04 June 2013

The Lost Art of LISTENING.

Before I launch into what will probably be my last post (though don't hold me to it), I want to introduce you to Raleigh Attorney Knicole C. Emanuel with Williams Mullen and her most excellently well written and legally sound Medicaid law blog. In my humble opinion, anyone who can so eloquently and factually draw a strong comparison and contrast between Shakespeare's "MidSummer's Night Dream" and the Medicaid providers' prepayment nightmare is nothing short of a poetic knight in shining armor (yes, chicks can be knights too - why not?)

Now, on with the show...

So, people keep asking where I've gone? Commenting that they've not heard much from me lately... Well, the truth is, that while I have been known to talk to myself on occation, there are some conversations that really need a active partner for successful dialogue. 

Frankly, I'm all talked out at the moment.

American author and journalist, Ernest Hemmingway was quoted as saying, "I like to listen. I have learned a great deal from listening carefully. Most people never listen."

Stephen R. Covey, author of The 7 Habits of Highly Effective People: Lessons in Personal Change said, "Most people do not listen with the intent to understand; they listen with the intent to reply.” 

Therein lies the problem. Nobody's listening.

Everyone has something to say in this Medicaid quagmire - the MCO's and LME's have plenty to say, providers have even more to say, DHHS and DMA have their say, facilities and group homes have something to say, advocacy groups keep trying to have their say, consultants and lobbyists get paid the big bucks to keep saying stuff, and members of the North Carolina General Assembly always seem to have the final say... and don't even get me started on the recipients and their family members that most everyone seems to conveniently forget in all this. 

Nobody can keep the stories straight, not even (and often, especially) the media, becasue it appears the right hand doesn't know what the left hand is doing while everybody's busy with their own personal diatribes and ass-saving.

Everybody's talking but nobody's listening.

Nevermind all of the asinine bureaucratic dynamics at play in the dirty politics of the NC Medicaid system - the inappropriate friendships, roles, relationships, mothers / daughters / board members, ethical conflicts of interest, and who's scratching who's back. Yep, we know about all that.

There are way too many egos on the line here (not to mention the obscene amount of money invested), meanwhile we continue to rearrange the deck chairs on the Titanic while ignoring the real issues of human concious. That's right, I said it again.

I find that this is especially true of the current political climate in North Carolina... For the first time in just over 100 years, the Republican party has finally won back the driver's seat and they seem to be hell-bent on making up for lost time with issues far more "important" than the welfare of our state's most vulnerable citizens, with such utter nonsense as nipples, fracking, abortion / right to chooseending size limits for K-3 public school classrooms, teaching about abortion risks in public schools while lifting smoking bans on college campuses, imposing rediculous voting restrictions and flat out denying many the right to vote, slashing unemployment benefits, requiring a 2 year waiting period prior to divorce (ironically dubbed the Healthy Marriage Act), vain attempts to negate the first amendment with a state religion, and arresting peaceful protestorsamong other idiocy. 

Handbasket anyone?

What with all that debauchery going on, who has time to worry about the threat of homelessness to residents of NC group home facilities (yet again)? Or whether developmentally delayed recipients and their tired-ass exhausted families have the resources to make it through yet another day, or even if they do - if they are actually receiving the services they are entitled through all this slimey red tape? 

I mean really? Who cares? We're such a small minority of the State's population when compared with the number of citizens who have nipples, for Christ's sake.

And speaking of Christ... Conservative politicians love to use the Bible as a platform and foundation for their arguments and justifications and while I've been known to agree with certain positions, it should be noted that countless infamous American psychopaths (Charles Manson, Jim Jones, Fred Phelps, etc.) have also used the good book as sources of inspiration and justification... just sayin'.

My Christ is not wrathful nor boastful, not judgmental nor unknind, and is not dis-compassionate nor cruel toward fellow man nor the world we live in. In the documented lifetime of Jesus, he exhibited love and compassion to all, even those who sought to destroy him and especially for those who could not do for themselves. 

I believe Christ to be alive in the very essence of our collective being, our hearts if you will, a state of mind we all should strive toward. --A perpetual state of love and forgiveness... a state of grace and joy I witness every single day in my own special daughter, Isabel, and her special peers. 

Where the hell are our priorities?

It's way past time for the North Carolina "powers that be" to start listening more to the people, their constituents and voting public, who must live with, and at times suffer from, the repercussions of their actions and decisions. 

You do NOT know what is best for me and mine; that, I can guarantee you. And I'm certainly not in the minority there.

Perhaps if everyone suddenly, miraculously began to listen more, really listen, and made an honest attempt at understanding one another, as I believe the late Steve Jordan had hoped, we wouldn't require knights in shining armor to mitigate such a shameful Comedy of Errors... though sadly, nothing seems to grab attention these days (and further waste taxpayer dollars) quite like a good ole American law suit, eh?

Hang in there folks.

28 February 2013

What's New in January & February?

January and February 2013 news, events, and updates.


25 February 2013

The NC Outpatient Mental Health Zeitgeist

-----Original Message-----
From: Geoffrey Zeger
To: ncadvocacy
Sent: Sat, Feb 2, 2013 4:34 pm
Subject: The NC Outpatient Mental Health Zeitgeist

NOTE: The following is somewhat long but is a reflection of the recent topsy-turvy, sinusoidal, and duplicitous events in the NC Outpatient Mental Health setting.......

During the summer of 2012, while I was standing outside of a clinic where I contract waiting for my next client, a car rapidly pulled up and out jumped 4 stony faced people with briefcases and a purpose in their steps as they entered the clinic.

It was an unannounced Medicaid audit.

Many clinicians and agencies knew these were occurring so it was not completely unexpected. At this particular free-standing private clinic which accepted Medicaid there was some anxiety (as any audit would produce) but we were pretty confident about our work - electronic medical records had fail safes for compliance, supervision occurred regularly, and the Clinical Coverage Policies for Medicaid were followed.

