The Lost Art of LISTENING.

Before I launch into what will probably be my last post (though don't hold me to it), I want to introduce you to Raleigh Attorney Knicole C. Emanuel with Williams Mullen and her most excellently well written and legally sound Medicaid law blog. In my humble opinion, anyone who can so eloquently and factually draw a strong comparison and contrast between Shakespeare's "MidSummer's Night Dream" and the Medicaid providers' prepayment nightmare is nothing short of a poetic knight in shining armor (yes, chicks can be knights too - why not?)

Now, on with the show...

So, people keep asking where I've gone? Commenting that they've not heard much from me lately... Well, the truth is, that while I have been known to talk to myself on occation, there are some conversations that really need a active partner for successful dialogue. 

Frankly, I'm all talked out at the moment.

American author and journalist, Ernest Hemmingway was quoted as saying, "I like to listen. I have learned a great deal from listening carefully. Most people never listen."

Stephen R. Covey, author of The 7 Habits of Highly Effective People: Lessons in Personal Change said, "Most people do not listen with the intent to understand; they listen with the intent to reply.” 

Therein lies the problem. Nobody's listening.

Everyone has something to say in this Medicaid quagmire - the MCO's and LME's have plenty to say, providers have even more to say, DHHS and DMA have their say, facilities and group homes have something to say, advocacy groups keep trying to have their say, consultants and lobbyists get paid the big bucks to keep saying stuff, and members of the North Carolina General Assembly always seem to have the final say... and don't even get me started on the recipients and their family members that most everyone seems to conveniently forget in all this. 

Nobody can keep the stories straight, not even (and often, especially) the media, becasue it appears the right hand doesn't know what the left hand is doing while everybody's busy with their own personal diatribes and ass-saving.

Everybody's talking but nobody's listening.

Nevermind all of the asinine bureaucratic dynamics at play in the dirty politics of the NC Medicaid system - the inappropriate friendships, roles, relationships, mothers / daughters / board members, ethical conflicts of interest, and who's scratching who's back. Yep, we know about all that.

There are way too many egos on the line here (not to mention the obscene amount of money invested), meanwhile we continue to rearrange the deck chairs on the Titanic while ignoring the real issues of human concious. That's right, I said it again.

I find that this is especially true of the current political climate in North Carolina... For the first time in just over 100 years, the Republican party has finally won back the driver's seat and they seem to be hell-bent on making up for lost time with issues far more "important" than the welfare of our state's most vulnerable citizens, with such utter nonsense as nipples, fracking, abortion / right to choose, ending size limits for K-3 public school classrooms, teaching about abortion risks in public schools while lifting smoking bans on college campuses, imposing rediculous voting restrictions and flat out denying many the right to vote, slashing unemployment benefits, requiring a 2 year waiting period prior to divorce (ironically dubbed the Healthy Marriage Act), vain attempts to negate the first amendment with a state religion, and arresting peaceful protestors, among other idiocy. 

Handbasket anyone?

What with all that debauchery going on, who has time to worry about the threat of homelessness to residents of NC group home facilities (yet again)? Or whether developmentally delayed recipients and their tired-ass exhausted families have the resources to make it through yet another day, or even if they do - if they are actually receiving the services they are entitled through all this slimey red tape? 

I mean really? Who cares? We're such a small minority of the State's population when compared with the number of citizens who have nipples, for Christ's sake.

And speaking of Christ... Conservative politicians love to use the Bible as a platform and foundation for their arguments and justifications and while I've been known to agree with certain positions, it should be noted that countless infamous American psychopaths (Charles Manson, Jim Jones, Fred Phelps, etc.) have also used the good book as sources of inspiration and justification... just sayin'.

My Christ is not wrathful nor boastful, not judgmental nor unknind, and is not dis-compassionate nor cruel toward fellow man nor the world we live in. In the documented lifetime of Jesus, he exhibited love and compassion to all, even those who sought to destroy him and especially for those who could not do for themselves. 

I believe Christ to be alive in the very essence of our collective being, our hearts if you will, a state of mind we all should strive toward. --A perpetual state of love and forgiveness... a state of grace and joy I witness every single day in my own special daughter, Isabel, and her special peers. 

Where the hell are our priorities?

It's way past time for the North Carolina "powers that be" to start listening more to the people, their constituents and voting public, who must live with, and at times suffer from, the repercussions of their actions and decisions. 

You do NOT know what is best for me and mine; that, I can guarantee you. And I'm certainly not in the minority there.

