Wednesday, September 19, 2007

DSS CARES: Cross Agency Response for Effective Services

Hello. My name is Melissa Ahrens, and I am a final year MSW student at UNC, and serving as an intern at the NASW-NC until this May. I will be joining Jack in updating the blog.

NASW-NC has received information regarding a new information sharing system to support child welfare practice. DSS CARES was created by Mayor John F. Street in Philadelphia, PA as a way to integrate the city's health and human services. The vision is "to provide a comprehensive social service system that efficiently improves the safety, health and well-being of indviduals and families within their own communities." Essentially, the information system allows a human services worker to enter the system and be provided a summary of services that have been provided by a City Department or funded through a City Department, for any client. DSS CARES explains that it is the most comprehensive way for a child welfare worker or other human services professional to "view" data from any City department. What about the issue of consent from our clients? The entire system is driven by consent, which is viewable, printable, time limited and HIPPA compliant. The consent can also be revoked at any time, in writing.

As a former child welfare worker, I have a few thoughts on this project. In general, I think it's a very smart idea. I can't tell you the number of times I wished for a program similar to this when I had just received a new child into foster care. Parents are not always reliable reporters at such a stressful time in their lives, and may not remember to tell you everything and everyone they are involved with. A central place to find this information for service planning and information gathering would be ideal.

I am curious though, about non-state/city agencies that a client is involved with, which can be many depending on your county. How would a child welfare worker be able to access this information? Would DSS agencies still have to have their own methods of gaining consent and gathering information from private agencies, thereby having to do almost double the work?

How will this be perceived by social work clients, particularly those who have just had their children removed? Will it seem too "big brother" for them, further alienating them from DSS? Or, will they be relieved that their social worker can access all of this information without them having to provide all the contact information and sign multiple consent forms?

And lastly, what's the back up plan for the day the system crashes? Child welfare workers in particular tend to have multiple tasks at one time, are often pressed for time, and need information right away. I am concerned that this system may add to their stress level if it is not functioning on any given day, and may decrease, rather than increase, efficiency. Child welfare workers need information quickly to make decisions for the children on their watch, and a system that has crashed could have a negative effect on these children.

I look forward to hearing more about this program and having my questions answered. If it works, this could be a valuable tool for North Carolina's child welfare workers, and could greatly improve service delivery. I hope we will not rush into a decision, but take the time to ensure it will help and not hinder our valuable social workers and the families they serve.

Want to learn more? Come to the joint meeting for the Collaborative and the Data Advisory Council on Thursday, September 26th from 9:00-11:00am in the Albemarle building. There will be a conference call with Philadelphia during this meeting.

