NCGA DHHS-JLOC Meeting, 12/11

NORTH CAROLINA GENERAL ASSEMBLY Raleigh, North Carolina 27601

November 30, 2012

MEMORANDUM

TO: Members, Joint Legislative Oversight Committee- Health and Human Services FROM: Senator Louis Pate Representative Nelson Dollar, Co-Chair Representative Justin Burr, Co-Chair SUBJECT: Meeting Notice DAY DATE TIME ROOM Tuesday December 11, 2012 10:00 am 3:00   pm 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_

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_

NCGA JLOC-HHS Meeting Notice 9/11

NORTH CAROLINA GENERAL ASSEMBLY

Raleigh, North Carolina 27601

August 27, 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: September 11, 2012
TIME: 10:00 am - 3:00 pm
ROOM: 643

NOTE: For scheduling purposes future meetings dates are as follows:

October 9, 2012
November 13, 2012
December 11, 2012
January 8, 2013

If you are unable to attend or have any questions concerning this meeting, please contact Rennie Hobby at 733-5639 or mentalhealthca@ncleg.net.

cc: Committee Record _X_
Interested Parties _X_

NCGA JLOC on HHS Committee Meeting 8/14

NORTH CAROLINA GENERAL ASSEMBLY

Raleigh, North Carolina 27601

July 31, 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:  August 14, 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 Rennie Hobby at 733-5639.

cc:   Committee Record _X_
       Interested Parties _X_

Arc NC's Legislative Summary

From The Arc of North Carolina
Legislative Summary regarding Developmentally Disabled Populations of North Carolina

[ original post ]


In this year’s legislative session, the General Assembly adjusted the budget, created policy direction in the budget, and passed important policy bills. The Arc worked on and monitored many issues of importance to people with intellectual and developmental disabilities as well as their families during the session. Below we have provided a brief recap of some of the most important issues.

Kindergarten Developmental Screening

Kindergarten Developmental Screening is part of the new budget bill (H950, which was passed by the General Assembly, vetoed by Governor Perdue, whose veto was then overridden, making the bill law). Section 115C-83.1 E orders the State Board of Education to ensure that every student entering kindergarten shall be administered a developmental screening of early language, literacy, and math skills within 30 days of enrollment. Section (e) states that the assessment shall be reliable, valid and appropriate for use with all children, including those with disabilities.

NC Teaching Corps to Include Disability Training

The new budget bill (H950, which was passed by the General Assembly, vetoed by Governor Perdue, whose veto was then overridden, making the bill law) establishes the North Carolina Teaching Corps, a training program for those who wish to become teachers via lateral entry (in other words, for those whose degree is not in teaching). The program is to include training on identification and education of students with disabilities, positive management of student behavior, effective communication for defusing and de-escalating disruptive and dangerous behavior, and safe and appropriate use of seclusion and restraint.

Personal Care Services and Short Term Rental Assistance to Adult Care and Group Homes

Personal Care Service (PCS) is a Medicaid funded service aimed at assisting individuals with disabilities with activities of daily living. Currently people who have Medicaid and live in a licensed residential setting receive one hour a day of this service.

The General Assembly choose not to follow the DHHS recommendation to create a 1915i option to address federal Medicaid officials’ concerns around Personal Care Services. The 1915i option is a relatively new Medicaid option for states to use. It allows for states to put in place Medicaid home and community based services without a Medicaid waiver. The Arc believes this option would best used to expand community based services for people with IDD.

Instead of following DHHS recommendations, the General Assembly passed language that will require DHHS to create a new Medicaid state plan amendment creating a comparable PC service for individuals living at home and in facilities. This impacts people living in Group Homes and Adult Care homes. The Arc has concerns that the new plan will eliminate PCS for some people (we are attempting to determine the scope), which could cause significant service reductions.

As part of H950, the Modify 2011 Appropriations Act, the State provided $39.7 million of non-recurring funding to provide temporary rental assistance to adult care homes. These funds will help pay rent at adult care homes for residents who are no longer eligible to receive Medicaid reimbursable personal care services (PCS), but for whom a community placement has not yet been arranged. Unfortunately, this fund will not assist residents who live in group homes and lose PCS. One of The Arc's top priorities for the interim will be to work with DHHS and the legislature to assure people living in group homes are not adversely affected.

Community Service Funding Cut

There was a $20 million non-recurring cut to community services funding. Approximately $345 million in State general funds remain in the budget for LME/MCOs to purchase community based services.

The Arc is disappointed in this cut. The original Senate budget had no cut in this area, and the original House budget had only a $10 million dollar cut. The change was made only two days before the final budget bill passed, giving little time for input from The Arc, other advocacy organizations, and families. We hope the General Assembly will restore this much needed funding during next year’s budget session.

Money for Transition to Community Living

As part of H950, the Modify 2011 Appropriations Act, the State allocated $10.3 million in recurring funding to speed up the transition of individuals with severe mental illness to community living arrangements, including establishing a rental assistance program. Some of the impacted individuals are dually diagnosed with a developmental disability as well. We believe this funding was allocated to respond to a potential negotiated settlement with the US Department of Justice (US DOJ) over North Carolina's use of Adult Care Homes as placements for people with Mental Illness, which it says violates Medicaid law.

Medicaid Shortfall Bills

There was a great deal of press surrounding the multi-million dollar Medicaid budget shortfall for the 2011-2012 fiscal year. The shortfall, initially estimated at $205,500,000, was addressed by S797 (Payment of 2012 Medicaid Costs/Inmate Medical Costs) early in the session. S797 drew funds from receipts, unanticipated federal bonus money, and Repair & Renovation Reserve Funds for the University of North Carolina System.

Unfortunately, in the last few weeks of the legislative session, it became obvious that there was an additional gap in Medicaid funding of approximately $94 million. To address this gap, the General Assembly passed H14, the Use R&R Funds for 2011-2012 Medicaid Costs Act. This bill appropriated $94 million from the Repairs and Renovations Reserve Account from the UNC System be transferred to the state controller. The controller was to manage Medicaid funding for the remainder of the 2011-2012 fiscal year.

