar it won't be in the homes of the clients.

Here is the article from the Winston Salem Journal and below that is my comment.

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http://www2.journalnow.com/news/2011/nov/28/wsopin02-betty-taylor-guest-columnist-waiver-chang-ar-1651544/

Betty Taylor: Waiver changes will impact consumers and providers

"....On Oct. 31, 2011, CenterPoint Human Services received approval to be a 1915(b)/(c) waiver site. As CEO of CenterPoint, the Managed Care Organization or "MCO" that will implement the waiver for Forsyth, Stokes, Davie and Rockingham counties, I want to share with you what this means for our community.

Your first question may be what is a "waiver"? The Social Security Act sets out requirements that must be satisfied before Medicaid will pay for services unless the state has federal approval to "waive" them. North Carolina received federal approval to "waive" two sections of the act in its provision of Medicaid-funded mental-health, substance-abuse and intellectual/developmental-disability services. Waiving §1915(b) allows North Carolina to implement managed-care delivery systems for these services while waiving §1915(c) allows long-term care services to be delivered in community settings instead of institutional settings.

Most of us agree that receiving care near home instead of in distant state facilities is a good thing. Unlike concerns with commercial, for-profit managed care, implementing a publicly managed care-delivery system also has benefits. Access to services is increased, quality is continually assessed and stakeholder input and education is key. It is up to the MCO in our community, CenterPoint, to assure these results. With wise management of funds, any remaining funds will be reinvested in the community to create additional services.

There are changes under the waiver that impact consumers and providers. Without a waiver, the Social Security Act requires that any "willing and able provider" be allowed to deliver and bill for Medicaid-funded services. This is called an "open network." Under waiver the MCO is not required to contract with all providers and a "closed network" can be created. The MCO is charged with analyzing local needs and designing its provider network to address those needs. In the closed network, consumers still have choice, although it is not unlimited. CenterPoint will maintain an open network in the first year of waiver operation allowing providers the opportunity to demonstrate their value in being included in the closed network in the second year.

North Carolina has toyed with expansion of waiver for several years as a way to contain Medicaid costs and to raise the bar on service quality. PBH, a MCO serving Cabarrus, Davidson, Rowan, Stanly and Union counties, launched its publicly managed waiver in 2005. The state watched closely and asked questions about outcomes, efficiencies, access to services and consumer responses. During this period, North Carolina experienced multi-million dollar Medicaid cost overruns for a service called Community Support. At the same time, PBH had no such economic issues and legislators noticed...."

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(Here is my comment place in the paper):

What a lot of double talk is being foisted on the public here.

First of all, let's write in clear English and/ or use an editor at the paper please. Is the Medicaid waiver associated w/ only substance abuse and developmental disabilities ONLY? I declare: this is news to me and its a very important point I might expect that this is not MOST of the people with Severe Persistent Mental Health challenges aka Medicaid consumers.

Secondly, there is no longer, for the most part, since 1970, as associated w/ Wyatt v Stickney (see FRIDAY, NOVEMBER 18, 2011: Ricky Wyatt of Wyatt v. Stickney Passes:Wyatt v. Stickney 1970 Case Discharged Thousands of Patients to Community Mental Health: http://madame-defarge.blogspot.com/) mental health care at a psychiatric hospital far removed from the residence of the citizen seeking mental health services. Outpatient Mental Health Care is where we've been heading and utilizing for the past 30 years.

Thirdly, re: the matter of 'open network', excuse me, but NC Mental health Reform was supposed to be about CHOICE and this provider, for one, provides services IN THE HOME of the client. So tell me, CenterPointe, that you can improve on that. I am a solo independent psychologist and I make a decent living doing just that.

Fourthly, the need for the waiver is not 'intensified.' See above.

Fifthly, (this seems silly: Point Number 5 and proceeding): show me the stats on the 'over-run' re: Medicaid services. What I suspect is being alluded to is Lanier Cansler's predecesor's 'over-run' re: the poorly planed Community Mental health Services. What i see taking place now is an appropriate use of Case Management, for the most part. This being said, most case management which is paid for by Medicaid NC/ NC DHHS is mostly paperwork and is not face to face contact hours w/ the client. That's what I DO.

Point Number 6: How nice to acknowledge the following: "Waiver changes will impact consumers and providers" (see: TUESDAY, OCTOBER 18, 2011: Piedmont Behavioral Health (smack! slurp!): How Can We Help You Out re: Collapsed New River LME (AND SHRED YOUR PUBLIC RECORDS LAWS;http://madame-defarge.blogspot.com/ )

Point Number 7: my grammatically tuned ear is wincing under the statements like "...Now waiver will be in operation..."

Marsha V. Hammond, PhD, Licensed Psychologist, NC

NC Mental Health Reform blogspot since 2007: http://madame-defarge.blogspot.com/

email: chomskysright@gmail.com

Ricky Wyatt of Wyatt v. Stickney Passes:Wyatt v. Stickney 1970 Case Discharged Thousands of Patients to Community Mental Health

2011-11-18T21:14:00.003-05:00

I did part of my internship at the giant Tuscaloosa, AL state hospital, sitting right next to University of Alabama. It was a grind driving from Birmingham, past the mimosas in bloom, in my loaned VA vehicle (I had no car) in order to satisfy the criteria of my clinical internship. But I saw some things there that anyone who ever worked in mental health should see and I had excellent supervision.

In 1994, when I was there, they were lobbing off part of the large main building, second only to the Pentagon in size. For, you see, there had been over 30,000 patients warehoused there. When I was there, about 1000 patients remained. That is what an impact the Wyatt v Stickney case made and it all started at Bryce Hospital in Tuscaloosa, AL.

The patients who rode in sheriffs' cars down the tree-lined boulevard, just around the corner from the Crimson Tide campus---up to the administration/ admission building, lived there and died there; they kept the gardens that fed them and occasionally ran into the medical records department and grabbed documents revealing their sordid histories while the medical records person was busy somewhere else. And then they ran like the wind, holding tight their mental health records, never to be documented as mentally ill again (as did one friend I made in Birmingham, a street singer, indicated he had done. His history included singing alongside Pete Seeger and he didn't like it one bit that Bryce State Hospital had records indicating him to have a serious mental health issue. )

As I walked the wards at Bryce Hospital, I carried around a key ring of skeleton keys that had an entire soundtrack associated with them. I used them to let myself into locked wards and behind those doors were occasionally people who would rush them, trying to get out. There was madness in their eyes. There was Haldol in their systems; there were pink rooms where they could be straight-jacketed should they get too out of control; there were restless souls padding the halls at all hours.

And one of the more interesting assignments my supervisor gave me was to simply walk around and document what I 'saw' on the wards. And what I saw, in my fly-on-the-wall position, since I was after all a person of no importance, was nursing staff sitting at the ward desks, busy as bees, working away on their paperwork, while patients mostly patient stood waiting for long periods of time for someone to look up and acknowledge their existence. Or, if you stepped behind the desk, as I could, they would be in the nurse's small lounge in the very very old buildings, drinking coffee and talking.

And at the 'meetings' prior to the dismissal of a patient being permitted to 'get out' what I remember was the fear and trepidation of the poor schmuck who was essentially being interrogated to see if they had the common sense to state that they were free of suicidal ideation or wanting to kill someone. The patient would sit on one side of the table, sweating and squirming, and the psychiatrist, psychologist, psychology intern, nurse, social worker, and any other interested or mandated professional, would sit on the other side.

All people who have been involuntarily committed or convinced to stay for any period of time on a mental ward have learned what to say in order to escape. Anyone who has some modicum of mental health is ready to bolt within a week regardless of how helpful the psych unit has been. Being locked up is like being in jail. After all, it is frequently the sheriff that drags you onto the unit.

I have a client who has repeatedly run from the police or sheriff trying to drag her into a mental health ward because she could not wear her belly-ring or keep her wedding band. There are no cell phones there because you could use the wire to hang yourself. And indeed I have had clients who have needed to sleep in the hallways due to their own fears that they might strangle themselves with their sleep apnea equipment.

I have a client who stated that she was buggered by the orderlies, late at night, as she lie in her Thorazine haze. Her husband noticed the evidence when she returned home. And from that time on, she swore she would never return to that public mental health hospital in Morganton, NC and indeed she ran into the woods behind her home and dislocated her shoulder when a mental health worker sent out the sheriff again, years down the road.

And so, Ricky Wyatt, who has just passed, is today listed in the NYT on the Op-Ed pages as "appreciated" and this is what it says, in part:

http://www.nytimes.com/2011/11/18/opinion/ricky-wyatt.html

".....The journey was Wyatt v. Stickney, the federal class-action lawsuit filed in 1970 against an Alabama state hospital and later expanded to other facilities. It was the first and most consequential of the legal challenges to the abuse and neglect that had doomed hundreds of thousands of patients to hellish lives in public psychiatric hospitals. It threw open the doors to treatment and to new homes in the community and, for the first time, established standards of adequate care and patients’ rights to receive it.

The ruling was made by an extraordinary federal judge, Frank Johnson Jr., a central figure in earlier desegregation rulings in the South. It was filed on behalf of thousands of Alabamans; Mr. Wyatt agreed to be its face. He had been placed as a teenager in the Bryce State Hospital in Tuscaloosa, where he was abused and drugged for no better reason than he was prone to troublemaking and in the care of an aunt who wanted to get rid of him. Back then, people could be locked up involuntarily, simply on a relative’s say-so.

The Wyatt standards led to civil rights and freedom for countless patients. But the follow-up was imperfect; many patients who were released with inadequate treatment and community support merely traded one form of warehousing for another — in prisons and on the streets. But no one who knew the pre-Wyatt world would want to return to it...."

20% of the Homeless are Former Veterans (Try Telling this to Tricare, Veterans' Insurer, With Whom Mental Health Professionals Cannot Engage)

2011-11-02T23:55:00.003-05:00

http://www.mountainx.com/article/37068/Highlights-from-the-Nov.-1-commissioners-meeting-Tough-times-for-veterans

"Highlights from the Nov. 1 commissioners meeting: Tough times for veterans

....Kevin Turner, supervisor of Buncombe County Veterans Services, updated commissioners on the problems facing veterans and the work of the department.

According to Turner's presentation:

• In 2010, roughly 21,390 vets lived in Buncombe County. Only five counties in N.C. had more vets living there.

• The U.S. Department of Veterans Affairs spent more than $136 million in Buncombe County – more than in all but six other counties in the state.

• About 1,000 WWII vets die around the country every day.

• An average of 18 vets commit suicide every day. The rate of suicide among vets is over twice the rate of the rest of the population.

• 8 percent of the population are veterans, but 20 percent of the homeless population are veterans.• Over 300,000 vets who served in Iraq and Afghanistan are estimated to suffer from mental health conditions; the lifetime treatment of those veterans is estimated to cost at least $660 billion (more than the direct costs of both wars combined).

• Some estimate that up to 35 percent of the 2 million vets who served in Iraq and Afghanistan over the last decade could suffer from Post Traumatic Stress Disorder......"

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If we wanted to effect the homeless population significantly and diminish human suffering in general, we would provide mental health treatment to veterans suffering w/ PTSD. The treatment for PTSD is Exposure Therapy/ Desensitization. This is very well established now .

However, trying to get on the panel, as a provider, associated w/ Tricare, the primary insurer for veterans, is next to impossible.

I've tried several times, in a concerted manner, to get on the panel of Tricare (I am a Medicare/ Medicaid/ Humana, etc., provider.) You send in the paperwork, something happens to it, then you get busy w/ the taking care of clients which leads to being paid-----months go by---you never hear anything----and then you have to start hammering on that system again. Its ridiculous. Haywood county, next to Buncombe, has more veterans than any other county in NC.

Here is my comment to the above recent overview in the Mountain XPress re: this veterans matter:

"Psychologists provide mental health care to veterans. Exposure therapy/ desensitization is the treatment approved for treatment of PTSD, be they survivors of sexual/ physical/ emotional abuse or vets exposed to trauma. It takes a well trained mental health provider to enact this service. Indeed, the largest psychologist doctoral level internships in the US are associated w/ the VA System.

Outpatient mental health care is provided, for the most part, by the insurer, Tricare. Trying to get onto the panel of Tricare, in order to work w/ veterans in western NC, is next to impossible even for a licensed doctoral level psychologist. They do not respond to queries; you get re-routed to various parts of the federal insurance system; endless e mails and queries go nowhere.

If the feds want the vets to receive efficient, quality mental health care for PTSD, then Tricare needs to become a functional entity, like Medicare.

Its sordid and frankly un-American to have former veterans as 20% of the homeless population.

Get it together, Tricare, and stop making it impossible for professionals to work w/ veterans trying to recover from serving the country.

Marsha V. Hammond, PhD, NC Lic Psychologist

Republican Dominated NC State Legislature Has Created ONE BILLION $$ Cut To NC Medicaid Services

2011-11-01T12:02:00.004-05:00

I saw a sign last week in Waynesville NC tauting the following:

"Stop the spending! Elect Fiscal Conservatives!"

Excuse me, but this has already happened, friend. What might be appropriate is an anarchist comment spray-painted over that tacky sign on Main Street.

Here is the what the Republican led NC State Legislature has done as outlined by Chris Fiztsimmons of NC Policy Watch:

http://www.reflector.com/opinion/fitzsimon/fitzsimon-gop-dodging-budget-blame-744481

Fitzsimon: GOP dodging budget blame

"You have to give Republican legislative leaders credit for one thing. They are getting better at avoiding the blame they deserve for the disastrous budget decisions they made this summer. And the Democrats are making it easier for them to get away with it.....

....The Republicans’ priority this year was to cut taxes no matter what, not keep teachers in the classroom or provide help for laid off workers or protect vital services to the most vulnerable people in the state.

That meant massive budget cuts in almost every state program. But the legislators didn’t want people to blame them for the services they were losing, so they wrote a budget full of smoke and mirrors to make it unclear who was behind the painful decisions.

Nowhere was that more true than in Medicaid. The budget slashed state funding for the program by more than $350 million this year, which translates to an actual cut of more than a billion dollars when you take into account that every state dollar is matched 2 to 1 by the federal government.

Thursday, HHS Deputy Secretary Michael Watson told lawmakers that Medicaid was facing a projected shortfall of $139 million, which had to be one of the least surprising revelations made at the General Assembly in quite a while.

Some of the Medicaid changes made in the budget have not yet been approved by the federal government, just as state officials predicted. The savings from Community Care of North Carolina, a successful managed care Medicaid program, are also falling well short of the Republicans wildly rosy predictions.

Watson told lawmakers the shortfall could mean an 18 percent reduction in rate Medicaid pays medical providers and acknowledged in response to a question that many adult mental health services could end.

The federal government is unlikely to approve the rate reduction, so that would mean slashing even more services for seniors and people with disabilities.

N.C. Rep. Nelson Dollar said budget writers had to deal with one-time payments and refunds in Medicaid because of bad decisions made by Democrats in previous years. In essence, it is all the Democrats fault.

True or not, building those payments and refunds into the budget is hardly justification for counting on savings that you know will never materialize.

Dollar and N.C. Sen. Pete Brunstetter both then repeated the misleading claims they made during the budget debate, that the expected savings were reasonable and they would work with HHS officials to find them.

Neither Dollar nor Brunstetter mentioned the doubly counted cut in the inflationary increase. It’s harder to blame that on somebody else.

Brunstetter said there was some “unfortunate finger pointing” going on about the Medicaid shortfall, apparently referring to comments by Perdue administration officials pointing out the absurdity in the Republicans’ claims.

But the problem wasn’t that finger pointing was going on, the problem was that not enough fingers were being pointed. Watson, the HHS official making the Medicaid presentation, missed several opportunities to make things clear for legislators and the media on hand.

And only Senator Minority Leader Martin Nesbitt asked any tough questions in the face of the Republicans blame-and-mislead dance.

The bottom line is that Republicans passed a budget that will force state officials to cut off vital services to seniors and people with disabilities. And they knew they were doing it.

The public deserves to hear that truth. Perdue and her administration need to plainly speak it.

Chris Fitzsimon is the founder and director of N.C. Policy Watch, a progressive public policy think tank that is a special project of the N.C. Justice Center."

The Little Understood 'WHY' the Family Care Homes are Problematic for Those With Mental Health Challenges

2011-10-25T13:21:00.003-05:00

Though I have not infrequently written about my experience, as a professional, with the family care homes in Western NC, I had not realized just what the issue was as to why NC DHHS (Medicaid) was being called on the carpet by the Department of Justice as pertaining to citizens w/ mental health challenges living in these homes. Apparently it has to do with the PERCENTAGE of people in the home who have PRIMARY mental health diagnoses.

The matter of 'primary' is very important as the profile of clients I have seen in family care homes have what you might expect from a life-time of living by their wits, best they could, and frequently have histories of childhood abuse and/ or neglect. These clients have BOTH physical and mental health issues. They commonly have chronic pain, diabetes, hypertension and then they have co-morbid depression, or other mood disorders or personality disorders that go along with living such a life.

So, HOW will these 'assessors' mentioned below in the NAMI article from the Fall, 2011 newsletter (see below), assess the clients as having a PRIMARY mental health issue, which is to say, this is the main and number one reason why they are in the family care home.

I am betting that this is the outcome of the matter: the 'assessor', depending on whether it is a mental health person or a allopathic medicine professional e.g., MD, Nurse Practitioner, Physician's Assistant, etc., will note----according to their expertise-----the primary illness. If I were NC DHHS, I would be hiring non-mental health professionals to assess these family care home residents.

I am betting that little will change in terms of where these people live because the method of assessment will have a hidden issue in it which is what are the professional qualifications of the person who does the assessment. Also bear in mind, as per the NAMI article, that the assessment is completely voluntary.

And I might imagine that most people having 'primary' mental health diagnoses will not want to be assessed because they are understandably suspicious of that and they do not want to be forced to leave unless they want to. And so, will those people who decline to be assessed simply be chalked up as having a 'primary' mental health or physical health diagnosis?

When I was a more brazen practitioner, I assisted clients in looking at their family care home charts to see 'what's happened to my money' (a frequent complaint) in that the residents are left with only $66 (yes, exactly that)/ month out of their disability check. There used to be more frequent complaints that they didn't get their money or they didn't know when they were going to get their money for that month, etc. That was my impetus for assisting the clients regarding the matter of 'where's money' and I have to say the quality of the family care homes has improved significantly over the past couple of years . They are generally more responsible people that run them and they act more professionally.

Complaints like mine surely made a difference as I carried them all the way to the regulatory agency of the family care homes.

See, for instance, one of these posts here: http://madame-defarge.blogspot.com/2009/04/wnc-family-care-homes-dss-buncombe.html

So, this is how the family care homes are paid:

1. the resident's disability check is taken by the family care home or rarely the client manages their own money and pays the family care home out of their check. Commonly, disability checks are anywhere from $650-850/ month----depending on whether the resident has 'vested' in the Social Security System or not. Bear in mind, that if the resident was mentally ill prior to turning 21 or perhaps 18, they could be utilizing the Social Security Number (and associated benefits) of a deceased parent's Social Security.

2. In that it costs approximately $1300/ month for living at the family care home----which is not a particularly bad deal given that they have a comfortable room, usually shared with someone else, a bigger family room where there is a TV, and food put on the table, as well as transportation to appointments----the remainder of the tab is picked up by the local county DSS. I assume that this is the problematic Medicaid money of which the article speaks.

3. out of the $66/ month that is by law given to the resident, they have to pay for medical co-pays and medication co-pays which for Medicaid are generally $3/ prescription. That leaves very little spending money as you can see.

The devil's in the details.

Here is the NAMI article:

"Adult care homes, originally designed as homes for the elderly and that now offer housing to people with mental illness, are being scrutinized byNorth Carolina because of a conflict with the federal regulations governing how the state pays for their care. Medicaid will not pay for care for the mentally ill in facilities that have more than half of the residents with a primary diagnosis of mental illness. Those residents woud have to be moved to other housing. There are now 52 facilities in North Caroina at that level. There is one in Western Carolina.

These homes and their residents will be assessed startig in the next few months. Cient assessment is done only w/ the client's permission.

Lanier Cansler, sec retary of DHS said. "We're working on this constantly. The problem is there's no easy solution."

Mental health organizations and advocates are concerned that some of the affected residents will end up in emergency rooms, jails, homeless shelters or on the street. this problem is yet another result of the state's mental health reform ten years ago. .....

Please contact the office of DHHS to voice your concern: contactmh@dhhs.nc.gov Subject Lines: Adult Care Homes/ Mental Health........"

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And so, accordingly, I wrote this e mail to that e mail address today:

Dear NC DHHS:

I note that there is an assessment taking place over the next several months----on a voluntary basis----of residents of family care homes that are deemed to have more than half the residents with a primary mental health diagnosis.

I have a couple of questions, when you get a moment:

1. What will be the status of the resident who does not want to engage in the assessment process, in that this is a voluntary process? More specifically, will their primary diagnosis be deemed to be what was already in their chart or will it be reassigned and on the basis of what criteria?

2. Who will be the assessors? Will they be mental health practitioners; will they be physicians, nurse practitioners? Will it be a team? Where are the rules/ regs regarding that assessment process.

Thanks for your hard work, NC DHHS.
Marsha V. Hammond, PhD

Did Smoky Mountain Center LME's Utilization Review Department Have a Role in the Downfall of New River Behavioral Health Care?

2011-10-23T23:21:00.003-05:00

Hey, all I know is my own experience and I have outlined it here re: the comment I have made to Richard Craver's article pertaining to the $6.5 million black hole associated with New River Behavioral Health Care.

Here is Craver's article:
http://www2.journalnow.com/news/2011/oct/21/wsmet01-new-river-behavioral-healthcare-losses-put-ar-1522170/

Here is my comment (and there are others at the article's URL):

"WHOA already. So, this appears to be what we 'know' at this point in time: (1) New River started experiencing money losses in 2010 of a significant degree (2) Medicaid 'fraud' accusations have been received from a 'credible source' according to NC DHHS.

I don't see how the two are necessarily related. WHY and what were the particulars of New River losing money in 2010? Was it because of some behavior on the part of the LME, specifically, Smoky Mountain Center LME? Was the director of New River 'misdirecting' money? Without the details which are pretty darn slow in coming forward, no one, except those on the inside, have any idea what has happened and why.

Who or what entity has made the Medicaid 'fraud' accusations? What are the accusations?

This is the question that I wonder about having worked with the Utilization Review Department (call that: 'tried to work with") of SMC LME: New River could not get paid for some reason. For me, it was merely a single client.

As regarding that case, for the life of me, regardless of what information I submitted about a very mentally ill client of mine who had been in the mental health care system since a child, I could not get dependable authorizations to see and be paid to see that state funded client. I threw in the towel re: working w/ SMC LME's state funded clients five years ago. Moreover, I won't take any state funded clients due to the paperwork re these clients. My worry, as a solo practitioner, has been that w/ the LME's taking over the management of Medicaid, that they will re-create paperwork equally onerous for Medicaid clients.

So, with the refusal of the SMC LME Utilization Review Department which provides the authorizations to work with the client (and thus get paid) and the overkill overviewing of what I submitted as 'the reasons' why the client needed therapy to the Clinical Director of SMC LME at that time----still the same people in place best I understand it from a recent review of their staff----I took the medical records of the client TO THE HOME of the Social Security adjudicator so that the client could at least be advanced to Medicaid----and that very well could have saved the client's life.

Given my experience with the Utilization Review Department of SMC LME 5 years ago, I have to wonder did SMC LME play any part in the non-payment/ non-authorization downfall of New River.

Details, please.

Who Stood to Gain by Killing New River LME After a Game of Patty-Cake: Follow the Money

2011-10-19T23:47:00.004-05:00

Counties will bear fiscal support of New River in transition

by Jesse Campbell

County managers and interim officials with New River Behavioral HealthCare continued to chart the transition for a new service provider at a meeting Monday morning as the final days of the organization begin to unfold.
Managers agreed Monday to pay for the services of contracted physicians and therapists, some of which have not been paid since August, along with past due utilities, property insurance, and other general operating costs.
Managers had already agreed to pay for last Friday’s payroll.

“We are in dire straits,” said interim Chief Executive Officer Sharon Wilcox in regards to the current provider’s past due expenses. “Some of these physicians refuse to come to work until they are paid.”

A week after her selection as interim finance officer by the five-county board for New River, Amy Oliver expressed her desire to step down. She has agreed to continue assisting the board until her replacement is found.
Although county officials still do not know what accounted for the provider’s current financial state, they do know that NRBHC had reported financial losses as early as 2007.

According to Ann Wilson, an auditor who has worked closely with NRBHC in the past, the provider incurred a $5.8 million loss for the two-year period leading up to fiscal year 2011.

Officials from the five affected counties formed a new board upon the dissolution of a 160A interlocal agreement to assist in the transition to a new service provider for Ashe, Alleghany, Wilkes, Watauga and Avery counties.
County officials revealed that Daymark Recovery Services will serve the area as the new mental health service provider. NRBHC will cease to exist on Nov. 15.

Daymark Services has expressed interest in using NRBHC’s current buildings once the transition is complete."

http://averyjournal.com/News/story/Counties-will-bear-fiscal-support-of-New-River-in-transition-id-008959

So, as per the above article outlining the demise of New River LME, insuring/ providing services 13,000 lives (more than the company that sank out of sight about 5 years ago in western NC which insured 10,000 lives), what are the details outlining that New River LME was sucking wind as far back as 2007? If their difficulties were so onerous, why didn't the multi-county commissioners ask some serious questions?

Reporters do us such an injustice by not digging into the details.

This is what I wonder about the entire matter:

"Medicaid fraud" could be leveled at most any provider/ company in NC. "Medicaid fraud' accusations are what reportedly sank New River LME. No one has given the public any information about the details of this' Medicaid fraud' that I know of. So, where's the proof? (I expect the answer to this question to magically turn up on the Piedmont Behavioral Health LME website within a week, as is often the case when 'queries' are posed and the public is 'given an explanation.' )

People do not seem to be questioning, as French philosopher, Michele Foucault, who outlined how power manipulates, suggested we ask: "Who is speaking?" Who or what entity stands to gain by shouting fire in the theatre or 'Medicaid fraud?" When one bills Medicaid----from the standpoint of this solitary practitioner billing directly to Medicaid for therapy only services----the information that is 'demanded' by Medicaid is multi-focal. It would be pretty damn easy to commit Medicaid fraud. And if your company or LME was sucking wind because the larger parent LME (that would be Smoky Mountain Center LME) had jerked your contracts and given them to another brown-nosing organization----well, its just a matter of time you have to tread water. There's waaaayyyy more news here that is not apparent.

A more salient question might be, "Who wanted New River LME dead?" I do not have an insider's knowledge; however as per articles recently by Richard Craver of the Winston Salem Journal (newspaper: see: http://www2.journalnow.com/news/2011/oct/16/wsmet01-group-has-ideas-for-health-service), there is an outline of a pretty concerted power struggle between providers in order to wrest the reins from (what was) New River LME administration. Apparently and reportedly, providers local to Piedmont Behavioral Health (PBH) LME, which launched, basically, a hostile take-over bid on Western Highlands Network LME in western NC in June, 2011, will not talk to local reporters for 'fears or retributions.' PBH LME's hand sits lurking in the background as per Craver's articles that they were 'willing' to 'offer suggestions' which, of course, were associated with they taking hold of the reins. Moreover, the people who ARE talking to reporters and feeding them information stand to gain by slanting a take on the news that causes their companies to appear like 'knights in shining armor.'

