Showing posts with label ADA. Show all posts
Showing posts with label ADA. Show all posts

23 October 2012

CAP-IDD ... this is NOT NC Innovations

From Mary K. Short:


The links to the announcements and guidance are below.  The changes from CAP-MR/DD to CAP-IDD are approved by CMS on 10/1/2012 BUT are not implemented until 1/1/2013.  If you are in an LME that is supposed to convert to an MCO before or on 1/1/2013 THIS DOES NOT APPLY TO YOU (or if you are already on the NC Innovations waiver) because you should be working on the transition to the NC Innovations waiver for your LME/MCO "go live" date prior to or on 1/1/2013.  The Special Medicaid Bulletin is specific about timelines and who is and who is not impacted.
Additionally, this is part of what Doug Sea sent out to providers/case managers.  I know he works with DRNC (Disability Rights North Carolina www.disabilityrightsnc.org) and you should probably contact them if you have questions.  If you are in Legal Services of the Southern Piedmont area (Mecklenburg & surrounding), then contact LSSP at www.lssp.org.
The instructions do not include the right to request continuation of current services as a reasonable accommodation under the ADA. Nor do the instructions provide for the right to a notice with appeal rights if such a request is made and denied. It will be up to advocates and providers to let families know they have the right to submit such a plan and to appeal to OAH if denied if they are at serious risk of institutionalization without continuation of their current services. Please make families aware of this.  
Essentially the same issue will occur for families transitioning to the Innovations waiver on January 1 .  Those 36 counties are also listed in this bulletin.
Here are some other possible specific issues to look for as CAP-DD families transition to the new CAP-IDD waiver (for a short time) and to the Innovations waiver:
A.      if LME doesn’t have adequate provider network, can family continue to be paid to provide home support services?
B.      If rate paid to provider is changing (eg no more enhanced personal care services or enhanced respite) and new rate is inadequate to attract qualified provider for this recipient, can recipient appeal rate reduction/loss of enhanced service?
C.      Does the requirement that  Intensive In home support have a fading plan and the 6 month limit for intensive night services violate the ADA or EPSDT?
D.      Does the restriction on services during school hours violate EPSDT if the child requests personal care (not hab serv) in excess of that limit?
E.       Does child recipient have right to case management in addition to care coordination under epsdt if medically necessary in that case because the LME staff are not adequately trained or don’t do medically necessary work the current case manager has been doing?
F.       Does the LME violate due process by “crosswalking” to new services without explaining right to request continued current service and to appeal if denied?
Mary K. Short
828-632-5888 or 704-451-4144 (cell)
Special Medicaid Bulletin:
http://www.ncdhhs.gov/dma/  (SCROLL down, it's the first bullet point on the left.)
OR direct link to the Bulletin:
CLINICAL POLICY 8M:
(Clinical Policy 8M ... this is the IDD 8M.  I do not have an answer for how it got approved and posted without an additional comment period!)

06 September 2012

NCGA JLOC-HHS Meeting Agenda 9/10

SUBCOMMITTEE ON MENTAL HEALTH

AGENDA

September 10, 2012, 1:00 P.M.,
Room 643, Legislative Office Building

Introductions and Comments 1:00-1:10
Chairman Burr
Chairman Pate

Review of Law Establishing Subcommittee Charge 1:10-1:15
FRD Staff

Overview of Major Mental Health Reform 1:15-2:00

  • Major Legislative and Policy Changes 2001 – Present
    Research Staff
(Presentation will address major changes in the State’s delivery of mental health services, including information on Olmstead/ADA – description, impact on the state’s mental health system)

  • Impact on State Facilities’ and Community Psychiatric Hospitals 2:00 – 2:45
    Ms. Laura White, Team Leader Psychiatric Hospitals
    Division of State Operated Healthcare Facilities

(Presentation will address number of people released into the community as a result of reforms/policy changes, adequacy of beds and services; changes in availability of state facility and community mental health beds over this period; state facility and community mental health bed capacity; state facility catchment areas)

  • LME Perspective on Impact of Major Reform/Policy Changes 2:45 – 3:30
    Pam Shipman, CEO PBH

Impact of Mental Health Policy on Law Enforcement 3:15 – 3:30
Eddie Caldwell, Executive Director, NC Sherriff’s Association

Committee Discussion/Comments 3:30-4:00

Adjourn

Parent Correspondence re CAP MRDD transition

Fwd: Waiver Update: CAP-MR/DD to IDD


MaryKShort@aol.com <MaryKShort@aol.com>Tue, Sep 4, 2012 at 7:37 PM
To: MaryKShort@aol.com
This is about the CAP-MR/DD to IDD transition ... not NC Innovations or MCO's!  It looks like the change to the IDD waiver (and the 40 hour rule) will happen on Sept. 28th for those of you still on the CAP waiver.  Remember:  You have a right to request a reasonable accommodation or an exception to the 40 hour policy under the ADA (American with Disabilities Act.)  You simply request the ADA exception with the reason WHY you need the exception.  You also have a right to request an ADA reasonable accommodation or an exception to the SNAP/SIS score guideline/limit on the amount of services that are "medically necessary for health and safety."  Katie SNAP's at a Level 3 and received Level 5 Home Supports, exception was granted for her medically necessary for health and safety level of services.  You can request an ADA accommodation to any rule, policy, procedure or whatever.  Only you know what it is that will truly meet the "medically necessary for health and safety" level of services.
 
For those of you who switched to the IDD services way back when (November?) and who have been working more than 40 hours BECAUSE the state was not enforcing the limit because the waiver was not CMS approved ... It is my guess that you will now be required to come into compliance or request the ADA accommodation.
 
