Letter to the editor and lead article from News and Observer

Letter to the editor and lead article from News and Observer

http://www.newsobserver.com/opinion/letters/story/960544.html

Letter: Published: Feb 23, 2008 12:30 AM Modified: Feb 23, 2008 05:17 AM

Committed to care

Since June 2006, ValueOptions has provided utilization review of mental health, developmental disability and substance abuse services for the Medicaid program in North Carolina. It was with great interest that I read Ruth Sheehan's Feb. 11 column "The greatest theft." I believe the column left readers with an incorrect impression of ValueOptions.

ValueOptions rarely, if ever, denies approval without recommending alternatives for treatment. These alternatives are based on medical necessity and clinical best practice. The alternatives are telephoned to the provider, and many times they include a higher level of care than requested.

ValueOptions relies on requesting providers to substantiate the need for a requested service, which is common medical practice. Accordingly, ValueOptions makes more than 6,000 approvals each week.

Specific to Threshold, the provider referenced by Sheehan, ValueOptions has approved 114 service requests and has made only one denial since June.

The column did note that consumers may appeal. The consumer never has to appear in person. In fact, the consumer is not even required to speak.
Providers and advocates can speak on behalf of consumers, typically via teleconference.

ValueOptions is committed to authorizing care that meets medical necessity and contemporary best practice parameters.

Will Woodell

Vice President, Public Sector, ValueOptions, Inc., Morrisville

Editor's note: The column highlighted the case of a Threshold client whose approved services had been reduced by ValueOptions.

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http://www.newsobserver.com/news/story/960768.html

Published: Feb 23, 2008 12:30 AM Modified: Feb 23, 2008 03:38 AM

State's mental health leader quits
Michael Moseley led the state system's reforms that left many seriously ill patients without care

By Lynn Bonner, Staff Writer

Michael Moseley, who presided over the state mental health system in an era of unrest, announced Friday he was retiring.

Moseley, 55, will leave his $131,430-a-year post as director of the mental health division Feb. 29, but he will work another three months in the state Department of Health and Human Services in an unspecified job.

The announcement of Moseley's retirement came two days before the start of a News & Observer series on the state's mental health system.

A recent overhaul of the system, which cares for 350,000 people, forced most counties to stop treating patients and left seriously mentally ill people without community care. In the past two years, the state has spent too much on a basic service provided by private companies; reviews determined that thousands of people getting the service didn't need it. And in the past year, investigators found problems at all four of the state's mental hospitals.

Moseley "presided over the devastating failures of mental health reform,"
said Harold Carmel, who used to work with Moseley and is now an associate consulting professor of psychiatry at Duke University and president of the N.C. Psychiatric Association.

Moseley was out of the office Friday, and efforts to reach him failed.
"I'm proud of what I've done to move things forward for the people who depend on this system for their care," he said in a prepared statement.

His boss, Dempsey Benton, the health and human services chief, was out of the office, and efforts to reach him were unsuccessful.

Moseley's retirement surprised those outside the department.

"Anytime new leadership comes in, there's always an adjustment, said Rep.
Verla Insko, a Chapel Hill Democrat who helps lead a legislative committee on mental health. "I didn't anticipate this."

Moseley, a Kinston native, worked for the state more than 30 years. He was promoted to lead the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services in 2004, after the state had begun privatizing community mental-health care. Before he took the job, Moseley had been in charge of the Caswell Center, a state institution for people with developmental disabilities in Kinston.

Moseley was picked to lead the division because of his experience at Caswell creating community care for the disabled. His skill in building such networks would be invaluable as the new mental health director, said Carmen Hooker Odom, the former secretary of the Department of Health and Human Services and his boss at the time. The state had begun a reform effort in
2001 aimed at emphasizing community care over treatment in big institutions.

But during Moseley's tenure, the system of private providers failed to develop in communities. Meanwhile, mental health offices run by counties had complied with a mandate to stop treating patients. People seeking short-term care overwhelmed state hospitals.

'He came in midstream'

Moseley often said he took over after the problems started and tried to put the brakes on the downhill slide by telling local mental-health offices that they did not have to get rid of their psychiatrists, a scarce medical resource.

Even those who criticized Moseley's work at the division, including Carmel, described him as friendly and accessible.

"Mike is a nice guy," said Sen. Martin Nesbitt, an Asheville Democrat who helps lead a legislative committee on mental health. "Obviously there have been problems with the management of the mental health system by anybody's definition." It's hard to know, Nesbitt said, whether Moseley bears responsibility.

"He came in midstream, when the mental health system was at its lowest point," he said.

When the community treatment network started to bloom in 2006, private companies rushed to provide a basic service called community support.
Costs exploded, while people who needed more intensive treatment could not find it.

Last year, all four state mental hospitals were threatened with the loss of federal insurance payments, and one, Broughton Hospital in Morganton, actually lost its money. After constant news of hospital trouble, Benton removed the responsibility from Moseley and took charge himself.

Seth Effron, a spokesman for Gov. Mike Easley, said Friday that the governor did not have anything to do with Moseley's retirement announcement but has told Benton to "do whatever needs to be done to address the mental health administration issues."

Effron did not know whether Moseley's retirement is related to those instructions to Benton.


lynn.bonner@newsobserver.com or (919) 829-4821