Showing posts with label CAP Services. Show all posts
Showing posts with label CAP Services. Show all posts

19 June 2012

AP Article: DMA Director Gray relieved of duties

NC Medicaid director is out of a job
The Associated Press
Posted: Tuesday, Jun. 19, 2012

RALEIGH, N.C. North Carolina's state Medicaid director is out of a job days after it became public that the government health insurance program faces a larger shortfall than previously expected.

State Department of Health and Human Services acting Secretary Al Delia announced Tuesday a shake-up in the agency's leadership that means Dr. Craigan Gray will no longer manage the Division of Medical Assistance. Gray had been on the job since 2009.

Department Chief Deputy Secretary Michael Watson will succeed Gray. Assistant secretary for mental health Beth Melcher will replace Watson.

Delia said late last week that an increase in provider claims would increase the Medicaid shortfall by $75 million.

A department spokeswoman said Gray was not replaced because of the shortfall but because Delia wanted someone with a different perspective.

Read more here:
http://www.charlotteobserver.com/2012/06/19/3328482/nc-medicaid-director-is-out-of.html
Posted by at
Labels: , , , , , , , , , , ,

04 June 2012

Reminder: 6/4 Town Hall Meeting Tonight!

Alliance Town Hall Meeting Reminder

When: Mon, June 4, 5:30pm – 7:00pm
Where: Durham Main Library; 300 N. Roxboro Street; Durham, NC (map)

Description
ALL STAKEHOLDERS AND THE GENERAL PUBLIC ARE INVITED TO A “TOWN HALL MEETING” TO DISCUSS THE PUBLIC BEHAVIORAL HEALTHCARE SYSTEM IN DURHAM AND WAKE COUNTIES, THE MERGER OF THE DURHAM CENTER AND WAKE LME, THE UPCOMING TRANSITION TO MANAGED CARE OPERATIONS UNDER MEDICAID WAIVERS, AND OTHER RELATED TOPICS.

Spanish and ASL translation provided
Sponsored by Durham CFAC and Alliance Behavioral Healthcare
Posted by at
Labels: , , , , , , , ,

31 May 2012

What's New in May?

May 2012 events and updates.


[ What's New Main ]






    Posted by at
    Labels: , , , , , , , , , , , ,

    24 May 2012

    from Arc NC: What is Managed Care & Why It's Not a Good Fit

    What is Managed Care & 

    Why It's Not a Good Fit

    WHAT IS MANAGED CARE?

    Managed Care is a term used to describe a method of financing and delivering health care with the goal of lowering costs and improving the quality of care. It attempts to achieve these goals by focusing on the following techniques:
    • Fixed, prepaid capitation rates - As a cost control measure, Managed Care Organizations (MCOs) have a set amount of money to pay for any and all service requests, or “claims,” for a given month. The capped amount of money is often based on an estimate of how much money was used in the past. This means that an MCO has a hard and finite amount of cash to pay for services each month, regardless of how many claims it receives. If/when the money runs out, MCOs don’t have an obligation to continue services.
    • A closed network of providers - MCOs will decide upon specific standards of quality required for all providers. Then the MCO will choose, among the providers who meet those standards, which can offer services under their plan. By limiting the total number of providers in the network, it creates greater economies of scale (a smaller number of providers servicing the same population), with the idea that consistency in service will improve quality and reduce costs.
    • Formal utilization review - Enrollees are required to get prior authorization from their MCO before receiving certain services. This is primarily a cost-saving tool used to avoid paying for unnecessary services.
    • An emphasis on preventative care - Enrollees are encouraged to have regular “check ups” and other preventative care. The goal, based on a classic Medical Model approach, is to catch and cure medical issues in their early stages when treatment is the least expensive.
    • Financial incentives to encourage enrollees to use care efficiently - In this model, providers may be given incentives to control costs or change how they work with specific populations to save money and improve quality.
    WHY MANAGED CARE ISN'T A GOOD FIT FOR PEOPLE WITH I/DD

    When one hears the term “managed care,” the first thing that comes to mind is likely HMOs (Health Maintenance Organizations). There’s a reason for that. Managed care was created by, and intended for, health insurance groups managing medical issues: things like rehabilitation after a fall, heart disease, diabetes, and other common reasons to visit a doctor.