Perhaps if everyone suddenly, miraculously began to listen more, really listen, and made an honest attempt at understanding one another, as I believe the late Steve Jordan had hoped, we wouldn't require knights in shining armor to mitigate such a shameful Comedy of Errors... though sadly, nothing seems to grab attention these days (and further waste taxpayer dollars) quite like a good ole American law suit, eh?

Hang in there folks.

NC Medicaid Law BlogDisability Rights NCFirst in Families NC The Arc of NCNC Health News 

Insult to Injury: Expungement?

Re: Talk about insult to injury?!! Fwd: [lme_providers] Expunction of Criminal Records in North Carolina
From: Crystal J. De la Cruz
Thu, Feb 21, 2013 at 1:35 PM


Dear Families, People of Conscience, Senators and House Members, and Federal Representatives,

Pardon my French, but seriously, WHAT THE HELL?

Please see below an listserv I received today in which Eastpointe MCO's CEO, Karen Salaki, offers up to her colleagues and underlings a helpful reference guide to Expunction of Criminal Records in North Carolina presumably for MHDDSA professionals and staff... which, in my humble opinion, is not only completely inappropriate for this field, but begs to question:

1. Is criminal activity really such a problem for employees in North Carolina's field of Health and Human Services that it warrants dissemination of this information to the entire NC Local Management Providers listserv?
2. And this problem, is it a global epidemic throughout the entire I/DD field or is it isolated to say, direct care staff who work with clients who can neither defend themselves and, in most cases, communicate their needs or fears?
3. Is there such a shortage of decent, trustworthy, qualified applicants that we gotta break the levy in order to widen the pool because it's near impossible to find direct care staff willing and able to work for what pitiful portion of funds are left after the hierarchy trickle-down?
4. Would you knowingly allow a convicted felon (even a non-violent one?) access to your home and more importantly, to babysit your children? How about a someone with just a little ole Class 2 Misdemeanor charge (in NC, charges of Simple Assault and Shoplifting are both Class 2 Misdemeanors, while Speeding is a Class 1) And would you allow this same individual to care for your elderly mother with dementia?
5. When are we as a society, as a state, as a community - going to STOP subscribing to this unwritten American caste system of human value?

I really hope this is a misunderstanding, however, given the trends of this entire Medicaid process, it feels more par for the course.

We, the parents and family members, are still waiting to be heard and taken seriously regarding our experiences, knowledge, expertise, fears, concerns, and stuff like this that we're simply shocked and appalled about. Gosh, there's really no end to all we could accomplish if we all chose to work together... Just sayin'.

Thank you in advance for you time and attention. As always, please do not hesitate to contact me at any time.


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

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

http://no2nchb916.blogspot.com/

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


----- Forwarded Message
From: Listserve Administration
Reply-To: Listserve Administration
Date: Tue, 19 Feb 2013 16:53:33 -0500
To: NC Local Management Providers
Subject: [lme_providers] Expunction of Criminal Records in North Carolina

To: Provider Network
From: Karen Salacki, Chief of External Operations
Re: Expunction of Criminal Records in North Carolina

Attached is a very helpful guide on how to have eligible offenses removed from criminal records. Please share with applicable staff within your agencies.


This e-mail is for informative purposes ONLY.

Please do not reply to this e-mail.

---

You are currently subscribed to lme_providers as: janet.presson@asmallmiracleinc.com.


To unsubscribe click here: http://lists.unc.edu/u?id=53091867.3571bb40e36a7e70f1361fb08a87d445&n=T&l=lme_providers&o=32779787

(It may be necessary to cut and paste the above URL if the line is broken)

or send a blank email to leave-32779787-53091867.3571bb40e36a7e70f1361fb08a87d445@listserv.unc.edu

Public Records Law Statement:
Please be advised that any e-mail sent to and from this e-mail account is subject to the NC Public Records Law and may be disclosed to third parties.

Confidentiality Statement:
This e-mail transmission and any documents, files or previous e-mail messages attached to it may contain confidential health information, such documents are legally privileged. The authorized recipient of this information is prohibited from disclosing this information to any other party unless required to do so by law or regulation. Recipients are required to destroy such information after its stated need has been fulfilled. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this information in error, please notify the sender immediately and delete the e-mail and accompanying file attachment.

------ End of Forwarded Message


EXPUNCTION OF CRIMINAL RECORDS IN NORTH CAROLINA.PDF [460K]

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.

