NC DHHS Request for Information

From the North Carolina Department of Health and Human Services 

Governor Pat McCrory and Aldona Z. Wos, M.D. Governor Ambassador (Ret.) Secretary DHHS 

[ download original .pdf ] 

To Whom It May Concern: 

The North Carolina Department of Health and Human Services (DHHS) is pleased to issue a Request for Information (RFI) requesting recommendations that will assist the Division of Medical Assistance in improving the efficiency and effectiveness of our state’s Medicaid program. As has been widely reported in the news media, the Division has not been managed in a way to use our resources most efficiently. This has not only resulted in a loss to the taxpayers through significant budget shortfalls for several years in a row, but also to patients, providers and other stakeholders in the state’s Medicaid program. 

Medicaid Director Carol Steckel and I are committed to transforming the operations of the Division of Medical Assistance through innovation and reform. We strongly believe that we must prove to the residents of North Carolina that the program can not only provide high quality access to health care services to our recipients, but also manage the tax dollars entrusted to us in a better, more efficient way. We intend to restore trust in the Division and look forward to a collaborative reform process. 

This RFI represents an effort on our part to quickly collect recommendations from any appropriate entity. We encourage bold recommendations. We also encourage recommendations that are both comprehensive in nature or address only one area of service such as long-term care. These recommendations will be evaluated by the Division’s leadership and utilized as a platform for future discussions regarding innovation and reform of the state’s Medicaid program. 

The due date is aggressive, but the importance of our task to the state of North Carolina requires the utmost urgency and innovative thinking. I encourage each of you to come to the table, respond to the RFI and be part of the transformation of the Medicaid program in our state. 

Sincerely, 

Aldona Wos, M.D. 

Secretary 

North Carolina Department of Health and Human Services 

Division of Medical Assistance 

Request for Information 

RFI-DMA100-13 

February 4, 2013 

Request for Information 

The North Carolina Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA), is charged with operating the North Carolina Medicaid program which provides health care services for over 1.5 million North Carolinians. The current Medicaid budget is over $13 billion. Concern over multi-year cost overruns and the need to better manage the budget and improve the quality of care has led DHHS to seek information regarding innovative system and payment reform. 

DHHS is interested in receiving information, recommendations and suggested approaches regarding innovative system and payment reforms to the Medicaid program that are based on the following principles: 

• Are market-based and utilize NC community-based providers 
• In addition to complying with federal laws and regulations regarding access to services for recipients, DHHS expects respondents to utilize local providers
• DHHS expects respondents to utilize cutting-edge reimbursement methodologies, incentives and other financial efforts in order to create a system that reimburses for proven and documented results
• DHHS prefers to receive recommendations and information from respondents familiar with the North Carolina healthcare system and those recommendations and information include approaches that build on the current community care network by enhancing that system’s effectiveness and building partnerships with other primary care providers
• Enhance recipients’ personal responsibility both for financial participation and health care decisions 
• While this issue has been attempted in a variety of ways DHHS seeks any and all information that encourage recipients to make better choices and improve their health 
• Use of co-pays, deductibles and other allowable financial incentives will be acceptable and encouraged 
• Use of non-health service incentives, such as added services, weight loss program and other ways to encourage and achieve an improved health status of recipients 
• Assess optimal level of benefits to appropriately meet the health care needs of Medicaid recipients 
• Provide both short term savings for the Medicaid program and provide a sustainable, predictable Medicaid program for the future; respondents should describe how it will create more appropriate care, at lower costs and with better outcomes versus the fee-for-service system over the short, intermediate and long terms. 
• Create payment policies that provide incentives to create a system that provides the right level of care at the right location 
• DHHS seeks to build on the development of patient-centered medical homes that encourage recipients to build a long-term relationship with a primary care provider instead of utilizing the emergency department. 
• DHHS seeks approaches in which the CCNC “patient portal” can be expanded beyond its current limitations (accessible only by care providers at present) to provide ED providers and hospital staff information currently available in the portal regarding the tests, prescriptions and services provided to Medicaid patients so that ED care can be better delivered and coordinated with the patient’s past medical history and providers. 
• Utilize accepted and verifiable financial measures to evaluate and assess the efficiency of the program 
• While DHHS seeks recommendations and information on the appropriate measures, DHHS proposes utilizing those measures already being used in the Medicare and Medicaid programs to avoid duplication in reporting. 
• Utilize accepted and verifiable quality, utilization, customer satisfaction metrics to ensure efficacy and appropriate levels of care and service
• While DHHS seeks recommendations and information on the appropriate measures, DHHS proposes utilizing those measures already being used in the Medicare and Medicaid programs to avoid duplication in reporting. 
• Address the need for coordination between physical health and behavioral health 
• May include information that address the full continuum of care, including long term care support and services 
• Focus on improving the health of our citizens and lawful residents 
• May require either Medicaid State Plan Amendments (SPAs) and/or waivers from Title XIX rules and regulations. DHHS encourages respondents to address how the Medicaid SPA and/or waiver would be phrased in order to enhance US DHHS approval in a rapid time frame. 

DHHS encourages respondents to address the use of North Carolina’s Health Information Exchange in order to provide health information to both the provider community and recipients as appropriate 

DHHS purposefully provided only an outline of goals for its program in order to receive recommendations, information and suggestions for approaches that are innovative. DHHS seeks information regarding programs that will build a state-of-the-art, sustainable Medicaid program. DHHS asks that respondents think boldly in the submissions. DHHS will consider all recommendations, information and suggestions for approaches including those that utilize the existing Community Care Networks or any other coordinated care proposal. 

Entities who submit documentation in response to this RFI may be invited to present their ideas in person to Agency leadership. An in-person presentation by an entity that submits documentation in response to this RFI will not serve as the basis for precluding that entity from responding to any future RFP or RFA regarding system reform. 

The responses to this RFI, any follow-up questions and the presentations to the DHHS may be used to design a system of health care for the North Carolina Medicaid program. 