    Expertise with the medical model has given many MCO’s some success with keeping costs down while maintaining a standard of medical care. We all know that the medical model doesn’t work for people with intellectual and developmental disabilities (I/DD), it’s a square peg for a round hole. What about cost? Do the cost-savings measures MCO’s maintain the necessary quality services and supports people with I/DD need? In many cases, the answer is no. Let’s look again at the core principles of managed care and see how they impact people with I/DD:
    • Fixed, prepaid capitation rates - Fixed capitation rates have had modest success in accurately predicting and reducing medical costs. But a recent report from the National Council on Disability, an independent federal agency cast doubts on its effectiveness for I/DD. It showed that states don’t have the data or measurement tools to accurately predict the costs of long-term services and supports as they’re administered now; let alone how they might be administered in the future. It’s tough to assign an appropriate lump sum dollar amount for services if you can’t predict the costs.
    • A closed network of providers - Creating a closed list of limited providers has real implications for individuals with disabilities. First, fewer providers will be asked to serve more enrollees. While providers will be asked to do more with less, individuals with I/DD will feel the pinch. Meanwhile, consumer choice will be limited. Long-term services and supports are individualized services that can impact nearly every aspect of daily life. An ongoing relationship with a trusted provider is important. If your provider is not on the list or you don’t like the service provider you’re working with, under an MCO model, you may have few alternatives to choose from.
    • Formal utilization review - Requiring prior authorization for services in a managed care system can make sense -- especially when you’re dealing with routine medical conditions. However, the needs of individuals with I/DD vary widely from person to person. A one-size-fits-all model simply can’t work, and often the people who authorize or deny services don’t have the expertise to make those decisions. Appealing denials will take time, and many individuals with I/DD may lack the support they need to successfully navigate this process.
    • An emphasis on preventative care - Preventative care is a good thing. We all want to be as healthy as we can be and avoid major illness tomorrow by taking care of ourselves today. Managed care can make it easier for us to take care of our health. This system understands the medical model well -- you fix what’s broken and prevent it from breaking in the future. People with I/DD aren’t broken. They need to be part of a system that truly understands that and provides services and supports that make the community around them more accessible.
    • Financial incentives to encourage enrollees to use care efficiently - Finally, incentivizing cost reduction can have some unintended consequences. While the goal is to find innovative approaches to provide better services at a lower cost, the reality can be devastating. The easiest way to control costs is to limit services, and long term services and supports is the most costly piece of Medicaid spending. Under a fixed, capitated model, MCOs have a finite amount of money to spend. What they don’t spend is used for other MCO priorities including profit or “reserves’. But it’s important to think long term about cost savings. Many long term services and supports for people with I/DD cost money upfront, but the savings will be recouped down the line. For example Early Intervention services have proven to lower the need for long term services but services for most people will still be needed. While many people can work with proper supports removing those supports can result in loss of employment. Good quality services designed in a person centered approach will allow individuals with IDD to live successful in communities but the supports will need to continue.
    Posted by at
    Labels: , , , , , , ,

    Parent Perspective: Voice from the Rally

    The Coalition rally sponsored in part by The Arc of North Carolina was held in downtown Raleigh by the Legislative Building Tuesday, May 22, 2012. There was an impressive turn out considering what many of these parents and caregivers had to undertake just to travel to the State capital with their children in hopes their voices would be heard.

    Pat, her daughter Casey and son Jason, and support friend Christy awoke at 4:45 am to travel to Raleigh, a round-trip mission of over 260 miles...


    You may recognize Casey and Jason from this post.

    P.S. Dearest Casey and Jason, It was SOOO nice to meet you both! Thank you Casey for the beautiful hug you gave me - you are sunshine! Love, Crystal
    Posted by at
    Labels: , , , , , , , , , , , , , ,
    Location: Raleigh, NC 27609, USA

    email to Rep. Tricia Cotham

    Representative Tricia Ann Cotham, from Matthews, NC has served 2.5 years in the NC House representing District 100 (Mecklenburg County). She is a member on the Health and Human Services Committee and Vice-Chairman of the HHS Subcommittee on Mental Health (both Standing).

    From: Crystal J. De la Cruz  Tue, May 22, 2012 at 3:29 AM

    To: Representative Tricia Cotham <Tricia.Cotham@ncleg.net>
    Cc: "Crystal J. De la Cruz"

    Subject: meeting request re: Medicad Waiver & special populations



    Although I am not among your voting constituents, I am writing as a mother and advocate for a very special little girl, my daughter Isabel, and as a concerned citizen to respectfully request a meeting with you to discuss concerns regarding the new Medicaid 1915(b)(c) Waiver and the detrimental impact cuts in services and supports will have upon Developmentally Disabled recipients and their families. 

    The vast majority of us currently receiving services for our children living at home already do not receive the level of supports we need to keep it together because we are unable to staff our needs with people we trust to care for a child who cannot speak to tell us what happened at the end of the day - because one can make more money stocking shelves than CAP direct care staff.

    The vast majority of us have really wonderful case managers and qualified professionals who do not abuse the system, but rather go above and beyond daily to let us know they care; we could not have gotten this far without their support. These are the people who will be without jobs at the end of this implementation; many who also own small agency businesses which will not survive this transition.

    I understand the economic crisis our State faces. It's a mess. What I do not understand is how we can continue to skim off the bottom, digging one hole to fill another... and why these innocent children must pay the price of the mismanagement of others? 

    The DOJ found NC to be in violation of ADA and Olmstead. To rectify the improper placement of mentally ill citizens, DHHS plans to "deinstitutionalize" and reintegrate these individuals into more community supported environments... while recipients living at home with family or assistive living arrangements will not being afforded the necessary community-based supports to maintain present level performance and care so that families can keep them out of institutions. 

    It is my believe that many of the members of the North Carolina General Assembly who sincerely wish to assure that the wellbeing of our most fragile of populations receive the proper supports and protections, despite their best efforts, are not receiving the most complete information from all stakeholders necessary to make the best possible decisions for all involved. True, it is not an easy system to understand, even for those who live and work in it. --All the more reason that after so many proven failures, we slow this train down, get it right, and make certain that we arrive at the destination intended. --All the more reason that those who will be most affected by these decisions and changes - the innocent and vulnerable developmentally disabled children and their overwhelmed and exhausted families - have a voice and that voice be heard.