Follow the money, as, I believe, Bill Clinton suggested. And remember to ask yourself "Who is speaking" which is to say, "Who stands to gain from this matter?"

All I know is that the last line of that article states the following:"Daymark Services has expressed interest in using NRBHC's current buildings once the transition is complete."

A curious reporter would wonder: what is the relationship between Daymark Recovery and Smoky Mountain Center LME; how much 'business' does Daymark Recovery have re: SMC LME clients?; did contracts to care for clients 'get jerked' from New River LME---somehow---and rewarded to Daymark Recovery?

Yeah, and who framed Roger Rabbit and who was playing patty-cake with New River LME? (wikipedia: " When he shows Roger photographs of Jessica 'cheating' on him by playing patty-cake (literally) with Acme, Roger becomes distraught and runs away. This makes him the main suspect when Acme is found murdered the next day."http://en.wikipedia.org/wiki/Who_Framed_Roger_Rabbit

Marsha V. Hammond,PhD Licensed Psychologist, NC

NC mental health reform blogspot since 2007: http://madame-defarge.blogspot.com/

Piedmont Behavioral Health (smack! slurp!): How Can We Help You Out re: Collapsed New River LME (AND SHRED YOUR PUBLIC RECORDS LAWS)

2011-10-18T04:35:00.003-05:00

There's a very good article by Richard Craver of the Winston-Salem Journal re: what amounts to a hostile take-over bid by Piedmont Behavioral Health (PBH) of New River LME, recently accused of 'Medicaid Fraud.' PBH wants to magnanimously offer that they have many good solutions to all these mettlesome LME's and would like for you to look at their latest rendering of the Trojan Horse. This is my reply to Mr. Craver's article and it is online with other like-minded comments:

"Group has ideas for health services"

http://www2.journalnow.com/news/2011/oct/16/wsmet01-group-has-ideas-for-health-services-ar-1504370/#fbcomments

Here are my comments re: what PBH is proposing:

Do NC lawmakers want to see the Public Records law shredded? That is the question we are presented with here, basically.

Mr. Craver's article outlined the following points: "Rebecca Troutman, the intergovernmental relations director for the N.C. Association of County Commissioners, said the association "sees a need for a study committee to review the statute in its entirety, given that the statutes are woefully out of date."

Excuse me, county commissioners-----overseers of the LME's-----you already have your information from the UNC Chapel Hill School of Government, rendered several months ago by Mark Botts in association with colleagues there, due to the persistent efforts of the Western Highlands Network LME Board who tried to back away from this (new! expanded!) version of hostile health take-over bid by Piedmont Behavioral Health, all the while having their heads held to the stink by the board's attorney telling them the board would be 'eaten alive' by PBH because NC DHHS was driving that PBH car, or at least sitting in the passenger seat. The WHN LME Board finally concluded it had to cave. And so here we have the PBH monster, fat and gluttonous after having rammed through its 'Non Disclosure Agreement' as per the WHN LME Board----now intending to do this at a state level. Is there no one here who can rid us of this troublesome LME and its head, Betty Taylor?

Here is what that School of Government attorney states re: PBH's hostile take-over 'mutual agreement' contract they floated to the WHN LME Board like a Trojan Horse in June, 2011:
(Published in its entirety, as passed to the public at the WHN LME June, 2011, Board meeting, and at my NC Mental Health Reform blogspot, June, 2011):

Saturday, June 25, 2011UNC Chapel Hill's Institute of Government Outlines Problems w/ Non Disclosure Agreement Driving Medicaid Waiver

".....To put it another way, the PBH non-disclosure agreement does not appear to strike the harmonious balance between public records law and copyright law that is described in the Seago case. The PBH non-disclosure agreement, at paragraph 3,b., not only restricts the subsquent commercial use or distribution of records received by LME's but has the recipient LMEs promise that they will not, without the prior written consent of PBH, "copy, use or disclose" any information that "has value in PBH's business," remove the information from the premises of the LME, or "deliver" any information "to any person or entity outside the LME." (LME contractors are excepted from this promise). The terms of the agreement appear to prohibit the LME that receives PBH records from providing public access to the records under the state public records law. Thus, the LME that signs the agreement appears to agree that it will not only protect the records from commercial use and distribution, but also that is will not comply with the North Carolina Public Records Act. ,,,,"

So, working w/ PBH = shredding of public records law = inability of consumers/ clients to obtain medical records efficiently and to hold accountable the LME.

Oh, boy, PBH certainly does have some terrific suggestions and the only reason they have gotten this far is that they are being tacitly supported by Lanier Cansler at NC DHHS. Remember: Mr. Cansler has not always been a public servant and will not remain one either.

Oh, did I say: WE NEED A ONE PAYER SYSTEM and that means a Federal system, such as Medicare/ Medicaid---not these bits and pieces of managers run amuck, amassing CEO salaries, not being held legally accountable. I say, 'Let's Occupy PBH.'

Marsha V. Hammond, PhD, Licensed Psychologist
http://madame-defarge.blogspot.com/

New River Mental Health Agency Being Investigated for Medicaid Fraud : How Clients Are Demanded to Manipulate the Medicaid System

2011-10-08T09:52:00.003-05:00

There is an article in the recent Mountain XPress out of Asheville regarding the investigation and withholding of payments to a large mental health provider in western NC. See:
www.mountainx.com/article/35870/N.C.s-Medicaid-agency-launches-investigation-of-major-WNC-mental-health-provider

These old 'Community Support' companies continue to offer similiar supports but only for six months at a time for Medicaid clients. Thus, there is an intense flurry of activity which may or may not overlap very well w/ ongoing therapy (I am thinking of a client of mine w/ a severe mental health challenge that this was happening with recently) and then poof!....it disappears. It would be nice to know just how much help this is. I could tell that the additional resource of a person 'to call' was advantageous to the client when he was in crisis but basically the crisis was determined by whether he had his meds or not.

Relatedly, I received a call from a county DSS re: the client's ability to parent children yesterday and very clearly stated to the DSS social worker that the problem was not that the client could not parent children-----but that Medicaid drops off every six months (even though the client receives SSDI---but paid Social Security such a lot of money that client 'earns' just a bit too much to keep Medicaid in place)...thus Medicaid drops off every six months. That means that the client is then without all medication which may be necessary to support mental health functioning which include parenting children.

So, then the client manipulated the system----which is built to be manipulated in that you can take only two years of CURRENT medical bills and have them applied to a Medicaid deductible in order to reinstate Medicaid OR you can make a small payment on medical bills up to 7 years old and then DSS can then 'pull forward' those medical bills to create the deductible. There is no other way to get Medicaid reinstated. One has to meet the deductible if one's Social Security Disability check is more than about $1200/ month. Nevermind that there are 4 mouths to feed and take care of on that.

So, very tiresomely and using a lot of time and organization, the client has to make a minimal payment on an old unpaid medical bill, usually a long stint at a psychiatric hospital, which allows the local DSS to 'pull forward' the bill and apply it to the commonly $5,000-7,000 deductible----which then----months later----allows the Medicaid to be put back into place for-----YOU GUESSED IT-----six more months. Then we do the whole thing all over again and if necessary the client goes into the hospital w/ the specific agenda of cranking a bill so that Medicaid can be recreated again.

This is a great way to save Medicaid $$$, don't you think?

NC Medicaid : 'You've got MRSA and All We Can Offer You Is Someone To Help You Take Your Bath": Haywood Regional Medical Center On The Skids

2011-08-12T23:12:00.005-05:00

There's a fight to the death here and it's being identified by the New York Times (NYT). Yeah, literally to the death. See: www.nytimes.com/2011/08/12/opinion/a-scalpel-not-a-ax-for-medicaid.html

People with 'proper health insurance' would never be serially dismissed from regional hospitals on the basis of "you seem good enough now.....guess you should go on home where you'll be 'more comfortable.'" It is frankly galling to see this level of lack of care and homilies when really the matter should be (may be?) reported to the hospital accreditation agency, JACHO (the accrediation agency for hospitals).

And so, more specific to the matter at hand, today I spoke w/ my client who is in Haywood Regional Medical Center. I visited that client day before yesterday in the hospital (psychologists cannot be paid for work done in hospitals unless they are on staff which is mostly unheard of). I am a clinical / health psychologist and boy do I know more than I need to know about hospital procedures. Need to get your pain medication actually given to you on time? Call on your hospital room or cell phone to the nursing supervisor who will put a hurt on the nurse that can't find time to give you the pain med.

The client is in a room with cap/ gown/ mask procedures. Cellulitis post surgical is now spreading up the fascia of the client's belly indicating that the bacterial infection has not been bought under appropriate control. Imagine a million microbes chewing your flesh, from the inside out. Think you'd hurt?

If the client had been in a charity hospital (the ones that take good care of everyone, such as Grady Hospital in Atlanta), the client would have been isolated and given appropriate care for such an infection. But hey, this is a 'MedWest' private hospital in western NC. On the other hand, those hospitals have been going broke for a long time due to the severity of illnesses of their patients that no other hospital will touch.

The client had surgery at Harris Regional Medical Center in Sylva, NC; 'got' MRSA (Methecillin Resistant Staphylococcus Aurea as associated with said surgery. This is a very, very serious infectious disease running rampant amongst hospitals). One assumes that the Infectious Disease nurse/ department at that hospital was advised that their operating theatre is perhaps passing on this deadly bacteria but who knows give the lack of communication amongst medical personnel and institutions. This being said, I'd wager a bet that JACHO would be interested in the matter, for whatever that's worth.

This is, of itself, amazing. A major hospital in western NC is spreading MRSA or so it appears. Hospitals, contrary to what the human eye believes it can see, are the filthiest places on the planet.

The client has extreme pain related to the surgical incision which client describes as leaking through bandages "like the Texas Chainsaw Massacre." It should be malpractice that this is allowed to take place. It should be malpractice that the client is not given sufficient pain relief prior to wound dressing taking place.

It does not matter that this is a person in 'physical' pain though they also have an overlapping mental health challenge. Pain is pain. Interestingly, when this psychologist strongly recommended to the Harris Hospital nursing supervisor that the client 'not go home after two days of major surgery' this was summarily dismissed. The client was actually queried as to whether it would be useful to go a psychiatric unit. Duh, no. The client was not experiencing a mental health challenge; the client had just had surgery and Medicaid had, apparently, no capacity to appreciate the severity of the surgery .

That's NC Medicaid for ya. They must really recoup some money when a re-admission takes place and the patient sits in the ER for about a dozen hours at some amazing rate charged to Medicaid.

So, there's no money saved; there's just the illusion of savings. And heck, did I tell you that someone will lose their life over these silly administrative parryings?

More recently, as per this current visit at Haywood Regional Hospital, and as per a social worker, assumably from Haywood Regional Medical Center, the Medicaid client has been advised that the 'only services' available to this MRSA----very contagious medical illness but we are still going to get you out of the hospital------are 'probably associated with someone to come over to the house to help you with your shower and getting dressed.' I have to wonder how the client's 4 children will cope with this matter. Will THEY get infected?

The person to be assigned to the 'bathing and dressing' obviously would not be a trained individual associated with 'wound care' such that the MRSA matter is addressed in a systematic manner.

Imagine the dismay you might experience if the hospitalist walked it your room and said, 'Have you ever heard of MRSA?' The client used an available cell phone to take pictures of the incision and was scared to death as research indicated on the cell phone what the seriousness of the matter was.

What happens when you get a MRSA infection? You commonly die a long, prolonged death associated with pain and septicemia (the bacteria overwhelms your immune system). You can bet that that the hospital has a keen desire to 'get rid of' the client as quickly as possible prior to such a scenario taking place. Nevermind that the person will be back pretty soon...with a life-threatening septicemia sure to take a life. Is it treatable? Sure, if you have enough money or health insurance. Even if you're a dually insured Medicare/ Medicaid client.

But heck, Medicaid clients have no recourse to asking for appropriate services and that is what the case moving towards the US Supreme Court is about. The NYT stays on the story (their banner states: "All the News That's Fit To Print")

"A Scalpel, Not an Ax, for Medicaid

....Medicaid is one of their (states') biggest, fastest-growing expenses. The risk is that injudicious cuts could harm their most vulnerable citizens....It should not be particularly hard for any state to demostrate that it cosidered all the facors mandated by law---not just access, but effects on quality and effiency as well----in making necessary cuts to Medicaid spending...."
**************************************************

"....Something's happening here.....what it is ain't exactly clear...." (Buffalo Springfield)

'Democrats Challenging (Obama) Administration on Medicaid: Gee, Where Have I Heard This Kind of Non-transparency Before....: Federal Lawsuit

2011-08-09T22:32:00.005-05:00

Western Highlands Network (WHN) LME, which oversees public mental health (Medicaid) in many western NC counties, including Buncombe County where Asheville, NC is, has a board which recently had its hand forced in terms of kowtowing to a 'Non Disclosure Agreement' hoisted by another LME (and anchored into place by NC DHHS). That 'Non Disclosure' Agreement forbids disclosure of language associated with behind-the-scenes contract agreements which blocks consumers e.g., Medicaid clients, from being able to potentially obtain medical records and information barring their access to services.

THAT was the big deal as associated with the June and July meetings of the Western Highlands Network LME Board meetings (the board cancelled their August, 2011 meeting, for unknown reasons).

This recent move by the Obama administration to block Mediciaid consumers from suing the government for denial of services is similar in its thrust as pertaining to the issue of blocking Medicaid clients from obtaining information about denial of services.

Today's New York Times (NYT) featured an article outlining how the Obama administration (didn't we elect a Democrat?) ".....maintains that beneficiaries and health care professionals cannot sue state officials to challenge cuts in Medicaid payment rates, even if such cuts compromise access to care for the poor...In a friend-of-the-court brief, the lawmakers said the administration's position 'would undermine the effectiveness of Medicaid'. In addition, they said, it conflicts with MORE THAN A CENTURY of court precedents that allow people to sue to block state actions that are inconsistent with federal law.....The issue, of immense importance to poor people and states, comes to the Supreme Court in a set of cases consolidated under the name of Douglas v. Independent Learning Center of Southern California, No 09-958." (see: http://www.nytimes.com/2011/08/09/us/politics/09medicaid/html

The 'denial of services' is at the heart of how consumers/ clients will and do interface with entities such as WHN LME or any other LME in NC that controls funding to Medicaid mental health services. Simply put, the Non Disclosure Agreement which WHN LME Board was forced to accept and this stance by the Obama administration are twin doppelganger reflections of a government that refuses to be transparent to the people who fund it: the taxpayers. (see: http://madame-defarge.blogspot.com/2011/06/whn-goes-its-own-way-re-medicaid.html)

As iconoclastic journalist, I.F. Stone ("Izzy") stated: "Its bad enough just to have a government."

"The Doctor Will See You.....Eventually" : the Wait Time for Resolving Medication Issues for Daymark Recovery Psychiatric Patients in Western NC

2011-08-02T20:56:00.005-05:00

The American Psychological Association has a Code of Ethics which psychologists are supposed to abide by. Its not just a professional organization so much as it is a guide-post for practice. Beyond that, however, I attempt to 'treat others as I would be treated' and frankly this seems like a good rule of thumb.

For over the past 28 hours, I have used up about two hours doing the following in an attempt to get an answer for the re-fill of a prescription for a client of mine that has been in place for about the past year and a half. The medication is Clonidine which doubled as an anti-hypertensive and more and more commonly, treatment for PTSD. It's not a controlled substance. I am now, as in the past, less well liked, as a professional and in general, that I was about a day ago.

The client ran into a debacle as regards the refill as the medication was, a few months ago, stolen from the trailer where the client lives, assumably because it has the appearance of a narcotic medication and boy, they are all the rage in terms of consumables in western NC. You can make a lot of money if you're poor, selling some pills.

The medical record of the company apparently did not reveal that the psychiatrist had 'reset' the time for writing the prescription due to that episode or at least that is what the executive of the company, whom had access to the medical records, inferred. Other than that small piece of information, I cannot understand why this became the boondoggle it did and why the client continues, even this evening, to suffer due to the lack of medication. It would do no good to go the ER as the client would not be given what is appropriate (if you're a betting person, contact me and we can bet on that).

And as times becomes more and more desperate, the selling of pills happens more and more frequently. I can't tell you how many times I have had clients whom left a window open, left a window unlocked, had someone knock down the door of their trailer, or left out their purse, or generally did not guard with their lives their medication.

The client is treated by a psychiatrist at Daymark Recovery whose base is in eastern NC. They have a contract via Appalachian Counseling to offer telemedicine at The Balsam Center in Waynesville, NC, where I have quite a few clients.

I practice as a clinical / health psychologist (my PhD was in that arena) and I not infrequently engage with physicians and physician extenders (PA's or nurse practitioners) re: medication issues or health issues. Indeed, one of the agendas of newer legislation regarding mental health care is to 'wrap around' to physicians and physician extenders in order that we all be on the same page. Trying to stay in touch w/ other providers is the most difficult part of my job. I write letters, usually cc'd to the client; I make telephone calls; in general, if necessary, I harass----the medical providers in order to get the job done for the client.

I was for many years a registered respiratory therapist working in ICU's and ER's of large city hospitals. I know my western medicine.

And so, it is troubling to me to find that regardless of my efforts----and they are an extensive bombardment inclusive of phone calling, e mailing, texting, etc.,----that I could not----after 4 text messages, one phone call when I talked to the psychiatrist, and numerous voice mails left for an executive of the company----resolve the problem of this rural client of mine, whom I have seen for several years. I even sent the executive the name and date of birth of the client to his specific e mail in order to try and get something done as I could turn no one up to help w/ the situation. This is perhaps not in keeping w/ HIPAA but given the APA Code of Ethics, it seems to me that I had best attend to the APA Code of Ethics regarding the treatment of others whom are my clients. I could not, in good conscience, dabble and make a few non-tethered calls----until I finally came to the conclusion----which I discussed with the client-----that I could not make an impact.

The client works hard to try and stabilize physical health issues. It is very sad and maddening to see how little impact I can have on the very large Daymark Recovery system re: my rural client, calling and calling----again and again to the local pharmacy----to the point that the client gave up as there are numerous medications they fill for said client and enraging the pharmacy was not something that was wise to do. We understand they are busy; however there is no efficient system for knowing if the script has been filled or not.

Lo and behold, the NYT has today in the Science Section an article about just that: "The Doctor Will See You....Eventually." ".....Nationwide, the average wait time to see a doctor last year was 23 minutes, according to the health care consultants Press Ganey." (I wonder what the wait time is to get an answer over the phone, however). See the article here: http://www.nytimes.com/2011/08/02/health/policy/02consumer.html

I am sorry to have perturbed the executive of the company but my allegiance is to the client and not to the extended provider network that throws up its hand when it hits the wall of not being able to get the prescriber to address the issue.

You need a new prescriber, I told the client. The issue is this, however: there are so few psychiatric providers in rural western NC. Pick your poison, I suggested.

NC Med.Journal: Hlth Reform: by 2014,20% state's population on Medicaid : Lanier Cansler, Secretary NC DHHS Speaks Out

2011-08-01T20:05:00.003-05:00

The March/ April 2011 NC Medical Journal has an interesting article by Secretary of NC DHHS, Lanier Cansler.

In about 3 years, 20% of the population of NC will be on Medicaid. Isn't it time to have a One Provider System? There's no sign of that taking place, however, re: the 'exchange' which Mr. Cansler described in his article: www.northcarolinamedicaljournal.com/archives/?72217

Some timely comments from Mr Cansler's article in this public policy medical journal for the state:

"....NC Medicaid (will cover).....more than 20 million individuals, or approximatley 20% of the state's population by 2014. Beginning in 2014, all legal residents younger than 65 years whose income falls at or below 138% of the federal poverty level will be eligible for Medicaid coverage....

One key provision of the ACA (Affordable Care Act) is the requirement that states establish a 'no wrong door' approach fo individuals seeking to learn whether they are eligible or want to apply for a health insurance exchange product.....

DHHS has accelerated developmentl work on North Carolia Families Accessing Services through Technolgoy, a Web-based eligibility simplification and electronic eligibility determination system for 13 different income-related programs and services.....

As North Carolina's population grows (NC is projected to be the seventh most populous state by 2030) and becomes older as the baby boomer generation ages, the cost of sustaining the Medicaid program will exceed the state's ability to pay for the program....

To mention a few improvements, the DHHS and its Division of Meidcal Assistance will evaluate the option of establishing a 'basic health plan' to assist persons likely to otherwise switch back and forth between the exchange and Medicaid coverage...."

Also in the issue of this good public health journal is the following information re: "Implementation of the Affordable Care Act":

".......One of the primary reasons for passingthe ACA was to make health insurance more accessible and affordable. In NC, approximately 1.7 million nonelderly people (20.4% of the nonelderly population) were uninsured in 2009.....

.....for a family of 4, the limit (of 138%, by 2014) is equivalent to an annual household income of $30,429..."

NC Disability Rights' Vicki Smith: NC Mental Health Mess: With Disappearance of Republican Driven De-Funding, NC Moves FURTHER Away From Law

2011-07-30T11:03:00.003-05:00

Vicki Smith, who is Executive Director of Disability Rights, undoubtedly a 501c3 entity (nonprofit) has to adhere to certain standards----as in it cannot be partisan, or coming down on the side of one political party or another. The same is true of another organization, NC Hope, which is a mental health consumer-driven group.

Here , in Adam Linker's online post, Vicki Smith is speaking about how the Department of Justice has determined that keeping people with mental health challenges in family care homes is cruel and ridiculous. It is. I've had plenty of clients in these family care homes where the only entertainment or things to do with your life is to smoke cigarettes, watch endless re-runs on TV, and take your psychiatric meds that hammer your head to your pillow. (see page 8: Policy and Progress: NC Justice Center: http://ncjustice.org/?q=node/44

In that the Republicans are cutting Medicaid funding, does anyone really think they are going to CREATE funding for this to happen? So, you can bring lawsuit after lawsuit and even fine NC DHHS, etc. etc. etc. Until you get the Republican Party out of control at the state and federal level, nothing will happen.

Non-profit groups such as these serve useful functions, obviously. However there is a very large rogue elephant walking around in the room, disrupting all of their attempts to do anything and it is called the Republican Party. And that party is in control of the NC State Legislature at this time.

Indeed, that party is in such control that they just cut Asheville out of the District 11 map which means that next time we vote,unless the NC Democratic party wins its suit in court, we will vote with the more conservative Gastonia, NC, and have absolutely no ability to choose or keep a Democrat in the US Congress or the State Legislature.

So, talk on, non-profit groups. Until you can get the Republicans out of the catbird seat, nothing good will happen.

Small 'Ahem' re: Department of Justice's Federal Investigation of NC Mental Health Services, Particularly Family Care Homes:Republicans Must Go

2011-07-29T10:21:00.004-05:00

The Department of Justice (aka 'the Feds') have, as we knew, begun an investigation of NC Mental Health Reform. The Feds, have most specifically as re: this investigation, surveyed the family care homes and the 'institutionalization' of people w/ mental health challenges in those family care homes----- of which there are many in the Asheville area.

Indeed, this psychologist has formally complained about the family care homes to the point of risking arrest by the Buncombe County Sheriff who 'accompanied' me off the campus of one family care home in Leicester, NC (I am glad to say that this home has improved and shaken its old owner; its problems remain, however, due to how rural it is, and thus isolated; so the Feds can talk on and on but unless there are mechanisms and money to put what they would like to happen into effect, well, little is going to change).

Here is that Madame Defarge matter from several years ago. I went to Buncombe DSS and had a meeting w/ the personnel at DSS and the thankfully long-gone owner, a meeting which I walked out of, as I said I would, because DSS could not keep the owner from attacking and dennigrating me: http://madame-defarge.blogspot.com/2009_03_01_archive.html.

In any case, the DOJ letter posted July 28, 2011, kindly made available by NC Mental Hope's David Cornwall is here and will not be posted by the DOJ until 10 days from July 28, 2011, on the Civil Rights webpage of the DOJ:

ncmentalhope.org/documents/DOJLetter.pdf

What this July 28, 2011 document argues is that a lawsuit will be pressed if NC DHHS does not clean up its act re: people who have mental health challenges who are interned in family care homes. Specifically, in the last part of the letter and Section E, it outlines that mental health care in NC must 'devlop sufficient supportive housing' at 'scattered sites' and 'connect to an array of services' people w/ mental health challenges and that moreover, there must be 'quality management' of those services.

Sure. Better go tell that to the Republicans who are driving all the cuts to human services.

Where does the DOJ think that these services are going to be turned up? 'Scattered site' housing': you bet. There is no more Section 8 housing available in Haywood or Buncombe county (or more coyly and correctly stated, 'there's a waiting list.')

Thus, they can talk and talk but money talks, bullshit walks----and this DOJ threatened lawsuit is therefore bullshit against the backdrop of a Congress that is being held hostage by a bunch of tea-baggers whom are giving the rest of us migraine headaches.

Or as Edgar Allen Poe said, this is all a dream within a dream. Sure, bring a lawsuit, DOJ. The little man or woman might best spend their time highlighting how the Republican agenda is to cut more services than are at this time in place.

J. J. Cale CD, "#8": "Money Talks":

"Money talks, you'd better believe it......
You'd be surprised the friends you can buy with small change...."

NC Medicare Transfer Confusion: It Does Not Matter That You Sent In Your Palmetto NC Medicare Paperwork Ages Ago

2011-07-28T12:59:00.003-05:00

When CIGNA Government Services assumeably lost its bid to continue managing NC Medicare, it was transferred to PalmettoGBA (whatever that stands for: here is their home page: http://www.palmettogba.com/palmetto/palmetto.nsf/DocsCat/Home

I sent in all my paperwork to Palmetto months ago, transferring my Medicare provider information. At least they send you paper remittances which CIGNA stopped doing about 8 months ago which was really unhelpful because then you could not see, easily, if some of your claims had problems and address the issue. Instead, you had to go online and peck around.

Even though there are paper remittances, there is still massive confusion in the system due to the transfer between CIGNA and Palmetto.

As per the personnel on the phone at Palmetto a moment ago, they have been managing NC Medicare for over 30 days now. However, when you call up the IT - Tech Services arm of the company, make note that of the 8 options, for there is not one referring to 'NC' as per that tel number: 1 866 749 4301. So, pick any one of them; I picked the 1st one' Trailblazers.' That will take you to an IT person who, if you're lucky, will tell you that your registration that you just created at the home page in order to access documents to do business w/ Palmetto, 'does not work' or there is some problem and that he will 'send it back to provider services and they should send you an e mail within 24-48 hours.'

Great. There's nothing like the ease of doing one's work.

These are all just barriers to health care. We need a ONE PAYER SYSTEM.

The IVR (automatic voice response system: I haven't even tried that yet to see if anything works) is: 888 414 8592.

More Confusion for Medicare Providers With Unprocessed Claims From CIGNA Gov't Services Transfer to Palmetto GBA Managing NC Medicare

2011-07-28T12:07:00.002-05:00

If you had any unresolved claims left in the lurch, as I did (gee: wonder why I never heard back from CIGNA Government Services in the 30 days they stated they would contact me) when CIGNA Government Services lost their contract earllier this year (did I say this before: We need a ONE PROVIDER SYSTEM) to process Medicare Part B Claims for Mental Health, make note that Executive Kay Cretch (the only number you can find on the internet associated w/ CIGNA Goverment Services for NC anymore), after asking 'how did you get this number', states that all this information was 'supposedly' 'given' to Palmetto GBA which now process NC Medicare claims.

