legislative correspondance to Senator Neal Hunt

UNSUBSCRIBE & personal note Re: Neal Hunt News 1 message

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

Dear Senator Hunt,

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

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

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

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

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

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

Our exhausted pleas continue to fall on deaf ears.

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

Kind regards,

--

Crystal J. De la Cruz - Hopper

Mother, Advocate & Concerned Citizen

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

http://no2nchb916.blogspot.com/

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

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

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

Twitter @SenatorNealHunt

Weekly Update from Alliance BHC

Here is the link for this week's Alliance newsletter - http://www.alliancebhc.org/wp-content/uploads/November-30-2012.pdf

...and here are a few highlights to note:

1. Alliance Announces MCO Delay
Alliance has submitted a request to NC DHHS for a 30-day delay in its start date as a managed care organization responsible for the implementation of the Medicaid 1915 (b)/(c) waivers. The new start date will be February 1, 2013. To access a press release, click:  http://www.alliancebhc.org/news/alliance-announces-delay-in-managed-care-implementation

Cumberland and Johnston Timetable
Alliance will initiate management of IPRS and locally-funded services for Cumberland County on December 17. The start date for Johnston County has been shifted to January 1.

2.  NC Innovations Individual and Family Guide
The Alliance NC Innovations Individual and Family Guide 2013 is available in English and Spanish on the Alliance website. To access these and other NC Innovations information and resources, click:

http://www.alliancebhc.org/consumers-families/idd-resources/nc-innovations-1915-c-waiver

3. Innovations Plus Community Forum

Alliance Behavioral Healthcare is working with the NC Department of Health and Human Services to improve the system of services offered to people with intellectual and other developmental disabilities who have CAP-I/DD now and will transition to the NC Innovations 1915(c) waiver in early 2013. The goal of this program is to create a fairer system and to ensure that people get the right amount of supports for their needs.

Thursday, December 13, 2012, 6:00-7:30pm
Alliance Corporate Office, 4600 Emperor Boulevard Room 105, Durham

To learn more about Innovations Plus, please join us at this meeting.  Alliance and DHHS staff will make presentations along with guest speakers from the Human Services Research Institute, which is assisting us with the program. For additional information, contact your I/DD Care Coordinator or Suzanne Goerger at (919) 651-8474.

4. ...and as always, check out the newsletter for calendar dates of Alliance CFAC meetings and are listed below for your convenience, too:

Alliance CFAC Meetings
    Alliance Corporate Office 4600 Emperor Boulevard Durham
    First Monday in February, April, June, August, October and December at 5:30pm

Alliance Durham CFAC Subcommittee Meetings
TROSA 1820 James Street Durham
First Monday in January, March, May, July, September and November at 5:30pm

Alliance Wake CFAC Subcommittee Meetings
401 E. Whitaker Mill Road Raleigh
Second Tuesday in January, March, May, July, September and November at 5:30pm

Hope to see you THIS Monday at Alliance CFAC meeting at 6400 Emperor Blvd in Durham at 5:30pm!

A Day in the Life...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you, thank you Dr. Grand!

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

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

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

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

Day Dreams from an Autistic Mind

Things tend to spread like wildfire on the net, with social networking fanning the flames... sometimes, there are jewels, like this gem from a Facebook page, Day Dreams from an Autistic Mind (click on the image to enlarge):

I loved the way this mom so succinctly summed up the challenges we face from those on the outside looking our way, and more importantly the sole reason we do what we do - for the love of our children.

Because I recognized the images are personal (with the exception of the upper center and cartoon), I contacted the mom to request permission to share her message and inspiration. She kindly obliged and included the following about her family:

"I am a mother of two children, Emma is 4 1/2 and Lukas is 3. He was diagnosed with Autism on November 17, 2011. He is moderately Autistic. He is also nonverbal. As soon as we found out we put him in early intervention that changed our lives. He is very smart and very clever. He is now in an Integrated Preschool using the TEACHH program and he gets OT, PT and ST. He is am amazing little boy and I love him just the way he is."

Thanks to Emma and Lukas's awesome mom for reminding us what it's all about! =)

Parent Guest Contributor: Anna Cunningham

There's a lot going in North Carolina regarding the statewide 1915(b)(c) Medicaid Waiver and CAP I/DD / mental health reform / overhaul... more than any one person (be it parent or professional, or I dare say, legislative member) can keep up with. 