    Currently, our voice is NOT being heard. 

    Currently, and perhaps most important of all, there are no appropriate appeal procedures in place for families regarding the care of their special loved ones and the hope of fail-safe due process protections are in dire jeopardy.

    For your review, I have attached the letter and enclosures previously sent to Governor Beverly Perdue and members of the General Assembly earlier this year outlining concerns shared by many across the state. I would greatly appreciate any time you could afford me to discuss my concerns in more detail. I will plan to call your office for an appointment and look forward to the opportunity to meet with you.

    Thank you in advance for your time and attention - on behalf of all special populations, and the families who love them.


    Sincere regards,

    -- 
    Crystal J. De la Cruz - Hopper
    Mother, Advocate & Concerned Citizen

    When we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – We Are in Crisis.

    http://no2nchb916.blogspot.com/

    "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." 
    --Hubert H. Humphrey
    Read more »
    Posted by at
    Labels: , , , , , , ,

    Parent Legislative Correspondence

    Colleen is the parent a 12-year-old son and CAP recipient with multiple diagnosis and special needs including an auto immune disease and Traumatic Brain Injury (TBI) attributing to many medical, developmental and behavioral issues. She also has another child with needs who is not being served. Posted with parent permission.


    Colleen is in NC House District 36, Senate District 17 and will fall under Alliance Behavioral Health Care LME (formerly the Durham Center) upon implementation.

    Legislative Correspondence 

    from another Parent Perspective


    From: COLLEEN  Thu, May 24, 2012 at 11:12 AM

    To:  Senator Richard Stevens <Richard.Stevens@ncleg.net>, 
    Representative Nelson Dollar <Nelson.Dollar@ncleg.net>, 
    House Speaker Thom Tillis <Thom.Tillis@ncleg.net>, 
    Office of NC Governor <governor.office@nc.gov>, 
    Representative Justin P. Burr <Justin.Burr@ncleg.net>,
    US HHS Commissioner Sharon Lewis <sharon.lewis@acf.hhs.gov>, 
    Joint Caucus Leader Marilyn Avila <Marilyn.Avila@ncleg.net>, 
    Representative William A. Current, Sr. <Bill.Current@ncleg.net>, 
    Senator Fletcher L. Hartsell, Jr. <Fletcher.Hartsell@ncleg.net>, 
    Senator Tommy Tucker <Tommy.Tucker@ncleg.net>


    Dear Representatives:


    As a constituent, I am asking you to reconsider the move forward with the current HB 916 until there is a restoration of Independent Case Management, establishment of a third party unbiased binding conflict resolution entity and an unbiased SIS evaluator not employed directly by the MCO. There are more issues that are relevant to this Waiver that are concerns to families like mine as well. Habilitative services is needed to ensure individuals the ability to provide some independent level of care if not complete independence, later on. Enhanced Personal Care is also imperative to families that have children with more involved personal care needs involving GI problems, medication administration, and intense behavior supports to name a few. Eliminating these services will create a bias against these more involved children as staff will not work and pick up cases that require much more effort and unpleasant things to deal with when there is no incentive to do so. The necessity of CAP services to enable families to function and allow siblings to have some normalcy, is imperative to allow for a system that is not burdened down the road with institutionalized adults and broken families. Lastly, appropriate CAP level services in place provides the support families need to just be a family. I will close with a personal example of how these services are needed to just allow families to deal with every day things that happen in all our lives, but can become a crisis without support from CAP:

    CAP services are imperative for families like mine. We have more than one child with special needs, but only one with CAP. When my husband's father just recently passed away, we would have been in a tailspin without our CAP workers. One of us would have had to miss all the planning, viewing, hanging out grieving with family and seeing family members that live out of State who we hadn't seen in many years, if it weren't for the supports we had. My son could not handle all the noise, chaos and environment of funeral planning and the viewing. His CAP workers and I brainstormed how to help him handle the loss of his grandfather and explain this to him. We came up with a wonderful concrete picture that he grasped. The CAP workers kept him with them at home while we traveled to another town in NC. They continued his programs/routine as we went about the various duties and family commitments involved in this type of loss. We decided it was best for him to not attend the viewing as it might confuse him. We explained to him that he would go to a "Funeral" and it was a place we would say goodbye to Grandpa and see his casket, which was a "car" that you ride to heaven in and we wouldn't see him again till we moved there too. He then came to the funeral with his CAP worker and she was able to keep him quiet and help him participate in this aspect of it all. She did various sensory strategies to keep him sitting still and attending, bringing along little hand toys, sensory brushes etc. to help him remain there. He did! To our amazement and thankfulness to his 10 year CAP worker who knows him so well, she had just the right strategies to enable him to do this. We all stood together as the casket was placed into the hurst and we said together "there goes Grandpa in his casket, he's riding to heaven". He understood. He hasn't asked for Grandpa again which is unusual since he saw him every Sunday and looked forward to his "tickles" and cuddling in the rocking chair. So we know he got it and is at peace with it. We are so thankful for our CAP workers and how they rallied behind our family and provided the supports that were necessary to enable us to spend long days with family, grieve and have this time together with extended family.