RFI Response Requirements 

Respondents to this RFI are asked to be thorough but concise. The response to this RFI should include the following: 

• The respondent’s name, address, place of business address(es), contact information, including representative name and alternative, if available, telephone numbers(s), and e-mail address(es). 
• DHHS seeks to solicit recommendations and information from respondents that are North Carolina entities that are licensed providers participating in Medicaid, including provider groups that participate, hospitals, provider networks that are provider owned or provider based. DHHS recognizes that respondents to this RFI may include individuals in other settings such as academia. 
• A description of the respondent’s business and/or its experience as it relates to the services outline in this RFI. This description should include a narrative explaining past experiences in which the respondent has engaged with other health care payers, health care agencies, health care providers or government agencies in the area of Medicaid, health system design, managed care, long term care programs. The respondent shall indicate any Medicaid experience it has for services similar in nature to those described in this RFI. 
• A description of how the respondent’s approach will offer advantages or improvements over existing processes. The description should also identify known or potential concerns with or barriers to the approach. 

Confidential Information

In accordance with 01 NCAC 05B.1501 the State may maintain confidentiality of certain types of information described in N. C. Gen. Stat. 132-1 et. seq. Such information may include trade secrets defined by N.C. Gen. Stat. 66-152 and other information specifically exempted from the Public Records Act pursuant to N.C. Gen. Stat. 132-1.2. Respondent may designate appropriate portions of its response confidential, consistent with and to the extent permitted under the Statutes and Rules set forth above, by marking the pages containing confidential information with boldface type at the top and bottom of each such page stating, “CONFIDENTIAL”. By so marking any page, the Respondent warrants that it has formed a good faith opinion, having received such necessary or proper review by counsel and other knowledgeable advisers that the portions marked confidential meet the requirements of the Rules and Statutes set forth above. The State may serve as custodian of Respondent’s confidential information and not as an arbiter of claims against Respondent’s assertion of confidentiality. If an action is brought pursuant to N.C. Gen. Stat. 132-9 to compel the State to disclose information marked confidential, the Respondent agrees that it will intervene in the action through its counsel and participate in defending the State, including any public official(s) or public employee(s). The Respondent agrees that it shall hold the State and any official(s) and individual(s) harmless from any and all damages, costs, and attorney’s fees awarded against the State or official or individual in the action. The State agrees to promptly notify the Respondent in writing of any action seeking to compel the disclosure of Respondent’s confidential information. The State shall have the right, at its option and expense, to participate in the defense of the action through its counsel. The State shall have no liability to Respondent with respect to the disclosure of Respondent’s confidential information ordered by a court of competent jurisdiction pursuant to N.C. Gen. Stat. 132-9 or other applicable law. 

Response Submission 

Please note: This is a request for information only and not a request for services. 

Respondents to this RFI shall submit one electronic copy of its response. The response shall not exceed twenty one-sided pages in length. The electronic format shall be submitted on CD-ROM. The software used to produce the electronic files must be Microsoft Word 2010 or newer. 

The respondent shall also submit one electronic redacted copy of the response suitable for release to the public. Any confidential information should be either redacted or completely removed. The redacted response shall be marked as the “redacted” copy and contain a transmitted letter authorizing release of the redacted version of the response in the event the Agency receives a public record request. We request that all interested parties respond to this RFI by submitting your responses by 2:00 p.m. EST, Friday March 15, 2013. 

For responses sent via US Mail, responses should be sent to the following address: 

NC Department of Health and Human Services 

Office of Procurement and Contract Services 

Attn: David Womble 

2008 Mail Service Center 

Raleigh, NC 27699-2008 

Hand delivered responses, or responses sent other than via US Mail, should be sent to the following address: 

NC Department of Health and Human Services 

Office of Procurement and Contract Services 

Hoey Building 

Attn: David Womble 

801 Ruggles Drive 

Raleigh, NC 27603 

IMPORTANT NOTE: Indicate firm name, and RFI-DMA100-13 on the outside of the envelope or package. Faxed or emailed responses will not be accepted. 

Respondent Costs 

Respondents are solely responsible for all costs incurred by the respondent in preparing and/or submitting a response to this RFI. Neither the state of North Carolina, DHHS nor DMA shall be responsible for any respondent costs associated with preparing and/or submitting a response to this RFI or any costs associated with presentations if requested. 

Questions 

Verbal questions will not be accepted. Clarification questions related to this RFI must be emailed to David Womble by 2:00 PM February 14, 2013 at: 

Email: david.womble@dhhs.nc.gov 

If applicable, answers to the questions or any other information concerning this RFI will be posted to the IPS Website (www.ips.state.nc.us) by February 20, 2013 under RFI # 30-DMA100-13. 

Rights to Submitted Materials 

All responses, inquiries, or correspondence relating to or in reference to this RFI, and all documentation submitted by the various respondents shall become the property of DHHS when received. Ideas, approaches, and options presented by respondents may be used in whole or in part by the State in developing a Request for Proposal (RFP) should DHHS decide to proceed with an RFP. Further, combinations of ideas from various respondents may also become part of a RFP, based on consideration of RFI various submissions and the needs of DHHS, which may differ from respondent’s experiences in other places. 

Obligations of the State 

DHHS may choose to issue an RFP for the development and implementation of innovative system and payment reforms to the Medicaid program. However, this RFI is not a guarantee that an RFP will be issued for some or all of the services about which ideas and approaches are being sought. 

If the state does determine that these services are of a benefit to the state an RFP will be issued. Until then all information sent in by respondents for this RFI will remain confidential until after the award of the RFP or until the state makes the decision to not issue an RFP. 

Critical Medicaid audit based upon unrealistic demands

http://www.ncpolicywatch.com/2013/02/04/critical-medicaid-audit-based-upon-unrealistic-demands/

Critics of North Carolina’s Medicaid program – the publicly-funded health insurance program for adults and children of low income – made some headlines in recent days by touting a new state audit that supposedly showed a large and previously unreported budget deficit. The critics, who included Governor McCrory and his State Health and Human Services Secretary Aldona Wos, claimed that Medicaid had gone $375 million over budget with state dollars and more than $1 billion over budget when federal dollars are included.

At the Governor’s news conference announcing the audit, DHHS Secretary Wos, lectured the Medicaid section of her agency: “Cost overruns will not be tolerated and will not be acceptable …There’s a budget for a reason.”

Conservatives are also using this audit as a reason for the state not to expand the Medicaid program to cover a half-million uninsured people as made possible by Obamacare (even though the expansion would be financed almost completely by the federal government).

There’s just one problem with McCrory and Wos’ conclusion: It’s bogus.

