This blog originally founded by Blogger who holds a theological degree and a doctorate in Counseling Psychology. Taught Psychology for 32 years and is now Professor Emeritus. Is a board-certified psychologist and was awarded the Lifetime Achievement Award in his profession. Ministered as a chaplain, and pastored Baptist and Episcopal churches. Publications cover the integration of psychology and theology. Served in the Army, the Merchant Marines and the Peace Corps.

Saturday, October 8, 2011

County Commissioners Adopt New Agreement for Mental Health

THE COUNTY COMMISSIONERS MET and adopted an amendment to the interlocal agreement formally in place for provision of Behavioral Heathcare Services in Allegheny, Ashe, Avery, Watauga, and Wilkes Counties.   Even though 30 or 40 concerned people showed up, the meeting
was over practically before people could settle into their seats.  The document had already been written.

Because all county commissioners have to agree, this meeting was only for Watauga commissioners to ratify it.

I was told that we could see the amendment on line.  However, I did not find it.  If anyone else does, please post the link.  Following then are the highlights:

HIGHLIGHTS FROM THE NEW AGREEMENT:  North Carolina General Statutes obligate counties to provide disability services.  In 2006, the county’s original agreement created the New River Service Agency (“NRSA”).  Today, that agreement was terminated which terminates all contracts.  It also dissolves the old board and creates a new board of five people.  Upon appointment of a new service provider, NRSA shall automatically be dissolved, and it will cease to exist.   It is hoped that all of this can be done by November 15, 2011.

A BRIEF BACKGROUND: For those to whom this subject is new, here is a brief history.  A reform of the state system was ordered in 2001.  Our state senator Virginia Foxx was appointed to the committee.  From that committee came the directive to privatize the then, government controlled system.  All 38 county systems did so with the exception of New River who received a special dispensation from the legislature not to follow the rest.

Instead of privatizing, New River formed the Behavioral Healthcare Services, a quasi-governmental organization which was supposed to generate its own income much like a private group.  I use the term quasi-governmental because since they were not private, the counties still had liability.  In the beginning, the NRSA was so successful that other systems contracted with them to be their private provider.

Also, scandals arose in the rest of the state system when the private providers they had hired began to game the system.  To give you an example, one of the great ideas of reform was to get the service providers off their butts and out where the clients lived and worked.  The obvious reason for this was that many mentally ill could not keep appointments, heck at times, they couldn’t even get out of bed.  In addition many were homeless.

So the new service delivery paid for providers to get proactive and go into the community.  But, because not much training was required for these new positions, private provider companies soon realized they could hire low trained people, pay them little and bill Medicare for the big bucks.  By the time the scandals were uncovered, More than $400,000,000 may have been milked from the system.

Another big change after reform was to separate the providers from the administrators.  Thus each North Carolina system now had those who would administer the system, including collecting funds, and managing money coming from the government and other sources.  This new group was entitled the Local Management Entity (“LME”).

NOW BACK TO NEW RIVER:   Though the local system NRSA, was to be financially self-sustaining and even possible make the counties a profit, instead by my calculations, they have blown through $10,000,000 above and beyond what they took in. They began with a $7,000,000 fund balance and on top of that right now officials are looking for $3,000,000 which cannot be accounted for.

LOSERS:  There are a lot of losers in this debacle.  First, are the providers in the NRSA.  They are now scrambling to find jobs.  More likely,  it was probably the LME’s which let the money slip away–finances  were their responsibility, not the NRSA providers.   Secondly, maybe we taxpayers can lose.  Because although the county commissioners (most of whom were not part of the original commissioners who set things up) are now breathlessly trying to get out from under the old contract.  Sums like $900,000 so far of counties’ liabilities are being tossed around in the press.

CONSUMERS WON’T LOSE:  One group who will probably not be losers however are the clients.  The local out-of-a-job providers, are people committed to helping the vulnerable.  They can set up their own private practices and go right on getting paid.  Beyond that, the new private provider entities which are already being negotiated with, will need to hire most of them because our folks are already here in these mountains.

Anyway, stay tuned.  The commissioners invited everyone to attend the meeting of the new board next week to find out what is next going to happen.

71 comments:

Blogger said...

I had not attended a county board meeting until today. inquiringmind posted that I should watch Jimmy Deal do his thing. Sure enough, as soon as the meeting opened, Deal moved to accept the amendment, and bang, it was all over.

The irony is that Jimmy Deal was the chairman of the board when this original deal was pushed through back in 2006.

Anonymous said...

What's very odd and tragic for the county taxpayers is that the BOC chairman and majority meekly allows Boss Deal to dominate the meetings.

Just as he did in the past.

guest said...

anonymous. If all you want to do is to attack the county commission, why don't you do it on the web site that specializes in hatred of conservatives and Republicans?

BOC Chairman Miller has done an exceptional job for this county and he chaired last nights meeting EXACTLY as he should have. You seem to think that every time Jim Deal speaks, Miller should gavel him down or something. Deal is an elected official who represents a substantial constituency in this county. You and I may not like what he has done on the BOC, but to constantly jump down Miller's throat because he doesn't publicly chastise Deal at every opportunity is just a reflection on you, your hatred for Deal and apparently for anyone who doesn't share your bitterness.

At least when you publish your venom in the local newspapers, you sign your name. Why be 'anonymous' here?

Thank you Nathan Miller for your service to the county, your exceptional leadership on the BOC and for your intelligent handling of this current situation!

Anonymous said...

Guest: The truth hurts, doesn't it?

And as for Jim Deal representing a substantial constituency, he sure does. But one thing for sure, he does not represent the district he is supposed to represent.

However, his most important constituent is Jim Deal.

Anonymous said...

I feel compelled to state that New River employees have not received a raise in four years, pay over $200 per month for individual health care with a several thousand dollar deductible, and have seen colleagues leave the mountains for sizable raises. We have chosen to stay here, raise our families, meet the needs of our most vulnerable citizenry, and for that some of us will lose our homes, our cars, our careers, and do not even know if we will get paid for the honest work we have done. We had no idea of the status of our agency, learned of it from a series of emails, and are as traumatized as some of the people we serve.
We work 24 hours a day 7 days a week with the schools, law enforcement, the hospitals, jails, the shelters and each and every citizen who requests our services, some of whom are suicidal or homicidal. We pay taxes, are consumers of local goods, go to church here, have children in school here, and love our mountain home. None of the staff had any idea of the status of our agency; that was left to the Boards who provided our oversight while we came to work every day to support our families and to do our job, like most everyone else in our community. I do not need to defend the work of myself or my colleagues; I know we are professionals, many of whom feel that we are called to our profession. I only ask for compassion as decisions are made that will affect these counties and their citizenry for a long time to come.

