NC House Bill 916 is NOT the Answer!: changes

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28 June 2012

DMA 8M Public Comment on CAP-I/DD 361

ote: Below is a Public Comment submitted to DMA regarding the 8M Clinical Coverage Policy proposal for CAP-I/DD during the 15 day comment period from July 28 - August 11, 2011. This exert was pulled from it's original source, a public record, and is posted exactly as it appeared save the removal of the submitter's personal contact information and abbreviation of last name.

[ More on DMA Public Comments. ]

Comment 361

To: Webmedpolicy, Dma
Subject: Comments to proposed CAP MR/DD Manual
Sent: Friday, August 12, 2011 3:04 PM

I have two major concerns about the proposed CAP MR/DD Manual. My 20 year old daughter is profoundly physically and intellectually disabled. She requires 100% care and has special medical and behavioral needs.

Proposed Elimination of Enhanced Personal Care
I am very concerned about the proposed elimination of enhanced personal care. This has been an authorized service because of an identified need of a small segment of the CAP waiver recipients. What is the justification to eliminate this service? It is certainly not because there are no longer any CAP recipients "who have intense medical or behavioral needs." I thought the objective of the CAP MR/DD waiver was to keep individuals out of institutions. Cutting services to individuals with the most complex needs makes it more likely that some of these individuals will have to be placed in 24 hour residential settings. This will not improve the quality of life for these individuals nor will it save money. In fact, it will cost a lot more than providing these individuals with enhanced personal care.

At the pay rate for regular personal care services, it is impossible to find and keep good staff qualified to make decisions regarding behavior management, to carefully monitor seizures, to provide g-tube feedings, and to safely transfer my daughter who has had several major orthopedic surgeries. My daughter needs consistency and I need a break physically from 20 years of caring for my daughter. Frequent turnover of staff and/or going for long periods without staff because of the low pay for personal care services would be very detrimental to my daughter's quality of life and safety at home.

Limit of 129 hours/month of Habilitative Services
Again, a decision has been made not to differentiate between CAP recipients based on their level of need, currently measured by SNAP score. I believe providing the same limit of 129 hours/month to all CAP recipients discriminates against my daughter and others with high levels of need. For adults who are no longer enrolled in public schools, there should be a higher monthly limit for habilitative services, incremented by SNAP Level.

When my daughter ages out of public school, she will need opportunities to participate in the community. I hope to enroll her in a day program which operates 6 hours/day 5 days per week. That one program will use up all of the allowed habilitative service hours. But my daughter needs habilitative services for other community experiences such as weekly Special Olympics bowling, a weekly community drumming group and a monthly evening social gathering. In addition, she has habilitative goals to work on at home.

These two policy changes seem to completely disregard the quality of life of CAP MR/DD recipients for the sake of an easy way to save a relatively small amount of money. I ask that these two changes be reevaluated, with a sincere consideration of quality of life and safety. Please don't abandon the CAP recipients with the greatest needs.

Thank you,
Beth H.
Wilmington, NC

27 June 2012

DMA 8M Public Comment on CAP-I/DD 292

Note: Below is a Public Comment submitted to DMA regarding the 8M Clinical Coverage Policy proposal for CAP-I/DD during the 15 day comment period from July 28 - August 11, 2011. This exert was pulled from it's original source, a public record, and is posted exactly as it appeared save the removal of the submitter's personal contact information and abbreviation of last name.

[ More on DMA Public Comments. ]

Comment 292

To: Webmedpolicy, Dma
Cc: Bradshaw, Tammie
Subject: 8M policy
Sent: Thursday, August 11, 2011 9:59 PM

DMA,

I am writing in response to the proposed policy recommendations. I own my own Case Management Company, and serve individuals in Mecklenburg, and Pathways LME. I am deeply concerned over the policy recommendations as well as recent increased activity at the State level of changes or proposed changes that will effect folks I serve. I was very involved with advocating against the recently accepted HB 916, and am now seeing my concerns being played out with this proposal, and previous proposals within the last several months. I warned lawmakers (Rep. Earle, and Insko) of the dangers of the HB, and am seeing my predictions being played out even before implementation of HB 916. I have served folks with disabilities for over 25 years, and am disappointed in DMA/DHHS (divisions that are set up to assist folks with disabilities) put out policy that actually hurts the folks they are supposed to support. I have done an analysis of some of my cases (about 5) with the proposed changes in the 8M policy from current services in their cost summary to proposed changes under the 8M policy recommendations. The outcome has been a reduction in cost/services of about 25% per client (good job state!!) without any medical justification for a reduction other than a policy change as recommended by the State. I plan on laying out my issues in this e-mail from my careful review of the 8M policy so you will better understand my concerns as well as the people I support. In an attempt to save money I believe you all have lost sight in the people that are being served. Your attempt at trying to save money by reducing or eliminating services will backfire and create more cost to the state as Families will be forced to place their disabled family members in placements that will cost the State much more money. My issues will be laid out in the following order with reference to the page number in the 8m policy so as to easily follow my point.