LME/MCO Governance Bill(s)

HB1075 came out of the House subcommittee that studied the LME/MCO Governance issue led by Representative Nelson Dollar. It dealt with rules governing the makeup of LME/MCO Boards of Directors. The bill as proposed by the sub-committee, while not perfect, was a compromise reached with input from most stakeholders in the MHDDSA system. After the bill passed the House, Sen. Fletcher Hartsell added a controversial amendment to the bill would have allowed LME/MCOs that had been operational for three years to become “Behavioral Health Authorities.” This new classification significantly changed the method of accountability and operation of the MCO system. Most advocates, including The Arc, opposed these changes due to serious concerns on how the LME/MCOs’ new authority would impact people with disabilities and their families.

Ultimately, some legislative maneuvering resulted in a new bill (S191, LME Governance) that included the original Board member rules, excluded the Behavioral Health Authority amendment, and allowed for MCO's with over 1,200,000 people to create new board structures, if approved by the Secretary of DHHS.

Parents as Providers

As many of you know, there were quite a few changes made to rules surrounding parents as providers. These changes were by and large not changes in laws, but in administrative rules. The Arc is very concerned with these changes and will delve into the problems around this and related issues in the near future.

The following bills did not become law this past session

The Arc's Proposed Changes to H916
Though our proposal did not receive formal consideration, we were pleased with the broad based legislative support it received. We believe that the majority of legislators now understand why it is important to have an independent person working with families and individuals to write their Person-Centered plan. In a future addition of Policy Partners, we will discuss in more detail why this proposal continues to be a critical component if managed care is to be successful. For now, we want to thank you for your incredible advocacy efforts you undertook towards making these changes. Your voice was heard!

Eugenics Compensation Bill (Did Not Pass)

This bill would have set up a fund to reimburse victims of forced sterilization at the hands of the State. A large percentage of NC’s sterilization victims were individuals with intellectual or developmental disabilities. The bill passed the House, but was not taken up in the Senate.

On a somewhat brighter note, a last minute compromise between the House and Senate provided funding for the Eugenics board to continue its work during the 2012-2013 fiscal year.

Incapacity to Proceed (Did Not Pass)

If a person with I/DD is arrested, they (like everyone else) go to jail while they await a bail hearing/trial. Often, people with I/DD are found to lack the capacity to proceed to trial, and are sent to an institution for treatment. Often, they eventually reach a point where they are deemed capable to proceed with their trial, at which time they are sent back to jail, and their trial is put back on the schedule. Once back in jail, the person with I/DD often regresses, is once again deemed incapable to proceed, and is sent back to an institution for treatment as the cycle continues. There are documented cases of individuals with I/DD arrested for a crime spending far longer (years even) bouncing back and forth between treatment institutions and jail before trial than they would spend in jail if they were tried and convicted.

H1048 would of made outlined clear steps to avoid this type of situation for both misdemeanors and felonies. This bill passed by an overwhelming margin in the House (114-0), but was not taken up in the Senate. Representative Pat Hurley has said she will file this bill again in 2013.

We are disappointed that the Senate chose not to put such an important and widely supported bill on this year’s agenda, and hope they choose to take it up in 2013.

Voter ID Bill (Veto was not overridden)

Originally, The Arc worked extensively with Representative David Lewis during the 2011 long session on what became known as the Voter ID Bill (H351, Restore Confidence in Government). We tried to address the many concerns that existed in the disability community around the topic of voter ID. While we came up with compromise language that would of addressed most of our concerns, unfortunately the compromise language was ultimately stripped from the version of the bill. This stripped down version of the bill passed the General Assembly and was vetoed by Governor Perdue in 2011.

While an override attempt of this bill was on the calendar throughout the short session, it never happened. The bill is dead for this year, but a new version of the bill is expected in 2013. We again will work diligently with the bill sponsors to ensure that the concerns of people with disabilities will be addressed.

N&O: LME Money Woes

Money woes snag mental-health center

Published Wed, Jul 18, 2012 09:38 PM
By Lynn Bonner - lbonner@newsobserver.com
The News and Observer

[ original article ]

The state’s latest plan for community mental health services has gotten off to a bad start with the first local mental health office to become a managed-care agency falling into a $3 million financial hole in its first six months of operation.

Western Highlands Network, which covers eight counties including Buncombe and Rutherford, is working with the state Department of Health and Human Services on a plan to correct the money problems that started the first day it became a managed-care agency in January.

The changes may involve reducing some mental health treatments the office believes are excessive, telling service providers to return money for services that were not approved, and enforcing rules for providers filing payment claims.

The experiences in the west are significant because, under a new state law, all government-paid mental health services in the state will be handled the way they are in Western Highlands. Advocates for people with disabilities are skeptical that the new system will work, and they worry consumers will be the losers.

Last year, the legislature passed a law that requires all local mental health offices to convert to managed-care agencies by January 2013, copying a system started in the state in 2005 by Piedmont Behavioral Health, a local mental health office now called PBH.

As managed-care agencies, the local mental health offices’ relationships with the state, mentally ill people in their coverage areas, and providers will change significantly. Each local office will be given a set amount of Medicaid and state money to treat patients. If they spend too much, they have to cover the costs. Local offices that save money can spend it on more Medicaid mental-health services.

Though the local offices take on financial risks, they also have more control. Under managed care, they will say which providers will treat patients in the region and what kinds of treatment – and how much government-paid mental-health treatment patients receive.

Choice and uniformity

This is the biggest change to mental-health services in the state in more than a decade. In 2001, the state told local offices to stop offering treatment in favor of having patients seek out private providers. The intent was to give patients more choice and foster uniformity across the state.

That 2001 reform was an expensive failure. Patients were left waiting for beds in state psychiatric hospitals while the state spent millions on low-level services for people who didn’t need treatment. A legislative report from 2009 said the state spent up to $635.3 million too much for community mental-health services between April 2006 and February 2009.

Legislators talked for years about giving more local offices more power and passed a law last year requiring it. Western Highlands was the first regional office to convert. Two more offices have followed. All 11 local offices will be managed-care agencies by January 2013. The office covering Durham and Wake counties will be in the last group converting.