    That is just one example of what CAP does for families like mine and that's not addressing all they have done habilitatively for my son, which I could also write personal examples of such as his ability to now toilet, feed and bath independently - we are so thankful for CAP.

    Thank you for your continued commitment to do what is right and to forge a plan that makes sense for our voiceless children caught up in fiscal difficulties that are not their faults and should not balanced on their already burdened backs.

    Respectfully,

    Colleen


    Read more »
    Posted by at
    Labels: , , , , , , , , , , , , , , ,
    Location: Raleigh, NC 27609, USA

    14 May 2012

    NCGA JLOC on HHS 5/15 Meeting Agenda

    Note for those unable to attend:

    Interested stakeholders unable to attend the JLOC HHS meeting (or any other legislative meetings) in Raleigh, may listen in via live Audio Broadcast on the NCGA website. 

    In the event you are unable to listen live, the audio recording, as well as agenda and supporting documents, reports, etc. for this meeting will be posted afterward on the JLOC HHS webpage.

    Meeting Agenda:

    JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON
    HEALTH AND HUMAN SERVICES
    AGENDA
    May 15, 2012
    8:30 A.M.; Room 643, Legislative Office Building
    Senator Louis Pate, Co-Chair, Presiding          


    Personal Care Services and Medicaid I-Waiver Status Update ......... 8:30-9:10
       Albert Delia, Acting Secretary, Department of Health and Human Services
       Tara Larson, Chief Clinical Operating Officer, Division of Medical Assistance

    Overview of State County Special Assistance and In-Home Special Assistance  .........  9:10-9:35
       Suzanne Merrill, Adult Services Section Chief, Division of Aging and Adult Services
       Curtis Crouch, Section Chief, Cost Accounting/Financial Reporting, DHHS Controller's Office

    Institutes of Mental Disease Status Update  .........  9:35-10:10
       Tara Larson, Chief Clinical Operating Officer, Division of Medical Assistance

    US DOJ Investigation of Mental Health System Status Update  .........  10:10-10:55
       Emery Milliken, General Counsel, Department of Health and Human Services

    Medicaid 1915 b/c Waiver Status Update  .........  10:55-11:30
       Kelly Crosbie, Chief, Behavioral Health Policy Section, Division of Medical Assistance

    Report of the Sub-Committee on LME Governance ......... 11:30-11:55
       Representative Nelson Dollar, Subcommittee Chair

    DHHS Requested Statutory Changes- Provisional Licensure  ......... 11:55-12:10
       Beth Melcher, Assistant Secretary for MH/DD/SAS Development

    JLOC-HHS - Recommended Legislation to the 2012 Regular Session ......... 12:10-12:30
       Committee Chairs

    Adjourn.

    Posted by at
    Labels: , , , , , , , , , , , , , , , , , ,
    Location: Raleigh, NC 27609, USA

    11 May 2012

    Wake / Durham Town Hall Meetings : Alliance Beahvioral Healthcare

    In Text...
    What is Changing?
    Our name. Alliance Behavioral Healthcare will officially replace The Durham Center and Wake LME on July 1, 2012. You’ll be hearing our new name and seeing our new logo even sooner!
    What is Staying the Same?
    Our commitment to high-quality mental health, substance abuse, and intellectual/developmental disability services promoting recovery and self-determination. You’ll be able to reach us at the same phone numbers you’re used to.
    TOWN HALL MEETINGS
    Tuesday, May 29, 6:30-8:00 pm
    Wake County Commons Building
    4011 Carya Drive; Raleigh, North Carolina 27610
    Monday, June 4, 5:30-7:00 pm
    Durham Main Library
    300 N. Roxboro Street; Durham, North Carolina 27701

    An open forum for all citizens to learn about the merger and how Alliance Behavioral Healthcare will operate. Your questions are welcome.
    Frequently Asked Questions
    durhamcenter.org/index.php/provider/pfaq/
    Don’t see the answer to your question?
    Send it to waiverquestions@durhamcountync.gov
    It will be reviewed and when an appropriate response is ready for sharing, it may be incorporated into the FAQs posted on the website
    Posted by at
    Labels: , , , , , , , , ,

    Response from Sen. Neal Hunt

    From: Sen. Neal Hunt <Neal.Hunt@ncleg.net>
    May 10, 2012
    To: Kathy, me


    Crystal, I am sorry about your daughter and know how hard that must be on you all. Give my office a call and we can set up a time to meet.




    Neal Hunt


    919 733-5850 Legislature
    919 781-3464 Business


    Sent from my IPad


    On May 9, 2012, at 11:14 PM, "Crystal J. De la Cruz " wrote:
    My email to Senator Neal Hunt from 5/9.


    Read more »
    Posted by at
    Labels: , , , , , , ,

    10 May 2012

    NCGA Meeting Time Change; Subcommittee on LME 5/14


    NORTH CAROLINA GENERAL ASSEMBLY
    Raleigh, North Carolina 27601

    May 10, 2012
     MEMORANDUM
     CORRECTED NOTICE – TIME CHANGE

    TO:
    Members, Subcommittee on LME Governance     
    FROM:
    Rennie Hobby
    SUBJECT:
    Meeting Notice – Time Change
    DAY
    DATE
    TIME
    ROOM
    Monday
    May 14, 2012
    3:00PM
    544

    COMMENTS: Meeting is scheduled for 3:00 instead of 2:00.