1) Respite for Residential Support folks (can they get Respite or not? if so why not on the same day?)
2) Elimination of Home Supports
3) Elimination of Enhanced services
4) change from "guidelines" to "Criteria" in the proposal
5) limitation of Habilitative hours to 129 H/M (30 H/W) for adults/children when out of school
6) Limitation of Habilitative hours to 86 H/M (20 H/W) for school age children
7) Limitation on hours a month for Guardians and family members to 40 H/W or 5.8 H/D

I want to start out this analysis by looking at what was written into the policy. On page 4 of the 8M policy this statement was made "The waiver, Community Alternatives Program for Individuals with Intellectual/Developmental Disabilities (CAP-I/DD) is designed to give persons with intellectual and developmental disabilities, a cost-effective alternative to care in an intermediate care facility for persons with mental retardation (ICF-MR). The goal of this funding source is to enable individuals to have a choice of living in the community instead of in an institutional setting and to have effective support in creating a preferred lifestyle that challenges each individual to live to his or her fullest potential." This I imagine is the driving force behind the waiver. If so, the 8M policy and DMA seems to forget the mission as outlined here. This statement was found on page 5 of the 8M policy that is also significant. "Person-centered planning is a process of determining real-life outcomes with individuals and developing strategies and goals to achieve those outcomes. The participant, the legally responsible person, or both direct the process and share authority and responsibility with system professionals about decisions made" (page 5). These decisions made in this policy were not made by the people that matter (the clients or their team members, but by politicians or people who are not concerned about what is best for the individual served). Another qoute I want to use from the 8M policy is from page 39 under amount and duration of service. "The amount and duration of services provided are determined through the person-centered planning process with the participant’s planning team. Services are based on the needs and priorities of the participant, the availability of other formal and informal supports, and rules of the funding source. The planning team shall ensure that medical necessity criteria are met for Medicaid reimbursement as cited in 10A NCAC 22O .0301.
Authority G.S. 108A-25(b); 42 CFR 440.230(d). In and throughout the policy you put limits on services that are in direct conflict with what is written in the policy. Amount and duration of services is determined by the participants planning team, not DMA.

Point # 1: The 8M policy is unclear on its stand as to Respite for folks recieving Residential supports. On page 11 of the 8M policy it seems to indicate that Respite would not be allowed for RS clients, but on page 94 of the policy it states that it can not be billed on the same day as RS, and then later states that it cannot be billed on the same time time as day as RS. Either way it presents problems. If totally eliminated then staff would have to pay out of pocket for Respite, and then the State would find themselves in a sticky situation because they could not mandate Staff requirements for non Medicaid payment opening themselves for a huge liablity issues and potential lawsuit if the staff have a friend do respite that may potentially abuse the client, and the staff/provider would have to say they had to do that because of state policy requirements. The other matter regards to not doing RS and Respite on the same day presents another issues. If staff provide RS for anytime during the day, and bill for it, and then have someone provide Respite the Respite will be paid out of pocket as illustrated in previous statement (huge state liability). If RS staff do services during the day, and don't bill because they want to use Respite and Respite is billed, then it becomes a labor law issue because the State is mandated staff work free if they provide RS services, and respite on the same day. This once again opens up the State for lawsuit due to policy changes.

Point #2: In the 8M policy it recommends elimination of Home Supports for individuals who live in their own home and recieve services from their Guardian or Family Member with replacement of HCS and personal care services. This is the biggest issues I have with this policy, and where most of the cuts are effected. Many individuals who recieve Home Supports do so because their Family Members have decided to quit their fulltime job to care for their loved one with a disability. Now the State wants to put an additional burden on these families because they consider them natural supports, and it is "their duty to care for their loved one" and so they decide to cut services. This puts an undue burden on the Families to provide the same quality of care with less support. Many of these Families provide this service because of past abuse by staff or because they live in an area that is hard to staff, or the individual has such intense needs no one would work with them. I will cover this in another area, but when the 8M policy limits the habilitative hours to 129 H/M, and the person recieves Day Supports (typically utilized at 30 H/W) then their is no more habilitation to be used even though the consumer needs it so Families are left to use PC, and only 40 H/W or 5.8 H/D of services. Many of these consumer require 12-20 H/D of services so this policy forces Families to care for their family members much more than they are compensated. The end result will be that Families will have to utilize other options such as institutionalization to care for their family member as they will not be able to take on the additional stress of caring for their loved one and meeting the daily responsibilites of paying their bills. This will result in cost increases at the state level.

Policy #3: In regards to elimination of enhanced services I believe that once again the State has failed to take in consideration the individual served and has decided to look at the cost savings. People recieve enhanced services primarily due to behavioral or medical issues that warrant intense need. By eliminating the enhanced services staff and/or Family will have to care for the the needs of the individual without appropriate commpensation due to the additional training required or additonial liability they take on. The long term effect will be an inabilty of providers or Family to provide well trained staff to provide services once again forcing alternative placement that will increase state costs

Policy #4: I am not clear on the differientiation between "Guidelines" and "criteria" when it pertains to limits on services. My understanding is that Guidelines are recommendations, and criteria is limits. Just need clarification

Policy #5: I have concerns that the limitation on Habilitation hours to 129 H/M conflicts with the concept of Person centeredness, and seriously effects folks recieving Home supports. 129 H/M limits folks to 4.2 H/D of habilitation of services if they recieve services 7 days a week. If folks get Day supports (typically done at 30 H/W) it would eliminate any habilitation being done at the home, only PC. This would force families, and staff in providing uncompensated work beyond what is needed to the individual. This has potential labor law issues, and rights violation issues for the State. This will directly effect adult consumers who live at home who reieve additional servcies, and will result in a cut in services. This policy recommendation also appears to comflict with other things in the policy that states that adults may recieve up to 12 H/D of Habilitative services in one day. Many of these individuals served have a treating physician stating they need more services beyond 129 H/M, and yet the State wants to limit services regardless of what the treating Physician states.