Mary K. Short
828-632-5888 or 704-451-4144 (cell)

From: Connie.Martin@cms.hhs.gov
To: MaryKShort@aol.com
Sent: 9/4/2012 10:43:26 A.M. Eastern Daylight Time
Subj: RE: Waiver Update: CAP-MR/DD to IDD
Good morning, Ms. Short,
Ms. Johnson left DMA a couple of months ago to take another position in the community according to the outgoing voice mail on her old telephone number.  At the end of June, CMS granted the NC DMA another extension to run until September 27th, 2012, so there have been no gaps in coverage.   CMS has recommended approval of the waiver renewal and it is going through the sign off process now. 
Thank you,
Connie 
From: MaryKShort@aol.com [mailto:MaryKShort@aol.com]
Sent: Sunday, September 02, 2012 7:26 PM
To: Martin, Connie L. (CMS/SC)
Subject: Waiver Update: CAP-MR/DD to IDD
Hello Connie.  I wrote to NC DMA (Susan Johnson, below) asking about the CAP-IDD waiver and have not heard back.  A number of families have asked me I knew for SURE that the CAP-MR/DD to CAP-IDD waiver had been approved by CMS or if there was an extension.  In fact, DMA's web site only officially lists the extension to the end of June!  That would imply there is no CAP-MR/DD or IDD waiver.  Please let me know where it stands.  Thank you.
Mary K. Short
828-632-5888 or 704-451-4144 (cell)

From: MaryKShort@aol.com
To: susan.e.johnson@dhhs.nc.gov
Sent: 8/30/2012 1:47:23 P.M. Eastern Daylight Time
Subj: CAP-MR/DD to IDD
Is the MR/DD going to IDD on October 1st or not?  I can't find anything in a Medicaid bulletin or Update ... I only see IU #92 that said until 6/29/12.  What's up?
Mary K. Short
828-632-5888 or 704-451-4144 (cell)

23 August 2012

NC-DHHS Settlement Agreement Dox w/ US DOJ

Settlement Documents (123KB pdf)

The above link will prompt a pdf download of the full settlement documents between the North Carolina Department of Health and Human Services and the United States Department of Justice, Civil Rights Division;

Documents to include:
  • Complaint for Declaratory and Injunctive Relief 
  • Joint Motion to Dismiss Without Prejudice and Retain Jurisdiction
  • Proposed Order
  • Settlement Agreement (Exhibit A)
  • Memorandum in Support of the Joint Motion


Hubert H. Humphrey said, "The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled."

On behalf of so many, THANK YOU North Carolina!! 

Disability Rights NC Applauds North Carolina’s Settlement with U.S. DOJ


FOR IMMEDIATE RELEASE
Thursday, August 23, 2012


Disability Rights NC Applauds North Carolina’s Settlement with U.S. DOJ

Raleigh – Governor Beverly Perdue took a major step today toward resolving one of the greatest challenges facing our State’s mental health system by signing a settlement agreement with the U.S. DOJ. The agreement addresses findings made July 28, 2011, that the State violates the ADA by segregating North Carolinians with mental illness in Adult Care Homes rather than allowing people the choice to live and be supported in the community.

“Disability Rights NC applauds the Governor and the Secretary Delia for their leadership. This agreement will protect the rights of people with disabilities and help the State avoid costly litigation,” said Vicki Smith, Executive Director.

The agreement provides for the creation of appropriate community mental health care, employment services and housing options for people with mental illness in our State. “This agreement will improve the lives of N.C. families – our brothers and sisters, mothers and fathers. Disability Rights NC pledges to remain vigilant, ensuring the agreement’s promise is permanent,” said Smith. “North Carolina has seized an opportunity to cultivate a robust system of care for people with mental illness which all of us can be proud of.”

Background on North Carolinians with Mental Illness Housed in Adult Care Homes

In July 2010, Disability Rights NC filed a complaint with the US DOJ alleging that the State of North Carolina is in violation of the Americans with Disabilities Act (ADA) because the State has a bias towards placing people with mental illness in Adult Care Homes (ACHs) rather than supporting them in more integrated settings in their home communities. ACHs are institutional settings that do not provide appropriate services to support recovery and meaningful community integration. Disability Rights NC alleged that the State, in relying on placements in these types of Adult Care Homes, is violating the ADA. Please see the Report: Trapped in a Fractured System - People with Mental Illness in Adult Care Homes on the website (www.disabilityrightsnc.org). Under the ADA the unjustified segregation of persons with disabilities is an illegal form of discrimination. The integration mandate allows individuals to interact with non-disabled persons to the fullest extent possible so people with disabilities are not isolated from their communities.

The US DOJ, Civil Rights Division, issued a letter of findings on July 28, 2011, concluding that North Carolina "fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs in violation of the ADA," and that "[r]eliance on unnecessary institutional settings violates the civil rights of people with disabilities." The central finding of the US DOJ is that North Carolina lacks an adequate community support system for people with mental illness. As a result, individuals are institutionalized in more expensive and more restrictive settings in Adult Care Homes. "Most people with mental illness receiving services in adult care homes could be served in more integrated settings, but are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies," wrote U.S. Assistant Attorney General Thomas Perez. "Reliance on unnecessary institutional settings violates the civil rights of people with disabilities.”
###

NC DHHS, US DOJ Reach Agreement on Community Based Care for Only Citizens with Serious Mental Illness

From The Arc of North Carolina

Breaking: NC DHHS, US DOJ Reach Agreement on Community Based Care for Only Citizens with Serious Mental Illness

[ view release at arcnc.org ]

Press Release from NC Dept. of Health & Human Services:

Raleigh — The North Carolina Department of Health and Human Services and the United States Department of Justice today reached an agreement on the state’s plan to offer more choices of where and how citizens with serious mental illness receive care and supportive services.

The plan, which was announced last month, will create housing slots in the community to offer the choice of community-based care for many adults with serious mental illness. It will also invest in job training and employment assistance for those citizens and will set up a comprehensive, 24/7 crisis care program for people with a serious mental illness.