The local offices do extensive prep work before they convert and a consulting firm assesses their readiness to switch.

Outdated figures


Western Highlands has been losing money all year. One of the problems, said CEO Arthur D. Carder, is that the lump-sum payment the office received to care for patients was based on outdated information from 2009 that did not take into account increased costs in 2010 and 2011.

Al Delia, the state Department of Health and Human Services acting secretary, said the office has been closely monitoring Western Highlands and is talking about taking another look at whether the $9.7 million a month the office receives to pay for patient treatment is enough.

Delia was in the western counties Wednesday, meeting with members of the office’s governing board.
“There’s going to be some adjustment in culture and attitudes and mindset in leadership of all these organizations in making these transitions,” Delia said.

Skeptics question whether managed care is the best system for all consumers.

“I think we’ve rushed to judgment on this,” said Dave Richard, executive director of The Arc of North Carolina. Parents of children with developmental disabilities and the agencies that provide services to the disabled have been among the most vocal skeptics of managed care, questioning conversion to a system they say isn’t designed to meet their needs.

“If you’re going to give up the system where people had a lot of choice to one where choice is limited and is controlled by one entity, you’d hope to see better outcomes,” Richard said. “We haven’t seen that with folks with developmental disabilities.”

Lawsuit under way

State officials and legislators have looked to PBH as an example for years, but not everyone is a fan.
Disability Rights North Carolina, an advocacy group, is suing PBH in federal court over allegations that it did not give residents proper notice of changes in their services or let them know how they could appeal.

Western Highland’s problems show that the office wasn’t ready to become a managed-care agency, said Vicki Smith, Disability Rights’ executive director.

“It would almost be too simple to say this was predictable,” she said.

Legislators are convinced that managed care is the path to follow for mental-health care. The legislature is committed to a new system where government does more than just pay the bills, said Rep. Nelson Dollar, a Cary Republican.

“We want to manage the care and the individuals receiving the care, and manage the costs and how we’re allocating scarce taxpayer resources,” he said.

Legislators have been working with DHHS since winter on Western Highland’s financial problems, Dollar said. A new law that adds members with experience in managed-care finances, insurance and health care administration to local governing boards is meant to strengthen oversight of Western Highlands and other managed-care operations.

“We’re going to be working with the department to straighten out issues like the ones that are being encountered in Western Highlands and making sure what lessons are learned there are being incorporated in the conversions in other areas of the state,” he said.

WSJ article: HB1075 & MCO/LME quest for power

Note: highlights, links and italicized quotes are entirely my own mark-up and not reflective of the author nor original posting, link below. Further, while, I usually avoid reading reader comments, I simply had to include the two articulate viewpoints posted at the time of this blog, following the article.

Changes to bill would give more power to groups overseeing mental health services
Published: June 18, 2012
By Richard Craver

[ Original Winston Salem Journal article posted here. ]

A late change to a bill giving more power to groups that oversee behavioral-health services in the state is raising concerns among advocates because the new language allows oversight groups to gain even more authority than the initial bill did.

The changes to the bill would create a new category of oversight group — a behavioral health authority. A BHA could borrow money and buy or sell property, would have no limits on executive salaries and would not be required to have any advocacy group members on its board.

The new language was inserted into N.C. House Bill 1075 on June 11 — five days after the bill had passed the House.

The substitute bill has been put on the Senate's agenda for Tuesday. If approved, the bill would return to the House for review and potential passage.

The changes would allow a local management entity (LME), such as CenterPoint Human Services, to become a behaviorial health authority after three years of serving as a managed-care organization (MCO) under the Medicaid waiver program being rolled out in the state.

The waiver program is intended to combine the management of Medicaid and state funds at the community level to reduce costs and add more accountability. MCOs would operate with fewer restrictions on how they manage the mental-health, developmental-disability and substance-abuse providers and services they oversee.

Becoming a behavioral health authority would take the oversight groups' level of independence to a higher level since public authorities can borrow money and buy or sell property. Authorities have limited or no local government oversight on their overall operations. They are allowed to file lawsuits and have a legal staff.

The initial bill already shifted much of the oversight of an MCO from county commissioners to the N.C. Department of Health and Human Services. The DHHS secretary would be required to approve a group's change to a behavioral health authority.

Local and statewide advocates expressed exasperation when informed of the new language. They worry that past mistakes in state mental-health reform will be repeated, hurting patient care and costing the state tens of millions of dollars in wasted spending.

David Cornwell, executive director of N.C. Mental Hope, said the proposals before the latest change already gave MCOs the best of being a private and a public entity.

"I don't see how it's conscionable for largely clueless legislators to consider such far-reaching changes to an already shattered system at a time the state faces multiple lawsuits over its (behavioral-health) services," Cornwell said.

Controversies over care

The bill is the latest development in the controversial recommendations submitted in September by Piedmont Behavioral Healthcare and the N.C. Council of Community Programs.

The bill's primary sponsors are state Reps. Nelson Dollar, R-Wake, and Justin Burr, R-Montgomery. The bill has bipartisan co-sponsor support.

Senate sponsors of the new language are not identified. Dollar and Burr could not be reached for comment about whether they approve of the new language.

Piedmont Behavioral Healthcare is the only local management entity operating as an MCO, but 11 MCOs, including CenterPoint, are supposed to be operating statewide by Jan. 1.

The council, led by CenterPoint executive director Betty Taylor, wants to eliminate limits on top executive salaries because MCOs compete with private-sector insurance companies for staff with specific expertise. Salary proposals would not require the approval of the DHHS secretary.

The bill removes the requirement that county commissioners approve the hiring of an MCO director, giving that responsibility to the MCO board. Advocates say many LME boards already operate as rubber stamps for their executive directors.

The benefit for county governments, particularly those with tight budgets, is that the changes could limit their liability for MCO overspending and put it on DHHS.

The new language represents substantial additions to those recommended by a 24-member General Assembly subcommittee before the legislative session began in May.

