Wednesday, September 24, 2008

Mental Health Provders Suggest Tweaks to PCP Rule

Mental health providers suggest tweaks to PCP rule

By Matthew E. Milliken : The Herald-Sun
Sep 21, 2008

DURHAM -- Depending on whom you talk to, a rule for mental health providers that some say is burdensome can be fixed in any number of ways -- or needs no change at all.

Susie Deter of Threshold Clubhouse has a simple fix. She wants the company that screens Medicaid service requests to exempt some providers from having person-centered plans (PCP) signed in the last 30 days.

"If [the Department of Health and Human Services] and the mental health part of DHHS would instruct ValueOptions to approve authorizations for all our services if the PCP is current, that would solve the problem," Deter said.
"And we understand that they're trying to deal with the abuses of community support [charges], but we're caught in the middle."

John Tote agrees. His organization, the Mental Health Association in North Carolina, provides services to and advocates for the mentally ill throughout the state.

"What we would I think like to see ultimately is a mechanism where the [secondary] program itself can simply write up that aspect of the PCP and get attached to it," he said.

"That would streamline and help really the whole process and ultimately get more people into and through services," Tote said.

Tommy Gunn runs Adventure House, a Shelby operation similar to Threshold that has lost at least $10,000 to the 30-day signature requirement.

"We have to sit and fax like 40 pages of stuff on someone with a long- term mental illness to ValueOptions and then they say, 'OK, they can come to the clubhouse for another six months,'" he said. "These are lifelong illnesses, but every six months we've got to prove that they still have it."

Gunn has asked Leza Wainwright, co-director of mental health and related services for the state Department of Health and Human Services, to change the payment authorization cycle to once a year.

But Wainwright supports the current regulations.

"You don't just keep doing the same thing forever without taking a look and seeing if it's working," she said. "And that's the whole point of these updates."

Because the rules cut down on ineffective services, Wainwright wants to maintain the status quo despite some complaints.

Like Wainwright, Ellen Holliman, the director of the Durham agency that oversees mental health care, said the 30-day requirement is appropriate. She said it had adversely affected only Threshold in this county.

Debra Dihoff, head of the state National Alliance on Mental Illness chapter, wants the impact of new rules to be studied in advance.
Consulting service providers could head off costly regulations that are hard to adjust after the fact.

"Where are [providers] going to find the time to fix the rule when they have to spend all this extra time following the rule so they can figure out how to get paid?" Dihoff asked.

C 2008 by The Durham Herald Company. All rights reserved.

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