Policy #6: Regards to the Policy recommendation on Limitation of Habilitative hours to 86 H/M (20 H/W or 3 H/D) for school age children. I have concerns because it seems to conflict with other things in the policy that states kids can recieve up to 6 H/D of habilitation services (129 H/M) or other places that says they can recieve up to 12 H/D on non school days.

Policy #7: Regards to the policy Limitation on hours a month for Guardians and family members to 40 H/W or 5.8 H/D. As stated earlier this puts an undue burden on Families who have quit their jobs to care for their adult child, and are now looking at a huge reduction in services, and are expected to continue to provide supports, but under the heading of natural supports (because that is what Families should do). This Policy recommendation will seriously effect Families who provide home supports. Many of those adult individuals also recieve Day Supports, and because of the other limitation recommendation of 129 H/M these families will only be able to provide PC which in many case is not sustainable given what they gave up to care for their child forcing many members to rethink caring for their loved one in their which will result in an increased cost at the State level. I have many Family members who provide well over 10 H/D of services due to intense needs of their family members who will now be forced to resign their day jobs or place their Family members in a group home/AFL/Institution due to service limitations put forth in this policy.

I hope I have been clear in my deliberation on my concerns and issues, and my desire to support the individuals, and Families I represent. If you have any questions or need to speak to any of my families on how these policy changes will directly effect tehm please call me at 704-249-7418.

Sincerely,

Paul Peters
Owner
Covenant Case Management Services, LLC

26 June 2012

DMA 8M Public Comment on CAP-I/DD 270

25 June 2012

DMA 8M Public Comment on CAP-I/DD 294

Enhanced Care: In 2010, Chelley had 100+ appointments. She was in the ER a few times and was hospitalized 6 times during the latter part of 2010. As a result of battling with an array of illnesses, she was only able to attend school SIXTEEN (16) days this past academic year. I am twice divorced to 2 cowardly men. I work two steady jobs, and during tax season, that goes up to 3 steady jobs. I am the primary caretaker of my 87 year old widowed father, and my 23 year old daughter, Christine, still in college, who we recently informed me, is expecting a child in October! (This just means another dependent to care for in the very near future). Because of my busy schedule and family responsibilities (both physically and financially), I am dependent of professional care for my daughter Chelley. Her health is very fragile, and the need for quality care is essential. Without the right enhanced services in place, I would have to quit all my jobs and stay home and care for her myself. And that would only lead me to be dependent on public assistance, which in turn would not be able to pay for her care, our home, basic standard of living...so that’s not an option. So the only alternative would be to institutionalize Chelley, which would NOT provide her with quality of life, and where she feels most acclimated and safe. This option is also against Chelley’s wishes and the family’s wishes. And that would be a tremendous cost to the government in the end. Eliminating Enhanced Care would have a tremendous NEGATIVE impact!
Home Supports: The change back to coupled services is the best thing going in this new waiver!
Habilitation Limitation: The maximum habilitative limit coupled with maximum personal care limit is clearly not enough for me to work my 2-3 jobs. The purpose of my working these additional jobs is to be able to supplement for Chelley’s care....which to me...is doing the government a favor. Because if she is institutionalized, that financial burden will fall in the good old US government’s lap. (Reminder: an institution is against Chelley’s and the family’s wishes) A typical family working member is required to work a 40 hr week outside of the home and come home from work and provide another 80 hrs a week to care for a disabled loved one. Because I don’t have a typical work week, my number of hours is substantially greater. Chelley is in need of consistent long-term person centered care!! Children with disabilities learn at a slower rate than the average person but yet the highest need individual can only receive 129 hrs per month? And I understand that there will be no exceptions? Whatever happened to the person centered approach??? These limitations surely support my belief of us living in a Hitler society. How can anyone deem that one set amount of time is suitable to everyone....regardless of their limitations, their dependencies, their abilities, etc.? Our children, both adults and minors, need additional care for a lifetime and it needs to be person centered so they can become productive in their community! Our children’s needs are great!!! Many individuals, specifically my daughter, will lose their freedom and possibility their life if this new waiver should take effect!
Personal Care Limitation: Please refer to my notes in Habilitation Limitation. Just to reiterate....The UR limits will cause many to be institutionalized!!!! My daughter will be one of them! This negative impact will be the detriment of not only my daughter, but my family....society will miss out of gaining a wonderful viable member; the government will be greatly impacted financially, etc. But more importantly, an institution is against Chelley’s and the family’s wishes.
Family Member: If it were not for the love of family, I think that my daughter would be a forgotten person in our society. We are quick to sweep problems under the rug so to speak and ignore people who are truly in need. But thank God that Chelley is loved by her family, and we are willing to stand up for her and protect her and provide her with the individual care that she needs. The BEST care that Chelley receives is from her family, because we have the patience, and the knowledge of her individual care, and always make the decisions which best fits her individual requirements. But this new policy seeks to limit the individual care provided by family members. This is not even logical!! What external staff will be willing to stay up hours upon hours each and every night when a child’s sleep patterns is only 3-5 hours? What external staff will be willing to sacrifice their time to fill out endless paperwork, attend grueling appointments/meetings, sacrifice not ever taking a vacation, etc.? External staff will not endure the pain and heartache that family members endure for the sake of caring for a loved one? And what about when qualified staff cannot be found, or are in transition? Who picks up the slack? How in anyone’s right mind would it be a good idea to punish the work and time that families put in for the care of their loved one?
Home Modifications: How is the 15,000 factored into the budget? Does it go toward the total cost of the current budget year? For example, participant current budget is 125000 without home modifications. Home modification is 13,000. This puts current budget 138000 but less than 15000 in 5 years. Would this case a denial in Home Modifications/Services? Although this does not personally apply to my daughter, it is still concerning. For example a specialized bathroom for a person who truly needs it, is not a luxury item and but rather is needed for health and safety. Adding an assessable bathroom into an existing bedroom should be added to the inclusive list. This would not be needed or provided for another child in an average home. Without this it would jeopardize the health and safety of the individual and put an individual at risk of institutionalization.
Respite: Restricting how Respite is to be used is purely inhumane! I work 2-3 jobs, work countless additional hours in the home caring for my daughter, don’t have options for vacation because of my unique family situation, have daily interruption of sleep, etc....and yet the state dares to think that I should not be entitled to some occasional respite to get some relief at my discretion???? Currently there is no other service that would be appropriate....and the reason why I and other families cherish every moment that can be had from respite care. And if I may add, those respite hours are not always spent resting...which is a novel idea....but I use those hours to give me time to grocery shop, to clean my house, to fill out paperwork, to cook, to do laundry, to care for other family members in my home, etc. It is impossible to accomplish all that I do for my daughter without having some occasional free time (if I can even call it that). With the past waiver, how many “typical” families can say they could survive on just 576 hrs per year of down time? It would be unfathomable!!!! I’d like to meet the person or committee who agreed to enforce this restriction. I would love to have them visit me and stay for a while to truly evaluate whether their decision was conscionable!!!
2.0 Eligible Participants: for the CAP waiver notes “Waiver-Specific Requirements” A person with mental retardation, developmental disabilities, or both may be considered for CAP-I/DD funding if s/he fulfills all of the following criteria: Can maintain his or her health, safety, and well-being in the community with the program”. Please clarify! If I am reading this correctly it states that individuals with great need will no longer be eligible for wavier services and will have no choice but to live in an institution. What does this mean for current participants that have high needs? Is there specific criteria that drives this statement? Who and or what makes that determinations; an individual; a committee; a dollar amount?