Like someone demanding blood be squeezed from the proverbial turnip and then professing to be “shocked” when the magic is not performed, the Medicaid “shortfall” is actually the result of absurd and unrealistic demands placed upon the program last year by the General Assembly.

Indeed, as anyone who pays real attention to the Medicaid program could have told the Governor and Secretary Wos last year, the overly-ambitious and ideologically-driven demands imposed by the General Assembly (and passed into law over then-Governor Perdue’s veto) were never realistic. Former Health and Human Services Secretary Lanier Cansler (a one-time Republican lawmaker) made this plain as far back as August of 2011 when he said:

“It’s just really going to be next to impossible to achieve this budget, and I’m not sure where the legislature will go with that. The fact that this budget plays into next year (means next year) is going to be a difficult budget year as well.”

Secretary Cansler reiterated this point in a letter sent directly to Republican General Assembly leaders again on October 27, 2011. According to Cansler:

“…aggressive budget cuts mandated by the General Assembly’s budget are unreasonable and unobtainable.”

Unfortunately, Cansler’s pleas had no effect.

Indeed, despite demanding massive Medicaid cuts, Republican General Assembly members further tied Secretary Cansler’s hands in January 2012 when the prospect of politically harrowing cuts in so-called “optional” services like artificial limbs and ambulance service (as well as major cuts in payments to doctors and hospitals) were on the table. The Legislature simply told Cansler to find other places to close the gap!

But, wait, it gets even more absurd.

Remember the amount in state funding the audit claimed the Medicaid program had exceeded its budget by ($375 million in state funds and $1 billion including federal money)? Here’s an amazing coincidence: Those sums are almost precisely equivalent to program cuts that the General Assembly demanded (but failed to provide the tools to attain) each year!

None of this is to deny the importance of efficiency. In a giant health program like Medicaid, one can and should always look for new ways to make reforms to be more efficient and effective.

But here’s another inconvenient truth for the critics: For the 2007-10 period (the most recent period for which national data are available) North Carolina’s Medicaid program had the lowest rate of spending growth of any Medicaid program in the United States. In fact, North Carolina’s Medicaid program spending growth was about half the national average! Not surprisingly, other states and even private health insurers are actually looking to North Carolina for lessons on how to run their own programs efficiently and effectively.

Got it? Over the last year and a half, in-the-know experts warned state budget-makers (and anyone else who would listen) repeatedly that the Medicaid program would not be able to meet the unrealistic budget set for it by the General Assembly.

For the McCrory Administration and the state auditor to effectively ignore this reality and then express shock and dismay when the program failed to meet such demands is, at best, remarkably disingenuous. At worst, it speaks to intentional misrepresentation of an efficient and effective program that delivers quality health care, garners strong support from the doctors and the hospitals doing the hard work, and makes a huge difference in the lives of over a million of our fellow citizens.

Adam Searing is Director of the Health Access Coalition at the N.C. Justice Center.

Special Medicaid Bulletin on b/c Waivers

Good Afternoon,

Please see the Special Medicaid Bulletin on the 1915 b/c waivers posted today. Please share with your stakeholders.

http://www.ncdhhs.gov/dma/bulletin/pdfbulletin/0113_1915bc_waiver_expansion.pdf

Thanks.

Kelly Crosbie, LCSW
Chief, Behavioral Health Section
Clinical Policy & Programs
Division of Medical Assistance
1985 Umstead Drive
2501 Mail Service Center
Raleigh, NC 27699-2501
(919) 855-4293
kelly.crosbie@dhhs.nc.gov

Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized State official. Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this e-mail in error, please notify the sender immediately and delete all records of this e-mail.

What's New in December

December 2012 news, events, and updates.

• WRAL (SpED) Teacher of the Week
• Important Information regarding the Supports Intensity Scale from a provider / mother.
• Arc NC Action Alert.
• NCGA Meeting Notice: JLOC on HHS, 12/11.
• added to Google events calendar.
• From the Arc NC: Tillis Requests Special Session To Address PCS/Group Home Crisis
• Alliance Behavioral Healthcare Weekly Updates, 11/30

[ What's New Main ]

Tillis Requests Special Session To Address PCS/Group Home Crisis

From The Arc of North Carolina

Tillis Requests Special Session To Address PCS/Group Home Crisis

Special Session first step to solve crisis before Holiday break   Speaker of the NC House Thom Tillis has formally requested that Governor Perdue convene a Special Session of the General Assembly in order to address the looming Personal Care Services (PCS) crisis that threatens the housing of thousands of people with disabilities living in group homes. The Arc of North Carolina is thrilled by this development and appreciates the Speaker's leadership on this issue and his continued dedication to North Carolinians with intellectual and developmental disabilities. The Arc will continue to keep you updated on the PCS/Group Home Crisis as it develops. Please check www.ArcNC.org for information as it happens. The Arc's advocacy staff is evaluating it's next steps in terms of advocacy. Look for an action alert next week. The letter from the Speaker's office is below. See a copy of the original here. --- Governor Perdue, As you know, the General Assembly appropriated $39.7 million in this year's budget to provide for temporary, short-term assistance to residents who would no longer be eligible to receive Medicaid State Plan Personal Care Services under the new eligibility criteria, effective January 1, 2013. The budget provision was drafted as a short-term measure to ensure the funds went to those affected residents who would be potentially discharged from their facility, but would not immediately have a safe community placement. This budget provision was intended to prevent the Department of Health & Human Services from using funds for administrative expenses, appeals, rent deposits, or other items, as requested by the Department during budget negotiations. The Blue Ribbon Commission was summarily tasked with developing long-term solutions to ensure Medicaid beneficiaries receive the services they need. The General Assembly has been working diligently over the last several weeks and months to determine solutions that would prevent the potential unintended closure of mental health and IDD group homes at the conclusion of this calendar year. It is now incumbent upon all of us to do what is necessary to solve this problem. In order to ensure that our state's most vulnerable citizens are protected and allowed to remain in their homes, it is my opinion that legislative action by the General Assembly is needed. Therefore, I respectfully request that you convene a Special Session of the General Assembly under the authority granted to you by Article Ill, Section 5(7) of the North Carolina Constitution. The North Carolina House of Representatives stands ready to take immediate action to resolve this impending problem. If you should decide to convene a Special Session, you have my word that no additional matters will be taken up by the House of Representatives. We will act quickly and decisively to protect the residents of mental health and IDD group homes, and the session will end when that action is concluded. I look forward to your prompt reply. Thank you for your time and attention concerning this very important matter. Sincerely, Thom Tillis   cc: Senator Phil Berger

Medicaid Block Grant & Impact on IDD Populations

From The Arc of the United States

Medicaid Block Grant Information

How will Medicaid Block Grants Impact People with Intellectual and Developmental Disabilities and their Families?

