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

SB 191 v 4: LME Governance

Mary K. Short is a strong and active advocate and the parent caregiver of an adult DD recipient with profound needs. She fights tirelessly for the rights of her daughter, Katie and other special families, as well as a great deal of time keeping folks informed! Posted with Mary's permission.


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

From: MaryKShort@aol.com
To: andrew.brock@ncleg.net, austin.allran@ncleg.net, dan.soucek@ncleg.net, doug.berger@ncleg.net, eric.mansfield@ncleg.net, fletcher.hartsell@ncleg.net, james.forrester@ncleg.net, jim.davis@ncleg.net, louis.pate@ncleg.net, martin.nesbitt@ncleg.net, ralph.hise@ncleg.net, stan.bingham@ncleg.net, tommy.tucker@ncleg.net, william.purcell@ncleg.net
CC: bert.jones@ncleg.net, beverly.earle@ncleg.net, bill.current@ncleg.net, fred.steen@ncleg.net, harris.blake@ncleg.net, justin.burr@ncleg.net, marian.mclawhorn@ncleg.net, marilyn.avila@ncleg.net, mark.hollo@ncleg.net, martha.alexander@ncleg.net, nelson.dollar@ncleg.net, mitchell.setzer@ncleg.net, pat.hurley@ncleg.net, rayne.brown@ncleg.net, shirley.randleman@ncleg.net, tim.moffitt@ncleg.net, Tillisla@ncleg.net, tom.murry@ncleg.net, tricia.cotham@ncleg.net, william.brisson@ncleg.net, MaryKShort@aol.com, Candace.SlateRep.Dollar@ncleg.net
Sent: 6/28/2012 10:43:35 A.M. Eastern Daylight Time
Subj: SB 191 v 4: LME Governance


To all: Dr. Porter wrote a dissertation in response to my email to you all. Her statement that the courts have somehow ruled against "family guardians" is a willful misrepresentation of the issue. She states:

"... the district court ruled that it was not in the best interest of the citizen for the agency that managed their service money also served as their guardian."

Please. Family guardians do no NOT manage their ward's service money! Just take out (f). It's not in existing guardianship laws now and it just doesn't need to be in there at all at this time. Again, study it, have hearings, etc. Just please take it out of SB 191 v 4.


And just so you all know, please see the email below. I added the RED.

From: Goda, Deborah A [mailto:deborah.goda@dhhs.nc.gov]
Sent: Tuesday, June 26, 2012 2:12 PM
To: Creative Case Management
Cc: Crosbie, Kelly
Subject: RE: [SMC Communication] Monday June 25, 2012 (SMC Communication: #80) 

Good afternoon, Kathy. 

The applications are for Relative and/or Legal Guardians. The provider of Residential Supports may be the Legal Guardian in an Alternative Family Living Arrangement; please note that this an out of home living situation.
Please let me know if I can be of further assistance. 

Deb Goda 

IDD Services Consultant
Clinical Policy
DMA
919-855-4297
deborah.goda@dhhs.nc.gov

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

In a message dated 6/27/2012 5:03:20 P.M. Eastern Daylight Time, Candace.SlateRep.Dollar@ncleg.net writes: 

From: Patricia Porter (Mental Health)
Sent: Wednesday, June 27, 2012 04:54 PM
To: 'MaryKShort@aol.com ' 

Cc: Rep. Nelson Dollar; Sen. Andrew C. Brock; Sen. Austin Allran; Sen. Dan Soucek; Sen. Doug Berger; Rep. Mitchell Setzer; Rep. Pat Hurley; Rep. Rayne Brown; Rep. Shirley B. Randleman; Rep. Tim Moffitt; Joe Nolan (Rep. Tillis); Rep. Tom Murry; Rep. Tricia Cotham; Rep. William Brisson; Sen. Eric Mansfield; Sen. Fletcher Hartsell, Jr.; Sen. Jim Davis; Sen. Louis Pate; Sen. Martin Nesbitt; Sen. Ralph Hise; Sen. Stan Bingham; Sen. Tommy Tucker; Rep. Beverly Earle; Rep. Bill Current; Rep. Fred Steen; Sen. Harris Blake; Rep. Justin P. Burr; Rep. Marian McLawhorn; Rep. Marilyn Avila; Rep. Mark Hollo; Rep. Martha Alexander; Sen. William Purcell; Rep. Bert Jones 

Subject: RE: SB 191 v 4: LME Governance 

Hello Ms. Short, 

Your message has been forwarded to me for reply. 

