What is North Carolina House Bill 916?
In order to have a better understanding of North Carolina House Bill 916 [NC HB 916 / SL 2011-264], you first need to know a little about the US Social Security Act (Chapter 7) under Title 42 (The Public Health and Welfare), Medicaid, and specifically 1915(b) and (c) Waivers...
US Social Security Act and Medicaid Waivers
From my letter: The North Carolina CAP I/DD (formerly, MR/DD) Waiver program, promulgated pursuant to Section 1915(b) and (c) of the United States Social Security Act [42 U.S.C. § 1396o], and was authorized in 1981, acknowledging the greater need of supports for Developmentally Disabled citizens and thus providing a means for states to manage the costs of those needs with federal funding. Section 1915(b) Managed Care and 1915(c) Home and Community-Based Supports Medicaid Waiver programs afford states the opportunity meet the medical and direct care needs of its DD population and afford parents an alternative to institutionalizing their loved ones in an effort to save tax dollars and comply with the Rehabilitation Act of 1973 [5 U.S.C. § 790] and later, Americans with Disabilities Act (ADA) [42 U.S.C. § 12101 et seq.].
These funds are distributed to state Departments of Health and Human Services (DHHS) through the federal Centers for Medicare and Medicaid Services (CMS).
Each state is tasked with the responsibility for the management and disbursement of the federal 1915(b)(c) Waiver funds and thus the implementation and delivery of supports and services. However, each state also has discretion in how they administer and govern their individual state HHS directed programs.
History of North Carolina Medicaid Program from 1970 to 2007.
Catalyst for Reform
Due to the historic abuse of federal funding from Medicaid Waiver programs by dishonest providers, recipients, and others, the state of NC has consistently exceeded the annual budget, heavily contributing to the state deficit. Federal agencies responsible for overseeing this funding have, in recent years, begun to tighten the thumbscrews, so to speak, urging NC to fix this mess. Of course, the 2011 Department of Justice Report finding the State in direct Violation of ADA and failing to meet even the minimum requirements under federal law has hardly helped with respect to state budgets or thumbscrews. Change was inevitable.
Inception and Formalities
As I understand it, the whole 1915(b)(c) federal funding programs have to be reauthorized every 3 years (not certain of the exact terminology or dynamic but you get the point), which means legislative action and decision-making.
History of North Carolina Medicaid Program from 1970 to 2007.
Catalyst for Reform
Due to the historic abuse of federal funding from Medicaid Waiver programs by dishonest providers, recipients, and others, the state of NC has consistently exceeded the annual budget, heavily contributing to the state deficit. Federal agencies responsible for overseeing this funding have, in recent years, begun to tighten the thumbscrews, so to speak, urging NC to fix this mess. Of course, the 2011 Department of Justice Report finding the State in direct Violation of ADA and failing to meet even the minimum requirements under federal law has hardly helped with respect to state budgets or thumbscrews. Change was inevitable.
Inception and Formalities
As I understand it, the whole 1915(b)(c) federal funding programs have to be reauthorized every 3 years (not certain of the exact terminology or dynamic but you get the point), which means legislative action and decision-making.
As indicative of PBH's 2007 Local Business Plan to the State, as well as the Request for Intent in 2008 and Legislative Agenda Announcement regarding the success of NC State Law 2008-107 (specifically, Section 10.15.(z) on page 68) and thanking key members (namely, Barnhart, Insko, Hartsell, and Purcell), it's obvious that the discussions, plans, proposals and other political actions have been steadily moving in this direction for some time.
NC House Bill 916 was formerly introduced in early 2011 to the NC General Assembly as the "Statewide Expansion of 1915(b)/(c) Waiver" by then House Representative Jeff Barnhart. You can see the entire progression of HB 916, the votes, and legislative documents on the NC General Assembly website.
NC House Bill 916 was formerly introduced in early 2011 to the NC General Assembly as the "Statewide Expansion of 1915(b)/(c) Waiver" by then House Representative Jeff Barnhart. You can see the entire progression of HB 916, the votes, and legislative documents on the NC General Assembly website.