Blogger said...

Thanks Anonymous supporting the New River providers. I hope you read my article all the way to the end. I tried to make clear you providers were not the culprits. The guilty will probably be discovered in the Smokey Mountain LME. Also, the county commissioners under Jimmy Deal should never have created your NRSA in the first place. New River should have privatized in 2006 like everyone else in the state. NRSA was always an accident waiting to happen to the tax payers of Watauga County.

NewGuy said...

Let me echo Blogger here, anonymous.
Very good post!

I am under the impression that all 5 counties are concerned about retaining the current New River staff. And, I am sure the New River clients will likely benefit more from continuing their present relationships than in establishing new ones.

Personally, I have no knowledge as to the salary schedules, benefit packages, retirement, or any other compensation issues relative to New River employees. I assume that all of you earn whatever it is you are receiving and I personally hope that you will come through this difficult time unscathed!

It would seem like all 5 counties are moving forward to resolve this issue in a way that will cause the least damage to the counties, the New River Employees and the New River clients.

I don't know what has happened to the millions of dollars at issue here. Let's hope that most of it can be found and possibly recovered. I would assume that if there are billing problems and insurance companies have not been properly billed, then those funds can be identified, billed and collected. If there it's simply bad management, or even embezzlement - it may be more difficult to recover losses.

inquiring mind said...

This comes from the 6/30/2010 Financial Statement for the County. There is not separate audited financial statement for NRBH and we assuming one is not needed.

"The County also participates in a joint venture to operate New River Behavioral Health Center with
four other local governments. Each participating government appoints one County Commissioner to
the Governing Board and they in turn appoint the other members. None of the participating
governments have any equity interest in the Behavioral Health Center Department, so no equity interest
has been reflected in the financial statements at June 30, 2010. In accordance with the
intergovernmental agreement between the participating governments, the County appropriated
$302,687 to the Behavioral Health Care Department to supplement its activities. Complete financial
statements for the Behavioral Health Care Department can be obtained at 895 State Farm Road, Suite
508, Boone, NC 28607."

Anonymous said...

As a New River employee, I know that we are being told that right now there is not enough money to cover our payroll. We get paid one time per month, in 5 days. This month, I think it fair to say that this could best be construed as a gamble. Counties had moved to address this, but when the amendment was re-amended, their contribution became unclear. I do believe that everyone WANTS to do the right thing, but fear is taking over. We are government employees, in the State Retirement system, entitled to sick and annual leave and have State health insurance, albeit with little employer contribution. The latest comments from commissioners throughout the five counties are that there is not a final audit, there is lack of clarity regarding liability, and that the attornies and the Courts will decide. They acknowledge that conumers may have a difficult transition.

Let's please remembert that 5 years ago New River and these commissioners or their predecessors travelled to Raleigh and made an impassioned plea to the legislature for a special dispensation to allow us to remain a public agency, and to create the interlocal agreement. They were the only commissioners to do so in the state. Please pay us now and fight later. Shut our doors now to stop the financial bleeding, maintain emergency psychiatric services with a skeleton crew, address the needs of the homicidal and suicidal who can jeopardize the safety of our community. Then realize that given the poverty of these hollars, the vast geographic spanse from Avery, through Watauga, Wilkes, Ashe and Alleghany, and our history as the moonshine capital, and our current status, as having some of the highest fatal OD rates in the country, many private providers will be cautious to come in, and few will succeed.

The interlocal agreement puts the liability fully in the hands of the counties, stating so in the introduction and the conclusion of the agreement. For employment purposes, we are like school teachers and librarians and DOT workers. Don't pay us on time, Friday morning, and there is a $1000 fine per charge, leading to an additional $300,000 bill for the counties. One can clearly read this on any breakroom wall on the Wage and Hour posting. In addition, we are licensed clinicians, which means we must work EVEN if we do not get paid, because not to do so with no notice to our patients would be construed as medical abandonment by our licensure boards and cause us to possibly lose our licenses permanently. I can say tht I personally greatly appreciate the support of the community for our work. We are not private therapists. We reach out to truly desperate people at times. We need the community's continued support and RAPID action from our commissioners, who can then go the LME, the State, Medicaid, and private insurers to make this right.

NewGuy said...

Another good post Anonymous. Very informative. It would be good if you could adopt a board ID so that we can tell when it is you posting something - and I hope you will continue to post and keep us informed!

Just click on the Name/URL button and enter a nickname in the blank space before you hit "publish" on future comments. You will still be as anonymous as before, but maybe can alleviate some confusion because of all the people posting with "anonymous" instead of a nickname.

Thanks for your post!

Blogger said...

Inquiring Mind wrote: "Each participating government appoints one County Commissioner to the Governing Board and they in turn appoint the other members.” IM, that is not new. It has always been that way from way back perhaps when Kennedy established community mental health centers.

However, I think we are learning that this next statement may not be accurate. “None of the participating
governments have any equity interest in the Behavioral Health Center Department, so no equity interest
has been reflected in the financial statements at June 30, 2010.” If that were true, then why are they scrambling for money to pay people at least through November? Also, why did the person who wrote today say she is a government worker? What government? The county government?

If in 2006, the commissioners had not gone for a special dispensation as the anonymous writer corroborates what I have been writing, then these current employees would be non-governmental private providers. Thus when the money ran out, they would be on their own. That is the way the rest of the state did it.

Blogger said...

So far, no one seems interested in why the mountain county commissioners did not follow the rest of the state in 2006. They will have to speak for themselves of course and at that time the only current commissioners who could speak to the subject are Jim Deal and David Blust, members at the time.

With no one explaining so far, I will give my own theories:
1. The New River Board at that time was terribly ingrown. Many of them knew little other than what they were told locally. Even so, those same people had been reappointed year after year, some as long as twenty years. Staff and board members were like family and the board members loved and honored the staff. Board members were not going to tolerate their people being uprooted.

2. The New River staff were able to convince the board members that few private providers would want to come up here to live in these mountains. So they needed to find a way to keep the present staff intact.

3. Finally, there is the anti-Raleigh reflex deeply embedded in these liberty loving mountain people. No one in Raleigh, including the legislators, was going to tell them what they could and could not do.

NREmployee said...

