31 July 2012

What's New in July

July 2012 Events and Updates.


Free Event: Role of Advocates in Health Care Reform 8/24

From: Titus, Trina
Tue, Jul 31, 2012 at 11:15 AM
Re: URGENT - AUGUST 24 CONFERENCE - PLEASE READ

Hi Coalition, PLLF, and Other Colleagues

On behalf of the Steering Committee for the Patient Advocacy Leaders Summit I want to ask your help in spreading the word far and wide about the PALS conference to be held on Friday, August 24 at the Friday Center in Chapel Hill.

The theme of the day is "The Impact of Health Care Reform on Patients: what is the Role of Advocates?" Attendance is aimed at people in advocacy, policy roles - members of your staff, CFAC members, anyone who is interested in public policy around health care reform and how to make an impact for people.

There is no charge for this event - the Steering Committee has received a grant from GSK which is being administered by the NC Psychological Foundation.

*See attached flyer and registration form.*

Due to the funding, licensed providers and state employees are not eligible to attend.

A list of the Steering Committee is posted below.

WE NEED YOUR HELP. Please send this information out to your networks to encourage people to attend. It is an excellent opportunity to hear from Pam Silberman from the NC Institute of Medicine about what will happen now that the Supreme Court has upheld the Affordable Care Act. The person who will be speaking on using social networking and media messaging is an expert who will give us practical advise on these important tools.

Lunch and the afternoon will be devoted to brainstorming about practical ideas and solution in North Carolina. 

While this isn't just about behavioral healthcare we want a huge showing from our community.

Please send this far and wide, consider having someone from your staff attend. Thanks and let me know if you have any questions.


Really appreciate your help.

Sally

Sally R. Cameron, Executive Director
NC Psychological Association & Foundation
1004 Dresser Court #106
Raleigh, NC 27609
919-872-1005 phone
919-872-0805 fax
ncpasally@mindspring.com

CONFIDENTIALITY: This e-mail (including any attachments) may contain confidential, proprietary and privileged information, and unauthorized disclosure or use is prohibited. If you receive this e-mail in error, please notify the sender and delete this e-mail from your system.

Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized State official. Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this e-mail in error, please notify the sender immediately and delete all records of this e-mail.

2 attachments

NCGA JLOC on HHS Committee Meeting 8/14

NORTH CAROLINA GENERAL ASSEMBLY
Raleigh, North Carolina 27601

July 31, 2012

MEMORANDUM

TO: Members, Joint Legislative Oversight Committee-Health and Human Services

FROM: Senator Louis Pate, Co-Chair
Representative Justin Burr, Co-Chair
Representative Nelson Dollar, Co-Chair

SUBJECT: Meeting Notice

DAY:  Tuesday
DATE:  August 14, 2012
TIME:  10:00 am - 3:00 pm
ROOM:  643

If you are unable to attend or have any questions concerning this meeting, please contact Rennie Hobby at 733-5639.

cc:   Committee Record _X_
       Interested Parties _X_

30 July 2012

Labels are for Jars.

Received a mail recently from a dear ole friend of mine, Joe Genera, and thought it appropriate to share his wisdom regarding labels and the human experience... but first, a bit about Joe:

I first met Joe in biology class as a student at Wake Tech, way back before marriage, before Isabel, in a time when I was "young, wild and free" as they say... As my "right brain" has consistently proven to be far more developed than my left, I quickly aligned myself with a sciency-minded study partner, who happened to be Joe. Not only was he (and remains to be) among the most down-to-earth, likable  fellows I've ever met, he's also wise beyond his years and exceptionally intelligent (which made for an excellent choice in lab partners). We became fast friends, sharing many experiences and countless laughs together. I sometimes camped at his house as he was one of the only people I knew back in the days of floppy drives to own a personal computer; I hammered out many a Criminal Justice term paper in his home office in the wee hours of the morning. And he took me to my first theatrical performance - Cats - and opened my eyes (and soul) to a new way of thinking about the poetry of life...

Joe was a slightly older-than-me single dad back then of a beautiful, young active girl who most days drove a sporty teal-blue convertible Corvette - on other days, he drove a custom van outfitted with a lift.

You see, once upon a time Joe was a young ramble-rouser with an affinity for restoring old hot rods... One day, the unimaginable happened when a car slipped from the garage lift pinning Joe beneath and crushing his spine - forever changing life as he knew it. And yet he finished school, worked, raised a daughter, and is a successful business owner, fierce disability advocate and a soon-to-be published author.

(If you want to know anything else, you'll have to read the book, "Arrested Youth" for it's not my tale to tell.)

These days though, back in Connecticut, it is no surprise that he still uses his powers for good, operating an autobody repair shop and program called Team-MuscleCar, LLC: "'TEACHING TEENS - ONE HOT ROD AT A TIME' tm Mentoring to keep kids in school by having them use their hands and minds, and expanding their life skills."

----------- from Joe...

Crystal - just saw your post about labels - thought this might hit a cord with you. An Op-ED piece I did last month.

"LABELS ARE FOR JARS – NOT PEOPLE." – Joseph P. Genera

In the thirty years since a car slipped off a lift, falling six feet through the air before breaking my back as it crushed my spinal cord, I have gone through many life changes. Some, like adapting to a world from a suddenly shorter stature and navigating a bumpy world via a wheelchair, took some getting used to. Other changes, like how the world saw me, or more pointedly - labeled me as, has been one of the more challenging aspects to get used to.

In the three decades since my world so abruptly changed, I have gone from being a ‘cripple’ to a 'person with a disability', with about ten other labels in between. Not because I myself had made any significant changes, or had some miraculous healing come my way. No, the different labels arose from our American society deciding that one name was better, or more ‘politically-correct’, than another. And as with other minority groups, I was personally never asked myself what I would like to be called.

In my own lifetime, I have seen the currently 'P.C.' African-American named population referred to as colored, black, people of color, evolving to today's accepted 'African-Americans.' But, I don't remember there ever being a vote taken of that population, asking them what they as a people, would prefer.

In the case of the 55 million 'persons with disabilities’ in America, there has never been a caucus of any kind that has asked, "What would you like to be called?"

And yet, in the last thirty years I have been dubbed everything from crippled, infirm, afflicted, handicapped, handi-capable and differently-abled. I have been wheelchair-bound, as if I never leave the chair to bathe, sleep or love. One of my least favorite of all is to be branded as an ’invalid,’ which suggests that portions of society thinks that people such as myself are not considered valid members of our world.