For example, advocates and analysts said they are concerned that although membership on a BHA board is expected to reflect expertise on local needs and priorities, including at least one family member or individual from an advocacy group is suggested only "when possible."

"There appear to be no absolute compositional requirements for the board of a behavioral health authority," said Mark Botts, an expert on mental health records and confidentiality at UNC Chapel Hill School of Government, in an email to advocates.

The initial bill required MCO board seats for a county commissioner, individuals or family members of those with behavioral-health issues, a member of the general public and professionals with expertise in health care.

Botts' email said a behavioral health authority would have even fewer requirements for board composition than in the current statutes or the previous version of the bill.

Laurie Coker, a local advocate who served on the General Assembly subcommittee, said a major concern is whether MCOs will be more responsive to customer demands.

"There have been troubling additions to the original bill on MCO governance," said Coker, who also serves director of the N.C. Consumer Advocacy, Networking and Support Organization.

"We could move toward much more privatized system management, in that public input and responsibility through counties could be cut out altogether from local management. Yet we supposedly are to have a public managed-care system, and not a private one."

Coker said the initial bill reflected agreements derived from "a level of critical discussion rarely had in committee meetings that involve such a variety of perspectives.

"North Carolina doesn't need further complication and confusion added to our already substantial system change. We need the inclusion of consumers, family members and county officials to ensure best outcomes locally."

Worries about unknowns

Al Delia, acting DHHS secretary, acknowledges that patients and caregivers are worried about the unknown. He said LMEs must clear several hurdles with state regulators before managed care is instituted, and mistakes are being fixed.

"DHHS believes this amendment represents a substantive change and that it deserves more thorough discussion," said Julie Henry, DHHS' acting director of public affairs.

"We are concerned about the limits the measure places on DHHS' authority and oversight. The amendment would exempt BHAs from provisions of the state mental health statute."

In an exchange reported by the Associated Press, Sen. Jim Davis, R-Macon, said "this whole thing scares me to death" during a discussion of the House bill before it was referred to the committee on mental health and youth services. The discussion, which lasted several hours, appears to have taken place before new language was inserted.

If lawmakers struggle with this bill, Davis asked, "How are we going to take care of the folks that this governance is supposed to be protecting?"

Dollar told Davis turning back now is a mistake.

Otherwise, Dollar added, "You're almost going to doom this iteration of reform to failure, and I would just submit that we cannot afford to do that for the citizens of this state."

Several legislators serving the Triad said the complex nature of creating a BHA will require more time to understand than the current short legislative session will allow.

Dave Plyler, a Forsyth County commissioner who has paid close attention to local behavioral-health issues, said, "Legislators appear badly divided with no sense of what needs to be accomplished. One size does not fit all."

The changes to the bill come as CenterPoint is requesting $1.53 million from Forsyth County to help with its estimated $3.7 million cost of transitioning to a Medicaid waiver program.

CenterPoint receives taxpayer funding as a local management entity in Davie, Forsyth, Rockingham and Stokes counties.

Without the allocation — to be paid back over five years — the agency warned it would cut its discretionary funding for services in Forsyth by about 42 percent. The agency also wants one-time funding of $228,579 from Rockingham, $148,127 from Stokes and $89,270 from Davie.

CenterPoint's first MCO application was rejected in July, primarily because a health-care consultant, Mercer, questioned the agency's financial liquidity, information technology and clinical operations. Mercer recommended CenterPoint pursue extra funding from the counties it serves and alternative sources. CenterPoint's second application was approved in October.

Advocates worried about the threatened service cuts at a time when more people with behavioral-health issues lack insurance.

Although the counties provide about $5.3 million annually, they do not, by state statute, have a say in how the money is spent.

"In an already underfunded system, a further reduction compounds the unmet needs," Taylor said in a statement.

However, at a May board meeting, Forsyth commissioners had too many questions about CenterPoint finances and legislative changes to decide on the funding request. Forsyth County Manager Dudley Watts said the board is working on finding a time for a briefing session on the issue in June.

Reader Comments

Marsha Hammond · University of North Texas
HOW IS IT THAT FEDERAL AND STATE MONIES ARE BEING USED TO CREATE EVER MORE PRIVATIZED PUBLIC ENTERPRISES SUCH AS THE LME-MCO'S, THE OLD COMMUNITY MENTAL HEALTH CENTERS?
What an important piece of news coverage and its coming right at the time when most providers are being denied or have refused to be recredentialed by the LME-MCO's, the old community health centers, as the Medicaid Waiver moves across the state in order that they continue to see Medicaid patients who have serious mental illnesses. For the population at large, this means people who could be dangerous or at least suicidal, roaming the streets due to no mental health treatment.

Can you say: Virginia Tech? Can you say: going postal? This is a public health dilemma, make no mistake about it. This is not an exaggeration. Yet, there will be no one clearly to sue when that happens and the real culprits will be the LME-MCO's who have further mismanaged Medicaid-----FEDERAL AND STATE ------monies.

For God's sake, Smoky Mountain Center (SMC) LME-MCO has a lobbyist. Where do they hide that in their accounting data? How is it that an entity funded by tax dollars has a lobbyist to protect its own interest? Here he is and he is registered with the state: Name: Joseph H. Lanier Address: PO Box 30519 Raleigh, NC 27622-0519 Phone: (919) 329-3871 http://www.secretary.state.nc.us/lobbyists/Lobbyist.aspx?PId=9039109.

And all this is taking place w/ the state legislature looking on, scratching their heads, being fed a wagonload of 'if you don't' stories by Piedmont Behavioral Health's LME-MCO (pbh) CEO Betty Taylor who wants a big fat raise for herself---an undisputable raise. And that LME-MCO is the one that started all this Medicaid Waiver stuff 5 years ago. And now it has spread like the bubonic plague across the state with officials at DHHS looking on the matter as a way to further distance themselves from the mess they created when the NC State Legislature passed a NC Mental Health Reform law in 2000.