So, don't bother calling the old CIGNA Government Services tel number which is on the paperwork of your non-processed claim (866 238 9651), for its been disconnected. You can read Kay Cretch of CIGNA whom will 'walk upstairs' (no, I'm not kidding; her number: 615 782 4525) your question so that someone can call you back and the machine will tell you only that OH and KY providers need bother calling.

For NC Providers, as regards Medicare claims, you now call
Palmetto GBA
J11 Mac
Mailcode GM-215
POB 100238
Columbia, SC 29202-3238

at the 866 830 3043.

Have your NPI, PCAN (Medicare Provider Number) and ever other piece of paper you can think of ready.

With the Loss of Teachers in NC, We're Going To Need More Mental Health Grants for Kids in School

2011-07-23T22:14:00.005-05:00

Gee: wouldn't it be great if other counties had such a program. This one is associated w/ Henderson County in Western NC.

The loss of teachers next year is exemplified here re: Cateret County in eastern NC.

What I know is that 'the best' school counselor at Asheville High School left for a Texas job; the dance teacher has been 'ushered out' after 30 years; and, the American history teacher took a hike also. This is just details from what I know as re: my 16 yr old son at Asheville HS.

The 'hit' to NC public education as associated w/ the Republican driven NC state legislature is massive. See, for example:

http://www.topsailvoice.com/articles/2011/02/06/news-times/news/doc4d4dc9b77c209082240349.txt

".....Using an N.C. Public Instruction PowerPoint presentation, Dr. Novey outlined the effects on the school system of a projected $3.7 billion state budget shortfall and the loss of more than $1 million in federal stimulus funds.

The bottom line would be the loss of 92 positions, of which about 80 are teachers and teacher assistants. This would result in larger class sizes and possible loss of programs.

Dr. Novey has posted the PowerPoint presentation on the school system’s website: www.carteretcountyschools.org. He also urged citizens to contact their state representatives to urge them to retain education funding....."

***********************************************

Grant establishes mental health wellness program for North Carolina students

JULY 19, 2011

http://www.casioprojector.com/news/classroom/800554998/Grant_establishes_mental_health_wellness_program_for_North_Carolina_students

For academic success to occur, it sometimes becomes necessary to meet the emotional needs of students first. According to the Citizen-Times, Henderson County schools in North Carolina recently received a federal grant that will establish mental health counseling for local students.

"I think a lot of kids wouldn't seek services outside of school," Tammy Greenwell, chief operating officer for Blue Ridge Community Health Services, told the media outlet.

The Henderson County grant, which totals $160,000, is part of a $95 million mental wellness program established by the Affordable Act, reported the news provider.

For some students, it may be difficult to speak their minds. Accordingly, counselors may want to engage them in innovative ways and use educational technology, such as a mental wellness computer program, a therapeutic robot or a DLP projector, to make them feel comfortable.

"The school and family health program allows the students and members of the community in those areas access to primary family care they would not have had access to otherwise," Chuck Shelton, Bakersville Community Medical Clinic administrator, told the Citizen Times.

NC Medicare Providers' Outpatient Therapy Problems w/ Palmetto (Which We Never Had With CIGNA Government Services Who Used to Manage Medicare in NC)

2011-07-08T21:42:00.005-05:00

Palmetto has been 'managing' NC outpatient Medicare for the past several months (CIGNA Government Services which used to manage Medicare must have been out-bid, resulting in a company that can no longer function efficiently, apparently).

This is what my biller, whom has done an excellent job for a couple of years advises me:

"....This new Medicare company (Palmetto) obviously does not send out denial EOB's before the 13 day pay drop as Cigna did so there was no reason to assume a problem. For some reason, Palmetto wants to see Box 32 (Facility Location were services rendered) completed with your information. This is not the norm since it is typical reserved for hospital, nursing facility, etc. info...."

These are all just barriers to mental health care in NC. This is just going to put more and more mental health providers out of business and these kind of 'glitches' seem to be epidemic now.

NC Medical Schools 'Area Health Education Centers' Mention That NC Has Mental Health Reform Challenges/ Circle Game of Value Options & HP Enterprises

2011-07-08T20:40:00.003-05:00

Ya think?

These kinds of things just make me want to cry. The medical schools 'education centers' (in Asheville, NC, its 'MAHEC' or Mountain Area Health Education Center') which must fell more trees than Planned Parenthood or the ACLU (yes, I'm glad to support them but give me a break w/ the US mail barrage please)---makes mention that 'NC Mental Health Reform is under way.'

Really? See here their challenging information:

NC Mental Health Reform: Facing the Challenge of Reform

http://www.ncahec.net/program/pubs/InfoUpdates/AHECmentalhealth.pdf

When the associated NC Medical Journal published a piece of mine about a year and a half ago, they ran it as 'Reader's Forum.' I guess I should be satisfied w/ having made some small statement regarding the mess that NC Medicaid has become.

I wrote in the NC Medical Journal, p. 574 NC Med J November/December 2009, Volume 70, Number 6, the following:

"....."....North Carolina mental health reform was instituted

in 2001, with implementation starting in the furthermost

point from Raleigh in western North Carolina where it was

created......Individual therapy and assessment becomes formatted group therapy

rendered by lesser qualified mental health professionals......"

Mark that last line and juxtapose it next to this sad matter re: state of affairs of one of the largest mental health providers in western NC as associated with one of the mental health 'providers' having an affair w/ an underage male and then running off to Florida with the child when the police came to investigate:

http://www.smokymountainnews.com/news/item/4076-doctor-authorities-did-not-do-enough

"......With barely any work history to boast of, she turned to her one and only employment asset: a psychology degree from those years at UNC. Mills applied for, and got, an entry-level position at Meridian Behavioral Health Services, a multi-county nonprofit mental-health provider......Joseph and some of the other kids from Meridian were soon “working” at Mills’ home, Petty said, cutting grass and painting walls. His daughters told him of parties, and he and his new wife, Meg, started witnessing the same behaviors firsthand...."

So, you see, it is upsetting to this professional, licensed, doctoral mental health care provider to have to call back and forth between Value Options, the authorizing agent (for outpatient therapy of more than 8 sessions/ year for Medicaid adults) and HP Enterprises (who creates the paperwork re: billing) in order to see where my professional money has gone.

So, today, while I am supposed to be on vacation, I needed to look at my NC Medicaid paperwork to see why in the world my bank account was so low given that I had done all of this Medicaid billing in the last month. Until recently, NC Medicaid webclaims was a dependable way to get paid....that is, perhaps, until HP (yes, that Hewlett Packard) Enterprises took over the 'remittances' arena----or is it Value Options, the authorizing agency that is to blame?

For, its become a circle game and you cannot pin the tail on the donkey anywhere....if you can even find the donkey.

For, you see, neither one of these businesses offers any more paperwork that one can quickly scan. Instead, for the 'remittances' (to understand if there are any billing errors that one needs to address) you go online to the 'remittance' arena at NC Medicaid webclaims which makes sense.....as managed by HP Enterprises----but then, HP Enterprises (aka "we-can-help-you-with-three-patients-only-but-we-can-put-you-back-in-the queu") cannot tell you anything about how many sessions the 'cousin' Value Options has authorized. Thus there is no ability of the provider to easily match up the authorizations and the payment system (everything has been outsources and made piece-meal, including Humana's outpatient therapy to a company in Texas named 'LifeSynch).

Unless, of course, you want to spend your vacation calling back and forth to HP Enterprises and Value Options----the functional arms of NC Medicaid outpatient mental health services.

Carmichael's Photo-Journalism of NC Mental Hlth Reform : Its the LONELINESS That Is Life-Annhilating: Argument for Self-Empowerment for Those w/ MI

2011-06-27T11:57:00.006-05:00

Here is a wonderful piece of photo journalism, a master's thesis, by J. Chris Carmichael as pertaining to the effects of NC mental health reform. One of the issues, well evidenced here, which seems a persistent issue for clients of mine w/ mental health challenges, is that they are LONELY in their isolation and the stigmatization of mental health challenges certainly contributes to that.

What this photo-journalism piece speaks to is the need for community which has been found as associated w/ several clubhouses----a model creating community for people w/ mental health issues, both in Europe and spottily, in the US. I know of no clubhouse in western NC. What we have is a more advanced (?) model, namely the Recovery Education Center at Meridian Behavioral HealthCare in Waynesville, NC, which is a good resource for learning about issues impacting mental health. I question this as it is run by good-meaning professionals and para-professionals but there is limited impact of the the clients/ consumers to determine what happens there.

Moreover, a recovery model has as its underpinning that the person can completely 'recover' from a mental health challenge when the fact is that there will be ups and downs throughout one's life. A model which has as an underpinning the empowerment of the impacted people----and that would be a clubhouse model I think----is more appropriate to the phenomenon associated w/ Severe Persistent Mental Illness (SPMI).

I was acquainted w/ a clubhouse in downtown Atlanta. It was always run-down, spilling over w/ people who had no where else to go. Best I know, it is no longer there after some decades of serving that community. There, some people were inside learning computer skills but the overall gist of the place was, as Carmichael seems to allude to, that this is the 'Last Exit' for many of them.

A client of mine yesterday, w/ her own demons re: narcotic addiction a few years ago, is struggling to make clear to her primary care provider how she does not want to become re-addicted, but at the same time knowing that somebody/ somehow has to address her chronic pain. From my experience, chronic pain, a significant stressor exacerbating mental health issues, such as depression, can much of the time be linked to sexual/ emotional/ physical abuse histories (this is well researched) but the story is deeper than that and just the wear and tear on a human body----particularly women re: child bearing-----has been vastly overlooked.

http://jchriscarmichael.com/InShadows/Voices/

Last Exit – Chris Carmichael | Visual Journalist | Chapel Hill, NC

Last Exit is a component of my master's thesis “In Shadows: Hardship and

Hope in Mental Health,” which examined mental health reform in North

Carolina seven ...

US Center for Medicaid/ Medicaid Services Versus Private Insurers Pay-Outs to Insured

2011-06-26T00:01:00.003-05:00

A picture or graph is worth a thousand words:

http://hcfan.3cdn.net/15b2e716998ad2bdd0_ktm6bz8u0.pdf

Medical benefit ratios

of private insurers, public

Medicare plan, 1993 to 2007

Percentage of federal Medicare benefit outlays spent on medical care

compared with percentage of premium revenue spent on medical care

by investor-owned private insurance companies

UNC Chapel Hill's Institute of Government Outlines Problems w/ Non Disclosure Agreement Driving Medicaid Waiver

2011-06-25T11:04:00.002-05:00

This was published in a previous Defarge post but I wanted to bring it forward again as the powers that be seem to be ignoring the issues driving the Medicaid Waiver. This document was passed out to the public at the June meeting of the Western Highlands Network LME Board:

"(e mail sent to WHN CEO Arthur Carder, 6.1.2011):

Arthur,

In response to your rquest that I examine some of the legal issues surrounding the use of the PBH "Non-Disclosure Agreement," I discussed the matter with my colleague, Frayda Bluestein, who has expertise in state public records law. Our review of the agreement raised two specific legal questions that the parties should consider before executing the agreement. One is how the state public records law might apply to restrict your LME's subsequent compliance with a public records request for documentary information you receive under the non-disclosure agreement. Another involves a state constitutional limitation, which I address in the next paragraph.

The constitutional limitation: Paragraph 6 of the agrement, the indemnity clause, says that the LME promises to indemnify PBH for any losses, liability, damages, and claims caused not only by any act of omission of the LME, but also for the acts and omissions of the LME's contractors. In other words, the LME promises to indemnify PBH for the negligence or liability of others. The Constitution of North Carolina, Art. V, Sec. 4, subsection 3, states that no unit of local government shall give or lend its credit in aid of any person, association, or corporation, except for public purposes and unless approved by a majority of the qualified voters. Because a loan of credit is defined to include the guaranteeing of debts of an individual, association, or private corporation, and because the indemnity clause (par 6 of the non-disclosure agrement) says that the LME promises to indemnity PBH for losses for which a contractor is liable (the contractor's debts), paragraph 6 is a "loan of credit" that triggers a constitutional requirement that cannot be agreed to unless approved by the voters. Therefore, paragraph 6 of the agreement is invalid if this vote is not taken and, generally, local government attorneys would not agree to such a provision.

The public records law question: I note that the non-disclosure agreement applies to "proprietary information," which the agreement defines to include "know-how" and "ideas," as well as "documents." To the extent that the information to be shared is documentary in nature (paper, film, audio recordings, photographs, magnetic tapes, electrtonically stores records, etc.), it is "public record" as defined in G.S. 132-1 and subject to disclosure under the public records law unless some or all of the records are exempt from the law's provision granting the public a right of access. On the rother hand, unrecorded information or knowledge in the minds of public employees (e.g., how to use or think about the records ) is not a public record. therefore, my discussion here of the public records law does not apply to the know-how or ideas that reside in PBH employees' minds and that are intended to be shared pursuant to the non-disclosure agreement. By extension, my concern that the public records law raises obligations that compete with those created by the non-disclosure agreement does apply to know-how and ideas, nor do I examine the validity, appropriateness, or applicability of the non-disclosure agreement to know-how or ideas.

My understanding is that the information PBH intends to share with other LME's includes written (in paper or electronic form) policies and procedures, manuals, forms, contracts, privileging and credentialing tools, provider standards, provider appeal processes and forms, consumer appeal process and forms, etc. The North Carolina Public Records Act permits public access to all public records in an agency's possession unles the agency or the record is specifically exempts from the statute. (I will presume, here, that no one takes the view that PBH is not a governmental agency subject tot he public records statute. If I am wrong on this point, and need to address this qustion, please let me know). I have identified no provision of state law that explicitly exempts the PBH records at issue here from public access under the public records law. The public records act exemption for trade secrets does not apply, as that exemption applies to a trade secret that is the property of a private person.

Neverthtless, under federal law, a North Carolina local government may obtain copyright protection for appropriate materials that are public records. David Lawrence, in his book Public Records Law for North Carolina Public Governments (2nd ed., 2009), at page 55, writes, "a member of the public retains the right, under the public records law, to inspect and make a copy of copyrighted material when the government owns the copyright, but the government may assert its rights as copyright owner and restrict the uses that may be made of a copy of the copyrighted material." It is unclear from a reading of the non-disclosure agrement whether PBH is asserting a copyright interest in the records to be shared and relying on that legal interest as the basis for the agreement. To the extent that PBH holds a copyright on material subject to the non-disclosure agrement, it may be lawful for PBH to refuse to produce the material unless the reeipient signs an agreement restricting the commercial use of the records without PBH consent (See, Seago v Horry County, 663 S.E. 2d 38 (S.C. 2008), holding that state public records law and federal copyright law could be read harmoniously by requiring the county to provide public access to its digital maps but allowing it to restrict the subsequent commercial distribution of the maps by requiring citizns to sign a licensing agreement prior to the county releasing the requested copyrighted material.)

The issue at hand seems analogous to the Seago case. However, the terms of the PBH non disclosure agreement appear to create obligations on the part of the LME's receiving PBH information that go beyond PBH's interest in restricting the subsequent commercial distribution of public records subject to the copyright law. To put it another way, the PBH non-disclosure agreement does not appear to strike the harmonious balance between public records law and copyright law that is described in the Seago case. The PBH non-disclosure agreement, at paragraph 3,b., not only restricts the subsquent commercial use or distribution of records received by LME's but has the recipient LMEs promise that they will not, without the prior written consent of PBH, "copy, use or disclose" any information that "has value in PBH's business," remove the information from the premises of the LME, or "deliver" any information "to any person or entity outside the LME." (LME contractors are excepted from this promise). The terms of the agreement appear to prohibit the LME that receives PBH records from providing public access to the records under the state public records law. Thus, the LME that signs the agreement appears to agree that is will not only protect the records from commercial use and distribution, but also that is will not comply with the North Carolina Public Records Act.

The Seago case is a South Carolina case that North Carolina courts are not bound by, and there is no North Carolina case on point. I don't know how a North Carolina court might strike the balance between a copyright holder's interests and the public's interes in access to government documents. It is theroretically possible that a North Carolina court might permit public access and inspection, but not copying of copyrighted records. But, if we assume that State's courts would reach the same or a similar result as Seago, then we can say that the public retains the right, under state public records law, to inspect and make a copy of copyrighted material when government owns the copyright. Because that public right would apply to requests made to the LME that receives PBH material, it is unclear from the agreement how the recipient LME would be able to comply with both the agreement and state law when subsequently faced with a public records requrest for PBH records (One way to strike the balance might be to require the LME, prior to complying with a public records request, to have the citizen or other seeker of records sign an agreement prohibiting commercial distribution and use.)

The foregoing issues are not trivial. I am concerned that the non-disclosure agreement generally lacks the specificity necessary for the parties to clearly understand the scope of information to which it applies and the nature of obligations it imposes. Because the obligations imposed by the agreement on any LME signing it are broad and significant (e.g., permitting PBH attorneys to act on the LME's behalf at the LME's expense, the LME agreeing to pay PBH for damages arising out of contractors' breach of the agreement, no disclosure permitted of information subject to the agrement to any person or entity other than LME contractors), because the agreement states that it applies to any and all information and records disclosed by PBH to the LME, and because the agreement, though possibly appropriate for private parties, does not acknowledge or reference the existence of laws applicable to governmental entities that may raise competing obligations, it is reasonable and appropriate for your governing board to carefully consider the agreement before signing it, seek advice from your agency attorney, and request modifications from PBH as necessary.

PBH appears to have valuable and legitimate interests to protect, and a contract or licensing agreement may be the appropriate means for obtaining that protection. It strikes me that an agreement could be written that protects PBH intersts, but also permits the LME's that receive the information to comply with laws applicable to local governments. Towards that end, I would rewrite paragraphs 6 and 3, b., to address the issues raised above, and perhaps add a paragraph that says that the obligations of the agreement are binding and enforceable only to the extent that they are consistent with any other state and federal law applicable to North Carolina local governments (I note that Paragarph 9 refers to resolving conflicts in accordance with NC law, but leaving "as is" provisions that we know conflict with NC law---which creates confusion and leaves the parties uncertain as to their obligations---and later, face the prospect of the parties having to litigate the meaning of NC law, does not seem prudent if agreement and clarity can be achieved now.) I also note that the agreement permits the LME to use PBH records "exclusively to prepare the LME to operate the waivers and for no other purpose." Due to this language, it is possible to argue that the LME can use the records only to prepare for operation, and that once the LME begins to operate the waiver any continued use of the PBH materials would be a violation of the agreement. While this may not be the intention of the parties, the agreement would be better if it were clear and unambiguous on this point.

The foregoing analysis and conclusions are based on my own research, and consultation with others who have expertise in local government law. I am not an expert in federal copyright law or intellectual property rights. Attorneys with expertise in those fields may have something to say that requires additions or modifications to my own analysis and conclusions. At a minimum, I hope this information helps you identify some specific issues raised by the non-disclosure agrement that are amenable to resolution through further discussion with PBH.

Mark Botts "

Daymark Recovery, Insuring 38,000 clients in 29 Counties Backs Medicaid Waiver But Non Disclosure Agreement Trashing of Public Records Law Ignored

2011-06-25T10:49:00.005-05:00

If NC DHHS and by default, large companies such as Daymark, see advantages to the Medicaid Waiver, then creating a LEGAL Non Disclosure Agreement in order to launch the Medicaid Waiver, that does not trash NC Public Health Records laws should be attended to. That would be the start of creating 'more accountability.'

Here is the article and its link: http://www.ncsapa.org/2011/executive-calls-for-changes-in-behavioral-services/

An influential voice in the intense debate over behavioral-health reform believes the state should give the groups charged with managing services more oversight power.

However, Billy West Jr., the executive director of Daymark Recovery Services Inc., also wants local management entities (LME), such as CenterPoint Human Services, to take on more accountability to ensure the system meets community and patient needs.

West’s opinion matters since Daymark, based in Lexington, is a nonprofit that provides mental-health and substance-abuse services for about 38,000 clients in 29 counties.

It also is noteworthy because few providers, large and small, discuss their opinions publicly out of concern for affecting their relationships with LME management officials.

West said LMEs need more oversight authority in order to keep the state from wasting money.

“Three years in a row, the state has spent almost $1 billion on community support Medicaid services only to find fraud, financial waste, enabling of patients and a high state hospital rate,” West said.

West said some of the fraud and inefficiency is a byproduct of not having all LMEs operate with a Medicaid waiver program, which allows LMEs to control how federal Medicaid money is spent.

Advocates are concerned the waiver program puts fewer restrictions on how LMEs manage the providers and services they oversee — allowing them to funnel clients to certain groups.

Associated Press: Early Retirees to Qualify for Medicaid under ObamaCare (plz, let's have another name)

2011-06-21T21:54:00.002-05:00

http://apnews.excite.com/article/20110622/D9O0JB0O1.html

I want some Medicaid. I haven't been able to afford any health insurance for over a year and a half. BCBSNC was charging my husband and adolescent son, all w/ excellent health histories, over $700/ month w/ a $2500 deductible. And surely NC Mental Health Reform is going to make me want to retire early.

Whoa, what's this? An effort to have 'ONE PROVIDER'?

We can only hope. But wait! Of COURSE, ".... Republicans already see a problem...."

Quick: make obscure the loophole, just as the Republicans have done re: corporate taxation.

How about the common people get a little taste of Congress's health care benefits? hmmm?

"......"The fact that this is being discovered now tells you, what else is baked into this law?" said Leavitt, who served as Health and Human Services secretary under President George H.W. Bush. "It clearly begins to reveal that the nature of the law was to put more and more people under eligibility for government insurance."

The Medicare actuary's office roughed out some examples to illustrate how the provision would work. A married couple retiring at 62 in 2014 and receiving the maximum Social Security benefit of $23,500 apiece could get $17,000 from other sources and still qualify for Medicaid with a total income of $64,000.

That $64,000 would put them at about four times the federal poverty level, which for a two-person household is $14,710 this year. The Medicaid expansion in the health care law was supposed to benefit childless adults with incomes up to 133 percent of the poverty level. A fudge factor built into the law bumps that up to 138 percent.

The actuary's office acknowledged its $64,000 example would represent an unusual case, but nonetheless the hypothetical couple would still qualify for Medicaid. ...."

After 140 Years of Not Being in Control, This is What NC Republicans Have Given Us

2011-06-20T21:26:00.002-05:00

This is the first time in 140 years that the Republican Party has been in control of both the NC Senate and House. And what they have given us, as a present, is a massively diminished public education system and massive cuts to public mental health.

Heckuva job, Brownie.

(see: Wikipedia, Michael D. Brown):

Resignation from FEMA

On September 12, 2005, in the wake of what was widely believed to be incompetent handling of the aftermath of Hurricane Katrina by state, local and federal officials, Brown resigned, saying that it was "in the best interest of the agency and best interest of the president."^[13] His standing had also been damaged when the Boston Herald revealed his meager experience in disaster management before joining FEMA. .....

By the time he resigned from FEMA, Brown had already been discharged from his functions as coordinator of the federal efforts in New Orleans and Gulf Coast by Homeland Security Secretary Michael Chertoff and was sent back to Washington to continue FEMA's central operations. Bush, who had appointed Brown in 2003, praised Brown shortly after the storm hit, saying "Brownie, you're doing a heck of a job,"^[15] but later deflected questions about the resignation, except to deny having discussed the resignation with him.

At least one reliable source, The Economist, recognized the likelihood that Brown was "pushed" out by the administration rather than having resigned voluntarily, although internal e-mails from Brown indicated that he was already planning to leave FEMA at the time Katrina hit.^[16]"

I guess this means that the Republicans---and the Fabulous Five Democrats who drove their budget over Perdue's veto----will now 'get scarce' (like Brownie did around the time that Katrina hit New Orleans) since they've done a maximum amount of damage:

(On Governor Perdue): Last week, she made history again by placing a red veto stamp on the two-year budget bill, which became law when Republicans — in charge of both chambers for the first time in 140 years — overrode her with the help of a handful of Democrats."

http://www.greenfieldreporter.com/view/story/a3583ffb40e549e28882f51cb1df19c2/NC--Perdue-Bill-Signings/

You GO, Bev Perdue.

Republican Led NC State Legislature Puts Education BEHIND MS: MA Mental Health Worker Slain by Mentally Ill Man

2011-06-17T10:38:00.002-05:00

Matters overlap. Behaviors can be predicted. And you can predict that the further shredding of NC Medicaid and Public Education by NC Republicans will lead to scenarios like the following.

But first, let's just be perfectly clear what has taken place here as per the midnight vote of the NC State Legislature, wherein the NC Republicans and the 5 Democrats who voted with them are responsible for what is about to happen to NC citizens: http://www.thepilot.com/news/2011/jun17/budget/budget-now-hangs-squarely-gop

In that the best predictor of future behavior is past behavior, and in that MA has had (not even nearly) the budget cuts to public mental health that NC has had, this is the kind of scenarios that you can expect to occur in NC as a result of the callow, misguided vote of the NC Republicans and the 5 Democrats whom did not seem to be able to stand behind the Dem governor:

A MENTAL PATIENT, A SLAIN WORKER, TROUBLING QUESTIONS

NYT Friday, June 17, 2011
www.nytimes.com2011/06/17/us/17MENTAL.html

"....The state mental health commissioner, Barbara A. Leadholm, said she believed her department was providing high-quality care despite the budget cuts it was obliged to accommodate.

"We have to be responsive to what the administration and the legislature feel they can financially afford.....

But advocates for the mentally ill, along with mental health care providers and experts, paint a picture of a underfianced department straining to meet the varying needs of its clients....Over the last two years, the department has increased its reliance on private community providers who say they are underfinanced and struggling to stay afoat. It has closed one state hospital and a small inpatient psychiatric center. It has whittled its client list by almost a thousand. And it has laid off a quarter of its case managers, severing important relationships for thousands of people with serious mental illness and transferrig them to younger, lower paid workers in the private sector......Over the last half-century, as Massachusetts eliminated over 20,000 long-term psychiatric hospital beds and many of the public, unionized jobs that went with them, the state developed a network of private agencies, mostly nonprofit, to provide care for severe mental illness.

The community system never had enogh money, many experts say, but recent budget cuts, combined with Medicaid reimbursement rates that did not keep pace with rising costs, have seriously weakened it.

"The outpatient treatment system in Massachusetts is dying on the vine,,", said Vicker V. DiGravio III, the chief executive of the Associaton for Behavioral Health care, which represents providers in the state." ....."The end result,", Mr. DiGravio said, "is a system where the folks with the least professinoal experience are serving the clients with the most intensive needs---because the Department of Mental Health serves only those people with the most severe mental illness."....

Care in "institutions for mental disease" has never been covered by Medicaid; community care is. Indeed, in the view of experts on public psychiatry like Dr. Jeffrey Geller of the University of Massachusetts Medical School, cost-shifting has been n"the major driving force" behind deinstitutionalization, "with the philosophy a tag-on." ...

Today only 3 percent of the Mental Health Department's clients live in state hospitals. For those in the community, the department has shifted in recent years from a model of care that sees serious mental illness as a long-term disability to a "recovery" model, which seeks to move clients into increasingly less restrictive, less supervised and less costly living situations.

