What's new in April?

April 2012 events and updates.

• PBH Documents post added.
• added Google Calendar for Waiver Events in pages.
• Website launch of NC Mental Health reform by research journalist and UNC student, Lydia Wilson.
• Email from Dr. Pat Porter regarding how changes will affect the salaries and benefits (or lack of) for direct care workers.
• PBH's Press Release and response on federal District Court Judge Flanagan's March 29th ruling in L.S., et al. v. Delia, et al. [No. 5:11-CV-354FL].

[ What's New main ]

email to Representative Bill Current

Republican Representative William Current from Gastononia, NC, has served 4 terms in the NC House of Representatives representing District 109, Gaston County. Currently, he is a Co-Chairman on the Health and Human Services (Standing) Committee and Member on the Appropriations Subcommittee on Health and Human Services (Standing), Health and Human Services Subcommittee on Mental Health and the Joint Legislative Oversight Committee on Health and Human Services (Standing), (Non-Standing). He has not filed for re-election.
 
March 14, 2012
Sent via email:

To: Representative Bill Current with re-forwarded 02/25 email to Members of the NC House and attached letter and enclosures to Governor Perdue per request following the 03/13 Joint Legislative Oversight Committee Meeting on Health and Human Services:


Dear Representative / Dr. Current or Bill per your request,

First, please know that my southern upbringing makes it difficult to address you informally as Bill, though I find your insistence in being recognized as a sincere person of the people both admirable and refreshing. I hope you don't mind my saying, upon meeting you briefly yesterday you reminded me very much of my late grandfather (in his best ways), a WWII veteran and former Johnston County Magistrate, who was a strong, unbending personality of sincerity and character to say the least.

Once more, I wanted to thank you kindly for taking a moment to chat with me as a parent of a beautiful little girl with profound developmental disabilities who, along with her family and many families such as ours across the state, will be directly and critically affected by the new Medicaid Waiver plan under NC House Bill 916 (now SL 2011-264) if allowed to proceed as intended.

I realize the enormity of the issues at hand regarding the State's exhausted budget and I understand that there are no easy answers for the predicament we as a State have placed ourselves. It is truly frightening on many levels... Realistically, I understand that this train cannot be turned around this late in its travels; it has, after all, been moving in this direction for quite a few years. Though I sincerely believe the destination can be changed.

I am just a mother and advocate; I am only an expert in the life of my child and my role as her mother and protector, and as such am also at a loss for perfect solutions, however, I know very well what the answers are not, because I live it every day. Of all the citizens of North Carolina, special populations are the least responsible for the State's economic crisis; it is truly heart-wrenching that they, as the most innocent and fragile among us, will once again pay the price for the ill-intent and misdeeds of those who should have protected their needs and interests.

You mentioned when we spoke that you would only be around (in your legislative seat) through December and expressed confidence in the ability of 'the smart, younger fellows to sort it all out.' I can only imagine that the roles of Members in the NC General Assembly are demanding and no doubt tireless; I do not doubt the hard work and dedication of all the members of legislature. Though with all due respect, I wish I shared your confidence. You see, there is a world of difference between intelligence and wisdom. Just as one cannot possibly know the life nor hardships of another without walking a mile in those ragged shoes, it is the experience of life itself, full of change and challenge, personal growth, sacrifice, humility and gratitude from which wisdom derives.

As mentioned, please see attached my letter and enclosures to Governor Perdue outlining in more detail my concerns and sharing an intimate glimpse into our life and a not-so-dissimilar story to many families across the State of North Carolina. Please, please take a few moments to read the words; they represent the lives of many.

I welcome you to contact me at any time should you have questions or if I can be of any assistance. I would very much like the opportunity to meet with you again for further dialogue at any time that is convenient for you. I can make myself available any time you're in Raleigh and would even be willing to drive to Gaston County. I work with my husband, a local small business owner, so that occasionally affords me flexibility - to love my child the best way I know how.

Thank you in advance Bill for your attention and consideration.

I look forward to speaking with you soon.


Kind regards,

--

Crystal J. De la Cruz - Hopper

Mother, Disability Advocate, & Concerned NC Citizen

contact information...

email to Senator Tommy Tucker

March 13, 2012

Sent via email:

To: Senator Tommy Tucker with re-forwarded 02/25 email to Members of the NC Senate and attached letter and enclosures to Governor Perdue per request following the 03/13 Joint Legislative Oversight Committee Meeting on Health and Human Services:

Dear Senator Tucker,

I very much appreciate your taking the time today to speak with me briefly regarding my concerns as a parent of a beautiful little girl with profound developmental disabilities. I know how busy you must be and how full your plate as a member of the NC General Assembly, committee member and vice-chair on the various Health and Human Services related committees, so I value the time you spared for me to chat.