 ####

*SEE ALSO http://no2nchb916.blogspot.com/2013/02/nc-dhs-request-for-information.html

legislative correspondance to Senator Neal Hunt

UNSUBSCRIBE & personal note Re: Neal Hunt News 1 message

---

Crystal J. De la Cruz <delacruz.hopper@gmail.com>	Mon, Feb 11, 2013 at 12:46 PM
To: "Sen. Neal Hunt" <Neal.Hunt@ncleg.net>

Dear Senator Hunt,

As your constituent, I met with you last year for a brief half hour regarding critical concerns as a parent for the Intellectually and Developmentally Disabled recipients caught in the middle of North Carolina's Medicaid reform "bru-haha." You were very kind and attentive though by your own admission, you were unfamiliar with the Health and Human Services programs that serve and help support children and adults like my daughter. I left you with quite a bit of paperwork. I never received any feedback, though perhaps I should have been more proactive in following up; I can only imagine however that you are as busy as I am.

I am writing to request that you please unsubscribe me from your mailings. 

I am not interested in political finger-pointing regarding who did why and for how much when current NC House and Senate cannot even be bothered to understand not only the Medicaid budget but the irresponsible dynamics behind the shortfalls and more importantly, the devastating repercussions to our state's most vulnerable citizens. In my humble opinion, we as a state will never be able to move ahead until we ALL begin to recognize our commonalities and work together with the very best of intentions for every one, not just those of like minds. 

Regarding the Medicaid reform, there are still very real issues endangering the livelihood of families such as mine, threatening the supports and services which allow us to work and provide for our families. 

To date, to my knowledge, no one outside of the DHHS "powers that be" and the like (MCOs and LMEs) have been permitted to speak / present to the NCGA nor even to the DWAC, unless you count the 3 minute allotment of time. Advocacy groups such as Disability Rights and The Arc of NC are accused of having an agenda (does not everyone?!!) and family members who sometimes drive hours just to speak up are most often met with condescension.

North Carolina historically is not a proactive state with regards to the welfare of the people. This issue will be no different as there are far too many egos on the line and obscene amounts of money invested in an unprecedented system of care. Meanwhile, it seems no one is interested in hearing from those who have the most to lose - the recipients and their families. Never mind those family members of recipients who are uninsured themselves. 

Our exhausted pleas continue to fall on deaf ears.

Again, I thank you for your time and as always, I invite you to contact me anytime.

Kind regards,

--

Crystal J. De la Cruz - Hopper

Mother, Advocate & Concerned Citizen

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

http://no2nchb916.blogspot.com/

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

On Fri, Feb 8, 2013 at 11:51 AM, Sen. Neal Hunt <Neal.Hunt@ncleg.net> wrote:

	Legislative Newsletter
Legislature 309 LOB (919)733-5850 neal.hunt@ncleg.net	February 8, 2013	Business (919)781-3464 info@nealhunt.com
On January 30th, the General Assembly convened to begin the work of the long session. The pomp and circumstance of opening day is over and it is now time to begin solving our state’s major issues. I’m confident that the Senate will foster solutions to help alleviate our state’s fiscal problems and get us back on the road to prosperity. The NC Senate leadership will focus on common sense, business-friendly approaches to our state’s fiscal issues. In addition, we will block federal mandates that we know will put North Carolina further into debt. Here is a summary of what we hope to accomplish this session: 1.    The Budget – I have the pleasure of serving as one of the three chairs to the Senate Appropriations Committee. Our state government needs to run a budget like any North Carolina family or business. When the leadership took office in January 2011, we inherited an approximately $3 billion budget shortfall from the previous leadership. This shortfall was created by excessive government spending, termination of federal stimulus dollars, and loss of revenue due to the recession. Last session, we created a balanced budget that cut wasteful spending, lowered taxes, and created more funding for teachers. We will face many challenges due to Medicaid funding and other federal mandates, but rest assured we will pass another balanced, common sense budget. 2.    Tax Reform – We need to modernize our tax system to make our state more competitive with other states and the global economy. North Carolina’s top personal income tax rate is the highest in the South and the 11th highest in the nation. The lowest personal income tax rate is higher than or the same as the highest rate in all but two southern states. Our corporate tax rate of 6.9% is also the highest in the southeast. We must reform our system to promote business productivity and lower our unemployment rate of 9%. Some proposals being discussed that we will explore include: ·         Lower or eliminate the personal income tax ·         Lower or eliminate the corporate tax ·         Broaden and increase our state sales tax to include services (legal fees, haircuts, movie tickets, etc.). ·         Implement a reasonable flat corporate business fee instead of a corporate tax ·         Implement a real estate transfer tax small enough to make sure we don’t stifle transactions. ·         Eliminate taxes on business to business transactions, and ·         It will be revenue neutral. We also need to address how the poor and elderly will be affected by adding sales tax to food.  I believe a tax rebate will probably be offered in the event the personal and corporate income taxes are eliminated. I look forward to debating these proposals as we make sure we have the best tax reform solution. Our goal is to produce a tax system that is transparent, simple, and promotes economic growth and prosperity for all.  It is about 50 years overdue as we transitioned from a manufacturing economy to a service oriented one. . 3.    Unemployment Insurance Reform – Currently, North Carolina has the most generous unemployment insurance in the southeast. The state is required to repay $2.57 billion to the federal government that was borrowed to pay unemployment benefits after unemployment soared during the recession. This is a heavy burden on our budget, and our businesses that pay for all federal unemployment insurance (FUTA). As long as the money is owed, the federal unemployment taxes that employers pay will increase $21 per employee each year. Our economic situation has left thousands of North Carolinians unemployed and looking for work. We believe we have to provide adequate unemployment insurance to our state’s unemployed, but still remain conscious about our state’s business environment by providing an atmosphere for business and employment expansion. 4.    Election Reform – This session will bring many changes to our election laws, including: ·         Voter ID - Providing photo identification to vote is necessary to combat voter fraud in our state. I have no doubt that a voter ID bill will pass both chambers and that Governor McCrory will sign it into law. ·         Early Voting - I expect we will see an effort to shorten the time period of early voting. This attempt to generate more voters during an election is costly to local government, confusing to voters and has not increased voter turnout. ·         Partisan Judicial Races - I am cosponsoring Senate Bill 39, which will make judicial elections partisan. Voters should not be blind to judicial candidates’ views. ·         Publically Financed Political Campaigns – I believe we will see an effort to eliminate tax payer funding of judicial campaigns. 5.    Medicaid Expansion – In the Supreme Court decision on the Affordable Care Act (Obamacare), the court exempted states from the federal mandate to expand Medicaid eligibility. I do not support expanding Medicaid given the tremendous budgetary burden of an expansion. Just last year, the General Assembly was forced to fill a surprise Medicaid shortfall that totaled more than $500 million. An expansion of the program would add hundreds of millions of dollars in additional state costs to our Medicaid budget through 2019. I am focused on identifying solutions that meet the challenges facing our state and fostering a health care system that offers more accessible and affordable care to North Carolinians. 6.    Obamacare – I have cosponsored Senate Bill 4, a bill that would prevent the establishment of a North Carolina health benefit exchange as provided by the Affordable Care Act (or Obamacare). Senate Bill 4 passed the Senate on February 5th(32-17) and now moves to the House. Obamacare specifies that each state must have in place a health exchange where individuals and small businesses can purchase health care coverage. Implementing a federally mandated, state-run exchange or a state-federal partnership would have serious unintended consequences for NC.  A state-run program will only force our taxpayers to foot a massive bill for administrative, infrastructure, and operational expenses. Obamacare was a federal bill that I and many others believe was a serious mistake.  The states should not be forced to shoulder the burden of funding and implementing it. We have many great new policy ideas for North Carolina. These policies will lead to private sector job growth, generate a new business-friendly environment and reinvigorate the private sector economy. As always, I greatly appreciate the opportunity to serve you in the Senate. If you need anything, please don’t hesitate to contact my office; your comments and thoughts are always welcome. Sincerely, Neal Hunt If for any reason you do not wish to receive further newsletters, please reply to this e-mail and type in “Unsubscribe” on the subject line. Join in the conversation and connect with me on facebook.com/SenatorNealHunt

Twitter @SenatorNealHunt

What's New in October

October 2012 news, events, and updates.

• An Open Letter to Ann Coulter and then some...
• CAP I/DD... this is NOT NC Innovations, from Parent Advocate Mary K. Short.
• Federal Medicaid Block Grants and the Impact to I/DD Populations and Families from The Arc of the United States.
• Voting Information for Adults with Disabilities - Make Your Voice Heard, from The Arc of North Carolina.
• Crisis in Personal Care Services in NC, and How to Address It from The Arc of North Carolina.
• NCGA JLOC on HHS Meeting Notice for 10/16.
• added to Google Events Calendar.
• A Day in the Life... [personal note]

[ What's New Main ]

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!)

