Last week, we wrote about a local mental health office that covers western North Carolina counties losing $3 million since switching to managed care in January.
A consultant's report issued this week describes problems at Western Highlands Network, one of the first local mental heath offices to convert to a managed care system.
Among other things, the report says that the information Western Highlands leaders receive about services, use and costs is inadequate, and that it is not keeping good track of Medicaid claims.
The report goes on for nine pages. In short, it says Western Highlands needs lots of improvements, and the consultant recommends close monitoring by the state Department of Health and Human Services.
Under managed care, the local mental health office gets a set amount of money to treat mentally ill patients who rely on Medicaid or state funds.
Western Highlands Network became a managed care organization in January. By next January, managed care organizations for government-paid mental health services will cover the entire state.
Here's the report:
Document(s):
WHN_Final_Report[1].pdf
Comments
Damning Mercer Report Matches My Experience as Provider
July 27, 2012 - 12:13am — mvh9355Medicaid Waiver: If I Were Working at WHN LME, I'd Not Be Sleeping Well at Night: Damning Mercer July 2012 Report
Remember: the Mercer audits, reportedly an independent audit of an LME's functioning, does not include any information from consumers or providers. This is, in any case, a very damning report and matches my experience w/ Western Highlands Network (WHN) LME.
For instance, re: massive disorganization and lack of efficiency in the LME, right now, I cannot get my Out of Network Provider application in because, unlike Smoky Mountain Center (SMC) LME, I must get the 'proper forms' of the Universal Provider Applicationn, filled out by my references, even though I have letters of reference on company letterhead from those references.
I predict that SMC LME will consume WHN LME. If you look at the map of the LME's, you will see that WHN LME is sandwiched between the two regions of SMC LME....
I am speaking here to "Clinical Operations" only:
And I note only one item which jumps out at me: If, which is true, that claims must be submitted within 90 days of service in order to be paid (NOTE: prior to Medicaid Waiver, providers had up to one year to submit claims) and the information is not reviewed efficiently, how can clients/ consumers continue to receive services? ...."
(taken from my blog on NC Mental Health Reform since 2007:---cannot post link or this will not publish: Madame Defarge: Marsha V. Hammond, PhD, Licensed Psychologist, NC)