This agreement will modernize our mental health system and ensure that North Carolina is providing the best possible treatment for adults diagnosed with severe mental illness. It will also provide the opportunity for many of these individuals to live in community settings if they choose to do so, and ensure that North Carolina is fully complying with the Americans with Disabilities Act and other federal laws.

This agreement is similar to ones signed by governors of a number of other states including, among others, the governors of Virginia and Georgia.

DHHS Secretary Al Delia agrees that more should be done to ensure access to community-based treatment for those with mental illness. “North Carolinians who have a serious mental illness have a right to choose the very best care environment to meet their personal needs,” he said. “That choice – whether they live in the community or in an adult care home – will be supported with access to mental health and other support services that will be available in part due to this agreement. Moving forward with a solution to help them identify and access those choices is the right thing to do,” he said.

“Disability Rights NC applauds the Governor and Secretary Delia for their leadership on this matter. They have not only done the right thing to protect the rights of people with disabilities, they have helped the state avoid costly litigation and destabilizing uncertainty,” said Vicki Smith, executive director of Disability Rights NC.

The agreement outlines DHHS’s plan of action to provide community-based services to people with mental illness. The budget the General Assembly passed in July expressly contemplated a settlement and appropriated funding to make this agreement possible. The timeline for completing the plan is eight years; this transition period will enable people who want to move to community-based settings to do so on a workable timetable and will allow sufficient time for North Carolina’s mental health infrastructure to implement this agreement.

# # #

20 August 2012

Panel Discussion on Housing 8/27

Panel Discussion about impact of PCS & IMD laws on Housing for People with Mental Illness: 8/27 @ 7pm

There is an impending crisis for people with mental illness who need assistance and/or supervision to live successfully in the community. There are two serious issues:
  1. The state has changed the requirements for residents in Group Homes, Adult Care Homes, and Family Care Homes to qualify for Personal Care Services (PCS). The new rules will make it virtually impossible for people with mental illness to qualify.

    All of this adds up to lots of problems for people with mental illness living in group homes and family care homes. In fact, the Chief Clinical Operating Officer of the State Division of Medical Assistance told the Legislative Oversight Committee for the NC DHHS on Tuesday, August 14 that the projected impact on supervised living group homes for people with mental illness is that nearly “0%” of residents will qualify based on the new guidelines and assessments. People with mental illness in other congregate living settings (Adult Care Homes and Family Care Homes) will be equally affected. The state projects that 12,000 people total will no longer qualify.

    We estimate that, on average group homes are billing about $6,000 per year for each resident for PCS. Loss of this amount of revenue will undoubtedly force some homes to close and those that stay open will need another source of revenue to be able to provide the quality care that is needed. The revenue from SSI and SA funds alone is not enough.
  2. The Department of Justice has ruled that the state is in violation of the Americans with Disabilities Act by housing people with disabilities in congregate settings. One outcome is that the federal Center for Medicaid and Medicare Services is requiring NC to enforce a 1965 Law. It is called the Institutions for Mental Disease (IMD) provision. It does not allow Medicaid payments for resident’s doctor’s visits or medication if a single provider has more than 16 individuals taking medications for mental illness even if they are in separate, small homes in different locations.

    One of the first things we have planned is a Panel Discussion on August 27, 7-8:30 pm at Highland United Methodist Church, 1901 Ridge Rd., Raleigh, NC in the Church Conference Rm (adjacent to the church office). You will have an opportunity to hear from the individuals who are involved in making and implementing these new policies as well as hearing from a group home manager and consumer who are impacted (See below). We hope to see you there and to hear your thoughts about this issue.
  • Selden Holt from UNC Center for Excellence in Community Mental Health, Moderator
  • Vicki Smith, DRNC – Background on PCS changes
  • Leza Wainwright, Chief Clinical Operations Branch, NC Division of Medical Assistance
  • Jenny Gadd, Group Home Director ‐ Likely Financial Impact of PCS Changes 
  • Robert Bullock, Group Home Resident, Why Group Homes are Needed 
  • Jim Jarrard, Div MH/DD/SAS, Viability of 5600A Group Homes in the Housing Continuum
  • Ann Akland, Advocacy Chair, NAMI Wake

Eric S. Fox, M.A.
Mental Health Program Coordinator
NC DHHS MH/DD/SAS
Advocacy & Customer Service Section
Consumer Empowerment Team
3009 Mail Service Center
Raleigh, NC 27699-3009
(919) 715-3197 ext 235
email: eric.fox@dhhs.nc.gov
website: http://www.dhhs.state.nc.us

09 August 2012

From Arc NC: Unintended Budget Cuts Must Be Fixed!


Unintended Budget Cuts Must Be Fixed!

[ view original posting ]

It’s time for the Governor and members of the General Assembly to fix the “unintended” reductions of the Social Services Block Grant (SSBG) for people with disabilities. Both legislators and the Governor’s administration seem to agree that an additional cut of $4.3 million to the community system was unintended. Unintended or not, this cut, on top of the $20 million intended reduction by the General Assembly, is causing serious harm to people with disabilities and their families.

It is hard do imagine that while the state is attempting to negotiate a settlement with the U.S. Department of Justice on ADA issues, we would allow further reductions to the fragile infrastructure of the community system. Services that allow people to live at home or in community residential settings are affected by this cut the most. Letting this “accidental” cut stand will hurt people.

The Arc, in a letter to the Governor, has asked that she take the lead on eliminating this cut. We are sending a similar letter to the House and Senate leadership asking them to join with the Governor to fix this unfortunate mistake. Hopefully, all parties will work together to do so.

Members can help by letting the Governor and General Assembly know that this cut must be restored. Let them know that our fragile community system cannot stand more reductions and that people with disabilities deserve better!