Over the next few months as the audit progressed a surrealistic Russian style bureaucratic nightmare occurred. Medical records were requested by the auditors and submitted by the clinic. CCME (Carolina Center for Medicaid Excellence) who was doing the audit would say 'we didn't get the records' and be elusive and dodgy. Medical records were re-submitted - hand delivered. Feedback from CCME was that the Treatment Plans did not meet standards. The Treatment Plans were being developed in line with the posted Clinical Coverage Policy and they were also in line with the recommendations of one of the LME/MCO's right over the county border but after much back and forth CCME continued to say they were not in compliance. CCME did not provide a clear indication of what compliance was nor did they provide a clear template for the Treatment Plans. (NOTE: The LME/MCO from the nearby county said the clinic's Medical Records per their site review were at a 92.5% accuracy!!!).

Staff at the clinic worked diligently to cooperate with CCME but every attempt at cooperation was met with a shift of the carrot on the stick. Conference calls were scheduled, emails were written, repetitive requests for clarification were pursued without any success or resolve.

The clinic was then put on a "pre-payment review" meaning claims for services rendered were not paid until the records were reviewed and approved. 'Pre-payment review' is an unguided process that could take 30 days - the approval of records is based on unclear standards so any clinical services rendered were like the lottery - maybe they'll get reimbursed if someone somewhere says documents meet some kind of unknown standards....or maybe they won't get reimbursed at all.

Eventually, so much unproductive hoop jumping occurred and time was wasted that a deadline for acceptance by the local LME/MCO came due. Because of the delays by the CCME, the LME/MCO which went live on 2/1/13 said to the clinic 'we can't enroll you' due to the 'pre-payment' status.

With only 3 days of lead time, over 100 clients - some of which were children in foster care or with PTSD or within the Juvenile Justice System - had to suddenly be terminated from treatment and referred to other agencies. Fortunately, the clinic will continue - contracted with the other county LME/MCO and accepting private insurance.

Was this top-down inefficient State bureaucracy? Was this effective Public Mental Health policy? Was there any consideration for how this would impact service provision and the clients? Was this purposeful - intended sabotaging of a clinic in order to reduce the number of providers within a community and save Medicaid dollars? Is this the CCME's way of insuring 'Excellence?'

I, and my colleagues who provide Public Mental Health services and who have weathered many pressures and changes, are not naive about accountability - we are ready to stand accountable and provide appropriate services with appropriate billing and documentation. I understand there are economic pressures at hand here but the current zeitgeist of audits, regulations and site reviews seems like a witch hunt and feels like a displacement for the past sins of others (http://www.inthepublicinterest.org/article/reform-wastes-millions-fails-mentally-ill). With the laser beam aimed at service providers - purposely geared to finding the smallest of errors in an effort to go 'GOTCHA' the zeitgeist is a culture of fear in order to insure accountability to DMA, CCME, DHHS, CMS, EDS, and the LME/MCO. Well what about accountability to our clients? Have policy makers forgotten about the clients in an effort to weed out the service provider playing field?

As a side note, it was rumored - and it may just be urban legend - that Medicaid auditors were paid based upon how much money they generated from the audit. If anyone has more information on this I would love to hear it - but at the community level it is understood that the contracted auditors were paid based upon how much money they were able to save Medicaid - how many claim denials they could find and how much money they were able to claw-back.

Wouldn't this contractual arrangement be considered a kickback?....'the more money you save or make us the more you will get from us?' Aren't kickbacks considered illegal within the Medicaid and Medicare system?

Clinicians, Clinics and Agencies believe that there has been an INTENDED consequence with the tightening of regulations (such as CABHA and Medicaid Waiver) - the intention is the eventual reduction of the number of private agencies that provide outpatient Mental Healthcare. Both, agencies that do enhanced services as well as core services, are being purposely circuitously and indirectly liquidated. When looking at lists of agencies that accept Medicaid over time, there was a 50% reduction of agencies after CABHA. With the implementation of the Medicaid Waiver the list has dwindled even further. Initially LME/MCO's have been accepting virtually all agencies that apply but it is anticipated that over the next year the bonsai tree will be trimmed even further with reviews of 'outcome measures.' More and more agencies will not be able to sustain. It is presumed that the final goal is to have a few large agencies contracted across the state.

Now, be advised that I have seen with my own eyes heinous service and billing improprieties in 2005 and 2006 and received backlash from profiteers when I called out inappropriate activities....so, I agree that it is necessary to set clear standards and hold providers accountable... HOWEVER, the zeitgeist is an over-rotation.

Let's see how the pendulum swing, tightening of the noose and reduction of reimbursements is working....

One of the larger agencies that has satellite offices in 15 counties in the central NC area just closed two of it's offices in 2 counties. In a different county where this large agency still has an office the pay for clinicians was cut, then cut again, then cut again, and a colleague of mine who works at this agency said that there were sweeping layoffis in her office. What is interesting is that many community clinicians believed this big multi county agency was one of the golden children that would sustain and still be standing while all the other 'mom and pop' or 'pop up' agencies were dissolved. Well, it seems like no one is immune anymore.

Another colleague of mine described how his multi county agency had radical re-structuring recently, specific Medicaid services were cut and the providers of those services were laid off, and there were across the board pay cuts.

Clinicians have no recourse either - 'if you don't like the pay cut then you can always try to find another job...wait...there are no other jobs since everyone else is closing so I guess you are stuck.'

On another side note, I recently head about a survey of private Psychologists who had been accepting Medicaid. The survey showed that over 40% of them intended to stop taking Medicaid clients due to the increase of regulations and requirements and reduction of reimbursements (all of which makes service provision cost and time prohibitive). Many of these surveyed Psychologists had over 8 years of experience - the intended consequence of reducing providers ALSO reduces your qualified and experienced professional base - these are the providers who know the clients and know the community and know the collateral resources.