    Parking for non-legislative members of the committee/commission is available in the visitor parking deck #75 located on Salisbury Street across from the Legislative Office Building.  Parking is also available in the parking lot across Jones Street from the State Library/Archives.  You can view a map of downtown by visiting http://www.ncleg.net/graphics/downtownmap.pdf.

    If you are unable to attend or have any questions concerning this meeting, please contact Rennie Hobby at 733-5639. 
      
    cc:  Committee Record  _X_
           Interested Parties    _X_




    * Google Calendar updated.
    Posted by at
    Labels: , , , , , , , , , ,

    09 May 2012

    email to Senator Neal Hunt

    May 9, 2012
    To: NC Senator Neal Hunt [neal.hunt@ncleg.net, nealh@ncleg.net]
    Subject: Personal Response & Request to Meet Re: Neal Hunt News

    Dear Senator Hunt,

    Thank you for you including me in your recipient list with the informative newsletter regarding the many successful accomplishments and challenges overcome by the North Carolina legislature to improve the lives of the citizens of this State.

    As a parent of two young children, I applaud your efforts toward improving the quality of education for our youngsters and for making environmental protection a priority. As the wife of a small business owner, I appreciate your plight in tax reduction and putting our State's budget in check. --Not unlike most parents, my greatest desire is to instill in our precious children a healthy respect for life, knowledge and nature and to see them grow to one day become productive, compassionate leaders who shall make the world a better place for generations to come.

    At least that is my hope for Liam, our happy, healthy, typically-developing 5 year old son.

    Liam's 14 year old sister, Isabel, however, will never "grow up," never attend college, and never live independently. In fact, she may never verbally speak nor progress beyond the cognitive capabilities of a toddler, and we've been potty-training for over a decade. You see, Isabel is a child with profound special needs and developmental disabilities, born with a one of a kind genetic rearrangement never documented prior to her birth. She is also a Medicaid Waiver / CAP recipient who, along with her family members, will be critically and detrimentally affected by the implementation of NC House Bill 916's new 1915(b)(c) Innovations Waivers in its current design.

    As a parent with extensive Medicaid and CAP services experience, I will be among the first to admit that change was long overdue, however, I cannot help but feel that in the race to alleviate historical abuse of the system and establish a self-sustaining managed care solution, the human element has been sorely lost in this process. Though the train has left the station and there is no turning it around now, I am confident that the final destination can be greatly improved. --The best ideas usually come from the best of intentions, though when poorly executed... well, you know what they say about paving those roads.

    As your constituent, I am responding to your email to respectfully request an opportunity to meet with you to discuss my concerns as a parent, stakeholder, and citizen of the State on behalf of my little girl and all special populations.

    For your convenience, I have attached in this mail my previous letter and enclosures to Governor Beverly Perdue outlining in more detail concerns shared by many families across the State, copied to all members of the General Assembly on February 25th.

    I will be contacting your office in the days following to schedule an appointment. I look forward to the opportunity to meet with you in person at your earliest convenience. 

    Thank you in advance for your time and attention on this most important issue vital to so many - the most vulnerable of North Carolina's citizens, and the families who love them.

    Kind regards,
    --
    Crystal J. De la Cruz - Hopper
    Mother, Advocate & Concerned Citizen
    contact info...

    When we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – We Are in Crisis.


    "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."

    --Hubert H. Humphrey

    On Wed, May 9, 2012 at 1:40 PM, Sen. Neal Hunt <Neal.Hunt@ncleg.net> wrote:


    LEGISLATIVE NEWSLETTER

    K. NEAL HUNT
    308 LEGISLATIVE OFFICE BUILDING


    District 15, Wake County

    May 9, 2012



    Legislature 733-5850
    nealh@ncleg.net

    www.nealhunt.com

    Business 781-3464
    info@nealhunt.com

    In one week the legislature will convene for the “short” session which meets during even years. The primary purpose of the upcoming short session is to make needed budget adjustments to the two year budget which we passed in 2011. The adjournment resolution from the 2011 long session stipulated that only budget amendments, noncontroversial local bills or bills that had passed either the House or the Senate can be considered. Typically the short session does not last very long as politicians want to go home to run their campaigns for reelection.