I realize the enormity of the issues at hand regarding the State's exhausted budget and I understand that there are no easy answers for the predicament we as a State have placed ourselves. It is truly frightening on many levels... Realistically, I understand that this train cannot be turned around this late in its travels; it has, after all, been moving in this direction for quite a few years. Though I sincerely believe the destination can be changed.

I am just a mother and advocate; I am only an expert in the life of my child and my role as her mother and protector, and as such am also at a loss for perfect solutions, however, I know very well what the answers are not, because I live it every day.

As mentioned, please see attached my letter and enclosures to Governor Perdue outlining in more detail my concerns and sharing an intimate glimpse into our life and a not-so-dissimilar story to many families across the State of North Carolina. Please, please take a few moments to read the words; they represent the lives of many.

Beyond my personal trials, I feel it's worth consideration that the impact of this new waiver's full implication upon our already strained economy is a topic that should be addressed... The reality of job loss for existing case managers as well as the many small provider agencies which will likely not be able to sustain themselves without the reimbursement rates for case management services. And of course, the effects of these changes upon the CAP workers we families depend upon for survival who already make next to nothing for the invaluable duties they perform, assuming we've found a good one... which I'm afraid goes back to personal trials.

I welcome you to contact me at any time should you have questions or if I can be of any assistance. I would very much like the opportunity to meet with you again for further dialogue at any time that is convenient for you. I can make myself available any time you're in Raleigh and would even be willing to drive to Union County. I work with my husband, a local small business owner, so that occasionally affords me flexibility - to love my child the best way I know how.

Thank you in advance Senator Tucker for your attention and consideration.

I look forward to speaking with you soon.

Kind regards,

--

Crystal J. De la Cruz - Hopper

Mother, Disability Advocate, & Concerned NC Citizen

contact information...

US Case Law

Federal Law Documents

United States statutes, case law, and documents relating to the US Social Security Act, Medicaid and the 1915(b)(c) federally funded Waiver programs, as well as Disability rights (in reverse chronological order), available for .pdf download.

Federal NC Lawsuits

• Order by Federal Justice Louise Flanagan issuing Preliminary Injunction re: Disability Rights NC: LS et al. v. Secretary Delia, in his official capacity as Secretary of the Department of Health and Human Services; Pamela Shipman, in her official capacity as Area Director of Piedmont Behavioral Health Care Area MHDDSAS Authority; and Piedmont Behavioral Healthcare area MHDDSAS Authority d/b/a PBH, [5:11-CV-00354-FL], issued March 29, 2012.
• Disability Rights NC: KC et al v. Secretary Cansler et al.; Plaintiffs' Memorandum in Support of Motion for Leave to File Supplemental Declaration in Support of Motions for Preliminary Injunction and Class Certification, [5:11-CV-00354-FL], filed March 2, 2012.
• Disability Rights NC Class Action Complaint: KC et al v. Secretary Cansler, in his official capacity as Secretary of the NC Department of Health and Human Services, Pamela Shipman, in her official capacity as Area Director of Piedmont Behavioral Health Care Area MHDDSA Authority, and Piedmont Behavioral Healthcare Area MHDDSA Authority d/b/a PBH, [5:11-CV-00354-FL], filed July 1, 2011.
• Disability Rights NC Class Action Complaint: Pashby et al. v. Secretary Cansler, in his official capacity as Secretary of the NC Department of Health and Human Services [5:11-CV-00273-BO], Filed May 31, 2011.
• Disability Rights NC Press Release: Class Action Challenges Cuts to Personal Care Services Provided to 4,000 Individuals with Disabilities. May 31, 2011.

Report from the US Justice Department re: NC

• United States' Investigation of the North Carolina Mental Health System Pursuant to the American's with Disabilities Act, US Justice Department (Civil Rights Division), report from US Assistant Attorney General, Thomas E. Perez, to NC Attorney General Roy Cooper, finding the State of NC in violation of Title II of the ADA and putting the State on notice for failure to comply and of the minimum steps required for the State to meet its obligations under the law; July 28, 2011.

Americans with Disabilities Act (ADA)

Social Security Act and the 1915(b)(c) Waiver

• Title 42. The Public Health and Welfare, Chapter 7. Social Security Act, Title XIX. Grants to States for Medical Assistance Programs [USCS § 1396n], Current thru PL 112-90; approved January 3, 2012.