I am aware of several private multi-county/multi-provider agencies that used to accept Medicaid clients but have stopped due to the cuts in rates and arduous regulations. What is interesting is that these private non-CABHA agencies provide excellent care, are preferred by clients, and ironically they bill a FRACTION of what CABHA agencies bill.

On February 1st a therapist from NC had an 'opinion' published in the Washington Post called:
"The risk of skimping on mental health funding"
Below is the link to this article which describes his frustrations with the Medicaid cuts in Southern Pines:


Since you may have to do a free 'Register' with the Washington Post online to see the article, here is an excerpt:

For mental health providers in North Carolina, 2013 marks another year of cuts to Medicaid reimbursement rates, which have declined steadily since 2008. States are responsible for a larger portion of mental health services than they are for physical services, which means mental health is hit hard by state budget negotiations. More than $4.3 billionhas been slashed from state mental health budgets nationwide since 2009, according to the National Association of State Mental Health Program Directors. South Carolina, Alabama, Alaska, Illinois and Nevada are among the states that have had the deepest cuts.

The director of our clinic in Southern Pines, N.C., in the center of the state, has told me that this year’s cuts are likely to force us to close. Our facility offers mental-health and substance-abuse counseling to 75 to 100 clients a week, half of whom are 18 years old or younger. Typically, they are referred to us from child protective services, doctor’s offices or the local domestic violence/sexual assault agency.

When the events at the service delivery level are brought to policy makers' attention, I deeply resent their disregarding platitude of "oh well....we know change is hard." Well, it has been change (2001 divestiture and privatization), and change (2005 slashing community support), and change (2006 ValueOptions authorization policy changes) and change (2010 CABHA), and change (2012 Medicaid Waiver) and change (2013 Medicaid rates rates slashed 40% effective 1/1/13 then returned to prior rate on 1/23/13 with delays of payment for 1/13) and change (2013 CPT code changes and Medicaid rate and service time reductions). You don't know how many times I have had to say to clients "....I am sorry but there are NEW Medicaid regulations which will effect you in the following way..." You don't know how many of my colleagues have said to me "....the agency where I was working closed....do you know who is hiring...."). 

Furthermore, I resent the proverbial 'pot calling the kettle black' when Community Agencies, Individual Clinicians, and Private Practices accepting Medicaid are being scrutinized and audited to the point of being inoperable ALL THE WHILE there is waste and mismanagement at the top - DMA mismanagement (http://pulse.ncpolicywatch.org/2013/02/01/problems-identified-by-medicaid-audit-largely-result-of-nc-republicans-own-budget/), cost over runs with Computer Sciences Corporation (http://www.newsobserver.com/2012/06/17/2142627/state-contract-for-updating-computer.html), "structural flaws," and more (http://www.wral.com/audit-mismanagement-costs-nc-medicaid-system-millions/12048026/).

I hope McCrory means what he says ( “We want to make sure that the money that’s supposed to help people is going to them, not to the administrative cost.”) and that 'Medicaid Reform' will have a positive result. I hate to be a 'Negative Nick,' but my fear (based on experience) is that if you squeeze on one side of the tube of toothpaste it gets smooshed (yes...a real word) to the other side....in other words, the ATTEMPT to reduce administrative waste may actually make its way down to the community level in the form of service and provider cuts. We shall see.....

I continue to provide services to Medicaid clients and IPRS clients through contracts with agencies, but it is unclear how much longer I will be able to provide Medicaid services through my own private practice. More to be revealed.

Please forgive the long ramble. I haven't written for a while and a lot has happened. Feel free to write back with your experiences, thoughts, and or comments.

Geoffrey Zeger, ACSW, LCSW
(919) 286-[ redacted ]
[ email address redacted ]

IMPORTANT: The sender intends that this electronic message is for exclusive use by the person to whom it is addressed. This message may contain information that is confidential or privileged and exempt from disclosure under applicable law. If the reader of this message is not an intended recipient, be aware that any disclosure, dissemination, distribution or copying of this communication, or the use of its contents, is prohibited. If you have received this message in error, please immediately notify the sender of your inadvertent receipt and delete this message from all data storage systems. Thank you.

21 February 2013

Provider Stonewalling via Paperwork Nitpicking?

Maintaining Mental Health Services for All

Maintaining Mental Health Services for All

Help Dr. April Harris-Britt and staff continue to serve children, adults, and families who will lose access to much needed mental health services in NC.

[ original post and fundraising page ]

This campaign is to raise legal funds, so that we can continue to fight for the children, adults, and families who will have limited or no access to much needed mental health services.

Short Summary

Our mental health agency has served individuals in our community for 8 years. We provide therapy for children and adults of all ages and backgrounds. A considerable portion of our work is focused on working with children in the foster care system, children who have been abused, and those with developmental disabilities. We provide psychiatric medication management, parenting classes, social groups, and psychological evaluations. We employ more than 25 people, including a Psychiatrist, Psychologists, Counselors, Social Workers, a LMFT, support staff, and even a local high school intern. We are a group of highly skilled, dedicated clinicians who remain committed to serving individuals of all backgrounds and needs, including the Medicaid population ignored by many others. We are requesting your help to continue doing so.

As you have probably heard, there has been enormous scrutiny of the NC Medicaid program and mental health services over the past few years. In a recent effort to revise and improve the system, a process was put into place that has disproportionately and adversely affected licensed independent providers such as at our Agency, and our ability to offer Medicaid services in the future

One such process involves the State requiring providers to submit all of their paperwork to a contracting agency called CCME that will then review and possibly approve payment to be made months after the client has been seen. There is no surprise that CCME has many flaws, inaccuracies, and inefficiencies in their system for monitoring providers. Even worse, they have a financial advantage to rejecting the claims – they get to extend their contracts for saving money. A CCME representative told us directly that they would be "working themselves out of a job" as they moved people off of prepayment reviews. A CCME representative told us directly that there are "tricks" that could ensure that we were taken off of prepayment.We have not tried any tricks as we naively believed that the system would work out!