As you know, in the original Local Management Entity(LME) Governance legislation language ( H1075) passed by the House, Guardianship was addressed in detail. The DHHS requested that we insert this clarifying language in that the courts had ruled that the LME/MCOs could no longer serve as guardians for people with mental illness, developmental disabilities or substance abuse disease due to a conflict of interest. While these LMEs had served for many years in this capacity, the district court ruled that it was not in the best interest of the citizen for the agency that managed their service money also served as their guardian. 

Taking the lead from the courts the state has moved to protect against conflict of interest. The state has an abiding interest in assuring that adults who receive services are provided with guardians who are not also responsible for being the paid provider of services. This prohibition has been in the Guardianship language in H1075 from the beginning.
Wisely, the DHHS called attention to the fact that there are about 200 parents of people with developmental disability who have elected to become paid providers of services for their adult children. Many of these parents, such as yourself, also serve as guardian for their adult child. In an effort not to disrupt this arrangement, the General Assembly amended the Guardianship language to designate paid parent service providers as exempt from this conflict of interest prohibition. 

In further discussion by the House HHS Committee, members posed the possibility of other family members being in a potential conflict of interest. In an effort to address this concern, while continuing to protect the best interests of adults with disabilities in the state, an amendment was proposed that will allow all immediate family members of an adult consumer who, before Jan 1,2013 are serving as both paid service provider and guardian to be able to continue to do so. However, there is also a recognition that this situation deserves more scrutiny. Accordingly, the provision that you have included in your message was provided to the House yesterday and that body voted in support of it. To formalize the process for review of this issue, a technical amendment was added to the budget bill today directing that a study of Guardianship will be added to the list of items for review by a subcommittee to be established by the Joint HHS Oversight Committee during the interim before the long session. This amendment can be found under Section 10.11 (a). Contrary to your assertion that this had not been a well thought out process, the General Assembly wants to make sure that knowledgeable individuals can carefully review the facts about this issue and come to a set of recommendations that will guide future actions on this issue. 

I hope this is helpful to you. Please let me know if I can provide additional assistance. 

Pat Porter 

Patricia Porter, PhD, Consultant
Health and Human Services
North Carolina General Assembly
301-B Legislative Office Building
300 N. Salisbury Street
Raleigh, NC 27603
(919)301-1982

From: MaryKShort@aol.com [mailto:MaryKShort@aol.com]


Sent: Wednesday, June 27, 2012 12:58 PM
To: Sen. Andrew C. Brock; Sen. Austin Allran; Sen. Dan Soucek; Sen. Doug Berger; Sen. Eric Mansfield; Sen. Fletcher Hartsell, Jr.; Sen. James Forrester; Sen. Jim Davis; Sen. Louis Pate; Sen. Martin Nesbitt; Sen. Ralph Hise; Sen. Stan Bingham; Sen. Tommy Tucker; Sen. William Purcell
Cc: Rep. Bert Jones; Rep. Beverly Earle; Rep. Bill Current; Rep. Fred Steen; Sen. Harris Blake; Rep. Justin P. Burr; Rep. Marian McLawhorn; Rep. Marilyn Avila; Rep. Mark Hollo; Rep. Martha Alexander; Rep. Nelson Dollar; Rep. Mitchell Setzer; Rep. Pat Hurley; Rep. Rayne Brown; Rep. Shirley B. Randleman; Rep. Tim Moffitt; Joe Nolan (Rep. Tillis); Rep. Tom Murry; Rep. Tricia Cotham; Rep. William Brisson
Subject: SB 191 v 4: LME Governance


I DO NOT AGREE with the proposed language found on page 8, (f) regarding Guardians and parents and other family members. I urge you to simply delete it ALL. I do AGREE with there being a "study" to determine what should happen going forward, but that the NCGA should leave well enough alone UNTIL AFTER THE STUDY! This is all too rushed and not heard or debated in committee or committees.