Friday, September 14, 2007

2nd N.C. mental hospital may lose federal funds (from N&O) 9/12/07

Michael Biesecker, Staff Writer RALEIGH

- Less than three weeks after federal officials cut off money to a state psychiatric hospital in Morganton, a second hospital is being threatened with the same punishment.
State officials were notified this week that the federal agency that oversees Medicaid and Medicare payments is considering the withdrawal of support from Cherry Hospital in Goldsboro. That could leave two of the state's four psychiatric hospitals unable to claim federal insurance reimbursements and force state taxpayers to pick up the cost of care for more poor and elderly patients -- a bill that could run into the tens of millions of dollars.
The move came after patient complaints about the quality of care at the Goldsboro hospital triggered a four-day visit last week by inspectors from the state office that enforces federal regulations. The team found several violations and recommended that the hospital's certification be revoked if the problems are not fixed and staff retrained by Sept. 30. The federal Centers for Medicare & Medicaid Services, which can impose the suspension, is considering the recommendation.
Dr. Jim Osberg, who oversees the state hospitals for the N.C. Department of Health and Human Services, said Tuesday he was still awaiting a full written report of the findings, but that he had been told of three recent incidents under investigation at Cherry:
* A patient escaped from the hospital, and the staff failed to "respond appropriately," Osberg said, adding that there was "inconsistency" in how the matter was reported.
* A patient was "improperly restrained" with handcuffs while being transported from the psychiatric facility to a nearby emergency room for medical treatment.
* A patient in the hospital's admissions office suffered a "delay" in receiving needed oxygen.
Osberg said that none of the incidents resulted in patient injuries.
Admissions at state psychiatric hospitals have soared since the implementation of a 2001 reform plan mandating that county-run mental health clinics be closed in favor of private facilities. Though the burden on the state's four psychiatric hospitals has grown, officials are pushing ahead with plans to close Dix Hospital in Raleigh and Umstead Hospital in Butner early next year.
Osberg said he is confident that issues at Cherry can be corrected quickly enough for the hospital to avoid the loss of its federal certification at the end of the month. "Cherry has already begun the process of fixing those problems," Osberg said Tuesday. "We're moving forward to ensure compliance."
On Aug. 25, the federal Centers for Medicare & Medicaid Services stopped payments to Broughton Hospital in Morganton following an investigation of the February death of patient Anthony Lowery. Lowery, 27, stopped breathing after being held down by seven staff members, one of whom was lying across his chest, according to the federal report.
Though it is not unusual for federal authorities to threaten cutting off money to a hospital, it is rare for such a serious sanction to be imposed. The Morganton hospital will still treat Medicare and Medicaid patients, but state taxpayers will have to pick up the tab. Federal authorities could not be reached for comment Tuesday.
This isn't the first time there have been problems at Cherry, a 284-bed hospital that serves patients from 33 eastern counties. Janella Williams died last year after being restrained by the staff. Another patient's leg was broken while he was being restrained. Both incidents are now the subject of lawsuits.
Osberg said he was aware of deaths at Cherry in 2005 and 2006 that triggered federal reviews. In one case, a patient got hold of a sheriff's deputy's gun, shot a staff member and then shot himself. In each case, the state was able to resolve the problems found by investigators before federal support was revoked.
While saying it is unfortunate that two of the state's four psychiatric hospitals are being scrutinized at the same time, Osberg said he was not concerned that the reviews indicate more widespread problems. "This does happen from time to time," Osberg said. "I see these as related. The only thing I think is systemic is that our four hospitals treat very challenging patients."
Staff writer Michael Biesecker can be reached at 829-4698 or

Thursday, September 13, 2007

Health Check and Early Periodic Screening, Diagnostic and Treatment (EPSDT) Information for Providers about Medicaid Services for Children

Health Check and Early Periodic Screening, Diagnostic and Treatment (EPSDT) Information for Providers about Medicaid Services for Children

Federal law requires that Medicaid-eligible children under the age of 21 receive any medically necessary health care service covered by the federal Medicaid law, even if the service is not normally included in the N.C. State Medicaid Plan.
This requirement is called Early Periodic Screening, Diagnostic and Treatment (EPSDT). All children covered by N.C. Medicaid are entitled to receive periodic screening, vision, dental, and hearing services.
Certain limits on services documented in Medicaid's clinical coverage policies may not be applicable to recipient under 21 years of age. The recipient's physician or licensed clincian can provide guidance about whether the service is medically necessary to correct or ameliorate the recipient's condition.
Many services require prior approval. The fact that a recipient is under the age of 21 does not eliminate the requirement for prior approval.
Services that are not covered by Medicaid may be provided to Medicaid recipients under the age of 21 if they are medically necessary. However, only those services that may be covered under federal Medicaid law can be considered for approval. If the recipient needs a service not covered by the N.C. Medicaid program, the provider should submit a Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years of Age on behalf of the recipient to:
Directorc/o Assistant Director for Clinical Policy and ProgramsDivision of Medical Assistance2501 Mail Service CenterRaleigh, NC 27699-2501Fax: 919-715-7659
A full explanation of the EPSDT policy and how to obtain approval for services can be found in:
January 2006 Special Bulletin, Prior Approval Process and Request for Non-Covered Services
December 2005 Special Bulletin, Medicaid for Children: Early Periodic Screening, Diagnostic and Treatment and Health Check
For additional information, refer also to:
EPSDT Policy Instructions Update, August 17, 2007
Health Check and Health Choice: Basic Information for Providers from the N.C. Healthy Start Foundation