Believe it or not, providers can not appeal this process. Within the past few weeks, numerous small, large, and long term providers in the area have already either gone out of business completely or stopped taking Medicaid. You will likely be hearing more and more about providers who have either gone out of business or who are no longer going to provide such Medicaid services.

These are a few links that may be helpful for you to put the story into context and to understand that laws have been broken by the DMA/DHHS (the Agency that runs Medicaid), not the providers.





The answer to these political problems should not be to cut Medicaid or to limit the number of providers. If we do, there will be individuals in our schools, workplaces, and communities without needed mental health services. They will likely face higher frequencies of academic, legal, and negative societal outcomes.

I have filed several legal motions due to this being an unconstitutional action and the DMA/DHHS/the State not following policies and procedures to support providers and families needing these services. Our Attorney, Knicole Allen Emmanuel has worked in the State Attorney General’s Office in the past and is now fighting on behalf of providers and small business. We need your help to raise $25,000 in legal funds to fight this process. The outcome of this fight may help establish a precedent that could benefit others. Any amount raised over this amount will be used to cover services for the many families who have already lost their therapy. No amount is too small and we do appreciate your support.

Other Ways You Can Help

If you can not make a contribution, we understand. But please share our campaign with others and spread the word about how these types of actions can and will impact the children and families in our schools, neighborhoods, and communities.

Insult to Injury: Expungement?

Re: Talk about insult to injury?!! Fwd: [lme_providers] Expunction of Criminal Records in North Carolina
From: Crystal J. De la Cruz
Thu, Feb 21, 2013 at 1:35 PM

Dear Families, People of Conscience, Senators and House Members, and Federal Representatives,

Pardon my French, but seriously, WHAT THE HELL?

Please see below an listserv I received today in which Eastpointe MCO's CEO, Karen Salaki, offers up to her colleagues and underlings a helpful reference guide to Expunction of Criminal Records in North Carolina presumably for MHDDSA professionals and staff... which, in my humble opinion, is not only completely inappropriate for this field, but begs to question:

  1. Is criminal activity really such a problem for employees in North Carolina's field of Health and Human Services that it warrants dissemination of this information to the entire NC Local Management Providers listserv?
  2. And this problem, is it a global epidemic throughout the entire I/DD field or is it isolated to say, direct care staff who work with clients who can neither defend themselves and, in most cases, communicate their needs or fears?
  3. Is there such a shortage of decent, trustworthy, qualified applicants that we gotta break the levy in order to widen the pool because it's near impossible to find direct care staff willing and able to work for what pitiful portion of funds are left after the hierarchy trickle-down?
  4. Would you knowingly allow a convicted felon (even a non-violent one?) access to your home and more importantly, to babysit your children? How about a someone with just a little ole Class 2 Misdemeanor charge (in NC, charges of Simple Assault and Shoplifting are both Class 2 Misdemeanors, while Speeding is a Class 1) And would you allow this same individual to care for your elderly mother with dementia?
  5. When are we as a society, as a state, as a community - going to STOP subscribing to this unwritten American caste system of human value?

I really hope this is a misunderstanding, however, given the trends of this entire Medicaid process, it feels more par for the course.

We, the parents and family members, are still waiting to be heard and taken seriously regarding our experiences, knowledge, expertise, fears, concerns, and stuff like this that we're simply shocked and appalled about. Gosh, there's really no end to all we could accomplish if we all chose to work together... Just sayin'.

Thank you in advance for you time and attention. As always, please do not hesitate to contact me at any time.

Kind regards,
Crystal J. De la Cruz - Hopper
Mother, Advocate & Concerned Citizen

When we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – We Are in Crisis.


"The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled."
--Hubert H. Humphrey

----- Forwarded Message
From: Listserve Administration
Reply-To: Listserve Administration
Date: Tue, 19 Feb 2013 16:53:33 -0500
To: NC Local Management Providers
Subject: [lme_providers] Expunction of Criminal Records in North Carolina

To: Provider Network
From: Karen Salacki, Chief of External Operations
Re: Expunction of Criminal Records in North Carolina

Attached is a very helpful guide on how to have eligible offenses removed from criminal records. Please share with applicable staff within your agencies.

This e-mail is for informative purposes ONLY.

Please do not reply to this e-mail.


You are currently subscribed to lme_providers as: janet.presson@asmallmiracleinc.com.

To unsubscribe click here: http://lists.unc.edu/u?id=53091867.3571bb40e36a7e70f1361fb08a87d445&n=T&l=lme_providers&o=32779787

(It may be necessary to cut and paste the above URL if the line is broken)

or send a blank email to leave-32779787-53091867.3571bb40e36a7e70f1361fb08a87d445@listserv.unc.edu

Public Records Law Statement:
Please be advised that any e-mail sent to and from this e-mail account is subject to the NC Public Records Law and may be disclosed to third parties.

Confidentiality Statement:
This e-mail transmission and any documents, files or previous e-mail messages attached to it may contain confidential health information, such documents are legally privileged. The authorized recipient of this information is prohibited from disclosing this information to any other party unless required to do so by law or regulation. Recipients are required to destroy such information after its stated need has been fulfilled. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this information in error, please notify the sender immediately and delete the e-mail and accompanying file attachment.

------ End of Forwarded Message


14 February 2013

FW: [ProviderNet] Hundreds of NC Lic. Mental Health Therapist unable to work

From: ProviderNet@yahoogroups.com
Sent: Thursday, February 14, 2013 11:56 AM
Subject: [ProviderNet] Hundreds of NC Lic. Mental Health Therapist unable to work

Hundreds of NC Mental Health Therapist unable to work.

