Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I am CJ Wolf with Healthicity and today's guest is Maeve O'Neill. Welcome, Maeve! We're glad you're on the show.  

Maeve: Thanks for having me.  

CJ: Yes, we're excited to have you. We appreciate your time and willingness to share some thoughts and expertise on compliance as it relates to behavioral health and mental health and those sorts of things. But before we get to that topic, Maeve, we always like to hear from our guests a little bit about themselves, how they got into compliance, or anything that you'd like to share about what you're doing now or what you've done in the past, we all come to compliance, usually from varied backgrounds, so, we find it interesting to hear others' stories. So, anything you'd like to share about yourself.  

Maeve: Yeah, great! Thank you! I said I'm a big fan of yours and follow your work. So, I'm just honored to be here and be having this conversation with you. I've been in behavioral health my whole career. I started right out of high school, working in mental health and addiction services. So, have 30 years in the field, more than 30 years working in all levels of care; from inpatient, outpatient, residential, pretty much all populations; children, adolescents, and adults, and in kind of all settings I've worked in community prevention, in schools, in treatment centers and an executive leadership position.  

So, I've spent about 10 years sort of on the ground doing the work with the clients 10 years in management, and then 10 years in leadership positions, running either organizations or multistate treatment organizations. And then about 10 years ago, I sort of fell into compliance, sort of like you're talking about.  

CJ: Right!  

Maeve: Working in a treatment center and they said; “Hey, we'd like you to do this thing. We need help in these areas.” And I went to help, you know, it was policies and procedures and education and training and sort of quality and safety stuff. And then I realized; “Oh, there's a name for this. It's actually the whole field of people already doing this work.”   

CJ: Exactly!  

Maeve: And there I discovered, you know that compliance associations and certifications and so I achieved those and joined those groups, and all of a sudden there was this amazing framework for me to follow and bring to my work not having to reinvent the wheel. So, that's what I've been doing now for 10 years.  

I currently am a compliance consultant for behavioral health organizations and I work for an organization called Circa Behavioral. We have programs all over the country that we are there, fractional compliance officer, or we just support their compliance teams.  

CJ: Wow, that's great! That's an amazing background. And you know, I think a lot of us have had kind of similar experiences where, cause who grows up thinking they want to be a compliance officer, like, do we even know what that is? You know, still want to be an astronaut or a fireman. And we either get voluntold that we're going to do this or we are offered an opportunity and we kind of find our way here and yeah, like you, you know, I thought it was great when I learned; “Oh! There's a whole profession here, right?” And like you said, there are organizations and colleagues that you can reach out to in a systematic way to think about compliance. So, thanks for sharing that.  

Maeve: Maybe someday just school kids will say I want to be a compliance officer someday, right? That would be the dream.  

CJ: Exactly! I still, my kids, still ask me, what do you do or what have you done? And I'm like; “Well, I was a compliance officer!” Like; “Well, what is that?” “Well, I help people follow rules.” They're like; “Dad, that is the most boring thing I can think of!” 

Maeve: Nobody wants to hear about that at school, yeah!  

CJ: Exactly! But I kind of get a kick out of it, right? The thing that I like about the field of compliance is, and I come from a clinical background, I always wanted to help the physicians and the hospitals and the organizations that I've worked for kind of maneuver and navigate this, you know, web of compliance rules so that they have time to focus on patient care or they have time to focus on, you know, what the organization's mission is and kind of help take that burden off of them as much as possible. And so that's what I enjoyed about it.  

So, as I mentioned, we're going to talk today about and this may introduce yourself, behavioral health, mental health, those sorts of things. And so maybe we just start off by hearing your thoughts on what you feel the current state of compliance in behavioral Healthcare is.  

Maeve: Well, the word you just used, the web of regulations, is exactly how I see it as well in our field. You've got sort of the corporate compliance world and you've got healthcare compliance. And I see behavioral health as a sort of a subset of that healthcare where a lot of it is still new for, I think behavioral healthcare.  

When I've worked in the field, very few of my organization sort of had a formal formalized compliance, even plan or program or team, the larger organizations might have them, but they still sort of operate more on that corporate compliance level, so it's still hard to kind of get a really mature compliance program in behavioral health. Many are still figuring it out. Some are still doing it as a, you know, additional job duty for a clinical person or a medical person or administrative person.  

So, I feel like we're just on the cusp of really formalizing it in our field, taking the best practices from healthcare compliance and corporate compliance and applying it to our specialized field, which also has even more maybe complications in all the different state regulations and national accrediting bodies that make it even more of a dense web that we have to navigate. 