Health Check and EPSDT Consumer Information
EPSDT Policy Instructions Update, August 17, 2007
Quick Links
Clinical Coverage Policies
Proposed Policies
Basic Medicaid Billing Guide
Health Check Billing Guide - 2007
Health Check Provider Info
EPSDT Training Slides
Basic Provider EPSDT Training
Comprehensive Provider EPSDT Training

Updated September 10, 2007

Monday, September 10, 2007

Information from NASW National

September 6, 2007

NASW Co-Signs Letter on HEA

There is a bill to reauthorize the Higher Education Act now before a committee of senators and congressman. They are negotiating the differences between the House version and Senate version. The House version would provide up to $5,000 in college loan forgiveness for up to five years of work in the child welfare field. NASW recently cosigned the letter below with the Child Welfare League of America.

Dear Conferee:
The undersigned organizations are pleased that the House and Senate "College Cost Reduction Act of 2007 " bills put greater attention on the need for providing loan forgiveness for individuals who participate in important public service careers. As you craft a final conference agreement we urge you to include in the final bill the sections 131 and 132 in the House version of HR 2669 to ensure that child welfare workers with a degree in social work or related field will receive a limited amount of loan forgiveness after being employed in public or private child welfare services.

A quality child welfare workforce is essential to promoting good outcomes for children in the child welfare system. No issue has a greater effect on the child welfare system's capacity to serve at-risk and vulnerable children and families than the shortage of a competent, stable workforce. This shortage affects agencies in every service field, including foster care, adoption, child protective services, child and youth care, social work, and support and supervision. The timely review of child abuse complaints, the monitoring and case management of children in foster care, the recruitment of qualified adoptive and foster families, and the management and updating of a modern, effective data collection system that can result in greater and more effective research all depend on a fully staffed and qualified child welfare workforce.

The U.S. Government Accountability Office (GAO) documented this crisis in the child welfare workforce. The GAO report (GAO-03-357) found that workforce problems limit states' ability to meet the goals established in the congressionally mandated Child and Family Service Reviews (CFSRs), and stated that the analysis of the CFSRs "corroborates caseworkers' experiences showing that staff shortages, high caseloads, and worker turnover were factors impeding progress toward the achievement of federal safety and permanency outcomes."

This provision will provide incentives for more caseworkers to work in the child welfare field, will help reduce the rate of turnover and help reduce caseloads. We believe that the building block to improving our child welfare system is a strong child welfare workforce. We hope you will give this issue a high priority and we urge you to make sure that this House provision as included in Section 131 is a part of the final Conference Report.

Thank you for considering these essential provisions.