Marie P.

24 June 2012

DMA 8M Public Comment on CAP-I/DD 227

[ More on DMA Public Comments. ]

Comment 227

To: Webmedpolicy, Dma
Subject: Proposed Changes
Sent: Wednesday, August 10, 2011 2:52 PM

I certainly understand the challenges of continuing to provide a full array of appropriate and necessary services via the CAP-MR/DD waiver in this most difficult economic climate. But, a number of the proposed changes to the CAP waiver need to be reconsidered due to the potential, and likely, negative impact they will have on consumers of service, and their families.

First, the removal of Home Supports seems to be antithetical to one of the primary intents of the waiver (i.e., assist individuals in continuing to reside in their community). For many families, this service is the only thing that prevents them from having to place their child in a more restrictive setting (e.g., Group Home). Ironically, in order to be placed in a group home, the CAP consumer would need to receive Residential Supports. Given that Residential Supports is almost identical to Home Supports, it seems illogical that the proposed waiver change would force an individual to move to a group home in order to receive essentially the same service they used to receive at home. Moreover, given that most individuals receiving Home Supports receive more hours per week than parents would be allowed to work (40 hours), per proposed changes to the waiver, additional staffing would be needed to meet the previously determined medical needs of the individual. On the surface, it makes no sense to force families to have outside staff come into their home to work with their family member due to an arbitrary determination that family members can work no more than 40 hours per week (providing a combination of HCS and Personal Care). The reality, which is known to all of us, is that parents already work many more hours with their family member than is required by the various Home Supports levels. Thus, the 40 hour limit seems rather arbitraty and solely designed to reduce costs.

Second, the removal of enhanced serviceswill almost certainly lead to increased rates of out-of-home placements. I understand that the State wishes to decrease costs by eliminating this service, but the higher rate of pay for enhanced services helps to ensure agencies can afford to provide families/staff with consultation/supervision by the professionals (e.g., nurses, psychologists) required by this service. Without the enhanced rate, agencies will not be able to provide the additional consultation and training required to ensure staff are competent to provide needed supports, and thus individuals' needs will go unment. As needs go unmet, consumers of CAP services will experience increased behavioral and medical challenges. And these challenges will result in increased rates of institutional/emergency/out-of-home placement. I understand the Innovations waiver does not include enhanced services, but I do not feel that the desire to have the CAP waiver closely match the Innovations waiver is sufficient reason to simply discontinue a service that is critical in helping many individuals to continue to reside in their communities.