As a New River employee, all I can say is I need to get paid on Friday. These commissioners now have a board to direct New River starting tomorrow, and employees will name them as well when laying down charges if payroll is not met.

inquiring mind said...

Blogger. You do realize that I was quoting from the 6/30/2010 financial statement of for the County.

DIRECT QUOTE FROM PAGE 47 NOTE 4:
"The County also participates in a joint venture to operate New River Behavioral Health Center with
four other local governments. Each participating government appoints one County Commissioner to
the Governing Board and they in turn appoint the other members. None of the participating governments have any equity interest in the Behavioral Health Center Department, so no equity interest has been reflected in the financial statements at June 30, 2010. In accordance with the
intergovernmental agreement between the participating governments, the County appropriated $302,687 to the Behavioral Health Care Department to supplement its activities. Complete financial statements for the Behavioral Health Care Department can be obtained at 895 State Farm Road, Suite
508, Boone, NC 28607."

You can view the financials at the County website under the finance department, county audits.

I would not be suprised that it is wrong. I found another footnote in the report that is out and out wrong as I posted on another Blog about the County financials. I have asked the LGC to look into this. Of course we are talking about financials that were prepared during the Deal regime.

And, Blogger, Commissioner Deal has to take center-stage when he want to limit discussion. He didn't want the history to come out. Plan to go back and look at other financials to see if this footnote changed. Stay tuned.

inquiring mind said...

October 16, 2006 County Commissioner Meeting Minutes:
“PROPOSED NEW RIVER BEHAVIORAL HEALTHCARE INTERLOCAL GOVERNMENT AGREEMENT

Mr. Don Suggs presented a proposed Interlocal Agreement to provide mental health services for Watauga County through the New River Service Authority (NRSA). In the past, New River Behavioral HealthCare (NRBHC) provided both management services as a LME (Local Management Entity) and client services as a mental health authority. NRBHC operated in the five county area of Ashe, Alleghany, Avery, Watauga, and Wilkes. Due to the state mandated reorganization of the mental health delivery system, a LME could no longer be a service provider. Therefore, the Board of New River Behavioral Healthcare was proposing to establish a new entity to provide services. Once this occurred, the required management function was to be merged with an existing LME entity. At that time the LME arm of NRBHC was to cease to exist and all assets were to be transferred to the new entity, NRSA.

County Manager Nelson stated that, based on review by staff and comments from the Board of Commissioners, changes were made in Article 10 Section 1 and Article 11 Section 2. These changes were to allow local control of the budgeted amounts each year and also allow Watauga County to maintain flexibility in furnishing space to NRSA.

Mr. Suggs stated that a Commissioner needed to be appointed to serve on the NRSA Board. The appointment needed to be a separate Commissioner from the seat on the existing NRBHC Board. Mr. Suggs requested that the appointment be made at this meeting if possible.

Commissioner Blust, seconded by Vice-Chairman Winkler, moved to approve the Interlocal Agreement as presented by Mr. Suggs.

VOTE: Aye-5
Nay-0

The appointment of a Commissioner to the NRSA Board was to be considered under “Boards and Commissions.”


By consensus, the Board agreed to appoint Vice-Chairman Winkler to serve as the Watauga County Commissioner on the New River Service Authority (NRSA) Board and to leave the NRBHC appointment vacant at this time.”

Also checked the financial statements for 6/30/2005, 6/30/2006 and 6/30/2007. The footnote did not change which might indicate that the finance director didn't notice that there was supposed to be a change and kept on with the cut and paste job.

So the new entity is New River Service Authority. This agreement should be in the agenda for the October 16, 2006 meeting. I will ask Anita Fogle, the Board of Commissioners Clerk.

inquiring mind said...

October 16, 2006 County Commissioner Meeting Minutes:
“PROPOSED NEW RIVER BEHAVIORAL HEALTHCARE INTERLOCAL GOVERNMENT AGREEMENT

Mr. Don Suggs presented a proposed Interlocal Agreement to provide mental health services for Watauga County through the New River Service Authority (NRSA). In the past, New River Behavioral HealthCare (NRBHC) provided both management services as a LME (Local Management Entity) and client services as a mental health authority. NRBHC operated in the five county area of Ashe, Alleghany, Avery, Watauga, and Wilkes. Due to the state mandated reorganization of the mental health delivery system, a LME could no longer be a service provider. Therefore, the Board of New River Behavioral Healthcare was proposing to establish a new entity to provide services. Once this occurred, the required management function was to be merged with an existing LME entity. At that time the LME arm of NRBHC was to cease to exist and all assets were to be transferred to the new entity, NRSA.

County Manager Nelson stated that, based on review by staff and comments from the Board of Commissioners, changes were made in Article 10 Section 1 and Article 11 Section 2. These changes were to allow local control of the budgeted amounts each year and also allow Watauga County to maintain flexibility in furnishing space to NRSA.

Mr. Suggs stated that a Commissioner needed to be appointed to serve on the NRSA Board. The appointment needed to be a separate Commissioner from the seat on the existing NRBHC Board. Mr. Suggs requested that the appointment be made at this meeting if possible.

Commissioner Blust, seconded by Vice-Chairman Winkler, moved to approve the Interlocal Agreement as presented by Mr. Suggs.

VOTE: Aye-5
Nay-0

The appointment of a Commissioner to the NRSA Board was to be considered under “Boards and Commissions.”


By consensus, the Board agreed to appoint Vice-Chairman Winkler to serve as the Watauga County Commissioner on the New River Service Authority (NRSA) Board and to leave the NRBHC appointment vacant at this time.”

Also checked the financial statements for 6/30/2005, 6/30/2006 and 6/30/2007. The footnote did not change which might indicate that the finance director didn't notice that there was supposed to be a change and kept on with the cut and paste job.

So the new entity is New River Service Authority. This agreement should be in the agenda for the October 16, 2006 meeting. I will ask Anita Fogle, the Board of Commissioners Clerk.

inquiring mind said...

The following comes from a document published on the NC DHHS website titled "Report on Interlocal Agreements Between Counties December 1, 2009"

This report only mentions one of these interlocal agreements- Watauga, Ashe, Avery, Alleghany and Wilkes.

It quotes the law in this report:

"The interlocal agreement must provide that any liabilities of the public provider shall be paid from its unobligated surplus funds and that if these funds are not sufficient to satisfy the indebtedness, the remaining indebtedness shall be apportioned to the participating counties."