As a short-staffed working mother of a DD teenager and new "typically developing" kindergartener, I often find it difficult to keep up with posting even the basic important stuff between "regular life" and "special life"...

I mean, as working parents of school-age children, we all know what it's like running the rat-race juggling our routine responsibilities, meet deadlines, pay bills, grocery shop, squeeze in the occasional doctor or hair appointment, and lug our kids around to various activities, play dates and so on... I do all that too.

But to put things in perspective for those working parents fortunate enough not to have to deal with the struggles and challenges of caring for and protecting a child (or adult) with Intellectual Disabilities, here's a breakdown of my extra "special" obligations so far for this calendar year:

• 1 three-day hospitalization,
• 22 (usually day-long)  medical appointments with doctors and specialists (to include: dental, endocrinology, behavioral, neurology, gastroenterology, ophthalmology, orthopedics, medical rehabilitation, and physical therapy),
• 2 (2+ hour) IEP's (last calendar year there were 5 or 6),
• 3 CAP-related meetings (not including countless phone calls), and
• 5 other special DD involved events, meetings, and happenings.

Those are just the appointments and meetings specially relating to the specialized care, well-being and education of my daughter and does not include sick days, Miracle League baseball games, legislative assemblies, meetings with Senators and Representatives, DWAC meetings, other advocacy meetings and rallys, nor does it include any of what most of us would consider "routine" responsibilities as a grown-up and a parent, such as extra-curricular activities and appointments for my "typical" child, nor for myself (as if I had time for me)...

Which is why I've frequently been asked, "When do you sleep?!" Well, I don't, much.

That's just how we special parents roll. 

But because the future of our children and their peers during this transition period is so vitally important and there's a great deal of important information to get out, explain, break down, dispel, and share with others, I've invited fellow Special Mother and Advocate, Anna Cunningham, to join in the blogging fun.

It's not uncommon when I'm out banging cans and preaching my cause to be asked if I know Anna or for someone wanting to connect us... I mentioned that to Anna when we spoke regarding sharing the voice of the World Wide Web; she laughed and said the same thing happens to her about me. ;-)

More about Anna...

Program Coordinator Needed for Lifetime Connections

FIF Lifetime Connections Program Seeks Program Coordinator

Program Coordinator for Lifetime Connections program; full-time, possible part-time options; generous benefits. Position is located in Durham at headquarters of statewide non-profit providing innovative supports and services to people with disabilities and their families. The Coordinator: recruits and maintains relationships with members, community connector staff and volunteers, ensures quality of services and support for member families, coordinates workshops, and manages budget. Seeking person interested in and experienced with disability issues and family support concepts, Community Development expertise, membership and volunteer recruitment, and budgeting. Applicant should have strong communication, organizational skills, be flexible to travel for some night and weekend meetings, and have use of car. 

First In Families of NC is an Equal Opportunity Employer. Review our website before applying: www.fifnc.org. Apply in writing to Human Resources; First In Families of NC; 3109 University Dr Suite 100, Durham NC 27707 or email betsym@fifnc.org. No calls or unscheduled visits please.

Betsy MacMichael

State Director

First In Families of North Carolina

3109 University Drive; suite 100

Durham, NC 27707

(919) 251-8368 X100

Fax: (919) 400-4846

www.fifnc.org

Believe, Achieve, Give Back

I/DD Budget Cuts May Be Worse than Expected

From The Arc of North Carolina

I/DD Budget Cuts May Be Worse than Expected

[ original post here ]

In what is being described as a mistake, a budget transfer intended to move Guardianship funding from one division to another has created an additional 4.3 million dollar cut primarily to community services for people with I/DD.

Department officials and legislative leadership agreed to transfer $4.3 million in the Social Services block grant from the Division of MHDDSA to the Division of Social Services. The money was to be used by either Corporate Guardians or local DSS to provide guardianship services. The transfer was needed because, as LMEs transfer to MCOs, they will no longer be allowed to be guardian for individuals in their catchment areas.

Somehow the transfer of funding happened twice causing an additional cut of 4.3 million dollars to MHDDSA community services funding. Department officials tell us that this was never the intent and discussions with legislative staff point to a mistake, although we have no official confirmation. Unfortunately, the reduction has been included in the allocations to LME/MCO’s and several are taking immediate action to cut services. We are hearing reports that some programs face 20% reductions effective August 1st.