[ original post on thearc.org ] 

Introduction

The House Budget Resolution for FY 2013 calls for drastic cuts to Medicaid ($810 billion over 10 years) that would fundamentally reshape the program—making it less reliable for the people who depend on it and shifting costs to consumers and to the states.

For millions of people living in poverty, Medicaid is a safety net. For many of the 7 million people with intellectual and developmental disabilities (I/DD), Medicaid is a life line. People with I/DD typically require more complex and costly services than Medicaid recipients without disabilities. Frequently, they need care from several different types of health care providers and they often need the services throughout their lifetimes.

What is a Medicaid “block grant?”

A Medicaid block grant would be a fixed amount of money from the federal government to the states to spend on health care for people who are poor, elderly, or have disabilities with only general rules and very little oversight about the way it is spent.

Based on previous federal block grants and the general statements that House Budget Committee Chairman Paul Ryan has made about the FY 2013 House Budget Resolution, we expect that a Medicaid block grant would:

• cap the amount the federal government spends on Medicaid.
• NOT increase this amount to keep up with health care inflation.
• radically cut the federal share of Medicaid.

Why do some Members of Congress want to block grant Medicaid?

All health care spending is growing. Experts claim that it will continue to grow and become an ever larger share of our federal budget. Most Members of Congress are looking for ways to get our fiscal house in order. Some Members of Congress are focusing on the growth of federal spending in the Medicaid program. They believe that block granting Medicaid will save federal dollars. Under a block grant, federal funding for Medicaid would not grow when more people need health services. The challenge of providing health care without any additional federal money to people who are poor, elderly or have disabilities would fall to the states.

What are the most critical Medicaid services for people with I/DD and how does Medicaid pay for them?

The most critical Medicaid services for people with I/DD are:

• Acute care - including hospital care, physician services, and laboratory and x-ray services. These acute care services are mandatory which means they must be provided to everyone who is eligible. States have the option to offer (and most do) prescription drugs, dental, physical therapy, speech therapy, prosthetic devices and other services.
• Long term services and supports - including help getting dressed, taking medication, preparing meals, managing money, getting in and out of bed.

Medicaid is a shared program between states and the federal government and each pays for part of it. The federal share of Medicaid ranges from 50% to 75% of costs. As the need for Medicaid grows in the states, the federal government spends more.

Is Medicaid an entitlement program?

Yes. This means that if a person meets the eligibility requirements (generally poverty, age and/or disability), he or she is entitled to the services available under the state Medicaid program.

What are people with disabilities currently entitled to in the Medicaid program?

Today, each state’s Medicaid program is required by the federal government to provide a minimum level of coverage for the elderly, people with disabilities, and low-income adults and children in order to receive federal matching payments. Minimum services include seeing a doctor, getting x-rays, going to the hospital, receiving care in a nursing home and vaccines for children. Nursing home care is also an entitlement and Medicaid pays for almost half of the long-term care expenditures in this country. It is the primary payer of long-term services and supports for people with I/DD.

What might states do if Medicaid is block granted?

Block grants could force bad choices and cause substantial conflict as groups with diverse needs compete for scarce dollars. Since the services to people with disabilities and the elderly are significantly more costly than health care coverage for children, states could decide to serve fewer costly adults and people with disabilities and focus scarce health care dollars on less costly children. However there is no certain way to know what states will do. Below are possible choices states might make:

• States may reduce coverage of home and community-based services (HCBS) and supports. Most people who need long term services prefer to receive them at home. Over 650,000 people with I/DD receive long-term services paid for by Medicaid. States could decide to stop providing these services or limit the number of people who could get them. There already are over 300,000 people with I/DD on waiting lists for Medicaid home and community-based services. There are 730,000 people with I/DD living with aging caregivers who are approaching the time when they no longer will be able to care for their adult children with I/DD at home. If states stopped providing long-term services for people with I/DD, the waiting lists would grow and the situation for older caregivers would become more dire.
• States may decide to move people into institutions. Under a block grant, rules for providing quality care could be more flexible and conditions in institutions could return to the way they were in the past. With fewer requirements, it may be cheaper for states to care for people with I/DD in large facilities.
• States may reduce eligibility by making it more difficult to meet financial or other criteria. To be eligible for Medicaid, people have to be poor. States could restrict health care services to only the very, very poor.
• States may increase the cost burden on the individuals or family members. States may decide that families should take care of their family members who are elderly, ill or have disabilities. States might decide that sons and daughters should care for their parents when they become frail or ill without any public dollars. In order to get health care, people might have to pay more out of their own pockets. Since people on Medicaid are poor to start with, requiring them to pay for their medical care or long term services and supports could be an insurmountable barrier.
• States may eliminate or reduce the availability of critical services such as personal care, prescription drugs, rehabilitative services, or home and community based waiver programs. All of these services are “optional” under Medicaid meaning that states may choose to provide them under their Medicaid plans or not. If funds become scarcer, states may decide to stop providing these optional services.
• States may slash the amounts they pay to doctors and other providers. It is already very difficult for people using Medicaid to find doctors and other health care providers. Finding a dentist or a specialist, such as a neurologist, is impossible in some communities. If states cut the amount they pay doctors and other providers, those professionals may quit serving people under Medicaid making the problem even worse.

If people with disabilities lose their entitlement to Medicaid, couldn’t they just purchase private insurance instead?

No. Most people with I/DD cannot get medical insurance through an employer because they do not work full time. In fact only 21% of people with all disabilities are working (March 2011). Others cannot find health insurers who will sell them policies because of their pre-existing conditions. Many people with I/DD cannot afford health insurance. Some people with I/DD find that if insurers will sell them policies it does not cover the services they need or the coverage is exorbitantly expensive.