This report refers to the New River Service Authority as a "160 A Service Authority". It looks like the New River Service Authority is doing business as (dba) New River Behavorial Health Care. The report states: "Smoky Mountain Center is the endoring LME for the public provider New River Behavioral Health Care." It goes on to say: "New River Service Authority, the public provider, receives funding from the five counties as well as state funds through Smoky Mountain Center totaling $4.1 million dollars."

It goes on to say: "The survey of (5) private providers who compete with the New River Service Authority in the five county region found that mental health and substance abuse consumers have limited choices as the LME contracts only with the New River provider for state funds. In addition, the providers voiced concern that the New River provider has an unfair advantage in staff recruitment and retention as the staff is eligible for local government benefits."

The NC DHHS decided to continue to support the New River Service Authority. "However, Division representatives will continue to monitor the relationship between New River and the LME as well as encourage an expansion of choice for consumers through the endorsement of additional providers when possible.

inquiring mind said...

The endorsing LME is Smoky Mountain. The Smoky Mountain Center Board Members:

At-Large Members
Don Suggs, Watauga County

Commissioner:
Tim Futrelle, Watauga County
County of Watauga
814 West King Street, Suite 205
Boone, NC
828-265-8000

xecutive Committee Members
Ed Tarleton, Chair
Bill Noland, Past Chair
Rick French, Vice Chair
Helen Alverson, At-Large
Judy Davis, At-Large
Janice Patterson, At-Large

Blogger said...

IM many thanks for the information on the Report on interlocal agreement between counties Section Law-2006-142, Section 4.(1) dated 12/1/2009. The original intent of the reform was that there would be no sweetheart deals or under the table deals between an LME and any specific groups of providers. Contracts between LME’s and private providers were open to everyone. From the document: “The Secretary is to ensure there is fair competition among the providers.”

As you wrote, the Report is for New River only. I could be wrong but I think the reason is that only New River commissioners invented this 160A. The rest of the 38 directors in the state took a look at it and decided not to go there. I would like to think they didn’t because they saw the risk being taken.

As you can see DHS allowed New River the local LME housed in Smoky Mountain to contract mainly with New River Behavioral which was being given special status by the county, even though private providers protested. The reason given was that we couldn’t get providers to come live in these beautiful mountains.

I believe by shutting out private providers, everyone should have anticipated that this unfair competition would discourage outside providers to come in–a sort of self-fulfilling prophecy.

Because the county commissioners got this special deal, but have abruptly terminated New River Behavioral, they are forced now to scramble and find companies or groups of local providers to set up shop in the area. In 2006, they would have had ample time to find out if providers would come. However, by creating this closed shop called New River Behavioral they only have a month. I can’t wait to see what they come up with.

Blogger said...

Inquiring Mind in the minutes you posted from 2006 the following appears: "also allow Watauga County to maintain flexibility in furnishing space to NRSA."

IM I don't know what they did, but if the county gave this NRSA any sweetheart deal on space, then they disadvantaged the competition. This would have been against the spirit of DSS' obligation to ensure competition. Does anyone know if they did provide space to the NRSA?

inquiring mind said...

What is really strange is that the footnote referencing this arrangement, in at least of the county's financial statements (the ones available on line) are not the same. It appears that the county's finance directors didn't get the memo back in 2006.

Basically, the County set up a mental health facility called New River Service Authority. The New River Service Authority to confuse matters started doing business under the old name of New River Behavioral Health Care. And, the County then contracted with a management company, Smoky Mountain Center to manage their facility. And, the County shares with 4 other counties, in the liability of any indebtedness. Everything went along with the lack of due diligence and oversight by the County as usual (cut and paste financials with no regard to potential liability). Then something went wrong and in typical fashion, the County now reacts. They were warned and ignored the warnings. However, we citizens that warn them are considered "trouble makers", "politically motivated", "not forward-thinking", "ultra-extremist" just to mention a few names that Commissioner Deal has thrown out there. And, the agencies that are established with the oversight of the local governments, they ignore the warnings also; they just want those citizens who actually read financial statements to go away. Things are just fine until we start asking questions. Right, Commissioner Miller?

Blogger said...

From today's Watauga Democrat: "With jobs uncertain, several other mental health service providers are working to recruit those mental health professionals."

This is exactly what should be happening and happening fast. The only legitimate move is for the New River providers to be setting up shop as private providers. They can contract as individuals with the LME. Many of them are eligible to bill medicaid directly and therefore won't be involved in the scandal if it turns out that Medicaid stops paying the Smokey Mountain LME.

Anything else will take us right back to where we were.

inquiring mind said...

With the Watauga, Ashe, Allehany and Wilkes financial statements now in, only Watauga realizes that the 5 county operation is called New River Service Authority dba New River Behavioral Health Care. The other 3 counties reporting think that the name of the organization is Smoky Mountain Center. These 3 counties are directing readers to Smoky Mountain for financial statements. It is so pathetic to realize that these guys didn't even know what they were getting into. Someone comes through the doors, with a proposition that is sure to benefit them, tells the commissioners that it is for their benefit and they all fall right in step. What is that oath that they take when they go into office?

NC State Constitution Article VI Section 7

"Sec. 7. Oath.

Before entering upon the duties of an office, a person elected or appointed to the office shall take and subscribe the following oath:

"I, _______________, do solemnly swear (or affirm) that I will support and maintain the Constitution and laws of the United States, and the Constitution and laws of North Carolina not inconsistent therewith, and that I will faithfully discharge the duties of my office as _______________, so help me God."


"Sec. 8. Disqualifications for office.

First, any person who shall deny the being of Almighty God.

Second, with respect to any office that is filled by election by the people, any person who is not qualified to vote in an election for that office.

Third, any person who has been adjudged guilty of treason or any other felony against this State or the United States, or any person who has been adjudged guilty of a felony in another state that also would be a felony if it had been committed in this State, or any person who has been adjudged guilty of corruption or malpractice in any office, or any person who has been removed by impeachment from any office, and who has not been restored to the rights of citizenship in the manner prescribed by law."

Commissioners are subject to the duties and powers of section 153A (which will reference the same powers given to cities in section 160A).

Therefore you are subject to your "ethic's policy" that you designed for yourselves. You have pledged to uphold every NC General Statute that touches every aspect of your office and your ethics policy (NCGS 153A-53) not to mention the NC State Constitution. And, you did so "so help you GOD"!

Your ethics policy is not on line. But, I have a copy. And, I would like to point out that you adopted it under the authority of NCGS 160A-86 instead of NCGS 153A-53 and you refer to council members instead of commissioners. I am asking too much for you to clean that up? And, while you are at it, could you make reference in your Whereas section to the entire NC State Constitution, especially, reaffirm your oath in Section 7 and eligibility to serve as in Section 8.