The Arc is calling on the DHHS to ask LME/MCO’s to hold off on implementing this reduction until all possibilities of fixing the problem have been exhausted. This reduction to an already fragile system is unwarranted and will harm individuals with I/DD.

The Arc is also concerned about how LME/MCO’s are implementing the one time $20 million reduction to community services. This cut is an extension of a reduction taken last year. While LME/MCO’s were encouraged to use fund balances to offset this reduction last year, we do not believe most did so. We are seeing a disturbing trend that has LME/ MCO’s passing on this entire cut to people with disabilities and their families. We believe a more responsive approach would be for LME/MCO’s to use fund balances to offset this reduction since it is a non-recurring cut. It does not seem appropriate for the Management Entities, who are charged with ensuring individuals have services, to use fund balances to become MCOs while the people they are created to serve lose services.

We will be tracking these reductions and will continue to encourage the State and LME/MCO’s to find alternatives to wholesale reductions for people with disabilities and their families.

Once we determine what steps the DHHS plans on taking, we will issue an action alert describing what actions people with disabilities and their families should take, if any, to influence these changes.

Related : 

• MCO Western Highlands Network estimates 3.5 Million Shortfall since January 2012.
• LME Smokey Mountain Center holds community forums regarding 3.4 Million Service Funding Reduction.
• Disability Rights NC Press Release : State fails to settle with DOJ but announces 8 year plan, 7/26.
• News and Observer article : LME Money Woes, from 7/18.

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

From The Arc of NC

Despite overwhelming support from families and people with disabilities across North Carolina, it appears the NC General Assembly will not act on The Arc’s proposal to restore balance in our state’s Managed Care Organizations. Without action, individuals with intellectual/developmental disabilities (I/DD) and their families will no longer have someone other than the Managed Care Organization write their person centered plan (plan of care), unless the MCO chooses to allow that option. Currently, no MCO in the state plans on offering this option. This means that plans of care for people with I/DD will continue to be developed by the same organization that determines how much funding an individual will receive.

Though our proposal faced long odds in the legislative short session, many legislators expressed support for the proposal. Unfortunately, erroneous information on the costs of our proposal given to legislators by certain MCOs, combined with the efforts of powerful lobbyists employed by some MCOs, proved too difficult to overcome. While there is still time for the legislature to act, it is unlikely any action will take place before their adjournment this week.

The lack of action will result in an additional ten thousand people with I/DD losing Case Management Services by January 2013, without the benefit of an independent broker working for them and not the MCO. Additionally, hundreds of private sector jobs will be lost while MCOs expand their workforce.

The legislature's lack of action is particularly disappointing since The Arc attempted to make our proposal fit what legislative leaders suggested. Though we believe a more robust private Case Management system makes sense for people with I/DD, we adjusted our proposal to the more limited two functions of Care Coordination. Legislative leadership needed a state budget neutral proposal, and our proposal would not increase the state budget. Our efforts were a sincere attempt to modify a model that is not a good fit for people with I/DD before the model was implemented statewide. The fact that legislators were unwilling to address these issues is very disconcerting.

While terribly disappointed in the outcome, we are pleased that so many spoke out for what is right for people with intellectual and developmental disabilities. Over 1100 North Carolinians from all parts of NC signed the petition to support this proposal with over 200 heartfelt comments about their situation. Hundreds of families called their elected representatives and participated in legislative meetings, making elected officials aware of the serious concerns they have about the future of our system.

The Arc encourages MCOs to listen to people with I/DD and their families in the coming months and contract with independent care coordinators to write plans and link to services, as is allowed under current law. Such a model, designed appropriately, will provide much needed support and be cost effective.

Regardless of the ultimate outcome of this legislative session, The Arc will continue its efforts to modify the State’s plan for Managed Care for people with I/DD. We believe legislators and administration officials, when properly informed, will see the flaws in the design of the current system for what they are and make appropriate changes.

We encourage families and consumers to continue to voice your concerns to legislators and the administration through all available channels. The Arc will begin publishing information on how best to influence the managed care Waiver implementation beginning in early July.

For now we want to thank all of you for your incredible advocacy this year! While not having our proposal adopted is disappointing, your actions significantly altered the debate around HB 916 in the legislature. Your voice will be needed more than ever as this transition moves forward.

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

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 270

To: Webmedpolicy, Dma
Cc: R&T Gmail account
Subject: 8M-CAP-I-DD
Sent: Thursday, August 11, 2011 4:43 PM

To whom it may concern,
I am extremely concerned by the proposed changes to the CAP waiver. Please consider the following before you make any changes.