Today, the favored phrase seems to be 'person with a disability.' If there has to be a label, this one is probably the least offensive, in that it at least puts the person before whatever condition or impairment that affects his or her life. While positive in nature, who knows how long this current term will be in favor before our polite world decides that I need to be called yet another unasked-for label. In fact, the ‘new and improved’ title that the national media seems to be trying to adapt today is the instantly dependent sounding label: ‘special needs population.’

No, no, no! People with disabilities do not want to be seen as special – they want to be seen as people, period. And they/we certainly do not want to be perceived as needy. As disability can affect any one of us at any time, with little consideration as to race, sex, religion or socioeconomic status, those who come up with these ‘titles’ should ask themselves – ‘If I were hit by a bus tomorrow and became paralyzed, would I want to be immediately affixed with the label ‘special needs person?’

In this country, much time, thought and energy go into defining what is politically correct, what words are best to use to ensure that the majority of a specific population is not offended, and so that the rest of society feels good for having come up with the next ‘right thing.’ Even within the ranks of the various disability groups, there is constant in-fighting as to what their own monikers should be. Energies and resources are wasted on such pursuits, when the time could be better used to improve the very real physical and psychological barriers that people with disabilities face every day.

No one wants to be offended, and most people with good sense do not want to offend. That’s the reason why everyone from the average person to the national media struggles with the question "What do we call 'those' people?"

I know exactly what I would say if I were ever polled, or had to vote for the very best label for the world to bestow upon me.

Just call me Joe. Thanks.

----------- my reply...

Dearest Joe, as long as I've known you - a lifetime it seems (I bought my first legal 6-pack with you if you recall [and much to my 21-year-old disappointment, was not even carded]), even back in pre-Isabel days when life for me was oh-so-much-easier though exceptionally less profound - I have never, ever thought of you as "disabled"... You??? LOL Not able to do something - outside of say a running long jump (which if this two of us were competing, you'd probably win truth be told) - preposterous! Pfft... And you know I am not saying this out of some misplaced need to defend myself regarding what I assume you to believe I think; I know you know me... My point is, you are among the most able and capable, intelligent and AMAZING human beings I have ever been blessed to know - who has yet once again, smacked my sensibilities upside the aha... reminding me of the absolute profundity of it all: human connection.

It's really all the same isn't it? There is not a one born among without purpose and no purpose is without importance, nor is one purpose greater than another... regardless of perceived 'ability', color spectrum, belief, education nor status. "Normalcy" indeed is a manmade definition to corral ourselves within our comfort zone. --Until we each recognize these truths within ourselves and step outside of our own limitations, we are doomed to remain ourselves "disabled."

I never imagined I would have another child after Isabel. When Liam came along, it was like being a first time parent all over again; a whole different ballgame! --As he grew and began to become aware of his world, talk and ask questions (OMG, does he talk!), he would ask me why sissy didn't speak or why she does things that she does... I tried to explain to him once that Isabel was "special"... I thought that explanation was a pretty good one and seemed to quiet his curiosities (I should have known better). The next days he came to me crying and told me that he wanted to be "special" too. --From the mouths of babes! Oh, talk about breaking your heart! ...So we had a long talk about purpose and God and how Isabel is as God intended for her to be; that while we may never know her intended purpose for this world, the fact that she does not speak verbally and doesn't think the same way we do was part of her purpose and that purpose was very important... That just maybe her purpose was to teach us to be better people and understand how to love everyone the same?

I have always made a conscious effort to never describe someone by their abilities, ethnicity, etc. because I did not want to plant the seed in his thinking that these things were a measure of an individual. --About a year ago, when Liam was four, it came home to me in such a profound way when he came home from preschool telling us about his new friend, "Johnny"... Who is Johnny we asked, trying to put a face with a name? You know, he said, the boy with the super-hero eyes - and then he put his fingers on each temple by his eyes and pulled back the skin to show us... (Johnny's parent's are of asian decent.) To Liam, his new friend was nothing short of a rock star. =)

Joe: In this world, in this life, we tend to get stuck so often in the gravity of ourselves, our own lives, problems, issues and goings on; I am no less guilty. Though I try to make certain that those sacred souls in my life always know how much I love them, that they have mattered to me in magical ways, and I could not have made it this far without them... You are one of those sacred souls - I know I don't say it often enough... so, just to reiterate: Not only have you shaped me in ways you will probably never know in all the years, but I love you dearly.

Thank you for your words dear one...

----------- from Joe...

Absolutely! And please know that was in no way a rebuke of any kind to you ...at all! I just love reading your posts, personal and the NC ones and thought it might fit... And it does, cuz of who you are!

I am so glad you came and asked about my motorcycle 20 years ago. I love you too Crystal

P.S. And of course you can post!

27 July 2012

I/DD Budget Cuts May Be Worse than Expected

From The Arc of North Carolina

I/DD Budget Cuts May Be Worse than Expected

[ original post here ]

In what is being described as a mistake, a budget transfer intended to move Guardianship funding from one division to another has created an additional 4.3 million dollar cut primarily to community services for people with I/DD.

Department officials and legislative leadership agreed to transfer $4.3 million in the Social Services block grant from the Division of MHDDSA to the Division of Social Services. The money was to be used by either Corporate Guardians or local DSS to provide guardianship services. The transfer was needed because, as LMEs transfer to MCOs, they will no longer be allowed to be guardian for individuals in their catchment areas.

Somehow the transfer of funding happened twice causing an additional cut of 4.3 million dollars to MHDDSA community services funding. Department officials tell us that this was never the intent and discussions with legislative staff point to a mistake, although we have no official confirmation. Unfortunately, the reduction has been included in the allocations to LME/MCO’s and several are taking immediate action to cut services. We are hearing reports that some programs face 20% reductions effective August 1st.

The Arc is calling on the DHHS to ask LME/MCO’s to hold off on implementing this reduction until all possibilities of fixing the problem have been exhausted. This reduction to an already fragile system is unwarranted and will harm individuals with I/DD.

The Arc is also concerned about how LME/MCO’s are implementing the one time $20 million reduction to community services. This cut is an extension of a reduction taken last year. While LME/MCO’s were encouraged to use fund balances to offset this reduction last year, we do not believe most did so. We are seeing a disturbing trend that has LME/ MCO’s passing on this entire cut to people with disabilities and their families. We believe a more responsive approach would be for LME/MCO’s to use fund balances to offset this reduction since it is a non-recurring cut. It does not seem appropriate for the Management Entities, who are charged with ensuring individuals have services, to use fund balances to become MCOs while the people they are created to serve lose services.