Our newly licensed therapist in our office applied for Medicaid enrollment and were informed that in accordance with North Carolina session law 2011-399:

"The Department shall conduct provider screening of Medicaid and Health Choice providers in accordance with applicable State or federal law or regulation. The Department must screen all initial provider applications for enrollment in Medicaid and Health choice, including application for a new practice location, and all revalidation requests based on Department assessment of risk and assignment of the provider to a categorical risk level of "limited," "moderate," or "high." If a provider could fit within more than one risk level described in this section the highest level of screening is applicable."

Public Consulting Group (PCG) on behalf of the North Carolina Division of Medical Assistance (DMA) will be conducting an onsite screening.

Public Consulting Group (PCG)
55 Capital Center Drive, Suite 550
Raleigh, NC 27606
The session law required the completion of 3- classes however, the classes are NOT available and NO ONE at PCG is answering the phones to provide information.

How can the legislature pass a law mandating the completion of training as a prerequisite for Medicaid Provider enrollment and not ENSURE that the training is available?

We are also being told that DMA will not back date the enrollment date.

So now we have two therapist that cannot provide services to Medicaid consumers and therefore do not earn enough money to support themselves. They are working PT and looking for other work to supplement their income. Many consumers that need therapy don't get it.

Does anyone at the North Carolina General Assembly care about the workers in this state?
Who will fix this?

13 February 2013

DHHS Invites Stakeholders to the Table: Begins Process for Long-Term Reform & Innovation in Medicaid

Dear All,

I know MANY of you have some terrific ideas on how to improve Medicaid service system... and here is the PERFECT opportunity to get them heard!

Please look over this Request for Information (RFI) from the new DHHS Secretary as they are looking for stakeholders who have ideas on how to better provide Medicaid services in our state.  Stakeholders definitely include consumers and families across the state, too!

This is a top level opportunity to provide needed input for reform in better utilizing dollars to meet the growing needs.  Please take a moment to read and consider how YOU can get involved in this work.



p.s.  Doug Wright is the Director of Consumer Affairs for Alliance (Wake & Durham & now interlocally linked with Cumberland and Johnston)
Note:  CFAC stands for "Consumer Family Advisory Committee"  and has advisory requirements as set in NC Statute 122C

----- Forwarded Message -----
From: Doug Wright <DWright@alliancebhc.org>
To: Alliance CFAC Members
Sent: Tuesday, February 5, 2013 12:05 PM
Subject: FW: NEWS RELEASE: DHHS Invites Stakeholders to the Table: Begins Process for Long-Term Reform and Innovation in Medicaid

From: Ellen Holliman
Sent: Tuesday, February 05, 2013 11:56 AM
To: SeniorManagement
Cc: yvonne@nc-council.org
Subject: FW: NEWS RELEASE: DHHS Invites Stakeholders to the Table: Begins Process for Long-Term Reform and Innovation in Medicaid

DHHS Invites Stakeholders to the Table
Begins Process for Long-Term Reform and Innovation in Medicaid
RALEIGH, N.C. – Today, the North Carolina Department of Health and Human Services (DHHS) published a Request for Information (RFI) for recommendations to assist the DHHS Division of Medical Assistance (DMA) in improving the efficiency and effectiveness of the state’s Medicaid program.
“Reforming Medicaid is crucial to everyone in North Carolina,” said DHHS Secretary Aldona Wos, M.D. “By publishing this RFI, the Department of Health and Human Services is inviting North Carolina healthcare providers to the table and also encouraging citizens with innovative ideas to participate.”
Today’s RFI released by the department marks the beginning of a process to engage interested parties to bring long-term reform and innovation to the state’s Medicaid system. Recommendations will be evaluated by leadership and utilized as a platform for future discussions. All recommendations must be submitted to the Division of Medical Assistance by March 15, 2013 at 2 p.m.
“We are seeking information and input that will help build a state-of-the-art, sustainable Medicaid program,” said Carol Steckel, director of the Division of Medical Assistance. “We must prove to the residents of North Carolina that the program can provide high quality access to health care services while at the same time, manage the tax dollars entrusted to us in a better, more efficient way.”
The North Carolina Department of Health and Human Services (DHHS) and the Division of Medical Assistance (DMA) are charged with operating the state’s Medicaid program, which provides health care services for over 1.5 million North Carolinians. A recent audit of the program raised concern over multi-year cost overruns and the need to better manage the budget.
A copy of the RFI and an open letter from Secretary Wos is attached.  The RFI may be found at https://www.ips.state.nc.us/IPS/Default.aspx , search for 30-DMA100-13.

11 February 2013

legislative correspondance to Senator Neal Hunt

UNSUBSCRIBE & personal note Re: Neal Hunt News
1 message

Crystal J. De la Cruz <delacruz.hopper@gmail.com>Mon, Feb 11, 2013 at 12:46 PM
To: "Sen. Neal Hunt" <Neal.Hunt@ncleg.net>

Dear Senator Hunt,

As your constituent, I met with you last year for a brief half hour regarding critical concerns as a parent for the Intellectually and Developmentally Disabled recipients caught in the middle of North Carolina's Medicaid reform "bru-haha." You were very kind and attentive though by your own admission, you were unfamiliar with the Health and Human Services programs that serve and help support children and adults like my daughter. I left you with quite a bit of paperwork. I never received any feedback, though perhaps I should have been more proactive in following up; I can only imagine however that you are as busy as I am.

I am writing to request that you please unsubscribe me from your mailings. 

I am not interested in political finger-pointing regarding who did why and for how much when current NC House and Senate cannot even be bothered to understand not only the Medicaid budget but the irresponsible dynamics behind the shortfalls and more importantly, the devastating repercussions to our state's most vulnerable citizens. In my humble opinion, we as a state will never be able to move ahead until we ALL begin to recognize our commonalities and work together with the very best of intentions for every one, not just those of like minds. 

Regarding the Medicaid reform, there are still very real issues endangering the livelihood of families such as mine, threatening the supports and services which allow us to work and provide for our families. 