This ethics policy was developed under a board that showed total disregard for ethics so you might want to fine tune it; obviously, they were just doing what the law required without any spirit of true public integrity.

inquiringmind said...

Journal patriot

Blogger said...

From today's Watauga Democrat: "With jobs uncertain, several other mental health service providers are working to recruit those mental health professionals.

Daymark Recovery Services, RHA Health Services and Triumph hosted a joint job fair Thursday evening in Boone.

Other classified announcements have advised of mental health positions, some specifically stating that New River staff will receive special consideration."

This is what should be happening, not the county commissioners trying to come up with another foolish scheme that exposes us tax payers.

NREmployee said...

Agreed, Blooger, but because of their original scheme, it IS the counties' responsibility to ensure those of us providing services are paid until the transition to other providers.

Blogger said...

NREemployee about being paid. I would be shocked if you didn't. I hope you can find a good place to keep on using your dedication to the seriously disabled.

One other idea I am sure you have considered is that there are a fair number of private providers in town who have office space they don't use full time. They could use the extra income when they rent the space out. Then as your practice takes off, you can stay or find your own place and maybe partners.

NREmployee said...

None of us will be shocked if we don't. Watauga wouldn't sign the original amendment because they wanted to try to weasel out of the responsibility and screw honest, hard-working citizens out of their pay. All of that language got changed in the new amendment - but it wasn't changed in the original paperwork that created NRSA. The fact is, they're trying hard to get out of their legal responsibility and nobody seems to be bothered by that fact.

Blogger said...

"nobody seems to be bothered by that fact."
NRE employee, we are and we are trying our best to see the story gets out. You guys are the innocent victims, especially if you are one of the newer people.

However, some of the older staff brought this on themselves by convincing the commissioners that no one would be interested in coming up here to God's country to serve the disabled. They should have tried that first before they went contrary to everyone else, not only in North Carolina but in many if not most other states.

NREmployee said...

Of course they should have, and I agree with your points so far. The problem I have is that we're still working - we have to even if we would prefer not - and we're being told that as of yet there isn't enough in the kitty for payroll. Then we look at what the county commissioners are doing and see that they are the reason there isn't enough. I may be the only one voicing it here right now, but I'm not alone in saying there better be enough in payroll and it better be on time. Yes, I'm dedicated to my job and the services we provide to the many troubled people in our great state. But I have to admit that like all others I work with, I'm not so dedicated that I'll do it without getting paid. The county "leaders" have shown quite clearly that not only don't they care about those receiving these much-needed services, they don't care about those providing them. They only care about scrambling in the last hours to get out of their own responsibility to both of these groups.

NREmployee said...

I should apologize, I'm not trying to take what these "leaders" are doing out on this blog or the readers here. It's just that what I'm seeing is a lot of "This shouldn't have been done this way", "they could have done this", "They should have done that"...when what's important is what they are doing right now, why they are doing it, and - more importantly - what they aren't doing and why.

NewGuy said...

"There better be enough" and "it better be on time"? What is that, a threat?

You have a mess on your hands and I sympathize with your position. If I were being paid monthly and learned halfway through the month that I might not be getting a pay check that month, I would be stressed out beyond belief, frustrated, and angry. You have every right to be so as well.

But, let's see what the county commissioners do before we go accusing them of anything. As I see it, the only thing they have done so far is to modify the 5 county agreement so as to change the wording which might have been read to guarantee employment of all current employees until November 15. That may not be in your best interests, but it hardly justifies an allegation that they don't:

"care about those receiving these much-needed services, they don't care about those providing them. They only care about scrambling in the last hours to get out of their own responsibility to both of these groups."

It seems to me that everyone involved is working pretty hard to do what they can to straighten out this mess. What about the liability of the State of NC? Are their payments current? Has SMC any accountability in this fiasco? Where was their oversight? How long has the CEO of New River been aware that they were on the verge of collapse? Why didn't she bring this to the attention of the counties involved and to SMC before this? She's the CEO, what's her responsibility? Is she still employed there?

What about Medicaid? Are their payments outstanding? Will they be released following the invetigation?

At the present time their is an investigation going on about the possible Medicaid Fraud; there is an audit to determine not just how much money is there, but how much is owed TO New RIver, and by whom; what accounts payable and accounts receivable are there? And, has their been any embezzlement of New River funds?

If it is determined that a negative balance exists, how much of that is the responsiblilty of the five counties? There were services being provided by New River to several other counties beyond the 5 current ones - including some not under the jurisdiction of SMC.

Do the 5 counties have financial responsibility for those counties as well? It may well be that the shortages (if any) are attributable to losses incurred in providing services to those counties. Why should Watauga taxpayers be liable for services performed outside the five county area?

It's all well and good that YOU have determined that Watauga county is liable, but maybe everyone doesn't agree with you and maybe those elected officials responsible for taxpayer funds are being prudent and fiscally responsible in confirming what their financial responsibility is before they start writing checks! If New River leadership had provided proper stewardship of the funds they were managing, we wouldn't have this problem. Let's let the BOC and the Board Attorney protect everyone's interests here and move forward in a deliberate, prudent and legal fashion.

I'm sure most citizens and most elected officials regardless of party are wanting to see New River employees paid for their services and New River clients continued to receive service!

NewGuy said...

NRE...We cross posted.

We are all on your side here. We know you are entitled to be paid for your services and it is my expectation that you will be.

If the legalities can't be straightened out in time for your payroll, I would hope that the 5 counties could, at least, pay the salaries outstanding even if they structure the payment as a loan to New River. That would likely give them SOME hope of recovering the payments from others who might, in the future, be found accountable for the losses.

Good luck to you all.

Blogger said...

NREmployee I am the person who is writing: "This shouldn't have been done this way", "they could have done this", "They should have done that"

I have a different set of problems then you do. As a taxpayer, I am trying desperately to make sure they don't make the same mistake this time. Mine is a cry of urgency.

NREmployee said...

Found here
"(3) The interlocal agreement must provide that any liabilities of the public provider shall
be paid from its unobligated surplus funds and that if those funds are not sufficient to
satisfy the indebtedness, the remaining indebtedness shall be apportioned to the
participating counties."