So, how does all of this relate to the Medicaid Waiver, which has been hoisted onto the LME-MCO's, the old community mental health centers, and is now moving step-wise across the state. Bear in mind that the purpose of the Medicaid Waiver, which was FEDERALLY allowed (we are talking about FEDERAL TAX DOLLARS HERE----not private insurance all the while the proposal is about a hostile take-over of FEDERALLY MANAGED ENTITIES) is to allow the LME-MCO''s to more efficiently manage their capped Medicaid $$.

Anything BUT efficiency iis what has taken place over the past year. Please refer to my multiple interactions with Smoky Mountain Center LME-MCO and Western Highlands Network LME-MCO over the past six months at my blog, http://madame-defarge.blogspot.com/, the purpose of which is to document the profound difficulties of working with these organizations. They have little accountability, are poorly organized.

The independent Mercer Reports have re-emphasized this time again and they are not even looking at any comments or feedback from providers or impacted citizens with mental health challenges. The Mercer Report is simply going into the LME-MCO and saying, 'show us what you've got.' What kind of report is that? Do they not understand that the LME-MCO will be putting its very best foot forward under such perusal?

Providers, you know, the ones who actually do the work of helping people who are suicidal and homicidal, have absolutely no representation anywhere at any table regarding even basic matters like the re-credentialinng process of providers who are already credentialed and licensed and have been seeing Medicaid clients FOR DECADES. And so, providers have done what any underrepresented group would do: OPT OUT. GONE. Refusing to take Medicaid. Sat down at the front of the bus, if you're like me: refusing to give up your seat.

We're not talking about a few citizens w/o mental health coverage. We are talking about 80,000 Medicaid recipients under WHN LME; 130,000 Medicaid recipients are SMC.

For January, 2012, WHN LME-MCO presented data at its monthly board meeting that only FIVE PERCENT of those 80,000 people had received mental health services.

Assuming that this trend will continue, this means that most of the FEDERAL AND STATE MONIES is being used to pay the fat salaries of the likes of Betty Taylor and the employees at the LME-MCO's who push paper around and standardly have salaries of 50 grand/ year w/ benefits.

Is THIS how the citizens of NC wish to have their tax dollars used? Isn't it supposed to be used to provide mental health services to people in need? Don't citizens deserve providers who are well credentialed with doctoral degrees who studied years in order to become experts on human behavior?

We may not be on Wall Street, but this is very much a Wall Street fat-cat CEO demanding---and getting it-----unlimited amounts of money in order to create a world and domain that has nothing to do with what it is supposed to be doing. There's not just one elephant in this room: there's an elephant at every LME-MCO in this state now: monkey see no evil, monkey do no evil.

Will NO ONE in the NC State Legislature rebutt this bill whose intention is simply to increase the inefficiency of the LME-MCO. For inefficiency is directly related to non-accountability and the very fact that things have been allowed to get this far----WHEN WE'RE TALKING ABOUT THE USE OF FEDERAL AND STATE TAX DOLLARS-----is indeed, 'scaring me to death', just like the NC State Legislator stated.

Marsha V. Hammond, PhD, Licensed Psychologist, Asheville, NC.
NC Mental Health Reform blogspot since 2007: http://madame-defarge.blogspot.com/.

          ------

Pamela Jarrett · Appalachian State University
Letter to the Editor:
The article by Richard Craven in Monday's Journal does not do justice to the depths that the mental health bottom feeders can sink to regarding the care for mentally ill and mentally disadvantaged people in this state. It chills me to think of LMEs gaining yet even more power locally and regionally to charge up huge amounts in Medicaid and Medicare funds, but they are following the hospitals of the state who charge enormous fees for emergency or patient care, yet are not accountable to patients or families.

The person seeking help at the street level is still facing stigma, often poverty, lack of mental health education, and 19th and early 20th century treatment. I have personally been treated in a rural hospital with isolation as a salve for my depression, and have seen people put in four-point restraints for being psychotic while waiting for a hospital bed. It is impossible to find a psychiatrist or psychologist in my county (Swain) or in the neighboring counties (Jackson, Macon and Graham).

There are no longer any civil rights attorneys in the state to keep a check on whether patients are granted even their basic Constitutional rights, as the state created a state agency for them under DHHS some years ago. All the good civil rights attorneys now protect the state against lawsuits, and humbly do not answer questions the public may have about some terrible medical abuse, citing a 'conflict of interest.' One cannot even get a referral to an outside attorney who might consideryour case.
So, now the LMEs get to magically transform into entities that are impervious to local government, and who will act without oversight by the state, as the local hospitals do now. They will even have their own lawyers, who I am sure will be well paid, but out of what funds--Medicaid or Medicare?
I see only doom and gloom ahead for the mentally ill in NC. I guess it will take a few people dying before this autocracy will start being responsible to the government. It will take a few more dying before we begin to see government oversight and a responsive legal system.
Pamela Jarrett, M.A., J.D.

NCGA 6/12 HHS Committee Meet & New Bills

NORTH CAROLINA HOUSE OF REPRESENTATIVES

COMMITTEE MEETING NOTICE

AND

BILL SPONSOR NOTIFICATION

2011-2012 SESSION

You are hereby notified that the Committee on Health and Human Services will meet as follows:

DAY & DATE: Tuesday, June 12, 2012
TIME: 10 :00 am
LOCATION: 544 LOB
COMMENTS: The following bills will be considered:

BILL NO. HB 975
SHORT TITLE: Promote Local/Healthy Food.
SPONSOR: Representative LaRoque, Representative Sanderson, Representative Insko 

BILL NO. HB 1098
SHORT TITLE: Continue the Sustainable Local Food Advisory.
SPONSOR: Representative Sanderson, Representative LaRoque 

BILL NO. SB 433
SHORT TITLE: Local Human Services Administration.
SPONSOR: Senator Hartsell 

BILL NO. SB 525
SHORT TITLE: Streamline Oversight/DHHS Service Providers.
SPONSOR: Senator Tucker, Senator Hartsell

Respectfully,
Representative Current, Chair
Representative Dollar, Chair
Representative Hollo, Chair

I hereby certify this notice was filed by the committee assistant at the following offices at 1 PM o’clock on June 07, 2011.