Contact:

30 July 2012

Labels are for Jars.

Received a mail recently from a dear ole friend of mine, Joe Genera, and thought it appropriate to share his wisdom regarding labels and the human experience... but first, a bit about Joe:

I first met Joe in biology class as a student at Wake Tech, way back before marriage, before Isabel, in a time when I was "young, wild and free" as they say... As my "right brain" has consistently proven to be far more developed than my left, I quickly aligned myself with a sciency-minded study partner, who happened to be Joe. Not only was he (and remains to be) among the most down-to-earth, likable  fellows I've ever met, he's also wise beyond his years and exceptionally intelligent (which made for an excellent choice in lab partners). We became fast friends, sharing many experiences and countless laughs together. I sometimes camped at his house as he was one of the only people I knew back in the days of floppy drives to own a personal computer; I hammered out many a Criminal Justice term paper in his home office in the wee hours of the morning. And he took me to my first theatrical performance - Cats - and opened my eyes (and soul) to a new way of thinking about the poetry of life...

Joe was a slightly older-than-me single dad back then of a beautiful, young active girl who most days drove a sporty teal-blue convertible Corvette - on other days, he drove a custom van outfitted with a lift.

You see, once upon a time Joe was a young ramble-rouser with an affinity for restoring old hot rods... One day, the unimaginable happened when a car slipped from the garage lift pinning Joe beneath and crushing his spine - forever changing life as he knew it. And yet he finished school, worked, raised a daughter, and is a successful business owner, fierce disability advocate and a soon-to-be published author.

(If you want to know anything else, you'll have to read the book, "Arrested Youth" for it's not my tale to tell.)

These days though, back in Connecticut, it is no surprise that he still uses his powers for good, operating an autobody repair shop and program called Team-MuscleCar, LLC: "'TEACHING TEENS - ONE HOT ROD AT A TIME' tm Mentoring to keep kids in school by having them use their hands and minds, and expanding their life skills."

----------- from Joe...

Crystal - just saw your post about labels - thought this might hit a cord with you. An Op-ED piece I did last month.

"LABELS ARE FOR JARS – NOT PEOPLE." – Joseph P. Genera

In the thirty years since a car slipped off a lift, falling six feet through the air before breaking my back as it crushed my spinal cord, I have gone through many life changes. Some, like adapting to a world from a suddenly shorter stature and navigating a bumpy world via a wheelchair, took some getting used to. Other changes, like how the world saw me, or more pointedly - labeled me as, has been one of the more challenging aspects to get used to.

In the three decades since my world so abruptly changed, I have gone from being a ‘cripple’ to a 'person with a disability', with about ten other labels in between. Not because I myself had made any significant changes, or had some miraculous healing come my way. No, the different labels arose from our American society deciding that one name was better, or more ‘politically-correct’, than another. And as with other minority groups, I was personally never asked myself what I would like to be called.

In my own lifetime, I have seen the currently 'P.C.' African-American named population referred to as colored, black, people of color, evolving to today's accepted 'African-Americans.' But, I don't remember there ever being a vote taken of that population, asking them what they as a people, would prefer.

In the case of the 55 million 'persons with disabilities’ in America, there has never been a caucus of any kind that has asked, "What would you like to be called?"

And yet, in the last thirty years I have been dubbed everything from crippled, infirm, afflicted, handicapped, handi-capable and differently-abled. I have been wheelchair-bound, as if I never leave the chair to bathe, sleep or love. One of my least favorite of all is to be branded as an ’invalid,’ which suggests that portions of society thinks that people such as myself are not considered valid members of our world.

Today, the favored phrase seems to be 'person with a disability.' If there has to be a label, this one is probably the least offensive, in that it at least puts the person before whatever condition or impairment that affects his or her life. While positive in nature, who knows how long this current term will be in favor before our polite world decides that I need to be called yet another unasked-for label. In fact, the ‘new and improved’ title that the national media seems to be trying to adapt today is the instantly dependent sounding label: ‘special needs population.’

No, no, no! People with disabilities do not want to be seen as special – they want to be seen as people, period. And they/we certainly do not want to be perceived as needy. As disability can affect any one of us at any time, with little consideration as to race, sex, religion or socioeconomic status, those who come up with these ‘titles’ should ask themselves – ‘If I were hit by a bus tomorrow and became paralyzed, would I want to be immediately affixed with the label ‘special needs person?’

In this country, much time, thought and energy go into defining what is politically correct, what words are best to use to ensure that the majority of a specific population is not offended, and so that the rest of society feels good for having come up with the next ‘right thing.’ Even within the ranks of the various disability groups, there is constant in-fighting as to what their own monikers should be. Energies and resources are wasted on such pursuits, when the time could be better used to improve the very real physical and psychological barriers that people with disabilities face every day.

No one wants to be offended, and most people with good sense do not want to offend. That’s the reason why everyone from the average person to the national media struggles with the question "What do we call 'those' people?"

I know exactly what I would say if I were ever polled, or had to vote for the very best label for the world to bestow upon me.

Just call me Joe. Thanks.

----------- my reply...

Dearest Joe, as long as I've known you - a lifetime it seems (I bought my first legal 6-pack with you if you recall [and much to my 21-year-old disappointment, was not even carded]), even back in pre-Isabel days when life for me was oh-so-much-easier though exceptionally less profound - I have never, ever thought of you as "disabled"... You??? LOL Not able to do something - outside of say a running long jump (which if this two of us were competing, you'd probably win truth be told) - preposterous! Pfft... And you know I am not saying this out of some misplaced need to defend myself regarding what I assume you to believe I think; I know you know me... My point is, you are among the most able and capable, intelligent and AMAZING human beings I have ever been blessed to know - who has yet once again, smacked my sensibilities upside the aha... reminding me of the absolute profundity of it all: human connection.