It's very clear to see what their fiscal responsibility is. They understood it or they wouldn't have agreed to it in the first place. They have the ability to close the doors anytime they choose, leaving only the services which are absolutely necessary running as they must be maintained. They have chosen instead to keep everything going, causing more and more payroll and debt, and at the same time look hard for a way to not be held responsible for that debt.
Of course the people you mention should be held accountable. Of course there must be investigation. That doesn't change the fact that people need to be paid, and paid on time, and that's the law.

guy faulkes said...

NREmployee. if you did the work, you certainly deserve the pay. However, if you had ever had your own business or worked for a private company, you would realize that occasionally people are late in paying you. Sometimes you even have to take them to court to get your money. You always have this option.

Blogger said...

NREmployee you wrote: "They only care about scrambling in the last hours to get out of their own responsibility to both of these groups."

Just so you won't get confused, there are two of us blogging on this blog NewGuy and Blogger.

"Scrambling at the last hours" is even the expression I have been using. However, the new Republicans on the Commission inherited this problem. Most of the majority members were not around when the deal was made. So the scramble is to clean up someone else's mess.

But NRE, don't let the fact that we pushed back a little discourage you. You are using this blog exactly as it is intended--a forum for citizens.

Blogger said...

NRE employee As happens sometimes, we cross paths while we are talking. I had not seen your last post when I wrote mine. You wrote: "It's very clear to see what their fiscal responsibility is. They understood it or they wouldn't have agreed to it in the first place. With the caveat of what I just wrote, I am with you 100%.

New River Therapist(aka anonymous) said...

Wow, miss a little, miss alot. The biggest concerns that I hear are that the very governmental bodies that sought the 160(a), who requested a special dispensation, and yes are the only commissioners in the state to do so, now have a case of amnesia.
Fear is a powerful motivator.I am not in management, so don't have all the answers. I do know that we have been audited by Medicaid regularly and have received strong reviews. We can go back and retroactively bill Medicaid if the Medicaid audit goes well. As for the finances, it is hard to make money off of people who are poor, or are substance abusing, or mentally ill, and when combined into a trifecta, the bank is in the red. I asked my supervisor once, "Where is the business model for serving indigent substance abusing mentally ill people," and he never answered. We have been known as seeing people with no resources when other agencies wouldn't. Given our history of quality services, our usual aptitude in medicaid audits, and the resilience of my colleagues, who have been hysterical in the past week, but have dried their eyes and smiled for consumers, I have more faith.
As for our status, we are Local Government Employees in the State Retirement System. We have the EXACT same benefits as law enforcement, eachers, librarians, etc, including sick leave, annual leave and retirement. We are eligible because the 5 counties agreed to adopt us into the 160(a) agreement. We are protected by all of the laws of state employees, and have been advied so by the State Office of Personnel, the same office that protects teachers, law enforcement, jailers, doctors in public settings. That is why some of this is so mute. There is a real chance that counties can have bonds downgraded if they do not satisfy this liability to government employees within their counties, and be charged $1000 per infrction, leading to over $300000 in fines. Last I heard, the counties are scrambling because four counties have always acknowleged what they did, and are respecting the decisions of their commissioners even though the current situation seems bleak. NRs debts will soon be OVER. We are all ready to move on. Please know that the last thing we want to do is allientate the communities that we have chosen to call home.

Blogger said...

NREmployee Thanks for the link. I hope our readers will read this document.

New River Therapist(aka anonymous) said...

Oh, and to the services provided by New River outside of the five counties...NRSA Board, comprised of these county commissioners, allowed NR to contract with Surry, Yadkin and Iredell as well as Alexander, Caldwell and McDowell, because profits would be shared with the five counties in the same prorata basis that was used to identify county's contributions and liabilities. The county commissioners have had to approve everything that our CEO did, and if they disagreed, they had the ability to terminate her every day of these past five years.

New River Therapist(aka anonymous) said...

Do note what NREmployee said. Business as usual is costing citizens money NOW. Better to close our doors in 72 hours, maintain emergency services,advise employees of job fairs by email, and stop paying salaries, rents, vendors, utilities. Let's make everyone whole instead of blowing this whole thing up. Consumers can call the crisis line, and the agency can be run for $4800 per day 7 days a week (staff cost only, no infrastucture)until new transition, much less than our whole payroll. This amount would cover all counties. Close the offices, let people work from home and the hospitals. the longer we stay open, the less services we will be able to provide, and there will be an even greater collapse.

NREmployee said...

I realize that this agreement was years ago and not all the current commissioners were privy to all that was going on. I guess the chip on my shoulder as regards the commissioners of all 5 counties is that they have been sitting on the NR board all along.

Every time NR employees get taken to the cleaners, it's a decision from the board which does it. Every decision made during this whole fiscal carnival was made by the board. Of course, now they say "OH we didn't KNOW"...and I call BS. I agree not all of them knew but the ones sitting on the NR board? right

Blogger said...

NRE "but the ones sitting on the NR board? right?"

Right

NREmployee said...

Sorry, Blogger, I don't get your last comment. I'm not sure if you are agreeing with my comment or if you are saying you believe the lie that's been told. Either way, it doesn't matter.

There ARE simple truths here. The 5 counties are just as liable for NR debt as they have been all along for NR profit. This was the agreement. Every week they keep everything running "business as usual" costs approximately $250,000. The sooner they lock down and limit services to only those necessary, the more funds they save. Investigate, find the money, blame somebody..do it all. Finding a new provider will be much easier and less painful if the counties aren't hemorrhaging money while they search.

It will cost a huge amount of money just to dissolve NR, and that amount isn't going to change. If they want so badly to show "fiscal responsibility" they need to act soon and save millions of taxpayer dollars.

NewGuy said...

NREmployee.

It's great that you have a legal opinion on the county's obligations. Are you a lawyer?
I ask that, because the county attorney doesn't seem to agree with your position. Nor does the Watauga Board of Commissioners who seem to think that other NC Statutes prevent them from paying NR liabilities at this point. Three attorney's on that board...

Also, it appears as if the NC School of Government agrees with the BOC on this matter.

From Watauga Democrat:

"Watauga Board of Commissioners - which includes three current or former attorneys - believes that another state law, NCGS 159A-28(a) , would trump the law making counties responsible."

With all due respect to you and your legal opinions, I believe the commissioners are doing the right thing at this point.

The 'new' board meets tomorrow. Perhaps we will get an update at that point. Good article on GoBLueRidge.Net
http://goblueridge.net/index.php?option=com_content&view=article&id=13441:new-board-for-new-river-meets-tomorrow&catid=1

Blogger said...

LRE I am agreeing with you.

NREmployee said...

