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.
Showing posts with label legislative action. Show all posts
Showing posts with label legislative action. Show all posts
27 June 2012
14 June 2012
Medicaid Reforms May Leave Developmentally Disabled in the Cold
Note: highlights, links, italicized quotes as well as comments in *purple are entirely my own mark-up and not reflective of the author nor original posting, link below.
--For more information in a detailed outline with supporting documents regarding critical issues facing NC's DD populations and families, CLICK HERE.
This is why we MUST PAUSE!
Jun. 11th, 2012
[ Original article from Carolina Journal Online ]
RALEIGH — Developmentally disabled North Carolinians could slip through the cracks as mental health services across the state transition into a new health care delivery system.
Advocates for developmentally disabled patients fear that thousands of patients might lose case management services as local and regional mental health organizations (often called local management entities, or LMEs) begin implementing a managed care system of health care delivery. Time is running out for lawmakers to make the statutory changes if they want to fix the problem before the transition is complete the first of the year.
People with developmental disabilities include people with autism, cerebral palsy, Spina bifida, Down’s syndrome, and intellectual disabilities.
A law that passed last year changes the delivery of patient care to Medicaid recipients of mental health, developmental disability, and substance abuse services. The effort seeks to expand a service-delivery model employed by Piedmont Behavioral Health Services, headquartered in Cabarrus County, statewide.
Lawmakers hope the change, when complete, will result in increased efficiencies for the Medicaid-related services.
The primary emphasis of the new law was to improve services for the mentally ill. But in what may have been an unintended consequence of the legislature’s actions, advocates for the developmentally disabled worry that the patients and families they serve may have been overlooked.
Julia Adams, assistant director of government relations for The Arc of North Carolina, said that case management is key to making sure developmentally disabled patients and their families get the health care and support services that they need.
Case managers are “experts in understanding the needs of this specific community and how to best help this community,” Adams said, noting that a lot of people with developmental disabilities often have difficulty figuring out the complexities of their care on their own.
Adams said that approximately 6,000 such patients could slip through the cracks.
While a handful of area mental health organizations already have made the move to the new managed care model, most have not. However, state law requires all of them to shift to the new model by Jan. 1, 2013.
*Whoa Nelly! WE ARE NOT READY.
Patients and family members already are reporting problems they’ve encountered from the changeover in some parts of the state.
Jane Lindsey, whose 21-year-old child suffers from a number of disorders, has encountered problems getting a psychiatrist for her child.
Lindsey’s family took guardianship of their child when she was 4 months old.
“She was a shaken baby,” Lindsey said. The adult child sees about 12 different specialists. “She has three immune disorders,” Lindsey said. “At times, she can have a list of 40-plus medications.”
Lindsey, who lives in Hendersonville, said that on Feb. 14, when her child was headed home from a doctor visit, she experienced a panic attack. Despite having numerous meetings with and calls to area officials, Lindsey has been unable to get a psychiatrist to see her child for clinical intervention.
Procedures stipulate that the managed care entity must authorize such services before they are delivered.
“According to her neurologist, if she continues to have these panic attacks, she will die,” Lindsey said.
Targeted management had been provided by for-profit and nonprofit private organizations. Those businesses will close down, Adams said. She said 150 people within the Arc of North Carolina will no longer work for the private sector.
*Small agency owners and providers - some of the best, most honorable, passionate professionals in the field - are being set up for failure!
Jim Jarrard, deputy director of the state Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, said that responsibilities of former case management workers will be divided among care coordinators and community guides.
*Care Coordinators will be accessible via central call center (unless there has been a recent change?) while the minimum qualifications for Community Guides include: 18 years of age, high school diploma, and valid NCDL.
While the new coordinators and guides won’t be as “robust” as the former case managers, Jarrard said that “they certainly help you navigate the system.”
Jarrard said he understands the concerns that have been raised about case management. “We’re trying as hard as we can to try to allay fears,” Jarrard said. “I think change is always hard for people.”
*Mr. Jarrad: We are NOT afraid of change; our lives ARE change... this is not our first rodeo. --We are afraid of losing wonderful staff who are payed nothing for the jobs they do; of losing the invaluable support of case managers we've built trusting relationships with; of having to quit our jobs to fill in gaps that shouldn't be there; of not being able to care for the children we love AND survive; of having to surrender our children to salvage the rest of our family members...
And we're afraid no one is listening - and too little too late is just too much to risk our lives for.
Adams counters that fear of change isn’t the problem. “People are actually getting into crisis because the system is not functioning,” Adams said.
Adams said she is working with lawmakers in an effort to make sure developmentally disabled patients get the treatment plans and service referrals they need.