It's really all the same isn't it? There is not a one born among without purpose and no purpose is without importance, nor is one purpose greater than another... regardless of perceived 'ability', color spectrum, belief, education nor status. "Normalcy" indeed is a manmade definition to corral ourselves within our comfort zone. --Until we each recognize these truths within ourselves and step outside of our own limitations, we are doomed to remain ourselves "disabled."

I never imagined I would have another child after Isabel. When Liam came along, it was like being a first time parent all over again; a whole different ballgame! --As he grew and began to become aware of his world, talk and ask questions (OMG, does he talk!), he would ask me why sissy didn't speak or why she does things that she does... I tried to explain to him once that Isabel was "special"... I thought that explanation was a pretty good one and seemed to quiet his curiosities (I should have known better). The next days he came to me crying and told me that he wanted to be "special" too. --From the mouths of babes! Oh, talk about breaking your heart! ...So we had a long talk about purpose and God and how Isabel is as God intended for her to be; that while we may never know her intended purpose for this world, the fact that she does not speak verbally and doesn't think the same way we do was part of her purpose and that purpose was very important... That just maybe her purpose was to teach us to be better people and understand how to love everyone the same?

I have always made a conscious effort to never describe someone by their abilities, ethnicity, etc. because I did not want to plant the seed in his thinking that these things were a measure of an individual. --About a year ago, when Liam was four, it came home to me in such a profound way when he came home from preschool telling us about his new friend, "Johnny"... Who is Johnny we asked, trying to put a face with a name? You know, he said, the boy with the super-hero eyes - and then he put his fingers on each temple by his eyes and pulled back the skin to show us... (Johnny's parent's are of asian decent.) To Liam, his new friend was nothing short of a rock star. =)

Joe: In this world, in this life, we tend to get stuck so often in the gravity of ourselves, our own lives, problems, issues and goings on; I am no less guilty. Though I try to make certain that those sacred souls in my life always know how much I love them, that they have mattered to me in magical ways, and I could not have made it this far without them... You are one of those sacred souls - I know I don't say it often enough... so, just to reiterate: Not only have you shaped me in ways you will probably never know in all the years, but I love you dearly.

Thank you for your words dear one...

----------- from Joe...

Absolutely! And please know that was in no way a rebuke of any kind to you ...at all! I just love reading your posts, personal and the NC ones and thought it might fit... And it does, cuz of who you are!

I am so glad you came and asked about my motorcycle 20 years ago. I love you too Crystal

P.S. And of course you can post!

26 July 2012

news : Adult care home plan for NC under way

APNewsBreak: Adult care home plan for NC under way
By GARY D. ROBERTSON - Associated Press

[ read at News and Observer ]

RALEIGH, N.C. --

North Carolina's state health agency is moving ahead with the first step of a multi-year plan to help move potentially thousands of mentally ill residents from adult care homes to affordable housing and less restrictive living conditions.

The state Department of Health and Human Services publicized Thursday the action plan, which responds to allegations made a year ago by the U.S. Department of Justice that the state was failing to comply with the Americans with Disabilities Act. The government threatened to sue unless improvements were made.

The plan is a calculated risk for state officials because federal attorneys haven't told them whether it's enough to avoid litigation. That could require a judge-approved agreement with the federal government that may be more rigorous and expensive to carry out.

Government lawyers said in July 2011 that thousands of people with mental illness were segregated from society in adult care homes that had essentially become mental health treatment centers without giving them access to community treatment.

The plan, which will cost $10.3 million this fiscal year, will begin moving at least 100 residents with severe mental illness outside the homes to other community housing. Based on their income and ability to function, the displaced residents also will get help with paying rent, job training and potential employment.

The eight-year plan, which could cost a total of $67 million, would work to create 3,000 "slots" for people seeking a full slate of community services, acting HHS Secretary Al Delia said. The number of people that move could be much more because not everyone will need all of the offered services, Delia said.

Those who want to stay in adult care homes can remain there, he told The Associated Press.

"People will have choice," Delia said in an interview. "They will not be required to live in any one place, whether it's in a facility or in the community."


The General Assembly set aside money in this year's budget to begin the transition, which has been the subject of months of talks with the Department of Justice. Delia described HHS and the federal government agreeing largely on the improvements being made.

HHS is "moving forward on implementation because we believe that it's the right policy," Delia said.

Vicki Smith with Disability Rights North Carolina, the group that leveled the 2010 complaint, said the plan sounds good on the surface but lacks a method to require the state to carry out the plan completely. Smith pointed out there's less than six months before Gov. Beverly Perdue leaves office and another administration arrives.

"Many of the people who are issuing these promises will not be around even at the end of the first year to ensure implementation," said Smith, adding that the state has fallen short of expectations in the past when it comes to mental health treatment.

"I just don't think people with mental illness can recover from another failed promise," Smith said.

The department said it still doesn't have an accurate count of the number of mentally ill residents in homes. DOJ wrote in July 2011 that 5,800 people with mental illness live at 288 adult care homes with at least 20 beds where people with mental illness comprise at least 10 percent of the population.

The action plan is one solution to deal with intertwined legal and government challenges involving North Carolina's adult care homes, whose residents include people with chronic health problems, Alzheimer's disease or mental illness. The homes don't have medically intensive services that are found in nursing homes.

The state budget also set aside another $40 million in part to provide assistance to adult care homes that aren't expected to receive some Medicaid reimbursements when a streamlined policy for personal care services goes into effect soon.

The plan's unveiling came on the 22nd anniversary of the signing of the Americans with Disabilities Act. The 2010 complaint by Disability Rights North Carolina also was filed on Thursday's date.

NC Fails at DOJ Settlement, but has a Plan!