Crisis in PCS in NC, & How to Address It

From The Arc of North Carolina

Crisis in Personal Care Services in NC, and How to Address It

[ original post ]

Issue:

For thousands of North Carolina citizens with intellectual and developmental disabilities (I/DD), as well as people with mental illness, the Medicaid State plan service "Personal Care" (or PCS) has provided supplemental funding for housing supports in small licensed group homes.

Earlier this year, the General Assembly raised the level of disability needed to receive PCS. Now, individuals must require assistance with three activities of daily living [ADL’s]. This rule applies to both in-home and facility based services, to achieve legally required comparability. Unfortunately, most individuals living in licensed group homes will no longer qualify.

This change could reduce a group home’s budget by up to 30%, creating significant budget shortfalls- yet another hardship for an already struggling community-based option.

Not only does this reduction affect the provider’s ability to provide basic support services, in many cases it could lead to an inability to meet the group home’s debt obligations. Many of these homes were financed using US Dept. of Housing & Urban Development (HUD) funding streams, and a significant number are tied together through HUD approved refinancing methods. If vacancy rates rise due to lack of support services, well over 250 properties could be at risk of failing.

Recommendations:

For most people living in these types of homes, PCS was not their most needed service. Individuals living in these settings most often need support services to allow them to live successfully in communities. For people with I/DD, they are most likely support services that are habilitative and for people with mental illness they would be recovery based support services.

For both populations there are Medicaid options that, if designed correctly, could support people in these settings and other community based options that should not increase the state funds needed to provide these supports. Unfortunately, it is impossible to get these new service definitions designed and approved by the Center for Medicaid Services by December 31- the end date of the current PCS definition.

With this in mind, we would recommend the following course of action.

1. Extend the state funds available to people living in Adult Care Homes to licensed group homes. Thirty-nine million dollars is already set aside for adult care homes during this period of transition. This reserve should be extended to licensed group homes as well. People living in licensed group homes often have more significant disabilities than the individuals in adult care homes and deserve the same protection provided by the funds appropriated for adult care home residents.
2. For people with IDD- Immediately begin the work of creating a specific 1915i option for services[s] that would support individuals living in community settings- both licensed and non-licensed. The 1915i option is a near perfect fit for this type of service. Not only can it provide funding to offset the loss of PCS, it could be designed to offset the state services dollars that are used in group homes and provide another meaningful Medicaid service for people living in other community settings. The match money for these services could come from already appropriated community base state funds. Preliminary estimates by The Arc indicate that a carefully crafted 1915i option could support individuals in these homes and make a significant dent in the waiting list without any additional appropriations from the State.
3. For people with Mental Illness– It is possible that the same type of 1915i option services may make sense for people with Mental Illness. It may be more difficult to craft services definitions that assure cost neutrality, but this option should be explored immediately.

At the same time, the state should review the possibility of creating a recovery-based support service under Medicaid that could be used in non-licensed community settings as well as licensed settings. Since Mental Health services are recovery based, such a service could be created without the use of a 1915i. In both cases, 1915i or state plan service funds already used for community services for people with mental illness could be used for match.

These recommendations are straightforward solutions to what will become a significant crisis if we do not act. While there may be other options, we suggest the above actions because they have to potential to solve the problem short term and create a low cost solution for the long term that is consistent with best practice. If we are able to follow this path we not only stabilize the licensed community based options but create good options for individuals who choose to live in less restrictive settings.

NCGA 10/16 HHS-JLOC Meeting Notice

NORTH CAROLINA GENERAL ASSEMBLY

Raleigh, North Carolina 27601

October 5, 2012

MEMORANDUM

TO: Members, Joint Legislative Oversight Committee - Health and Human Services

FROM: Senator Louis Pate, Co-Chair
Representative Justin Burr, Co-Chair
Representative Nelson Dollar, Co-Chair

SUBJECT: Meeting Notice

DAY Tuesday
DATE October 16, 2012
TIME 10:00 am - 3:00 pm
ROOM 643

If you are unable to attend or have any questions concerning this meeting, please contact Candace Slate at (919) 715-0795, Dina Long (919) 733-5908, or Joey Stansbury (919) 733-7659.

cc: Committee Record _X_
Interested Parties _X_

A Day in the Life...

Lots of people have hectic lives. Apparently, it's the new norm. We barely have time to sync our tech devices designed to simplify our hectic lives.