Two legislators — Sen. Ralph Hise, R-Mitchell, and Tom Murry, R-Wake — said they are working on legislation to resolve the problem.
“We know what we want to do,” Murry said. “We’re just trying to see if we can get it done in the time remaining.”
“We’re in the drafting process,” Hise said. But he noted that Senate committees are shutting down and legislative leaders have set a June 19 target date for adjournment.
Adams said the changes need to be made this session, and if legislators believe it’s a priority, it can be accomplished.
“I think they need a green light from the leadership,” Adams said.
If they wait until the 2013 session, which would start in late January, case management services would have already ceased, she said.
*Why are we in such a hurry to race this through haphazardly? Shouldn't we want to make absolutely, positively certain that this is done RIGHT? That no one falls through the cracks? That no one ends up with egg on their face and the State is not opening itself up to more federal lawsuits and yet another DOJ investigation?
“By the time the fix comes, there may be nobody left to work with these people,” Adams said.
*What if this were your child? Would you leave these issues hanging 'til next session?
Barry Smith is an associate editor of Carolina Journal.
--For more information in a detailed outline with supporting documents regarding critical issues facing NC's DD populations and families, CLICK HERE.
This is why we MUST PAUSE!
Medicaid Reforms May Leave Developmentally Disabled in the Cold
Unintended consequence of 2011 law to improve treatment of mentally ill
By Barry SmithJun. 11th, 2012
[ Original article from Carolina Journal Online ]
RALEIGH — Developmentally disabled North Carolinians could slip through the cracks as mental health services across the state transition into a new health care delivery system.
Advocates for developmentally disabled patients fear that thousands of patients might lose case management services as local and regional mental health organizations (often called local management entities, or LMEs) begin implementing a managed care system of health care delivery. Time is running out for lawmakers to make the statutory changes if they want to fix the problem before the transition is complete the first of the year.
People with developmental disabilities include people with autism, cerebral palsy, Spina bifida, Down’s syndrome, and intellectual disabilities.
A law that passed last year changes the delivery of patient care to Medicaid recipients of mental health, developmental disability, and substance abuse services. The effort seeks to expand a service-delivery model employed by Piedmont Behavioral Health Services, headquartered in Cabarrus County, statewide.
Lawmakers hope the change, when complete, will result in increased efficiencies for the Medicaid-related services.
The primary emphasis of the new law was to improve services for the mentally ill. But in what may have been an unintended consequence of the legislature’s actions, advocates for the developmentally disabled worry that the patients and families they serve may have been overlooked.
Julia Adams, assistant director of government relations for The Arc of North Carolina, said that case management is key to making sure developmentally disabled patients and their families get the health care and support services that they need.
Case managers are “experts in understanding the needs of this specific community and how to best help this community,” Adams said, noting that a lot of people with developmental disabilities often have difficulty figuring out the complexities of their care on their own.
Adams said that approximately 6,000 such patients could slip through the cracks.
While a handful of area mental health organizations already have made the move to the new managed care model, most have not. However, state law requires all of them to shift to the new model by Jan. 1, 2013.
*Whoa Nelly! WE ARE NOT READY.
Patients and family members already are reporting problems they’ve encountered from the changeover in some parts of the state.
Jane Lindsey, whose 21-year-old child suffers from a number of disorders, has encountered problems getting a psychiatrist for her child.
Lindsey’s family took guardianship of their child when she was 4 months old.
“She was a shaken baby,” Lindsey said. The adult child sees about 12 different specialists. “She has three immune disorders,” Lindsey said. “At times, she can have a list of 40-plus medications.”
Lindsey, who lives in Hendersonville, said that on Feb. 14, when her child was headed home from a doctor visit, she experienced a panic attack. Despite having numerous meetings with and calls to area officials, Lindsey has been unable to get a psychiatrist to see her child for clinical intervention.
Procedures stipulate that the managed care entity must authorize such services before they are delivered.
“According to her neurologist, if she continues to have these panic attacks, she will die,” Lindsey said.
Targeted management had been provided by for-profit and nonprofit private organizations. Those businesses will close down, Adams said. She said 150 people within the Arc of North Carolina will no longer work for the private sector.
*Small agency owners and providers - some of the best, most honorable, passionate professionals in the field - are being set up for failure!
Jim Jarrard, deputy director of the state Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, said that responsibilities of former case management workers will be divided among care coordinators and community guides.
*Care Coordinators will be accessible via central call center (unless there has been a recent change?) while the minimum qualifications for Community Guides include: 18 years of age, high school diploma, and valid NCDL.
While the new coordinators and guides won’t be as “robust” as the former case managers, Jarrard said that “they certainly help you navigate the system.”