22 Years Ago Today...

Thu, Jul 26, 2012 at 7:59 AM
From: Vicki Smith, Executive Director of Disability Rights North Carolina
Re: State fails to settle with DOJ but announces 8 year plan



FOR IMMEDIATE RELEASE


[ view the DRNC Press Release ]


DOJ Update
NC Secretary of Health and Human Services, Al Delia, will announce the details of an 8 year plan to develop services for 3,000 individuals with mental illness in living in Adult Care Homes to more integrated setting appropriate to their needs later today. 


The State and USDOJ have been in confidential negotiations for the last year. At the table were representatives from the Governor’s Office, Department of Health & Human Services, and the Attorney General’s Office. Little information was shared about discussions until today’s announcement that the parties have failed to reach agreement but the state is moving forward with a plan. However, the General Assembly’s inclusion of $10.3 million in the 2012 - 2013 Budget to begin implementation of any settlement was seen as a sign that resolution was near. The announcement will also include acknowledgment by the State that it was unable to reach a settlement agreement with USDOJ, largely because of disagreement regarding an enforcement mechanism.


Our Response

“We are disappointed that the State was unable to come to an agreement to resolve our complaint with USDOJ,” said Vicki Smith, Executive Director of Disability Rights NC. “It is reassuring to have the State acknowledge the enormity of the unmet needs of people with mental illness and their plan to increase supported housing, supported employment and other services. However, the plan outlined by the State lacks a binding agreement, one which once and for all commits the state to fulfill the promises we’ve heard today. “ 

The Department of Justice may still pursue legal action against the state. Whatever steps the USDOJ takes next, Disability Rights NC will continue to address this situation. 

North Carolina has failed to:

Develop a meaningful Community Integration Plan as required by the 1999 Supreme Court’s Olmstead Decision including policies that provide incentives for community based services and placements;

Adequately fund the state’s Mental Health Trust Fund;

Develop community based services as hospital beds were closed, instead it relied on an industry that was neither designed nor competent to promote the recovery and inclusion of people with mental illness in the community; and

Most importantly, the State failed to focus first and foremost on the interests and needs of people with mental illness. It lost sight of its purpose - protecting the health and safety of all its citizens while providing essential human services.

What a way to celebrate the 22 anniversary of the signing of the ADA into law.

Take a look at this short video:  http://youtu.be/6ieH8FE9Dhw

“Let the shameful wall of exclusion finally come tumbling down.”

More information as it develops!


Vicki Smith
Executive Director
Disability Rights NC
2626 Glenwood Avenue, Suite 550
Raleigh, NC 27608
Phone: 919-856-2195
TTY: 1-888-268-5535
Fax: 919-856-2244
vicki.smith@disabilityrightsnc.org


Disability Rights NC is the state's protection and advocacy system. 

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20 June 2012

DRNC Press Release: Move to Intervene in ACH matter

Disability Rights North Carolina
FOR IMMEDIATE RELEASE 

Tuesday, June 19, 2012

Disability Rights NC Moves to Intervene in
Tiffany Healthcare, Inc., et al., Petitioners v.
North Carolina Department of Health and
Human Services, Division of Medical Assistance

Raleigh - Disability Rights NC filed a motion to intervene in the case Tiffany Healthcare, Inc., et al., Petitioners v. North Carolina Department of Health and Human Services, Division of Medical Assistance. This case was filed last Thursday on behalf of the owners of eighteen Adult Care Homes (ACHs) who were notified that as Institutions for Mental Disease (IMD), their residents were no longer eligible to receive services under Medicaid.

“The outcome of this case could have a profound effect on the welfare of adults with mental illness – people we are mandated to protect,” said Vicki Smith, executive director of Disability Rights NC. “In the event that the Court rejects Tiffany Healthcare, Inc’s claim, the subsequent loss of Medicaid funding would require a change in the residential placements of more than one thousand individuals. Many of these residents live with mental illness. All of the residents are disabled to some degree.”

A little over a year ago, the Centers for Medicare and Medicaid Services (CMS) informed NC DHHS/DMA that it must develop a method of determining whether ACHs whose residents receive Medicaid benefits qualify as IMDs. NC was required by CMS to develop a protocol to assess whether certain ACHs meet the definition of an IMD and to assure that Medicaid dollars were not being used inappropriately to pay services to residents of those homes.

If the Court rules in favor of the State, the consequence would be the immediate termination of Medicaid payments to the facility. One likely consequence is that, once found to be an IMD, an ACH may face immediate closure owing to the loss of a significant revenue stream for the facility. It is also possible that the ACH might fail to provide the required 30-days’ notice of discharge to each resident. More important, the need to find alternative placements for all of the discharged ACH residents could overwhelm the ability of the local Department of Social Services and the Local Management Entities to meet the discharge needs of the displaced residents as guaranteed by law.

Smith stated, “In the event that the affected residents lose their Medicaid eligibility, an orderly process for locating alternative housing – which is required by law – must be assured. Both Chambers of the General Assembly have recognized the need to budget some transitional support for ACHs. It is our hope that those funds will be specifically targeted to pay for residents’ medications and other medical expenses while alternative housing and services are located. ”

The Court issued a TRO on Friday, June 15 preventing the State from immediately terminating Medicaid benefits. Further proceedings are scheduled at the Office of Administrative Hearings for June 28th.

Background on North Carolinians with Mental Illness Housed in Adult Care Homes
The state’s practice of employing adult care homes as the default residential placement for people with mental illness has been a longstanding subject of interest, investigation and study by Disability Rights NC. In July 2010, Disability Rights NC filed a complaint with the U.S. Department of Justice claiming that the practice of warehousing adults with mental illness in adult care homes violated the Americans with Disabilities Act and the U.S. Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999). One year later, the Department of Justice issued a letter containing its findings, and concluded that “adult care homes are institutional settings that segregate residents from the community” and that those with mental illness “are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies … .”