We will be tracking these reductions and will continue to encourage the State and LME/MCO’s to find alternatives to wholesale reductions for people with disabilities and their families.

Once we determine what steps the DHHS plans on taking, we will issue an action alert describing what actions people with disabilities and their families should take, if any, to influence these changes.

Related : 

26 July 2012

First LME to become MCO Facing Budget Overruns

From The Arc of North Carolina

First LME to become MCO Facing Budget Overruns

[ view original article ]

Western Highlands Network (WHN), the Managed Care Organization (MCO) that provides state funded services to people with intellectual and developmental disabilities (I/DD) in several western counties, recently reported that they are running a monthly defecit of $500,000 since they became a managed care organization in January 2012. WHN officials indicate they feel the State’s original capitation (reimbursemnt) rate was insufficient to cover the Medicaid cost of their program.

When questioned by members of the Disability Waiver Advisory Committee on July 24th, State officials responded that the budget deficit had been uncovered in a routine monitoring visit and that they would be attending the upcoming WHN board meeting. They offered no further explanation.

Apparently the State, along with the Mercer consulting firm, reviewed WHN in mid -July to determine what was causing the cost overruns. At this time, we do not have the results of this review, but we will report as we find more details.

The revelation of these cost overruns is concerning on many levels. Most importantly, we are concerned WHN will be forced to make significant cuts to services in an area that already has significant numbers of people with I/DD waiting for services. To correct this deficit, WHN plans to evaluate rates paid to providers and the amount of service provided to consumers. If this problem results in service reductions, it will be further evidence that Managed Care “savings” are really just another name for “cuts.”

If the capitation rate is too low, as WHN claims, and the state adjust it upwards, it will erode the “savings” North Carolina hopes to gain from the implementation of the Managed Care Waiver. Such a development would call into question why we would make such a massive change for little gain.

Another concern is how the state deems a MCO ready to proceed. According to state officials, all pending MCOs pass rigorous tests to assure that they are ready to go “live” as a managed care entity. The State contracts with Mercer to engage in this process, as do state officials charged with implementing the Waiver. If WHN was really ready to go “live” in January, it is hard to believe they could be losing money at such a pace.

The Arc believes the WHN staff and DHHS staff are sincerely attempting to find solutions to this serious problem. We hope that this issue is only temporary and that services will not be disrupted to the people this complicated system is intended to serve. However, we do believe this issue should prompt the DHHS and the General Assembly to truly examine the model and pace of this implementation. In an at risk Managed Care system, the only people truly at risk are the people it is intended to serve.

SMC Public Forums re MHDDSAS Funding Cuts

But at least LME executives were authorized those salary increases...

From: smc.news@smokymountaincenter.com
To: marykshort@aol.com
Sent: 7/26/2012 11:31:29 A.M. Eastern Daylight TimeSubj: Community Forums: Funding Cuts for MH/IDD/SA Services



Smoky Mountain Center
Funding Cuts 
Regional Community Forums:
Funding Reductions for Mental Health, Intellectual/Developmental Disability, and Substance Abuse Services 
  • NC's 2012-2013 State Budget includes major funding reductions for mental health, substance abuse, and intellectual/developmental disability. The reductions are effective July 1, 2012.
     
  • The funding reduction for services in Smoky Mountain Center (SMC) counties is $3,482,254.
     
  • Get information about our plan to manage these reductions, and the possible impact for you and others in your community.
     
  • See dates and locations below, or click to view the event flyer
Monday, August 6
6:00 p.m.
SMC Western Region
Administrative Office
44 Bonnie Lane
Sylva, NC 28779 

Tuesday, August 7
6:00 p.m.
SMC Northern Region
Administrative Office
895 State Farm Road
Suite 400-B
Boone, NC 28607 

Thursday, August 9
6:00 p.m.
Caldwell County
Public Library 
120 Hospital Avenue
Room # 7
Lenoir, NC 28645

For Access to Services, call toll-free:
24 hours a day, 7 days a week

    
Smoky Mountain Center manages mental health, intellectual and developmental disability, and substance abuse services in Alexander, Alleghany, Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga, and Wilkes counties in North Carolina.

This is What it's ALL About Folks... from Tampa Bay Times

Twins bond in the gift of the other: Hailey is there for Olivia, born with epilepsy and cerebral palsy

By Rebecca Catalanello, Times Staff Writer
Published Friday, July 13, 2012

[ see original Tampa Bay Times article & video clip ]

CLEARWATER

It was just after the 2 p.m. opening time and already Hailey Scheinman's lemonade stand had attracted a crowd.

The 7-year-old turned around to brush the sleep from her twin sister's eye. Olivia sat quietly in a hot pink wheelchair that was decorated with flowers and butterflies.

Hailey's best friend arrived to help, and the pair jumped up and down at the end of the driveway.

"Lemonade! Lemonade!"

Hailey's friend said goodbye a couple of hours later, and Hailey stood at the edge of the driveway watching the girl's car disappear down the street.

Hailey retreated to the front porch and counted the profits: $142.65, all for her sister's physical therapy.

What makes a good sister?

In the womb, Olivia and Hailey Scheinman formed to the thump of the same heartbeat. Cells divided and organs sprouted, skin and hair knitted together while fluids swirled. Their mother rocked them with her every step.

For reasons no one knows, something didn't proceed normally for Olivia. During the first trimester, her brain didn't form the way it should, the way her twin sister's did.

Her body shook with seizures shortly after birth. At first, doctors diagnosed her with Ohtahara Syndrome, a neurological condition that comes with a high incidence of infantile death. Later, they reassessed, calling what she has multifocal partial epilepsy and cerebral palsy. She has undergone two major brain surgeries and takes a laundry list of drugs to control what Hailey calls "the shakies."

For seven years, life has relentlessly pulled Hailey and Olivia apart — milestone by milestone.

Hailey walked at 11 months, talked at 15 months, kicked her first soccer ball at 5. At 7, Olivia cannot stand and struggles to hold her head up. She smiles when she's happy, but she cannot say it. For years, Olivia's progress has been measured hour by hour, with each letter "S" her mother scribbles on calendars when she has a seizure.

