LifeQuest appeals decisionPublished 9:56pm Wednesday, October 10, 2012
LifeQuest Inc. is appealing the decision by East Carolina Behavioral Health to discontinue its contract with LifeQuest Inc.
Georgia Claxton, spokeswoman for ECBH, said during a brief interview Wednesday that she is not sure when the appeal would be heard or if it’s been scheduled.
LifeQuest, located at East Eighth Street in Washington, has served adults with severe to persistent mental illness in Beaufort, Martin and Pitt counties for the past eight years. Currently, it serves 70 people. In a letter to its supporters and stakeholders, LifeQuest gives its view on the contract discontinuation.
“On Tuesday afternoon, October 2nd, we received devastating news from ECBH. Upon reviewing our documentation, they have determined LifeQuest, Inc. to be 76% NON-COMPLIANT, thus resulting in a discontinuation of our contract,” reads the letter. “They have given us essentially 30 days to either appeal or close our doors. … We immediately contacted individuals at ECBH to request an appeal.”
Claxton said the dispute centers around a post-payment review process that ECBH uses with its contract service providers.
“There were 29 different providers who were involved in that process. We reviewed 10 percent of their records, their medical records for individuals receiving that service. … If they scored 80 percent or better, they have no further action. If they scored between 79 and 30 percent, they would be required to pay back the money for the services that were determined not to be medically necessary. That’s the bottom line — if the records demonstrate that the service given was medically necessary,” Claxton said. “If they scored that 79 to 30, then we would ask that they pay back for those services that did not meet that criteria and probably also … a plan of correction to prevent that from happening in the future. Those providers who scored less than 30 percent compliance would be requested to pay back that amount, and we would terminate the contract for that particular service. Some agencies provide more than one service and some provide only one. That may be the case with LifeQuest.”
Adam Congleton, LifeQuest’s program director, on Wednesday said he’s at a loss to understand what ECBH terminated the contract. He’d like ECBH to answer some questions.
“All we want to know, really, are the specifics. What tool did you use, what was the result? Can we see the completed evaluation of what you did? Then give us as an agency, as an upstanding, productive agency for the past eight years … give us an opportunity to right our wrongs, to do a plan of correction. That’s where we’re coming from,” he said.
The LifeQuest letter notes that LifeQuest requested a meeting with ECBH officials to discuss details of ECBH’s finding but was told “a meeting is not an option.”
The letter indicates LifeQuest was surprised by ECBH’s action.
LifeQuest said it submitted required documents, as part of the post-payment review process, to ECBH without reservation. “As we awaited their feedback, we were not concerned, due to the fact that we have always passed with flying colors, and felt strongly that our program is among the best in the catchment area, if not the state,” reads the LifeQuest letter.
In the LifeQuest letter, written by Congleton, it reads, “Among all of those in charge of terminating our services, none have ever stepped foot into our program. Their ability to determine the quality and magnitude of our services is thereby hindered.”
LifeQuest recently went through an international accreditation survey in which the surveyor said she planned to submit extra documentation to characterize LifeQuest’s psychosocial rehabilitation model as exemplary, Congleton said in a brief interview.
Congleton said he’s disappointed with how ECBH has communicated with LifeQuest about the situation.
Congleton said LifeQuest’s services are needed in the area.
“We’ve made an impact in the community in Beaufort County,” he said.
Claxon, in an email, said there are two levels of appeal.
“The first appeal is heard by an ECBH management staff not involved in the initial decision, an ECBH clinician not involved in the initial decision and a peer representative from a provider agency — in this case it will be someone who runs a similar program,” reads the email. “If the provider is not happy with the results of the first appeal, they may appeal again and that appeal will be heard by our senior psychologist, another peer provider representative, and the Executive Director. If the provider is not satisfied with those outcomes, they may appeal to the Office of Administrative Hearings at the State level and, ultimately, to District Court. Per state law, no actions may be taken against the provider while they exercise their right to appeal.”