Maintaining Mental Health Services for All

Maintaining Mental Health Services for All

Help Dr. April Harris-Britt and staff continue to serve children, adults, and families who will lose access to much needed mental health services in NC.

[ original post and fundraising page ]

This campaign is to raise legal funds, so that we can continue to fight for the children, adults, and families who will have limited or no access to much needed mental health services.

Short Summary

Our mental health agency has served individuals in our community for 8 years. We provide therapy for children and adults of all ages and backgrounds. A considerable portion of our work is focused on working with children in the foster care system, children who have been abused, and those with developmental disabilities. We provide psychiatric medication management, parenting classes, social groups, and psychological evaluations. We employ more than 25 people, including a Psychiatrist, Psychologists, Counselors, Social Workers, a LMFT, support staff, and even a local high school intern. We are a group of highly skilled, dedicated clinicians who remain committed to serving individuals of all backgrounds and needs, including the Medicaid population ignored by many others. We are requesting your help to continue doing so.

As you have probably heard, there has been enormous scrutiny of the NC Medicaid program and mental health services over the past few years. In a recent effort to revise and improve the system, a process was put into place that has disproportionately and adversely affected licensed independent providers such as at our Agency, and our ability to offer Medicaid services in the future

One such process involves the State requiring providers to submit all of their paperwork to a contracting agency called CCME that will then review and possibly approve payment to be made months after the client has been seen. There is no surprise that CCME has many flaws, inaccuracies, and inefficiencies in their system for monitoring providers. Even worse, they have a financial advantage to rejecting the claims – they get to extend their contracts for saving money. A CCME representative told us directly that they would be "working themselves out of a job" as they moved people off of prepayment reviews. A CCME representative told us directly that there are "tricks" that could ensure that we were taken off of prepayment.We have not tried any tricks as we naively believed that the system would work out!

Believe it or not, providers can not appeal this process. Within the past few weeks, numerous small, large, and long term providers in the area have already either gone out of business completely or stopped taking Medicaid. You will likely be hearing more and more about providers who have either gone out of business or who are no longer going to provide such Medicaid services.

These are a few links that may be helpful for you to put the story into context and to understand that laws have been broken by the DMA/DHHS (the Agency that runs Medicaid), not the providers.

http://www.wral.com/audit-mismanagement-costs-nc-medicaid-system-millions/12048026/

http://medicaidlawnc.wordpress.com/

http://www.wral.com/nc-auditor-dhhs-improperly-paid-580k-in-overtime/12108305/

http://www.wral.com/providers-getting-squeezed-out-by-medicaid-rules/12085183/

The answer to these political problems should not be to cut Medicaid or to limit the number of providers. If we do, there will be individuals in our schools, workplaces, and communities without needed mental health services. They will likely face higher frequencies of academic, legal, and negative societal outcomes.

I have filed several legal motions due to this being an unconstitutional action and the DMA/DHHS/the State not following policies and procedures to support providers and families needing these services. Our Attorney, Knicole Allen Emmanuel has worked in the State Attorney General’s Office in the past and is now fighting on behalf of providers and small business. We need your help to raise $25,000 in legal funds to fight this process. The outcome of this fight may help establish a precedent that could benefit others. Any amount raised over this amount will be used to cover services for the many families who have already lost their therapy. No amount is too small and we do appreciate your support.

Other Ways You Can Help

If you can not make a contribution, we understand. But please share our campaign with others and spread the word about how these types of actions can and will impact the children and families in our schools, neighborhoods, and communities.

DRNC Press Release: Move to Intervene in ACH matter

Disability Rights North Carolina

FOR IMMEDIATE RELEASE 

Tuesday, June 19, 2012

Disability Rights NC Moves to Intervene in

Tiffany Healthcare, Inc., et al., Petitioners v.

North Carolina Department of Health and

Human Services, Division of Medical Assistance

Raleigh - Disability Rights NC filed a motion to intervene in the case Tiffany Healthcare, Inc., et al., Petitioners v. North Carolina Department of Health and Human Services, Division of Medical Assistance. This case was filed last Thursday on behalf of the owners of eighteen Adult Care Homes (ACHs) who were notified that as Institutions for Mental Disease (IMD), their residents were no longer eligible to receive services under Medicaid.