Twenty hours of habilitative care per week during the school year is not sufficient for our autistic son. The improvements in behavior, language and social skills we have seen as a result of the hab techs hard work with our son have been a blessing and are truly invaluable. A decrease in hours would be devastating to all the effort put forth by our family and his workers. I know that we are not the only family that feels this way and this strongly about this proposed change. Please do not cut these hours!!!!!

Do not remove home supports either! Our son is not yet 18, but we know other families that are relying heavily on these services for their kids. I would hope and pray home supports would be available when he is 18 to give him a chance at a better life.

I know each one of you cares about the population supported by CAP. I would hope you would not be in this job otherwise. It took our family six long years from our initial application date until our son received his waiver. It was a devastating time financially for our family from which we have not recovered as we tried to do what we could without any support. I know that these are desperate financial times for everyone in this state and in this country, but this population of people and their families are already deeply in debt and desperately need the invaluable assistance provided by the CAP waiver. I beg you not to make a stressful and difficult situation worse. The autistic population in this state had no choice when it came to being autistic. You can make a choice to support them by not changing the CAP waiver. Thank you for your consideration of our ideas on this matter

DMA 8M Public Comment on CAP-I/DD 293

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 293

To: Webmedpolicy, Dma; Office of the Governor; kpowell@arcnc.org; Michael Cooper; admiral ballard; opinion@charlotteobserver.com
Subject: 8M-CAP-I/DD
Sent: Thursday, August 11, 2011 9:59 PM

To Whom it may concern:

I am writing to share my thoughts on the waiver changes proposed by DHHS/DMA for Community Alternatives Program for Individuals with Intellectual/Developmental Disabilities. I do not understand the details and technical terms as well as I should but I understand enough to know vital services are proposed to be cut. I worked outside the home for the first 18 years of my daughter's life to provide for her and was lucky to have parents to help me with childcare. When Jordan turned 18 I was able to stay home and provide Home Supports through CAP for her which resulted in an amazing improvement in our lives. I was no longer so exhausted from working all day and taking care of her all night that we actually began to enjoy our life rather than getting by.

If Home Support hours are cut I will be forced to work an outside job again to pay our bills. If other support services are cut then who will care for Jordan while I work this other job? My parents have retired, moved and are unable to help me now that they're older. I have never even thought of a group home or institution until now. If I can't care for her and she was to go to a group home or institution then the government would be paying for that. Why would you take my income and give it to a group home or institution when my sole purpose in life is to love and care for her. I would personally live in my car if that's what it took to keep Jordan with me but I would hope it would never come to that. I have worked from the age of 16, paid my taxes, never had government assistance and never plan on it. I don't want food stamps or welfare or my daughter placed outside our home. I want to be paid for the job I am doing which is to provide 24/7 care for Jordan. I love her, want to care for her and grow old with her.

I would hope you wouldn't make these changes so the families of people with disabilities can stay together and have the lives they deserve. I thought that was the purpose of Home Supports and other support services. Stop giving more money to drug addiction programs, released convict programs, etc. and let us keep what our children deserve and need.

Sincerely,

Donna C.
Pineville, NC

DMA 8M Public Comment on CAP-I/DD 257

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 257

To: Webmedpolicy, Dma
Cc: Marty Johnson; marysam@westernhighlands.org
Subject: comment on cap changes for I/DD
Sent: Thursday, August 11, 2011 1:35 PM