To date, to my knowledge, no one outside of the DHHS "powers that be" and the like (MCOs and LMEs) have been permitted to speak / present to the NCGA nor even to the DWAC, unless you count the 3 minute allotment of time. Advocacy groups such as Disability Rights and The Arc of NC are accused of having an agenda (does not everyone?!!) and family members who sometimes drive hours just to speak up are most often met with condescension.

North Carolina historically is not a proactive state with regards to the welfare of the people. This issue will be no different as there are far too many egos on the line and obscene amounts of money invested in an unprecedented system of care. Meanwhile, it seems no one is interested in hearing from those who have the most to lose - the recipients and their families. Never mind those family members of recipients who are uninsured themselves. 

Our exhausted pleas continue to fall on deaf ears.

Again, I thank you for your time and as always, I invite you to contact me anytime.

Kind regards,

Crystal J. De la Cruz - Hopper
Mother, Advocate & Concerned Citizen

When we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – We Are in Crisis.

"The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled."
          --Hubert H. Humphrey

On Fri, Feb 8, 2013 at 11:51 AM, Sen. Neal Hunt <Neal.Hunt@ncleg.net> wrote:

Legislative Newsletter

309 LOB

February 8, 2013


On January 30th, the General Assembly convened to begin the work of the long session. The pomp and circumstance of opening day is over and it is now time to begin solving our state’s major issues. I’m confident that the Senate will foster solutions to help alleviate our state’s fiscal problems and get us back on the road to prosperity.

The NC Senate leadership will focus on common sense, business-friendly approaches to our state’s fiscal issues. In addition, we will block federal mandates that we know will put North Carolina further into debt. Here is a summary of what we hope to accomplish this session:

1.    The Budget – I have the pleasure of serving as one of the three chairs to the Senate Appropriations Committee. Our state government needs to run a budget like any North Carolina family or business. When the leadership took office in January 2011, we inherited an approximately $3 billion budget shortfall from the previous leadership. This shortfall was created by excessive government spending, termination of federal stimulus dollars, and loss of revenue due to the recession. Last session, we created a balanced budget that cut wasteful spending, lowered taxes, and created more funding for teachers. We will face many challenges due to Medicaid funding and other federal mandates, but rest assured we will pass another balanced, common sense budget.

2.    Tax Reform – We need to modernize our tax system to make our state more competitive with other states and the global economy. North Carolina’s top personal income tax rate is the highest in the South and the 11th highest in the nation. The lowest personal income tax rate is higher than or the same as the highest rate in all but two southern states. Our corporate tax rate of 6.9% is also the highest in the southeast. We must reform our system to promote business productivity and lower our unemployment rate of 9%. Some proposals being discussed that we will explore include:
·         Lower or eliminate the personal income tax
·         Lower or eliminate the corporate tax
·         Broaden and increase our state sales tax to include services (legal fees, haircuts, movie tickets, etc.).
·         Implement a reasonable flat corporate business fee instead of a corporate tax
·         Implement a real estate transfer tax small enough to make sure we don’t stifle transactions.
·         Eliminate taxes on business to business transactions, and
·         It will be revenue neutral.
We also need to address how the poor and elderly will be affected by adding sales tax to
food.  I believe a tax rebate will probably be offered in the event the personal and corporate
income taxes are eliminated. I look forward to debating these proposals as we make sure we
have the best tax reform solution. Our goal is to produce a tax system that is transparent,
simple, and promotes economic growth and prosperity for all.  It is about 50 years overdue as
we transitioned from a manufacturing economy to a service oriented one.
3.    Unemployment Insurance Reform – Currently, North Carolina has the most generous unemployment insurance in the southeast. The state is required to repay $2.57 billion to the federal government that was borrowed to pay unemployment benefits after unemployment soared during the recession. This is a heavy burden on our budget, and our businesses that pay for all federal unemployment insurance (FUTA). As long as the money is owed, the federal unemployment taxes that employers pay will increase $21 per employee each year. Our economic situation has left thousands of North Carolinians unemployed and looking for work. We believe we have to provide adequate unemployment insurance to our state’s unemployed, but still remain conscious about our state’s business environment by providing an atmosphere for business and employment expansion.

4.    Election Reform – This session will bring many changes to our election laws, including:
·         Voter ID - Providing photo identification to vote is necessary to combat voter fraud in our state. I have no doubt that a voter ID bill will pass both chambers and that Governor McCrory will sign it into law.
·         Early Voting - I expect we will see an effort to shorten the time period of early voting. This attempt to generate more voters during an election is costly to local government, confusing to voters and has not increased voter turnout.
·         Partisan Judicial Races - I am cosponsoring Senate Bill 39, which will make judicial elections partisan. Voters should not be blind to judicial candidates’ views.
·         Publically Financed Political Campaigns – I believe we will see an effort to eliminate tax payer funding of judicial campaigns.

5.    Medicaid Expansion – In the Supreme Court decision on the Affordable Care Act (Obamacare), the court exempted states from the federal mandate to expand Medicaid eligibility. I do not support expanding Medicaid given the tremendous budgetary burden of an expansion. Just last year, the General Assembly was forced to fill a surprise Medicaid shortfall that totaled more than $500 million. An expansion of the program would add hundreds of millions of dollars in additional state costs to our Medicaid budget through 2019. I am focused on identifying solutions that meet the challenges facing our state and fostering a health care system that offers more accessible and affordable care to North Carolinians.
6.    Obamacare – I have cosponsored Senate Bill 4, a bill that would prevent the establishment of a North Carolina health benefit exchange as provided by the Affordable Care Act (or Obamacare). Senate Bill 4 passed the Senate on February 5th(32-17) and now moves to the House. Obamacare specifies that each state must have in place a health exchange where individuals and small businesses can purchase health care coverage. Implementing a federally mandated, state-run exchange or a state-federal partnership would have serious unintended consequences for NC.  A state-run program will only force our taxpayers to foot a massive bill for administrative, infrastructure, and operational expenses. Obamacare was a federal bill that I and many others believe was a serious mistake.  The states should not be forced to shoulder the burden of funding and implementing it.

