NC House Bill 916 is NOT the Answer!: Innovations Waiver

Showing posts with label Innovations Waiver. Show all posts

13 February 2013

DHHS Invites Stakeholders to the Table: Begins Process for Long-Term Reform & Innovation in Medicaid

Dear All,

I know MANY of you have some terrific ideas on how to improve Medicaid service system... and here is the PERFECT opportunity to get them heard!

Please look over this Request for Information (RFI) from the new DHHS Secretary as they are looking for stakeholders who have ideas on how to better provide Medicaid services in our state. Stakeholders definitely include consumers and families across the state, too!

This is a top level opportunity to provide needed input for reform in better utilizing dollars to meet the growing needs. Please take a moment to read and consider how YOU can get involved in this work.

THANKS!!

Anna

p.s. Doug Wright is the Director of Consumer Affairs for Alliance (Wake & Durham & now interlocally linked with Cumberland and Johnston)

Note: CFAC stands for "Consumer Family Advisory Committee" and has advisory requirements as set in NC Statute 122C

----- Forwarded Message -----
From: Doug Wright <DWright@alliancebhc.org>
To: Alliance CFAC Members
Sent: Tuesday, February 5, 2013 12:05 PM
Subject: FW: NEWS RELEASE: DHHS Invites Stakeholders to the Table: Begins Process for Long-Term Reform and Innovation in Medicaid

From: Ellen Holliman
Sent: Tuesday, February 05, 2013 11:56 AM
To: SeniorManagement
Cc: yvonne@nc-council.org
Subject: FW: NEWS RELEASE: DHHS Invites Stakeholders to the Table: Begins Process for Long-Term Reform and Innovation in Medicaid

DHHS Invites Stakeholders to the Table

Begins Process for Long-Term Reform and Innovation in Medicaid

RALEIGH, N.C. – Today, the North Carolina Department of Health and Human Services (DHHS) published a Request for Information (RFI) for recommendations to assist the DHHS Division of Medical Assistance (DMA) in improving the efficiency and effectiveness of the state’s Medicaid program.

“Reforming Medicaid is crucial to everyone in North Carolina,” said DHHS Secretary Aldona Wos, M.D. “By publishing this RFI, the Department of Health and Human Services is inviting North Carolina healthcare providers to the table and also encouraging citizens with innovative ideas to participate.”

Today’s RFI released by the department marks the beginning of a process to engage interested parties to bring long-term reform and innovation to the state’s Medicaid system. Recommendations will be evaluated by leadership and utilized as a platform for future discussions. All recommendations must be submitted to the Division of Medical Assistance by March 15, 2013 at 2 p.m.

“We are seeking information and input that will help build a state-of-the-art, sustainable Medicaid program,” said Carol Steckel, director of the Division of Medical Assistance. “We must prove to the residents of North Carolina that the program can provide high quality access to health care services while at the same time, manage the tax dollars entrusted to us in a better, more efficient way.”

The North Carolina Department of Health and Human Services (DHHS) and the Division of Medical Assistance (DMA) are charged with operating the state’s Medicaid program, which provides health care services for over 1.5 million North Carolinians. A recent audit of the program raised concern over multi-year cost overruns and the need to better manage the budget.

A copy of the RFI and an open letter from Secretary Wos is attached. The RFI may be found at https://www.ips.state.nc.us/IPS/Default.aspx , search for 30-DMA100-13.

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31 December 2012

What's New in December

December 2012 news, events, and updates.

added to Google events calendar.

[ What's New Main ]

01 December 2012

Important Info. re: SIS

Forwarded to me by a provider / mother...

*Note attachments below.

-----------

The Supports Intensity Scale—SIS—is the new tool used to determine the level of services and supports needed for people on the Innovations Waiver. I have attached a copy of the child version and the adult form (age 16 and up). Currently, DDTI is scheduling these interviews for about 5,000 people. If you have not been selected yet, the SIS will be completed before the 2014 plan of care is developed.