    I thought it might be helpful to outline the accomplishments of the “long” session which ended July 1, 2011. As you may be aware, the new leadership of the Legislature found many challenges when we took office in January 2011. We had an approximately $3 billion budget hole left for us by the previous leadership. Excessive government spending, termination of federal stimulus dollars and loss of revenue due to the recession were the causes of this huge shortfall. We were able to fulfill our promises. To summarize last year’s session:

    Actions Promised - Actions Accomplished:
    1. HB-200 passed Bipartisan Balanced Budget – Reduced spending by over $1 billion and avoided a tax increase (we already had the highest taxes in the southeast). As Co-chair of Senate Appropriations, I can attest to many long days and nights to get the budget balanced. Governor vetoed…Legislature over-rode. 
    2. SB-689, SB-283, H-777 passed fair and legal Redistricting Maps for Congressional, State Senate and State House districts. Received US Department of Justice pre-clearance approval. Legislative attorneys are currently in court defending against lawsuits brought by the Democrat Party and the NAACP. 
    3. SB-33 passed Medical Malpractice Liability legislation. Helped to make health care affordable and available while reducing the cost of health care by eliminating the need for the practice of defensive medicine.Governor vetoed…Legislature over-rode. 
    4. HB-709 passed Workers’ Compensation Reform Legislation. 
    5. SB-781 passed Regulation reform legislation to make North Carolina businesses more competitive and to insure that our state’s regulations do not overburden those businesses. 
    6. HB-2 passed legislation to exempt North Carolina citizens and businesses from the high cost of National Health Care proposed by President Obama (Obamacare). Governor vetoed…Legislative over-ride pending. 
    7. SB-709 passed Energy Jobs Act legislation to study the possibility of “fracking” and off shore oil drilling. Job creation and energy independence are the goal if this energy production can be done with no environmental damage.Governor vetoed…Legislative over-ride pending. 
    8. HB-351 passed Voter (photo) ID legislation to promote and ensure honest and fair elections. Governor vetoed…Legislative over-ride pending. 
    9. SB-532 passed Employment Security reform legislation to reorganize, improve operation efficiency, and set on a pathway to solvency. Governor vetoed…Legislature over-rode. 
    10. Education Reform – Passed Education Reform to re-direct education funding into the classroom, added 1,100 new teachers, eliminated Charter School Cap, and required all third grade students to be reading proficiently before advancing to fourth grade. 
    11. As you can see, we had a busy agenda, but with hard work and strong leadership, we delivered on our promises to the people of this great State.
    These actions are just the beginning of our effort to create a business-friendly environment and energize the private sector economy to help create jobs in North Carolina

    In 2013 our plan is to present a comprehensive North Carolina tax modernization proposal which will allow our state to be competitive in a 21st Century global economy. Our goal is to produce a tax system that is transparent, simple, and promotes economic growth and prosperity for all.

    Your comments and thoughts are welcome.


    Neal
    neal hunt signature




    If for any reason you do not wish to receive further newsletters, please reply to this e-mail and type in “Unsubscribe” on the subject line.

    Join in the conversation and connect with me on Facebook and Twitter
    Posted by at
    Labels: , , , , , , , , , , , , ,
    Location: Raleigh, NC 27609, USA

    08 May 2012

    Years of CAP Service vs. No. of CAP Workers

    I posed a question today in the Facebook group, "For those receiving CAP services: How long have you received services?... and to the best of your recollection, how many CAP workers have been employed to work with your child in that time?"

    Responses:
    • Crystal (me) = 19 CAP employees over 10 years
    • JC. = 2 CAP employees over 7 years
    • PF. (child 1) = 6 CAP employees in less than 3 years
    • PF. (child 2) = 6 CAP employees in less than 3 years
    • CT. = 23 CAP employees over 8 years
    • LB. = 3 CAP employees over 3 years
    • BF. = an estimated 50 CAP employees over 7 years
    • TH. = 5 CAP employees over 7 years
    • SG. = 9 CAP employees over 5 years
    • LW. = 6 or 7 CAP employees over 2 years
    • AC. = approximately 15 CAP employees over 5 years
    • RB. = 3 CAP employees in 3 years
    • KF. (child 1) = 9 CAP employees in 7 years
    • KF (child 2) = 12 CAP employees in 6 years
    Can you guess the lucky exception? 
    Care to speculate the reasons behind such extreme turnover rates?

    The implementation of the new 1915(b)(c) Medicaid / Innovations Waivers and the service cuts it brings, will steepen and compound the improbabilities of finding and retaining reliable, trustworthy and professional direct-care staff to aid in the care, supports and life-skill goals of our children. 

    While for most families, the bulk of service hours allotted will remain in the same ballpark, many others will have their hours cut due to a maximum ceiling, irrespective of individual level of need. Of the total service hours for an individual recipient, much of those hours will be shifted from the  higher paying Home and Community Supports (HCS) rate to the much lower Personal Care Services (PCS) rate, essentially resulting in a very substantial pay cut (in some cases, nearly half a worker's salary) for direct-care staff who already make less than peanuts for the important and vital work that they do - and with no benefits.