John SciamannaCoDirector,Government AffairsChild Welfare League of America

Wednesday, September 5, 2007

Action Alert from NASW National

Government Relations Action Alert
August 30, 2007
Lobby Senate on Medicare SWRI Agenda
Congratulations to NASW’s Advocacy Network, on August 1, 2007 the U.S. House of Representatives passed a key component of NASW's SWRI agenda, the Clinical Social Work Medicare Equity Act along with an across the board 5% increase in CSW payments under Medicare Part B. Your advocacy was a huge help!
The House and Senate will return next week from a month-long recess to begin a difficult conference over Medicare and child health insurance legislation (CHAMP, HR. 3162). NASW members should contact their Senators now to urge their support for critical provisions for clinical social workers in this conference on CHAMP. NASW has prepared a suggested message to send your Senators, click here to send your message today.
CHAMP must still be reconciled with the Senate’s child health insurance proposal and signed by the President, two very high hurdles. The Senate supports a narrower bill that does not include any Medicare provisions. NASW seeks retention of Sections 606, 610 and 203 from HR. 3162 in the final conference agreement, but it is unclear how these two very different bills will be reconciled. The President has pledged to veto either the House or Senate bills, but Democratic leaders and NASW anticipate an eventual political accommodation that enacts much of the CHAMP legislation. It is therefore vital that NASW support our provisions during the conference process.
The House of Representatives passed crucial legislation on August 1, 2007 for clinical social workers, the Children’s Health and Medicare Protection Act (CHAMP, H.R. 3162). NASW scored a major early victory for its Social Work Reinvestment Initiative (SWRI) by attaching our legislation to CHAMP. This bill both increases Medicare payment rates for all clinical social workers billing Part B and restores clinical social workers’ ability to bill Medicare independently for services provided to Part A skilled nursing facility residents. One key SWRI component, the Clinical Social Work Medicare Equity Act (S. 1212 sponsored by Sen. Mikulski) has long been sought by NASW was included in CHAMP. Additionally, NASW has recently sought relief for CSW payments under Part B, which were cut 9% late last year by federal administrative action. CHAMP will increase CSW payments by 5% above their current level beginning on January 1, 2008. This special payment increase applies only to psychotherapy and behavioral services that were cut on January 1, 2007. In addition to the increase in 2008, CSWs will receive the same percent payment update that CHAMP authorizes for all physician services in the program, currently a positive .5% payment update under CHAMP.
NASW has been working aggressively with its advocacy network and behind the scenes to secure these crucial social worker payment increases. CHAMP is the necessary vehicle for our changes, and it contains many different components. Other key provisions include a significant expansion of the State Children’s Health Insurance Program (SCHIP), increases in physician payments, and other benefit improvements in both Medicare and Medicaid. These improvements are offset by cuts in managed care payments for Medicare, nursing home rates and a substantial increase in tobacco taxes. NASW strongly supports passage of CHAMP to protect the Medicare program and expand child health insurance coverage.
The following CHAMP provisions are NASW’s top priorities in the upcoming CHAMP/child health insurance (HR. 3162) conference:
Retain Section 606: Removes clinical social worker services from coverage under the Medicare SNF prospective (consolidated) payment system, permitting CSWs to bill Medicare separately, the same as psychiatrists and psychologists services for Medicare Part A beneficiaries served in skilled nursing facilities.
Retain Section 610: Increases Medicare Part B payments to CSWs and psychologists by 5% starting on January 1, 2008. This increase will partially restore a CMS cut for these professional services that occurred on the first of this year. This "bump up" is limited to four years, after which, another administrative rebalancing will occur among payments for Part B professional services. Additionally, CSWs will receive the same SGR payment update as physicians, now a positive .5% in the bill.
Retain Section 203: Corrects Medicare’s current discriminatory co-payment on outpatient mental health services from 50/50 beneficiary cost sharing to the standard 80/20 coverage for other Part B services. This “Medicare parity” provision would go into effect on January 1, 2008.
For further information, contact Jim Finley at NASW:

Tuesday, September 4, 2007

Broughton Hospital looses Medicaid & Medicare Certification

From the September 4 Insider:

FUNDING CUT: The federal government has announced that it will not pay Medicare or Medicaid expenses for patients at the state psychiatric hospital serving western North Carolina, saying administrators failed to make adequate safety improvements after a patient’s death while being restrained. The state Department of Health and Human Services said Friday that federal officials will not pay for patients admitted to the hospital in Morganton on or after Aug. 25. Payments will continue for 30 days for patients in the hospital by that date, the department said.
It's believed to be the first time one of the state's four psychiatric hospitals has been denied Medicaid and Medicare payments, said Jim Osberg, chief overseer of the hospitals for the state. Federal funding amounting to $1 million a month could resume, should federal inspectors approve safety changes. State officials said a federal review will take at least 30 days. The federal government’s action stems from the Feb. 1 death of a patient identified in records as Anthony Dawayne Lowery. An autopsy report said Lowery, who had a history of schizophrenia, died of asphyxia after a 300-pound staff member sat on his torso for two or three minutes.
The development is the latest blow for North Carolina’s battered mental health system. A reform plan, started in 2003 to get people out of state-run hospitals and back into the community, has resulted in a series of rate cuts that have meant less money for local providers. The cuts have the potential for sending more people to the state’s hospitals as providers scale back their services or get out of the business all together. Western North Carolina has already lost one provider -- ARC N.C. Officials say Broughton will continue to accept Medicaid and Medicare patients and find other sources of money to pay for treatment. (Jon Ostendorff, ASHEVILLE CITIZEN-TIMES, 9/01/07; THE ASSOCIATED PRESS, 8/31/07)