“The outcome of this case could have a profound effect on the welfare of adults with mental illness – people we are mandated to protect,” said Vicki Smith, executive director of Disability Rights NC. “In the event that the Court rejects Tiffany Healthcare, Inc’s claim, the subsequent loss of Medicaid funding would require a change in the residential placements of more than one thousand individuals. Many of these residents live with mental illness. All of the residents are disabled to some degree.”

A little over a year ago, the Centers for Medicare and Medicaid Services (CMS) informed NC DHHS/DMA that it must develop a method of determining whether ACHs whose residents receive Medicaid benefits qualify as IMDs. NC was required by CMS to develop a protocol to assess whether certain ACHs meet the definition of an IMD and to assure that Medicaid dollars were not being used inappropriately to pay services to residents of those homes.

If the Court rules in favor of the State, the consequence would be the immediate termination of Medicaid payments to the facility. One likely consequence is that, once found to be an IMD, an ACH may face immediate closure owing to the loss of a significant revenue stream for the facility. It is also possible that the ACH might fail to provide the required 30-days’ notice of discharge to each resident. More important, the need to find alternative placements for all of the discharged ACH residents could overwhelm the ability of the local Department of Social Services and the Local Management Entities to meet the discharge needs of the displaced residents as guaranteed by law.

Smith stated, “In the event that the affected residents lose their Medicaid eligibility, an orderly process for locating alternative housing – which is required by law – must be assured. Both Chambers of the General Assembly have recognized the need to budget some transitional support for ACHs. It is our hope that those funds will be specifically targeted to pay for residents’ medications and other medical expenses while alternative housing and services are located. ”

The Court issued a TRO on Friday, June 15 preventing the State from immediately terminating Medicaid benefits. Further proceedings are scheduled at the Office of Administrative Hearings for June 28th.

Background on North Carolinians with Mental Illness Housed in Adult Care Homes

The state’s practice of employing adult care homes as the default residential placement for people with mental illness has been a longstanding subject of interest, investigation and study by Disability Rights NC. In July 2010, Disability Rights NC filed a complaint with the U.S. Department of Justice claiming that the practice of warehousing adults with mental illness in adult care homes violated the Americans with Disabilities Act and the U.S. Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999). One year later, the Department of Justice issued a letter containing its findings, and concluded that “adult care homes are institutional settings that segregate residents from the community” and that those with mental illness “are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies … .”

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Disability Rights North Carolina is a 501(c)(3) nonprofit organization with offices in Raleigh and Asheville. Its team of attorneys, advocates, paralegals and support staff provide advocacy and legal services for people with disabilities across North Carolina. As the state’s federally mandated protection and advocacy system, Disability Rights North Carolina is charged with finding and fighting the abuse and neglect of people with disabilities.

PBH Documents

 Piedmont Behavioral Health (PBH) documents.

• PBH Press Release and Response to US District Court Judge Louise Flanagan's March 29th ruling for preliminary injunction (DRNC KC et al. v. DHHS and PBH), from PBH Communications Director, Rachel Porter. April 2, 2012.
• PBH Waiver Expansion Frequently Asked Questions. December 19, 2011.
• The PBH Managed Care Experience; A Comparison to Non-Managed Care Local Managed Entities, power point presentation. December 1, 2011.
• PBH Continuous Quality Improvement Program Description, 2011-2012. October 31, 2011.
• The NC NH/DD/SAS Health Plan; PBH Consumer & Family Member Handbook, Fourth Edition, 2010. October 31, 2011.
• The PBH Model; The Provider's Council, by Pam Shipman and Stephen Tomlinson, re: Public Management of a system of care for the delivery of privately operated Mental Health, Intellectual/Developmental Disabilities and Susbtance Use Services; A real public private partnership. October 5, 2011.
• PBH Press Release and Response to Support Needs Matrix Litigation (e.g. lawsuit filed by Disability Rights NC alleging violations of due process rights). July 15, 2011.
• PBH Finance Communication Bulletin FY-1011-FN-10, Innovations Service Rate Revisions. April 14, 2011.
• The PBH Model, a power point presentation entitled, Public Management of a system of care for the delivery of privately operated Mental Health, Intellectual/Developmental DIsabilities and Substance Abuse Services, by Pam Shipman. March 8, 2011.
• PBH Waiver Expansion Advantages. January 11, 2011. 
• PBH 2010 Annual Report.
• PBH Provider Manual, Comprehensive Update. December 22, 2010.
• PBH power point presentation: Medicaid Waivers, PBH Outcomes and Thinking Ahead to 2014; A Presentation for the NC Alliance for the Mentally Ill, by Pam Shipman. September 10, 2010.
• PBH Support Needs Matrix: Words to Know. July, 2010.
• PBH Response to the Position Paper of the Arc of NC entitled, Why People with Intellectual and Developmental Disabilities and their Families should support the expansion of the 1915b/c waiver to other LME's in NC. April 29, 2010.
• PBH Myths and Facts Booklet on Innovations Waiver. April, 2010.
• PBH Board Meeting Minutes. January 21, 2010.
• PBH System of Care Collaborative Minutes. January 19, 2010.
• PBH Press Release announcing Transition to State-wide Waiver Plan. January 6, 2010.
• PBH Legislative Agenda Success announcement. July 7, 2008.
• PBH Request for Intent; Innovations Waiver Community Guide Service. January 16, 2008.
• PBH Local Business Plan, 2007; Executive Summary. May 8, 2007.
• PBH NC Quality Assessments and Improvement Strategies. January 1, 2007.