On onother topic, the State has done a woeful job of informing families and consumers of proposed changes. Most families and consumers of service have no idea that the State is even proposing changes to the CAP waiver. Because of this, the vast majority of consumers and families will have had no opportunity to provide input regarding the State's proposed changes. To implement any changes without ensuring all vested parties have been directly contacted by the State regarding proposed changes, and thus have had the opportunity to provide comment, is unfair and certainly poor practice.

Finally, the new waiver makes reference to Behavioral Analysts as professionals who can provide CAP services. As has been communicated on numerous occassions by various parties, the practice of behavioral analysis, per the NC Psychology Practice Act, considered the practice of psychology. As such, it is illegal for anyone not licensed as a psychologist, or not supervised by a psycyhologist, to provide behavior analytic services. The only caveate is that other professionals certified/licensed by a regulatory board would be exempt from the authority of the Psychology Practice Act. If, of course, behavior analysis was within their scope of practice. Behavior Analysts, however, are not covered by any NC regulatory board. Thus, it is my understanding that it would be inappropriate to include them in the list of professionals who are eligible to bill for CAP services.

Edward H.

21 May 2012

Arc NC Action Alert

From The Arc of North Carolina

Attend The Coalition Rally! Also, Calls & Emails Needed....

It’s crunch time. Legislators are considering changes to HB 916 this week, and we have an opportunity to suggest improvements to the 1915 b/c waiver. The Arc continues to work with legislators to create reasonable solutions to issues many of you are already experiencing with the implementation of the 1915 b/c waiver. Here’s what we’re working on:

First, restoring access to some form of independent case management for people with intellectual and developmental disabilities is critical for the 1915 b/c waiver model to succeed. Second, individuals with CAP or Innovations slots need assurances that they can continue to use them regardless of where they live. Third, where a person originally received Medicaid should not be an impediment to receiving services today.

As we work on these issues, it is critical that legislators hear from you -- Nothing is more powerful than you telling your story.

Decisions on potential changes to HB 916 are being made this week.

Please call & email:

Download my list with copy+paste contact info by Committee:

Word Contact List

PDF Contact List

Tell them:

Restore Independent Case Management: People with I/DD need an independent case manager who works for them, not for the Managed Care Organization!
Slow the pace of Managed Care – Get it right: There are many problems with the current managed care plan, as many of you can personally attest to. It is important that the pace of implementation be slowed so these problems can be addressed before they become an established part of the system.

The Coalition Rally (Tuesday, May 22)

If you can attend the Rally at the NC Legislative Building (16 W Jones Street) in Raleigh, please do so! Even if if you can only spare an hour …Call your legislator and ask to see them. It will make a difference. Registration Starts at 8:00 AM and the Rally itself is at noon. Details on the rally can be found here, including parking info.

The Arc will have staff avalible from 7:30 AM through the end of the day avalible to assist you in getting around. The Day of the event, please call 919.500.8382 if you have any questions or problems.

DHHS Waiver Advisory Committee Meeting (Tues, May 22, 1-3 PM)

If you can attend the DHHS Waiver Advisory Committee, please do so as well!! It will be meeting from 1:00 - 3:00 PM at the McKimmon Center (1101 Gorman Street) in Raleigh - a quick 10 minunte drive from where The Coalition Rally is taking place. There is plenty of free parking. Public Comments will be heard beginning at 2:30 PM. More information on the DWAC can be found here.

Again, if you have any questions at all, please feel free to contact Ben Akroyd at bakroyd@arcnc.org or 919.500.8382.

12 May 2012

Family Story: NC Creates Dilemma for the Grahams

Real Faces in North Carolina

It's not the mere idea of "change" that frightens North Carolina parents regarding the State's new Medicaid Waiver reform. We aren't afraid of change; our lives are change and adaptation - a carefully balanced juggling act that most cannot imagine, unless you live it.

No, what we are afraid of is failure. We are afraid of failing the precious children we love and care for. And without proper supports, services and assistance for our children's unique needs and circumstances, many families will be forced to make the unfathomable choice of giving their loved one up to an State operated institutional setting.

Such a failure would be the failure of the State of North Carolina.

See NC Creates a Dilemma for the Grahams on North Carolina Health News.

Video and article by Lydia Wilson.

Lydia's Medicaid Waiver focused website: www.ncmentalhealthreform.com

10 May 2012

NCGA Meeting Time Change; Subcommittee on LME 5/14

NORTH CAROLINA GENERAL ASSEMBLY

Raleigh, North Carolina 27601

May 10, 2012

MEMORANDUM

CORRECTED NOTICE – TIME CHANGE

TO:	Members, Subcommittee on LME Governance
FROM:	Rennie Hobby
SUBJECT:	Meeting Notice – Time Change
DAY	DATE	TIME	ROOM
Monday	May 14, 2012	3:00PM	544

COMMENTS: Meeting is scheduled for 3:00 instead of 2:00.

Parking for non-legislative members of the committee/commission is available in the visitor parking deck #75 located on Salisbury Street across from the Legislative Office Building. Parking is also available in the parking lot across Jones Street from the State Library/Archives. You can view a map of downtown by visiting http://www.ncleg.net/graphics/downtownmap.pdf.