Actually, that chick from the School of Government is disagreeing with the others from that school. Also, the other counties' lawyers and commissioners disagree with Watauga's on exactly the same question. So, my "legal opinion" actually has more backing than the three lawyers who don't want to pay their share.

NREmployee said...

Nah, you know what? This whole argument is REALLY STUPID. We're employed by the county - that's a fact. The county commissioners are having trouble agreeing whether or not to pay their own employees - that's another fact. Is there a single person who thinks that makes any sense?? Is it now considered "prudent" and "financially responsible" to waffle on whether or not to pay your own employees??

guy faulkes said...

In my opinion, you are due pay for the work that you have already done under the prior arrangement.

It is now up to the commissioners if they want to obligate the county for any future work to be done.

Blogger said...

From what we read, it sounds like the county commissioners are trying to use a legal technicality to waffle out of their obligations. To do so would be shameful. The present Republicans were elected to clean up the Democrats’ messes. This present New River debacle is just one more of the many burdens the Democrats loaded onto the poor taxpayers of Watauga County.

When the New River Area Board were ordered by DHS and the legislature to dismantle the government run entity and replace it with private companies, the Democrats on that board bucked. At the time, the head of the New River board was a Democrat–a true believer in government solutions as opposed to private ones.

It was he who crafted the 160A and sold it to an acquiescent board. At the time, he was publicly and privately debated over this issue. The conservative on the board warned that if the board followed him into the 160A they would see a day when taxpayers would discover they had been made financially responsible if it failed. On the other hand, if they followed most of the rest of the country and privatized, the taxpayers would not be nearly as exposed.

The Watauga County commissioner on the board was the Democrat, Billy Winkler. Seated right next to the conservative protester, he heard and understood all of the reasons the 160A was a very bad idea.

Nevertheless, as the record shows, he presented it to the Democrat run Watauga County Commissioners, who passed it. So, I repeat this is just one more Democrat mess, almost equal to the school fiasco, the present Republican leaders were hired to fix.

So my message to the Republicans is man up and do the right thing.

New River Therapist said...

That's all we ask. Recognize that we were adopted into the county system, and have full county benefits within the NC Retirement System. Pay us our wages, pay out annual leave, transfer our sick to the state system, refer our consumers to other agencies and shut our doors. We lose our jobs, our retirement, and gain unemployment for now, and hopefully a new job with a stable company. I would never ever support another 160(a). Mental health has never been a money maker. EVER.

NREmployee said...

Hear Hear, Therapist, especially not for me

inquiring mind said...

New River Employee. I am with you. I would never ever support a 160A agreement either. The government has no business trying to be BIG DADDY. They are not competent enough for that! Not today or tomorrow. Government has deteriorated due to the lack of moral character in the people that we elect. Back when the US Constitution was written, moral character was a criteria for office. Those that have the list bit of moral fiber are hood-winked by those that are in it for what they can get. They have a very cavalier attitude about what is going on. And, the one thing that we can be assured of; this will not be the last thing to go bad. They never address the route of the problem; lack of internal control and due diligence and ethics.

inquiring mind said...

Finally, someone has told it like it is. These are county employees and the county commissioners are responsible. During the Deal regime anything passed in front of their noses was 'ayed' with few exceptions and with no discussion. You could put anything in front these people and they don't have a clue. And, the staff just files it away and with a lick and rubber stamp they push send the peddler out the door. Then when something goes wrong they don't realize that they had a thing to do with it. As they famously say, "they didn't read it". There isn't much that they do read. Somebody else tells them what to do and they do it. And, it goes up the food chain passing from one incompetent or timid hand to another. The corruption, incompentence and/or dysfunction is so far up the chain that it has become the norm. It falls back on the staff! Commissioners come and go. Staff is supposed to stay on top of things and bring issues to the commissioners attention. Where are those audited financial statements for the New River Service Authority. The address the county gives in their financial is on State Farm Road. Why aren't they in the County office being review annually by the County? Do they even know whether they have audited financial statements? Of course, as we have learned recently an audit doesn't mean much.

NREmployee said...

NewGuy, you are right that a lot of this has to do with them being lawyers. Because it doesn't come down to their political party, it comes down to who and what they really are at the core.

If NR sent them a check this month made out for their pro-rata share of profit, would they send it back? But instead it's a bill for services already rendered and they throw a legal tantrum, asking "New River who?" like greedy, selfish children. I guess for people like you who think they are "doing the right thing" by denying payment to their employees - people who work hard daily to serve you and your family in their times of greatest need - it's a great feeling to have such conscientious people on the BOC. It sure makes me want to vote Republican.

New River Therapist said...

Here is post from senior UNC Gov Professor who helped orchestrate the 2006 separation of mental health from state services...

Mark Botts, an associate professor in the University of North Carolina School of Government in Chapel Hill, said he was aware of New River's situation and that it was possible that the governments of counties served by New River could be held responsible for New River's debts. Botts said this depended on several factors.

He said county governments are legally responsible for making sure mental health care services are provided in their counties.

The contract with Smoky Mountain states that each of the counties agree to allocate to New River on an annual basis... such appropriations as are commensurate with said county's annual funding for behavioral healthcare services immediately prior to the establishment of New River Service Authority." It says the level of funding "shall be reasonably sufficient, together with all of NRSA's other expected sources of revenue, to ensure that NRSA is able to adequately and effectively carry out its purpose and undertaking hereunder."

The board, comprised of commissioners, was aware of state cuts and maintained the current budget and array of services, leading to us requiring greater funds to carry out our purpose. Most of the fraud allegations come from closing offices in Alexander, Caldwell and McDowell too quickly, not transitioning to other providers smoothly enough, which the State in part holds the counties accountable for. Like I said, close us down NOW, maintain emergency services and med management until new provider is in and save taxpayers $1000000 in additional payroll. There is insurance and annual leave to be paid out and sick leave to be transferred to the state. The quicker the better to stop the bleeding, and let everyone get on with their lives.

Blogger said...

Thanks New River Therapist. Mark Botts is one of the most significant persons in NC mental health law.

By the way, don't you and NRE have other colleagues who would want to weigh in on this blog?

Everyone is completely anonymous. I have been doing this blog for a number of years, neither I nor anyone else knows the identity of the participants--a couple of people over the years have come in under their own names but it was their choice.

Anonymous said...

Speaking of history, Chairman Miller has been the county liaison for this Board since last December. I'm no Deal fan, but why didn't Miller know something was amiss? Seems to me this is on his shoulders more than anyone else.

Blogger said...