• Title 42. The Public Health and Welfare. Chapter 144. Developmental Disabilities Assistance Bill of Rights; Programs for Individuals with Developmental Disabilities; General Provisions [42 USCS § 15002], Current through PL 112-90, approved January 3, 2012.

Federal Registers

• Federal Register, Vol. 76, No. 73 Proposed Rules re: DHHS and CMS / 1915(b)(c); April 15, 2011. 

Federal Lawsuits

Olmstead

• US Supreme Court (No. 98-536) Tommy Olmstead, Commissioner, Georgia Department of Human Resources, et al., Petitioners v. L. C., By Jonathan Zimring, Guardian Dd Litem and Next Friend, et al. June 22, 1999, decided.
• Olmstead: Syllabus. June 22, 1999.
• Olmstead: Opinion of the Court. June 22, 1999.
• Olmstead: Concurrence of Justice Kennedy. June 22, 1999.
• Olmstead: Concurrence of Justice Stevens. June 22, 1999.
• Olmstead: Justices Thomas and Scalia, Dissenting. June 22, 1999.
  

... more to come ...

letter from DHHS Director Steve Jordan

March 8, 2012
Response via USPS:

From NC DHHS MHDDSAS Director Steve Jordan on behalf of Governor Beverly Perdue regarding my letter to the Governor dated 02/23.

*To date, I understand that Governor Perdue has not personally read my letter.

enclosure email to CMS

February 24, 2012

Sent via email:

To: Centers for Medicare and Medicaid Services

Cindy Mann, JD, Deputy Administrator / Director of State Operations [Cynthia.Mann@cms.hhs.gov] 

Ms. Connie Martin, Waiver Analyst for NC [connie.martin@cms.hhs.gov]

Subject: Letter to NC Governor Perdue re NC HB 916 / 1915(b)(c) NC Medicaid Waivers

Dear Ms. Martin and Ms. Mann,

Per my recent conversation with Ms. Martin, please find attached my letter and enclosures to North Carolina Governor Beverly Eaves Perdue regarding North Carolina House Bill 916 in relation to the 1915(b)(c) Medicaid Waiver programs and its detrimental impact to the supports and services of the Developmentally Disabled recipients and their families across the State of North Carolina. Including my daughter, Isabel.

This letter will go out in tomorrow's postal mail to Governor Perdue and subsequently to the members of the NC House of Representatives, Senate, and others copied in days following.

I respectfully request to be kept abreast of any developments, actions, investigations, and the like, relating to North Carolina's restructuring of the 1915(b)(c) Waivers under HB 916

Please do not hesitate to contact me at any time with questions and for further dialogue.

Thank you in advance for your time and attention on this very important matter.

Kind regards,

--

Crystal J. De la Cruz - Hopper

Mother, Disability Advocate, & Concerned NC Citizen

contact information...

email to NC Senate

February 24, 2012
Sent via email:


To: Members of the North Carolina Senate

Subject: Letter to NC Governor Perdue re NC HB 916 / 1915(b)(c) NC Medicaid Waivers

Dear Member of the North Carolina Senate,

While I may not be among your direct voting constituents, I am writing to you as concerned North Carolina citizen, disability advocate, and mother of a beautiful, innocent daughter with profound special needs who, along with her family members, will be directly and critically affected by the implementation of the new 1915(b)(c) Medicaid Waiver plan under NC House Bill 916 (now SL 2011-264) if allowed to proceed as intended.

Please find attached, my letter and enclosures to Governor Beverly Eaves Perdue sharing our story and explaining, in more detail, the concerns shared by many families across our state regarding NC HB 916.

I greatly appreciate you taking the time to read my words as I can think of no more important topic on the State's Health and Human Services agenda. I invite you to please contact me at any time should you have any questions, desire further dialogue, and to meet with me personally.

I respectfully request a written response relaying your position and intentions regarding North Carolina House Bill 916. I would like to be kept abreast of of any developments, actions, investigations, decisions, changes, and the like, relating to North Carolina's restructuring of the 1915(b)(c) Waivers under HB 916, services and supports, and the implementation of those services and supports.

It is my most sincere hope that you will carefully examine and consider this matter, make an effort to communicate with those who will be directly affected, to include not only families but small business service providers and case managers in the field, and most importantly, know and understand the desperate needs of those whose very quality of life lies now in your hands.

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

I look forward to your reply.


Sincere regards,
--
Crystal J. De la Cruz - Hopper
Mother, Disability Advocate, & Concerned NC Citizen
contact information...