I have participated in one child and one adult interview. It is very different from the NC-SNAP in that the person and his/her family and staff are asked to identify what types of supports are needed in order to accomplish a variety of activities. Specifically, you will be asked to rate the frequency, time and type of support needed for your family member. A same aged, non-disabled person is the point of reference. There are 57 questions in the adult version with more than that for children. Remember that each question has the three component parts. The first question is presented below as a sample.

Please pay attention to this interview tool. It is critical because the budget for your family member’s services will eventually be tied to the SIS outcomes. While you can appeal the results of the interview, it is important that you be prepared for the two to three hour session. Print the form down and review it. The child form is longer and the document has more description of the instrument, but review it. Make certain that you take with you the staff person (or two!) who know your child’s needs best. I completed the form in anticipation of my adult son’s interview. He was unhappy with having to talk about himself and he did not make it through even half of the interview before he left. That didn’t bother the interviewer. I also took a list of his diagnoses and medications with me as well and had examples and illustrations.

EXAMPLE: Using the toilet.

Compared to a same aged, non-disabled person, what is the frequency of support needed?

O = none or less than monthly

1 = at least one a month, but not once a week

2 = at least one a week, but not once a day

3 = at least once a day, but not once an hour

4 = hourly or more frequently

Compared to a same aged, non-disabled person, what is the daily support time needed?

0 = none

1 = less than 30 minutes

2 = 30 minutes to less than 2 hours

3 = 2 hours to less than 4 hours

4 = 4 hours or more

Compared to a same aged, non-disabled person, what is the type of support needed?

0 = none

1 = monitoring

2 = verbal/gestural prompting

3 = partial physical assistance

4 = full physical assistance

SIS Form Example for Adults

SIS Child Version

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:

http://www.ncdhhs.gov/dma/bulletin/pdfbulletin/1012_Special%20Bulletin_IDD_Waiver.pdf

CLINICAL POLICY 8M:

http://www.ncdhhs.gov/dma/mp/index.htm

(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!)

09 September 2012

Thoughts to Share...

Hi, All!

Those of you who already know me are aware that I am more comfortable in small group settings where information is being actively discussed verbally… so this form of communication is a stretch for me… blogging. I have had to learn to stretch much in my life as has many of you, too… and each stretch has its time of pain and relief. Pain in the act of learning how to do it and relief that perhaps I will not only live through it but actually find something of value to take away to help my family and others and hopefully personally grow into that person I always wanted to be when I grow up…;)! Therefore, with that said, I will be sharing in this venue as though I am visiting with you all in a small group to encourage dialogue so we can all learn together! One of the HUGE advantages I find in this venue is that whatever your schedule, you can access and be part of the conversation...

Now, talking about VERY serious topics that affect lives so directly is vital to finding real world solutions; however, I have also learned from my middle daughter, Cassie, just how VITAL humor is to life, too… so I am taking a life stretch lesson from her and hoping you all will allow me this license to suggest we create our own version of a traditional arcade-style game to help us work through our frustrations while we learn together as well… and just maybe a better real world solution will emerge… (Okay, I admit it freely, I have often been accused of being a dreamer… but we all know, too, what is needed is also possible…if we work together throughout the system!)

So…

Have you ever played Whack-a-Mole? You know, the arcade-style game where a mole suddenly appears and you have a soft mallet that you hit it to score points… the game increases in speed as you progress through the levels until the moles appear so frequently and randomly you cannot predict where they will appear or react fast enough when they pop up…and then soon after, the GAME OVER sign appears… and your tickets earned spit out of the meter for you to go redeem at the prize counter and it usually takes a LOT of tickets to get the item you actually want when you get to the counter? Yeah, that is the one I am talking about…;)!!

Traditional Whack-a-Mole Arcade Game

picture source is http://www.arcadeamusements.com/products.cfm?n=products&id=154

I mention this game because at first glance we feel we are caught in this type of arcade-style life where the holes in the ground are the various funding streams, service definitions, operational functions, etc and the moles are the various items that seemingly pop up all of a sudden and are all “urgent” in some way or another requiring our immediate attention, input, advocacy. It is so hard to keep up with what is happening in the URGENT file (the moles appearing quickly on the screen) much less to delve into understanding where it is coming from or what is causing them to pop-up in the first place (ongoing systemic issues that require deeper investigation along with committed effort and resources to address).