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_

* Google Calendar updated.

09 May 2012

email to Senator Neal Hunt

May 9, 2012

To: NC Senator Neal Hunt [neal.hunt@ncleg.net, nealh@ncleg.net]

Subject: Personal Response & Request to Meet Re: Neal Hunt News

Dear Senator Hunt,

Thank you for you including me in your recipient list with the informative newsletter regarding the many successful accomplishments and challenges overcome by the North Carolina legislature to improve the lives of the citizens of this State.

As a parent of two young children, I applaud your efforts toward improving the quality of education for our youngsters and for making environmental protection a priority. As the wife of a small business owner, I appreciate your plight in tax reduction and putting our State's budget in check. --Not unlike most parents, my greatest desire is to instill in our precious children a healthy respect for life, knowledge and nature and to see them grow to one day become productive, compassionate leaders who shall make the world a better place for generations to come.

At least that is my hope for Liam, our happy, healthy, typically-developing 5 year old son.

Liam's 14 year old sister, Isabel, however, will never "grow up," never attend college, and never live independently. In fact, she may never verbally speak nor progress beyond the cognitive capabilities of a toddler, and we've been potty-training for over a decade. You see, Isabel is a child with profound special needs and developmental disabilities, born with a one of a kind genetic rearrangement never documented prior to her birth. She is also a Medicaid Waiver / CAP recipient who, along with her family members, will be critically and detrimentally affected by the implementation of NC House Bill 916's new 1915(b)(c) Innovations Waivers in its current design.

As a parent with extensive Medicaid and CAP services experience, I will be among the first to admit that change was long overdue, however, I cannot help but feel that in the race to alleviate historical abuse of the system and establish a self-sustaining managed care solution, the human element has been sorely lost in this process. Though the train has left the station and there is no turning it around now, I am confident that the final destination can be greatly improved. --The best ideas usually come from the best of intentions, though when poorly executed... well, you know what they say about paving those roads.

As your constituent, I am responding to your email to respectfully request an opportunity to meet with you to discuss my concerns as a parent, stakeholder, and citizen of the State on behalf of my little girl and all special populations.

For your convenience, I have attached in this mail my previous letter and enclosures to Governor Beverly Perdue outlining in more detail concerns shared by many families across the State, copied to all members of the General Assembly on February 25th.

I will be contacting your office in the days following to schedule an appointment. I look forward to the opportunity to meet with you in person at your earliest convenience.

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

Kind regards,

Crystal J. De la Cruz - Hopper

Mother, Advocate & Concerned Citizen

contact info...

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

http://no2nchb916.blogspot.com/

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

--Hubert H. Humphrey

On Wed, May 9, 2012 at 1:40 PM, Sen. Neal Hunt <Neal.Hunt@ncleg.net> wrote:

	LEGISLATIVE NEWSLETTER K. NEAL HUNT 308 LEGISLATIVE OFFICE BUILDING District 15, Wake County May 9, 2012
Legislature 733-5850 nealh@ncleg.net	www.nealhunt.com	Business 781-3464 info@nealhunt.com

In one week the legislature will convene for the “short” session which meets during even years. The primary purpose of the upcoming short session is to make needed budget adjustments to the two year budget which we passed in 2011. The adjournment resolution from the 2011 long session stipulated that only budget amendments, noncontroversial local bills or bills that had passed either the House or the Senate can be considered. Typically the short session does not last very long as politicians want to go home to run their campaigns for reelection.

I thought it might be helpful to outline the accomplishments of the “long” session which ended July 1, 2011. As you may be aware, the new leadership of the Legislature found many challenges when we took office in January 2011. We had an approximately $3 billion budget hole left for us by the previous leadership. Excessive government spending, termination of federal stimulus dollars and loss of revenue due to the recession were the causes of this huge shortfall. We were able to fulfill our promises. To summarize last year’s session:

Actions Promised - Actions Accomplished:

HB-200 passed Bipartisan Balanced Budget – Reduced spending by over $1 billion and avoided a tax increase (we already had the highest taxes in the southeast). As Co-chair of Senate Appropriations, I can attest to many long days and nights to get the budget balanced. Governor vetoed…Legislature over-rode.
SB-689, SB-283, H-777 passed fair and legal Redistricting Maps for Congressional, State Senate and State House districts. Received US Department of Justice pre-clearance approval. Legislative attorneys are currently in court defending against lawsuits brought by the Democrat Party and the NAACP.
SB-33 passed Medical Malpractice Liability legislation. Helped to make health care affordable and available while reducing the cost of health care by eliminating the need for the practice of defensive medicine.Governor vetoed…Legislature over-rode.
HB-709 passed Workers’ Compensation Reform Legislation.
SB-781 passed Regulation reform legislation to make North Carolina businesses more competitive and to insure that our state’s regulations do not overburden those businesses.
HB-2 passed legislation to exempt North Carolina citizens and businesses from the high cost of National Health Care proposed by President Obama (Obamacare). Governor vetoed…Legislative over-ride pending.
SB-709 passed Energy Jobs Act legislation to study the possibility of “fracking” and off shore oil drilling. Job creation and energy independence are the goal if this energy production can be done with no environmental damage.Governor vetoed…Legislative over-ride pending.
HB-351 passed Voter (photo) ID legislation to promote and ensure honest and fair elections. Governor vetoed…Legislative over-ride pending.
SB-532 passed Employment Security reform legislation to reorganize, improve operation efficiency, and set on a pathway to solvency. Governor vetoed…Legislature over-rode.
Education Reform – Passed Education Reform to re-direct education funding into the classroom, added 1,100 new teachers, eliminated Charter School Cap, and required all third grade students to be reading proficiently before advancing to fourth grade.
As you can see, we had a busy agenda, but with hard work and strong leadership, we delivered on our promises to the people of this great State.