CAP-MR/DD (now IDD)

CAP Services Documents

NC Department of Health and Human Services and Division of Medical Assistance documents relating to CAP I/DD (formerly MR/DD) services and supports (in reverse chronological order), available for download in .pdf format.

 

Planned Changes under 916

• Updated Service Definitions issued by PBH, February 2012.
• New Comparison Grid of Services under NC Innovations verses CAP MRDD & IDD Waiver, January 27, 2012.
• Comparison Grid of Services under NC Innovations verses CAP-MRDD, December 2011.
• NC DMA Durable Medical Equipment proposed Changes, November 1, 2011.
• NC 1915(b)(c) Medicaid Waiver Initial DHHS Strategic Implementation Plan (July 1, 2011 - June 30, 2013), October 19, 2011.
• NC DHHS DMA Fact Sheet regarding LME / LMO Waiver Appeals Process. July 2010. 
• NC DHHS Division of Mental Health / Developmental Disabilities / Substance Abuse Services; Top 12 Individual / Family Questions about the NC Innovations (1915b/c) Waiver presentation from the NC Council on Developmental Disabilities with PBH, DMA, DMHDDSAS representatives. May 20, 2010. 
• NC DHHS DMA Fact Sheet entitled Responsible Change to Acheive Easy Access, Better Quality Personal Outcomes. April 2010.
• NC DHHS DMA Fact Sheet regarding The 1915(b)(c) Waiver Expansion for People with Intellectual and Other Developmental Disabilities. April 2010.
• NC DHHS Joint Oversight Committee on Mental Health / Developmental Disabilities / Substance Abuse Services; Comparison of Current CAP-MR/DD Waivers, PBH Innovations Waiver, and New NC Innovations Waiver (1915b/c) presentation by Director, Leza Wainwright. April 14, 2010.

  
Medicaid Waiver Documents and Reports Since 06/23/02011 916 Enactment

• NC DHHS 1915(b)(c) Waiver Status Report to the Joint Legislative Oversight Committee. January 9, 2012. 
• NC DHHS Trustfund for DMHDDSA and Bridge Funding Needs Report. October 2011.
• Commission for Mental Health, Developmental Disabilities and Substance Abuse Services, Commission Meeting Minutes. August 25, 2011.

NC ADA Violations Findings Report from the US DOJ

• United States' Investigation of the North Carolina Mental Health System Pursuant to the American's with Disabilities Act, US Justice Department (Civil Rights Division), report from US Assistant Attorney General, Thomas E. Perez, to NC Attorney General Roy Cooper, finding the State of NC in violation of Title II of the ADA and putting the State on notice for failure to comply and of the minimum steps required for the State to meet its obligations under the law. July 28, 2011.
• Complaint from Disability Rights NC to the US Department of Justice regarding ADA and Olmstead Violations. October 2010.

Prior to 06/23/2011 Enactment of HB 916

• NC DHHS / DMA Special Medicaid Bulletin: New Due Process and Prior Approval Procedures for Providers. May 1, 2011.
• NC DHSS Division of MH/DD/SAS Strategic Plan Process for 2010-2013, A Report to the NC General Assembly. July 1, 2010.
• NC CAP MR/DD Waivers: Summary of Planned Tiers (3 waivers), three targeted waivers - Supports, Comprehensive, Community Intensive. February 7, 2010.
• NC DHHS Olmstead Report to the: Joint Legislative Commission of Government Operations, Senate Appropriations Committee on HHS, House of Representatives Subcommittee on HHS, Fiscal Research Division, and Joint Legislative Oversight Committee on MR/DD/SAS. December 1, 2007.

CAP Manuals

• NC DHHS DMA CAP-MRDD Supports Manual Revisions Overview of the two versions of the 2010 versions of the 2008 CAP Manuals below. July 22, 2010.
• side-by-side Adobe Acrobat document comparison of the two manual versions: Comprehensive v. Supports (210 pages differ, 26 pages deleted).
• 2008 NC DHHS DMA CAP-MRDD Supports Waiver Manual. July 21, 2010.
• 2008 NC DHHS DMA CAP-MRDD Comprehensive Waiver Manual. July 21, 2010.
• 2008 NC DHHS DMA CAP Manual for I/DD Services, DRAFT (with mark-ups). May 12, 2010.
• 2005 NC DHHS CAP-MRDD Manual. 2005.
• 2003 NC DHHS MHDDSA Service Definitions Manual. January 15, 2003.

... more to come ...