"Its all about getting people discharged as opposed to getting them treatment," said Jill Homer, a state employed case manager for three decades who nnonetheless feels that the system has "fumbled through" its downsizing fairly well.

Dr. Marie H. Hobart, medical director of Community Healthlink in Worcester, said she worried that the new approach "pretends" serious metal illness is linear, that people who improve will never suffer setbacks. She said that seriously ill clients were being allowed to leave the care of the Department of Mental health, with some ending up homeless or in jail.....

"THE ELEPHNAT IN THE ROOM IS THE STATE MENTAL HEALTH BUDGET," she (Laurie Martinelli, the executive director of the NAMI in MA) said. "Did the murders have something to do with funding cutbacks?"

The "historical budget levels" posted on the department's Web site show a nearly 10 percent decline in appropriations for mental health from 2009 through 2011.

******************************
(Regarding the mentally ill man whom stabbed and bludgeoned the mental health care worker at the family care home):

"....Mr. Chappell was admitted to Massachusetts General for a couple of weeks. that is when schizophhrenia was diagnosed and he was prescribed antipsychotic medication, his mother said. Over the next couple of years, though, he did not take his medication consistenty because the side effects bothered him, she said. ....

The psychologist, Jeffrey Miner, cited non sequiturs that Mr. Chappell had spouted in a private session. He said that Mr. Chappell, a native of nearby Chelsea, told him various that he hailed from Texas and rooted for the Wasington Redskins and that he wanted "a lawyer from UCLA with a 3.5 grade point average." When Dr. Miner asked a follow-up question, Mr. Chappell responded, "Masseuse." ....

Ms. Moore, the chief executive of North Suffolk, would not discuss Mr. Chappell's case. Asked what her employeed did if residents becamse non-compliant with their medication, she said: "I don't like to use the word 'compliant.' that implies you can force people to take medication, which you can't." Still, she said, "Our staff is trained to observe and document, to note and report any changes, any symptomology. We would not ignore it." ....

Overall, the risk of violence from people with mental disorders is considered low. But studies have shown that it can be elevated by various factors apparent in Mr. Chappell's profile----delusions and hallucinations, a lack of treatment or failure to take medication, abuse of alcohol or drugs. the strongest predictor of violence by a mentally ill perso nis believed to be past violence...."

***************************************

Rest in peace, Stephanie Moulton. You did the best you could under the circumstances. The blame lies squarely in the lap of the Republican Party, both nationally and on a state-by-state basis.

5 NC Democrats are Poised to Vote Down Perdue's Veto of Budget Which Republicans Created, Slaughtering Medicaid

2011-06-14T12:09:00.006-05:00

Governor Bev Perdue of NC wisely vetoed the budget bill created by NC Republicans whom have, as an agenda, to push NC to 49th in terms of funding for education and to further decimate NC Medicaid. Support the governor's veto by calling or sending e mail to these Democratic Representatives whom are poised to go along with the Republican agenda of smashing schools and NC Medicaid.

The VOTE is scheduled for Wednesday, June 15, 2011.

These are the Democratic Party representatives whom are purportedly leaning towards voting to smash schools' budgets and further undo NC Medicaid. I called them and hope you will also:

William.Brisson@ncleg.net: Bladen, Cumberland, counties

Jim.Crawford@ncleg.net: Granville, Vance counties

Dewey.Hill@ncleg.net: Brunswick, Columbus counties

Bill.Owens@ncleg.net: Camden, Currituck, Pasquotank, Tyrrell counties

Timothy.Spear@ncleg.net: Chowan, Dare, Hyde, Washington counties

Here is the referenced information about the above:

http://signon.org/sign/tell-the-party-of-five?source=mo&id=28023-17999971-cIjwe6x&t=2

Tell the Party of Five to support the Governor

By Action NC (Contact)

To be delivered to: Representative William D. Brisson, Representative James W. Crawford, Jr., Representative Dewey L. Hill, Representative Bill Owens and Representative Timothy L. Spear

....If passed as written, this budget will cut millions from public education, cripple our public health services, and badly damage public infrastructure for years to come. These five Democrats are all that stands between North Carolina and this horrible budget. We need them to understand the damage they could cause and tell them we expect better from our representatives.

Medicare Will Be The Game-Changer : APA Recognizes Psychologists' Role in Creating Healthcare Networks

2011-06-13T12:46:00.004-05:00

http://www.apapracticecentral.org/update/2011/06-09/proposed-medicare.aspx

The following was just sent out by the American Psychological Association as associated w/ their 'looking ahead' regarding the coordination of health care amongst providers. Already, as associated with Humana cients, whose mental health care has been outsourced to a company in Irving, TX, called LifeSynch, clients must fill out forms indicating a release to coordinate health care between this psychologist and their primary care physician and other health care providers. Finally, we are beginning to get the bigger picture as associated with patient health care being coordinated so that health care providers can all be on the same page. This is a very positive move. See this URL for that letter from APA to the (federal) Department of Health & Human Services.

Comments call for psychologists’ inclusion in ACOsAPA Chief Executive Officer Norman B. Anderson, PhD, and APA Executive Director for Professional Practice Katherine C. Nordal, PhD, urge inclusion of clinical psychologists as participants in Medicare Accountable Care Organizations (ACOs)By Government Relations Staff http://www.apapracticecentral.org/update/2011/06-09/proposed-medicare.aspx

Republican Paul Ryan's Medicare 'Vouchers' : Seniors Would Pay $6000 More Out of Pocket :Linking the Dots

2011-06-06T11:19:00.004-05:00

I have a lot of clients whom are dually eligible re: Medicare and Medicaid. Indeed, those two are managed by CMS (Centers for Medicare and Medicaid Services). Medicare acts as the primary insurer and Medicaid wraps around and pays for the remainder of the bill. If one has Medicare and Medicaid, there is no co-pay.

All disabled citizens receiving Social Security Disability, for the most part, are dually eligible----that is unless they receive over about $950/ month as per their Disability check in which case, they have to pass through the 'doughtnut hole' in order to get to their Medicaid. These commonly would be people who own something, like a trailer, or a car, and are not completely impoverished.

Therefore, the Republican agenda is to sink even deeper into the mire of poverty not only the disabled but also the lower middle class and middle-middle class whom would not be able to afford payment out of pocket. They say its about saving money and balancing the budget but please tell me what is the worth of your gated community if you are afraid to outside of it for the chaos of the multitudes whom have been undone by your budget policies?

Or, to paraphrase the Bible, what shall it profit a man if he should gain the whole world (in terms of his tax savings) if he is bludgeoned by an insane person whom cannot get any mental health care? Better be making some bullet-proof luxury cars. We can, thankfully, depend on our access to guns.

That means that citizens who cannot pay, would not be able to pay, and as per the findings of the Congressional Budget Office, an analysis which ".....found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan than they would if Medicare as we know it was preserved. Based on the budget office estimates, the typical senios would end up paying around $6000 more out of pocket in the plan's first year of operation." (see: "Vouchercare is not Medicare": NYT: www.nytmes.com/2011/06/06/opinion/06krugman.html)

The Congressional Budget Office's role (see their webpage) is to provide "objective,non-partisan" information to Congress and the public.

People who receive Medicare, if the Republicans have their way, would receive 'premium support payments' (as per the CBO document, otherwise known as 'vouchers') and would have severely truncated services for they would not be able to afford it.

And if you are Medicare only client, who has to go through a 'doughnut hole' in order to get to Medicaid, boy, you would sure move through that quickly-----that is, if you had the thousands of dollars to pay from your pocket in order to get to Medicaid which would be impoverished at the state level by the NC State Legislature Republicans.

Therefore, at the federal level, as per the Republican plan via Paul Ryan (R; Chairman of the House Budget Committe) to create 'vouchers' which citizens would use in lieu of regular Medicare, the Republicans are attempting to create a plan which would utterly fail and further sink mental as well as all other health care. I'd say that they were successful! as per their desire to drown government and successful! at lining the pockets of for-profit industry.

Here is the Congressional Budget Office's letter and analysis to Chairman Ryan: www.cbo.gov/ftpdocs/121xx/doc12128/04-05-Ryan_Letter.pdf

For, if we have Republicans at the NC State Legislature level refusing to continue a .1 cents sales tax (which we do)----which is decimating Medicaid and the public school system-----backing up to the US Congress, w/ the House of Representatives led by the Republicans whom want to create 'vouchers' for Medicare, then you might as well drag out the coffin related to NC mental health care.

WHN LME 'Goes Its Own Way' re: Medicaid Waiver: pbH Non-Disclosive Agreement Hoisted Upon LME's Deemed by UNC Institute of Government to Be 'Illegal'

2011-06-03T10:40:00.005-05:00

Its a good day for those supporting open government and efficient public mental health service delivery in western NC. The Western Highlands Network Board and administration has made this happen (with a little help from the concerned CFAC, Consumer and Family Advisory Council appointed to advise the board as per NC Mental Health Reform; the NC Commissioners on the Health and Human Services committee; legal opinion from the UNC Chapel Hill Institute of Government; and, other concerned citizens/ providers such as this one).

Today was the Western Highlands Network (WHN) LME (manages mental health services for 7 counties in Western NC) June Board meeting (1st Friday of every month). The Board, to its credit, after something of a closed session, voted to 'go its own way' re: the NC DHHS mandated Medicaid Waiver. Comments from the WHN LME Board included that, "pbh acts like a public entity when it wants to and a private entity when it wants to." The chairman of the Board indicated that WHN LME Board had made a 'request for public records' of pbH as associated w/ the Medicaid Waiver, which they refused or did not acknowledge. Other associated comments included that pbH has 'state legislators now in control of the mental health reform process' whileas Martin Nesbitt, co-chair of the NC Joint Legislative Oversight Committee (D-Buncombe) has lost some impact even though he is the head of the NC State Legislature Senate (must be some pretty powerful Republican state legislators; yes, they're Republicans).

The Board indicated they wanted to 'cooperate' w/ pbH (Piedmont Behavioral Health LME, in eastern NC, whom have utilized and developed a Medicaid Waiver plan since 2005 at the behest and approval of NC DHHS). The Board indicated that they wanted a face-to-face meeting with the pbH Board or members associated with the Non-Disclosure Agreement which I hope they will make public. The legal opinion, offered in its entirety below, as per the written information handed out to the public today at the WHN LME Board meeting, states, in part:

".....The terms of the agreement appear to prohibit the LME that receives PBH records

from providing public access to the records under the state public records law...."

Therefore, if an LME has signed on w/ this Non-Disclosure Agreement of pbH's, they have cut-off (illegally, it appears) citizens' rights to obtain public records. This was the stated over-riding concern of the WHN LME Board at their May, 2011 meeting, during which they voted down the signing of the pbH Non-Disclosure Agreement (which pbH subsequently revised to take out some of the more onerous requirement, previously referred to as 'The Borg' on Madame Defarge; but the document, though truncated, is essentially the same).

Relatedly, in a letter to Robert Carey, a member of the Consumer and Family Advisory Committee for WHN LME, from NC DHHS's Michael Watson, Deputy Secretary for Health Services, dated 5.23.2011, states (and this was handed out at the Board meeting also):

"......More than 15 LME's have already signed the agreement and are currently working with the materials. LMEs will also develop and utilize their own materials, so long as all waiver and Medicaid contract requirements are met....."

That's a little bit of arm twisting, eh?

Moreover, as per attorney Mark Botts reading of the pbH Non Disclosure Agreement which 15 LME's have signed, he states:

".......Thus the LME that signs the agreement appears to agree that it will not only protect the records from commercial use and distribution but also that it will not comply with the North Carolina Public Records Act....The terms of the agreement appear to prohibit the LME that receives PBH records from providing public access to the records under the state public records law. "

The overall conclusion of the WHN LME Board seemed to be that, as per obtaining an opinion from Mark F. Botts, J.D., Associate Professor of Public Law and Government, School of Government, The University of North Carolina at Chapel Hill, tel 919 962 8204, e mail: Botts@sog.unc.edu, that the pbH Non-Disclosure Agreement, which was quite massively upgraded as per the version that Mr. Botts overviewed, is still problematic and this is particularly troublesome given the fact that 15 LME's have already signed a document deemed to be disharmonious with state law (the state mental health programs are already, reportedly, being investigated by the Feds and surely this will throw more kindling on that fire).

Here is Botts letter, in its entirety except for the underlining associated with discriminating the sections, which was in a set of documents given to the public at the WHN LME Board meeting today (see previous Madame Defarge posts within the past month to see the old pbH Non-Disclosure Agreement; after I posted it online on 6.3.2011, I noted, on the Monday following the Friday of the board meeting, that there were some mispellings. I was eager to get the document online, admittedly, given the importance of it and I had hand-typed, rather than scanned, the document, into this blog and so I have tried to correct all of those as per the original document):

*********************************
(e mail sent to WHN CEO Arthur Carder, 6.1.2011):

Medicaid Waiver & Its Permutations as the State Legislature Changes the Language Associated w/ Using Piedmont Behavioral Health LME's Medicaid Model

2011-05-28T15:29:00.004-05:00

Meantime, the Medicaid Waiver continues to roll out across the state.

Sure, we want to save money. Everyone gets that and the premise is that locally the Medicaid money can be managed more efficiently and there is some sense to this.

The problem is that the LME's, that manage state funded mental health care and have done this since 2002, are now being demanded by the NC State Legislature to oversee their catchment area's Medicaid. Those LME's are going to---and already have---- created a mountain of unnecessary paperwork when what is currently in place is an efficient authorization mechanism vis a vis Value Options (for more than 8 outpatient therapy sessions for adults; for more than 26 outpatient therapy sessions for adolescents/ children).

Whenever you see that someone has suicided or killed someone in the NC newspapers, and they talk about that person having a mental health challenge, know that the most important question to ask in order to understand what didn't take place in terms of their mental health care is: was the person a 'state funded mental health' client. I'll eat my hat if this isn't true of every single story I've seen over the past year regarding these kinds of events. No reporter ever asks the question, either, for to ask the question is to reveal the failure of NC Mental Health Reform. The purpose of NC Mental Health Reform, in part, was to provide mental health care for EVERY citizen. Thus, the 'state funded' mental health care category was created and that has been what the LME's have been doing for the past 10 years: managing state funded clients. For, you see, the paperwork created by the LME's in order to work w/ people who had no Medicaid or other health insurance, was this 'state funded' avenue and it does not work because no provider is willing to fill out reams of paperwork and not be paid. NC Mental Health Reform was a well intentioned idea that has been very poorly planned and diminishing paperwork is part of the planning and NC DHHS and the LME's can't or won't do anything about that matter.

Thus, a tremendous barrier to outpatient treatment by professionals, such as this psychologist, is waiting in the wings and the name of that is the Medicaid Waiver. Its the outpatient treatment that keeps people out of the hospital and saves taxpayer money. When you create a massive barrier to that, guess what: more people will go into the hospital and more money will be spent. Additionally, no patient I have ever known has wanted to go into a psychiatric unit; they simply get so ill that there is no other choice. This matter is true for ANY mental health professional working in an outpatient setting.

Moreover, the paperwork for Enhanced Services, the Service Definition that has sunk NC Mental Health Reform, requires even more paperwork. Rather than NC DHHS having created that Service Definition in 2000, they might have more carefully PLANNED how money was going to be spent by all the private companies that understandably sprung up to 'catch the wave' of the Enhanced Services monies. The lack of planning is evident to providers and Medicaid consumers and their families and that is what all the complaining is about from the public: once again, another major shift in Medicaid funding and its management is being created and we can already see the places that the planning is absent. Our comments are ignored.

Why is the Medicaid waiver a problem for Medicaid recipients and their families as it is being launched, with the NC Legislature pushing this, from the loins of Piedmont Behavioral Health LME? Because there is no transparency to Medicaid recipients/ their families as per the Non-Disclosure Agreement created by Piedmont Behavioral Health (pbH, their logo), an LME in eastern NC. pbH attempted to hoist onto Western Highlands Network (WHN) LME that agreement during the WHN LME board's May, 2011 meeting (see this link for that document:: http://madame-defarge.blogspot.com/2011/05/watergate-ii-or-borg-public-funds-being.html. The WHN LME Board voted the acceptance of that document down, against the advice of their attorney and the CEO of WHN LME.

So, NC DHHS has not done its job regarding how to utilize already Medicaid certified mental health providers as per this waiver and rather than do their work, has allowed the LME's to simply demand that providers spend hours and hours of unpaid work, filling out forms and gathering up unnecessary information, in order to continue to work w/ Medicaid clients. The CEO of WHN LME, when I queried him about the 18+ page form to be filled out, indicated that CMS (Centers for Medicaid/ Medicare Services) demands such. I have asked the legislative arm of the American Psychological Association to find out whom I can speak to at CMS in order to revamp this matter.

As re: psychologist mental health providers (and others), don't ask the NCPA for help: the public mental health committee members of that organization are salaried psychologists working in state mental health hospitals and do not function independently and do no billing and therefore have no horse in that race. Been there, done that.

And, the NC State Legislature has not done their work re: the Medicaid Waiver as they hem-haw around the language in the various bills outlining the Medicaid Waiver as they attempt to demand that 'fealty' (they have now changed that word to 'kind of looks like' or something akin to that) to the pbH Medicaid Waiver model be adhered to. It is clear that the complaining of providers, citizens, and county commissioners is impacting how the NC State Legislature writes the bills outlining the implementation of the Medicaid Waiver.

Yes, it is clear that there is no reason for each LME to re-create the wheel re: the management of Medicaid monies since the state legislature is so damned intent on hoisting this Medicaid Waiver on all the LME's----if they can keep standing. However, there is no good reason why public monies supplied to pbH to create their Medicaid Waiver beginning in 2005, should cause pbH to act like a private enterprise and send mental health reform right back to 'where we were 7 years ago' (the statement of the Chair of the WHN LME Board during the May, 2011 meeting of that board).

On the 2nd Friday of June, at 9:30 am, the Western Highlands Network (WHN) LME Board will meet; they administer state mental health and will soon administer Medicaid for 7 counties in Western NC. You can bet there will be a great deal of talk about the Medicaid Waiver matter.

Over the past several weeks since the May, 2011 WHN LME Board meeting, there has been a great deal of complaining about the arm twisting associated w/ the Medicaid Waiver matter and I suspect that the county commissioners have done their fair share of that complaining as they had to have voted to allow the Medicaid Waiver to move towards adoption by the LME. (I bet they recognize that as a Trojan Horse now).

Marsha V. Hammond, PhD, Licensed Psychologist

NC DHHS : Please Do Your Work Re: the Medicaid Waiver Prior to Giving Everyone Else the Work To Do

2011-05-14T08:32:00.003-05:00

In Mr. Cansler's 'Medicaid Waiver' presentation to state representatives in 2009, he mentioned, on page 4, that one thing that could be expected would be 'frequent billing and payment difficulties." Here is that information that Mr. Cansler gave out in 2009: www.ncdhhs.gov/dma/legis/071009MedicaidWaiverLME.pdf

Does the below lack of regard for provider's time come under that heading? And I really cabnot understand why is it acceptable to not anticipate these kinds of issues PARTICULARLY if one of the LME's, specifically, Piedmont Behavioral Health (pbH; their logo) 'has gone through' the Medicaid Waiver process since 2005.

Thus, I have written to the following representatives associated with these matters:

"Rep. Jeff Barnhart" ,
"Rep. Harold \"Bru\" Brubaker" ,
"Rep. Justin P. Burr" ,
"Rep. Nelson Dollar" ,
"Rep. Verla Insko" ,
"Rep. Darren Jackson" ,
"Rep. Beverly Earle" ,
"Rep. David Lewis" ,
"Rep. Bill Current" ,
"Rep. Fred Steen" ,
"Rep. Hugh Blackwell" ,
"Rep. Jean Farmer-Butterfield" ,
"Rep. Jennifer Weiss" ,
"Rep. Jim Crawford" ,
"Rep. Julia Howard" ,
"Rep. Mark Hollo" ,
"Rep. Pat Hurley" ,
"Rep. Rayne Brown" ,
"Rep. Shirley B. Randleman" ,
"Rep. Tom Murry" ,
"Rep. Tricia Cotham" ,
"Rep. William Brisson" ,
"Rep. William Wainwright" ,
"Rep. Garland Pierce" ,
David Gantt

Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 5197
e mail: chomskysright@gmail.com

May 16, 2011

Dear State Representatives and County Commissionersi:

I am in receipt of advocates' concerns re: the Medicaid Waiver . Providers have concerns also. I voiced these to Secretary Cansler as re: the Western Highlands Network (WHN) LME meeting last week during which they voted NO to the "Non-Disclosure Agreement" sent to them by Piedmont Behavioral Health (pbH; that's their logo). That means, that they are voting NO to the Medicaid Waiver . He wrote me back via his assistant 5.9.2011 and indicated that they were 'working on it.' That 'working on it' should precede the doing of the waiver. (you can see that letter at my blog: http://madame-defarge.blogspot.com/)

My concern, which I presented to the Executive board of WHN LME on 5.6.2011, was the 18+ pages of 're-certification' to render Medicaid Services. I am a licensed psychologist; I am a Medicaid provider; I am a Medicare Provider; I am a provider on most insurance panels. I have an NPI number (national provider number which was supposed to have taken the place of Medicare/ Medicaid numbers).

WHY can't NC DHHS work w/ CMS (Centers for Medicare/ Medicaid Services) to seguae this Medicaid Waiver thru the LME's if they are so intent on making it happen? Why leave it to the providers to do the work that NC DHHS should have done, this in addition to my work as a psychologist? Why am I having to ask the American Psychological Association's CMS liasons about what to do here? These are long processes, that of working with CMS and NC DHHS should have done this prior to hoisting this Medicaid Waiver which they have been doing since 2005 vis a vis pbH.

I would ask you to slow down this Medicaid Waiver matter until NC DHHS does its footwork and homework which has now become my work, unless I want to fill out 18+ page applications LME-by-LME. The concerns of the advocates and families of consumers has been exactly the same: please stop railroading this Medicaid Waiver prior to having done your work.

Sincerely,

Marsha V. Hammond, PhD, Licensed Psychologist

Secretary Canlser Responds to Medicaid Waiver Provider Request to Please Save Us From the Unnecessary 18+ Page Re-certification of Medicaid Provider

2011-05-13T13:56:00.004-05:00

I'm already a Medicaid provider. Now the LME's vis a vis this Medicaid Waiver, are insisting that all the providers re-certify themselves LME-by-LME as re: this Medicaid Waiver.

They blame it on CMS. Sure. I mean, I know from sitting and listening at APA to Tony Puente's talks re: CMS and psychologists who work in public mental health that there is the necessary creation of 'avenues' regarding psychologists' reimbursement fees, and all that kind of thing. However, if NC DHHS wanted to prevent a further deterioration of public mental health, they would have gone and talked to CMS.

I'm soliciting help from the APA CMS liasons. I'll be back w/ info as I get it.
______________________________________________________

Marsha V. Hammond, PhD, Licensed Psychologist, NC
Member, American Psychological Association
Mailing address: Asheville, NC 28806
Cell: 828 772 5197 e mail: chomskysright@gmail.com

May 15, 2011

RE: 18 page + application forms for already licensed & Medicaid certified psychologists as re: Medicaid Waiver process in NC/ public mental health

Dear American Psychological Association_____________________________

I am a licensed psychologist in NC; I am a member of APA. I am certified by NC Medicaid to provide services to Medicaid clients; I am certified by Medicare to provide Medicare Services; I have an NPI number which was reportedly to have taken the place the Medicare & Medicaid numbers.
The Medicaid Waiver program is being advanced by NC DHHS in a most unprepared manner, and even though I have been for years a Medicaid provider, I am being required to re-apply for certification vis a vis this Medicaid waiver process as associated with an 18 page+ application, assembling of items like a ‘sealed college transcript’, etc., in order to be certified to provide Medicaid services for an LME (mental health administration government entity) in NC which is under the administration of NC DHHS. Why, I ask? Why not just disband the licensing board, please, and save me and the taxpayers some money.
I enclose a letter from Dr. Beth Melcher, PhD, Asst Secretary for MH. DD./ SA Services of NC DHHS, dated 5.9.2011.
In that letter, she explains:
“….Secretary Cansler requested that I respond to your letter dated May 1, 2011. In this letter you raise concerns regarding the process for becoming a credentialed Medicaid provider within the Western Highlands Network LME provider network. The process you have outlined is approved by the federal Center for Medicaid/. Medicare Services (CMS). As additional LMEs become waiver sites the provider application process is one of the areas to be standardized across the Managed Care Organizations (MCOs). While licensure is a critical piece of the certification process additional information is required. There is discussion about whether information from licensure boards could be shared for verification information which would streamline this process. …”
As you probably know, any citizen can go onto the internet and discern as to whether I, or anyone else, is a licensed psychologist. It is public information. Why can’t NC DHHS utilize the licensing board information in order to curtail this unnecessary recreation of the wheel, LME by LME?
In order to render services to Medicaid eligible clients (and most of my clients are either Medicaid clients or dually eligible Medicare/ Medicaid clients), I am being required to create paperwork-----LME-by-LME-----in order to continue to work as a Medicaid provider. Why?
NC Mental Health Reform, as administrated by NC DHHS, has destroyed the provider network and this kind of paperwork, surely to be succeeded by reams of paperwork on each and every Medicaid client, session by session, is a very very serious matter which will contribute to more mental health crises, as was outlined today in a Raleigh newspaper regarding a woman who quite obviously was supposed to have received mental health services and was kept in the hospital two days (I assume she was a ‘state funded client’; this means that no private provider would render services for any period of time due to the paperwork involved with such a client; NC Mental Health Reform, started about 10 painful years ago now, was to have made mental health services available to ALL citizens), was released to a group home, which she left, and then she proceeded to jump off the local hospital’s parking deck (she was not a patient there!), killing herself.
Can someone from APA please address this issue? I am forwarding this to Division 42, Division of Independent Practice, of APA, of which I am a member, in the hopes that someone has an idea as to how to inform CMS that it is not necessary for Medicaid providers to be re-approved by each and every LME as the Medicaid Waiver is unjustifiably hoisted onto the LME’s in NC----by the NC State Legislature and as per NC DHHS.
Thanks for any assistance and attention you can give to this matter.

Sincerely,

Marsha V. Hammond, PhD
Licensed Psychologist, NC; certified Medicaid & Medicare provider

Cc: Beth Melcher, PhD, Asst. Secretary for MH./ DD/SA Services
Secretary Lanier Cansler
Arthur Carder, CEO WHN LME
David Gantt, Chair Buncombe County Commissioners; members of the Buncombe
County Board of Commissioners
Representative Verla Insko, Co-Chair Joint Legislative Oversight Committee for MH
Reform, NC
Senator Martin Nesbitt, Co-Chair Joint Legislative Oversight Committee for MH
Reform, NC
NC Mental Health Reform blogspot maintained by Marsha Hammond, PhD:
http://madame-defarge.blogspot.com/

Watergate II or The Borg?:Public Funds Being Used to Create Private Wealth? per NC Medicaid Waiver as Western Highlands Network is Bullied by pbH LME

2011-05-07T16:57:00.005-05:00

The document below almost caused me to weep for the citizens of NC.