Principal Clerk
Reading Clerk – House Chamber

Wendy Miller (Committee Assistant)

HHS Committee Meet 6/5 & Bills

Corrected Notice

NORTH CAROLINA HOUSE OF REPRESENTATIVES

COMMITTEE MEETING NOTICE

AND

BILL SPONSOR NOTIFICATION

2011-2012 SESSION

You are hereby notified that the Committee on Health and Human Services will meet as follows:

DAY & DATE: Tuesday, June 5, 2012
TIME: 10 :00 am
LOCATION: 544 LOB
COMMENTS: Added bills H1003 and H1055; removed S525.

The following bills will be considered:

BILL NO. HB 1003
SHORT TITLE Child Nutrition Program Solvency and Support.
SPONSOR Representative Howard 

BILL NO. HB 1055
SHORT TITLE Eliminate LME Provider Endorsement.-AB
SPONSOR Representative Burr, Representative Dollar

BILL NO. HB 1056
SHORT TITLE Partnership for Children Participant Records.
SPONSOR Representative Burr, Representative Dollar 

BILL NO. HB 1075
SHORT TITLE LME/MCO Governance.
SPONSOR Representative Dollar, Representative Burr 

BILL NO. HB 1081
SHORT TITLE Provisional Licensure Changes Medicaid.-AB
SPONSOR Representative Burr, Representative Dollar

Respectfully,
Representative Current, Chair
Representative Dollar, Chair
Representative Hollo, Chair

I hereby certify this notice was filed by the committee assistant at the following offices at 11 AM o’clock on June 04, 2011.

Principal Clerk
Reading Clerk – House Chamber

Wendy Miller (Committee Assistant)

NCGA HHS 5/31 Meeting & Bills

NORTH CAROLINA HOUSE OF REPRESENTATIVES

COMMITTEE MEETING NOTICE

AND

BILL SPONSOR NOTIFICATION

2011-2012 SESSION

You are hereby notified that the Committee on Health and Human Services will meet as follows:

DAY & DATE: Thursday, May 31, 2012
TIME: 10 :00 am
LOCATION: 1228 LB
COMMENTS: Bills Added

The following bills will be considered:

BILL NO. : HB 1075
SHORT TITLE : LME/MCO Governance
SPONSOR : Representative Dollar, Representative Burr 

BILL NO. : HB 981
SHORT TITLE : Dix Property Sale to Require GA Approval.
SPONSOR : Representative Hurley, Representative Dollar, 
Representative Burr 

BILL NO. : SB 433SHORT TITLE : Local Human Services Administration.
SPONSOR : Senator Hartsell

Respectfully,

Representative Current, Chair
Representative Dollar, Chair
Representative Hollo, Chair

I hereby certify this notice was filed by the committee assistant at the following offices at 9 AM o’clock on May 30, 2011.

Principal Clerk
Reading Clerk – House Chamber
Wendy Miller (Committee Assistant)

Legislative Correspondence from a Provider

In my research, and most especially my conversations and dialogues with members and representatives of the General Assembly - and yes, event PBH Consumer Affairs  folks, throughout this controversial DD managed care overhaul, there seems to be a common theme regarding the poor quality of dishonest providers abusing the system as an argument for reform. --While I know they are out there, I personally have not had such experiences and find the habit of tossing all the apples in one basket offensive... The various agencies and professionals I have had the pleasure of working with in over 10 years have always proved exemplary, going above and beyond to assist families such as mine and assure our needs were met.

Were it not for my agency QP, I would have lost my job years ago when we had to fire both my staff for unethical conduct. Every day this woman picked up my child from school and cared for her personally for 3 weeks or more while I worked at the time as a contractor (with no benefits) at FPG Child Development Institute at UNC-CH and searched for new care-givers. I was a single parent then; I could not have done it without her nor without the peace of mind that Isabel was well taken care of.

Below is an email (posted with permission) from an agency Qualified Professional from A Small Miracle here in Raleigh. Though ASM isn't the agency I referenced, I can attest they are among the best in the field; their reputation is one of compassion and love for what they do and are they are well loved by their families because of it.

Just one example of the many non-family small business stakeholders who will be greatly impacted by changes to come.


Wendy is a constituent of NC Senate District 17 and House district 37. 

Legislative Correspondence 

from a Provider Perspective

From: Wendy Singleton
Date: Fri, 25 May 2012 10:46:23 -0400
Conversation: Imploring you to FIX HB 916!
Subject: Imploring you to FIX HB 916!

Good Morning Representatives:

I am contacting each of you today appealing for further review and overhaul of proposed HB 916, with extra plea Representatives Mr. Barnhart, Mr. Dollar, Mr. Burr, Ms. Insko, Mr. Ingle, Mr. Moffit, and Mr. H. Warren. As a community member, constituent, taxpayer and proud advocate for individuals with special needs I am deeply troubled by the proposed statewide expansion of the 1915 (b)/(c) waiver.

If the The 1915 (b)/(c) Waiver goal is “for implementation improvements in the Medicaid program designed to increase cost effectiveness, efficiency, consumer access, consumer choice and provider quality. . .” as a qualified professional, NCI instructor and therapist working in the field with the IDD population I can say from first hand experience this proposed waiver is not meeting goals.

-The overhead costs of new vs. refurbished buildings does not save money, nor does elimination of targeted case management with two new jobs of Care Coordination and Community Guide as well as Qualified Professionals writing individual’s short term goals. Purported savings with the 5 county model are now being refuted, with legal cases surrounding “satisfaction rates” and “Savings” from this waiver model.

-Efficiency is no longer a word most families, staff, QP’s and current case managers would use to describe the process of the CAP system. With lessened oversight and elimination of third party case manager the proposed waiver will likely become as efficient as the now defunct Value Options authorizing entity. As targeted case managers are being told their jobs will be eliminated on January 1st, 2013 many highly qualified, gifted and talented advocates are leaving their jobs to provide for their families. This has left many of our families without a case manager or plans not being authorized in a timely manner requiring provider agencies in some cases footing the bill until they can be paid—Many smaller agencies have closed their doors because they simply can’t afford to provide services on “good faith” of being paid. Individuals who have waited for CAP services for 5 or more years in some cases are being told by Wake County they may lose their CAP slot if services are not provided in 15 days, and their CAP slot is eliminated after 30 days without services—This should NEVER happen because of a lack of efficiency in a system purported to be created for the well being, consumer access, and consumer choice of individuals served!