Why are we concerned that services to people with disabilities might be targeted in the states if Medicaid is turned into a block grant?

People with disabilities and the elderly account for most of the Medicaid spending. While children and parents make up about 75 percent of Medicaid enrollees, they account for less than a third of the spending. In contrast, the elderly and individuals with disabilities make up about 25 percent of enrollees but about two-thirds of spending. Medicaid spending per capita in 2009 was $3,442 for families (parents and children) and more than five times higher for the elderly and people with disabilities at $17,763. The elderly and people with disabilities use health care services more often and use more health services and the elderly and people with disabilities are more likely to use long-term services and supports. We are very concerned that states may slash the supports that help people with I/DD live independent, productive lives.

Are block grants cost effective?

A Medicaid block grant doesn’t control the cost of health care which continues to rise as people get older and use more health care services and as the general cost of all health care increases. They do shift more of the cost to that state and likely the individual. Costs may actually rise significantly because people who lose their health care or can’t afford it will stop seeing their doctors or taking their medication. When that happens it makes existing health conditions worse leading to more doctor or hospital visits and more costs down the road and the individual faces more illness and hardship. If home and community based services are reduced it will likely lead to greater levels of costly and unnecessary institutionalization or homelessness. If people are not provided needed services they may not be able to work, learn or function in the community. This creates lost productivity from the individual and family members if they are called upon to provide care when there are no other options.

What can advocates do?

Advocates must make clear to their Members of Congress that block granting Medicaid is not the answer to our nation’s deficit. Advocates must tell their Members what exactly is at stake. The health of people with I/DD may very well be at stake if it becomes more difficult or costly to access needed health services. What will happen if you or your family member loses services under Medicaid or if you have to pay for long term services and supports? Advocates must let their Members know what the biggest concerns are for individuals and families with I/DD if state Medicaid programs are turned into block grants. With less money, would states make it more difficult to become eligible for Medicaid?

• Would they cut benefits?
• Would they cut current levels of spending?
• Would they decide not to cover currently eligible populations?
• Would the states stop serving certain groups of people?
• Would they stop providing entire categories of services?
• Would people with I/DD be able to obtain health care?
• Would people with I/DD have long term services in community settings or would they be forced into institutions?

We must make our voices heard. We all understand that sacrifices will need to be made to address our nation’s money problems. Advocates need to help Congress understand that solving these problems is going to take a common sense, balanced approach. We cannot solve our problems only by focusing on the poor, the elderly, and people with disabilities.

[1] Center on Budget and Policy Priorities Rhode Island’s Global Waiver not a Model for How States Would fare under a Medicaid Block Grant, March 2011. Rhode Island’s block grant is held up as a model by some supporters of block grants. However, the state’s fixed amount of federal funds was greater than their normal federal share of Medicaid dollars. Rhode Island’s program does not reflect what likely would happen under block grant proposals currently being discussed. There also is disagreement about the state’s claims of savings under its block grant.

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

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.

NC DHHS Press Release

From:  Titus, Trina Tue, Jun 19, 2012 at 4:51 PM

N.C. Department of Health and Human Services
For Immediate Release
June 19, 2012

Contact: Chrissy Pearson
919-855-4835 or Chrissy.pearson@dhhs.nc.gov

Secretary Delia Announces Reorganization of State Medicaid, DHHS Leadership Team

State Medicaid office will now report directly to Secretary

Raleigh– North Carolina Department of Health and Human Services (DHHS) Secretary Al Delia today announced that he is reorganizing the leadership teams that oversee the state’s Medicaid division.

The changes come after careful evaluation of the Department’s management, said Delia, who was named acting secretary in February.

Michael Watson, DHHS chief deputy secretary, will become the new head of the state’s Medicaid office, the Division of Medical Assistance (DMA). That position will be elevated to serve on the Secretary’s executive leadership team. Watson joined the Department in 2009 as an assistant secretary. He is the former CEO for Sandhills Center for MH/DD/SAS, with more than 20 years of experience and leadership in developing and operating mental health, developmental disabilities and substance abuse services on a local and regional level. His salary remains $160,000.

Watson replaces Dr. Craigan Gray, who served as director of DMA since April 2009 at a salary of $270,000.

Beth Melcher, assistant secretary for mental health, developmental disabilities, and substance abuse services development since August 2010, will become chief deputy secretary. Melcher, a licensed psychologist, is the former president of Recovery Innovations North Carolina. She was clinical director of The Durham Center, and also worked with the National Alliance on Mental Illness North Carolina as its executive director and as public policy director. Her salary will be $141,797.

John Dervin, the secretary’s senior policy adviser since March 2012, will step into a newly created role as chief of staff. Dervin previously served as policy adviser for health and human services for Governor Perdue. His salary will remain $84,000.

“After nearly six months in this role, my first priority for strengthening our management team is to elevate the state Medicaid office to play a more prominent role in the Department’s decision-making process,” said Secretary Delia. “Medicaid is not a stand-alone division. It touches not only multiple DHHS divisions but also plays a huge part in shaping the state budget. We need better communications and stronger oversight of this $12 billion program. I believe these changes will accomplish that.”

These staff changes are effective immediately.

###

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

N&O article: Thing$ that make$ U$ go Hmmm...

Note: highlights, links and italicized quotes are entirely my own mark-up and not reflective of the author nor original posting, link below. 

Costs soar for updating NC's Medicaid computer system
PUBLISHED SUN, JUN 17, 2012 02:25 AM
BY JOSEPH NEFF - JNEFF@NEWSOBSERVER.COM

[ Original News and Observer story here. ]

RALEIGH  In a bland office park off Lake Boone Trail, two computer teams toil away on behalf of the biggest contract in state history – the computer system that processes 88 million Medicaid claims each year.

The 500-plus team of workers from Computer Sciences Corporation, a tech company from northern Virginia, is working to finish the new system by next summer. Upstairs, 200 workers from Hewlett Packard, the technology giant from California, keeps the old 1980s-era system running, receiving, auditing and paying about 250,000 claims each day.

The project has gone in fits and starts since it began in 2004: cancelled and rebid, then amended and extended. Costs have kept rising, so much so that the expense of setting up the new system and running it for seven years, plus maintaining the old system, now adds up to an eye-popping figure: $851 million.