These actions are just the beginning of our effort to create a business-friendly environment and energize the private sector economy to help create jobs in North Carolina

In 2013 our plan is to present a comprehensive North Carolina tax modernization proposal which will allow our state to be competitive in a 21st Century global economy. Our goal is to produce a tax system that is transparent, simple, and promotes economic growth and prosperity for all.

Your comments and thoughts are welcome.

Neal

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08 May 2012

Family Stories Video

A very moving presentation and just a tiny glimpse into the challenging lives of families caring for children (and adults) with Intellectual and Developmental Disabilities... faces of families whose services and supports, and thus daily survival, will be and are detrimentally impacted by the implementation of the new 1915(b)(c) Innovations Medicaid Waivers...

Raleigh Trip Presentation of IDD Caregiver Voices and The Breakfast Club.

* If you are a parent or caregiver with a story to contribute, have correspondence exchanges  with legislative members you would like to share, please contact me at no2nchb916@gmail.com.

Parent Perspective: Parent Letter from K.Feller

A couple of months back, I received a heartfelt letter from a local special mom of two boys with Autism to deliver and share with Dr. Pat Porter in one of my meetings. I am posting with her permission. Thank you Kimberly!

Parent Perspective

March 1, 2012

RE: Concerns with NC HB 916

My name is Kim Feller and I live in Wake County. I am writing to you because I have two sons who both have autism and are covered by the Medicaid CAP Waiver program. Nick is 14 years old and James is 11 years old. I am concerned about the NC HB 916 which will greatly affect services. Both of my boys participate in several different therapies including occupational, speech, and social skills therapies. Also, they both take different medications for the treatment of aggressive behaviors, anxiety, and seizures. My youngest son who is 11 years old recently had a temporary residential placement at the Murdoch Developmental Center in Butner, NC where he stayed for three months. He was placed there due to aggressive behaviors which we were unable to handle at home. He is living back home again only because we have home staff provided through the Medicaid CAP Waiver program. We feel very fortunate that both our sons are currently covered by the Medicaid CAP Waiver program. The CAP Waiver program has been critical in providing our boys Home and Community services as well as funding for the aforementioned therapies, medicines, and residential services. These services support individuals in their home and community and avoid more costly institutional settings. Provider agencies just took an almost 3% rate cut on November 1, 2011, in addition to a 5% cut a few years ago. We are concerned that the cut to Home & Community service hours will make it difficult to retain the quality service providers we need to care for our boys. Working with children who have autism requires a certain level of commitment, sensitivity, and resilience which must be compensated accordingly. Also, the DHHS has recently implemented new limits on the number of hours our sons can receive. This concerns us a great deal because our youngest son needs constant supervision. If we don’t have enough home support hours the chances of our son reverting back to his prior aggressive behaviors will be greatly increased. It is much more economical to pay home staff than it is to pay for a residential placement!

The 1915 (b)(c) managed care waiver proposes that a single entity with a financial interest to keep funding low will determine eligibility for services, control who can provide services, develop the Person Centered Plan, and decide the level of funding. This is of concern to us because the decision makers would work for the Local Management Entity (LME) which has a financial interest to contain costs. There needs to be a decision maker representing solely the interests of the person with the disability as is currently happening with the Case Managers. The new plan should recognize the integrity of the Developmental Disability model by excluding Case Management from the Managed Care Entity and separating Developmental Disability from Mental Health and Substance Abuse. Developmental Disability is not an illness, and therefore should not be combined with Mental Health and Substance Abuse.

We appreciate any efforts you can make toward avoiding cuts in Home & Community Service hours as well as excluding Case Management services from the Managed Care Entity.

Thank you for your time and efforts.

Sincerely,
Kimberly H. Feller
contact info...

* If you are a parent or caregiver with a story to contribute, have correspondence exchanges with legislative members you would like to share, please contact me at no2nchb916@gmail.com.

Advocay Day & Popcorn Rally; Raleigh

Download flier.

In text:

THE MHDDSAS COALITION OF NORTH CAROLINA INVITES YOU TO OUR ANNUAL ADVOCACY DAY & POPCORN RALLY

TUESDAY, MAY 22, 2012

ADVOCATE FOR SERVICES AND SUPPORTS FOR MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES & ADDICTIVE DISEASE

THE LEGISLATIVE BUILDING IN RALEIGH

16 WEST JONES STREET, RALEIGH, NC 27601

Registration will open at 8:00 am on the back portico of the Legislative Building. Participants can get information on the day’s legislative committee meetings, the current budget proposal and begin visits with legislators.