Here's the outline of what I think is taking place:

Piedmont Behavioral Health (pbH, as they so cutely call themselves), which is an LME, or public mental health agency under NC DHHS---just like Western Highlands Network LME or Smoky Mountain Center LME-----covering all of western NC re:Medicaid and state funded mental health services----is twisting,big time, the arm of WHN LME. Who cares,you say?

Well, pbH is funded by tax-payers as is WHN and SMC. pbH wants to own WHN LME, hook, line, and sinker. If you don't believe that, simply read the public document below.

And from WHN LME, they will simply move on to their next conquest w/ a similar arm-twisting 'Non-Disclosure Agreement.' I assume that SMC LME is next.

Unless I am badly mistaken, sitting behind pbH is Daymark Recovery, a private, for profit company in eastern NC (I do have one client in western NC, whom receives psychiatric services from a Daymark Recovery psychiatrist via a modality here which I will not describe as I do not want to be sued, and I wrote him/ her a letter re: his medication which caused her to go to jail; that psychiatrist, duh, denied that). So much trouble ensued, that the client and talked about the possibility of suing that psychiatrist.

Maybe some activist has the information linking Daymark Recovery to pbH?

Daymark Recovery insures 38,000 lives in terms of mental health services. I'm betting that they are the largest private mental health company in this state.

Yesterday, the Executive Board of WHN LME met and one of the public documents given to anyone that was there was the pbH 'Non-Disclosure Agreement' (see below; I copied the entire thing and nothing is changed except for underlining and bolding some of the headers: this is what the WHN LME looked at and voted down yesterday----God bless those brave people).

pbH was able to 'offer' this 'Non-Disclosure Agreement' as they (pat on the back, boyo) have been in the Medicaid Waiver business a la NC DHHS/ NC Medicaid since 2005. Therefore, they are now acting like they can very exactingly tell everyone else what to do, how to do it, and how long they are going to do it.

Its a very , very scary contract which is being hoisted onto the backs of NC citizens in order that public monies be used to line private pocket. (there will be no justice in the land until medical care is non-profit)

If this isn't Jean Luc Picard's (see Star Trek) Borg experience, I don't know what is. I'm looking around to see if I should be meeting someone in a garage a la Watergate but hey, folks: this is a public document. I simply copied it.

Its as if an alien, for profit, out only for themselves------ empire swooped down on a public entity and said sign this or we throw you off the train with an 85 pound bag of concrete tied to you-----and this is exactly what the WHN LME attorney said would happen if the Board did not approve this 'Non-Disclosure Agreement.'

When I digitalize the film given to me by Jerry Rice, simply a private man who states that his 'ministry' is to record every single Buncombe County public meeting since 1999----for no pay, he states-----it will be seen what took place yesterday during that WHN LME meeting.

Read it in its entirety below. Even Jean Luc Picard weeped when he was overtaken by the Borg (but he got his identity back-----eventually) . The section on "Moral Rights", in particular, made me shudder. But then, even that shudder was offset by the knife that I personally felt in my own back re: the 'we've signed this voluntarily.'

______________________________________________________________
pbH

NON-DISCLOSURE AGREEMENT

This Non-Disclosure Agreement (“Agreement”) is effective as of May 2, 2011 (“Effective Date”) by and between PBH, a Managed Behavioral Healthcare Organization, having its principal place of business at 245 LePhillip Court, Concord, North Carolina 28025 (“PBH”)) and Western Highlands Network a Local Management Entity, having its principal place of business at 356 Biltmore Avenue, Asheville, NC 28802 (“WHN”)

In consideration of the mutual covenants and agreements hereafter set forth, the parties agree as follows:

Relationship of the Parties. WHN desires to operate North Carolina’s 1915 (b) and 1915(c) Medicaid waivers and to contract with the North Carolina Division of Medical Assistance to manage behavioral health benefits for Medicaid consumers. PBH has operated the 1915(b) and 1915(c) waivers since 2005. PBH has agreed to share with WHN Proprietary Information which PBH has developed during its five years of operating the waivers. WHN will contract with various contractors who may have access to and utilize PBH’s Proprietary Information as part of the business relationship ship between WHN and its contractors. This agreement addresses the desire that Proprietary Information shared with WHN will be used exclusively to prepare WHN to operate the waivers and for no other purpose. Specifically, PBH and WHN desire that Proprietary Information which is shared may not be used, sold, licensed, or any way offered for the benefit of any party other than WHN. WHN agrees to require any contractor who may have access to the Proprietary Information to be bound by the terms of this Agreement.

Term/ Termination. This Agreement will commence on the Effective Date and continue, unless terminated earlier pursuant to this Section 2, until 5( five ) years thereafter. This Agreement may be terminated by either party at any time by giving written notice of termination to the other party. In the events of such termination, WHN will be obligated to return to PBH all Proprietary Information and to destroy any copies of the Proprietary Information, whether it is in hard copy, electronic, or any other form, whether in the possession of WHN or a WHN contractor, with 7 (seven) days of the date of the written notice of termination.

Confidentiality

a. Proprietary Information. WHN understands that PBH possesses and will possess Proprietary Information that is important to its business. For purpose of this Agreement, “Proprietary Information” is all information that is disclosed to WHN by, or on behalf of PBH, and that is developed at PBH’s facilities or with use of PBH’s equipment and/or personnel. Proprietary Information includes, but is not limited to, information (and all tangible items in any form incorporating, embodying or containing information) relating to (a) all client, customer, vendor, and contractor lists and all lists or other compilations containing client, customer, vendor, or contractor information; (b) information about products, proposed products, research, product development, know-how, techniques, processes, costs, markets, marketing plans, strategies, forecasts, sales, and unpublished information relating to technological and scientific developments; (c) plans or ideas for future development and new produict concepts; (d) all techniques or processes,documents, books, papers, drawings, schematics, models, sketches, computer programs, data bases, and other data of any kind and descriptions including electronic data recorded or retrieved by any means; (e) the compensation, performance and terms of employment of PBH employees; (f) software in various stages of development, and any designs, drawings, schematics, specifications, techniques, models, data, source code, algorithms, object code, documentation, diagrams, flow charts, research and development, processes and procedures relating to any software; and (g) all other information that has been or will be given to WHN in confidence by PBH (or any affiliate) concerning PBH’s actual or anticipated business, research or development or that is received in confidence by or for PBH from any other person or entity. Proprietary Information does not include information that WHN demonstrates, by written documentation created in the ordinary course of business, (i) is in the public domain through lawful means that do not directly or indirectly result from any act or omission of WHN in breach of its obligations hereunder; (ii) was already rightfully known or available to disclosure to WHN; (iii) is independently developed by WHN; (iv) is disclosed under operation of Law, provided WHN has promptly notified PBH of any legal process requiring production of Proprietary Information prior to compliance and has taken all reasonable precautions to ensure confidential treatment of any information so disclosed; (v) is disclosed by WHN with PBH’s prior written approval.

Non-DisClosure. WHN understands that this Agreement creates a relationship of confident and trust between WHN and PBH with regard to Proprietary Information. WHN will at all times, both during and after the term of the Agreement, keep the Proprietary Information securely in confidence and trust. WHN will not without the prior written consent of an authorized representative of PBH (i) copy, use of disclose any Proprietary Information, (ii) remove any Proprietary Information from the business premises of WHN, or (iii) deliver any Proprietary Information to any person or entity outside WHN. Notwithstanding the foregoing, WHN may use the Proprietary Information (and disclose and deliver same to WHN’s contractors, if applicable, who have a need to know, provided such contractors have previously entered into written agreements protecting third-party proprietary information received by WHN and containing provisions at least as restrictive as those set form in the Section 4) as may be necessary and appropriate for WHN to operate North Carolina’s 1915(b) and 1925(c) Medicaid waivers and to contract with the North Carolina Division of Medical Assistance to manage behavioral health benefits for Medicaid consumers.

Ownership and License.

a. Assignment of Proprietary Information. All Proprietary Information covered by this Agreement and proprietary rights of any kind that pertain to the Proprietary Information, which currently exist or may exist in the future (collectively, the “Rights”), shall be the sole property of PBH. WHN hereby irrevocably assigns and agrees to assign to PBH, without further consideration, any and all Rights that WHN may have or acquire in the Proprietary Information, except as is otherwise agreed to in writing by the parties.
b. Cooperation. WHN agrees to perform, during and after the term of this Agreement, all acts deemed necessary or desirable by PBH to permit and assist it, at WHN’s expense, in evidencing, perfecting, obtaining, maintaining, defending and enforcing Rights and/ or WHN’s assignments herein. Such acts may include, but are not limited to, execution of documents and assistance or cooperation in legal proceedings. If WHN is unable or unwilling to perform the acts required by this provision, WHN hereby irrevocably designates and appoints PBH and its duly authorized officers and agents, as WHN’s agents and attorneys-in-fact, with full power of substitution, to act for and in behalf and instead of WHN, to execute and file any documents and to do all other lawfully permitted acts to further the above purposes with the same legal force and effect as if executed by WHN.
c. Moral Rights. Any assignment of copyrights hereunder (and any ownership of a copyrights as a work made for hire) includes all rights of paternity, integrity, disclosure and withdrawal and any other rights that may be known as or referred to as “moral rights” (collectively, “Moral Rights”). To the extent such Moral Rights cannot be assigned under applicable law and to the extent the following is allowed by the laws in the various countries where Moral Rights exit, WHN hereby ratified and consents to any action of PBH that would violate such Moral Rights in the absence of such ratification/ consent. WHN will confirm any such ratifications and consents from time to time as requested by PBH.
d. Interference With PBH Business. WHN agrees that for the term of this Agreement as described in Section 2 and for a period of six (6) months following any termination of the Agreement, WHN shall not, for itself or any third party, directly or indirectly divert or attempt to divert from PBH (or any affiliate of it that might be formed) any business of any kind in which PB H is engaged including, without limitation, the solicitation of or interference with any of its customers, clients or vendors. WHN understands that none of the foregoing activities will be prohibited if WHN can prove that the action was taken without the use in any way of Proprietary Information.
e. Privacy. WHN recognizes and agrees that it has no expectation of privacy with respect to PBH’s telecommuncations, networking, or information processing systems (including, without limitation, stored computer files, e mail messages and voice messages( and WHN’s activity, and any files or messages, on any of those systems may be monitored at any time without notice.

Independent Entities. The Parties shall act as independent entities and not as an employees or authorized agents of each other. The Parties have no authority to enter into contracts or binding commitments in the name or on behalf of the other. The Parties will not use each other’s logos or marks without prior written approval, and then such use shall be only for the benefit of the other Party and the at the direction of the other Party. The Parties shall not be, nor represent themselves as being, authorized to bind the other Party.

Representations and Warranties. Each Party represents and warrants that, as of the Effective Date and at all ties during the term of this Agreement: (i) this Agreement will not breach any agreement that either Party has with any other party including, without limitation, any agreement to keep in confidence proprietary information acquired in confidence or trust prior to the executive of this Agreement; (ii) neither Party is, nor will be bound by any agreement, nor will they assume any obligation, which would in any way be inconsistent with this Agreement; (iii) neither Party will disclose to, or induce the other Party to use, any confidential or proprietary information of any person or entity other than themselves; and (iv) each Party’s employees and contractors, as applicable, have executed written non-disclosure, assignment of rights, and other appropriate agreements sufficient to protect the confidentiality of the Proprietary Information, and sufficient to allow the Parties to grant the assignments and licenses as provided herein.

Indemnity. Each Party agrees to defend, indemnify and hold the other Party and their affiliates (and their respective employees, directors and representatives( harmless against any and all losses, liabilities, damages, claims, demands and suits and related costs and expenses (including, without limitation, reasonable attorneys’ fees and court costs (arising or resulting, directly or indirectly, from (i) any act or omission or breach of any representation, warranty or covenant of this Agreement of the indemnifying Party, or (ii) infringement of any third-party intellectual property rights by the indemnifying Party.

Limit of Liability. NOTWITHSANDING ANYTHING ELSE IN THIS AGREEMENT OR OTHERWISE, NEITHER PARTY WILL BE LIABLE WITH RESPECT TO ANY SUBJECT MATTER OF THIS AGREEMENT UNDER ANY CONTRACT, NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL OR EQUITABLE THEORY FOR ANY INCIDENTAL, SPECIAL, EXEMPLARY OR CONSEQUENTIAL DAMAGES, THE FOREGOING LIMITATION DOESNOT APPLY TO EITHER PARTY’S OBLIGATIONS OF CONFIDENTIALITY UNDER SECTION 3, ASSIGNMENT AND DISCLOSURE UNDER SECTION 4, OR INDEMNITY UNDER SECTION 7.

Miscellaneous.

a. Governing Law. WHN agrees that any dispute in the meaning effect or validity of this Agreement shall be resolved in accordance with the laws of the State of North Carolina without regard to the conflict of laws provisions thereof. If any provision of this Agreement is held to be illegal or unenforceable, such provision shall be limited or excluded from this Agreement to the minimum extent required, and the balance of the Agreement shall be interpreted as if such provision was so limited or excluded and shall be enforceable in accordance with its terms.
b. Assignment. This Agreement (together with all attached exhibits) shall be binding upon WHN, and inure to the benefit of the parties hereto and their respective heirs, successors, assigns, and personal representatives; provided, however, that WHN shall not assign any of its rights or delegate any of its duties hereunder without PBH’s prior written consent and any attempted assignment or delegation will be void.
c. Entire Agreement/ Modifications. This Agreement (together with all executed Work Statements and attached exhibits( contains the entire understanding of the parties regarding its subject matter. This Agreement may only be modified by a subsequent written agreement executed by authorized representative of both parties.
d. Notice. All notices required or given under this Agreement shall be deemed given upon receipt or upon deposit in the US mail, postage pre-paid; by facsimile; or by commercial overnight delivery service with tracking capabilities.
e. Remedies. WHN recognizes that nothing in this Agreement is intended to limit any remedy of PBH under the Uniform Trade Secrets Act and other trade secre laws and that WHN could face p0ossible criminal and civil actions, resulting in substantial monetary liability if WHN misappropriates PBH’s trade secrets. In addition, WHN recognizes that a violation of this Agreement could cause PBH irreparable harm, the amo0unt of may be extremely difficult to estimate, thus making any remedy at law inadequate. Therefore, WHN agrees that PBH shall have the right to apply to any court of competent jurisdiction for an order restraining any breach of threatened breach of this Agreement and for any other relief PBH deems appropriate without being required to post any bond or other security. This right shall be in addition to any other remedy available to PBH in law or eq1uity.
f. Survival. The provisions of this Agreement that may be reasonably interpreted as surviving its termination shall continue in effect after termination of this Agreement. PBH is entitled to communicate WHN’s obligations under this Agreement to any customers, clients, vendors, or contractors of WHN.
g. Time. TIME IS OF THE ESSENCE INTHIS AGREEMENT, AND THE TERMS HEREOF SHALL BE SO CONSTRUED.

WHN HAS READ THIS AGREEMENT CAREFULLY AND UNDERSTANDS AND ACCEPTS THE OBLIGATIONS WHICH IT IMPOSES UPON WHN WITHOUT RESERVATION. NO PROMISES OR REPRESENTATIONS HAVE BEEN MADETO WHN TO INDUCE WHN TO SIGN THIS AGREEMENT. WHN SIGNS THIS AGREEMENT VOLUNTARILY AND FREELY.

In witness whereof , THE PARTIES HERETO HAVE EXECUTIED THIS Agreement as of the first day above written,

For PBH

By: __________________________________
Daniel R. Coughlin
CEO

For Western Highlands Network

By: ___________________________________
Arthur D. Carder, Jr.
CEO

I Think I Need To Be In a Witness Protection Program After that Western Highlands Network LME Board Meeting Today

2011-05-06T12:38:00.003-05:00

I understand that Burnsville, NC (sssssshhhhhh) is the area to be if you're in the Witness Protection Program. Its a nice city; they even got liquor there now.

There is a saintly citizen, Jerry, whom records w/ a videocam every single Buncombe County public meeting and has created a giant library since 1999. He taped the WHN LME Board meeting today and I'm gonna see if I can get it you-tubed (digitalized) which is why I think I need to be in the Witness Protection Program.

The CFAC representatives stood up while the sharks swam around them; I stood up and was stupidly ignorant about the sharks; Jerry, the recorder guy, stood up for the little guy and has seen lots and lots of sharks. The head of DSS Buncombe, a board member, sighed and pushed for a letter to the governor; a board member commented that pbh seems to be acting like a private enterprise instead of a government entity; others commented that it seemed like a really really bad idea to sign it as completely obliterated any transparency as re: impacted citizens (and citizens in general).

So, you might say that in a hostile take-over attempt, Piedmont Behavioral Health (PBH, though on their letterhead----this was public information----it's little 'pbh'---how modest; this reminds me of the French vs the British at Agincourt: you guess who's playing the French) sent a 'Non-Disclosure Agreement' to be signed by the WHN LME Board.

That's right about when I figured out that the dark shadow of the shark the size of the Titanic on the other side of that rock was pbh aka NC DHHS Medicaid and I tried to swim for shore without flailing too obviously.

(Its pretty weird? crazy? to be writing about a 'Non-Disclosure Agreement' and therefore disclosing it but I always did love that White House Correspondent's dinner talk by Stephen Colbert; no Laura Bush did not shake his hand after that even though he smelled nice and was wearing a tuxedo).

The pbh Non-Disclosure Agreement states, in part:

".....effective as of May 2, 2011.....Relationship of the Parties. WHN desires to operate North Carolina's 1915 b and 1915c Medicaid waivers and to contract with the North Carolina division of Medical Assistance to manage behavioral health benefits for Medicaid consumers. PBH has operated the 1915b and 1915c waivers since 2005. PBH has agreed to share with WHN Proprietary Information which PBH has developed during its five years of operating the waivers. WHN will contract with various contractors who may have access to and utilize PBH's Proprietary Information as part of thet business relationship between wHN and its contractors. This agreement addresses the desire that Proprietary Information shared with WHN will be used exclusively to prepare WHN to o[erate the waivers and for no other purpose......continues for 5 years......"

And then there's 3 more legal pages with the last one being a blank line (the WHN LME board swam with the sharks and tried not to bleed which is to say they voted 8 to 6 NOT to accept this; they needed 9 votes to pass it) with the signature awaiting the pen of CEO of pbh, Daniel R. Coughlin. The WHN LME attorney took a very careful count of the people who voted.

Oh, by the way: all the LME's will be MCO's by 2013 and Magellan was discussed as a fall back position if the LME's put up too much of a fight re: these Medicaid waivers and hostile take-over maneuvers.

And so I pulled someone aside afterwards and asked, 'why is everyone so afraid of pbh?' to which s/he replied: 'Cabarrus county has two Republicans that are in cahoots w/ pbh and also they're pushing against (Martin) Nesbitt (Buncombe; head of NC Senate).

...now, I think I'll take a little drive over to Burnsville......

What To Expect Per the Medicaid Waiver Endorsed by NC DHHS and In Place at WHN & PBH LME's

2011-05-05T13:22:00.002-05:00

I was curious if the other LME whom is engaged in the 'its a done deal' NC DHHS Medicaid Waiver, Piedmont Behavioral Health----all the way over in eastern NC (you don't want people to be able to organize and riot together due to their physical proximity)-----also had an 18 page provider application.

They sure do! But its not the same 18 pages! They require different information than the 18 page WHN LME network!

Moreover, here's something I bet providers over there may or may not know and this portends what is to happen here: its a closed network and as it is right now, as per Haley, in administration at PBH, they don't want no more stinkin' LCSW's (to use film-maker John Houston's phrasing). They sure want psychologists but do psychologists want them?

Moreover, as per my question to Haley, about things like, "Why are you asking me to fill out paperwork about my internship and post-doctoral work", etc., etc., etc.,----when the NC Licensing Board would not license me if I had not had those things: she stated, "well, the licensing board indicates that you're licensed but we don't know if you had the internship because they won't answer that question."

Great! Mounting piles of duplicitous paperwork and no hand looking to see what the other one has or does. It sure looks like it makes jobs for the LME's that have no contact w/ the patients though!

Can we PLEASE have a uniform application for professional providers as per this Medicaid Waiver process?

As one of my supervisors of my documented 2000 hour INTERNSHIP, prior to my 2000 hour POST-DOC year----- said as I exited my experience there: "Pray for your Profession." That was 15 years ago. I think initiating blood sacrifice rites would be in order now.

Resolution Regarding the Western Highlands Network 1915 b/c Medicaid Waiver Project.....

2011-05-03T23:52:00.002-05:00

....it was signed by all the associated county commissioner chairmen and declares that 8 county managers will be part of the WHN LME Board (best I can understand the document) . This being said, all the counties had something slightly different to say re: their support of the Medicaid Waiver.

Here is the person to contact about the document: Rhonda Mckee, Human Resources Director, WHN LME.

For instance, a funny thing is that it is indicates that 'it will support our federally qualified health clinic (FQHC), Minny Jones Health Clinic", the largest integrated provider in our county....." (ahem: Minny Jones, I assume the same person, is on the WHN LME Board).......

It doesn't say HOW it is going to create that support and in that there are lots of health clinics in Asheville, and in that Minny Jones is on the WHN LME Board, I'm scratching my head.....

Maybe I'm out of the loop, but I don't know anything about the Minny Jones Health Clinic. When I google it up, this is what I get: 264 Haywood Road, Asheville, NC (that's around the corner from me); its a 'permanent health services provider'

WHY, I want to know, is this stipulation sitting in the
Buncombe county 'sign off' vis a vis this
WHN LME Executive Board Member?

Inquiring minds want to know.......Let's ask the chairman of the County Commissioners, David Gannt, whom signed off on the document.......

Chair of WHN LME Board Did NOT Support Medicaid Waiver: WHN LME Board Meeting 9:30 am, 5.6.2011

2011-05-02T11:52:00.002-05:00

I spoke w/ the Chairman of the WHN LME Board, Ryan Whitson, tel 894 3301, x 8, a moment ago. He indicated, very clearly, that he did not support the Medicaid waiver 'because I don't trust the state of NC.' He reported that 3 other of the 16 members did not support the waiver.

There is a meeting of the WHN LME Board this Friday, 9:30 am. Providers may make public comment, something he indicated he put into place, by 'signing in' at 9:15 am, in order to speak before the board . I will be there.

A helpful woman at Western Highlands Network LME, Rhonda, in Human Resources (rhonda@westernhighlandsnetwork.org) indicated to me that there are 16 members of the WHN LME board and amongst those 16 are 8 county manager, one of whom is Ryan Whitson. She was not able to tell me who the other managers were who voted against the Medicaid wavier (she simply did not recall but perhaps she could tell me later when I send her an e mail)

Rhonda explained that prior to the WHN LME Board acting on the matter, that the resolution was approved by each of the county commissioner boards. She indicated she would scan that resolution and send it to me and then I will place it on this blog.

THUS, THE BOTTOM LINE IS THIS: IF PEOPLE BEING SERVICED BY AN LME DO NOT WANT THE MEDICAID WAIVER, THEY NEED TO MAKE SURE THAT THE COUNTY COMMISSIONERS, WHOM VOTE ON THE MATTER FIRST, ARE INFORMED.

I don't know if this ridiculous waiver is a 'done deal' or not but I intend to drag my fingernails across the chalkboard the entire time.

The current members of the WHN LME Board are:

Ryan Whitson, chair
Mandy Stone
Minny Jones
Steve Wyatt
Abigail Karroubi
Steve Garriso
Carolyn Moser
Charles Vines
Keith Holtzclaw
Barbara Trumble
John Coudrey
Susan Hendrick
Arthur Wilson
Steven Smith
Mason Bennett
Joe Martin

Letter to Lanier Cansler re: Medicaid Waiver Program of Western Highlands Network LME

2011-05-01T23:07:00.003-05:00

Marsha V. Hammond, PhD Licensed Psychologist, NC
Billing address:
Cell phone: 828 772 5197 e mail: chomskysright@gmail.com

DATE: May 1, 2011

RE: Medicaid Waiver for WHN LME

Dear Lanier Cansler, Secretary of NC DHHS:

Thank you for reading this letter. I know you are an extremely busy man and I don’t mean to maintain that I have some special status re: my questions here. Nevertheless, I must say something about this ‘Medicaid Waiver’ program as prescribed by Western Highlands Network (WHN) LME. I must say something as the other LME’s are poised to utilize a similar strategy. I have no idea if the outline of this ‘application’ is being issued from NC DHHS but I would beg you to consider the time that providers are utilizing to do hours and hours of work which is unpaid and has absolutely nothing to do w/ patient care.
The NC Psychology Licensing Board has given me a license to practice as a fully-fledged psychologist in this state and so why is this LME asking all of these duplicitous questions? I wish I could say that the NC Psychological Association concerns themselves w/ these important issues but alas their behavior is indicative of a dysfunctional system that has no idea what is taking place re: the practice of public mental health services.
Sir, if you simply take a look at the WHN LME webpage outlining the ‘application’ for being a Medicaid provider under WHN LME, I think you might ascertain that all of that information is included under the rubric known as my license as a psychologist in the state of NC. Here is that website: http://www.westernhighlands.org/images/stories/4contractapplicationforlicensedindividualpractitioners.doc
I am admittedly very perturbed at being asked to provide the following kinds of information if for no other reason that I have clients to attend to---and Medicaid clients are usually more ill and challenging that other insured clients (I stopped working w/ state funded clients years ago re: the paperwork log jam created by the LME’s):
1. a sealed transcript associated w/ my PhD (the NC Psychology Licensing Board did this years ago; that is why I have a license here)
2. references from my colleagues (the NC Psychology Licensing Board did this years ago; their recommendations allowed me, in part, to have a license here)
3. a demand to submit ‘2 evaluations’ (the NC Psychology Licensing Board, in addition to my doctoral program, internship, and post-doctoral year did this)
4. my ‘Physician Coverage’ (if I did not work w/ these helpful colleagues, I could not care for my clients)
5. what kind of ‘approach’ do I use in my work (the NC Psychology Licensing Board is associated w/ my training as was my doctoral program, internship and post-doc training)
6. ‘Exclusion Sanction Information’ (the NC Psychology Licensing Board has a record of any complaints or associated information or they would not grant me a license every two years & any judgement is public information at the Board’s website)
7. “Electronic Claims Submission” (I have been successfully utilizing NC Webclaims for my NC Medicaid clients for years w/o difficulty and so why are we creating all this paperwork other than to bury the few remaining providers?)
8. my NPI certification (this can be determined by going to the online NPI site)
9. my Medicare certification (the NPI number was to have supplanted the Medicare & Medicaid provider number)
10. my Medicaid provider certification (surely NC DHHS whom manages NC Medicaid has this information??)
11. my previous license as a psychologist in another state many years ago (the NC Licensing board has this information)
12. my malpractice insurance limits ( this is one matter I can understand that the LME might be interested in re: any 'deep pockets' that an insured might go after as associated w/ a malpractice suit)

Mr. Cansler: Can you please explain to me why I should use my time creating reams of paperwork in order to continue to service my Medicaid clients under this Medicaid Waiver program? If my license as a psychologist does not evidence my expertise, then why not ask the Secretary of State of NC to just disband the NC Psychology Licensing Board? That would save me over $200 every couple of years and would fully employ a host of people at the LME’s who utilize their time shuffling, needlessly, in my opinion, reams of paperwork.
I would like to call you and speak to you about this. I am very disturbed by this Medicaid Waiver plan and see no sense in it.
Thank you for your time, Mr. Cansler. I mean you no disrespect by this letter.

