ECBH Questioned at Town Hall Meeting: Why Are You Denying So Many Services??

East Carolina Behavioral Health (ECBH), one of North Carolina’s 10 MCOs had to defend itself at a local Mental Health Town Hall Meeting in Greenville, NC.

Amy Brown, who works at Arc of North Carolina, which is a company-advocate for people suffering from mental illness and/or developmental disabilities, finally asked what so many providers and recipients have been asking for months:

WHY ARE SERVICES GETTING DENIED????

For the news video, click here.

“It appears that there is a growing trend of families being denied services,” Brown, who works at the Arc of North Carolina, told the panel.

Brown, like other families who have shared their story with 9 On Your Side, is frustrated with East Carolina Behavioral Health – the organization that manages local providers.

She says the processes ECBH requires to approve services for the mentally ill is long, tedious and ineffective.

“For those families that are willing to fight it out and go through the appeals process, it’s very frustrating, it’s very long,” Brown says.

ECBH, or any MCO, that denies medically necessary services, are denying Medicaid services for the most needy. 

But, believe me, this is NOT isolated to ECBH.  ECBH serves Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell & Washington counties.  But medically necessary services are being denied outside the above-mentioned counties. 

Not only are medically necessary services being denied, but quality, competent health care providers are being DENIED Medicaid contracts or the Medicaid contracts are being rescinded.

People, listen, if a health care provider resides in Beaufort county, NC, that health care provider, in order to provide mental health services to the Medicaid population must contract with ECBH in order to provide services.  There is no other option.  The provider cannot, for example, just contract with a different MCO, to provide mental health services within Beaufort county.  ECBH is  the only option in Beaufort county for a Medicaid contract in behavioral health.  So, if ECBH, arbitrarily decides that it does not want to contract with Provider X, for whatever reason, Provider X cannot provide mental health services to Medicaid recipients within Beaufort county and be reimbursed for services rendered. Period.

And this is happening. Providers, who have been providing mental health services to Medicaid recipients for, sometimes, years and years, and who have, some, hundreds of Medicaid recipients, are being denied a Medicaid contract with ECBH, and other MCOs, are not receiving the reimbursement for services rendered for themselves and their staff, and are being forced to close their doors or no longer accept Medicaid patients.

The MCOs, including ECBH, seem to be pushing mental health care providers away from Medicaid, resulting in Medicaid recipients not receiving desperately-needed mental health services.

And here I thought mental health is such an important topic…

It’s easy to proclaim that you care about providers and recipients and you want Medicaid recipients to receive quality health care, but it’s a whole other thing to actually determine if the WAY the system is IMPLEMENTED is broken.  Maybe it’s not the Medicaid system that is broken; maybe it is the implementation of the system.

George Bernard Shaw said, “People who say it cannot be done should not interrupt those who are doing it.”

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on May 3, 2013, in DHHS, Division of Medical Assistance, ECBH, Harassment, Health Care Providers and Services, MCO, Medicaid, Medicaid Appeals, Medicaid Contracts, Medicaid Recipients, Medicaid Reimbursement, Medical Necessity, Mental Health, Mental Illness, North Carolina, Provider Medicaid Contracts, Termination of Medicaid Contract and tagged , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: