Red tape strangling some mental health caregivers

Red tape strangling some mental health caregivers

By Matthew E. Milliken : The Herald-Sun
mmilliken@heraldsun.com
Sep 21, 2008

DURHAM -- Some mental health caregivers say that a state rule meant to cut down on unnecessary services and Medicaid payments is producing extra paperwork and problems instead.

The rule in question requires requests for Medicaid-funded services be accompanied by a personal-care plan (PCP) that has been reviewed and signed within the last 30 days. These documents are produced by primary caregivers and typically reviewed every three months. Some secondary providers say primary agencies are loathe to sign plans between scheduled updates, meaning the secondary providers must either give care for free or refuse to take on clients without recently refreshed plans.

"The documentation requirements are sort of out of control for providers,"
said Debra Dihoff, head of the state branch of the National Alliance on Mental Illness. "The billing requirements are out of control. And now this.
This is making it more difficult for people to get the help they need when they need it."

Susie Deter heads Threshold Clubhouse, which helps people with severe mental illness. The Durham agency relies on community support providers or other primary-care-giving agencies to maintain client plans.

"If our authorization falls somewhere beyond the last 30 days it has updated signatures, we have to go back and get [primary-care providers] to revisit the plan and get [an] updated plan and updated signatures for us to be able to get an authorization," Deter said. "And that is difficult because it's extra work for them. And there's basically nothing in it for them. They're not getting their authorization, we're just getting ours."

Threshold helps clients even if there are payment problems, Deter said. She blames various bureaucratic holdups for incurring $100,000 annually in unreimbursed costs. The 30-day signature requirement could cost Threshold $20,000 or more a year.

The rule has affected 17 clients of the Mental Health Association in North Carolina, a statewide advocacy group and service provider. The association recently lost $14,000 for 1,200 service-hours due to the requirement, official Cliff Anderson said.

Leza Wainwright, co-director of the branch of the state Department of Health and Human Services that oversees mental health, developmental disability and substance abuse care, defended the rule.

"The point of having a person-centered plan updated within 30 days of a request for [service payment] authorization is that's the way you say that that is still the appropriate service," Wainwright said. Without such reviews, Medicaid might pay for ineffective or unnecessary services.

Providers that have trouble getting recently signed plans are told to complain to local management agencies. That seems to be working, Wainwright said.

Wainwright and the rule's critics differed on when the rule took effect.

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