To whom it may concern,

The changes that maybe made to CAP for l/DD will greatly impact my "son'. Especially, the changes to Residential. lf the changes go into effect, my wife and I will probably have to seek ICF/MR placement for him.
This is a long story. My "son" came to live with us when he was five. He had already been assessed at Amos cottage in Greensboro twice which recommended that he be institutionalized. The foster home that he was in could only contain him by locking him in his room. He came to us with CAP services and we were his foster parents. During the first eighteen months, we had a habilitation worker for 6 non-consecutive months. No afterschool or summer program would work with him without a worker. Both my wife and I were taking off work to cover his care which started to put us in trouble at work. At this point, the local Area Program helped my wife to become his CAP provider. This solved the
problem for us for a long time. Our "son" made a great deal of progress. We had wanted to adopt him, CAP made several back and forth decisions on parents providing CAP services for their children. And given our experience with not being able to keep CAP workers(which put our jobs at risk), we decided not to adopt him to be able to continue to have him live with us. I could not see giving him our name, if he then had to live outside our home. Overall CAP has worked well for him and made a different prognosis from the earlier one possible. When my "son" became a teenager, it became necessary for my wife and I to switch roles. She now works outside the home and I work with my "son". My "son" has autism and mental retardation. And despite medical intervention, he does not sleep through the night. When he gets up, I have to get up with him as he willget into the kitchen, etc. without regard to his safety.
The proposed changes to residential with limits to day supports and respite v0ill impact us greatly. I have experienced working around the clock with our "son" during the last three summers of high school when no summer programs where available or would take him because of his activity level. When he left school and started a year round day program with day supports, lwas able to recover from being worn out. Now I am able to prepare for my "son" while he is at the day program.
For many years we had a couple who provided overnight respite for our "son" in spite of his not sleeping. But two years ago, they had to stop. Since then I have had one ovemight break, despite numerous requests for service providers. To keep going I have used hourly respite during the day to take a break. Without this it will be difficult to keep going and will place a financial hardship on our family.

Thank you for listening.

Martin J.
Asheville, NC

Public & Parent Perspectives: Did You Hear Our Voice?

In case you missed the posting of DMA's Public Comments on the 8M Clinical Coverage Policy proposals in May and July of 2011, I'm posting again as I recently updated the post with additional files - namely the 2 different proposals which were posted for comment, a side-by-side comparison of the two proposals, and the 2010 8M Clinical Coverage Policy prior to the changes.

Here are the documents again:

ORIGINAL PROPOSED CLINICAL POLICIES for CAP-IDD:

• DMA 8M Clinical Coverage Policy for CAP-IDD proposal posted for 45 day Public Comment period (05/12 thru 06/26).
• DMA 8M Clinical Coverage Policy for CAP-IDD proposal posted for 15 day Public Comment period (07/28 thru 08/11).

NOTE: The 15-day posted proposal drastically differs from the 45-day posted proposal, with a total of 14 pages deleted from the second proposal posted.

• Side-by-side document comparison of DMA's two 8M proposals.
• DMA 8M Clinical Coverage Policy for CAP-MR/DD from July 2010.

PUBLIC COMMENTS on CAP-IDD CHANGES:

• DMA Clinical Coverage Policy for CAP-IDD proposal Public Comments from May 12, 2011 thru June 26, 2011 (101 comments; 79 pages).
• DMA Clinical Coverage Policy for CAP-IDD proposal Public Comments from July 28, 2011 thru August 11, 2011 (439 comments; 539 pages).

Comments were made from across North Carolina by many parents and caregivers sharing heartfelt details of their lives as well as professionals, providers, and advocates in the DD field who know well the devastating impact such changes and service cuts would have not only on the recipients and families they serve and care for, but on their small businesses, their livelihood and the lives of staff they employ as well.

It is our sincerest hope that our elected officials - our Governor and members of the North Carolina Senate and House of Representatives - aspiring candidates, policy-makers, Health and Human Services administrators, LME's, MCO's, and other stakeholders and powers that be take the time now to hear that voice as our lives are in your hands... not merely the quality of our lives but rather our ability to live.

Here's a synopsis / overview of the initial 8M Clinical Coverage Policy proposal posted for comment from May 12 - June 26 from special parent, Mary K. Short (Mary's comment in blue, the rest are quotes from the 8M). --Remember, the second proposal is less 14 pages.

There are a couple of things that caught my eye. The most important may be that they have proposed changing the respite policy so that you CANNOT use respite on a day you use Home Supports or are an AFL. I would hope you all contact your child's primary care physician and ask him/her to send in a comment to the DME web site in opposition of that proposal. Remember, the comments are reviewed by the PAG (Physician's Advisory Group) and I think your MD's comments are going to carry more weight than your comments. BUT you should send you comment, too! I have never understood where the "best practice" is that says respite cannot be regular and scheduled, so I certainly cannot understand where the "best practice" is that says the primary caregiver can't use four (4) hours of respite every Sunday so they can attend church services in order to pray for strength to continue fighting the battle against ridiculous proposed clinical policies!


The respite changes are throughout the document! However, in the list of Service Definitions, either Crisis Respite or Respite pretty much spells it out. Page 54 of the document or page 101 and then go to the "Service Limitation."