It wouldn't be hard to imagine a scenario in which the trajectory of the sisters' lives simply continues to diverge. But something in Hailey has resisted that. She seems determined not to lose her grip on the being to whom she is closest in the world. Her mom thinks that because of Hailey's efforts, the sisters are closer now than ever.

What makes a good sister?

Hailey Scheinman doesn't have the answer. She's 7.

Hailey Scheinman is the answer.

• • •

It was the week before Mother's Day at Leila Davis Elementary, and the first-graders fidgeted and laughed, many of them sitting "crisscross" on the floor as their teacher had instructed. Hailey was one of them.

Two little girls in wheelchairs appeared on a video screen.

"Hi, Livy!" Hailey waved to the screen. Her teacher called on Hailey to read the first few pages of My Mom to Olivia's class at Paul B. Stephens Exceptional Student Education Center via Skype.

"She's nice, my mom," Hailey read aloud, her head tucked into the hardbound library book. "My mom's a fantastic cook. And a brilliant juggler."

She turned the book toward the videocamera so her sister could see the illustrations.

Ms. Davis called on someone else to read. Hailey took her seat among the other students.

On the screen, a teacher's aide fed Livy PediaSure through a tube connected to her stomach.

• • •

Two rooms. One lavender-painted wall separating them.

On one side, dolls and miniature furniture fill a three-story dollhouse. Children's books cram a bookshelf. Figurines pose around a Harry Potter Lego castle. Family photos, soccer trophies and achievement medals sit on tables and hang on walls. Fairy stickers and butterflies are everywhere.

On the other side of the wall, a red-wheeled mechanical lift is positioned beside a massage table turned changing table. A video baby monitor hangs above the comfy full-sized bed, which is pushed into a corner for safety.

Butterflies adorn this room, too, including a butterfly-shaped pinata from one of the girls' birthday parties. Two plaques from Lampert's Therapy Group hanging above the changing table describe Livy as a "brave child" for her hard work completing two rounds of three-week-long intensive therapy.

One night in March, Allison Scheinman dressed her daughter Livy in soft cotton pajamas that read "Sweet Dreams" across the top. She leaned across the massage table to squeeze a stuffed glow worm that lit up and played Hush, Little Baby. She brushed her daughter's hair, wet from the bath, then lifted her to a sitting position. Livy smiled.

Hailey flitted in and out, wearing a lavender nightgown. When her mom asked her to fetch the "good stuff," Hailey ran to the bathroom to get her sister's toothbrush and toothpaste.

If it were up to Hailey, these two rooms would be one. They'd have sleepovers every night.

But Livy doesn't sleep well through the night, so her parents have told Hailey no. "Maybe one day," her mom has said.

Allison deposited Livy on Hailey's bed. Hailey sat at the edge and searched for her journal.

"Hailey, what are you going to write about?" Allison asked on her way out.

"You'll see," Hailey answered.

In the quiet of the dimly lit room, Hailey hunched over her paper.

After a few minutes of silence, she leaned back to lie next to her sister and raised her journal for Livy to see.

"I just wrote this in cursive for you," Hailey said.

You are the best Livy, it said. Love, Hailey

"And I wrote it in cursive."

Earlier that day, Allison, 37, steered her silver Chrysler Town & Country minivan up U.S. 19 toward her in-laws' vacation home in Clearwater to pick up Hailey.

Livy was strapped in the back of the van, worn out after a therapy session, from moving her body in ways her mom once doubted she ever could.

"I've always wanted to stop things with Livy," Allison said.

Meanwhile, her sister is charging forward into life. "With Hailey, we're like, 'Where's your stop button?' "

"With Livy," Allison said, "I don't want to see the future just yet because I don't know what to expect with it. With Hailey, I want to see her grow and go on to college and get married and have kids. I don't ever want to stop and think about Livy's future. She's not going to grow up and get married. She's not going to have children. We just have to imagine her the way she is."

• • •

Hailey Madison Scheinman was born at Bayfront Medical Center in St. Petersburg on Dec. 15, 2004, weighing 6 pounds 5 ounces, after 12 hours of labor. Nurses showed her to her parents — Allison, a graphic artist with a love of books and theater, and Jon, a lifelong soccer player who worked in finance at HSN — then ushered her to the nursery while her mother labored another hour more.

Four hours later, Olivia Hope Scheinman, 6 pounds 11 ounces, looked up at her father from a crib in the Neonatal Intensive Care Unit at All Children's Hospital in St. Petersburg.

He watched her body shake in her first documented grand mal seizure.

• • •

Twenty-two days later, at home with Olivia for the first time, Jon wanted to be excited. But his videocamera was still.

No one spoke.

Cradled in her grandmother's arms, Olivia's body curled in an infant-sized abdominal crunch.

Crunch. Crunch. Crunch.

Within hours, Olivia was readmitted to All Children's with infantile spasms.

• • •

Eleven-month-old Hailey wobbled excitedly across the living room floor toward her daddy, her hands raised in the air, her mouth open in glee.

Jon's camera captured the steps, then he panned to Livy resting across his lap. Her eyes flickered uncontrollably in what family calls her "blinkies."

• • •

First Christian Preschool teacher Cherryl Sonnenberg couldn't help but overhear the lunch table conversation between two 5-year-olds.

"Does your brother walk?" Hailey asked.

"No," the boy replied. "He doesn't walk."

"I have a sister, Livy, who can't walk. But she rides in a chair," Hailey said. "Does your brother ride in a chair?"

"Yes," the boy said.

"Does your brother eat by himself?"

"No."

"My sister doesn't either."

• • •

Every day before she went to preschool, Hailey slurped down PediaSure in a cup.

She called it her "Livy Shake."

• • •

The kindergartener glued herself to the kitchen stool, repeatedly clicking "refresh" on her parents' laptop computer.

Click. Click. Click.

Her painting had to sell.

Two pink flowers. Two pink ladybugs. One ant hill. One butterfly.

Hailey had titled it Spring Is Coming, and now she was trying to sell it on eBay.

Click. Nothing. Click. Nothing.

Allison and Jon stood by, unsure what to do.

Click.

Five dollars.

Five dollars! Hailey went berserk.

Three days later, Spring Is Coming sold for $66.

Hailey gave the money to her parents to help with Livy's physical therapy bills.

• • •

On a Saturday morning early this year, Livy started having a seizure while napping on the couch.

