In my research, and most especially my conversations and dialogues with members and representatives of the General Assembly - and yes, event PBH Consumer Affairs folks, throughout this controversial DD managed care overhaul, there seems to be a common theme regarding the poor quality of dishonest providers abusing the system as an argument for reform. --While I know they are out there, I personally have not had such experiences and find the habit of tossing all the apples in one basket offensive... The various agencies and professionals I have had the pleasure of working with in over 10 years have always proved exemplary, going above and beyond to assist families such as mine and assure our needs were met.
Were it not for my agency QP, I would have lost my job years ago when we had to fire both my staff for unethical conduct. Every day this woman picked up my child from school and cared for her personally for 3 weeks or more while I worked at the time as a contractor (with no benefits) at FPG Child Development Institute at UNC-CH and searched for new care-givers. I was a single parent then; I could not have done it without her nor without the peace of mind that Isabel was well taken care of.
Below is an email (posted with permission) from an agency Qualified Professional from A Small Miracle here in Raleigh. Though ASM isn't the agency I referenced, I can attest they are among the best in the field; their reputation is one of compassion and love for what they do and are they are well loved by their families because of it.
Just one example of the many non-family small business stakeholders who will be greatly impacted by changes to come.
Wendy is a constituent of NC Senate District 17 and House district 37.
Wendy is a constituent of NC Senate District 17 and House district 37.
Legislative Correspondence
from a Provider Perspective
From: Wendy Singleton
Date: Fri, 25 May 2012 10:46:23 -0400
Conversation: Imploring you to FIX HB 916!
Subject: Imploring you to FIX HB 916!
Good Morning Representatives:
I am contacting each of you today appealing for further review and overhaul of proposed HB 916, with extra plea Representatives Mr. Barnhart, Mr. Dollar, Mr. Burr, Ms. Insko, Mr. Ingle, Mr. Moffit, and Mr. H. Warren. As a community member, constituent, taxpayer and proud advocate for individuals with special needs I am deeply troubled by the proposed statewide expansion of the 1915 (b)/(c) waiver.
If the The 1915 (b)/(c) Waiver goal is “for implementation improvements in the Medicaid program designed to increase cost effectiveness, efficiency, consumer access, consumer choice and provider quality. . .” as a qualified professional, NCI instructor and therapist working in the field with the IDD population I can say from first hand experience this proposed waiver is not meeting goals.
-The overhead costs of new vs. refurbished buildings does not save money, nor does elimination of targeted case management with two new jobs of Care Coordination and Community Guide as well as Qualified Professionals writing individual’s short term goals. Purported savings with the 5 county model are now being refuted, with legal cases surrounding “satisfaction rates” and “Savings” from this waiver model.
-Efficiency is no longer a word most families, staff, QP’s and current case managers would use to describe the process of the CAP system. With lessened oversight and elimination of third party case manager the proposed waiver will likely become as efficient as the now defunct Value Options authorizing entity. As targeted case managers are being told their jobs will be eliminated on January 1st, 2013 many highly qualified, gifted and talented advocates are leaving their jobs to provide for their families. This has left many of our families without a case manager or plans not being authorized in a timely manner requiring provider agencies in some cases footing the bill until they can be paid—Many smaller agencies have closed their doors because they simply can’t afford to provide services on “good faith” of being paid. Individuals who have waited for CAP services for 5 or more years in some cases are being told by Wake County they may lose their CAP slot if services are not provided in 15 days, and their CAP slot is eliminated after 30 days without services—This should NEVER happen because of a lack of efficiency in a system purported to be created for the well being, consumer access, and consumer choice of individuals served!
-Individuals and their families once had a voice to advocate for what targeted case manager / agency they wished to have to provide best services for their loved ones. Today they have laryngitis. No longer are there several agencies to choose from, nor are there case managers available due to the overwhelming caseloads given to them at 45-80 individuals per case manager!!!! Families served feel ‘lucky’ to have a case manager, even if they don’t see them for 6 months or more due to overwhelming work load required of case managers in the field. The reason for this is that most people, when faced with certain job loss, will seek a different job. With the 1915 (b)/(c) model having no oversight with model due to authorizing body having decision in type/scope of service as well as no reputable process for mediation there are major concerns with families having ability to challenge decisions when one player holds all cards in the deck. The “Right Sizing” of the network poses even bigger questions for provider agencies in that there is no known parameters of criteria for elimination of a provider agency in the network.
-With the current freeze on new CAP recipients (formerly slots) access is simply not available. With the proposed waiver utilizing last month’s numbers as a benchmark for current need this will further increase lack of access due to some families not having staff available to them due to the 10% rate cuts already imposed on a burdened system, or family / individual situations such as hospitalization, accident or death. If an individual goes out of town for two weeks to travel out of state for a funeral / service, it is impossible and irresponsible to make a correlative relationship that the next month the person ‘survived’ with only two weeks therefore that is what they should receive in services.
Care Coordinators are not required to have advanced degrees, nor is the reimbursement rate adequate to entice providers to enroll to participate in this service, further eliminating access to services.
-Most provider agencies strive to provide the highest caliber and quality of services, and wish to continue to do so in a timely, organized, cost effective manner. I ask that you reconsider this waiver model until issues of oversight and alleged ‘budgetary savings’ can be addressed. Many families if given the opportunity would manage the money allocated to them very wisely, and if the model moves forward with more oversight and known system with third party entity to appeal decisions made by authorizing body for scope and amount of services provided for their loved ones would be more comfortable with restructure of the CAP system which is integral, imperative, and is cost effective in decreasing rates of institutionalization for the people we proudly serve.
As NAMI stated in a letter to Representative Barnhart last year on 1915 (b)/(c) waiver “We no longer have the resiliency to endure more failures”.
Thank you,
Wendy Singleton, QP
A Small Miracle Inc.
Raleigh, NC 27607
(919) 900-4422
(919) 900-4466 (fax)
-- This electronic message (e-mail) and any documents accompanying this message may contain confidential information that is privileged. This information is intended only for the use of the recipient named above. If you have received this e-mail in error, please notify us immediately by telephone at 1-800-760-0665 to arrange for return of the documents to us and you are hereby notified that any disclosure, copy, distribution, or taking of any action in reliance on the contents of this information is strictly prohibited.
*As special parents, our perspectives, interests, and priorities in various issues surrounding NC's new 1915(b)(c) Innovations Waivers and the changes they bring to our families differ according to the unique needs of each of our children.
If you have something to share, email: no2nchb916@gmail.com