And that’s if it goes on line next summer, as scheduled.

Little in this project has gone as scheduled. The first contractor was dismissed, only $16 million into the work. The second, CSC, is two years behind its original timeline. In the world of information technology, the delays and overruns earn it the title of a “black swan” project.

Most of the delays and cost increases come from changes in federal and state laws and regulations, according to Al Delia, secretary of the state Department of Health and Human Services. He likened it to a home construction project where the owner asks the builder to add a second floor and garage midstream.

“Most of what have been called cost overruns aren’t really cost overruns,” Delia said.

In the long run, state officials say, the new system has the potential to save the state hundreds of millions of dollars. Along with processing claims for Medicaid – the government health care plan for the poor and disabled – the contract requires the system to be able to process claims from other payers, such as the State Health Plan or the state prison system.

“We expect this will be cutting edge, state of the art,” Delia said.

If so, it will be an unusual cutting-edge system: it’s largely written in COBOL, a computer language developed in the 1950s that is scarcely taught in North Carolina – just community colleges in Hickory and Charlotte. CSC has imported workers from India to fill the jobs in Raleigh.

Legislators wonder if state officials will ever be able to get the project finished.

“The $640 million question is, will the Medicaid system operate as billed?” asked state Rep. Nelson Dollar, a Cary Republican who co-chairs a committee that oversees DHHS. “We are skeptical until we see it.”

CSC declined to answer questions, but released a statement saying the project would be completed on time and within budget: “This new system will enable the State to better manage costs, improve healthcare administrative efficiency and enhance customer service for healthcare providers and recipients.... We are focused on delivering a high performance healthcare system that meets the specific needs of North Carolina and its constituents.”

High hopes

In 2003, the state solicited bids to replace the outmoded Medicaid claims system, which had been operated for 35 years by EDS, a Texas company later purchased by Hewlett Packard. Millions of lines of computer code power the program, which accepts claims from some 70,000 providers – doctors, clinics, hospitals, nursing homes and others.

It’s a big business: the Medicaid program will cost nearly $13 billion in North Carolina this year, about 23 percent from state funds and the rest federal. The new system is designed to detect fraud and avoid waste.

Federal tax dollars pay for 90 percent of the design of the new program and half of its operating costs.

There were high hopes in 2004 when the state gave the $171 million contract to Affiliated Computer Systems to replace the 1980s system.

The project “continues to forge ahead with great expectations,” according to a 2005 letter from Angeline Sligh, the director of the project. “It is our goal that this be one of the best replacement implementations in the nation.”

The project soon fell behind, with DHHS officials and ACS arguing over timeline and payments, each blaming the other for the mess. In May 2006, State Chief Information Officer George Bakolia threatened to kill the project unless the two sides could resolve their differences and come up with workable plan. Bakolia demanded new project managers at DHHS and ACS.

In July 2006, the state cancelled the contract, and eventually paid ACS $16.5 million, partly for work, partly to settle a lawsuit.

The state replaced its project managers, who run the program day to day. Their supervisors – Sligh and her boss, Assistant Secretary for Finance Dan Stewart – remained on the job.

An extension, a picnic

Round two began in 2008, when the state awarded a $265 million contract to CSC, with a go-live date of August 2011.

The contract sparked a fierce fight. HP, which runs the 1980s system, was a bidder on the new contract and protested on technical and political grounds: CSC had retained former DHHS Deputy Secretary Lanier Cansler as a lobbyist. Weeks after the contract award, Cansler was named DHHS secretary by Gov. Bev Perdue.

Stewart denied the protest.

In its bid documents, CSC estimated that 90 percent of the millions of lines of computer code needed could be copied from its New York Medicaid program. CSC later revised that to 73 percent; in the end, because of big differences between the New York and North Carolina Medicaid programs, only 32 percent of the New York code was used.

The program soon fell behind, and in the summer of 2010 CSC asked for an extension. Following a lengthy negotiation, the state granted an 18- to 22-month extension and raised the contract price to $495 million.

CSC celebrated the amended contract with an invitation to a July 28, 2011, picnic at Umstead Park: “Please plan to join us for BBQ and Indian Cuisine! It will be a great time to get to know your co-workers as well (as key CSC and DHHS) executives. You might even have the chance to challenge them to a game of bean bag toss or horseshoes!”

Delia, who became DHHS secretary in February, says CSC added six months of delay by overestimating how much code it could bring from New York. The company agreed to pay the state $10 million in damages, an amount criticized as unsubstantiated and low in a subsequent state audit.

The rest of the delay, Delia said, stems from changes in federal and state laws and regulations, and was out of the control of DHHS.

A January report from State Auditor Beth Wood questioned the six-month figure, saying that DHHS did a poor job of documenting how it made key decisions: determining the six-month delay; calculating the damages owed by CSC; and tracking $30 million in unauthorized changes that CSC made in the program.

The audit was contentious from the start. Stewart told Wood that his staff was too busy to answer questions and provide documents. Their cooperation “will, by necessity, be minimal due to the lack of staff time, the urgency to complete the project and the liability related to delaying the IT contractors working on the project.”

The department’s response, twice as long as the audit, disagreed with virtually every paragraph, calling the audit biased, inaccurate, unproductive, ill-informed, unfounded and asinine.

Wood called the audit the most difficult of her career.

“It was the most uncooperative, dragging-the-feet, missing-deadlines audit like I’ve never seen,” she said.

During a hearing in January, legislators looking into the project asked Angie Sligh to grade her management of the contract. She gave herself an A.

Writing in COBOL

The audit did not touch on the fact that the state contracted in 2008 for a program written in COBOL, a computer language written in the 1950s. According to Bakolia, the former state chief information officer, COBOL is used in banking, transportation and federal systems that have been in use for decades, but it is almost never used in new systems.

“If the programs are written well and operate, companies don’t want to rewrite them,” Bakolia said. “If I were to write something today, it would not be COBOL. You can’t support it.”

In North Carolina, classes in COBOL are as popular as 8-track tapes. Wake Tech’s extensive computer science offerings don’t have COBOL, and neither does N.C. State.

Frank Mueller, an N.C. State computer science professor, said the supply of COBOL programmers is dwindling as people retire.

“As a consultant to any company, I would probably advise them against using COBOL,” Mueller said. “The problem is that it’s harder to find someone to change the code. If you change the law, you have to change the code.”

