Note: Below is a Public Comment submitted to DMA regarding the 8M Clinical Coverage Policy proposal for CAP-I/DD during the 15 day comment period from July 28 - August 11, 2011. This exert was pulled from it's original source, a public record, and is posted exactly as it appeared save the removal of the submitter's personal contact information and abbreviation of last name.
Comment 227
To: Webmedpolicy, Dma
Subject: Proposed Changes
Sent: Wednesday, August 10, 2011 2:52 PM
I certainly understand the challenges of continuing to provide a full array of appropriate and necessary services via the CAP-MR/DD waiver in this most difficult economic climate. But, a number of the proposed changes to the CAP waiver need to be reconsidered due to the potential, and likely, negative impact they will have on consumers of service, and their families.
First, the removal of Home Supports seems to be antithetical to one of the primary intents of the waiver (i.e., assist individuals in continuing to reside in their community). For many families, this service is the only thing that prevents them from having to place their child in a more restrictive setting (e.g., Group Home). Ironically, in order to be placed in a group home, the CAP consumer would need to receive Residential Supports. Given that Residential Supports is almost identical to Home Supports, it seems illogical that the proposed waiver change would force an individual to move to a group home in order to receive essentially the same service they used to receive at home. Moreover, given that most individuals receiving Home Supports receive more hours per week than parents would be allowed to work (40 hours), per proposed changes to the waiver, additional staffing would be needed to meet the previously determined medical needs of the individual. On the surface, it makes no sense to force families to have outside staff come into their home to work with their family member due to an arbitrary determination that family members can work no more than 40 hours per week (providing a combination of HCS and Personal Care). The reality, which is known to all of us, is that parents already work many more hours with their family member than is required by the various Home Supports levels. Thus, the 40 hour limit seems rather arbitraty and solely designed to reduce costs.
Second, the removal of enhanced serviceswill almost certainly lead to increased rates of out-of-home placements. I understand that the State wishes to decrease costs by eliminating this service, but the higher rate of pay for enhanced services helps to ensure agencies can afford to provide families/staff with consultation/supervision by the professionals (e.g., nurses, psychologists) required by this service. Without the enhanced rate, agencies will not be able to provide the additional consultation and training required to ensure staff are competent to provide needed supports, and thus individuals' needs will go unment. As needs go unmet, consumers of CAP services will experience increased behavioral and medical challenges. And these challenges will result in increased rates of institutional/emergency/out-of-home placement. I understand the Innovations waiver does not include enhanced services, but I do not feel that the desire to have the CAP waiver closely match the Innovations waiver is sufficient reason to simply discontinue a service that is critical in helping many individuals to continue to reside in their communities.
On onother topic, the State has done a woeful job of informing families and consumers of proposed changes. Most families and consumers of service have no idea that the State is even proposing changes to the CAP waiver. Because of this, the vast majority of consumers and families will have had no opportunity to provide input regarding the State's proposed changes. To implement any changes without ensuring all vested parties have been directly contacted by the State regarding proposed changes, and thus have had the opportunity to provide comment, is unfair and certainly poor practice.
Finally, the new waiver makes reference to Behavioral Analysts as professionals who can provide CAP services. As has been communicated on numerous occassions by various parties, the practice of behavioral analysis, per the NC Psychology Practice Act, considered the practice of psychology. As such, it is illegal for anyone not licensed as a psychologist, or not supervised by a psycyhologist, to provide behavior analytic services. The only caveate is that other professionals certified/licensed by a regulatory board would be exempt from the authority of the Psychology Practice Act. If, of course, behavior analysis was within their scope of practice. Behavior Analysts, however, are not covered by any NC regulatory board. Thus, it is my understanding that it would be inappropriate to include them in the list of professionals who are eligible to bill for CAP services.
Edward H.