On June 23, 2011, North Carolina legislature ultimately passed HB 916, thus becoming SL 2011-264, authorizing a complete managed care restructuring of the former CAP Waiver program in an effort to cut costs. As currently designed, the new statewide Medicaid Waiver plan essentially grants the State and State agents (DHHS, LME's, MCO's and the like) absolute authority over recipient service determination, level of service need, and service delivery with no sound system of accountability nor appropriate due process for North Carolina's most vulnerable citizens.
The Office of State Governor holds executive authority over state legislature and as such, the power to veto any House Bill deemed harmful to the citizens of North Carolina, though Governor Perdue signed off on HB 916.
The Issue
The Issue
The issue is not whether or not change is needed. That goes without question. The issues revolve around the chosen solution. The new statewide Waiver plan currently in the process of being implemented slowly across the state, uses what is commonly being referred to as the "PBH model."
From the DHHS website:
PBH Request for Intent; Innovations Waiver Community Guide Service. January 16, 2008.
... definitely more to come ...
From the DHHS website:
"In April 2005, the N.C. Department of Health and Human Services (DHHS) began the MH/DD/SAS Health Plan, a pilot project where Medicaid-funded services for mental health, substance abuse, and development disabilities are provided on a capitation basis in a five-county area through a prepaid inpatient health plan (PIHP) under a 1915(b)/(c) Medicaid waiver. PBH, formerly know as Piedmont Behavioral Healthcare, a local management entity (LME), operates the PIHP. DHHS has elected to expand this waiver beyond PBH to be phased-in statewide.See the Initial DHHS Strategic Implementation Plan of the 1915(b)(c) Waiver for July 1, 2011 - June 30, 2013. October 19, 2011.
Toward this goal, DMA and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) worked in partnership to submit waiver amendment requests to CMS in December 2009 to expand the capitated counties through the modification of the exisiting Piedmont Cardinal Health Plan 1915(b) Freedom of Choice waiver and the modification of the 1915(c) Innovations Home and Community Based Services (HCBS) waiver."
PBH Request for Intent; Innovations Waiver Community Guide Service. January 16, 2008.
... definitely more to come ...
Although the transition into the new Waiver model is already underway, the effects of which already being felt in many parts of the state, it is not too late to Demand the REPEAL of House Bill 916. However, without desperately needed feedback from families of CAP recipients - telling our stories, the daily struggles and challenges as special parents, putting faces of the most vulnerable and defenseless citizens of North Carolina on those statistics represented by Medicaid - HB 916 can and will continue to move forward.
My Opinion
My personal objection to NC HB 916 is not toward that change; change is certainly in order. I'm not even really objecting to the idea of "managed care" itself if quality care is available and managed properly so as to benefit the consumer first, management second. My objection is, based upon my own knowledge and opinions, is that this whole process has not been well-thought out with appropriate input from those who will be personally and tragically affected.
Decisions are being made for our children and families' lives by those who have not a clue how these changes will directly affect those in need. The arguments being are made that services are unfairly disproportionate from case to case and not fully utilized, but is anyone asking why? It is impossible to imagine what we go through as parents and care-takers on a daily basis unless you live it and know it intimately, know what we put up with, endure, fight for; see our frustrations, challenges, and needs, and the ones not even close to being met...
For those whose platforms include improving the economy, supporting small business growth, creating employment opportunities: It is impossible to imagine the impact of employment loss by Case Managers and providers as well as failed small business provider agencies (the decent, caring, reputable ones) because there's simply no safeguards for these folks and no way of knowing.
My whole purpose of this writing crusade was simply to make it personal. Instating an entirely new assembly-line system of provision to an entire state giving absolute authority over the care and supports for the most fragile and helpless of populations whose very quality of life and the lives of their families is critically dependent upon that care and support solely based upon a well-packaged business plan, absent the human element, is nothing less than socially irresponsible. It may sound great in theory, but reality is an entirely different matter and no one knows better that us that there is absolutely no round hole our precious little square pegs will fit neatly into.
Do we need a better system? No question.
Do we need accountability and safeguards to prevent further abuse of funds designated for our children? Absolutely.
But I remain firm that HB 916 as intended is not the answer we are looking for...
... more to come ...
Changes Under the New Waiver...
How the New Waiver Changes Will Affect Recipients...
Comparison of Waiver Models...
Changes Under the New Waiver...
How the New Waiver Changes Will Affect Recipients...
Comparison of Waiver Models...