Asked about COBOL in an interview Thursday, Stewart said: “This is the first time I’ve ever heard that question raised.”

To fill the jobs, CSC recruited heavily in India – over half the staff, according to CSC workers who asked to remain anonymous out of fear of being fired. CSC did not respond to questions about foreign workers.

Stewart said he had no idea about the staff makeup.

“I have never seen their staff,” he said.

Delia said it is not an issue.

“It’s a private company, we have no way of knowing,” Delia said. “They are legal workers, it’s kind of a non-question.”

After working through a tough audit, firing a contractor and enduring multiple extensions, state officials have now turned their attention to another participant in the project: their own watchdog.

They are threatening to fire Maximus Inc., the Virginia firm paid to police the project for the state. Maximus, nearing the end of a three-year contract, is paid $1 million a year.

Neff: 919-829-4516

N&O article re TRO Issues Against DHHS

Judge halts effort to assign adult care homes special status
Published Fri, Jun 15, 2012
By Lynn Bonner - lbonner@newsobserver.com
Published in: Health/Science

[ Original News and Observer article here ]

An administrative law judge on Friday put a temporary stop to the state assigning adult care homes a special status that cuts off their federal Medicaid payments.

A group of adult care homes went to court this week to ask that the state Department of Health and Human Services no longer be allowed to designate certain adult care homes “institutes of mental disease.”

To comply with federal rules, the state is surveying adult care homes to determine how many of their residents are mentally ill. Adult care homes have long offered housing for mentally ill people, but the practice conflicts with federal policy.

Senior Administrative Law Judge Fred G. Morrison Jr. granted a temporary restraining order Friday telling the DHHS it could continue its surveys but that it could not take the final step to stop the flow of Medicaid money from adult care homes they find to be violating federal rules before June 28.

The federal Medicaid program won’t reimburse adult care homes where more than half the residents have mental illness as a primary diagnosis. The adult care homes said losing the federal money would create a financial hardship because the government health insurance program pays more than 40 percent of each eligible patient’s yearly costs.

Bonner: 919-829-4821

N&O article re: 75M Medicaid Budget Shortfall

Medicaid budget to come up $75M short
Published Fri, Jun 15, 2012 07:45 PM
By Lynn Bonner - lbonner@newsobserver.com
Published in: State

[ Original News and Observer article here ]

Legislators learned this week that the Medicaid budget would show a bigger than expected shortfall this year, just weeks after they passed a law they thought would solve the problem.

Medicaid claims paid June 12 were much higher than expected, said Al Delia, state Department of Health and Human Services acting secretary, costing the state about $25 million more than anticipated. The state has to pay two more rounds of Medicaid provider claims before the fiscal year ends, leading the office to project that the Medicaid budget will come up about $75 million short. Claims were higher than expected in the previous two payment cycles as well, Delia said, but the increases were smaller. Legislators were kept apprised of the increases and were told this week of the trend, Delia said.

Medicaid is the biggest wildcard in the state budget, with costs for the government insurance for the poor and disabled routinely higher than projected. The legislature a few weeks ago passed a law to fill a $205 million Medicaid budget shortfall for this year.

Delia said health-care provider claims tend to dip at this time of year, so the increase surprised Medicaid and state budget officials. The uptick resulted from providers filing claims at a faster clip, Delia said. The bills can be covered with temporary transfers from other state accounts, he said.

“Providers will be paid,” Delia said. “Services will continue.”

State Rep. Nelson Dollar said legislators are ready to work with state administrators to solve what he called a “cash flow problem.”

“They may need to move funds from one area of the budget to another so they can pay those obligations in the current fiscal year,” said Dollar, a Cary Republican.

Legislators asked state administrators to investigate the cause of the higher claims, Dollar said, but they do not think this month’s spike in bills portends higher than anticipated costs next year.

Bonner: 919-829-482

Medicaid per diem Reimbursement Rates for State DD Facilities

Without proper home and community supports, the decision to place our children in State DD facilities may be a decision many special NC parents will be forced to make...

Donin, Carol   Tue, May 15, 2012 at 8:26 AM

To:  Crystal J. De la Cruz 

Per your request, below are the per diem rates for the 3 developmental centers. These are the full cost rates and are inclusive of Medicare Part D and the ICF-MR Provider Tax. The per diem rates cover habilitative services, medical services and medications, dental services, all special therapies, adaptive equipment, nutrition, etc.

Caswell Center: $606.36
Murdoch Center: $536.36
Riddle Center: $482.36

Additional information may be requested through the DHHS Public Affairs Office, attention Julie Henry. Ms. Henry’s email address is Julie.henry@dhhs.nc.gov.

Thank you.

Carol Donin

Team Leader, Developmental Centers

Division of State Operated Healthcare Facilities

3006 Mail Service Center

Raleigh, NC 27699-3006

phone: 919-855-4700

fax: 919-508-0955

Please note that my email address has changed - carol.donin@dhhs.nc.gov

Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized State official. Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this e-mail in error, please notify the sender immediately and delete all records of this e-mail.

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

Federal Government changes re Long Term Care

May 9, 2012

From: Mary K. Short [MaryKShort@aol.com]

Subject: Federal Government changes re Long Term Care

I would like you all to read the information below. I have been following the changes that are talked about. I have been sending you all some information about what is happening at the federal level ... even The Arc put the information about the new Administration on Community Living (ACL) in their Action Alert. On April 17th I sent an email with the press release about the new ACL to Rep. Dollar and Rep. Avila asking them to use that information as a basis for stopping the further implementation of this move to Managed Care! I asked for them to consider the idea of moving IDD to Dept. of Aging or Dept. of Long Term Care because that is the direction the feds are taking. (http://www.hhs.gov/news/press/2012pres/04/20120416a.html.)

The information is from Steve Gold, an ADA attorney in PA, http://www.stevegoldada.com, is clear. Please use this information when you contact your Legislators! This is about NOT moving us to a capitated managed care system.

