Mary K. Short is a strong and active advocate and the parent caregiver of an adult DD recipient with profound needs. She fights tirelessly for the rights of her daughter, Katie and other special families, as well as a great deal of time keeping folks informed! Posted with Mary's permission.
Mary and her daughter live in NC House District 88 and Senate District 42. Her daughter is being served by Smoky Mountain LME.
From: MaryKShort@aol.com
To: Bev.Perdue@nc.gov, Thom.Tillis@ncleg.net, Phil.Berger@ncleg.net
CC: MaryKShort@aol.com, louis.pate@ncleg.net, justin.burr@ncleg.net, nelson.dollar@ncleg.net, martha.alexander@ncleg.net, william.brisson@ncleg.net, bill.current@ncleg.net, mark.hollo@ncleg.net, pat.hurley@ncleg.net, bert.jones@ncleg.net, marian.mclawhorn@ncleg.net, tom.murry@ncleg.net, fred.steen@ncleg.net, austin.allran@ncleg.net, doug.berger@ncleg.net, stan.bingham@ncleg.net, harris.blake@ncleg.net, jim.davis@ncleg.net, fletcher.hartsell@ncleg.net, eric.mansfield@ncleg.net, martin.nesbitt@ncleg.net, william.purcell@ncleg.net, tommy.tucker@ncleg.net, james.forrester@ncleg.net, andrew.brock@ncleg.net, ralph.hise@ncleg.net, marilyn.avila@ncleg.net, rayne.brown@ncleg.net, tricia.cotham@ncleg.net, beverly.earle@ncleg.net, shirley.randleman@ncleg.net, mitchell.setzer@ncleg.net
Sent: 6/25/2012 11:06:27 A.M. Eastern Daylight Time
Subj: Delay NC Innovations Expansion - URGENT
Dear Gov. Perdue, Speaker Tillis, President Pro Tempore Berger, and ladies and gentlemen of the NCGA:
I have tried over and over again to inform you of the urgent concerns I have had about DHHS/DMA/DMHDDSAS (the Department and its Divisions) in regards to the Medicaid 1915(c) waivers for the IDD/MR/DD/Autism population. I have tried to inform you of my urgent concerns regarding the role of CMS in approving waivers that were in violation of any number of federal statutes beyond CMS's own regulations, particularly the ADA and Olmstead.
On June 12, 2012, the Office of the Inspector General of the U.S. Department of Health & Human Services issued a report entitled, "Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs." I have provided the link to that report and copied the summary posted to the OIG.HHS.GOV web page below. Please see in particular the text I have highlighted in red/underline/bold.
I am once again asking you to stop the further implementation of the NC Innovations waiver. The fact that too much money has already been spent on the ADMINSTRATIVE components of implementation, is no justification for continuing the implementation. None of the LME/MCO's that have already transitioned have been adequately prepared. The absolute proof is NOT whether any one beneficiary has been institutionalized since their transition, but rather, the fact that none of the LME/MCO's is negotiating "enhanced" rates with providers for those beneficiaries who had been receiving CAP-MR/DD Enhanced services. Those Enhanced services are not available in the NC Innovations waiver.
Appendix J: Cost Neutrality Demonstration of the CAP-MR/DD Comprehensive Waiver (CMS NC 0662.R00.02 Jul 01, 2010): d. Estimate of Factor D. i. Non-Concurrent Waiver (chart). This document lists: Enhanced Personal Care Services # Users 366; Respite Nursing LPN # Users 37; Respite Nursing RN # Users 41; and Enhanced Respite Care # Users 415.
PBH, Pam Shipman, stood before the DWAC on Wednesday, June 20, 2012 and said that only 4 persons had a reduction/denial in services due to the transition: "No denials except for 4 requests for services or items not allowed under Innovations." [Link to document: (see page 11) http://www.ncdhhs.gov/mhddsas/providers/1915bcwaiver/dwac/6-20-12/pbh-presentation6-20-12.pdf.]
Please, delay the further implementation of the NC Innovations waiver.
Mary K. Short
828-632-5888 or 704-451-4144 (cell)
http://oig.hhs.gov/oei/reports/oei-02-08-00170.asp
Report (OEI-02-08-00170)
06-21-2012
Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs
Complete Report
Download the complete report: http://oig.hhs.gov/oei/reports/oei-02-08-00170.pdf
Summary
WHY WE DID THIS STUDY
In recent years, States have altered their approach to providing Medicaid-funded long-term care services. Rather than providing the majority of that care in institutions-such as nursing homes-States are now providing more care in homes and other community-based settings. States most often provide this care through 1915(c) home and community-based services (HCBS) waiver programs, and the individuals served by these programs are most commonly disabled and/or over age 65. In fiscal year 2010, Medicaid expenditures for HCBS waiver programs serving this population totaled an estimated $8.9 billion. Strong oversight of waiver programs is critical to ensuring the quality of care provided to HCBS beneficiaries. The beneficiaries who rely on HCBS waiver programs are among Medicaid's most vulnerable, and the nature of these programs puts beneficiaries at particular risk of receiving inadequate care.
HOW WE DID THIS STUDY
States must operate their HCBS waiver programs in accordance with certain "assurances," including three assurances related to quality of care. To meet these assurances, States must demonstrate that they have systems to effectively monitor the adequacy of service plans, the qualifications of providers, and the health and welfare of beneficiaries. We based this study on a review of documents from CMS's most recent quality review of waiver programs from 25 States, as well as information gathered from structured interviews with staff from the 10 CMS regional offices.
WHAT WE FOUND
Seven of the twenty-five States that we reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries. Although CMS renewed the waiver programs in all seven of these States, three did not adequately correct identified problems. Not only did these States fail to correct these problems before renewal of their programs, they also had still not adequately addressed the problems long after renewal. In addition, CMS did not consistently use the few tools it has to ensure that States correct problems related to quality of care.
WHAT WE RECOMMEND
We recommend that CMS: (1) provide additional guidance to States to help ensure that they meet the assurances, (2) require States that do not meet one or more assurances to develop corrective action plans, (3) require at least one onsite visit before a waiver program is renewed and develop detailed protocols for such visits, (4) develop a broader array of approaches to ensure compliance with each of the assurances, and (5) make information about State compliance with the assurances available to the public. CMS concurred with four of the recommendations and partially concurred with our recommendation to require onsite visits.