"Mom," Hailey said as her parents approached, "I can take care of this."

The little girl knelt beside her sister's outstretched body, looked into her face, stroked her forehead with her thumb and held Livy's hand.

Three days later, the Pinellas County School Board had been meeting for 50 minutes before someone nudged Hailey. She left her sister's side, walked to the lectern and stood beside her principal.

"Hailey truly loves her twin sister Olivia," a school district employee told the board. "That is evident in the compassion and pride that she shows in introducing Olivia, who is a special needs child attending Paul B. Stephens School."

Hailey reached up to shake seven hands, School Board members happy to recognize her as a "Young Hero," an award given to students who inspire others.

• • •

Allison pushed Livy's wheelchair through the grass toward Hailey's soccer game. A shamrock garland wound around Livy's chair glimmered in the sunlight — a remnant of the St. Patrick's Day parade teachers held at her school that day.

Hailey saw her best friend, Ainsley Walling, with the rest of their team and ran toward them.

Jon squeezed into a sideline spot among the other parents and set up Livy's blue and white bath chair, which she sometimes uses instead of her wheelchair. For years, Hailey and Livy bathed together, Hailey tucking her legs underneath this very chair. But Livy's legs are longer now, and there's no room left for Hailey.

"Go, Hailey!" Ainsley's mom, Tracey Walling, called from the sidelines as Hailey ran the ball up the field.

Ainsley and Hailey had spent all day in class together and now they were going to spend all night playing together — first on the soccer field, and then at Hailey's house for her first official sleepover.

The two red-faced girls hugged when the game ended. They held hands on the way to the Scheinmans' van, with Livy, Allison and Jon following behind. They laughed as Ainsley shuffled up and down the handicapped ramp after Livy was loaded in.

"Before Jon slid the van door closed, a giggling Ainsley called out from the backseat.

"Can me and Hailey get in the shower together?"

"No," Jon said with a laugh. "I think you'll be taking separate showers."

• • •

In June, Hailey stood beside Livy at an Orlando conference for families of children with disabilities.

"No," Hailey said, holding a microphone in one hand and her note cards in another. "I don't remember what it was like with Livy when I was little. But I can tell you how it is now. First, Livy and I like to cuddle together on the couch. It seems like she is trying to push me off because her arm is pushing against me. I don't think she means it though . . .

"And I would like to tell you about how I feel about having a sister with disabilities. I like to spend a lot of time at home with my sister. We've never had a fight over toys or clothes or anything else. She's always nice to me. I know this because she always smiles at me.

"Sometimes, she tickles me by accident. She always listens to me and she likes my singing . . .

"If Livy didn't have disabilities, I wouldn't be here speaking to you now. I wouldn't know anything about disabilities, and neither would my friends . . .

"She has taught me that everyone should be treated equally and with respect. The only thing she sees in the world is good and so do I. She has taught me how to have more empathy to others. She has taught me how to be a better person."

• • •

In late February, shortly after Hailey won the award from the School Board, Jon got the girls together and read Hailey a thank-you note he'd written for the family's blog, one he imagined Livy might give her sister if she could speak or write.

"To my sister, my best friend, and my biggest supporter . . . you amaze me. You protect me, comfort me and love me like no other. You include me in all that you do and look past my disabilities. You are so proud of me and are not afraid to tell others my story . . .

"You visit me in the hospital when I am sick. You are not afraid of the medical equipment and procedures I have to go through. You console me when I am upset or in pain. When my body doesn't work like it should, you are there to assist me . . .

"I couldn't do this without you. I may never be able to walk or talk, but you make me feel like I can do anything. You frequently tell me I am the best sister in the world. But it is I who could not imagine a better sister than you."

When her father had finished reading, Hailey wrapped her arms around Livy.

"You are the best sister in the world," she said.

Rebecca Catalanello can be reached at rcatalanello@tampabay.com or (727) 893-8707.


To learn more about twins Olivia and Hailey Scheinman, visit links.tampabay.com to view an audio slide show and family videos. Also see the family's website, livyshope.com, to learn more about Hailey's artwork, jewelry and lemonade stands to benefit her sister's therapy costs.

news : Adult care home plan for NC under way

APNewsBreak: Adult care home plan for NC under way
By GARY D. ROBERTSON - Associated Press

[ read at News and Observer ]

RALEIGH, N.C. --

North Carolina's state health agency is moving ahead with the first step of a multi-year plan to help move potentially thousands of mentally ill residents from adult care homes to affordable housing and less restrictive living conditions.

The state Department of Health and Human Services publicized Thursday the action plan, which responds to allegations made a year ago by the U.S. Department of Justice that the state was failing to comply with the Americans with Disabilities Act. The government threatened to sue unless improvements were made.

The plan is a calculated risk for state officials because federal attorneys haven't told them whether it's enough to avoid litigation. That could require a judge-approved agreement with the federal government that may be more rigorous and expensive to carry out.

Government lawyers said in July 2011 that thousands of people with mental illness were segregated from society in adult care homes that had essentially become mental health treatment centers without giving them access to community treatment.

The plan, which will cost $10.3 million this fiscal year, will begin moving at least 100 residents with severe mental illness outside the homes to other community housing. Based on their income and ability to function, the displaced residents also will get help with paying rent, job training and potential employment.

The eight-year plan, which could cost a total of $67 million, would work to create 3,000 "slots" for people seeking a full slate of community services, acting HHS Secretary Al Delia said. The number of people that move could be much more because not everyone will need all of the offered services, Delia said.

Those who want to stay in adult care homes can remain there, he told The Associated Press.

"People will have choice," Delia said in an interview. "They will not be required to live in any one place, whether it's in a facility or in the community."


The General Assembly set aside money in this year's budget to begin the transition, which has been the subject of months of talks with the Department of Justice. Delia described HHS and the federal government agreeing largely on the improvements being made.

HHS is "moving forward on implementation because we believe that it's the right policy," Delia said.

Vicki Smith with Disability Rights North Carolina, the group that leveled the 2010 complaint, said the plan sounds good on the surface but lacks a method to require the state to carry out the plan completely. Smith pointed out there's less than six months before Gov. Beverly Perdue leaves office and another administration arrives.

"Many of the people who are issuing these promises will not be around even at the end of the first year to ensure implementation," said Smith, adding that the state has fallen short of expectations in the past when it comes to mental health treatment.