Sincerely,
Marsha V. Hammond, PhD, Licensed Psychologist

I'll Be Calling Lanier Cansler, Secretary of NC DHHS, re: the WHN LME 'Medicaid Waiver' Application Process, Tomorrow

2011-05-01T18:47:00.003-05:00

Well, I'm fit to be tied re: this WHN LME 'Medicaid Waiver' application process.

It has taken me over an hour to fill out pages and pages WHICH SHOULD BE ASSOCIATED WITH MY LICENSE AS A PSYCHOLOGIST IN THE STATE OF NC. This should be true of any professional whom is licensed in this state. Otherwise, please tell me why I pay over $200 every couple of years to have my license continued? Why not just get rid of the licensing board and let every little LME gather up every little piece of paper from every single professional?

They want:

*a sealed transcript from the university that gave me my PhD! (the NC Psychologist licensing board has this)

references from colleagues! (the NC Psychologist licensing board has this)

my address! (which they darn better not release to the public, as I have specified repeatedly over the 10+ pages...so far)

2 EVALUATIONS! (what's an 'evaluation'?: is that the same as a psychological evaluation and why do they need such if I am verified by the State of NC to be licensed as a psychologist?)

Hellooooo, Mr. Cansler..........

Western Highlands Network LME Buries Providers With New 'Medicaid Waiver' Paperwork (and that's not even associated w/ anything related to clients)

2011-05-01T17:41:00.004-05:00

Amazing! "Who will rid me of these troublesome mental health providers?"

Where is the NC Psychological Association (nowhere in sight).

See this link for the massive amount of documentation being provided by the 'new & improved' Medicaid waiver process associated with any Medicaid mental health under Western Highlands Network catchment area:

http://www.westernhighlands.org/images/stories/4contractapplicationforlicensedindividualpractitioners.doc

What the first round of mental health reform didn't do, this Medicaid waiver mess surely will----in terms of finishing off the mental health providers. There's 18 items associated w/ paperwork such as one's authorization to provide Medicaid services, etc., which you'd think NC DHHS could validate.

Now NC DHHS is attempting to have all the LME's create this massive boondoggle/ paperwork log jam. Its not enough to already be a Medicaid provider as per NC DHHS: now we have to submit individual massive packages to the various LME's.

What's money saving about this? There will simply be more homidical/ suicidal people who do not receive services, spending more expensive time in psychiatric units----unless they are thrown out 'prematurely' and kill someone on their way down (as happened about a month ago in eastern NC).

So, we are demanded to submit all this duplicitous paperwork and then attend a mandatory meeting for which we will not be paid.

Heckuva job, Brownie!

NC 43rd in USA re: Per-Capita Annual Mental Health Spending

2011-04-08T12:25:00.002-05:00

.....I'd say that the Republicans had met their 'quota' re: defunding mental health care in NC.....but will they be satisfied w/ that? Don't count on it. As the NYT today indicates, the Dems and Republicans are hung up (or more correctly stated, the Republicans insist) on the defunding of Planned Parenthood, where millions of women have received billions of birth control pills to prohibit millions of pregnancies over the past 40 years. I know: I was of those women. I called Congressman Shuler's office today and his aide indicated that he voted 'for' the other sticking point which is the Clean Air environmental issues (seems like the western NC environmentalists are better organized that the women).....and he voted against the continued funding of Planned Parenthood. (head banging time)....

Peer Support's Ability to Intervene in the Lives of People w/ Severe Persistent Mental Illness : "The Personal is the Political"

2011-03-27T13:01:00.005-05:00

The below is my comment to Dr. Jim Pitts video at NC Policy in which he outlines the benefit of peer support for his schizophrenic son. See: http://pulse.ncpolicywatch.org/2011/03/24/the-affordable-care-act-jim-pitts-and-mental-health/

Susan Sontag, writer, suggested that, "The personal is the political." I take my politics personally and the defunding of schools and mental health is an affront to me.

______________________________________________________

Dr. Pitts, a retired sociologist from UNCA, and active in NAMI NC, mentioned that 'mental health is a human problem', not one associated w/ being a Democrat or Republican.

Its nice to reach across the aisle, important even. The fact is, however, that its the Republicans whom are in control of the NC State Legislature, currently, are intent on denying the extension of the $.01 sales tax which impacts directly schools in NC. Dr. Pitts speaks in this video about other defunding of mental health-related services.

But what do schools have to do w/ mental health?

As a mother of a 16 yr old son w/ ADHD and learning disabilities, which are commonly linked to ADHD, smaller classrooms make a difference in terms of his mental health. Lack of funding means loss of teachers and larger classrooms.

I would like to hear more about the peer support of which Dr. Pitts speaks as having been so helpful to his son whom has schizophrenia. I can well imagine that linking to others within the community is a key to his son's mental health improvement. What I see as one of the number one problems of people with SPMI (Severe Persistent Mental Illness) is loneliness and peer support is a partial solution to that existential issue.

As a clinical psychologist, I work mostly in Haywood County. Peer support there consists of classes, good ones, which are run by Meridian Behavioral Health Care, which spun out of Smoky Mountain Center LME, in terms of those who started Meridian. I have clients whom go to those peer support meetings but one of the comments I have received from one of my SPMI clients is that the information is not easy to understand...it is too full of psychobabble, it sounds like. NAMI, perhaps, provides a base for people and their families as associated w/ SPMI, to meet and connect.

There are other issues associated with accessing peer support. You have to transport yourself to Meridian in order to obtain peer support. Transportation is an issue in rural western NC, moreso in Haywood county than Buncombe County, where Dr. Pitts works w/ NAMI.

In Haywood county, and as associated w/ that NAMI meeting which is on the 3rd Thursday of every month at the Methodist Church in Waynesville, @ 7 pm, there is undoubtedly another form of peer support.

All the barriers associated w/ not being able to obtain peer support is a very important issue and those include: transportation---which is associated w/ 'rural-ness', if you will; outreach capacity of peer support people (the 'classes' at Meridian are 'run' by people w/ mental health experience); and, relevance, to name some off the top of my head and as associated w/ what clients tell me. While there may be good peer support 'specialists' in Waynesville/ Haywood county, the ability to outreach to those whom need a persistent plan for how to deal w/ their loneliness is a complex issue.

Without peer support------which is what Community Support Services (CSS) was about in part------people w/ SPMI are lonely, depressed, usually jobless, impoverished, and recipients of small disability checks which are just enough to cover expenses if they eat in the local soup kitchen.

So, again, I would like to hear more from Dr. Pitts about how he and we think we can better establish peer support in western NC.

Peer support that works and is in the community on a persistent basis would be a balm for the loneliness which is killing my clients w/ SPMI.

Marsha V. Hammond, PhD

Clinical / Health Psychology

e mail: chomskysright@gmail.com

Western Highlands Network LME to keep Medicaid $$ management "local" : (this undoubtedly means reams of paperwork to be completed)

2011-03-24T10:43:00.005-05:00

A local news article chirpily indicated that Western Highlands Network (WHN) LME which manages 8 counties for Medicaid mental health services in western NC, has scrambled to grab a contract from NC DHHS in order that local mental health Medicaid $$ be managed locally. (see: blueridgenow.com/article/20110322/articles/103221004 : Western Highlands Keeps Mental Health Dollars Local by Gary Glancy from a publication entitled, "Blue Ridge Now"

Arthur Carder, the CEO of WHN LME, is stated in the article to note that this will increase the Medicaid $$ that are managed by WHN LME from $27 million to $93 million. Asheville does need some jobs and so hopefully this will result in that.

However, my concern is this: my outpatient mental health services which I provide to NC Medicaid clients under Smoky Mountain Center LME (Haywood county is next to Buncombe and Medicaid is not managed by SMC LME, godforbid) are quite efficiently managed by NC DHHS. Why are we moving AWAY from a one-payer system or more of a one-payer system and towards increased administrative costs because each LME is managing a set of money?

This is what happens when I see clients for NC Medicaid outpatient therapy:

1. for adults, I see them up to 8 sessions and then must ask Value Options (NC DHHS farmed out the authorizations to them years ago) on a one page piece of paper to reauthorize. As long as I fill out the piece of paper correctly, I always get the sessions I want for the year. For adolescents/ children the number of visits before you must send VO a request is 26.

2. to bill for outpatient psychological assessment or therapy, I then go online to NC webclaims portal, and spend about 10 second submitting my billing which must be in every Thursday by 5 pm in order to be paid the following week.

And so tell me again how this is going to be made more efficient?-----it's not computing for me.

Other than creating jobs locally, this appears to be a waste of administrative tax-payer $$.

We need to move towards more ONE PAYER systems not towards more bits and pieces of the system fraught w/ administrative paperwork.

If what we're talking about is the administration of the case management services which Governor Perdue was so keen about----which is nothing more than moving papers around----a really silly expenditure of money that is very very minimally associated w/ patient contact----then sure, go manage that. Its already a bunch of paperwork and it gives the illusion of stuff being done.

This case management was put into place as Community Support Services (CSS) was being disbanded. CSS provided face-to-face contact w/ clients and while it may have cost money, in rurual western NC, in particular, it accessed Medicaid clients to services that are now----you guessed it----provided by this psychologist. I can do therapy driving someone to their medical appointment as well as I can sitting in an office or their home. Yes indeed, I take that mileage off my taxes at the end of the year.

Another case in point as re: the very real dollars and human costs of having lots of little insurance companies like Humana providing what I call 'pretend' Medicare services (they are called Medicare advantage companies and tax payers support private enterprise to the tune of 15-20% administrative costs versus -----federally!!-----administered Medicare which has administrative costs of less than 5%): this week I finally figured out why I am not getting paid to see my Humana clients in Haywood county (Humana ditched its PPO 12.31.2010 for no clear reason other than, to my mind, they weren't making enough money) and they outsourced their outpatient mental health services to a company in Texas (yeah, that's local) called LifeSync. This company sent me letters saying they couldn't 'find' so and so in their roster and so after calls and obtaining of social security numbers and they spending hours going thru a list of names sent to them---or not----by Humana's new program in Haywood county----they finally found the clients.

What a waste of time---for those administrators----and this psychologist.

The 'pretend' Medicare 'advantage' companies are temporary insurance companies. Doesn't anyone get this? Doesn't anyone understand the meaning of 'administrative monies going into private owners pockets'?----versus federally managed Medicare w/ its honed mechanisms? Or have all the tea baggers finally convinced everyone that yes indeed the feds are taking your money and you're not getting anything back for it? Shucks, let's give it to that rich guy who lives in that gated community you can't get to........

Any mechanism which is creating more paperwork is the wrong direction and I believe that as per my experience with WHN LME related to state funded clients (people who cannot get to Medicare/ Medicaid and need services and are thus defined as 'state funded'), there is nothing but an onslaught of useless, non-necessary paperwork heading any mental health practitioner's way who works w/ NC Medicaid clients.

Arthur Carder, CEO of WHN LME: refute what I surmise, if you would, please.

NC State Legislature Republicans To Vote Against Funding Schools in NC

2011-03-22T10:18:00.003-05:00

Getting an education has something to do w/ mental health issues, a suitable topic for a dissertation, to be sure.

In NC, Republicans, 'the majority' in the NC House, are going to vote down an extension of the $.01 sales tax which would continue to fund NC schools, in part.

David Gannt, Chairman of the Buncombe County Commissioners states that 'the majority', namely the Repupblicans of the NC State Legislature, will NOT fund the extension of this sales tax, thus endangering educational efforts in NC.

Way to go.

Why Does It Take People Getting Maimed or Killed to Promote Necessity of Mental Health Care?

2011-02-17T00:05:00.003-05:00

abcnews.go.com/US/wireStory?id=12936482

Tucson Shooting Victim Promotes Mental Health

...speaking is the Congresswoman's aide whom was shot in the face and neck.......

geez...what's it gonna take to have real mental health parity?

Medicare Patients Going Into Psychiatric Hospitals Because they Cannot Afford One $3 Co-Pay : "Eat The Future"

2011-02-16T11:52:00.005-05:00

Hey! I know....let's increase the co-pays for Medicare recipients, Part D, and the (pretend, funded by US tax payers $$ at administrative rates of 15-20% versus Medicare's less than 5%) Medicare 'Advantage' companies ---------and let's do it AFTER the period of time during which Medicare recipients can ENROLL or change their enrollment for the year (every year between Nov 15 thru Dec 31 people can change their Medicare company) so that the Medicare recipient, and the mental health provider, cannot discern what they are going to be charged or paid because dontchaknow, the likes of Humana, having farmed out their various contracts, can't tell you if a particular outpatient CPT code associated with an outpatient mental health service is going to be PAID FOR or NOT---like it was LAST year.

Today I have a patient going into a local psychiatric unit, charging Medicare literally thousands of $$ because she cannot afford a $3 co pay for additional medication which her psychiatrist prescribed (no, he did not have any of that med in his little stash in his office given the kind of drug it was and there was no substitute, really, and the client merely needed to double up on what she was already taking because she was early-waking, like really depressed people do, and could not go back to sleep after 3 am every night).

Last week, I called up the county DSS office related to another client whom, dontchaknow, could not discern (as in, cannot look into a crystal ball) the how much more her co-pays were going to be come January 15th of the new year. So, she has to choose between FOOD or MEDS. Inquiries to the local DSS indicated that though she is a 'catastrophic coverage' CAP patient, which means that she receives one-on-one services from a care-taker from 9 to 2 everyday---due to the extent of her disability-------- she may or may not be able to obtain some additional Food Stamps which she uses very very carefully.

This is dumb management and as Krugman said yesterday in the New York Times, it is merely a foolhardy policy of 'EATING THE FUTURE':

http://krugman.blogs.nytimes.com/2011/02/12/eat-the-future/

"February 12, 2011, 10:10 am

Eat the Future

The public says it wants to see government spending cut — and the Tea Partiers really, really want spending cut — but people don’t want to cut any program they like; and they like almost everything. What’s a conservative to do?

The obvious answer, once you think about it, is to eat the future: to cut spending in a way that undermines the nation’s long-run prospects, but doesn’t impose all that much pain on voters right now.

And that, as best as I can tell, is the running theme in the cuts proposed by House Republicans.

______________________________________________________________

You too can blog at this article by Krugman by easily registering for the NYT:

Register for NYTimes.com

It’s free and easy.

'Listening Heart' Emergency Mental Health Telephone Line Available 24/7 : 828 239 1111

2011-02-04T00:25:00.004-05:00

Its a small miracle to have a volunteer agency doing this. However, forgive me while I blink at the dimness of the 'thousand points of light' which should be part and parcel of what mental health (Can you HEAR me, NC Department of Health and Human Services---DHHS) should be doing in this state?

WLOS news story, 2.3.2011:
www.wlos.com/shared/newsroom/top_stories/videos/slow_vid_3834.shtml

Joint Legislative Oversight Committee on Mental Health is Being Pushed off the Cliff by NC DHHS

2011-01-22T13:26:00.004-05:00

This was posted at the website where Martha Brock, a mental health care advocate, outlined how the Joint Legislative Oversight Committee (LOC) for mental health reform, has been disbanded due to 'budget restraints.'

Here is that information indicating that NC DHHS is now telling the state legislature 'what will happen':

http://www.examiner.com/statehouse-in-raleigh/mental-health-legislative-committee-meets-wednesday-lob-raleigh#comm

"Tomorrow's meeting of the Legislative Oversight Committee (LOC) led by Co-Chair Verla Insko of Chapel Hill may be its last based on interviews with senior legislators and a briefing by the top official at the Division of MH/DD/SAS in the Department of Health and Human Services (DHHS).

In a meeting with members of the State Consumer and Family Advisory Committee Thursday, Mental Health/Developmental Disabilities/and Substance Abuse Services Director, Steve Jordan, said that it is possible that there will be a change in the coming session of the legislature that begins Wednesday, January 26th.

Jordan speculated that rather than limiting the scope of an Oversight Committee to one DHHS Division as it has been in recent years, the new Republican leaders may appoint instead a "DHHS Oversight Committee."

Here is my comment:

"Having a committee to oversee 'all things Medicaid' at NC DHHS will simply dilute any actions to remedy problems associated with mental health issues. In that you will not be able to call up Verla Insko or Martin Nesbitt, co-chairing the Joint Legislative Oversight Committee on Mental Health Reform, nothing will get done but will simply pass through an endless number of committees that have no accountability. Therefore, citizens, advocates, and practitioners will have no ability to impact the process.

"Who will rid me of this troublesome priest?", said Shakespeare.

"Who will rid me of these troublesome advocates?"

Why, we have no money to have these legislative oversight committees. Golly gee. Let's bury everything in a NC DHHS oversight committee so large that we can't wrestle the beast.

Marsha V. Hammond, PhD

NC Mental Health Reform blogspot : http://madame-defarge.blogspot.com/

Two Models of Comparison: NC DHHS's CABHA model vs Well-trained Available and Mobile Mental Health Provider

2011-01-14T13:42:00.003-05:00

There's a lot of talk about CABHA, the newest version of NC Mental Health Reform to be rolled out starting 1.1.2011.

Here are some comments re: CABHA from mental health advocates across NC. Secondly, I present a model which I think works superiorly to that administratively-heavy model.

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HI all:

Here is Dr. Hammond, Licensed Psychologist, whom has created another model (and there are lots of Dr. Hammond's out there, perhaps------whom operate beyond the confines of CABHA).

I continue to stay outside the CABHA loop and bill directly to Medicare/ Medicaid/ 3rd parties. My license as a psychologist allows me to do this.

Moreover, best I can tell, I perform most all the duties of the CABHA: I provide high quality therapy; I wrap around to primary care physicians and specialists by phone and letter; I cross link across Departments of Social Services, physicians, attorneys, probation officers, and clients. Another name for this is case management. This is an item associated w/ CABHA services as is therapy or outpatient therapy.

You might recall that Governor Perdue was keen on case management. This is a mistake, in my estimation, as a case manager does not stay 'close', if you will, to the client, whom, I might venture to say, is empowered by being included in the process of 'getting better.' Case management is all about creating paperwork which inches its way through a system in an attempt to get things cranked. Enough already, I say.

So, contrary to case managers, I know the clients and their families very well as I see them regularly--- and in their homes.

The only thing I don't provide is intensive in home therapy; no, I'd have to say that as re: families I see, what I try to do is PREVENT things from going to that intensive level.

And I don't see state funded clients because the paperwork does not get paid for and I didn't earn a PhD in order to fill out paperwork well.

Additionally, I believe I save NC Medicaid money by keeping people out of the psychiatric hospitals due to my availability. As you might surmise, people really do not like going into a psychiatric unit and will do a lot in order to avoid having their freedom removed, even for a few days.

I'd say that the most valuable property of any mental health service is AVAILABILITY; MOBILITY is a subset of being available as many people w/ mental health issues have transportation challenges.

Moreover, I might suggest that the quality of the system can be evaluated as associated with the paperwork requirements: a lot of paperwork means, implicitly, that the system that was created is burdened by run-away administrative costs, inefficient, and commonly not helpful to the client in a timely manner.

All my model requires is that I be mobile----that I see my clients in their homes----a subset, as I stated, of availability. This works well in rural western NC and I have a zip no-show rate and command a decent salary. Additionally, the IRS provides a nice tax deduction in terms of mileage as associated with business costs impacting my salary.

Thus, to my mind, the mental health model that works for clients and assumeably practitioners, is associated with mobility and availability. This attends to the nature of mental health issues. Strike while the iron is hot in terms of issues and you can make a lot of progress in terms of clients learning how to handle their own challenges---such that they get it 'right' or at least 'better' the next time around. Thus, they are empowered and become more self sufficient and move away from spending the mental health care $$.

If CABHA is heavy w/ paperwork, it won't work; moreover I assume it appears that NC DHHS still has not figured out that paperwork has nothing to do w/ mental health care (this is probably too radical a thing to expect of such a large organization, frankly). If you are using licensed or certified or appropriately qualified providers, you can get the work done efficiently as long as you remember what their expertise is and its not in doing paperwork.

This is why we need a one-provider medical system (remember that?): because administrative work, inclusive of paperwork, weighs down the system and diminishes availability and mobility which is what must be in place re: the mental health care business.

Marsha V. Hammond, PhD, Licensed Psychologist, Asheville, NC

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Here is a comment outlining an advocate's concern re: CABHA:

Lets see if I understand all the issues in this email:

1. Why was there not consumer input?

2. Who thought of CABHA?

3. Who are they accountable to?

4. Will it be another “boondoggle” as described in the email

Just my opinion …

1. There was lots of consumer input but indirectly…….community support rolled out, LME s divested and everyone had a fit because EDs filled up and state hospitals filled up. Community support agencies treated kids and Medicaid, statistically speaking and fraud was prevalent. Everyone wanted something different and things had to move quickly

2. Who thought of it? Well that is a good question. It is not rocket science…..lets see the Area Program model with limited dollars worked. You have similar safety net type models with local health departments and DSSs…..and then you had PBH that had a comprehensive provider model that seemed to work. The state could not manage a 1,000 providers billing the day lights out of Medicaid community support. So it is not a stretch or some conspiracy to say that the state leaders did not have to look far to see what direction to drive the ship in. They just had to decide on what to call it.

3. Who are CABHAs accountable for……in a non-waiver area they have many masters. They are accountable to the State, the LME and the Feds. In waiver areas it is just accountable to the LME for they control all state, local and federal dollars.

4. Will it be another mess……….well it should prove to be less of a mess at worst. But the reality is that the devil is in the details. This good idea has not gone without its glitches. For example, the large number of CABHAs has increased supply and demand on MDs and that has driven up cost beyond reimbursement rates. Then you have child and adult CABHAs. Well what means is the child CABHAs will be Medicaid funded and adult CABHAs will limit the indigent they see and treat only Medicaid when possible or they will take their Medicaid earnings to support the indigent adults. Fat chance with a private company of that happening. Just my opinion but CABHAs need to be CABHAs, not child, adult or SA. You don’t have a local DSS to have a child DSS or an Adult DSS do you? No, they have different units within the same DSS because it is cheaper, creates synergy between professionals and is less confusing to folks needing the service. So a boondoggle? I don’t know. Growing pains, yes. Step in the right direction? Yes.

Sarah Palin : Enemy of the State & Mental Health Treatment: She Targeted AZ Congresswoman for Supporting Health Care Reform

2011-01-09T00:19:00.003-05:00

Yesterday I called Heath Shuler's office in D.C. to find out how he voted on the matter of the House of Representatives repealing the very minimal health care reform we gave so far been thrown-----like a dog being thrown a bone. His aide quickly indicated that he had not voted for repeal. I informed him that if I had a sense he would not support Obama's health care reform (BRING BACK THE PUBLIC OPTION NOW PLEASE), there would be no reason for me to vote for there would be no discrimination between Republicans and Democrats.

This afternoon, a Democratic Congresswoman, Gifford, was shot in the head, her aide killed, a 9 yr old child slaughtered, and others killed or maimed----and that Congresswoman was on Sarah Palin's hit list of Blue dog Dems to be taken out---to be 'targeted.'

Here is what Sarah Palin's Nazi-style plans are. It seems to me she needs to be charged federally with events leading up to this slaughter. God, that should get rid of that worthless woman.

Lack of health care reform means lack of mental health reform:

"....Miss Giffords had been named in March as a political campaign target for conservatives in November’s elections by former Alaska governor Sarah Palin for her strong support for the health reforms of President Barack Obama.

Mrs Palin had published a “target map” on her website using images of gun sights to identify 20 House Democrats, including Miss Giffords, for backing the new health care law.

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/us-politics/8248267/American-congresswoman-Gabrielle-Gifford

Mental Illness is COMMONLY Chronic in nature: What NC's DHHS has Missed Regarding Critical Access Behavioral Health Agency Program (CABHA)

2011-01-05T11:18:00.003-05:00

Long, long ago, in another galaxy, when NC Mental Health Reform was instituted (in 2000) so that consumers would have a 'choice' regarding providers (this never panned out) and so that 'free enterprise' would losen the bolts of a system disallowing a proliferation of providers (many have gone out of business due to the waxing and waning of funds vis a vis NC DHHS), there was a Service Definition created by NC DHHS called Community Support Services which was to create vital services for people with mental health challenges such that they could 'get back on their feet' ( a rehabilitation model).

However, as could have been expected, there was not enough money to pay for such a model and so it collapsed in 2007 or so. Then NC DHHS attempted to recreate something like this (CABHA)---- with an expanded array of services----to be manned and administered by a increasingly shrinking number of providers (for no one could keep up with the paperwork).

All of the models associated with NC DHHS thinking denies something as plain as the nose on your face: for many people, mental health challenges are chronic and a system that fesses up to this reality and utilizes $$ in an efficient and informed manner----is what is being called for.

The below is excerpted from a recent news article pertaining to the creation of this CABHA.

_____________________________________________

Mental- health efforts faulted

http://www2.journalnow.com/news/2011/jan/02/wsmain01-mental-health-efforts-faulted-ar-659829/

"....The N.C. Consumer Advocacy, Networking, and Support Organization, led by local advocate Laurie Coker, said its concern with CABHA is that providers "will be largely focused on quick medical fixes for symptoms and not on truly working with a more comprehensive, recovery-focused approach."

"There is nothing compelling CABHA to move toward timely interventions and supports, which reduce crises and promote more self-regulated living....

The state has flipped the switch on its latest attempt at mental-health reform — the Critical Access Behavioral Health Agency program.

Though CABHA has been 14 months in the planning, there has been lukewarm confidence among many advocates, beneficiaries and providers that the program, which took effect Saturday, was going to begin smoothly.....The N.C. Department of Health and Human Services said the purpose behind CABHA is ensuring that critical services in five categories are delivered by a clinically competent organization with appropriate medical oversight.

The categories: case management; peer support for recovery initiatives; community support teams for adults; intensive in-home treatment for children; and day treatment for children and adults dealing with such issues as substance or sexual abuse......

It's a bigger-is-better approach, leading to fewer, but larger, providers. It has reduced the number of statewide providers in those categories from 966 in November 2009 to 161 CABHA qualifiers as of Dec. 23. ..."

Medicare Pays Most Consistently (Why NC Mental Health Reform Continues to Crash & Burn): HELLO NC PSYCHOLOGICAL ASSOCIATION

2010-12-16T14:02:00.006-05:00

The following article was written by psychologist, Ivan J. Miller, PhD associated with the American Psychological Association's Div 42 (Independent Practice) Division.

"Underfunding Mental Health Services—Disparity 2.0

Isn’t It Time for Real Reform?
Click here to download the PDF

http://www.ivanjmiller.com/disparity_action.html

Summary

Although parity legislation has passed almost everywhere, a new mental health funding disparity has emerged, Disparity 2.0. Psychiatric hospitals are closing. Mental Health Provider reimbursements are well below the level of those for physical health care. Treatment rates are flat or falling. The cause of Disparity 2.0 is the current U.S. health insurance system that relies on multiple insurers who cover the population with a series of temporary health insurance plans. The only funding systems that have parity for mental health and physical health are single, unified, and transparent systems. It is time for mental health advocates to campaign for a real system change.

.....In addition, the behavior of the mental health professional organizations and health care economists has been inappropriate to the reality of the situation. Instead of the recognizing and protesting the continuing discriminatory funding of mental health services, mental health advocates and professional organizations have been touting the victory of parity legislation.....