The next couple of things that caught my eye are outlined below. The first is this idea of "habilitative" and how it jumps in and out throughout the proposed clinical policy. The most disturbing loss of habilitation comes in the form of Residential Services to replace Residential Supports. The new Residential Services is NONHABILITATIVE and that would seem to signal the providers that they could now simply park an individual in front of a TV! I am sure it also signals a tremendous rate change coming to them. But somehow, AFL's, who are paid that service definition of Residential Services, is singled out as HABILITATIVE. Huh? And then that designation as HABILITATIVE for both AFL's and HOME SUPPORTS limits the individual to 129 hours of any combination of habilitative services (day supports, HCS, etc.), yet the Residential Services individual has a limit of 209 hours! That is a HUGE penalty for living in an AFL or in a family home ... or is it a HUGE incentive to move to a group home?

Bottom of page 2: ...

1.1.5 Habilitation Services
Habilitation services are those services designed to assist participants in acquiring, retaining, and improving the self-help, socialization and adaptive skills necessary to reside successfully in home- and community-based settings.

Bottom of page 10: ... this is eliminated:

Residential Supports is a habilitation service, with built-in Personal Care at a daily rate to meet the flexible daily needs of the individual. As a blended service, its range of hours for each NC-SNAP level of service (Level 1 through Level 4) includes both components—personal care and habilitation. This hour range
indicates the hours of direct contact service and support expected for each level of the service.

Top of page 11: ... and is replaced with this:

The service also provides assistance, support, supervision, and monitoring that supports individuals to participate in home or community activities. This service is not a habilitative service; however, the service shall be conducted in a manner that promotes and encourages independence

Page 12: Home Supports remains habilitative:

5.1.3 CAP-MR/DD CAP-I/DD Participants Receiving Home Supports 
Home Supports is provided only to adult participants who reside in their natural home with their parents (natural, adoptive or step parents) and other family members, where the parents (natural, adoptive or step parents) of the adult participant request to provide the Home Supports to the participant. Home Supports is a habilitation service, with built-in Personal Care at a daily rate to meet the flexible daily needs of the individual. As a blended service, its range of hours for each NC-SNAP level of service (Level 1 through Level 5) includes both components—personal care and habilitation. This hour range indicates the hours of direct contact services and support expected for each level of the service.

Page 14: The second paragraph says to focus on habilitation needs:

5.3.2 Person Centered Plan Reviews
At a minimum, the responsible professional (Targeted Case Manager) shall review the Person Centered Plan based upon the target date assigned to each goal, when the individual’s needs change, or when a service provider changes. For CAP-MR/DD CAP-I/DD participants, the Targeted Case Manager shall
review the Person Centered Plan every year prior to the individual’s birthday month.

The person-centered planning team shall focus on the habilitation needs of the
individual. Services that are habilitative in nature are not covered under the State
Plan except in an ICF-MR; however, they may be covered as a distinct waiver
service. In reviewing the Person Centered Plan, the Targeted Case Manager shall
include a review of the individual’s progress toward meeting goals identified on
the existing plan and document adjustments made as necessary.

Page 37: An AFL setting is habilitative:

Alternative Family Living
For the purposes of the CAP-MR/DD CAP-I/DD waiver, an Alternative Family Living (AFL) home or adult foster home is considered an out-of-home setting for a person who chooses this setting. The participant receives 24-hour care and lives in a private home environment with a family who are paid to provide services to address the care and habilitation needs of the participant. The family will continue to reside in this home if they choose to no longer provide supports and the participant moves from their home. The LME and targeted case manager are responsible for monitoring the health and safety of the participant. CAP-MR/DD CAP-I/DD funds may not be used for room and board costs.

Page 64: (Day Supports AND Home & Community Supports service limitations both have this service limit sentence about habilitation hours and residential setting.)

Service Limitations:
The maximum combined habilitation services limit is 129 hours per month for all habilitative services with the exception of individuals receiving Residential Services who may receive up to 204 hours per month for all habilitative services.

Page 75: (Home Supports is habilitative.)

K. Home Supports
Service Definition and Required Components:
The intent of this service is to meet the habilitation and personal care needs of adult participants (18 years or older) who choose to live with and receive supports from their families and whose families wish to provide services to the participant in their family homes. Home Supports is designed to provide flexibility and reflect the natural flow of the participant’s day. ...

