SB 191 v 4: LME Governance

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: andrew.brock@ncleg.net, austin.allran@ncleg.net, dan.soucek@ncleg.net, doug.berger@ncleg.net, eric.mansfield@ncleg.net, fletcher.hartsell@ncleg.net, james.forrester@ncleg.net, jim.davis@ncleg.net, louis.pate@ncleg.net, martin.nesbitt@ncleg.net, ralph.hise@ncleg.net, stan.bingham@ncleg.net, tommy.tucker@ncleg.net, william.purcell@ncleg.net
CC: bert.jones@ncleg.net, beverly.earle@ncleg.net, bill.current@ncleg.net, fred.steen@ncleg.net, harris.blake@ncleg.net, justin.burr@ncleg.net, marian.mclawhorn@ncleg.net, marilyn.avila@ncleg.net, mark.hollo@ncleg.net, martha.alexander@ncleg.net, nelson.dollar@ncleg.net, mitchell.setzer@ncleg.net, pat.hurley@ncleg.net, rayne.brown@ncleg.net, shirley.randleman@ncleg.net, tim.moffitt@ncleg.net, Tillisla@ncleg.net, tom.murry@ncleg.net, tricia.cotham@ncleg.net, william.brisson@ncleg.net, MaryKShort@aol.com, Candace.SlateRep.Dollar@ncleg.net
Sent: 6/28/2012 10:43:35 A.M. Eastern Daylight Time
Subj: SB 191 v 4: LME Governance


To all: Dr. Porter wrote a dissertation in response to my email to you all. Her statement that the courts have somehow ruled against "family guardians" is a willful misrepresentation of the issue. She states:

"... the district court ruled that it was not in the best interest of the citizen for the agency that managed their service money also served as their guardian."

Please. Family guardians do no NOT manage their ward's service money! Just take out (f). It's not in existing guardianship laws now and it just doesn't need to be in there at all at this time. Again, study it, have hearings, etc. Just please take it out of SB 191 v 4.


And just so you all know, please see the email below. I added the RED.

From: Goda, Deborah A [mailto:deborah.goda@dhhs.nc.gov]
Sent: Tuesday, June 26, 2012 2:12 PM
To: Creative Case Management
Cc: Crosbie, Kelly
Subject: RE: [SMC Communication] Monday June 25, 2012 (SMC Communication: #80) 

Good afternoon, Kathy. 

The applications are for Relative and/or Legal Guardians. The provider of Residential Supports may be the Legal Guardian in an Alternative Family Living Arrangement; please note that this an out of home living situation.
Please let me know if I can be of further assistance. 

Deb Goda 

IDD Services Consultant
Clinical Policy
DMA
919-855-4297
deborah.goda@dhhs.nc.gov

Mary K. Short
828-632-5888 or 704-451-4144 (cell)

In a message dated 6/27/2012 5:03:20 P.M. Eastern Daylight Time, Candace.SlateRep.Dollar@ncleg.net writes: 

From: Patricia Porter (Mental Health)
Sent: Wednesday, June 27, 2012 04:54 PM
To: 'MaryKShort@aol.com ' 

Cc: Rep. Nelson Dollar; Sen. Andrew C. Brock; Sen. Austin Allran; Sen. Dan Soucek; Sen. Doug Berger; Rep. Mitchell Setzer; Rep. Pat Hurley; Rep. Rayne Brown; Rep. Shirley B. Randleman; Rep. Tim Moffitt; Joe Nolan (Rep. Tillis); Rep. Tom Murry; Rep. Tricia Cotham; Rep. William Brisson; Sen. Eric Mansfield; Sen. Fletcher Hartsell, Jr.; Sen. Jim Davis; Sen. Louis Pate; Sen. Martin Nesbitt; Sen. Ralph Hise; Sen. Stan Bingham; Sen. Tommy Tucker; Rep. Beverly Earle; Rep. Bill Current; Rep. Fred Steen; Sen. Harris Blake; Rep. Justin P. Burr; Rep. Marian McLawhorn; Rep. Marilyn Avila; Rep. Mark Hollo; Rep. Martha Alexander; Sen. William Purcell; Rep. Bert Jones 

Subject: RE: SB 191 v 4: LME Governance 

Hello Ms. Short, 

Your message has been forwarded to me for reply. 

As you know, in the original Local Management Entity(LME) Governance legislation language ( H1075) passed by the House, Guardianship was addressed in detail. The DHHS requested that we insert this clarifying language in that the courts had ruled that the LME/MCOs could no longer serve as guardians for people with mental illness, developmental disabilities or substance abuse disease due to a conflict of interest. While these LMEs had served for many years in this capacity, the district court ruled that it was not in the best interest of the citizen for the agency that managed their service money also served as their guardian. 

Taking the lead from the courts the state has moved to protect against conflict of interest. The state has an abiding interest in assuring that adults who receive services are provided with guardians who are not also responsible for being the paid provider of services. This prohibition has been in the Guardianship language in H1075 from the beginning.
Wisely, the DHHS called attention to the fact that there are about 200 parents of people with developmental disability who have elected to become paid providers of services for their adult children. Many of these parents, such as yourself, also serve as guardian for their adult child. In an effort not to disrupt this arrangement, the General Assembly amended the Guardianship language to designate paid parent service providers as exempt from this conflict of interest prohibition. 