"I just don't think people with mental illness can recover from another failed promise," Smith said.

The department said it still doesn't have an accurate count of the number of mentally ill residents in homes. DOJ wrote in July 2011 that 5,800 people with mental illness live at 288 adult care homes with at least 20 beds where people with mental illness comprise at least 10 percent of the population.

The action plan is one solution to deal with intertwined legal and government challenges involving North Carolina's adult care homes, whose residents include people with chronic health problems, Alzheimer's disease or mental illness. The homes don't have medically intensive services that are found in nursing homes.

The state budget also set aside another $40 million in part to provide assistance to adult care homes that aren't expected to receive some Medicaid reimbursements when a streamlined policy for personal care services goes into effect soon.

The plan's unveiling came on the 22nd anniversary of the signing of the Americans with Disabilities Act. The 2010 complaint by Disability Rights North Carolina also was filed on Thursday's date.

NC Fails at DOJ Settlement, but has a Plan!

22 Years Ago Today...

Thu, Jul 26, 2012 at 7:59 AM
From: Vicki Smith, Executive Director of Disability Rights North Carolina
Re: State fails to settle with DOJ but announces 8 year plan



FOR IMMEDIATE RELEASE


[ view the DRNC Press Release ]


DOJ Update
NC Secretary of Health and Human Services, Al Delia, will announce the details of an 8 year plan to develop services for 3,000 individuals with mental illness in living in Adult Care Homes to more integrated setting appropriate to their needs later today. 


The State and USDOJ have been in confidential negotiations for the last year. At the table were representatives from the Governor’s Office, Department of Health & Human Services, and the Attorney General’s Office. Little information was shared about discussions until today’s announcement that the parties have failed to reach agreement but the state is moving forward with a plan. However, the General Assembly’s inclusion of $10.3 million in the 2012 - 2013 Budget to begin implementation of any settlement was seen as a sign that resolution was near. The announcement will also include acknowledgment by the State that it was unable to reach a settlement agreement with USDOJ, largely because of disagreement regarding an enforcement mechanism.


Our Response

“We are disappointed that the State was unable to come to an agreement to resolve our complaint with USDOJ,” said Vicki Smith, Executive Director of Disability Rights NC. “It is reassuring to have the State acknowledge the enormity of the unmet needs of people with mental illness and their plan to increase supported housing, supported employment and other services. However, the plan outlined by the State lacks a binding agreement, one which once and for all commits the state to fulfill the promises we’ve heard today. “ 

The Department of Justice may still pursue legal action against the state. Whatever steps the USDOJ takes next, Disability Rights NC will continue to address this situation. 

North Carolina has failed to:

Develop a meaningful Community Integration Plan as required by the 1999 Supreme Court’s Olmstead Decision including policies that provide incentives for community based services and placements;

Adequately fund the state’s Mental Health Trust Fund;

Develop community based services as hospital beds were closed, instead it relied on an industry that was neither designed nor competent to promote the recovery and inclusion of people with mental illness in the community; and

Most importantly, the State failed to focus first and foremost on the interests and needs of people with mental illness. It lost sight of its purpose - protecting the health and safety of all its citizens while providing essential human services.

What a way to celebrate the 22 anniversary of the signing of the ADA into law.

Take a look at this short video:  http://youtu.be/6ieH8FE9Dhw

“Let the shameful wall of exclusion finally come tumbling down.”

More information as it develops!


Vicki Smith
Executive Director
Disability Rights NC
2626 Glenwood Avenue, Suite 550
Raleigh, NC 27608
Phone: 919-856-2195
TTY: 1-888-268-5535
Fax: 919-856-2244
vicki.smith@disabilityrightsnc.org


Disability Rights NC is the state's protection and advocacy system. 

Disability Rights NC is a 501 (c)(3) organization. Donations support our efforts to promote a clear and independent voice for North Carolinians with disabilities. If you are a state government employee, you can support Disability Rights NC through the State Employees Combined Campaign (SECC). Please use code # 1544.

This transmission is intended for the sole use of the individual or entity to whom it is addressed, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any dissemination, distribution or duplication of this transmission by someone other than the intended addressee or its designated agent is prohibited. If your receipt of this transmission is in error, please notify us by telephone (919) 856-2195 or return e-mail to the sender. Please delete all copies of this message and any attachments.

20 July 2012

Video from Jordan Institute Leadership Congress

From Dr. Gary Nelson
Jordan Institute for Families, UNC-CH School of Social Work
Leadership in Transition to Accountable Behavioral and I/DD Care Team
On June 8th, 2012, over 100 leaders of North Carolina’s behavioral health and I/DD system – including those from state health and human service agencies, local government, the General Assembly, provider groups, faith organizations, universities, and consumers – convened to shape the plans for making ours the best public system in the country. The working session was convened by the Leadership in Transition team at the Jordan Institute for Families at UNC. 
The 100 participants brought their wide-ranging perspectives to bear, collaborating to identify the most critical steps forward for the system. The link below takes you to a video that captures the energy and the momentum in the room that day. 
The recommendations that emerged and were voted on that day include:
  • Utilize data to become less reactive. Identify a few meaningful citizen outcomes to measure performance and make the data accessible to all through multiple venues.
  • Keep all citizens informed through public engagement, education and training so all citizens can become stakeholders of the system.
  • Connect across systems to develop a one stop shop to access services.
  • Employ regulations and incentives for good and poor performers.
  • Gather around a shared vision and outcomes.
  • Ensure an appropriate level of funding.
On July 4th, North Carolina lost Steve Jordan, the director of the Division of Mental Health, Developmental Disabilities and Substance Abuse. His thoughtful leadership of the system and his guidance through our process were indispensable. We wish his family and his colleagues peace and healing.
In the coming weeks, the Jordan Institute for Families will be finalizing the recommendations and delivering them in a report summarizing the activities in 2011-12 that led up to the Leadership Congress. All June 8th participants, members of the General Assembly, and the Governor will receive that report.


19 July 2012

Arc NC's Legislative Summary

From The Arc of North Carolina
Legislative Summary regarding Developmentally Disabled Populations of North Carolina

[ original post ]


In this year’s legislative session, the General Assembly adjusted the budget, created policy direction in the budget, and passed important policy bills. The Arc worked on and monitored many issues of importance to people with intellectual and developmental disabilities as well as their families during the session. Below we have provided a brief recap of some of the most important issues.