CJ: Yeah, you know, and in my experience with mental health, behavioral health, you know, you mentioned states like, you know, a lot of times we get a little bit more into the weeds with Medicaid. It seems like in this area just because maybe the patient population and the patient base has circumstances in their lives that they might have Medicaid, of course, Medicare is important too from a compliance standpoint, as is all payers are important. But do you think that's true that it seems like behavioral health, mental health is really connected a little bit more to Medicaid at the state level? 

Maeve: There's certainly that if a treatment organization takes Medicaid and Medicare, many do, but many don't as well. Some are just private pay. So just insurance contracts, it seems like there's some that do both, but most are sort of separate. You've got the public funding organizations and you've got the private funding organizations. It's hard to find some that mix, and if they do, it's even more obviously complex to navigate, but sometimes it's nice because the Medicaid and Medicare are really clear what they want and tend to be pretty consistent, right? And enforcing it where if you're private, you've got state regulations, you've got, you know, 20-30 different payer contracts that you're navigating as well as the state licensing, which is different in every state.  

CJ: Exactly!  

Maeve: And then if your Joint Commission or car for other accrediting bodies, DEA or SAMHSA, you know other things that we might use in our treatment centers, it really becomes difficult to make sense of it all and align it all to make the job, as you said, easier for those that are doing the care. 

CJ: Yeah, absolutely! So, on that kind of point, do you see common challenges for mental health and addiction treatment organizations in compliance, right? like, you know, I spent a lot of time in hospitals and with doctors and, you know, they all have kind of their unique challenges. What are some of those for this space?  

Maeve: Yeah! I think probably much like other health care compliance bodies, you know, I think it's figuring out what is required in the regulations, making sense of it, and then aligning it with the other accrediting bodies. I think the challenge in behavioral health is sometimes we overcomplicate things. We create a policy manual for this and a separate one for that, and then we add or change as we get surveyed or we get findings and we sort of just kind of add on to before you know it you've got thousands of pages of policies and no one's really reading them. No one's really looking at them. No one's taking a broader view of how this all fits and really serves the daily work, so it becomes sort of an administrative process rather than something that makes the job easier.  

CJ: Right! 

Maeve: So, I think that's the challenge, is figuring out how to take all these regulations, make them make sense, and then here's how we do it in our organization. And in a simplified format, but still that meets the regulations and ensures that good quality care. 

CJ: Yeah, you know, I work with some clients in this space and there seem to be common themes that I run into. I'm curious if you think this is also true from your perspective, where you know I might be working with a client to help them with denials or appeals from a certain payer, and it seems like in this space a lot of payers expect either in their policies or in their regulations like a plan, right?  

So like if a patient comes to me and I do an initial diagnostic exam and I set up a plan, they expect a detailed plan of you know I'm going to do psychotherapy for this many sessions or I'm going to do this or I'm going to do that, and they expect improvement in that documented in the medical record that they're improving because you know like some of my clients, you know, they might have patients in nursing homes who don't have the cognitive ability to actually expect any improvement. And so, payers are like; “Well, if we're not expecting any improvement and seeing any improvement, we're not going to cover this.”  

So, is that true that you see some of that as well?   

Maeve: Absolutely! And it's a daily occurrence where we're talking about, we want to show improvement. We want to show that what we're doing is helping and worthwhile. But at the same time, they still need the services, right? So, they're not, ready to leave, they're not completing. But to make that justification can be really challenging. And each payer, sometimes each regulatory body has a different way of defining that, so that where it really does become a challenge and we just want to do what's best for the client. So, we're often coaching programs on, you know, medical necessity and improvements. There's a new movement in our field and much like other healthcare I suppose, you know, measurement-based care and outcomes where we're showing at admission and maybe Midway point and at discharge that there is improvement based on clients’ goals and how they're achieving those. So that's a nice way that we're starting I think to maybe define that in more clear ways.  

CJ: Yeah! I mean, you and I have been doing this for decades now. And I remember, you know, when like mental health parity was the argument, right? Like years and years ago of just having mental health services being recognized, you know, in par with more what people might say more medical type of type of issues and it seems like there's still a little bit of that, I don't know! 

Maeve: Yeah, it's, I have not achieved that in any consistent fashion.  

CJ: Yeah, absolutely! Well, everybody, we're going to take a quick little break and then we'll be back with me to ask her some more questions.  

Welcome back from the break, everybody. We have been talking about behavioral health and compliance in this space. Maeve, I wanted to ask kind of on our next question about how do most behavioral health organizations manage their compliance programs, what have you seen?  

Maeve: I've seen just about everything! 

CJ: Right! Me too.  