In further discussion by the House HHS Committee, members posed the possibility of other family members being in a potential conflict of interest. In an effort to address this concern, while continuing to protect the best interests of adults with disabilities in the state, an amendment was proposed that will allow all immediate family members of an adult consumer who, before Jan 1,2013 are serving as both paid service provider and guardian to be able to continue to do so. However, there is also a recognition that this situation deserves more scrutiny. Accordingly, the provision that you have included in your message was provided to the House yesterday and that body voted in support of it. To formalize the process for review of this issue, a technical amendment was added to the budget bill today directing that a study of Guardianship will be added to the list of items for review by a subcommittee to be established by the Joint HHS Oversight Committee during the interim before the long session. This amendment can be found under Section 10.11 (a). Contrary to your assertion that this had not been a well thought out process, the General Assembly wants to make sure that knowledgeable individuals can carefully review the facts about this issue and come to a set of recommendations that will guide future actions on this issue. 

I hope this is helpful to you. Please let me know if I can provide additional assistance. 

Pat Porter 

Patricia Porter, PhD, Consultant
Health and Human Services
North Carolina General Assembly
301-B Legislative Office Building
300 N. Salisbury Street
Raleigh, NC 27603
(919)301-1982

From: MaryKShort@aol.com [mailto:MaryKShort@aol.com]


Sent: Wednesday, June 27, 2012 12:58 PM
To: Sen. Andrew C. Brock; Sen. Austin Allran; Sen. Dan Soucek; Sen. Doug Berger; Sen. Eric Mansfield; Sen. Fletcher Hartsell, Jr.; Sen. James Forrester; Sen. Jim Davis; Sen. Louis Pate; Sen. Martin Nesbitt; Sen. Ralph Hise; Sen. Stan Bingham; Sen. Tommy Tucker; Sen. William Purcell
Cc: Rep. Bert Jones; Rep. Beverly Earle; Rep. Bill Current; Rep. Fred Steen; Sen. Harris Blake; Rep. Justin P. Burr; Rep. Marian McLawhorn; Rep. Marilyn Avila; Rep. Mark Hollo; Rep. Martha Alexander; Rep. Nelson Dollar; Rep. Mitchell Setzer; Rep. Pat Hurley; Rep. Rayne Brown; Rep. Shirley B. Randleman; Rep. Tim Moffitt; Joe Nolan (Rep. Tillis); Rep. Tom Murry; Rep. Tricia Cotham; Rep. William Brisson
Subject: SB 191 v 4: LME Governance


I DO NOT AGREE with the proposed language found on page 8, (f) regarding Guardians and parents and other family members. I urge you to simply delete it ALL. I do AGREE with there being a "study" to determine what should happen going forward, but that the NCGA should leave well enough alone UNTIL AFTER THE STUDY! This is all too rushed and not heard or debated in committee or committees.


Mary K. Short
828-632-5888 or 704-451-4144 (cell)

From: MaryKShort@aol.com
To: MaryKShort@aol.com
Sent: 6/27/2012 12:38:46 P.M. Eastern Daylight Time
Subj: URGENT TODAY: Language change re Guardians!

Here we go! The NCGA changed the LME Governance bill number from HB 1075 to SB 191. You need to care about this because NEW LANGUAGE WAS ADDED ABOUT GUARDIANS AND FAMILY MEMBERS WHO ARE ALLOWED TO BE PAID TO PROVIDE SERVICES. My comments are inserted in blue, after the sentence in question.


What this says is that after January 1st, 2013, NO FAMILY MEMBER WHO IS NOT A PARENT, BUT WHO IS A GUARDIAN WILL BE ALLOWED TO BE PAID TO PERFORM ANY SERVICES. Going forward, if you, the parent, falls over dead after January 1st, 2013, any family member you have ready to become the Guardian, WILL NOT BE ALLOWED TO BE PAID TO PERFORM SERVICES. As long as the family member is NOT A GUARDIAN, they may be paid to perform services.

(f) An individual who contracts with or is employed by an entity that contracts with a local management entity (LME) for the delivery of mental health, developmental disabilities, and substance abuse services may not serve as a guardian for a ward for whom the individual or entity is providing these services, unless the individual is a parent of that ward. (That first sentence is fine.) The prohibition provided in this subsection shall not apply to a member of the ward's immediate family who is under contract with a local management entity (LME) for the delivery of mental health, developmental disabilities, and substance abuse services and is serving as a guardian as of January 1, 2013. (This is vague. It should have the same language as the first sentence: ... immediate family who contract with or is employed by an entity who contracts with a local management entity (LME) ...) For the purposes of this subsection, the term "immediate family" is defined as a spouse, child, sibling, parent, grandparent, or grandchild. The term also includes stepparents, stepchildren, stepsiblings, and adoptive relationships."

[ Read more: Mary's full original email here. ]