We have many great new policy ideas for North Carolina. These policies will lead to private sector job growth, generate a new business-friendly environment and reinvigorate the private sector economy.

As always, I greatly appreciate the opportunity to serve you in the Senate. If you need anything, please don’t hesitate to contact my office; your comments and thoughts are always welcome.


Neal Hunt

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NC DHHS Request for Information

Governor Pat McCrory and Aldona Z. Wos, M.D. Governor Ambassador (Ret.) Secretary DHHS 

To Whom It May Concern: 

The North Carolina Department of Health and Human Services (DHHS) is pleased to issue a Request for Information (RFI) requesting recommendations that will assist the Division of Medical Assistance in improving the efficiency and effectiveness of our state’s Medicaid program. As has been widely reported in the news media, the Division has not been managed in a way to use our resources most efficiently. This has not only resulted in a loss to the taxpayers through significant budget shortfalls for several years in a row, but also to patients, providers and other stakeholders in the state’s Medicaid program. 

Medicaid Director Carol Steckel and I are committed to transforming the operations of the Division of Medical Assistance through innovation and reform. We strongly believe that we must prove to the residents of North Carolina that the program can not only provide high quality access to health care services to our recipients, but also manage the tax dollars entrusted to us in a better, more efficient way. We intend to restore trust in the Division and look forward to a collaborative reform process. 
This RFI represents an effort on our part to quickly collect recommendations from any appropriate entity. We encourage bold recommendations. We also encourage recommendations that are both comprehensive in nature or address only one area of service such as long-term care. These recommendations will be evaluated by the Division’s leadership and utilized as a platform for future discussions regarding innovation and reform of the state’s Medicaid program. 

The due date is aggressive, but the importance of our task to the state of North Carolina requires the utmost urgency and innovative thinking. I encourage each of you to come to the table, respond to the RFI and be part of the transformation of the Medicaid program in our state. 


North Carolina Department of Health and Human Services 
Division of Medical Assistance 
Request for Information 
February 4, 2013 

Request for Information 

The North Carolina Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA), is charged with operating the North Carolina Medicaid program which provides health care services for over 1.5 million North Carolinians. The current Medicaid budget is over $13 billion. Concern over multi-year cost overruns and the need to better manage the budget and improve the quality of care has led DHHS to seek information regarding innovative system and payment reform. 
DHHS is interested in receiving information, recommendations and suggested approaches regarding innovative system and payment reforms to the Medicaid program that are based on the following principles: 
  • Are market-based and utilize NC community-based providers 
    • In addition to complying with federal laws and regulations regarding access to services for recipients, DHHS expects respondents to utilize local providers
    • DHHS expects respondents to utilize cutting-edge reimbursement methodologies, incentives and other financial efforts in order to create a system that reimburses for proven and documented results
    • DHHS prefers to receive recommendations and information from respondents familiar with the North Carolina healthcare system and those recommendations and information include approaches that build on the current community care network by enhancing that system’s effectiveness and building partnerships with other primary care providers
  • Enhance recipients’ personal responsibility both for financial participation and health care decisions 
    • While this issue has been attempted in a variety of ways DHHS seeks any and all information that encourage recipients to make better choices and improve their health 
    • Use of co-pays, deductibles and other allowable financial incentives will be acceptable and encouraged 
    • Use of non-health service incentives, such as added services, weight loss program and other ways to encourage and achieve an improved health status of recipients 
  • Assess optimal level of benefits to appropriately meet the health care needs of Medicaid recipients 
  • Provide both short term savings for the Medicaid program and provide a sustainable, predictable Medicaid program for the future; respondents should describe how it will create more appropriate care, at lower costs and with better outcomes versus the fee-for-service system over the short, intermediate and long terms. 
  • Create payment policies that provide incentives to create a system that provides the right level of care at the right location 
    • DHHS seeks to build on the development of patient-centered medical homes that encourage recipients to build a long-term relationship with a primary care provider instead of utilizing the emergency department. 
    • DHHS seeks approaches in which the CCNC “patient portal” can be expanded beyond its current limitations (accessible only by care providers at present) to provide ED providers and hospital staff information currently available in the portal regarding the tests, prescriptions and services provided to Medicaid patients so that ED care can be better delivered and coordinated with the patient’s past medical history and providers. 
  • Utilize accepted and verifiable financial measures to evaluate and assess the efficiency of the program 
    • While DHHS seeks recommendations and information on the appropriate measures, DHHS proposes utilizing those measures already being used in the Medicare and Medicaid programs to avoid duplication in reporting. 
  • Utilize accepted and verifiable quality, utilization, customer satisfaction metrics to ensure efficacy and appropriate levels of care and service
    • While DHHS seeks recommendations and information on the appropriate measures, DHHS proposes utilizing those measures already being used in the Medicare and Medicaid programs to avoid duplication in reporting. 
  • Address the need for coordination between physical health and behavioral health 
  • May include information that address the full continuum of care, including long term care support and services 
  • Focus on improving the health of our citizens and lawful residents 
  • May require either Medicaid State Plan Amendments (SPAs) and/or waivers from Title XIX rules and regulations. DHHS encourages respondents to address how the Medicaid SPA and/or waiver would be phrased in order to enhance US DHHS approval in a rapid time frame. 

DHHS encourages respondents to address the use of North Carolina’s Health Information Exchange in order to provide health information to both the provider community and recipients as appropriate 

DHHS purposefully provided only an outline of goals for its program in order to receive recommendations, information and suggestions for approaches that are innovative. DHHS seeks information regarding programs that will build a state-of-the-art, sustainable Medicaid program. DHHS asks that respondents think boldly in the submissions. DHHS will consider all recommendations, information and suggestions for approaches including those that utilize the existing Community Care Networks or any other coordinated care proposal. 