These days we're all running ourselves into the ground trying to keep up with the necessities of life, let alone the rest of our "To Do" lists. Anyone with a job or children is swimming in a bubbling cesspool of stress and chaos; those with jobs and children are just trying our best to stay out of the psych ward... and for those of us who work and have children with special needs, God help us, because a mental health breakdown emergency just isn't an option - especially if you live in North Carolina!

A couple of months back, I was filling up at a local gas station and chatting with the kindly manager about the damaged fuel pump which had been knocked ajar from its island perch. He tells me that people are so busy, distracted and hurried that they don't pay attention to what they're doing... "I can believe it," I tell him, "I've seen people drive off with the pump nossel still inserted in their gas tanks." He shook his head and tells me that that happens at his store at least 4 or 5 times a month.

Why do I bring this up? Because we, as a society, all need to slow down and pause!

We need to take a step back, take inventory of our lives, our purpose, our priorities and our conscience... To take a look at what's really important to us right now in this moment. Are we where we need to be? And even more importantly, are we being the best of who we are in every decision we make? Especially those in positions of authority... Like those whose names you'll see on the ballots this fall.

Whether you're "just a parent," a laborer, professional, CEO, a politician, or an ordinary Joe - consider: what will be your legacy? Will you be remembered for your uncompromising compassion and honor for humanity or will your eulogy read like a padded resume?

Every decision creates action and every action has an impact -- upon us individually and upon the world around us. Sometimes we don't always get to see it and most often, we don't go looking. Ignorance is bliss as they say. 

Sometimes I wish I could be blissfully ignorant. But I digress...

So lemme share with you the catalyst for this post; a recent adventure in my special mommie life as can only be imagined by other special parents - a typical, atypical day if you will:

This past Thursday, I finally got around to taking my 6-year-old son to the pediatrician for his Kindergarden Heath Assessment and shots as it was the very last day before the school would have to kick him out (frankly, considering I've had over 20 doctor's appointment this year for my daughter, I naturally forgot the "typical" child).

When I was Liam's age, I was deathly afraid of needles. (Of course, I happened to have the nurse from hell back then who loved nothing more than a tender young caboose for target practice...) I spent quite a bit of time talking to my little guy about the reason we must have certain vaccinations, breathing techniques, how he had to be very brave, and it would only hurt for a moment.

When the time came for his two shots, my little man was so very brave he barely flinched and shed nary a tear! I was over-the-moon proud and tried my utmost to make the rest of the day be a celebration of his triumphant big-boy milestone... though it was short lived.

Not two hours later as we played in the back yard waiting for Daddy to come home so we could have a special dinner and tell him how awesome and brave our big boy had been, Miss Kim, Isabel's  wonderful Habilitative Tech (direct care worker), came running through the door in a worried fit of panic and announced that Bell had just eaten a wild mushroom at a nearby park. Oye.

Yes, it seems that our daughter, who has never been in the habit of eating random stuff off of the ground (though an unattended picnic is another matter), decided to help herself to a little snack... I certainly don't fault Miss Kim in the least; Isabel is quick like that, especially after she's heard her name combined with the word "No!" But now the party was over and Liam was left to entertain himself as we sat about trying to figure out what to do.

According to Dr. Larry Grand, mycology expert and Professor at the NCSU Department of Plant Pathology, 98% of all mushrooms are not poisonous; however digestion of the other 2% can produce results ranging from "a minor upset stomach to a rather painful protracted death, depending upon the species of mushroom eaten, the amount eaten, and the person who has eaten it." 

After spending some time perusing internet photos of mushrooms in an effort to try to identify what percentile Bella's snack fell into, we narrowed it down to the Bolete species (as evidenced by the presence of pores rather than gills on the underside of the mushroom cap) - of which there are many, many varieties, most of which being edible varieties, though, a few being deadly 'evil twins.'

I attempted to reach Dr. Larry Grand by phone as well as emailed to him photos of the remainder of Bell's snack, then heeding Dr. Grand's "Steps to follow if it is suspected a person has eaten an unidentified mushroom," I packed an overnight hospital bag for me and Isabel in anticipation of a long night ahead involving Ipecac cocktails.