Maeve: Oftentimes wish the accrediting bodies and legal buyers would require, you know, that you should have a compliance officer and a compliance plan and a program, and maybe that's coming down the road. But at this point, it's as long as you do these things, there's not really a retirement of what it looks like, so you often have someone who really likes this stuff or has a passion for policies or likes the rules and regulations. So that person sort of gets assigned it as an extra duty, or maybe they get a position carved out, but they're often times trying to figure it out themselves.  

CJ: Right! 

Maeve: We find that sometimes we don't give them the resources they need, whether it's time and support and other people, or even access to the different departments or leadership. So, in an ideal world, we would have more of a standardized approach to it, so then it can be compared, what's the best practice, where some improvements needed, but it's really across the board. You find every program does it differently.  

CJ: Yeah! When you introduced yourself, you mentioned kind of healthcare compliance organizations. Have you found certain pockets of people in this space that you collaborate with, you know, like colleagues, right, that are in a similar role that have been helpful, or has it just been kind of one-on-one type of stuff?  

Maeve: Yeah, it's been really wonderful. I go to lots of conferences and get to speak and network at lots of organizational conferences and you know, obviously, the Healthcare Compliance Association has been a great guide for me, and met lots of folks from there. We're actually planning our first behavioral health-specific webinar coming up soon, the call for programs just went out and I've been helping them along with that, becoming a huge advocate and nag, I guess in their ear about; “Hey, we need this over here for that.”  

CJ: Yes, I saw that the other day.  

Maeve: Yeah, super exciting! Because you know, while we share a lot in common with healthcare, I think we do have specific challenges and needs that we feel a little bit different sometimes given our client populations and you know the reality of kind of the daily work. So, I would love to see us have a little bit of a specialty there and have that support and networking with each other in particular.  

So, yeah, there's not a week that goes by where someone's not reaching out to me or I'm reaching out to someone and we're saying; “Hey, how do you do this here? How did you navigate this?” There's a handful of folks that specialize in behavioral healthcare compliance at Circa, we really partner with a lot of those. There are two or three that we talked to on a daily basis and to say; “Hey, here's a client that approached us, they're more fit for you, can you take it?” you know, we're always getting referrals from different people. So, I think when we know kind of what our strengths are and how we can best support the programs, that's really ideal. 

CJ: Yeah, and I'm glad you mentioned that conference because I saw that come out. I want to say it was just yesterday, we're recording this in early July of 2024 and I was excited to see that they're going to have their own behavioral health compliance, I think it's a virtual conference, right? I didn't look at the details. Is it like a one day or is it a 2 day?  

Maeve: The goal is one day, at this point virtual, and I'm hoping we get enough attendance and participation that will do an in-person longer, maybe down the road.  

CJ: Yeah, that's awesome. I mean, that kind of just to me shows that there really is a need for kind of this specialization, you know, in health and it might take a unique approach and you know kind of on that, have you found a best practice approach for compliance in this space? You know, is it really just every organization does it differently, or what best practices have you found?  

Maeve: Well, I think much as I have learned over the years is there's definitely frameworks that we can borrow from, you know, even for me when I enter it, even the seven elements of an effective compliance program were new to me. So, even just making that language or that knowledge and saying; “Let's start with there, we obviously have to then layer on our ethics codes and our regulatory body codes and those kind of complicating factors.” So, I think that's a really important piece to do and because we're already doing the seven elements, we're just not calling that and so that's why I like to figure out how do we not add more, but actually, you're doing this there and you know we call it quality or safety or risk or performance improvement, we call all these different things and it really is compliance. So, if we can understand that and simplify it, then I think we can maybe make it clearer for people, this is what we're doing. We often find people are either duplicating the work, or they've completely missed, they think they've got it covered because they do chart audits and chart audits is a part of compliance, but it's not everything in compliance, yeah.  

CJ: That's right!  

Maeve: And then I'm a big proponent too, of what I've learned over the years is we need all the elements we need, obviously ethics and the regulatory stuff. But we also I think really need to take care of our people that are doing the work. So, I like to layer in some really good workplace and workforce, well-being initiatives as part of compliance and team out for that to be compliance, but I think we can be the drivers of ensuring our staff are well.  

CJ: Yeah, absolutely. Those are all great ideas and thoughts. You mentioned, you know, chart audits aren't the only thing about compliance. I work with a lot of people that think when like we talk about healthcare compliance; “Oh, it's just HIPAA!”  

And on that point, there's probably some unique things about HIPAA, right? In behavioral health. And not just HIPAA, but patient privacy. I think this is still the case, right? Where psychotherapy notes are not necessarily considered a part of the designated record set, like it's a different kind of protection and I think you know, in the addiction medicine type of treatment, I think there's special laws around protecting those types of records as well. Is that something you deal with or is privacy and HIPAA kind of not in your daily work? 

