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 

Geraldo Rivera - The P&A System

The most effective advocates, says Bernard, former Willowbrook "inmate," are the parents and the consumers themselves because they know what they need and they know what they want.

Of course, that's assuming that the powers-that-be listen & give a hoot rather than having their opinions handed to them by the 'trained experts' who have never met my child nor yours... just sayin'.

NC Fails at DOJ Settlement, but has a Plan!

22 Years Ago Today...

Thu, Jul 26, 2012 at 7:59 AM
From: Vicki Smith, Executive Director of Disability Rights North Carolina
Re: State fails to settle with DOJ but announces 8 year plan



FOR IMMEDIATE RELEASE


[ view the DRNC Press Release ]

DOJ Update

NC Secretary of Health and Human Services, Al Delia, will announce the details of an 8 year plan to develop services for 3,000 individuals with mental illness in living in Adult Care Homes to more integrated setting appropriate to their needs later today. 

The plan is an attempt to address a July 28, 2011 Letter of Finding issued by the US Department of Justice. The letter was issued in response to a complaint filed July 26, 2010 by Disability Rights NC alleging North Carolina’s practice of warehousing people with mental illness in adult care homes violated the ADA’s integration mandate. 

The State and USDOJ have been in confidential negotiations for the last year. At the table were representatives from the Governor’s Office, Department of Health & Human Services, and the Attorney General’s Office. Little information was shared about discussions until today’s announcement that the parties have failed to reach agreement but the state is moving forward with a plan. However, the General Assembly’s inclusion of $10.3 million in the 2012 - 2013 Budget to begin implementation of any settlement was seen as a sign that resolution was near. The announcement will also include acknowledgment by the State that it was unable to reach a settlement agreement with USDOJ, largely because of disagreement regarding an enforcement mechanism.

Our Response

“We are disappointed that the State was unable to come to an agreement to resolve our complaint with USDOJ,” said Vicki Smith, Executive Director of Disability Rights NC. “It is reassuring to have the State acknowledge the enormity of the unmet needs of people with mental illness and their plan to increase supported housing, supported employment and other services. However, the plan outlined by the State lacks a binding agreement, one which once and for all commits the state to fulfill the promises we’ve heard today. “ 

The Department of Justice may still pursue legal action against the state. Whatever steps the USDOJ takes next, Disability Rights NC will continue to address this situation. 

North Carolina has failed to:

Develop a meaningful Community Integration Plan as required by the 1999 Supreme Court’s Olmstead Decision including policies that provide incentives for community based services and placements;

Adequately fund the state’s Mental Health Trust Fund;

Develop community based services as hospital beds were closed, instead it relied on an industry that was neither designed nor competent to promote the recovery and inclusion of people with mental illness in the community; and

Most importantly, the State failed to focus first and foremost on the interests and needs of people with mental illness. It lost sight of its purpose - protecting the health and safety of all its citizens while providing essential human services.

What a way to celebrate the 22 anniversary of the signing of the ADA into law.

Take a look at this short video:  http://youtu.be/6ieH8FE9Dhw

“Let the shameful wall of exclusion finally come tumbling down.”

More information as it develops!

Vicki Smith

Executive Director

Disability Rights NC

2626 Glenwood Avenue, Suite 550

Raleigh, NC 27608

Phone: 919-856-2195

TTY: 1-888-268-5535

Fax: 919-856-2244

vicki.smith@disabilityrightsnc.org

http://www.disabilityrightsnc.org

Disability Rights NC is the state's protection and advocacy system. 

Disability Rights NC is a 501 (c)(3) organization. Donations support our efforts to promote a clear and independent voice for North Carolinians with disabilities. If you are a state government employee, you can support Disability Rights NC through the State Employees Combined Campaign (SECC). Please use code # 1544.

This transmission is intended for the sole use of the individual or entity to whom it is addressed, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any dissemination, distribution or duplication of this transmission by someone other than the intended addressee or its designated agent is prohibited. If your receipt of this transmission is in error, please notify us by telephone (919) 856-2195 or return e-mail to the sender. Please delete all copies of this message and any attachments.

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.