Are there systems that do not discriminate against mental health patients?

In the U.S., the exception to declining reimbursements for the past two decades is the Medicare system. Medicare reimbursements have risen 21% since 1990. Medicare reimbursements are negotiated transparently under public scrutiny. Professional organizations are permitted to reason with Medicare about the need to reimburse providers adequately in order to maintain the infrastructure of mental health services. The consequence is that Medicare reimbursements have increased with inflation and have not followed the decline of insurance reimbursements.....

......Reimbursements for psychotherapy services have been stagnant or falling for 20 years, psychiatric hospitals are closing,[1] and funding for public mental health services are being cut.[2] Legislation requiring parity for mental health services has passed in most states and the federal government, so a person would think that mental health services would be accessible, patients would be receiving quality services, and mental health professionals would be thriving. Instead of real parity with physical health care, mental health has unfortunately merely transitioned to a more insidious form, Mental Health Disparity 2.0

.....The relationship between insurance and Medicare is another indication of reimbursement disparity. It is widely considered the norm that insurance pays about 125% of Medicare rates. The Medicare rates are partially based on factors that reflect the necessary level of education and training needed, overhead expenses, and the reimbursement rates needed to sustain an adequate workforce. It is considered the norm that insurance rates tend to follow changes in Medicare with annual adjustments. Indeed, in the Lewin study in 2007[23], inpatient physical health care was reimbursed at the rate of 164% of Medicare. On the other hand, mental health service reimbursements are not adjusted to keep up with changes in Medicare. In 2009, in Colorado, the typical reimbursement ($72/hr.) for an hour of psychotherapy was 79% of Medicare.....

Comparison of annual earnings for various professions, U.S. Bureau of Labor Statistics, 2008

Occupation	Annual earnings
Primary care physicians	$186,044/yr.[12]
Psychiatry	$163,660/yr.[13]
Physical therapists	$72,790/yr.[14]
Nurses	$62,450/yr.[15]
Psychologists who provide individual and family services	$57,440/yr.[16]
Auto Mechanics who work at a dealer	$40,788/yr.[17]
Mental health and substance abuse workers	$37,210/yr.[18]
Marriage and family therapists	$36,730/yr.[19]
Carpenters	$36,171/yr.[20]

20% of U.S. Adults Had Psych Disorder 2009 // 38% (of those 20%) Got Treatment // 8% of Youths Had Major Depression //Women Had More MH Issues

2010-11-20T12:13:00.003-05:00

This week, in western NC, one of the main psychiatric nurse practitioners has advised her patients that she has to 'switch companies' (thus, creating chaos re: treatment) as she is not able to 'take care of herself' re: the lack of benefits from Appalachian Counseling which took over the Balsam Center contract which provides medication for thousands of consumers in western NC.

Earlier this week, a Community Support Services worker, Peggy Anderson, was buried; she was in her 50's and a fine woman, helpful and courteous to all. She had been complaining about a 'pain in my throat' and the private mental health care company which employed her did not/ could not provide health insurance. She died of cancer.

Statistics gathered by federal agencies (SAMHSA:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies) for 2009 indicate the following grim statistics regarding mental health treatment, which , in a nutshell, indicates that one-fifth of the American population had mental health needs last year but less than 40% received any treatment of that.

http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf

" Highlights
• In 2009, there were an estimated 45.1 million adults aged 18 or older in the United States
with any mental illness in the past year. This represents 19.9 percent of all adults in this
country. Among adults aged 18 or older in 2009, the percentage having serious mental illness
(SMI) in the past year was 4.8 percent (11.0 million adults).

• Women aged 18 or older were more likely than men aged 18 or older to have past year any
mental illness (23.8 vs. 15.6 percent) and SMI (6.4 vs. 3.2 percent)....."

Resiliency & Bouncing Back from Stressors: NC Near the Bottom re: Health, Education, Income: American Human Development Project

2010-11-15T13:56:00.003-05:00

NC is way towards the bottom...in other words, people are not doing well here.

See:

http://www.measureofamerica.org/

"......The report presents strong evidence that the capabilities a person has going into a crisis—ranging from a financial downturn to a man-made or natural disaster—strongly determine how fast he or she can bounce back. It concludes with a set of recommendations to boost the American HD Index scores of all Americans and to enable those left behind to realize their full potential.

“As poverty is rising and high unemployment is causing searing pain across society, we need an accurate understanding of America’s diverse and complex conditions," said Jeffrey Sachs, Director of the Earth Institute at Columbia University. “No other publication comes close to this one in documenting and explaining America’s disparate socioeconomic realities, especially the vast differences across regions and social groups and the alarming shortfall of America’s performance compared with other high-income countries."

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"The American Human Development Project is dedicated to stimulating fact-based public debate about and political attention to issues that affect people’s well-being and access to opportunity in the United States. The hallmark of this work is the American Human Development Index, a measure that paints a portrait of Americans today and empowers communities with a tool to track progress in areas we all care about: health, education, and income.

In July 2008, the project launched The Measure of America: American Human Development Report 2008-2009, the first-ever report on human development in the United States or any affluent country. In 2009, the project released two state-level human development reports. Through these studies and the project’s interactive website, the American Human Development Project aims to breathe life into numbers, using data to create compelling narratives that foster understanding of and support for social change.

The American Human Development Project is an initiative of the Social Science Research Council and is made possible through the generous support of the Conrad N. Hilton Foundation and The Lincy Foundation."

Barriers to Providing Veterans Mental Health Services in Western NC: More Have Served From Here Than Any Other Part of the State

2010-11-10T09:41:00.005-05:00

I have been trying to sign on as a provider for veterans in western NC for almost a year now. The veterans outpatient mental health care provider services are managed by a company, MHN https://www.mhn.com/ that is slower than molasses.

Two issues present themselves here for me:

1. If NAMI wants to make an impact on the mental health services available in rural, western NC, they can try and figure out why that company has such a difficult time putting providers onto their rosters so that veterans have someone to contact.

2. Not only are there veterans, but there are family members of veterans whom are left out in the cold in terms of benefits from deceased veterans whom were so paranoid and mentally ill that they were afraid of signing up for benefits-----leaving their family members indigent and without recourse to any funds decades later.

As a salute to Veteran's Day, November 11:

From the NAMI website:

http://www.nami.org/

"Reality in Number:

Almost one in five veterans returning from Afghanistan and Iraq will experience mental illness.

Approximately 30 percent of veterans treated in the veterans health system have depressive symptoms, two to three times the rate of the general population.

More Vietnam veterans have now died from suicide than were killed directly during the war.

Approximately 40 percent of homeless veterans live with mental illnesses."

This is Why Outpatient Mental Health Has Fallen Apart in NC: Splitting up the Duties of Medicaid Authorizations/ Payments

2010-11-08T10:02:00.011-05:00

Post Script #8, Friday pm, November 19, 2010: I talked to Monika at HP Enterprises yesterday and she faxed to me a form which allows me to pay $4.90 for Remittances so that I can see what errors (there are commonly errors) on my Medicaid billing which I can address and resubmit. Instead of HP making the Remittances handily available on the NC Webclaims website, and having the form demanding (in my case, a whopping $4.90, 35 cents/ page) the payment interfacing efficiently on the NC DHHS/ Medicaid 'Basic Medicaid Billing' website----one has to spend hours going back and forth between Amy and Monika of HP Enterprises in order to get a few pieces of paper in order to fix the billing. But FIRST you would have had to turn up the telephone number and the appropriate people with whom to talk. So, all this took me several hours not to mention the work on the end of HP. Very efficient, NC Medicaid. This is why outpatient mental health is rolling over and (not pretending to be) dead in NC. ARRGH.

Post Script #7, Thursday am, November 18,2010: there is a mismatch between the information re: Remittance documents at NC Medicaid & what the billing company, HP Enterprise states; this is a note to NC Medicaid Behavioral Health Section employee, Katherine Nichols: "Hi Ms. Nichols: I am sorry to be such a pest. However, basically, the information at HP Enterprises and what the NC Medicaid online information does not match. (see below) . This being said, when she transferred me to the extension of the woman at HP Enterprises, Monika, whom was obviously, per her voice mail, responsible for remittances beyond the 'last 10 billing cycles' of Medicaid, there is absolutely no information about how the requesting provider is supposed to pay the 35 cents/ page. Do you know? Moreover, in looking at the NC Medicaid 'Section 9. Remittance and Status Report' pdf, under 'Basic Medicaid Billing Guide' which is the responsibility, I guess, of NC Medicaid, under the section, How to Request a Duplicate Remittance and Status Report', it states: "Providers may contact HP enterprise Services Provider Services for a duplicate copy of an RA. Guidelines vary according to the timeframe of the request. RAs within10 checkwrites (one is issue every week, BTW---as you know----I put this here because this info is going on my blog)...... will result in a charge per page. Timeframe of "10 checkwrites" is determined by the date the RA request is received by HP Enterprise Services Provider Services. Note: All duplicate RA requests will be mailed to the provider. Routine business operations do not allow HP Enterprise Services Provider Services to fax or e mail RA requests." HOWEVER, as per the RA woman at HP Enterprise, she wants to FAX the information as this is what her voice mail asks for. I don't use faxes for the most part, so I gave her my address. Pt #1: the information at HP Enterprises and what the NC Medicaid online information DOES NOT MATCH. Pt #2: How is HP Enterprises supposed to get their 35cents / page for older RA's? there is no info about how to do this. It seems amazing to me that such a company would expend energy to recoup a few cents, frankly. I'll give it a week and see if the RA (I requested two of them) will come to me. Then I will call you back. Pass this to any salient party. Sincerely, Marsha V. Hammond, PhD"

Post Script #6, Tuesday (same day, at 10:20 am or so) received several calls, e mails, from Behavioral Health section and one from Amy of HP Enterprises informing me that only 10 of Remittances (information indicating how claims were handled,whether paid or not and codes as to any problems) were available 'free of charge' and after that they are '35 cents/ page' which I indicated I would pay. She then shuttled me to an extension for Remittances where there was a message machine asking for detail information and declaring that some response would be made available 'within 24 hours.'

Post Script #5, Tuesday (same day, at 9:38 am) calling the Behavioral Health section of NC Medicaid at 919 855 4290, the message machine states: "Sorry, the number you have called is either busy or......BEEEPPP."

Post Script #4, Tuesday (a week later, 11.16.2010), calling Amy of HP Enterprises, tel 919 816 3063, whom is reportedly contact for Medicaid Remittances (records of billing submitted which was made electronic by HP Enterprises beginning in July, 2010), as she has not responded after three telephone calls to make available remittances at the NC Medicaid Webclaims website where all billing is done. I'll be calling (again) NC Medicaid and then at the end of the day, Mr. Cansler's office.

Post Script #3, Tuesday am and afternoon, 11.9.2010 (funny how cc'ing Lanier Cansler, NC DHHS Secretary, will get you calls back on your billing and authorizations from the various companies associated w/ billing): Nice people from HP Enterprises (yes, that's Hewlett Packard) called looking over remittances which I have yet to get to. They can see the info but I, the provider, cannot (remittances are feedback on billing which HP electronicized, so to speak, creating additional barriers to mental health providers being able to see what is going on with billing). Additionally, one person from Behavioral Health unit called me twice today in order to see if things were being followed up re: my questions.....will keep you posted about further problems w/ the various bits and pieces of NC Medicaid laying everywhere, in every direction OR as Amy from HP Enterprises (which does the billing for NC Medicaid) said: "It was hard for providers when Medicaid was privatized....."

Post Script #2 at 3:30 pm 11.8.2010: I have sent an e mail to Lanier Cansler as the Behavioral Health Unit personnell are unable to answer the below questions. I am sorry to be so obnoxious, but the last time I asked one of them, Peter Bernadini, a question via e mail, it was over two weeks when he got back to me; by that time I had gotten an answer from the helpful Bert Bennett. Bert Bennett was on vacation last week and he is on vacation today and it appears that whether you call the Behavioral Health Unit, which I have 3x today, or if you send e mail, you still cannont get an answer. It would appear to me that you can't run a division of NC DHHS if only ONE person knows the answer to questions which are pressing outpatient mental health providers who are trying to keep people 'out of the ditches.'

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Post Script # 1 at 10:30 am, 11.8.2010: After sending Bert Bennett of NC DHHS the following e mail, I called the number he gave me, which is for the Behavioral Health Unit of NC DHHS at 919 919 855 4290. The message on the machine (not even any options) was: "Sorry, but the number you have called is either busy or not available. Please leave your name." BEEEEEEEEEPPPPPP

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I'll be calling Lanier Cansler, Secretary of NC DHHS, this afternoon if I don't hear something from these people.

In Texas, they are considering just ridding themselves of Medicaid, since the Republican got elected to governor. While I did my PhD there, I am sure glad I don't live in that godforsaken place.

In NC, this is part of the reason why Outpatient Behavioral Health (read: mental health) is falling apart. Here is my letter to a person whom has generally been helpful at NC DHHS, Bert Bennett. This being said, with all the pieces of NC Medicaid scattered to the winds, it is no surprise that these kinds of problems exist. Here is my letter sent today:

Marsha V. Hammond, PhD Clinical / Health PsychologyNC Licensed Psychologistcell: 828 772 No Faxe mail: chomskysright@gmail.com

November 8, 2010

Hi Wendy Korb & Bert Bennett of NC DHHS Behavioral Health Unit
Thank you for assisting me.

I sent Bert an e mail last week asking about the matter of filling out the ORF 2 form (which authorizes providers to render outpatient behavioral health after the first 8 sesssions every calendar year) which, I assume, wraps around----necessarily-----to the NC Webclaims billing page as regards the matter of the terms 'attending/ referring.'

This being said, I am not being paid for authorizations which were in place as of April, 2010, for a number of clients and I am having a hair-pulling time simply getting remittances. Today, I talked to Margo at HP Enterprises to find out that there are two log on numbers associated w/ my name, Marsha Hammond, PhD. She apparently corrected that and I have logged back on using a new password. I have no idea if this has anything to do with not being paid. I am exasperated to say the least.

HERE are my TWO questions to you, Bert, and Wendy, whom you referred me to, Bert, as you were out of the office some last week:

ON the ORF 2 form, and as per the directions online at NC DHHS, and as I understand it, when I fill in the line which states:

Attending Provider Name/ Medicaid # I AM supposed to fill in (which I faxed on Saturday a large set of ORF 2 forms as I am not being paid, not receiving remittances, and can in no way figure out what is going on):

"Marsha Hammond PhD --------- LP # 2748" (it is HARD to get all this on that line as demanded by the directions)

Then the next line which states, Billing Provider Name/ Medicaid #, I have filled in:

"Marsha Hammond PhD -------------"

***********************Is this CORRECT?

Then, in terms of wrapping around to NC Webclaims billing, in the section on the CMS 1500 claims form, which I have been filling out for years, and only since HP moved into NC DHHS billing as well as the general dismantling of the entire NC Medicaid authorization and billing system have I had these massive problems, this is what I fill in:

1. the information about the provider at the onset of the claims information
2. I also fill in the Rendering/ Attending provider information as THIS IS WHAT THE ORF 2 FORM TELLS ME TO DO.

*****************Is this correct?

Pass this to anyone you like but I need an answer quickly.

I am looking forward to getting my remittances dating back to July, 2010, as today I talked to the remittance people (yet another piece lost in the system) which has demanded that behavioral health providers fax in a special form----a service which WAS IN PLACE prior to HP Enterprises being contracted w/ NC DHHS as associated w/ Behavioral health.

Sincerely, Marsha V. Hammond, PhD

'Legislative Research Commission' to Study 'cost-effectiveness' of Supportive Housing : Rep Insko Outlines Possible State Supportive Living Measures

2010-10-04T09:21:00.005-05:00

When you're 'urban hiking' in Asheville, NC, its not uncommon to come across someone's sleeping bag---indicating that fairly recently that person has been sleeping within the city's limits, but under a bridge or just off a path where you might hike w/ your dog. There are lots of homeless looking young people in downtown Asheville, walking w/ a leashed dog as if he was their last friend

Accordingly.....from Representative Wray's website/ blog re: NC Legislative activities (this being said, it's Verla Insko, D-Orange County, as in, is the woman going to run for governor someday, who created the details to be studied regarding 'supportive housing' (see below). First, Rep Wray provides a helpful overview of the issues around mental health vis a vis the state legislature first.......

In a nutshell, Verla, if all the pieces of 'supportive living' could be organized and were administratively overseen by one clearly demarcated entity, it might be speculated that the costs would go down and that citizens' rights would be better protected. Addtionally, we would not have (public & therefore pertinent to the NC State Legislature) embarassing events like the former Administrative Director of Smoky Mountain Center being charged with creating real estate endeavors so as to funnel available monies for the establishment of housing for people having mental health issues------towards himself and his real estate agent wife.

Hidden costs that need to be taken into account regarding 'supportive living' include the following (and there are a lot of 'quality of life' issues/ costs here). :

1. State costs which are not federally picked up as re: Section 8 housing; in particular, and as related to the more rural areas of the state, 'supportive living' in the forms of trailers and poorly insulanted houses create housing that has to be attended to by the local county DSS e.g., heating bills, emergency phone bills, other utilities that free-standing 'supportive housing' crank.

2. Splintered agencies across the state all think they see the elephant when in fact they are simply a mole on its haunch: there are city housing authorities (see below) and DSS staff dedicated to family care homes, etc.

3. If one was to consider 'cost-effectiveness' it might be useful to include the interdictory activites of the management/ police/ DSS/ mental & physical health practitioners vis a vis those who live under the umbrella of 'supportive housing'.
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Here is Rep Wray's overview of matters pertaining to MH as per what is up and coming in the NC State Legislature:

see: http://www.homeinhenderson.com/?p=16769

"......Mental Health

While we had to balance our budget and trim spending in many areas, we believed it was important to continue trying to improve our mental health services by providing more local options. For that reason, we increased funding for local inpatient beds for mental health patients by $9 million to $29 million and directed that the money be spent equitably throughout the state. (SB 897)

We extended the First Commitment Pilot Program until October 2012 and authorized the expansion of the program to up to 20 local mental heath management groups. The program allows properly trained licensed clinical social workers, master’s level psychiatric nurses, or master’s level certified clinical addictions specialists to conduct first-level examinations in the involuntary commitment process. Since local community hospitals have greater access to these professionals, the pilot reduces unnecessary time delays while maintaining essential safe guards of the process. State law generally allows only physicians to conduct such exams. The act also directs the Division of Mental Health/Developmental Disabilities/Substance Abuse Services to expand its training requirements to include refresher training and to evaluate the participation rate of eligible examiners. (SB 1309)

The North Carolina Institute of Medicine has been asked to put together a task force that will study the needs of children aged birth to five with mental health problems, as well as the needs of their families. The task force’s report is due to the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services by January 15, 2012. (SB 900, Part XVI)

The Legislative Research Commission has authority to establish a task force to study the cost‑effectiveness of supportive housing as an alternative to institutionalization of people with mental health, developmental or substance abuse problems. The study would examine whether such housing would help reduce the number of emergency room visits and hospital admissions, improve treatments and decrease homelessness, among other outcomes. (SB 900, Part XVIII)...."
********************************************************************************
Defarge comment re: 'cost effectiveness of supportive housing': (see this URL for that bill:
http://www.ncleg.net/Sessions/2009/Bills/Senate/PDF/S900v7.pdf

In surveying the bill, everything from ownerless dogs & cats to beauty pageants to changing demographics of community colleges is about to be 'studied.'

Insko, whom works with Martin Nesbitt (D-Buncombe County), is the co-chair of the Joint Legislative Oversight Committee for Mental Health Reform. From the just above URL, she has outlined the particulars of what needs to be studied as regards 'supportive living':

"The Commission should address all of the following in its findings and
recommendations:

(1) A recommendation as to whether and how a statewide supportive housing
initiative could achieve each of the goals referenced in subdivisions (1)
through (9) above.

(2) The number of supportive housing units that would be necessary for
successful implementation of a statewide supportive housing initiative in
North Carolina.

(3) The amount of capital investment that would be necessary for initiating and
maintaining a statewide supportive housing initiative.

(4) Different funding resources that could be used to pay for ongoing
operational costs of a statewide supportive housing initiative.

(5) The potential cost-savings to be achieved by the State through
implementation of a statewide supportive housing initiative.

*********************************************************
I would like to outline the current 'supportive living' measures that are in place.

Currently, there are four ways that people w/ mental & physical health issues can live, to a varying degree, independently in 'supportive housing'. 'Supportive housing' means,however, that the residents have to pay attention to the tidyness of their apartments and there can be no unseemly activity (see below).

These citizens do not have the rights that people living in non-supportive housing have. If one was to consider 'cost-effectiveness' it might be useful to include the interdictory activites of the management/ police/ DSS/ mental & physical health practitioners vis a vis those who live under the umbrella of 'supportive housing'.

Additionally, cost saving measures that everyday people employ, particularly when it gets cold, cannot be used by people living in Section 8 housing. They cannot have wood stoves or free-standing propane heaters (I reckon due to their potentially incendiary nature). Their heating bills are commonly addressed, in some good measure, by the county DSS. Thus, that is another expense that needs to be taken into account re: 'supportive living.'

Citizens living in the most restrictive environment, specifically family care homes, must have moved through the Social Security Disability process and have a disability check that comes to them on a monthly basis. Therefore, another cost associated w/'supportive living' would be all those legal machinations around the obtaining of a disability check. I know of only two individuals who obtained Social Security Disability within a year; both were heavily vested in the Social Security System and one of them was an attorney with a head injury. Mostly, people wait for years. Who can calculate the monies lost/ put at risk related to waiting for a clogged-up system to open the sluice so your family can eat?

I believe you would obtain an innacurate picture of the overall cost of 'supportive housing' unless you included those components, as well as others I have not even considered below:

1. Free-standing Section 8 housing (if there is even a hint of any illegal drug use or inability to care for oneself e.g., keep a tidy apartment, as a surprise inspection is always possible----the person is removed from the housing and there is a three year moratorium w/o any ability to intercede utilizing local legal aide services, to intervene and resume Section 8 Housing. Thus, the burden of proof of difficulties like the above rests on the tenant whom is disabled and commonly not completely functional). Section 8 Housing lists are long for Buncombe county and assumably the more populated counties, in general. By free-standing, I mean apartments, trailers, or houses that can be rented utilizing a Section 8 Housing voucher. In most of Western NC, the entity that concerns itself w/ that is Mountain Projects, administratively housed in Waynesville, NC, in Haywood County. Poor people live in crummy environments and landlords are not inclined to pay much attention to the housing.

2. Local Housing Authorities e.g., Waynesville Housing Authority, etc., create housing in the form of multi-story buildings w/ free standing apartments within. For instance, Waynesville Housing Authority has two very good multi-story apartment buldings for people having disabilities located in Waynesville, NC. Asheville also has some good multi-story buildings right downtown. One of them, across from Lake Junaluska, would satisfy me : its beautiful, has wonderfully designed apartments, a library downstairs, and a view that only the very wealthy can command.

3. Local Section 8 Housing in the form of 'the projects.' Asheville,for instance,has some very conveniently and centrally located 'projects' and indeed,the current mayor of Asheville, Terry Bellamy is rumored to have 'come out of' one of 'the projects.' This being said, when I was doing voter registration at many of these projects in Asheville several years ago, it was the norm for the crack dealers---in broad daylight--- to run towards my car as fast as possible, assuming that this odd white lady was there for that reason. So, imagine raising your children in that environment. It is weird to me that a resident may not smoke a joint in their Section 8 housing apartment without risking losing their housing,whileas crack dealers roam the streets in broad daylight, with the entire community standing around. Yes, I have a client whom was arrested and escorted from his muti-story Section 8 housing in Asheville by a handful of Asheville Police Department policemen whom stormed in and said, 'show us your marijuana' upon which he very willingly emptied his pockets. He had no Miranda Rights for he was in public housing.

4. Family Care Homes: I have written a lot about these homes over the past couple of years as associated with my clients who live there. These are mid to large size houses, owned by private individuals, with probably six to ten people living in private bedrooms in one house, with a living room, with multiple houses on the property. There is a person who passes out medication; most residents take meds. Commonly, bedrooms are shared with another person; you guessed it: just like you and me, we don't want to share our bedroom with a stranger.

These family care homes address the issue of homelessness moreso than the other housing and are funded by the county Medicaid offices as well as the entire disability checks (for the most part) of the residents. If someone has worked for a number of years,their disability checks are usually $850-900/ month. If they had a parent who placed them under their social security number prior to they turning 21, they receive the full benefits of said parent. Contrarily, people who have never worked have disability checks of around $600/ month. These citizens have Medicaid only whileas those who have vested in the Social Security System receive Medicare as primary and Medicaid as secondary. This is important because there are a lot more physicians who will take Medicare but not Medicaid. As for this psychologist, NC Medicaid pays me pretty well. Go figure.

Funding to pay for the housing, utilities, food and 24/7 attending Supervisor-in-Charge (SIC) and roving medication tech, derives from scooping all of the residents' disability check (of whatever amount) minus $66; the county Medicaid office pays the rest and the overall cost of staying in such a family care home/ month is about $1300. For that, residents receive meals three times/ day; they usually have TV's in their rooms; and, they receive some transportation to important medical appointments. 'Social activities' are posted e.g., playing bingo, etc., but are poorly attended. There is a great deal of cigarette smoking on the porches and inactivity and boredom are rampant. People get overweight and then Type II Diabetes sets in.

To my mind, these are the descendents of the large state mental health hospitals which were very significantly downsized as associated w/ a lawsuit back in the late 1970's which created the community mental health treatment centers due to the change in the law which demanded that the large hospital facility could not keep people without 'giving them treatment.' (warehousing them was considered to be non-treatment).

The NC Department of Health Service Regulation (under NC DHHS) oversees these family care homes and there are representatives in each county as well as someone(s) at the local Department of Social Service whom interfaces w/ the family care home and provides for inspections and complaints. The residents are loathe to complain as they know who butters their bread. There is a telephone number for an ombudsperson posted on the living room walls of these homes; supposedly this is a helpful person when one has a complaint but again, you don't want someone to withdraw their helpful attentions if you begin to complain.

The homes are run by some well meaning people but there is also a hidden massive scramble to drag off the residents to 'my' family care home and I have been threatened with arrest by the Buncombe County Sheriff's Office when one particularly obnoxious manager of a family care home in Leicester, NC, told me I was not welcome to render therapy to my client 'after hours' (with they being able to determine what 'after hours' means, regardless of the client's desires.

Thus, of all the 'supportive living' alternatives, the family care homes are the least desirable place to end up but certainly can address the issue of homelessness but FIRST----for the most part----the citizen has to have a disability check which pays for a good measure of staying there.

Medicaid or Medicare for ALL?

2010-10-03T14:58:00.002-05:00

This was posted on the Division 42 (Independent Practice) of the American Psychological Association, as associated (first part) Kaiser (insurance) and secondly, by the identified psychologist----below:

********************************************

"....Under health reform, Medicaid will be expanded to cover nearly all individuals with incomes below 133 percent of poverty resulting in a large adult expansion in most states, particularly adults without dependent children who had historically been barred from coverage under the program. This expansion provides the foundation for new coverage under health reform.