    In the last 10 years, I can recall no less than 19 CAP Workers / care providers to whom I have entrusted my helpless little girl; I cannot even remember all their names as the turn-over rates for these positions is quite high. (In special parent circles, a CAP Worker who sticks around past one year is Gold.) Consider the emotional and developmental damage that such constant inconsistency creates in the daily life of a child with special needs; learning a new person, loving a new person, and losing that person – over and over again (never mind what it does to the parent). And while there have been some wonderful trustworthy care providers in our life, I wish that were the only issue... During this parade of CAP Workers, practical strangers in my home and personal space, I have experienced: the physical abuse of my child when an employee pinched my 3 ½ year old numerous times leaving dark purple and green bruises on her tiny body, thousands of dollars worth of property stolen from my home, and a week’s worth of groceries devoured that I could not afford to replace; I had an employee who took my daughter on a date with her ex-husband she’d previously had a DVPO against who was unaware she was living with a new guy; I once had two employees who became friends and later found that they spend quite a bit of time hanging out together in bars smoking and drinking with my child in their care; one girl who was fired for drug abuse; and last but not least, yet another who filed a DSS complaint against me for “abuse and neglect” in retaliation for being terminated – an incident that wasted the time and resources of 5 separate agencies, including the Morrisville Police Department, Cedar Fork Elementary School, Wake County Human Services, and the Department of Social Services. And that’s just the stuff I know about; anything else that has happened throughout the years, my daughter is unable to tell me. 
    During the last Bush Administration, the federal Medicaid reimbursement rate was cut by eight dollars ($8.00) per hour, a significant amount when one considers the cost of overhead and employee salaries. Today, the average CAP Worker makes between nine to twelve dollars ($9.00-12.00) per hour when performing “Home and Community Supports” (HCS) services (this is the minimal time designated for working on pages and pages of specific life-skill goals and continuation of therapies, not unlike an IEP) and minimum wage to eight dollars ($7.15-8.00) per hour for “Personal Care Supports” (PCS) services (the bulk of allotted hours which includes bathing, grooming, toileting, etc.) and “Respite” (time built in for unscheduled relief). Comparatively, a Certified Nurse Aide 1 working in a long-term care environment in Wake County makes roughly $13.03 hourly, while a Wake County Teacher Assistant in Special Education averages $10.27 per hour and a Wake County Public Schools Custodian, $12.80 per hour, not including benefits or shift differential. For the record, the average Garbage Collector in the State of North Carolina is paid an average hourly rate of $11.75. A CAP Worker receives only their hourly wages with no benefits whatsoever when working consistently less than 30 hours weekly, not even mileage reimbursement to offset the cost of driving their clients around in their personal vehicles attending community activities as dictated by their care plan.

    Suffice it to say that the vast majority of families not utilizing the maximum amount of service hours allotted are not choosing not to do so because the need is not present. Quite the contrary, there is a critical need that cannot be staffed with competent, quality, reliable, professional care providers dedicated to a profession that includes a daily routine of cleaning feces, urine, and vomit; preparing special foods and feeding; heavy lifting; changing G-tubes and catheters and diapers; administering medications; bathing and dressing; utilizing sign language and specialized communication devices; and completing endless amounts of paperwork tailored to a non-applicable medical model to justify their existence all while being subjected to nerve-racking and often abusive behaviors such as hitting and biting, because frankly, people can make a better salary emptying garbage cans than caring for an innocent human being unable to do for themselves.
    * If you would care to share your stats regarding years your loved one has received CAP direct-care services and the number of CAP workers that have been employed in your home to care for your child, likewise any related stories regarding difficulties in direct-care coverage, experiences, etc. please feel free to respond to this blog post, post in our Facebook group or contact me privately via no2nchb916@gmail.com.
    Posted by at
    Labels: , , , , , , , , ,

    Family Stories Video

    A very moving presentation and just a tiny glimpse into the challenging lives of families caring for children (and adults) with Intellectual and Developmental Disabilities... faces of families whose services and supports, and thus daily survival, will be and are detrimentally impacted by the implementation of the new 1915(b)(c) Innovations Medicaid Waivers...

    Raleigh Trip Presentation of IDD Caregiver Voices and The Breakfast Club.



    * If you are a parent or caregiver with a story to contribute, have correspondence exchanges with legislative members you would like to share, please contact me at no2nchb916@gmail.com.
    Posted by at
    Labels: , , , , , , , , , , ,

    Parent Perspective: Parent Letter from K.Feller

    A couple of months back, I received a heartfelt letter from a local special mom of two boys with Autism to deliver and share with Dr. Pat Porter in one of my meetings. I am posting with her permission. Thank you Kimberly!

    Parent Perspective

    March 1, 2012

    RE: Concerns with NC HB 916

    My name is Kim Feller and I live in Wake County. I am writing to you because I have two sons who both have autism and are covered by the Medicaid CAP Waiver program. Nick is 14 years old and James is 11 years old. I am concerned about the NC HB 916 which will greatly affect services. Both of my boys participate in several different therapies including occupational, speech, and social skills therapies. Also, they both take different medications for the treatment of aggressive behaviors, anxiety, and seizures. My youngest son who is 11 years old recently had a temporary residential placement at the Murdoch Developmental Center in Butner, NC where he stayed for three months. He was placed there due to aggressive behaviors which we were unable to handle at home. He is living back home again only because we have home staff provided through the Medicaid CAP Waiver program. We feel very fortunate that both our sons are currently covered by the Medicaid CAP Waiver program. The CAP Waiver program has been critical in providing our boys Home and Community services as well as funding for the aforementioned therapies, medicines, and residential services. These services support individuals in their home and community and avoid more costly institutional settings. Provider agencies just took an almost 3% rate cut on November 1, 2011, in addition to a 5% cut a few years ago. We are concerned that the cut to Home & Community service hours will make it difficult to retain the quality service providers we need to care for our boys. Working with children who have autism requires a certain level of commitment, sensitivity, and resilience which must be compensated accordingly. Also, the DHHS has recently implemented new limits on the number of hours our sons can receive. This concerns us a great deal because our youngest son needs constant supervision. If we don’t have enough home support hours the chances of our son reverting back to his prior aggressive behaviors will be greatly increased. It is much more economical to pay home staff than it is to pay for a residential placement!