I have a retraction I need to make. I thought Smoky Mountain LME handled all the financial aspects of New River Behavioral. The Smoky Mountain LME auditor told me today I was incorrect. The LME only handles the monies of the State and Local contributions. On the other hand, the big money which comes from Medicaid, is billed directly by the providers at New River. Under the system as originally set up, the LME's were to handle all the funds, thus leaving the providers to do what they do best.

Unfortunately, because Medicaid now pays New River providers directly bypassing the Smoky Mountain LME, then the missing $3,000,000 falls on New River directly.

I still think if I were one of the New River staff threatened with being let go, I would quickly set up my own private practice and start billing Medicaid for myself. That way they would be out of the firing line of Medicaid officials who could be looking for someone to do a perp walk.

NREmployee said...

The problem with that, Blogger, is that the larger number of clinicians at New River are Qualified Professionals, not Licensed Professionals. Another problem with it is none of it can actually be done "quickly", even if you are Licensed. It's a drawn-out process with many pieces which must be in place in order to become a mental health services provider. The provider is the agency, not the actual therapist doing the work. There's a lot involved.

NREmployee said...

I realize during most of this conversation I've been all about getting paid. Sorry, I have a tendency toward pragmatism. Those of you who want to look deeper and speculate on what actually happened and is happening, should read this article, pay attention to Cornwell - not just here but everywhere.

NREmployee said...

Here is the article quoted above. Good links to documents there and food for thought.

NREmployee said...

Wanted to share this:

We're getting paid and there's a new provider coming in!

Anonymous said...

http://wataugarepubs.blogspot.com/2011/10/daymark-to-take-over-new-river-bhs.html

inquiring mind said...

Anonymous. Why did Nathan Miller not know that something was amiss? Because the staff at the County didn't know. That is the problem. When you want minutes for these agencies, the staff tells you to go to the agencies because they don't monitor anything. When you ask for the financial statements, they send you on a wild goose chase. Again, no one is monitoring anything. They set it up; appoint board members and that is it. They don't even read the agreements that they sign. They don't know who is responsible for what, when, where or why. They don't have any internal controls! The financial statement is a cut and paste job for Watauga County. They can't even keep their own financial statement straight much less the financial statement of an agency that they established. You would think with the an "undefined" potential liability, that they would want a copy of the audited financial statement of the NRSA. But, they don't have one. And, the another interesting note - we contacted the State Comptroller who used to require that the financial statements be sent to them; they stopped that in 2009 (does that tell you anything?) And, look at the County and BOE financial statements; they are audited and we have seen that doesn't mean a thing. The Local Government Commission is still trying to unravel that mess. And, I understand that they are now in on the NRSA financial statement audit investigation also.

Where are the financial statements for NRSA? Where are the board minutes for NRSA?
They are not in Watauga, Ashe, Avery, Wilkes or Alleghany. So, how would anyone know anything. They just send in the money. We have a finance director. Did our finance director know that we had a potential future liability? Should have, the finance director pre-audits all contracts.

inquiring mind said...

The bigger question, why didn't the commissioner that was appointed to sit on the NRSA board, Tim Futrelle, not know?

inquiring mind said...

The amended 160A Service Agency Agreement for NRSA states that the new board will take steps to acquire all records and assets. Where are the records? We have finally located the 2009 and 2010 financial statements. Where are the board minutes?

Former NR employee said...

I wanted to make a comment about some of the suggestions/concerns. I am a former employee of NRBHC. I left the agency to go into private practice several years ago. My choice for doing this was the level of stress I was incurring at NRBHC and to get time to work on a project/passion of mine. The stress was from all the paperwork mandates I was being required to do - some on the part of NRBHC, some mandated by SMC and some mandated by the state. It was ridiculous and prevented me from giving the quality care I wanted to give to the folks I was working with. So in comes my private practice which did take some time to set up and time to figure out how to do certain processes like the Medicaid reimbursement so I could keep serving folks with Medicaid. I refused to do IPRS which is the county funding for the folks with no insurance at all. It wasn't because I didn't want to work for those folks but because I did not want to deal with the paperwork mandates which was more than the Medicaid requirements. It's tough being on my own and after a few years, I had to get another job. (Part of that is because of not marketing the way I should so I could remain open for my project.

As for our new service provider that is coming in, Daymark Recovery Services, I hope that they stay true to the people of our communities. My fear though is that we are repeating the same situation. Even though they are a for profit rather than non-profit, they are huge - now 28 counties of our 100 counties in NC.

When agencies get bigger, you stand the chance of harder falls. It's harder to maintain control the bigger a company is. Why the criteria that the new provider had to already be serving 3 other LME's? Are you kidding me? That has nothing to do with how well a smaller company more local could do. Focus on the services. Split them up. Quit being so greedy and spread the wealth when it comes to the care we already have in the area.

Did you know that the CEO of SMC used to work for Daymark who they have decided to give the contracts to? Yes contracts, several contracts for several services. Why monopolize the system? Monopolizing serves no purpose other than to run out good quality smaller guys. Did the CEO of SMC refrain from voting? I doubt it. Isn't that a conflict of interest? But the state doesn't care about conflicts of interest. Look at another state service:

TASC is a service that is supposed to be a hub for criminal justice offenders to see for a substance abuse assessment and then get referred to the appropriate agency if needed. The one TASC supervisor in Wilkes County also owns a private practice in Ashe county that she refers TASC consumers to all the time. Her reasoning of it being okay and not a conflict? She only refers DWI folks to her but all others to her partner. Well HELLO! You still own the agency! Conflict of interest. I told her supervisor this and still nothing happened.

Ah well. I despise government and politics. None of it seems to really care about our people and what truly is the best care for them. Instead it's about quantity and reaction rather than quality and pro-action.

Okay, this was much longer than I suspected it would be. I just hope that in the end Daymark works out but my fear is that we are just repeating history.

Blogger said...

Thanks Former Employee. One thing you and the other private providers need to watch for is whether the commissioners give sweetheart deals to Daymark for space in the county building. If they do, this is totally contrary to the spirit of reform which is to create competition in the system. Medicaid also demands a level playing field for competition for all providers. New River has been guilty all along, giving themselves an edge on their competition.

The maddening part for me was at the time the original deal was cut, there were RHINO Republicans on that board. No one could get them to see that they were not true conservatives but wolves in sheep's clothing.

If you do find out the commissioners are cheating again, blow the whistle to DHS.

Anonymous said...

order xanax online xanax 902 - what is xanax bars