... This service is distinctive in that it includes habilitation and training activities, as well as care and assistance with activities of daily living when the participant is dependent on others to ensure health and safety. ...

Bottom of page 77: (Underline indicates STRIKE OUT.) Utilization Management (UM) for Home Supports eliminates habilitation:

f. This service requires identification of goal directed progress
g. Habilitation requires goal related process on the Person Centered Plan

Page 85: (NO STRIKE OUT ?!) UM for Long Term Vocational Supports or Specialized Consultative Services or Supported Employment keeps habilitation:

f. This service requires identification of goal directed progress
g. Habilitation requires goal related process on the Person Centered Plan

Page 93: (COMPLETE STRIKE OUT) Residential Supports eliminated.

Residential Support Services
Service Definition and Required Components:
Residential Support Services provides assistance with acquisition, retention, or improvement in skills related to activities of daily living, such as personal grooming and cleanliness, bed making and household chores, eating and the preparation of food, and the social and adaptive skills necessary to enable the individual to reside in a non-institutional setting. Habilitation, training and instruction, blended with elements of support, supervision and engaging participation, are combined to reflect the natural flow of training, practice of skills,
and other activities as they occur during the course of the person’s day. This service is distinctive in that it includes habilitation and training activities, as well as care and assistance with activities of daily living when the individual is dependent on others to ensure health and safety. ...


Page 97: Residential Services replaces Residential Supports and is now non-habilitative:

Q. Residential Services
Service Definition and Required Components
Residential Services provides personal care and supervision for individuals residing in out of home placements. These homes include licensed residential Group Homes and Alternative Family Living Homes (AFLs) and residential settings not requiring licensure such as one person Alternative Family Living Homes and One Person Group Homes. A one person group home is a home that is operated by a provider agency. In a One Person group home if the participant wishes to change to a different Residential Service provider, the individual is required to move to another location/residential setting.


Residential Services includes personal care and assistance with activities of daily living as appropriate for the support need of the individual. The service also provides assistance, support, supervision, and monitoring that supports individuals to participate in home or community activities. This service is not a habilitative service; however, the service should be conducted in a manner that promotes and encourages independence. ...

Page 100: Again, an AFL is habilitative:

Additional Guidance:
For the purposes of the CAP-I/DD waiver, an Alternative Family Living Home or Adult Foster Home for one person is provided as an out of home placement for a person who chooses this setting or whose family cannot provide care for that person. The individual receives 24-hour care from and lives in a private home with a family in a home environment where the services are for the care and/or habilitation of the individual. The home does not require a license because it serves only one adult with a developmental disability. The LME and targeted case manager jointly monitor the health and safety of the participant. ...

NC DHHS DMA CAP I/DD Public Comments Dox

Where are the voices you ask?...

Whenever the Department of Health and Human Services / Division of Medical Assistance proposes new policies and / or policy changes, they are required to post them online for so many days for public review and comment. Policy proposals on all Medicaid related topics can be found here. Spring of 2011, the two Clinical Coverage Policy proposals for CAP IDD 8M were posed for public review comment twice.

ORIGINAL PROPOSED CLINICAL POLICIES for CAP-IDD:

• DMA 8M Clinical Coverage Policy for CAP-IDD proposal posted for 45 day Public Comment period (05/12 thru 06/26).
• DMA 8M Clinical Coverage Policy for CAP-IDD proposal posted for 15 day Public Comment period (07/28 thru 08/11).

NOTE: The 15-day posted proposal drastically differs from the 45-day posted proposal, with a total of 14 pages deleted from the second proposal posted.

• Side-by-side document comparison of DMA's two 8M proposals.
• DMA 8M Clinical Coverage Policy for CAP-MR/DD from July 2010.

Comments were made from across North Carolina by many parents and caregivers sharing heartfelt details of their lives as well as professionals, providers, and advocates in the DD field who know well the devastating impact such changes and service cuts would have not only on the recipients and families they serve and care for, but on their small businesses, their livelihood and the lives of staff they employ as well.

On behalf of Isabel and all her special friends, Thank You! - each and every one of you for all that you do and sacrifie to give our children a Voice!

It is our sincerest hope that our elected officials - our Governor and members of the North Carolina Senate and House of Representatives - aspiring candidates, policy-makers, Health and Human Services administrators, LME's, MCO's, and other stakeholders and powers that be take the time now to hear that voice as our lives are in your hands... not merely the quality of our lives but rather our ability to live.