###

Disability Rights North Carolina is a 501(c)(3) nonprofit organization with offices in Raleigh and Asheville. Its team of attorneys, advocates, paralegals and support staff provide advocacy and legal services for people with disabilities across North Carolina. As the state’s federally mandated protection and advocacy system, Disability Rights North Carolina is charged with finding and fighting the abuse and neglect of people with disabilities.

19 May 2012

NC Chickens Coming Home to Roost

Tuesday's Joint Legislative Oversight Committee on Health and Human Services Meeting (May 15, 2012) focused a great deal on the Department of Justice Complaint (filed by Disability Rights of NC in 2010) and the 16-page DOJ letter of findings resulting from that Complaint. 


The 53-page Complaint and supporting documents focused on NC's Mental Health System and the service delivery to persons with Mental Illness in Adult Care Homes and other settings across the state, alleging namely the improper placement of mentally ill persons in adult care homes and the failure to provide necessary treatment by mental health professionals as well as supports for community integration and independent living, violations of the Americans with Disabilities Act and Olmstead Act. 

It should be noted that the initial Complaint to DOJ was not news to the State of North Carolina. Here are just a few examples from the 5 page synopsis of NC's mental health care history spanning more than a decade:
  • In 2001, North Carolina undertook a massive effort to reform mental health care, including the privatization of many mental health services and the creation of regional management entities that replaced local county mental health agencies. North Carolina’s State Plan 2001: A Blueprint for Change, emphasized the need to provide meaningful integrated services in accessible community settings for adults with severe and persistent mental illness. (page 4)
  • In 2003, just two years following the initiation of mental health care reform, “a number of North Carolina communities were already ‘seeing increasing numbers of psychiatrists refusing to see Medicaid patients due to low reimbursement levels.’" (page 6)
  • An advocacy group, NC Policy Watch, reports that nearly 1,200 people who were discharged from psychiatric hospitals ended up in homeless shelters in 2007. (page 6)
  • A 2008 study commissioned by the North Carolina General Assembly magnified Disability Rights NC’s concern about Adult Care Homes and the lack of true, integrated community placements for adults with mental illness in Adult Care Homes. (page 3)
  • To the detriment of community integration efforts, the N.C. General Assembly directed DHHS to eliminated Case Management as a service in 2009 as a stand-alone service to adults who receive mental health services. Some of Case Management’s functions have been absorbed into the new Community Support Team service, but where Community Support Team services are inappropriate or unavailable, Case Management services do not exist. (page 6) 
  • The General Assembly’s 2010 Budget Bill instructed the Department to replace Medicaid funded community PCS with two new services: In-Home Care for Children (IHCC) and In-Home Care for Adults (IHCA). The In-Home Care services perform the same function as PCS, but the eligibility criteria for IHC are much stricter. It is estimated that more than one-half of the 37,000 current PCS recipients will not meet the eligibility criteria for IHCA and will subsequently lose the services that allow them to live in their own homes. Earlier policy changes also altered the eligibility requirements to only authorize community PCS when a person required hands-on assistance in performing an ADL. Mental capacity was no longer considered to be a factor in eligibility, but instead could only be taken into consideration after a person was found to be eligible for community PCS, and only then to allow a small increase in the total number of hours. While community PCS were drastically cut and access to the service restricted, PCS for Adult Care Home residents remained intact, essentially unaffected by budget cuts. As a result of this drastic cut in community-based services, thousands of individuals who have been living successfully in the community will be at risk of institutionalization in violation of Olmstead as they will be forced into Adult Care Homes, Assisted Living Facilities, and other non-community settings in order to obtain needed Personal Care Services. (pages 7-8)

The Department of Justice Civil Rights Division, found the adult care homes to be "Segregated, Institutional Settings"... and from their I. Summary of Findings (pages 1-3):
We conclude that the State fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs in violation of the ADA. The State plans, structures, and administers its mental health service system to deliver services to thousands of persons with mental illness in large, segregated adult care homes, and to allocate funding to serve individuals in adult care homes rather than in integrated settings. Adult care homes are institutional settings that segregate residents from the community and impede residents' interactions with people who do not have disabilities. Most people with mental illness receiving services in adult care homes could be served in more integrated settings, but are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies, which include:
  • The State's failure to develop a sufficient quantity of community-based alternatives for individuals with mental illness unnecessarily and indefinitely confined to adult care homes;
  • The State's failure to redirect resources already available to expand community-based alternatives;
  • The State's prioritization of investment in institutional settings at the expense of community-based settings; and
  • The use of policies and practices that cause individuals with mental illness to enter adult care homes to obtain support services. 
Our findings are consistent with the following conclusions made in several State-issued and State-funded reports:
  • Adult care homes "are not optimal for community integration" and "[r]esidents of 
  • ACHs may be cut off from active participation in the local community.
  • Adult care homes are "highly likely to qualify as restricted settings'
  • There is an "institutional bias" in North Carolina: "People who enter an ACH or  other type of facility can obtain certain financial assistance, services, and supports that are not equally available to people with similar levels of disability and financial need who choose to remain in their own homes'
  • "[M]any with mental illnesses continue to live in long term care settings because  there are not yet more appropriate alternatives available to them in their communities'"Adult care homes are not the most appropriate setting for people with mental illness because they are not designed to provide services to allow people with mental illness to achieve greater independence.' and
  • Supportive housing promotes community integration and achieves "positive  impacts in terms of cost-effectiveness and improvement in quality of life, housing stability and health and behavioral outcomes for people with mental illnesses, developmental disabilities and substance abuse disorders.
We agree with these conclusions and observations. Reliance on unnecessary institutional settings violates the civil rights of people with disabilities. Community integration will permit the State to support people with disabilities in settings appropriate to their needs in a cost effective manner.
It's not necessarily a matter of the State seeing the error of their ways after 10 or 15 years however, but rather the year-long negotiations with the US DOJ and the knowledge of numerous other states who have also been investigated for similar ADA and Olmstead violations and the financial consequences they are now facing, like New Jersey's 2009 5-year court order for $752 million annually or Georgia's $685 million annual required payment to the federal government, Texas at $464 million, and Virginia, who entered into a total settlement of $2.1 million.