Kindergarten Developmental Screening

Kindergarten Developmental Screening is part of the new budget bill (H950, which was passed by the General Assembly, vetoed by Governor Perdue, whose veto was then overridden, making the bill law). Section 115C-83.1 E orders the State Board of Education to ensure that every student entering kindergarten shall be administered a developmental screening of early language, literacy, and math skills within 30 days of enrollment. Section (e) states that the assessment shall be reliable, valid and appropriate for use with all children, including those with disabilities.

NC Teaching Corps to Include Disability Training

The new budget bill (H950, which was passed by the General Assembly, vetoed by Governor Perdue, whose veto was then overridden, making the bill law) establishes the North Carolina Teaching Corps, a training program for those who wish to become teachers via lateral entry (in other words, for those whose degree is not in teaching). The program is to include training on identification and education of students with disabilities, positive management of student behavior, effective communication for defusing and de-escalating disruptive and dangerous behavior, and safe and appropriate use of seclusion and restraint.

Personal Care Services and Short Term Rental Assistance to Adult Care and Group Homes

Personal Care Service (PCS) is a Medicaid funded service aimed at assisting individuals with disabilities with activities of daily living. Currently people who have Medicaid and live in a licensed residential setting receive one hour a day of this service.

The General Assembly choose not to follow the DHHS recommendation to create a 1915i option to address federal Medicaid officials’ concerns around Personal Care Services. The 1915i option is a relatively new Medicaid option for states to use. It allows for states to put in place Medicaid home and community based services without a Medicaid waiver. The Arc believes this option would best used to expand community based services for people with IDD.

Instead of following DHHS recommendations, the General Assembly passed language that will require DHHS to create a new Medicaid state plan amendment creating a comparable PC service for individuals living at home and in facilities. This impacts people living in Group Homes and Adult Care homes. The Arc has concerns that the new plan will eliminate PCS for some people (we are attempting to determine the scope), which could cause significant service reductions.

As part of H950, the Modify 2011 Appropriations Act, the State provided $39.7 million of non-recurring funding to provide temporary rental assistance to adult care homes. These funds will help pay rent at adult care homes for residents who are no longer eligible to receive Medicaid reimbursable personal care services (PCS), but for whom a community placement has not yet been arranged. Unfortunately, this fund will not assist residents who live in group homes and lose PCS. One of The Arc's top priorities for the interim will be to work with DHHS and the legislature to assure people living in group homes are not adversely affected.

Community Service Funding Cut

There was a $20 million non-recurring cut to community services funding. Approximately $345 million in State general funds remain in the budget for LME/MCOs to purchase community based services.

The Arc is disappointed in this cut. The original Senate budget had no cut in this area, and the original House budget had only a $10 million dollar cut. The change was made only two days before the final budget bill passed, giving little time for input from The Arc, other advocacy organizations, and families. We hope the General Assembly will restore this much needed funding during next year’s budget session.

Money for Transition to Community Living

As part of H950, the Modify 2011 Appropriations Act, the State allocated $10.3 million in recurring funding to speed up the transition of individuals with severe mental illness to community living arrangements, including establishing a rental assistance program. Some of the impacted individuals are dually diagnosed with a developmental disability as well. We believe this funding was allocated to respond to a potential negotiated settlement with the US Department of Justice (US DOJ) over North Carolina's use of Adult Care Homes as placements for people with Mental Illness, which it says violates Medicaid law.

Medicaid Shortfall Bills

There was a great deal of press surrounding the multi-million dollar Medicaid budget shortfall for the 2011-2012 fiscal year. The shortfall, initially estimated at $205,500,000, was addressed by S797 (Payment of 2012 Medicaid Costs/Inmate Medical Costs) early in the session. S797 drew funds from receipts, unanticipated federal bonus money, and Repair & Renovation Reserve Funds for the University of North Carolina System.

Unfortunately, in the last few weeks of the legislative session, it became obvious that there was an additional gap in Medicaid funding of approximately $94 million. To address this gap, the General Assembly passed H14, the Use R&R Funds for 2011-2012 Medicaid Costs Act. This bill appropriated $94 million from the Repairs and Renovations Reserve Account from the UNC System be transferred to the state controller. The controller was to manage Medicaid funding for the remainder of the 2011-2012 fiscal year.

LME/MCO Governance Bill(s)

HB1075 came out of the House subcommittee that studied the LME/MCO Governance issue led by Representative Nelson Dollar. It dealt with rules governing the makeup of LME/MCO Boards of Directors. The bill as proposed by the sub-committee, while not perfect, was a compromise reached with input from most stakeholders in the MHDDSA system. After the bill passed the House, Sen. Fletcher Hartsell added a controversial amendment to the bill would have allowed LME/MCOs that had been operational for three years to become “Behavioral Health Authorities.” This new classification significantly changed the method of accountability and operation of the MCO system. Most advocates, including The Arc, opposed these changes due to serious concerns on how the LME/MCOs’ new authority would impact people with disabilities and their families.

Ultimately, some legislative maneuvering resulted in a new bill (S191, LME Governance) that included the original Board member rules, excluded the Behavioral Health Authority amendment, and allowed for MCO's with over 1,200,000 people to create new board structures, if approved by the Secretary of DHHS.

Parents as Providers

As many of you know, there were quite a few changes made to rules surrounding parents as providers. These changes were by and large not changes in laws, but in administrative rules. The Arc is very concerned with these changes and will delve into the problems around this and related issues in the near future.

The following bills did not become law this past session

The Arc's Proposed Changes to H916
Though our proposal did not receive formal consideration, we were pleased with the broad based legislative support it received. We believe that the majority of legislators now understand why it is important to have an independent person working with families and individuals to write their Person-Centered plan. In a future addition of Policy Partners, we will discuss in more detail why this proposal continues to be a critical component if managed care is to be successful. For now, we want to thank you for your incredible advocacy efforts you undertook towards making these changes. Your voice was heard!

Eugenics Compensation Bill (Did Not Pass)

This bill would have set up a fund to reimburse victims of forced sterilization at the hands of the State. A large percentage of NC’s sterilization victims were individuals with intellectual or developmental disabilities. The bill passed the House, but was not taken up in the Senate.

On a somewhat brighter note, a last minute compromise between the House and Senate provided funding for the Eugenics board to continue its work during the 2012-2013 fiscal year.