PUBLIC COMMENTS on CAP-IDD CHANGES:

• DMA Clinical Coverage Policy for CAP-IDD proposal Public Comments from May 12, 2011 thru June 26, 2011 (101 comments; 79 pages).
• DMA Clinical Coverage Policy for CAP-IDD proposal Public Comments from July 28, 2011 thru August 11, 2011 (439 comments; 539 pages).

Mary K. Short was kind enough to forward the compilation of comment documents along after finally receiving them from DMA. Thank you Mary.

*Please note: Though public documents, I have done my best to remove personal contact information to include email and postal addresses for individuals. 

In a message dated 5/29/2012 2:27:25 P.M. Eastern Daylight Time, brad.deen@dhhs.nc.gov writes:Dear Ms. Short,
Again, I apologize for the email mixups. Attached are the public comments you requested. If we can assist further, please do not hesitate to call me.
Brad DeenNC DHHS, Office of Public Affairs919-855-4840
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized State official. Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this e-mail in error, please notify the sender immediately and delete all records of this e-mail.
-----Original Message-----From: "Skinner, Eric"
To: "Bush, Melanie E"
Subject: FW: Public comments Date: Wed, 9 May 2012 17:06:27 +0000
Here is the first email.
Eric Skinner Administration Services Officer Director's Office NC DHHS Division of Medical Assistance
1985 Umstead Drive 2501 Mail Service Center Raleigh, NC 27699-2501 919-855-4108
919-733-6608 (fax)

From: Terrell, Sandra D
Sent: Wednesday, May 09, 2012 12:28 PM To: Skinner, Eric Subject: FW: Public comments
Eric:
This was sent on April 10th but to Brad Deen who sent it to DMA clinical policy. There is another email with attachment to follow.

From: Johnson, Susan
Sent: Wednesday, May 09, 2012 12:12 PM To: Terrell, Sandra D Cc: Crosbie, Kelly Subject: FW: Public comments
Sandy,

There was so much info, I divided and sent in two emails. My next email will be the remainder. Please let me know if you have any questions. Thanks
Susan E. Johnson Developmental Disabilities Manager Behavioral Health Section, Clinical Policy Division of Medical Assistance 919.855.4299 susan.e.johnson@dhhs.nc.gov
From: Johnson, Susan
Sent: Tuesday, April 10, 2012 12:12 PM To: Deen, Brad Cc: Crosbie, Kelly Subject: Public comments
Brad,

Attached you will find the first part of the public comments. I am sending the second in the next email.
Susan E. Johnson Developmental Disabilities Manager Behavioral Health Section, Clinical Policy Division of Medical Assistance 919.855.4299 susan.e.johnson@dhhs.nc.gov
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized State official. Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this e-mail in error, please notify the sender immediately and delete all records of this e-mail.
-----Original Message----- From: "Skinner, Eric"
To: "Bush, Melanie E"
Subject: FW: Public comments 2 Date: Wed, 9 May 2012 16:52:23 +0000
Do you want me to forward this to Brad? You weren’t’ copied on this.
Eric Skinner Administration Services Officer Director's Office NC DHHS Division of Medical Assistance
1985 Umstead Drive 2501 Mail Service Center Raleigh, NC 27699-2501 919-855-4108
919-733-6608 (fax)

From: Terrell, Sandra D
Sent: Wednesday, May 09, 2012 12:29 PM To: Skinner, Eric Subject: FW: Public comments

The second set. Again, sent on April 10th to Brad Deen
From: Johnson, Susan
Sent: Wednesday, May 09, 2012 12:12 PM To: Terrell, Sandra D Cc: Crosbie, Kelly Subject: FW: Public comments

Sandy, Here is the 2nd email sent.
Susan E. Johnson Developmental Disabilities Manager Behavioral Health Section, Clinical Policy Division of Medical Assistance 919.855.4299 susan.e.johnson@dhhs.nc.gov
From: Johnson, Susan
Sent: Tuesday, April 10, 2012 12:14 PM To: Deen, Brad Cc: Crosbie, Kelly Subject: Public comments 2
Brad,
Here is the second set of comments. This set is from the 15 day posting. Please let me know if you have any questions. Thanks
Susan E. Johnson Developmental Disabilities Manager Behavioral Health Section, Clinical Policy Division of Medical Assistance 919.855.4299 susan.e.johnson@dhhs.nc.gov