Entities who submit documentation in response to this RFI may be invited to present their ideas in person to Agency leadership. An in-person presentation by an entity that submits documentation in response to this RFI will not serve as the basis for precluding that entity from responding to any future RFP or RFA regarding system reform. 

The responses to this RFI, any follow-up questions and the presentations to the DHHS may be used to design a system of health care for the North Carolina Medicaid program. 

RFI Response Requirements 

Respondents to this RFI are asked to be thorough but concise. The response to this RFI should include the following: 
  • The respondent’s name, address, place of business address(es), contact information, including representative name and alternative, if available, telephone numbers(s), and e-mail address(es). 
  • DHHS seeks to solicit recommendations and information from respondents that are North Carolina entities that are licensed providers participating in Medicaid, including provider groups that participate, hospitals, provider networks that are provider owned or provider based. DHHS recognizes that respondents to this RFI may include individuals in other settings such as academia. 
  • A description of the respondent’s business and/or its experience as it relates to the services outline in this RFI. This description should include a narrative explaining past experiences in which the respondent has engaged with other health care payers, health care agencies, health care providers or government agencies in the area of Medicaid, health system design, managed care, long term care programs. The respondent shall indicate any Medicaid experience it has for services similar in nature to those described in this RFI. 
  • A description of how the respondent’s approach will offer advantages or improvements over existing processes. The description should also identify known or potential concerns with or barriers to the approach. 

Confidential Information
In accordance with 01 NCAC 05B.1501 the State may maintain confidentiality of certain types of information described in N. C. Gen. Stat. 132-1 et. seq. Such information may include trade secrets defined by N.C. Gen. Stat. 66-152 and other information specifically exempted from the Public Records Act pursuant to N.C. Gen. Stat. 132-1.2. Respondent may designate appropriate portions of its response confidential, consistent with and to the extent permitted under the Statutes and Rules set forth above, by marking the pages containing confidential information with boldface type at the top and bottom of each such page stating, “CONFIDENTIAL”. By so marking any page, the Respondent warrants that it has formed a good faith opinion, having received such necessary or proper review by counsel and other knowledgeable advisers that the portions marked confidential meet the requirements of the Rules and Statutes set forth above. The State may serve as custodian of Respondent’s confidential information and not as an arbiter of claims against Respondent’s assertion of confidentiality. If an action is brought pursuant to N.C. Gen. Stat. 132-9 to compel the State to disclose information marked confidential, the Respondent agrees that it will intervene in the action through its counsel and participate in defending the State, including any public official(s) or public employee(s). The Respondent agrees that it shall hold the State and any official(s) and individual(s) harmless from any and all damages, costs, and attorney’s fees awarded against the State or official or individual in the action. The State agrees to promptly notify the Respondent in writing of any action seeking to compel the disclosure of Respondent’s confidential information. The State shall have the right, at its option and expense, to participate in the defense of the action through its counsel. The State shall have no liability to Respondent with respect to the disclosure of Respondent’s confidential information ordered by a court of competent jurisdiction pursuant to N.C. Gen. Stat. 132-9 or other applicable law. 

Response Submission 

Please note: This is a request for information only and not a request for services. 
Respondents to this RFI shall submit one electronic copy of its response. The response shall not exceed twenty one-sided pages in length. The electronic format shall be submitted on CD-ROM. The software used to produce the electronic files must be Microsoft Word 2010 or newer. 

The respondent shall also submit one electronic redacted copy of the response suitable for release to the public. Any confidential information should be either redacted or completely removed. The redacted response shall be marked as the “redacted” copy and contain a transmitted letter authorizing release of the redacted version of the response in the event the Agency receives a public record request. We request that all interested parties respond to this RFI by submitting your responses by 2:00 p.m. EST, Friday March 15, 2013

For responses sent via US Mail, responses should be sent to the following address: 
NC Department of Health and Human Services 
Office of Procurement and Contract Services 
Attn: David Womble 
2008 Mail Service Center 
Raleigh, NC 27699-2008 
Hand delivered responses, or responses sent other than via US Mail, should be sent to the following address: 
NC Department of Health and Human Services 
Office of Procurement and Contract Services 
Hoey Building 
Attn: David Womble 
801 Ruggles Drive 
Raleigh, NC 27603 
IMPORTANT NOTE: Indicate firm name, and RFI-DMA100-13 on the outside of the envelope or package. Faxed or emailed responses will not be accepted. 

Respondent Costs 

Respondents are solely responsible for all costs incurred by the respondent in preparing and/or submitting a response to this RFI. Neither the state of North Carolina, DHHS nor DMA shall be responsible for any respondent costs associated with preparing and/or submitting a response to this RFI or any costs associated with presentations if requested. 


Verbal questions will not be accepted. Clarification questions related to this RFI must be emailed to David Womble by 2:00 PM February 14, 2013 at: 

If applicable, answers to the questions or any other information concerning this RFI will be posted to the IPS Website (www.ips.state.nc.us) by February 20, 2013 under RFI # 30-DMA100-13. 

Rights to Submitted Materials 

All responses, inquiries, or correspondence relating to or in reference to this RFI, and all documentation submitted by the various respondents shall become the property of DHHS when received. Ideas, approaches, and options presented by respondents may be used in whole or in part by the State in developing a Request for Proposal (RFP) should DHHS decide to proceed with an RFP. Further, combinations of ideas from various respondents may also become part of a RFP, based on consideration of RFI various submissions and the needs of DHHS, which may differ from respondent’s experiences in other places. 

Obligations of the State 

DHHS may choose to issue an RFP for the development and implementation of innovative system and payment reforms to the Medicaid program. However, this RFI is not a guarantee that an RFP will be issued for some or all of the services about which ideas and approaches are being sought. 
If the state does determine that these services are of a benefit to the state an RFP will be issued. Until then all information sent in by respondents for this RFI will remain confidential until after the award of the RFP or until the state makes the decision to not issue an RFP.