    The 1915 (b)(c) managed care waiver proposes that a single entity with a financial interest to keep funding low will determine eligibility for services, control who can provide services, develop the Person Centered Plan, and decide the level of funding. This is of concern to us because the decision makers would work for the Local Management Entity (LME) which has a financial interest to contain costs. There needs to be a decision maker representing solely the interests of the person with the disability as is currently happening with the Case Managers. The new plan should recognize the integrity of the Developmental Disability model by excluding Case Management from the Managed Care Entity and separating Developmental Disability from Mental Health and Substance Abuse. Developmental Disability is not an illness, and therefore should not be combined with Mental Health and Substance Abuse.

    We appreciate any efforts you can make toward avoiding cuts in Home & Community Service hours as well as excluding Case Management services from the Managed Care Entity.

    Thank you for your time and efforts.

    Sincerely,
    Kimberly H. Feller
    contact info...

    * If you are a parent or caregiver with a story to contribute, have correspondence exchanges  with legislative members you would like to share, please contact me at no2nchb916@gmail.com.

    Posted by at
    Labels: , , , , , , , , , , , , , ,

    Additional Message from the Arc NC

    Earlier today, you should have received a Policy Partners email outlining why North Carolina Should Slow Down Managed Care Implementation. It will take the combined efforts of our members and allies to get the General Assembly and the Administration to listen. That's why we are asking you to:

    TAKE ACTION TODAY!
    We need you to tell your story to the decision makers in state government about how changing to a Managed Care system has affected you or will affect you, making sure to tell them:
    • North Carolina needs to Slow Down Managed Care Implementation Until They Get It Right!
       
    • Restore Case Management to People With Intellectual & Developmental Disabilities!
       
    • Require that Managed Care Organizations (MCOs) prove that they are prepared to manage the new system effectively before they can move forward
    Who Should I Contact, Where Should I Go?
    Who to Contact:
    Events to Attend:
    • Joint Legislative Oversight Committee for Health and Human Services
      Tuesday, May 15, 2012 at 9:30 am
      Room 643 of the NC Legislative Office Building (Across from the Legislative Building)
      330 N Salisbury Street
      Raleigh, NC 27603
    • The Coalition Rally at the NC Legislative Building (flyer posted here)
      Tuesday, May 22, 2012
      8:00 am - Registration on the back portico of the Legislative Building
      9:00 am - Advocacy Training in the Legislative Building Auditorium (third floor)
      12:00 noon - Rally at 12 noon on Bicentennial Mall on Jones Street, across from the Legislative Building 
    • The DHHS Waiver Advisory Committee
      (Sign up to speak ahead of time by calling Kathy Nichols with DMA at 919-855-4289 or Ken Marsh with DMHDDSAS at 919-715-1294)
      May 22, 2012 from 1-3:00 pm
      NCSU McKimmon Center
      1101 Gorman Street
      Raleigh, NC 27603
    Thank you for your continued advocacy! We are facing some of the biggest changes to the I/DD system in over forty years, and your help is needed now more than ever!
    If you have any questions at all, please feel free to contact Ben Akroyd at bakroyd@arcnc.org or 919.500.8382.
    Posted by at
    Labels: , , , , , , , , , , , , , , ,

    07 May 2012

    Arc NC message : Slow Managed Care

    The Arc of North Carolina
    May 7, 2012

    NC should slow down Managed Care Implementation
    Cost of overly rapid tranistion being paid by those with I/DD in NC

    The Arc of NC believes the state of North Carolina must slow the implementation of the 1915(bc) combination waiver in order to avoid serious transition issues and unintended consequences due to unreasonable implementation timelines, and to revise plans in the design of the Managed Care Waiver.

    The Arc raised significant concerns about the managed care model during the last legislative session. In good faith, we have attempted to work with the state to implement this model and to point out where it does not work. Our good faith efforts resulted in little action from the State and a continued rush to implement a system that could harm people with developmental disabilities and their families. 


    For example:
    • Despite language allowing for the provision of care coordination by independent agencies, no MCO has chosen to implement this option; individuals and families are losing their case management and their independent voice 
    • Individuals cross walking from CAP to the Innovations waiver are having service changes that are not in the best interest of the individual
    • Medicaid “county of origin” is causing serious implementation issues
    • Payment and authorization systems are not working as intended
    • Community Guide is not available for the people who need it now (since they no longer have a Case Manager)
    • There is little coordination between the service and the medical side of Medicaid
    • How guardianship will be provided has yet to be resolved 
     - Click to Read More -  



    Policy Partners is The Arc of North Carolina's biweekly email newsletter. It covers developmental disability policy on the federal, state, and occasionally local level. Its also a great way to learn about events The Arc is having in your area!
    Posted by at
    Labels: , , , , , , , , , , , ,
    Location: Raleigh, NC 27609, USA
    Subscribe to: Posts (Atom)