Jarrard said he understands the concerns that have been raised about case management. “We’re trying as hard as we can to try to allay fears,” Jarrard said. “I think change is always hard for people.”
*Mr. Jarrad: We are NOT afraid of change; our lives ARE change... this is not our first rodeo. --We are afraid of losing wonderful staff who are payed nothing for the jobs they do; of losing the invaluable support of case managers we've built trusting relationships with; of having to quit our jobs to fill in gaps that shouldn't be there; of not being able to care for the children we love AND survive; of having to surrender our children to salvage the rest of our family members...
And we're afraid no one is listening - and too little too late is just too much to risk our lives for.
Adams counters that fear of change isn’t the problem. “People are actually getting into crisis because the system is not functioning,” Adams said.
Adams said she is working with lawmakers in an effort to make sure developmentally disabled patients get the treatment plans and service referrals they need.
Two legislators — Sen. Ralph Hise, R-Mitchell, and Tom Murry, R-Wake — said they are working on legislation to resolve the problem.
“We know what we want to do,” Murry said. “We’re just trying to see if we can get it done in the time remaining.”
“We’re in the drafting process,” Hise said. But he noted that Senate committees are shutting down and legislative leaders have set a June 19 target date for adjournment.
Adams said the changes need to be made this session, and if legislators believe it’s a priority, it can be accomplished.
“I think they need a green light from the leadership,” Adams said.
If they wait until the 2013 session, which would start in late January, case management services would have already ceased, she said.
*Why are we in such a hurry to race this through haphazardly? Shouldn't we want to make absolutely, positively certain that this is done RIGHT? That no one falls through the cracks? That no one ends up with egg on their face and the State is not opening itself up to more federal lawsuits and yet another DOJ investigation?
“By the time the fix comes, there may be nobody left to work with these people,” Adams said.
*What if this were your child? Would you leave these issues hanging 'til next session?
Barry Smith is an associate editor of Carolina Journal.
12 June 2012
Sign Arc NC's Online Petition!
In 2011, the NC General Assembly passed House Bill 916 (now SL 2011-246). It mandates that North Carolina’s Mental Health, Developmental Disability, and Substance Abuse (MHDDSA) system of care convert to a Managed Care System by January of 2013. The shift happens in stages, with many areas of our state already affected. While The Arc has concerns about managed care for people with intellectual and developmental disabilities, we understand the state will convert to this system.
A major issue with the new design is the replacement of independent Case Management with Care Coordination provided by the Managed Care Organization (MCO). Though we understand that Case Management as it currently exists will not be available in Managed Care sites, we believe individuals should have someone not working for the MCO responsible for writing their person centered plan and to assist them in finding the appropriate service providers. Otherwise, a conflict of interest exists.
In addition to the need for independent care coordination,
In an effort to make NC’s system more responsive, The Arc is recommending a modest set of changes to members of the General Assembly. These changes would establish independent care coordinators not working for the MCO to assist in writing Person Centered Plans and to help find the appropriate services providers. Additionally, it would require that Innovations Medicaid Waiver Slots be portable, and that where a person first received Medicaid not become a barrier for services.
These changes will have no impact on the budget that the NC House and Senate are currently working on and will not cause cost increases in future years. MCOs may have to change the way they organize Care Coordination, but with careful planning that involves qualified agencies, families, and consumers, we believe the cost to MCOs will be minimal.
It is important to note that our proposal does not restore Case Management, but rather builds upon the option that is already available in the law- Care Coordination. Our proposal requires MCOs to contract these functions for people not on the Innovations Medicaid Waiver and assures that people on Innovations have the option for an Independent Care Coordinator.
Many members of the General Assembly want to help with this plan but they need to hear from their constituents.
Please sign our petition today!
07 June 2012
NCGA 6/12 HHS Committee Meet & New Bills
NORTH CAROLINA HOUSE OF REPRESENTATIVES
COMMITTEE MEETING NOTICE
AND
BILL SPONSOR NOTIFICATION
2011-2012 SESSION
You are hereby notified that the Committee on Health and Human Services will meet as follows:
DAY & DATE: Tuesday, June 12, 2012
TIME: 10 :00 am
LOCATION: 544 LOB
COMMENTS: The following bills will be considered:
BILL NO. HB 975
SHORT TITLE: Promote Local/Healthy Food.
SPONSOR: Representative LaRoque, Representative Sanderson, Representative Insko
BILL NO. HB 1098
SHORT TITLE: Continue the Sustainable Local Food Advisory.
SPONSOR: Representative Sanderson, Representative LaRoque
BILL NO. SB 433
SHORT TITLE: Local Human Services Administration.