Mary K. Short

828-632-5888 or 704-451-4144 (cell)

From: ncadvocacy@yahoogroups.com

Reply-to: notify-dg-ncadvocacy@yahoogroups.com

To: ncadvocacy@yahoogroups.com

Sent: 5/9/2012 6:22:25 A.M. Eastern Daylight Time

Subj: [ncadvocacy] Digest Number 2011

Messages

________________________________________________________________________

1. Fw: [NYAPRS Enews] Gold Urges States to Adopt Community First Choice

    Posted by: "lauriecoker" 

    Date: Tue May 8, 2012 7:18 am ((PDT))

The Centers for Medicare and Medicaid announced this funding program, the "Community First Choice" option, just last week. It is a funding option that would specifically impact our citizens who could live independently with some services rather than being housed in large facility settings such as many of our adult care homes or "assisted living" facilities. It aims to impact states like ours, New York, and others that have become dependent on the convenience of placing people in "homes" -- some of which have 100 plus beds!

New York, which has had a similar ruling by the DOJ to ours about the institutional bias and limiting rightful choices for citizens, is planning to use this to change their behavior.

We could use this to help us in the very near future, but we have to advocate for it!

See some of Steve Gold's strategy suggestions re: this opportunity, below. It may be time to build a cross-disability coalition to bring change.

Please talk to decision-makers about using dollars for services in real community settings so that individuals can envision personal lives with goals and hopes. It costs less to the taxpayer, and surely less to the person who wishes to live differently than in a facility based setting.

Laurie Coker

Director, NC CANSO

North Carolina Consumer Advocacy, Networking, and Support Organization

Citizen self-advocacy and empowerment - State-wide from Winston-Salem

www.nccanso.wordpress.com

There is no more blessed bondage than to be a prisoner of hope.     --R .Z. Kemp

----- Forwarded Message ----

Sent: Tue, May 8, 2012 7:50:39 AM

Subject: [NYAPRS Enews] Gold Urges States to Adopt Community First Choice Programs

NYAPRS Note: New York State officials have already committed to adopting the CFC program, which will also apply to those at risk for residing in what’s called an IMD (institute for mental disease) that includes facilities over 16 beds.

Community First Choice Regulations Published.

Steve Gold  May 2012  Information Bulletin # 357

Let's hear the trumpets and the Halleluiahs chorus.

Finally, the Department of Health and Human Services / Centers for Medicare & Medicaid Services issued the final regulations for the Community First Choice option. The regulations state that CFC's scope is designed to make available home and community-based attendant services and supports to eligible individuals, as needed, to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, or cueing.

CMS listed CFC's Total Benefits as providing States with additional flexibility to finance home and community-based services and attendant services and supports. The regulations state that CFC will increase State and local accessibility to services that augment the quality of life for individuals through a person-centered plan of services and various quality assurances. CMS further noted that CFC reduces the financial strain on States and Medicaid participants.

CFC is a win-win for States to save money and for people who need community-based and attendant services to stay in their homes and apartments.

For many years, the Community First Choice was strongly supported and initiated by ADAPT, a national grass roots organization of people with disabilities of all ages and all disabilities. ADAPT organized large numbers of supporters, testified before Congressional committees, and last week demonstrated in front of HHS's Washington offices demanding CMS release CFC's regulations.

Now that the federal regulations have been released, the struggle shifts to you disability and aging advocates in each State - to make sure this program is implemented in your State. Nothing happens automatically. Unless advocates demand CFC state-by-state, it will not happen. Yes, another local effort but quire worth the effort.

Here's why your State should amend its Medicaid Plan to include the CFC the federal government will pay an additional 6 percentages to your State's Federal Medical Assistance percentages. (Go to http://aspe.hhs.gov/health/fmap.htm to see what the FMAP is now WITHOUT the additional six points.) That translates into a LOT of federal money!

Another reason: yes, your State can save a lot of State funds while at the same time complying with the ADA/Olmstead requirements to prevent unnecessary isolation and institutionalization of people with disabilities.

Here's a brief summary of the final regulations:

1. CFC provides home and community-based attendant care services and supports to persons with disabilities.
2. Such services must assist the individual with activities of daily living, instrumental activities of daily living (e.g., shopping cleaning) and health-related tasks.
3. States can provide, at the State's option, transition costs (rent and utility deposits, first months rent/utilities, basic kitchen/bedding needs).
4. Individual eligibility requires that the person with a disability meets your State's institutional level of care criteria. The person need not be in the institution nor packing their bags or at risk of being imminently institutionalized. If the person meets the level of care for the institution, the CFC services can be provided.
5. Individual financial eligibility is the same as what your State has established for the institution.
6. Under the CFC, States must use a person-centered service plan and the services must be self-directed, either with a self-directed service budget or an agency-provider model.
7. This plan must be in writing and agreed to by the individual and must be based on a functional needs assessment. The regulations state that the person-centered service plan must reflect the services and supports that are important for the individual to meet the needs identified through an assessment of functional need.
8. These plans must be reviewed, and revised upon reassessment of functional needs, at least every 12 months, when the individual's circumstances or needs change significantly, and at the request of the individual.

What advocates must do:

1. Your State Medicaid Plan must be amended to include the CFC. Advocates should be at the table to ensure the services meet your needs.
2. You need a statewide, multi-disability coalition and strategy to ensure your State amends its Medicaid plan to include the CFC. If your State does not already have such a coalition, the CFC presents an opportunity to develop one.
3. If your State has such a coalition, convene it!
4. You need to show your Governor why s/he should amend your State's Medicaid plan to provide CFC services. This will require real live people who want and need CFC services. They must be ready to speak out. CFC is a critical opportunity to end waiting lists.
5. You should get to your media and explain how this program will save your State money, while bringing into your State additional Federal funds.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com.
FYI:  This is the link to the actual regulation (45 pages!)  It is still open for public comment and if you click on the link, there is a section that explains how to make public comment. This is about multiple populations ... elderly, other adult disabled, and IDD. This relates with the federal move to an "Administration on Community Living" department that was created.

http://www.gpo.gov/fdsys/pkg/FR-2012-05-03/pdf/2012-10385.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 430, 431, 435, 436, 440,

441, and 447

[CMS–2249–P2]

RIN 0938–AO53

Medicaid Program; State Plan Home

and Community-Based Services,

5-Year Period for Waivers, Provider

Payment Reassignment, and Setting

Requirements for Community First

Choice

AGENCY: Centers for Medicare &

Medicaid Services (CMS), HHS.

ACTION: Proposed rule.