Maeve: It is, there's been some recent alignment with the 42 CFR, rules that apply to us and then HIPPA they've sort of made it more simple to do both at the same time. They don't have to be opposing sort of regulations. So, that is part of what we do. But there's also that sort of specialty area, I feel like as a compliance officer and behavioral health professional, privacy and security are not my strengths. So, I always look for those specialized folks, you know, I'll do a basic policy that says, of course we're always protecting confidentiality and having certain things, but to do a full HIPAA audit or security and privacy check is not something I do, but there's great people out there that have the right certifications and expertise for us to lean on and I think as our systems get bigger and we get more virtual care and electronic health records, it's definitely a growing area and field for those in our work.  

CJ: Yeah, I found that to be true too. It's like a lot of people think; “Oh, you're the compliance officer, you know everything!” It's like; “No, we kind of specialized too!” It's like we've got the people who are experts in the technical side of HIPAA or the privacy or, you know, like you said, quality and those sort of licensure, all these different things.  

Maeve: Yeah, we can't do it all and actually in Circa we're really lucky we actually have folks on our team that like the privacy stuff. We've got folks that are more HR, we've got some nurses, some clinicians. And so it's nice to have sort of delegating. So, we don't have to all know everything all the time. We can have some people that have passions and expertise that we can rely on.  

CJ: Yeah, that's awesome. It sounds like a great team. You know, a lot of our listeners are compliance professionals. Any advice for compliance professionals that may be interested in or working in behavioral healthcare?  

Maeve: Yeah, I think it's. Well, first of all, welcome and glad that we have some more peers and companions coming along the way it. I think I would suggest that they join the organizations and the associations reach out for help. There’re some really great resources out there. Don't be afraid to say you don't know something or ask those questions. And then I think too, recognizing that we have a unique view of what this looks like. So, to be able to advocate in our organizations, or sometimes I'm just saying to, you know, like call it a chief position because it shows it's important, you know, we're not saying we have to have certain pay or certain status, but to give it the importance of a financial or a HR or a clinical role, I think compliance needs to be up there at that C-Suite.  

And I do like to move away from more of the legal and more into the specialized behavioral health experience because I think that does inform, sometimes you have people outside of behavior health coming into our field and either not quite understanding it or again laying it on top or rather than simplifying and making it, taking things away, not just adding some responsibilities to it, and that you can feel people's sense of relief and understanding when we do that.  

CJ: Yeah, absolutely! And I think what you've said really echoes, you know what we read like, for example from the OIG's recent, you know, general compliance program guidance document that they released back in November last year, 2023. You just said it, you said, you know kind of having that compliance officer at that C-Suite level having the seat at the table, in strategic discussions, so that compliance is not an afterthought, like a lot of us have experienced this as compliance officers where you know, Friday afternoon at 4:00 PM, somebody from the from the operations side says; “Oh, we need compliance to sign off on this project we've been working on for eight months. We're going to start it Monday.” It's like; “Well, you know, it would have been nice to been involved in the beginning because you can't do this. And you can't do that.”  

Maeve: That's right!  

CJ: Yeah! I like what you said. You know, having kind of that that. gravitas, if you will, at the higher levels and it really, you know, that's really where it's expected to be now.  

So, Maeve, we're kind of coming to the end of our time. I always like to give our guests the last word. If there's anything else that you think you'd like to share on this topic before we end?  

Maeve: Well, I just thank you for again for the time and the focus here. I have come to believe that many of us, probably most of us are in some point in our lives touched by addiction and mental health in our personal world. So, it's hard to find someone who isn't impacted by the work we do. So, I think elevating compliance in these spaces, if our true goal is to prevent, detect and correct, you know, risk areas that's going to benefit everyone. And my new mantra is; “Happy and healthy staff are ethical and compliant to provide quality and safe care. We can't do one without the other.” So, is our attention and all that we can actually take care of those loved ones that we all have in those service areas and really everyone benefits from it.  

CJ: I love it! I love that! Thank you for bringing it back to how it touches each of our lives, right? Like you said and compliance is a part of making sure that type of service will be there for all of us as we need help and those that we care about. And so, I love that great, great mantra. Great, great vision there.  

Maeve: Thank you! 

CJ: So, thanks again for your time and expertise and thank you to everybody for listening to another episode of Compliance Conversations. We always invite our listeners to share with us other topics and ideas that they'd like to hear about or if you have an individual in mind that you think would be a great guest, please send us a note we'd love to hear that. We want these conversations to be pertinent to what each of you are dealing with on a regular basis in the compliance industry. So, until next time, everybody take care.