Not surprisingly, Medicaid officials are playing a lead role in preparing for health reform implementation, in many cases alongside insurance commissioners. Some of the key challenges that states will face in implementing reform include implementing the Medicaid expansion, transitioning to a new income eligibility methodology for Medicaid, setting up Health Insurance Exchanges and re-designing eligibility systems to coordinate with the Exchanges.

These challenges are magnified by recent administrative cuts and state workforce reductions limiting states’ capacity to focus on new responsibilities. Many states said that they need
timely regulations and guidance as well as financial support to help them move forward and meet tight implementation timelines.

http://www.kff.org/medicaid/upload/8105_ES.pdf

*********************************************************
"Comment: In spite of the infusion of funds from the American Recovery and Reinvestment Act of 2009 (ARRA), states are implementing Medicaid provider rate cuts and implementing Medicaid benefit restrictions. Yet with the enactment of the Patient Protection and Affordable Care Act (ACA), the Medicaid program will be greatly expanded to include almost everyone with incomes below 133 percent of poverty.

Medicaid always has been and always will be a welfare program for low-income individuals. Serving a population that lacks an adequate political voice, it also has been and always will be a chronically underfunded program.

Most physicians who do accept Medicaid patients do so, in spite of inadequate reimbursement, because they believe that everyone should have health care. With a much greater volume of Medicaid patients some physicians will certainly face the dilemma of crowd-out of privately insured patients because of the Medicaid overload in their appointment schedules.

Imagine a physician facing Medicaid overload, declining net revenues, and frustrations of trying to help patients negotiate a system with diminishing benefits and with impaired access to specialized services because of a lack of willing providers.

Certainly some physicians will feel that they have no other choice than to close their practices to Medicaid patients. What will that do to other physician practices that are already overloaded with Medicaid patients?

Adverse selection can sink insurers, but it would be much more tragic to see adverse selection sink the practices of those physicians who are trying their hardest to do the right thing.

If everyone were in the same health care program, say an improved Medicare for all, an underfunded, segregated sector of stigmatized and humiliated welfare patients wouldn't even exist. They would have access to the same care the rest of us have. Wouldn't that be nice for a change.

Don McCanne, M.D. Physicians for a National Health Plan, Senior Health Policy Fellow, writes daily on health care financing, reform, etc. at: http://www.pnhp.org/news/quote_of_the_day.php

______________________________________________
David Byrom, Ph.D.
Co-Director, Family Therapy Institute of Suffolk
39 Landing Avenue
Smithtown, New York
(O)631-361-3662 (Fax)631-361-8750
Secretary, National Board, Universal Health Care Action Network
www.uhcan.org"

'Coalition for Parity' (NOT!): Insurers Block MH Parity across the US

2010-09-28T10:50:00.002-05:00

There has been a recent conversation amongst independent psychologists in Division 42 (Independent Practice Division) of the American Psychologist Association particularly associated w/ the 'blues' (BCBS, Blue Cross Blue Shield) companies across the US in terms of they refusing MH parity.

Indeed,in NC, BCBSNC was allowed to opt out of MH parity even though it was put into law back in 2009. You guessed it: there is a 'special liason' committee moving between the NC State Legislature and BCBSNC. Much information re: this can be found at my other blog which concerns itself w/ 'Scrutinizing BCBSNC': http://madamedefarge2scutinizingbcbsnc.blogspot.com/

************************************************************************************
"....
Psychiatrists, Psychologists and Mental Health Counselors Take Note: Insurers are Trying to Delay Mental Health Parity! The Whole Managed Care Industry is in Danger and Trying to Fighting Back.

A group of managed care organizations, cynically called the Coalition for Parity Inc., has filed suit in U.S. District Court to delay the implementation of the federal mental health parity bill. The Coalition claims its members were not given enough time to comment on the parity rules before they became final....."

see: http://www.carolinapartners.com/blog/2010/07/psychiatrists-psychologists-and-mental-health-counselors-take-note-insurers-are-trying-to-delay-mental-health-parity-the-wh

NC MedAssist Program: mail order central pharmacy: meds 4 free!: 1-866-331-1348

2010-09-28T10:43:00.001-05:00

From a new blog with great information: http://www.carolinapartners.com/blog/

"Every Raleigh Psychiatrist, Every Durham Psychiatrist, Every Cary Psychiatrist and Every Chapel Hill Psychiatrist Should Know About the NC MedAssist Program

People in North Carolina who are unable to afford their medicines can now get some of them for free. The NC MedAssist program has created a mail-order central pharmacy to provide medications for free. Both generics and brand name drugs are covered. With a shout-out to Big Pharma for donating the pharmaceuticals in the first place! In 2009, the state rolled out a pilot program to give low-income North Carolinians access to needed prescription drugs. Now that program has been expanded state-wide, so I guess it has been a success thus far. The project was developed as a partnership between the NC Attorney General’s Office, NC Association of Free Clinics, and NC MedAssist. Among other medications available under NC MedAssist, low-income patients will have access to: Antipsychotics: Zyprexa, Haldol, and Seroquel; Antidepressants: Cymbalta, Prozac, Nortioptyline, and Trazadone Others: Lithium, Depakote, Clonidine, and Hydroxyzine. This program is available to North Carolinians, both adults and children, living at or below 200% of the federal poverty line; adults and children who do not qualify for Medicaid, VA, or private insurance; and/or Medicare Part D participants who fall in the infamous “Donut Hole.” One can enroll in NC MedAssist by downloading an enrollment packet at www.medassist.org, or by calling 1-866-331-1348....."

Public Health Improvement Program: Feds give almost 2 million to NC DHHS: how will they spend it?

2010-09-23T09:06:00.003-05:00

I'm all for what the Feds state this money is to do, in part: "improve networking, coordination, and cross-jurisdictional cooperation for the delivery of public health services ." 48 states and jurisdictions received money and NC was in the top 10 of amount received.

I might imagine, however, that such monies are going to go to the larger private mental health care companies whom will simply utilize it in order to fold in more of the mental health care 'consumers' in order to provide yet more 'administration' of public mental health-----when what is called for is money to providers who work f2f (face to face) w/ citizens experiencing mental health challenges.

In the best of all possible worlds, I might imagine the creation of a HIPAA compliant, internet portal, such that providers could actually efficiently correspond w/ each other about clients' needs-----like I did yesterday afternoon when I was able to reach the very efficient Nurse Practitioner on the phone for a quick change in meds for a client of mine with a SPMI (Severe Persistent Mental Illness).

I figure I save NC DHHS a bunch of money by keeping these kinds of people OUT of the hospital by utilizing strategies like this as well as sending encrypted e mail (watching out for HIPAA) via WORD as per its Security 'Save As' device.

I wish I was a more optimistic kind of person.
*****************************************************
http://www.thegovmonitor.com/world_news/united_states/u-s-invests-42-5-million-for-public-health-improvement-programs-38934.html

U.S. Invests $42.5 Million For Public Health Improvement Programs
Source: Department of Health & Human Services Posted on: 21st September 2010

"......This new 5-year cooperative agreement program entitled, Strengthening Public Health Infrastructure for Improved Health Outcomes, will provide health departments with needed resources to make fundamental changes in their organizations and practices, so that they can improve the delivery of public health services including:

Building and implementing capacity within health departments for evaluating the effectiveness of their organizations, practices, partnerships, programs and use of resources through performance management

Expansion and training of public health staff and community leaders to conduct policy activities in key areas and to facilitate improvements in system efficiency

Maximizing the public health system to improve networking, coordination, and cross-jurisdictional cooperation for the delivery of public health services to address resource sharing and improve health indicators

Disseminating, implementing and evaluating public health’s best and most promising practices

Building a national network of performance improvement managers that share best practices for improving the public health system....."
*********************************
This is what was allocated for NC:

"$1,903,858 to North Carolina State Department of Health and Human Services"

Adult Care or Family Care Homes: the New Prison for Those w/ Mental Health Challenges

2010-09-15T10:57:00.004-05:00

I'm on my way to see two of my clients in their Adult Care Homes (ACH) also known as Family Care Homes. Chris Fitzsimmons of NC Policy Watch has recently written about the trajectory of how people w/ mental health challenges usually end up in such a place and this is certainly my experience. They get into a pickle related to their mental health behaviors, there is nowhere to go, and so they get warehoused in the ACH's.

If you don't think they sometime function like prisons, remember I was threatened to be arrested by the Buncombe County Sheriff's Department for rendering therapy to a client of one of these homes in Western NC a year and a half ago. I took the matter to the Buncombe County DSS where they allowed the manager of the home to try and dress me down with the Adult Care Licensure people sitting mutely in the room (see their rules and regs here: don't bother with making a complaint for it will come back 'groundless': http://www.dhhs.state.nc.us/dhsr/acls/index.html)

While there are some exceptions, usually they are run like petty fiefdoms with the residents having little privacy. The residents have no spending money as their disability checks are consumed by the owner of the ACH, except for $66 (mark of the beast, ya know), minus their co-pays for their medical prescriptions and doctor's visits, every month. That would leave most of them about $45 for the month.

As per the state guidelines, the cost of staying in such a home is about $1300/ month and this includes a room (usually shared), a 24/7 Supervisor-in-Charge or SIC (they have a terrible burn-out rate given that they usually live there themselves), food on the table (gets pretty grim sometimes and is completely dependent on the ability of the SIC to cook), and plenty of boredom.

99% of these people are not working either because they are too disabled (and the longer they don't work the more likely it is that they willn ot work) or have no way to get to a supported employment facility such as Haywood Vocational Opportunities in Waynesville, NC (a good place for people to work, for the most part), or they would lose their disability checks if they go over a 'bright line' of earned income which is approximately $12,000/ year.

So, if they're working, they could earn 1 million $$ or $12,001-----the results would be the same: they would lose their disability checks until the entire sum of what they earned was paid back. Talk about a complicated system that will chew you up......

If NC wants to do something about warehousing these people, which is what is taking place---and yes,these are the new state mental health hospitals.....only privatized......what has to be addressed is a significant way to improve the quality of life of these people and that would include they being able to work and feel like functioning people within the community.

Oh, that would mean there would have to be more jobs of course......and more sheltered workshops.

Below is what Fitzsimmons has to say. Additionally, here are some of the links to my previous notes on the problems w/ the Adult Care Homes also known as Family Care Homes, in NC:

*************************************************************************************
Wednesday, April 08, 2009

WNC (Family Care) Homes: DSS Buncombe finds rule violation as re: mental health client re: opening of private mail
see: http://madame-defarge.blogspot.com/2009/04/wnc-family-care-homes-dss-buncombe.html

***********************
Wednesday, May 13, 2009

NC Family Care Homes: mental health issues go unaddressed & providers are banned from premises: defacto mini-prisons
see: http://madame-defarge.blogspot.com/2009/05/nc-family-care-homes-mental-health.html

***********************
(what the Adult Care Home people do during the day time----or not-----as re: the local library system; they take a lot of medication that has, as a side effect, fatigue):

Buncombe County Library system: No place for the sleepy
by Marsha V. Hammond in Vol. 16 / Iss. 17 on 11/18/2009
see: http://www.mountainx.com/opinion/2009/111809buncombe_county_library_system_no_place_for_the_sleepy
**********************************************

What Fitzsimmons recently wrote about these homes:

http://www.ncpolicywatch.com/cms/2010/09/15/north-carolina%E2%80%99s-broken-emergency-mental-health-system/

"......
Because there were no beds available at any of the State's psychiatric hospitals he stayed handcuffed to a stretcher in the emergency department with a 24-hr. police detail. Finally, after 96 hours without treatment, he calmed down and was discharged but his elderly parents were afraid to let him come home. His options - live on the streets - homeless - or find a bed in an adult care home (ACH). Either choice left him without treatment for his mental illness increasing the chance that it would happen again.

Sadly, this is not an isolated story. Over 6,000 adults with mental illness live in ACHs in North Carolina. And that number only reflects people with a known mental illness. There isn't an accurate count of the number of people who would rather be homeless than live in an institutional setting like an ACH or who are not receiving any services at all. With extreme cuts in funding, that number is likely to grow and include more people with other types of disabilities......"

Smoky Mountain Center LME: Cracks to Fissues & the Case for Synthetic Cannabanoids

2010-08-04T10:14:00.003-05:00

(submitted as an Opinion piece to the Smoky Mountain News):

Smoky Mountain Center LME’s Balsam Center : Cracks to Fissures & the Case for Synthetic Cannabanoids

By Marsha V. Hammond, PhD, Licensed Psychologist

The Balsam Center, located on the main highway, between Waynesville and Sylva, has undergone another quiet revolution. With Smoky Mountain Center LME’s now legislatively mandated complete divestment of clinical services, Appalachian Counseling Services, in the area for several years now, has taken over the maintenance and supervision of the psychiatric services which are manned by some fine psychiatric nurse practitioners, psychiatrists, inclusive of the ACT Team, which attends, in home, to people with SPMI, Severe Persistent Mental Illnesses. Several months ago one of the members of the ACT Team killed himself. Was it the stress or his job? People say he was acting normally just prior to this tragic incident.

Another matter has more fundamentally impacted citizens who have received clinical services at The Balsam Center: about six months ago the Clinical Director, a man known to be a likeable psychiatrist, mandated that no more anxiolytics e.g., Klonepin, Ativan, Valium, Xanax or psychostimulants e.g., Adderall, Ritalin, Vivance, would be prescribed. The histories of addictions to Ativan, Valium, and Xanax are well documented. Klonepin, on the other hand, has provided non-addictive relief to patients of mine whom experience depression coupled to anxiety, for instance. I’ve now had to spend my clinical time, first of all finding a psychiatric medication provider, then writing the referral with details of the history of medication issues for the patient; then the patient has to drive 25 miles, if they have transportation, to Asheville or further in order to receive some Klonepin. Klonepin has what is known as a slowly accelerating ‘clean drug profile’, unlike Valium, for instance, which has a ‘double peak’, quite a few hours after its first jolt of addictive relief. Many people take Klonepin to help with sleep; Ambien, another sleep medication, is supposed to only be taken for a short period of time. There is no kick when you take Klonepin. So, why has it been removed from the formulary of The Balsam Center?

Was it the diversion of the medications by poor people, receiving disability checks, and thus access to NC Medicaid’s $3 co-pay, to others who offset their own health difficulties or poverty? Some, to be sure, stock-pile these meds and/ or stand to profit as the middle man as the pills pass from one hand to another, each time with a hike in the price. The problems of diversion are very probably even more true pertaining to narcotics which are not prescribed by psychiatrists but by local physicians (less and less) or pain treatment doctors (some of them) whom give their patients a whopping seven minutes of their time (and if you’re one minute late, you miss your appointment all together; this is not a confabulated story).

A couple of weeks ago, the New York Times documented that the #1 killer in some of these United States is overdoses of prescribed medication. Thus, a more fundamental issue is the impact of Big Pharma on our very living conditions. Are there safer avenues to relief from mental pain which is certainly exacerbated by conditions known well to displaced factory workers (there are many), and their adult spouses, living in their months-behind rented trailers and apartments? Can the Balsam Center reconsider the usefulness of anxiolytics and psychostimulants?

Pandora’s box is full of unexpected surprises, some of them scary jack-in-the-boxes and some associated with matters to perhaps be reconsidered. Moreover, science continues to relentlessly race ahead regardless of our ability to ethically consider matters. Candace Pert is well known for having discovered the opiate receptor over 20 years ago; surprisingly, it is present in your gut. Now, to expand upon that notion of the vast mystery of this human body, and given that some people want to make money and others want relief, the colloquially known ‘head shops’ are selling ‘synthetic marijuana’ which provides considerable relief to people with anxiety coupled to depression (as it often is). Of course, there is a law in the NC State Legislature, knocked down, perhaps temporarily, to cut off this access.

‘Synthetic cannabanoids’ generally are shorter acting than cannabis, the plant, because there are one or two cannabanoid analogues rather than dozens, which are present in the plant cannabis. It cannot be detected with a drug or urine screen because the drugs bind to a different site on the two known cannabinoid receptors, CB1 and CB2, which all humans have. CB1 receptors are on cells present mostly in the Central Nervous System, less so in the Peripheral Nervous System whileas CB2 receptors are present peripherally and in the spleen, which concerns itself with immune system functioning. The first cannabanoid receptor, Anandamide, discovered rather recently, derives its name from the Hindi root word, ‘ananda’ or ‘bliss’ and is commonly associated with the euphoria of ‘being stoned.’ This was followed by the discovery of the 2-AG cannabanoid receptor.

This means that there must be a reason why the receptors are present in humans and as good a theory as I have heard was recently posited by a physician colleague of mine: the cannabanoid receptor system is activated with stress and injury or as he calls it, ‘the lost battle’ scenario: you’ve lost the fight with the saber-tooth tiger or the bear drug your kill off into the woods, leaving you to run up into the tree and nurse your injuries and catch your breath. Internally, your body is ramping up the cannabanoid receptor system, pumping up your immune system, tamponading the bleeding, and relieving your pain.

Big Phama, on the other hand, willing to make money, and a lot of it, finds medications, such as Klonepin, which provide specific relief for specific symptoms. And it’s problematic due to diversion? Pick your poison and to my mind, the further we get away from assisting Big Pharma in accumulating massive profits, the closer we get to well-deserved research on the endocannabanoid system present in every one reading this opinion piece.

_________________________________________
Reference:

http://www.nytimes.com/2010/07/29/business/29pain.html

".....Nationwide, fatalities from prescription drug overdoses are the second-leading cause of accidental death behind car accidents and, in some states, are the leading cause, according to the Centers for Disease Control and Prevention. ..."

NC Family Care Homes Report 4 Killings : Come IN Department of Health Service Regulation (under NC DHHS)

2010-08-02T11:59:00.002-05:00

I contacted NC Disability Rights about a year ago about the conditions in these homes. I have clients who live there.
______________________________________________
Study: Four killings reported in rest homes
by Michael Biesecker

"....The state estimates that about a quarter of all patients in the 627 adult care homes across North Carolina have a primary diagnosis of mental illness.....

Lanier Cansler, the state's secretary for Health and Human Services, said Tuesday that if mentally ill patients weren't housed in rest homes, many would be on the street.....

The explosion of mental patients in rest homes is an unintended result of a 1999 U.S. Supreme Court ruling that mandated that people be cared for in their home communities whenever possible, rather than being institutionalized in big state hospitals. As part of a 2001 effort aimed at complying with the ruling, North Carolina downsized its state-run psychiatric hospitals and disbanded county-run mental health agencies in favor of a plan to treat patients through a network of private, for-profit companies....."

http://www.newsobserver.com/2010/07/28/600887/four-killings-in-rest-homes.html#storylink=misearch%23ixzz0v0q5yHe9#ixzz0vT9IPxuc

________________________________________

See these other Defarge notes on the family care homes:

1. http://madame-defarge.blogspot.com/2009/02/painting-lipstick-on-pig-family-homes.html

2. http://madame-defarge.blogspot.com/2009/05/nc-family-care-homes-mental-health.html
Wednesday, May 13, 2009

NC Family Care Homes: mental health issues go unaddressed & providers are banned from premises: defacto mini-prisons

3. http://madame-defarge.blogspot.com/2009/03/nc-departof-hlth-service-regulations.html

Monday, March 16, 2009

NC Depart.of Hlth Service Regulations & what they have to say about my complaints on a Family Care Home:nothing useful to those w/ mental health problems

MHA-NC, since 1939 NOW to Close It's Doors:NC DHHS Waltzing Matilda While Looking Out The Window

2010-08-01T23:39:00.004-05:00

Man, what is it going to take to wake up the state legislature...to call their attention to the strain on the Medicaid, in particular, system (state run)?

This is the oldest MH provider in NC, operating since 1939.

Everytime the NC State Legislature vis a vis NC DHHS has jerked the choke collar of the providers.....saying they would do this and then that...and then pulling the rug out from under the providers...its been like a family that keeps trying to pay its mortgage when the jobs keep being pulled out from underneath the family providers.

Sorry, I don't think it was because Mr. Tote and some executives were making what moderately paid executives usually make. You can't run a company when the funds ebb and flow just like you can't run a house-hold when you keep getting downsized.

This is a VERY big deal.

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"Sunday, August 1, 2010

Oldest mental health advocacy group in NC to close due to financial problems

http://www.newsobserver.com/2010/05/28/504355/mental-health-group-can-pay-only.html

From The News & Observer:
RALEIGH, N.C. -- The financially troubled Mental Health Association of North Carolina is shutting down.A brief statement released July 30 by the organization’s interim executive director, Christie Foppiano, confirmed that MHA is insolvent and shutting its doors.“In the days ahead, MHA will be working to wind up its affairs and close,” the statement said. “MHA-NC is disappointed that it is unable to meet its financial commitments and continue to carry out its mission to promote mental health awareness, prevent mental illness and eliminate discrimination against people with mental illness.”

Incorporated in 1939, MHA is the oldest advocacy group for people with mental illness in the state and once one of North Carolina’s largest providers of housing and treatment for the population it served.The true depth of the group’s financial problems in recent years, hidden from most of its employees and even its board members, came to light in May when MHA’s longtime executive director, John Tote, was appointed to head the state’s mental health system.

Tote was forced to withdraw from the high-profile appointment less than a week later, after news reports that MHA faced more than $1.5 million in IRS liens related to years of unpaid payroll taxes.On July 26, MHA lost its accreditation, cutting off the group's access to federal Medicaid reimbursements. Without the ability to bill Medicaid, the organizations fate was sealed.The operation of MHA's remaining group homes and treatment programs across the state will be assumed by Easter Seals UCP of North Carolina."

NYT: Insurance Companies Duke it Out over 80 Cents On The Dollar To Be Used Towards 'Welfare of Patients':State Legislators at Risk 4 Secret Deals

2010-07-27T00:23:00.005-05:00

whew: leave to a Rockefeller to speak the truth:.....

BCBSNC has a 'liason' committee which 'interfaces' with the NC State Legislature. NOTE: the suffixes of said committee all indicate alliance w/ BCBSNC (see: http://madamedefarge2scutinizingbcbsnc.blogspot.com/

NYT
July 23, 2010For Insurers, Fight Is Now Over
By REED ABELSON

http://www.nytimes.com/2010/07/24/business/24insure.html

".....The legislative battle over the health care overhaul ended months ago, but it is hard to tell from the intense effort now under way by insurance companies to retool a critical provision.The law requires health insurers to spend at least 80 cents out of every dollar they collect in premiums on the welfare of patients, a critical issue for the companies’ bottom lines.....

But state regulators are only now deciding what precisely that means, as they draft the rules to enact the law. WellPoint, (gee, that's the company that just turned down some charges I sent in utilizing guidelines which Medicare adheres to but which they, as a 'pretend Medicare' company ----Medicare Advantage---dontyaknow----company---do not adhere to) which operates Blue Cross plans in more than a dozen states, wants to include the cost of verifying the credentials of doctors in its networks.

Insurance companies like Aetna argue that ferreting out fraud by identifying doctors performing unnecessary operations should count the same way as programs that keep people who have diabetes out of emergency rooms.Some insurers even insist that typical business expenses — like sales commissions for insurance agents and taxes paid on investments — should not be considered part of insurance premiums, which would make it easier for them to meet the 80-cent minimum.But consumer advocacy groups and others see the insurers’ proposals and their lobbying for a more expansive definition of what would be permitted as an effort to water down the law by including too many administrative costs under the umbrella of patient care. “A lot of what they are hoping to shift over there does not — and should not — qualify to improve an individual policyholder’s quality of care,” said Wendell Potter, a former insurance executive who now is critical of the industry and represents consumers in the discussions with state regulators.

On Tuesday, Senator John D. Rockefeller IV, Democrat of West Virginia, sent a letter to regulators expressing his concern that the insurers could have too much influence on how the regulations were being drafted. By his reckoning, insurers and their compatriots have submitted nearly 160 comment letters, totaling more than 600 pages, to the state regulators. Consumer advocates have submitted just 23, he wrote.“The health insurance lobbyists failed to beat the health care reform bill in Congress — but with billions of dollars at stake, we cannot and we should not expect them to throw up a white flag and start looking out for the livelihoods of American families,” Senator Rockefeller said in a statement. “They’re working every angle of the implementation process to shirk their obligations under the new law.”At stake, according to a report issued Thursday by Health Care for America Now, a coalition that supports the new law, is hundreds of millions of dollars when the law goes into effect next year. If the six largest for-profit insurers had had to meet the new standards last year, they would have been required to refund $1.9 billion, the coalition said.

NC's Needs Increase While Per Capita Spending Drops by 6.4%

2010-07-13T22:51:00.002-05:00

From the desk of NC State Representative Verla Insko, of Orange County, co-chair of the Joint Legislative Oversight Committee on Mental Health Reform:

"The table shows a few interesting things over this time period:

1. The state budget has increased .4 percent ($92 million)
2. Population has grown 7.3 percent (650,000)
3. K-12 enrollment inched up 2.9 percent (41,000)
4. UNC enrollment grew 9.8 percent (20,000)
5. Community college enrollment jumped 27.7 percent (53,000)

The state is doing more with its money. Budgets are stretched, despite claims there have been no hard choices out of this legislature. Per capita spending in actual dollars (not adjusted for inflation) has fallen from $2,127 to $1,991, a decline of 6.4 percent. "

MH Reform Delayed Two Months Affects the Private Companies,not the Individual Professional Providers (Unless They Are Employed by the Private Company)

2010-07-10T18:27:00.004-05:00

Recent article by reporter covering mental health concerns on a consistent basis:

http://www2.journalnow.com/content/2010/jul/01/010240/mental-health-reform-delayed-two-months/

".....For months, the N.C. Department of Health and Human Services stressed that only agencies certified as CABHA would provide services in five key categories as of today. Those that did not qualify, or chose not to, would have their clients involuntarily transferred to other agencies.

The categories are: case management; peer support for recovery initiatives; community support teams for adults; intensive in-home treatment for children; and day treatment for children and adults dealing with issues such as substance or sexual abuse....

"I find it amazing how the state does business and changes the rules on a dime," said Judy Briggs, the chief executive of Carolina Behavioral Health Alliance and a local mental-health advocate. "I cannot imagine how difficult it must be for providers. You will never accomplish efficiencies when the rules constantly change."'
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My comment:

"Let's be clear: the 'sickest' (SPMI: Severe Persistent Mental Illness) clients are still being seen by well qualified professionals IF they have Medicare/ Medicaid/ 3rd party insurance. I bill directly to Medicare/Medicaid/ 3rd party and am always paid. I'm not going broke. However, I provide therapy services not the four services which are being covered here and which is concerned w/ the private companies which cranked up when NC mental health reform began almost 10 yrs ago now. This being said, w/ the collapse of Community Support Services, my therapy gets done, not uncommonly, while I drive the client around to get things done that CSS used to do. So, the state can pay the psychologist the fatter rate to take care of issues or pay attention to the very real needs of the clients---MANY which are associated w/ transportation issues. One of the PURPOSES of NC Mental Health Reform was to provide mental health services to those WITHOUT insurance and THAT is the service is long gone and is breaking NC Medicaid as people move onto the Medicaid roster. Marsha V. Hammond, PhD"
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So, NC Mental Health Reform, at a meta level, if you will, had, as an agenda to 'unify' mental health services but alas, the only providers who are not sucking wind and wince everytime NC DHHS takes another sharp turn on the road and runs into a ditch-----are the solo providers.

You can't work for an organization and stay alive vis a vis this NC DHHS.

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