-Individuals and their families once had a voice to advocate for what targeted case manager / agency they wished to have to provide best services for their loved ones. Today they have laryngitis. No longer are there several agencies to choose from, nor are there case managers available due to the overwhelming caseloads given to them at 45-80 individuals per case manager!!!! Families served feel ‘lucky’ to have a case manager, even if they don’t see them for 6 months or more due to overwhelming work load required of case managers in the field. The reason for this is that most people, when faced with certain job loss, will seek a different job. With the 1915 (b)/(c) model having no oversight with model due to authorizing body having decision in type/scope of service as well as no reputable process for mediation there are major concerns with families having ability to challenge decisions when one player holds all cards in the deck. The “Right Sizing” of the network poses even bigger questions for provider agencies in that there is no known parameters of criteria for elimination of a provider agency in the network.

-With the current freeze on new CAP recipients (formerly slots) access is simply not available. With the proposed waiver utilizing last month’s numbers as a benchmark for current need this will further increase lack of access due to some families not having staff available to them due to the 10% rate cuts already imposed on a burdened system, or family / individual situations such as hospitalization, accident or death. If an individual goes out of town for two weeks to travel out of state for a funeral / service, it is impossible and irresponsible to make a correlative relationship that the next month the person ‘survived’ with only two weeks therefore that is what they should receive in services. 

Care Coordinators are not required to have advanced degrees, nor is the reimbursement rate adequate to entice providers to enroll to participate in this service, further eliminating access to services.

-Most provider agencies strive to provide the highest caliber and quality of services, and wish to continue to do so in a timely, organized, cost effective manner. I ask that you reconsider this waiver model until issues of oversight and alleged ‘budgetary savings’ can be addressed. Many families if given the opportunity would manage the money allocated to them very wisely, and if the model moves forward with more oversight and known system with third party entity to appeal decisions made by authorizing body for scope and amount of services provided for their loved ones would be more comfortable with restructure of the CAP system which is integral, imperative, and is cost effective in decreasing rates of institutionalization for the people we proudly serve.

As NAMI stated in a letter to Representative Barnhart last year on 1915 (b)/(c) waiver “We no longer have the resiliency to endure more failures”.

Thank you,

Wendy Singleton, QP
A Small Miracle Inc.
Raleigh, NC 27607
(919) 900-4422
(919) 900-4466 (fax)

-- This electronic message (e-mail) and any documents accompanying this message may contain confidential information that is privileged. This information is intended only for the use of the recipient named above. If you have received this e-mail in error, please notify us immediately by telephone at 1-800-760-0665 to arrange for return of the documents to us and you are hereby notified that any disclosure, copy, distribution, or taking of any action in reliance on the contents of this information is strictly prohibited.

*As special parents, our perspectives, interests, and priorities in various issues surrounding NC's new 1915(b)(c) Innovations Waivers and the changes they bring to our families differ according to the unique needs of each of our children.

If you have something to share, email: no2nchb916@gmail.com

Parent Legislative Correspondence

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

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

Legislative Correspondence 

from another Parent Perspective

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

To:  Senator Richard Stevens <Richard.Stevens@ncleg.net>, 

Representative Nelson Dollar <Nelson.Dollar@ncleg.net>, 

House Speaker Thom Tillis <Thom.Tillis@ncleg.net>, 

Office of NC Governor <governor.office@nc.gov>, 

Representative Justin P. Burr <Justin.Burr@ncleg.net>,

US HHS Commissioner Sharon Lewis <sharon.lewis@acf.hhs.gov>, 

Joint Caucus Leader Marilyn Avila <Marilyn.Avila@ncleg.net>, 

Representative William A. Current, Sr. <Bill.Current@ncleg.net>, 

Senator Fletcher L. Hartsell, Jr. <Fletcher.Hartsell@ncleg.net>, 

Senator Tommy Tucker <Tommy.Tucker@ncleg.net>

Dear Representatives:

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

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

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

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

Respectfully,

Colleen

NC House Committee Meeting Notice 5/31

NORTH CAROLINA HOUSE OF REPRESENTATIVES
COMMITTEE MEETING NOTICE
AND 2011-2012 SESSION

You are hereby notified that the Committee on Health and Human Services will meet as follows:

DAY & DATE: Thursday, May 31, 2012
TIME: 10 :00 am
LOCATION: 1228 LB
COMMENTS: Bills TBA

Respectfully,
Representative Current, Chair
Representative Dollar, Chair
Representative Hollo, Chair

I hereby certify this notice was filed by the committee assistant at the following offices at 11 AM o’clock on May 24, 2011.

Principal Clerk
Reading Clerk – House Chamber

Wendy Miller (Committee Assistant)

Parent Legislative Correspondence

Mary K. Short is a strong advocate and the parent caregiver of an adult DD recipient with profound needs.


Mary and her daughter live in NC House District 88 and Senate District 42. Her daughter is being served by Smoky Mountain LME.