Bottom line: money talks... especially if it's due to come out of your pocket book.

Durring DOJ update portion of the JLOC meeting by DHHS General Council, Emery Millikin, Senator Tommy Tucker  asked if NC had just been sweeping this problem under the rug for 10 or 15 years and "now the chickens have come home to roost?" Attorney Millikin denied any under-rug-sweeping, though did acknowledge, that the chickens of North Carolina have indeed come home to roost.

*I'll be explaining more about what this means to DD families and how this is due to affect our children as Medicaid recipients...



NC Faces Potentially Massive Legal Settlement Over Housing for Mentally Ill

May 16, 2012

From NC Health News by Rose Hoban

Negotiations with the US Department of Justice over North Carolina’s use of Adult Care Homes to house mental health patients are reaching a head after a year of negotiations. And the tab is likely to be large for the state.

The situation dates back to 2010, when Disability Rights North Carolina wrote to the US Department of Justice, complaining about the state’s use of adult care homes to house thousands of people with mental health disabilities. Disability Rights alleged the state’s way of housing these mental health consumers was ‘biased’ towards putting people in institutions, such as adult care homes, rather than helping them move out into the community, as required by law.

“Right now what’s happening to those folks, is that they’re in a placement, where they’re getting no treatment, and there are no incentives to move them out,” said Vicki Smith, head of Disability Rights.

Federal officials investigated early last year and concluded in June, 2011 that North Carolina policies were in violation of the Americans with Disabilities Act. The DOJ also found that North Carolina had failed “to develop a sufficient quantity of community-based alternatives for individuals with mental illness.”

State officials have been negotiating with federal officials since.

“I was pretty optimistic about what I was hearing about moving forward,” Smith said about the discussion in Tuesday’s hearing. “There is at least an acknowledgment that the pattern of practice needs to change.”



14 May 2012

DRNC Press Release: Governor Ignores Crisis for People with Disabilities


Disability Rights of NC issued a Press Release today regarding Governor Perdue's 2012-2013 budget for the State of North Carolina and citizens with disabilities.

May 14, 2012

The Governor has been in negotiations with the US DOJ since June 2011 to develop a voluntary compliance agreement and avoid the possibility of the US DOJ filing suit against the State. Staff familiar with budget development and US DOJ negotiations have asserted repeatedly over the last three months that the Governor’s budget would include funding for the changes required to avert litigation. However, the Governor released her budget last week with no funding for any efforts to end the institutionalization of people with mental illness leaving the responsibility for crafting a plan entirely to the General Assembly. Smith says, “There is still time to make historic changes to our system -- to stand up for the dignity of people with mental illness in North Carolina -- but we will need courage and conviction from our leaders in the General Assembly to make it happen.”


29 March 2012

DRNC Press Release on federal Court ruling


For Immediate Release
March 29, 2012

Raleigh, North Carolina – A federal District Court today ordered the State of North Carolina to halt reductions to home and community based services and restore lost services until the state Medicaid agency and its managed care contractor, Piedmont Behavioral Healthcare (PBH), comply with legal requirements for providing Medicaid beneficiaries with adequate notices and opportunities for impartial hearings when their services are denied, reduced or terminated. The Court noted that without an injunction, the plaintiffs—children and adults with disabilities—would experience deteriorating health, financial strains, and the threat of having to go into institutions to get care. “We are gratified by the court’s thorough, careful analysis and hopeful that the state and PBH will quickly accept this decision and correct their illegal practices,” said Doug Sea, an attorney at Legal Services of Southern Piedmont. “Scores of our most vulnerable citizens desperately need the services that have been taken away from them, without due process, to be promptly restored.”

Judge Louise Flanagan’s decision found that the plaintiffs are likely to succeed on the merits of their legal claims that the Medicaid agency and PBH are not complying with the most basic federal constitutional and statutory requirements for participating in the Medicaid program. “Health care coverage is complicated,” said National Health Law Program attorney Jane Perkins. “The court’s decision is welcome and important because it recognizes that the Medicaid agency and its managed care plan, PBH, have obligations to make sure that people with disabilities who are insured through Medicaid get timely and accurate information about why their services are being reduced or terminated and what they can do about it if they object.” 

The suit, L.S., et al. v. Delia, et al. (No. 5:11-CV-354FL), was brought by Medicaid beneficiaries who suffer from chronic developmental disabilities and require significant medical or personal care. North Carolina operates a Home and Community Based Care program (North Carolina Innovations Waiver), which provides plaintiffs with access to services so that they can remain in their homes and avoid costly institutionalization. In March of 2011, PBH began implementing a new budgeting system which reduced services for beneficiaries that had previously been found necessary, even though their underlying conditions had not changed, and without the legally required notice explaining why the action was being taken. “Once again, the courts confirm that the desire to save resources does not allow a provider or state to deny due process,” said Disability Rights North Carolina attorney John Rittelmeyer. 

Click here to view the court’s decision. 

For questions or comments about the case, contact:

Doug Sea                                                                                              
Legal Services of Piedmont                                      
dougs@lssp.org                                                             
704-971-2593                                      

Jane Perkins
perkins@healthlaw.org
919-968-6308

John Rittelmeyer
John.rittelmeyer@disabilityrightsnc.org   
919-856-2195

--
Vicki Smith, Executive Director
2626 Glenwood Avenue, Suite 550
Raleigh, NC 27608
Phone: 919-856-2195
TTY: 1-888-268-5535
Fax: 919-856-2244