Poor Liam. Once again, it was no longer about my "typical" child, rather his proud and special day was overshadowed, no - pushed to the back and buried, by yet another freak emergency resulting from his sister's unintentional antics. --That is not to say that I wasn't worried and frightened for my daughter as any parent would be in such a situation. Though when you have a child with the cognitive understanding of a perpetual toddler, emergencies, accidents, incidents, outbursts, etc. are an all too common occurrence - and yes, the whole family's life, schedule, and system of being, more often than not, revolves around the child whose excessive needs demand your constant attention and care. Everyone else sucks it up and moves to the back of the bus. (Heck, truth be told, parents aren't even on the damn bus. We're kinda running along behind it trying to keep up.)

My proud big brave boy, who had not shed a single tear during his shots earlier that day, was still crying when I left with his sissy for the hospital. 

We arrive at the children's ER, I give Bell's name to the lady behind the desk and begin explaining why we're there while Isabel grabs everything on her desk, starts signing "potty" emphatically (not because she actually has to go, but rather to steer my attention back to her), before she spies the hand sanitizer and sprints off across the lobby to douse her hands. We're told to have a seat and someone will call our name.

While simultaneously praying that my child had not poisoned herself, I was filling with dread (and guilt and heartache) imagining a sleepless night of shrieks, being hit and slapped by an angry sick child, and  fun with vomit. --A half hour or so had passed when my husband called to say he had just spoken to Dr. Grand (God bless him!) who, thankfully, was able to positively identify the mushroom remains from the photos as a non-poisonous variety. Isabel would be fine.

Thank you, thank you Dr. Grand!

As I said, a typical, atypical day in our life, the life of a family caring for and loving a child with profound developmental disabilities... There is no pause for us, no down time, we never get to clock out or recharge, plans are subject to change constantly and there is never a dull moment - and we just roll with it because it's what we do. Because we love our children unconditionally.

We've all heard the proverb, "It takes a village to raise a child." Well, it takes a society to care for special populations - our most vulnerable and pure of heart. We cannot do it alone and we cannot make do with less - we already are.

Now, back to legacies: I can only guess what colorful descriptors might comprise my eulogy one day... stubborn and strong-spirited, honest to a fault, opinionated, moody, mouthy, fearless and strong, aggressive and somewhat intimidating... while I've heard it all and then some at one point or another and perhaps there's some truth there; I take no issue either way. 

Though I hope somewhere in there someone will be able to say: She was loyal and genuine and compassionate; she always spoke her truth and always fought for what she knew to be right and just with a clear conscience... I hope they can say: She was a great mother and loved her two beautiful, amazing children; there was nothing more important to her than nurturing their little souls... and she never, ever gave up.

What's New in September

September 2012 news, events, and updates.

• Day Dreams from an Autistic Mind.
• Candidate Meet and Greet sponsored by DRNC & The Coalition, 9/25.
• Inquiring Minds Wanna Know: 10,000 Blog Views! and Counting...
• Thoughts from Anna Cunningham: Whack-a-Mole and CAP MR/DD to I/DD...
• Transition to Managed Care Free Advocacy Trainings - NC Innovations Waiver: Advocating for Appropriate Services Under the Managed Care System.
• Next Step Meeting: A Frank Conversation with Suzanne Goerger from Alliance Behavioral Healthcare regarding residential supports and options, 9/15.
• added to Google Calendar of Events
• NCGA Housing Subcommittee Meeting Notice for Blue Ribbon Commission 9/12.
• added to Google Calendar of Events
• NCGA JLOC on HHS Meeting Agenda for 9/10.
• Parent Correspondence with CMS re: CAP MR/DD transition to I/DD.
• What I've learned about "Home Modifications."
• Welcome blog guest contributor: fellow Special Mom, Anna Cunningham.

[ What's New Main ] 

Come to the Candidate Meet & Greet 9/25

Join us for a Candidate Meet & Greet co-sponsored by Disability Rights NC and The Coalition. The event will be held on Tuesday, September 25, 2012 from 5:30 – 7:30 pm at the Contemporary Art Museum, 409 W. Martin Street in Raleigh. The Meet & Greet will be held in conjunction with National Voter Registration Day and the Horowitz Your Land/My Land: Election ’12 art exhibition at the CAM.
Talk to candidates from across North Carolina and get engaged!

This is a free event but please let us know if you plan to attend. You can RSVP online at http://www.signupgenius.com/go/4090E4DAFAE22A20-candidate, call 919-856-2195, or email us at info@disabilityrightsnc.org.

Next Step Meeting: Frank Convo. with Suzanne Goerger

The Next Step…

An information group for persons interested in residential options for persons with intellectual and developmental disabilities, as well as how to create a fulfilling life once launched!

“Change is Coming!”