Crystal with help of others has provided this site with extensive information that shows the moles on the screen in the “Urgent” file and additional in-depth sourcing information that gives a view into the tunnel to understand why. I applaud this approach to allow ANYONE interested to participate at whatever level desired.

So, let’s play a round of Whack-a-Mole together… shall we?! For today, I select the Medicaid funding channel and the current “Urgent” mole is the imminent change at the end of this month from CAP-MRDD plan to the CAP-IDD Plan. This does not affect those who are currently being served through NC Innovations Waiver. See the CAP-IDD Decision Flowchart below:

Please share your thoughts, and also let us know which “mole” should we take a whack at understanding better at our next blog time together? (Be aware that just like the game, we often have a “mole” appear in the same place many times usually for different aspect of that topic that needs dealing with at that moment)…

To all those who know that “Game Over” can truly be a life and death matter for those we love and does reflect the overall health of a community, too! ~ Anna

07 September 2012

NC Trainings re Innovations Waiver & Advocacy

Transition to Managed Care Advocacy Trainings

[ from Disability Rights NC ]

Free Training Opportunity

NC Innovations Waiver: Advocating for Appropriate Services Under the Managed Care System

As our state transitions to a managed care system, Disability Rights NC is here to help you understand what this means for you and your loved ones. We are holding a series of free trainings in collaboration with Family Support Network of NC local programs. We have lots of locations and dates coming up. Tell us which one you will be attending by clicking here to register or contact your local Family Support Network coordinator at http://www.fsnnc.org/findlocal.

In this training, staff from Disability Rights NC will discuss:

The transition to managed care
“How-to” advocacy skills to help families protect a person’s rights during and after the transition
How care coordination differs from case management
Strategies on navigating Medicaid appeals and how the process changes under managed care
General self-advocacy tips

BRING YOUR QUESTIONS AND CONCERNS!

Upcoming Trainings

Rockingham -- September 5, 2012 at 12:00 pm (noon)
Thomas H Leath Memorial Library, 412 E. Franklin St, Rockingham, NC 28379

Sanford - September 13, 2012 at 12:00 pm (noon)
Lee County Arts & Community Center, 507 Steele St, Sanford, NC 27330

Fayetteville - September 14, 2012 at 10:00 am
CDSA, 1211-A Ireland Dr, Fayetteville, NC 28304

Charlotte - September 20, 2012 at 12:00 pm (noon)
Location TBA

Hickory - September 25, 2012 at 12:00 pm (noon)
Patyrick Beaver Memorial Library, 375 Third St NE, Hickory, NC 28601

**Pittsboro - September 27, 2012 (Time TBA)
Location TBA

Lumberton - September 28, 2012 at 12:00 pm (noon)
Partnership for Children, 210 E. 2nd St, Lumberton, NC 28358

Rocky Mount - September 28, 2012 at 12:00 pm (noon)
Braswell Memorial Library, 727 N. Grace St, Rocky Mount, NC 27804

*Goldsboro - October 3, 2012 at 6:00 pm
Wayne County Public Library, 1001 E. Ash St, Goldsboro, NC 27530

Raleigh - October 4, 2012 at 7:00 pm
Good Shepherd Lutheran Church, 7000 Creedmoor Rd, Raleigh, NC 27615

Wilmington - October 11, 2012 at 12:00 pm (noon)
New Hanover County Public Library - Northeast Branch, 1241 Military Cutoff Rd, Wilmington, NC 28405

*Jacksonville - October 11, 2012 at 6:00 pm
Onslow County Public Library, 58 Doris Ave E, Jacksonville, NC 28540

Winston-Salem - October 25, 2012 at 6:00 pm
Little Creek Recreation Center, 610 Foxcroft Dr, Winston-Salem, NC 27103

Burlington - November 8, 2012 at 7:00 pm
LIFESPAN Circle School, 919 Stokes St, Burlington, NC 27215

*Goldsboro and Jacksonville events are not coordinated by local Family Support Network programs.
**Disability Rights NC is participating as a panelist in a program coordinated by FSN on Managed Care.

06 September 2012

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.