Legislative Correspondence 

from another Parent Perspective

Mon, May 21, 2012 at 1:49 PM
From: MaryKShort@aol.com
To: Senator Louis Pate <louis.pate@ncleg.net>, 
Representative Justin P. Burr <justin.burr@ncleg.net>, 
Representative Nelson Dollar <nelson.dollar@ncleg.net>, 
Representative Martha Alexander <martha.alexander@ncleg.net>, 
Representative William D. Brisson <william.brisson@ncleg.net>, 
Representative William A. Current, Sr. <bill.current@ncleg.net>,  
Representative Mark W. Hollo <mark.hollo@ncleg.net>,  
Representative Pat B. Hurley <pat.hurley@ncleg.net>, 
Representative Bert Jones <bert.jones@ncleg.net>,  
Representative Marian N. McLawhorn <marian.mclawhorn@ncleg.net>, 
Representative Tom Murry <tom.murry@ncleg.net>, 
Representative Fred F. Steen, II <fred.steen@ncleg.net>, 
Senator Austin M. Allran <austin.allran@ncleg.net>, 
Senator Doug Berger <doug.berger@ncleg.net>, 
Senator Stan Bingham <stan.bingham@ncleg.net>, 
Senator Harris Blake <harris.blake@ncleg.net>, 
Senator Jim Davis <jim.davis@ncleg.net>, 
Senator Fletcher L. Hartsell, Jr. <fletcher.hartsell@ncleg.net>, 
Senator Eric Mansfield <eric.mansfield@ncleg.net>, 
Senator Martin L. Nesbitt, Jr. <martin.nesbitt@ncleg.net>, 
Senator William R. Purcell <william.purcell@ncleg.net>, 
Senator Tommy Tucker <tommy.tucker@ncleg.net>, 
Senator Andrew C. Brock <andrew.brock@ncleg.net>, 
Senator Ralph Hise <ralph.hise@ncleg.net>, 
Joint Caucus Leader Marilyn Avila <marilyn.avila@ncleg.net>, 
Representative Rayne Brown <rayne.brown@ncleg.net>, 
Representative Tricia Ann Cotham <tricia.cotham@ncleg.net>, 
Representative Beverly M. Earle <beverly.earle@ncleg.net>, 
Representative Shirley B. Randleman <shirley.randleman@ncleg.net>, 
Representative Mitchell S. Setzer <mitchell.setzer@ncleg.net>, 
House Speaker Thom Tillis <Thom.Tilllis@ncleg.net>

Dear Speaker Tillis and Members of NCGA:

I have sent emails to DMA requesting the best practice documentation that was used to support the 40 hour Policy limit on parent/family that is in the NC Innovations Waiver, the CAP-IDD Waiver, and Clinical Policy 8M. At that same time, I requested the best practice documentation that was used to support the Home Supports (HS) service definition from the 2008 CAP-MR/DD Comprehensive Waiver. I have not received a response.

Here is what the State Strategic Plan for MHDDSAS 2010-2013, dated July 1, 2010, page 12 of 46 says:

"Evidence based practices are those that have been shown to be effective in multiple, scientifically conducted research studies, while best practices are accepted clinical practices that demonstrate success for the individuals served."

I have asked for that documentation because they are in direct conflict with one another.

In 2008, DMA said parents may only work a daily service, no limit on the number of days.

(Home Supports has a "direct contact hours" component attached. Using DMA guidelines for HS Level 2, 6.5 hours a day maximum, would require a parent to work 45.5 hours a week maximum for the past 3+ years AND the highest level, HS Level 5, 12.5 hours a day minimum, would require the parent to work 87.5 hours a week minimum.)

Then in 2011-12, DMA said we cannot work over 40 hours a week. This is only parents or family members who live with an individual, not any unrelated staff who comes into the home or any AFL or other Group Home worker. I did not ask for the best practice documentation that DMA has used to consistently support unrelated workers working more than 40 hours a week.

As I have been waiting for a response from DMA, I did find this information posted below to PBH's web site: "To date, there are no national practice guidelines for the I/DD population." (Link provided below.)

If that statement was true when published on PBH's web site on 09292011, then what are families to believe about any DMA best practices placed into any waiver, rule, policy, or procedure? If DMA suspects some sort of rampant abuse by parents (or other living with family member) performing services, then why haven't their internal monitoring controls exposed those abuses?

I am asking that you all intervene on behalf of the 1,091 (+/-) parents (or other living with family members) who have been providing Home Supports for the past 3+ years and STOP the implementation of the 40 hour policy once and for all. I am asking you to believe me when I tell you that NO family who has participated as a formal stakeholder has said to me at any time that they SUPPORT the 40 hour limit on parents/family members. In fact, I am consistently told by formal stakeholder family members or individuals, that they SUPPORT CHOICE by the individual and/or guardian.

Finally, I want you to consider the following two NC Innovations service plans:

(Home Supports changes to: PC = Personal Care / I-HSB = In-Home Skill Building)

After accounting for unpaid supports, if he/she needs less than 40 hours of PC/I-HSB, then he/she gets to choose to use his/her parent to perform all PC/I-HSB services.

After accounting for unpaid supports, if he/she needs more than 40 hours of PC/I-HSR, then he/she CANNOT choose to use his/her parent to perform all PC/I-HSB services or any number of hours over 40 hours.

Why is it that the individual with the least ability to adjust to change is forced to change?

Mary K. Short
828-632-5888 or 704-451-4144 (cell)

http://www.pbhcare.org/guidelinearticles.asp **(Reviewed/Updated 03/26/2012)**

http://www.pbhcare.org/pubdocs/upload/documents/intro%20to%20IDD.pdf (09292011)

Introduction to I/DD (Intellectual/Developmental Disabilities)
Practice Guidelines

To date, there are no national practice guidelines for the I/DD population. In response to this situation, PBH initiated the development of an I/DD workgroup to draft guidelines. The I/DD work group includes stakeholders such as clinicians, providers, and family members who worked on a variety of projects related to the development of Practice Guidelines for I/DD Population. While the Practice Guidelines developed by the I/DD Workgroup are not exhaustive, the intention is that the guidelines will give providers and families useful information that can facilitate the process of learning more about I/DD.

http://www.pbhcare.org/pubdocs/upload/documents/Best%20Practice%20Guidelines%2011%2006%2006.pdf (10202011)

Practice Guidelines In
Working with Individuals Who
Have Developmental Disabilities

Tassé, M.J., Havercamp, S.M., & Thompson, C. (2006). Practice Guidelines in Working with Individuals who have Developmental Disabilities. Concord, NC: PBH.

From page 107:

PBH is concerned about the impermanence of funding sources and services for individuals with developmental disabilities. We are committed to empowering consumers and their families by giving you the information, skills, and resources you need to identify and obtain the best available supports. In this way, we help you become less reliant on the service delivery system to achieve your goals.