Mental Health Care

Continuity of care between the inpatient and outpatient settings continues to be a challenge. Current hospital payments assume that hospitals are actively involved through discharge and the transition to outpatient settings and advocating for payments for outpatient providers to assist in this process is viewed as duplicative. This undermines mental health care providers' ability to smoothly transition clients between service settings.
Meeting the credentialing requirements for program services and mental health professionals has posed new challenges. Community behavioral health organizations employ professionals that may not meet private insurers' credentialing standards (for example, 3 years of post-licensure experience). Community providers have addressed this through contractual arrangements in which quality assurance and supervision requirements substitute for these credentialing standards. Services are billed under a supervisory protocol in which the supervising professional's national provider identifier is used.
Additionally, some programs offer services that rely on a combination of funding sources such as county, state, and private insurers. In these situations, counties sometimes want to limit private insurance clients' access to these programs because a portion of the overall program is covered by the county.
Impact of State Budget Cuts on Mental Health Care -
In a dramatic turnabout that may foreshadow dilemmas faced by other states, the governor of Minnesota vetoed funding for the state's mental healthcare program. The legislature would have extended the program for several months, as a compromise was negotiated to retain elements of coverage for the state's mental health population - a hospital uncompensated care fund, medication/pharmacy, and "coordinated care delivery systems." In the system, an accountable hospital-centered program paid a fixed amount to cover about 40% of the state's mental illness population who elected to participate. As there is no reimbursement for outpatient clinic and all non-hospital services, providers and consumers now are scrambling to seek disability determination or enroll in Medicare type coverage after the six month state mental illness coverage enrollment period ends.
While these cuts are only effective as of June 1, 2010, it is expected that they will result in increases to the uncompensated care burden on hospitals and community safety net providers.
How Do We Minimize The Impact of Budget Cuts on Mental Health Care?
Many not-for-profit membership organizations representing community mental health and other service provider agencies throughout Minnesota have been working in coalition with national mental health groups on advocacy related to the state's mental health program changes. Initially, advocacy efforts were focused on encouraging the state legislature to vote in support of expanding the state Medicaid program early to receive additional federal funding (as provided for in the national healthcare reform bill). Unfortunately, this proved to be politically untenable in the immediate future; however, a measure was passed to allow the governor to use executive authority to expand Medicaid coverage for mental illness patients.
While being actively involved in this advocacy process is vitally important to the community behavioral health system, national mental health advocacy medicaid organizations and their members are also evaluating ways in which they can optimize their business practices to meet this changing budgetary reality. Among other strategies, community behavioral health providers are working to develop partnerships with community hospitals to reduce the number of avoidable emergency department admissions and ease the transition from the inpatient to outpatient settings, supporting clients through the disability determinations process so they may become eligible for Medicaid as quickly as possible, and raising funds that will help to cover the cost sharing requirements for state sponsored mental health care and the enrolled clients that are unable to pay.
Through this two-pronged approach that includes both advocacy and pragmatic business considerations, it is hoped that the community behavioral health system will be able to develop new cost-effective ways of delivering services that will be well-positioned to withstand funding changes while taking advantage of new opportunities made available through national and state health care reform initiatives.

The 25 Biggest Mistakes Dentists Make After Being Notified of a Department of Health Complaint

The investigation of a complaint which could lead to the revocation of a dentist's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the dentist who receives it. Yet, in many cases, attorneys are consulted by dentists after the entire investigation is over, and they have attempted to represent themselves throughout the case. Often, the mistakes that have been made severely compromise an attorney's ability to achieve a favorable result for the dentist.
These are the 25 biggest mistakes we see in the dentist cases we are called upon to defend after a DOH investigation has been initiated:
1. Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.
2. Contacting the DOH investigator and providing him/her an oral statement or oral interview. (Note: There is no legal requirement to do this.)
3. Making a written statement in response to the "invitation" extended by the DOH investigator to do so. (Note: There is no legal requirement to do this.)
4. Failing to carefully review the complaint to make sure it has been sent to the correct dentist. (Note: Check name and license number).
5. Failing to ascertain whether or not the investigation is on the "Fast Track" which may then result in an emergency suspension order (ESO) suspending the dentist's license until all proceedings are concluded. (Note: This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, or failure to comply with PRN instructions.)
6. Providing a copy of the dentist's curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so. (Note: There is no legal requirement to do this.)
7. Believing that if they "just explain it," the investigation will be closed and the case dropped.
8. Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.
9. Failing to forward a complete copy of the patient dental record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.
10. Delegating the task of providing a complete copy of the patient dental record to office staff, resulting in an incomplete or partial copy being provided.
11. Failing to keep an exact copy of any dental records, documents, letters or statements provided to the investigator.
12. Believing that the investigator has knowledge or experience in health care matters or procedures being investigated.
13. Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.
14. Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.
15. Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.
16. Believing that because they haven't heard anything for six months or more the matter has "gone away." The matter does not ever just go away.
17. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.
18. Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case.
19. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of your licensing board for a decision.
20. Taking legal advice from their colleagues regarding what they should do (or not do) in defending themselves in the investigation.
21. Retaining "consultants" or other non-lawyer personnel to represent them.
22. Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel.
23. Attempting to defend themselves.
24. Believing that because they know someone with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.
25. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.
Bonus Point: 26. Communicating with the Department of Health about the pending case.
Not every case will require submission of materials to the Probable Cause Panel after the investigation is received and reviewed. There will be a few where the allegations made are not "legally sufficient" and do not constitute an offense for which the dentist may be disciplined.
In other cases, an experienced health care attorney may be successful in obtaining a commitment from the DOH attorney to recommend a dismissal to the Probable Cause Panel. In other cases (usually the most serious ones), for tactical reasons, the experienced health care attorney may recommend that you waive your right to have the case submitted to the Probable Cause Panel and that you proceed directly to an administrative hearing. The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Medicine in such cases and does so on a regular basis.
Contact Health Law Attorneys Experienced with Department of Health Investigations of Dentists.
The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations and other types of investigations of health professionals and providers.