Incapacity to Proceed (Did Not Pass)

If a person with I/DD is arrested, they (like everyone else) go to jail while they await a bail hearing/trial. Often, people with I/DD are found to lack the capacity to proceed to trial, and are sent to an institution for treatment. Often, they eventually reach a point where they are deemed capable to proceed with their trial, at which time they are sent back to jail, and their trial is put back on the schedule. Once back in jail, the person with I/DD often regresses, is once again deemed incapable to proceed, and is sent back to an institution for treatment as the cycle continues. There are documented cases of individuals with I/DD arrested for a crime spending far longer (years even) bouncing back and forth between treatment institutions and jail before trial than they would spend in jail if they were tried and convicted.

H1048 would of made outlined clear steps to avoid this type of situation for both misdemeanors and felonies. This bill passed by an overwhelming margin in the House (114-0), but was not taken up in the Senate. Representative Pat Hurley has said she will file this bill again in 2013.

We are disappointed that the Senate chose not to put such an important and widely supported bill on this year’s agenda, and hope they choose to take it up in 2013.

Voter ID Bill (Veto was not overridden)

Originally, The Arc worked extensively with Representative David Lewis during the 2011 long session on what became known as the Voter ID Bill (H351, Restore Confidence in Government). We tried to address the many concerns that existed in the disability community around the topic of voter ID. While we came up with compromise language that would of addressed most of our concerns, unfortunately the compromise language was ultimately stripped from the version of the bill. This stripped down version of the bill passed the General Assembly and was vetoed by Governor Perdue in 2011.

While an override attempt of this bill was on the calendar throughout the short session, it never happened. The bill is dead for this year, but a new version of the bill is expected in 2013. We again will work diligently with the bill sponsors to ensure that the concerns of people with disabilities will be addressed.

N&O: LME Money Woes

Money woes snag mental-health center

Published Wed, Jul 18, 2012 09:38 PM
By Lynn Bonner - lbonner@newsobserver.com
The News and Observer

[ original article ]

The state’s latest plan for community mental health services has gotten off to a bad start with the first local mental health office to become a managed-care agency falling into a $3 million financial hole in its first six months of operation.

Western Highlands Network, which covers eight counties including Buncombe and Rutherford, is working with the state Department of Health and Human Services on a plan to correct the money problems that started the first day it became a managed-care agency in January.

The changes may involve reducing some mental health treatments the office believes are excessive, telling service providers to return money for services that were not approved, and enforcing rules for providers filing payment claims.

The experiences in the west are significant because, under a new state law, all government-paid mental health services in the state will be handled the way they are in Western Highlands. Advocates for people with disabilities are skeptical that the new system will work, and they worry consumers will be the losers.

Last year, the legislature passed a law that requires all local mental health offices to convert to managed-care agencies by January 2013, copying a system started in the state in 2005 by Piedmont Behavioral Health, a local mental health office now called PBH.

As managed-care agencies, the local mental health offices’ relationships with the state, mentally ill people in their coverage areas, and providers will change significantly. Each local office will be given a set amount of Medicaid and state money to treat patients. If they spend too much, they have to cover the costs. Local offices that save money can spend it on more Medicaid mental-health services.

Though the local offices take on financial risks, they also have more control. Under managed care, they will say which providers will treat patients in the region and what kinds of treatment – and how much government-paid mental-health treatment patients receive.

Choice and uniformity

This is the biggest change to mental-health services in the state in more than a decade. In 2001, the state told local offices to stop offering treatment in favor of having patients seek out private providers. The intent was to give patients more choice and foster uniformity across the state.

That 2001 reform was an expensive failure. Patients were left waiting for beds in state psychiatric hospitals while the state spent millions on low-level services for people who didn’t need treatment. A legislative report from 2009 said the state spent up to $635.3 million too much for community mental-health services between April 2006 and February 2009.

Legislators talked for years about giving more local offices more power and passed a law last year requiring it. Western Highlands was the first regional office to convert. Two more offices have followed. All 11 local offices will be managed-care agencies by January 2013. The office covering Durham and Wake counties will be in the last group converting.

The local offices do extensive prep work before they convert and a consulting firm assesses their readiness to switch.

Outdated figures


Western Highlands has been losing money all year. One of the problems, said CEO Arthur D. Carder, is that the lump-sum payment the office received to care for patients was based on outdated information from 2009 that did not take into account increased costs in 2010 and 2011.

Al Delia, the state Department of Health and Human Services acting secretary, said the office has been closely monitoring Western Highlands and is talking about taking another look at whether the $9.7 million a month the office receives to pay for patient treatment is enough.

Delia was in the western counties Wednesday, meeting with members of the office’s governing board.
“There’s going to be some adjustment in culture and attitudes and mindset in leadership of all these organizations in making these transitions,” Delia said.

Skeptics question whether managed care is the best system for all consumers.

“I think we’ve rushed to judgment on this,” said Dave Richard, executive director of The Arc of North Carolina. Parents of children with developmental disabilities and the agencies that provide services to the disabled have been among the most vocal skeptics of managed care, questioning conversion to a system they say isn’t designed to meet their needs.

“If you’re going to give up the system where people had a lot of choice to one where choice is limited and is controlled by one entity, you’d hope to see better outcomes,” Richard said. “We haven’t seen that with folks with developmental disabilities.”

Lawsuit under way

State officials and legislators have looked to PBH as an example for years, but not everyone is a fan.
Disability Rights North Carolina, an advocacy group, is suing PBH in federal court over allegations that it did not give residents proper notice of changes in their services or let them know how they could appeal.

Western Highland’s problems show that the office wasn’t ready to become a managed-care agency, said Vicki Smith, Disability Rights’ executive director.

“It would almost be too simple to say this was predictable,” she said.

Legislators are convinced that managed care is the path to follow for mental-health care. The legislature is committed to a new system where government does more than just pay the bills, said Rep. Nelson Dollar, a Cary Republican.

“We want to manage the care and the individuals receiving the care, and manage the costs and how we’re allocating scarce taxpayer resources,” he said.

Legislators have been working with DHHS since winter on Western Highland’s financial problems, Dollar said. A new law that adds members with experience in managed-care finances, insurance and health care administration to local governing boards is meant to strengthen oversight of Western Highlands and other managed-care operations.

“We’re going to be working with the department to straighten out issues like the ones that are being encountered in Western Highlands and making sure what lessons are learned there are being incorporated in the conversions in other areas of the state,” he said.