PBH Press Release on federal Court ruling

02 April 2012


Press Release and response from Piedmont Behavioral Health (PBH) Director of Communication, Rachel Porter on federal District Court Judge Flanagan's ruling in L.S., et al. v. Delia, et al. [No. 5:11-CV-354FL].

DRNC Press Release on federal Court ruling

For Immediate Release

March 29, 2012

Raleigh, North Carolina – A federal District Court today ordered the State of North Carolina to halt reductions to home and community based services and restore lost services until the state Medicaid agency and its managed care contractor, Piedmont Behavioral Healthcare (PBH), comply with legal requirements for providing Medicaid beneficiaries with adequate notices and opportunities for impartial hearings when their services are denied, reduced or terminated. The Court noted that without an injunction, the plaintiffs—children and adults with disabilities—would experience deteriorating health, financial strains, and the threat of having to go into institutions to get care. “We are gratified by the court’s thorough, careful analysis and hopeful that the state and PBH will quickly accept this decision and correct their illegal practices,” said Doug Sea, an attorney at Legal Services of Southern Piedmont. “Scores of our most vulnerable citizens desperately need the services that have been taken away from them, without due process, to be promptly restored.”

Judge Louise Flanagan’s decision found that the plaintiffs are likely to succeed on the merits of their legal claims that the Medicaid agency and PBH are not complying with the most basic federal constitutional and statutory requirements for participating in the Medicaid program. “Health care coverage is complicated,” said National Health Law Program attorney Jane Perkins. “The court’s decision is welcome and important because it recognizes that the Medicaid agency and its managed care plan, PBH, have obligations to make sure that people with disabilities who are insured through Medicaid get timely and accurate information about why their services are being reduced or terminated and what they can do about it if they object.” 

The suit, L.S., et al. v. Delia, et al. (No. 5:11-CV-354FL), was brought by Medicaid beneficiaries who suffer from chronic developmental disabilities and require significant medical or personal care. North Carolina operates a Home and Community Based Care program (North Carolina Innovations Waiver), which provides plaintiffs with access to services so that they can remain in their homes and avoid costly institutionalization. In March of 2011, PBH began implementing a new budgeting system which reduced services for beneficiaries that had previously been found necessary, even though their underlying conditions had not changed, and without the legally required notice explaining why the action was being taken. “Once again, the courts confirm that the desire to save resources does not allow a provider or state to deny due process,” said Disability Rights North Carolina attorney John Rittelmeyer. 

Click here to view the court’s decision. 

For questions or comments about the case, contact:

Doug Sea                                                                                              

Legal Services of Piedmont                                      

dougs@lssp.org                                                             

704-971-2593                                      

Jane Perkins

National Health Law Program

perkins@healthlaw.org

919-968-6308

John Rittelmeyer

Disability Rights NC

John.rittelmeyer@disabilityrightsnc.org   

919-856-2195

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Vicki Smith, Executive Director

Disability Rights NC

2626 Glenwood Avenue, Suite 550

Raleigh, NC 27608

Phone: 919-856-2195

TTY: 1-888-268-5535

Fax: 919-856-2244