SPONSOR: Senator Hartsell
BILL NO. SB 525Respectfully,
SHORT TITLE: Streamline Oversight/DHHS Service Providers.
SPONSOR: Senator Tucker, Senator Hartsell
Representative Current, Chair
Representative Dollar, Chair
Representative Hollo, Chair
I hereby certify this notice was filed by the committee assistant at the following offices at 1 PM o’clock on June 07, 2011.
Principal Clerk
Reading Clerk – House Chamber
Wendy Miller (Committee Assistant)
24 May 2012
NC House Committee Meeting Notice 5/31
NORTH CAROLINA HOUSE OF REPRESENTATIVES
COMMITTEE MEETING NOTICE
AND 2011-2012 SESSION
You are hereby notified that the Committee on Health and Human Services will meet as follows:DAY & DATE: Thursday, May 31, 2012Respectfully,
TIME: 10 :00 am
LOCATION: 1228 LB
COMMENTS: Bills TBA
Representative Current, Chair
Representative Dollar, Chair
Representative Hollo, Chair
I hereby certify this notice was filed by the committee assistant at the following offices at 11 AM o’clock on May 24, 2011.
Principal Clerk
Reading Clerk – House Chamber
Wendy Miller (Committee Assistant)
31 March 2012
What's New in March?
March 2012 events and updates.
- Preliminary Injunction 3/29 Ordered by Federal Justice Flanagan in the Disability Rights NC suit against NC DHHS and PBH; posted on US Case Law page.
- added Updated Service Definitions (02/2012) and new Comparison Grid of Services document (01/2012) to CAP-MR/DD page.
- Second meeting with Dr. Pat Porter in Raleigh, 3/28.
- Met with Dr. Patricia Porter in Chapel Hill, 3/16.
- moved Correspondence page to top tab link Correspondence... (apparently there is too much data for a regular entry post; information truncates upon upload). Correspondence exchanges to date can be found there...
Updated Correspondence page with responses and replies to date.- Sent email to Joint Caucus Leader Rep. Marilyn Avila, 3/15.
- Email sent out today from DHHS Sandy Ellsworth announcing, "CMS has approved the extension of the Comprehensive and Supports CAP-I/DD waivers though June 28."
- Sent follow-up email to Representative Bill Current, 3/14.
- Sent follow-up email to Senator Tommy Tucker, 3/13.
- Attended the 3/13 Joint Legislative Oversight Committee meeting on Health and Human Services downtown Raleigh:
- DHHS Chief Clinical Operating Officer, Tara Larson, announced that Federal funding for Medicaid programs which provide Personal Care Services (PCS) in residential settings for Physically Disabled, Developmentally Disabled, and Elderly recipients is due to end April 30, 2012... And the State has NO PLAN.
- News article: NC personal care services for thousands may end byGary D. Robertson - Associated Press on NewsObserver.com; March 13, 2012.
- News article: Medicaid deadline jeopardizes residents of adult care homes by Lynn Bonner - LBONNER@NewsObserver.com
- Introductions and brief chats with: Senator Tommy Tucker, Representative Bill Current, Senator Fletcher Hartsell, Joint Caucus Leader / Representative Marilyn Avila... and though try as I might, couldn't seem to pin down Representative Nelson Dollar.
- expanded on 916 to Waiver Plan to include more background information on House Bill 916 to State Law to the new statewide Medicaid Waiver plan.
- changed name of About HB 916 header link to 916 to Waiver Plan.
- added page with MHDDSA and legal acronyms and legal terminology: Acronyms, Etc. If you have others to add, please let me know.
- Posted Disability Right NC's Federal Class Action Complaint on behalf of KC et al. against NC DHHS and PBH, filed 07/01/2011 and Memorandum in Support, filed 03/02/2012 to US Case Law page.
- Met with Disability Rights of North Carolina, 3/7.
- Posted Disability Rights NC's Federal Class Action Complaint on behalf of Pashby et al. against NC DHHS, filed 05/31/2011, as well as the DRNC Press Release to US Case Law page.
- Received a written response from Commissioner Lewis of the US Administration on Developmental Disabilities; posted in Correspondence, 3/5.
- Called the Office of the Governor to confirm receipt of hard copy letter and inquire of anticipated response date... Was told letter had been forwarded to NC DHHS for response on behalf of Governor Perdue; could not confirm whether or not the Governor herself had actually reviewed letter; requested that the letter be flagged for personal review and stressed the importance, that this is not merely a person letter but a letter that is very personal written on behalf of not only my DD child but the DD community across the State, 3/5.
- created new page Links with links to resources and information websites on everything from DD to government agencies, advocacy, and even Special Education. Please let me know if you have one (or more) to add!
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