Advocacy Trainings will take place in the Legislative Building Auditorium (third floor). Beginning at 9:00 am, short trainings will be held on ways to effectively communicate your message to Legislators. Volunteers will be in the auditorium with tips & techniques for making the most of your legislative visit.

Popcorn will be available on the portico beginning at 11:00 am!

(Please note that lunch will NOT be provided.)

RALLY – at 12:00 pm on Bicentennial Mall on Jones Street, across from the Legislative Building.

PARKING: Passengers in vehicles of any kind must be dropped off at the LEGISLATIVE BUILDING and park in other locations. Directions & parking information can be found on the website for the General Assembly.

Visit www.thecoalitionnc.org for more information.

The Coalition encourages you to participate in this event as we advocate for funding for mental health, developmental disability, and addictive disease services!

Additional Message from the Arc NC

Earlier today, you should have received a Policy Partners email outlining why North Carolina Should Slow Down Managed Care Implementation. It will take the combined efforts of our members and allies to get the General Assembly and the Administration to listen. That's why we are asking you to:

TAKE ACTION TODAY!

We need you to tell your story to the decision makers in state government about how changing to a Managed Care system has affected you or will affect you, making sure to tell them:

North Carolina needs to Slow Down Managed Care Implementation Until They Get It Right!
Restore Case Management to People With Intellectual & Developmental Disabilities!
Require that Managed Care Organizations (MCOs) prove that they are prepared to manage the new system effectively before they can move forward

Who Should I Contact, Where Should I Go?

Who to Contact:

Your NC legislators (both your NC Senator & Representative) Click here to see who represents you, or contact Ben Akroyd at The Arc of NC for help (bakroyd@arcnc.org, 919.500.8382)
Acting Secretary of DHHS Albert Delia (919.855.4800, al.delia@dhhs.nc.gov)
Your friends, family, and neighbors! Ask them to reach out to NC's decision makers as well!

Events to Attend:

Joint Legislative Oversight Committee for Health and Human Services
Tuesday, May 15, 2012 at 9:30 am
Room 643 of the NC Legislative Office Building (Across from the Legislative Building)
330 N Salisbury Street
Raleigh, NC 27603
The Coalition Rally at the NC Legislative Building (flyer posted here)
Tuesday, May 22, 2012
8:00 am - Registration on the back portico of the Legislative Building
9:00 am - Advocacy Training in the Legislative Building Auditorium (third floor)
12:00 noon - Rally at 12 noon on Bicentennial Mall on Jones Street, across from the Legislative Building
The DHHS Waiver Advisory Committee
(Sign up to speak ahead of time by calling Kathy Nichols with DMA at 919-855-4289 or Ken Marsh with DMHDDSAS at 919-715-1294)
May 22, 2012 from 1-3:00 pm
NCSU McKimmon Center
1101 Gorman Street
Raleigh, NC 27603

Thank you for your continued advocacy! We are facing some of the biggest changes to the I/DD system in over forty years, and your help is needed now more than ever!

If you have any questions at all, please feel free to contact Ben Akroyd at bakroyd@arcnc.org or 919.500.8382.

07 May 2012

Durham, Wake merge mental health agencies : NewsObserver.com

News and Observer article regarding the Durham - Wake merger:
Durham, Wake merge mental health agencies - Durham County - NewsObserver.com

Rally in Raleigh: 5/22 Mark Your Calendars!

The Arc of North Carolina
07 May 2012

The Rally in Raleigh: The Coalition Advocacy Day

Managed Care Issues Make Rally Especially Important

On Tuesday May 22, The Coaltion will have its Annual Advocacy Day & Popcorn Rally at the NC Legislative Building in Raleigh. The implications of the current Managed Care implementation schedule make it especially important for self-advocates and their families to attend!

The Coalition is an alliance of over 40 Mental Health, Developmental Disability, and Substance Abuse organizations of which The Arc of NC has long been a part.
Details on the Rally coming soon.

Sign up for The Arc of NC's newsletter.

Policy Partners is The Arc of North Carolina's biweekly email newsletter. It covers developmental disability policy on the federal, state, and occasionally local level. Its also a great way to learn about events The Arc is having in your area!

JLOC on HHS Meeting 5/14 - LME Governance Subcommittee

Email alert received from:

NCGA Committee Notices noreply@ncleg.net

North Carolina General Assembly

Joint Legislative Oversight Committee on Health and Human Services

Local Management Entity Governance Subcommittee

Representative Nelson Dollar, Chair

May 14, 2012

Legislative Office Building – Room 544

2:00-5:00 PM

[Driving Directions on the NCGA website]

Agenda

Welcome and Introductory Comments
Review of the Purpose of the Subcommittee
Review and Discussion of Revisions to the Statutory Language
Recommendations to the Joint Oversight Committee on Health and Human Services
Adjournment and Comments by Chairman Dollar

This message was sent to you by Rennie Hobby (Mental Health CA) (mentalhealthca@ncleg.net) because you signed up to receive NC General Assembly Committee Notices by email. To unsubscribe, visit http://www.ncleg.net/gascripts/Committees/Committees.asp?sAction=ViewDLForm&sActionDetails=Non-Standing&sActionDetails2=N6507