A Frank Conversation with Suzanne Goerger

I/DD Care Coordination Manager

Alliance Behavioral Healthcare

September 15, 2012

9:30 a.m. to 11:00 a.m.

Millbrook Exchange Community Center

1905 Spring Forest Road in Raleigh

Meetings are every 3rd Saturday of the month, from 9:30 a.m. to 11 a.m., at Millbrook Exchange Community Center, 1905 Spring Forest Road (between Falls of the Neuse Road and Atlantic Avenue) in Raleigh. Meetings are free, and light refreshments will be available. No reservation necessary.

Sign in at the door. For more info, contact Kathy Honeyman at kathyhoneyman@earthlink.net.

NCGA JLOC-HHS Meeting Agenda 9/10

SUBCOMMITTEE ON MENTAL HEALTH

JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON HEALTH AND HUMAN SERVICES

AGENDA

September 10, 2012, 1:00 P.M.,

Room 643, Legislative Office Building

Representative Justin Burr, Co-Chair

Senator Louis Pate, Co-Chair

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

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

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

• Major Legislative and Policy Changes 2001 – Present
  Research Staff

(Presentation will address major changes in the State’s delivery of mental health services, including information on Olmstead/ADA – description, impact on the state’s mental health system)

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

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

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

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

Committee Discussion/Comments 3:30-4:00

Adjourn

Parent Correspondence re CAP MRDD transition

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

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MaryKShort@aol.com <MaryKShort@aol.com>	Tue, Sep 4, 2012 at 7:37 PM
To: MaryKShort@aol.com
This is about the CAP-MR/DD to IDD transition ... not NC Innovations or MCO's!  It looks like the change to the IDD waiver (and the 40 hour rule) will happen on Sept. 28th for those of you still on the CAP waiver.  Remember:  You have a right to request a reasonable accommodation or an exception to the 40 hour policy under the ADA (American with Disabilities Act.)  You simply request the ADA exception with the reason WHY you need the exception.  You also have a right to request an ADA reasonable accommodation or an exception to the SNAP/SIS score guideline/limit on the amount of services that are "medically necessary for health and safety."  Katie SNAP's at a Level 3 and received Level 5 Home Supports, exception was granted for her medically necessary for health and safety level of services.  You can request an ADA accommodation to any rule, policy, procedure or whatever.  Only you know what it is that will truly meet the "medically necessary for health and safety" level of services.   For those of you who switched to the IDD services way back when (November?) and who have been working more than 40 hours BECAUSE the state was not enforcing the limit because the waiver was not CMS approved ... It is my guess that you will now be required to come into compliance or request the ADA accommodation.   Mary K. Short 828-632-5888 or 704-451-4144 (cell) From: Connie.Martin@cms.hhs.gov To: MaryKShort@aol.com Sent: 9/4/2012 10:43:26 A.M. Eastern Daylight Time Subj: RE: Waiver Update: CAP-MR/DD to IDD Good morning, Ms. Short, Ms. Johnson left DMA a couple of months ago to take another position in the community according to the outgoing voice mail on her old telephone number.  At the end of June, CMS granted the NC DMA another extension to run until September 27th, 2012, so there have been no gaps in coverage.   CMS has recommended approval of the waiver renewal and it is going through the sign off process now.  Thank you, Connie  From: MaryKShort@aol.com [mailto:MaryKShort@aol.com] Sent: Sunday, September 02, 2012 7:26 PM To: Martin, Connie L. (CMS/SC) Subject: Waiver Update: CAP-MR/DD to IDD Hello Connie.  I wrote to NC DMA (Susan Johnson, below) asking about the CAP-IDD waiver and have not heard back.  A number of families have asked me I knew for SURE that the CAP-MR/DD to CAP-IDD waiver had been approved by CMS or if there was an extension.  In fact, DMA's web site only officially lists the extension to the end of June!  That would imply there is no CAP-MR/DD or IDD waiver.  Please let me know where it stands.  Thank you. Mary K. Short 828-632-5888 or 704-451-4144 (cell) From: MaryKShort@aol.com To: susan.e.johnson@dhhs.nc.gov Sent: 8/30/2012 1:47:23 P.M. Eastern Daylight Time Subj: CAP-MR/DD to IDD Is the MR/DD going to IDD on October 1st or not?  I can't find anything in a Medicaid bulletin or Update ... I only see IU #92 that said until 6/29/12.  What's up? Mary K. Short 828-632-5888 or 704-451-4144 (cell)