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

From: MaryKShort@aol.com
To: MaryKShort@aol.com
Sent: 6/27/2012 12:38:46 P.M. Eastern Daylight Time
Subj: URGENT TODAY: Language change re Guardians!

Here we go! The NCGA changed the LME Governance bill number from HB 1075 to SB 191. You need to care about this because NEW LANGUAGE WAS ADDED ABOUT GUARDIANS AND FAMILY MEMBERS WHO ARE ALLOWED TO BE PAID TO PROVIDE SERVICES. My comments are inserted in blue, after the sentence in question.


What this says is that after January 1st, 2013, NO FAMILY MEMBER WHO IS NOT A PARENT, BUT WHO IS A GUARDIAN WILL BE ALLOWED TO BE PAID TO PERFORM ANY SERVICES. Going forward, if you, the parent, falls over dead after January 1st, 2013, any family member you have ready to become the Guardian, WILL NOT BE ALLOWED TO BE PAID TO PERFORM SERVICES. As long as the family member is NOT A GUARDIAN, they may be paid to perform services.

(f) An individual who contracts with or is employed by an entity that contracts with a local management entity (LME) for the delivery of mental health, developmental disabilities, and substance abuse services may not serve as a guardian for a ward for whom the individual or entity is providing these services, unless the individual is a parent of that ward. (That first sentence is fine.) The prohibition provided in this subsection shall not apply to a member of the ward's immediate family who is under contract with a local management entity (LME) for the delivery of mental health, developmental disabilities, and substance abuse services and is serving as a guardian as of January 1, 2013. (This is vague. It should have the same language as the first sentence: ... immediate family who contract with or is employed by an entity who contracts with a local management entity (LME) ...) For the purposes of this subsection, the term "immediate family" is defined as a spouse, child, sibling, parent, grandparent, or grandchild. The term also includes stepparents, stepchildren, stepsiblings, and adoptive relationships."

[ Read more: Mary's full original email here. ]

Parent Legislative Correspondence re PBH Executive Salary & Staff Council

Pat Wiegand is the parent caregiver of two adult DD recipients, Casey and Jason, who depend upon CAP Waiver supports to keep her family together and maintain some small level of community involvement.

You may recognize their names from their May 22nd Arc video at the Coalition Rally or from the touching Family Stories video earlier this year.

Pat and her family reside in Senate District 9 and House District 18. Her children, Casey and Jason, receive services through Southeastern Regional MH/DD/SAS Services (SRMHC) LME.

Parent Legislative Correspondence

> -----Original Message-----
> From: Pat Wiegand
> Sent: Monday, June 18, 2012 5:18 PM
> To: Sen. Stan Bingham; Sen. Harris Blake; Sen. Louis Pate; Sen. Chris Carney; Sen. Austin Allran; > Sen. Bob Atwater; Sen. Doug Berger; Sen. Jim Davis; Sen. Ellie Kinnaird; Sen. Eric Mansfield; 
> Sen. Wesley Meredith; Rep. William Brisson; Rep. Bill Current; Sen. Bill Rabon; 
> Sen. Gladys Robinson; Sen. David Rouzer; Sen. Bob Rucho; Sen. Tommy Tucker
> Subject:
>
> I would like you all to know me and mine all oppose any changes to state
> general statue 122C!
>
> In recent days I have learned that PBH ceo is earning 160.000 a year
> which I bet does not include bonuses. Plus they have 10 Attorneys on
> staff. Please tell me is this any way to spend money intended to help
> the disabled. As a family member I must say this is very upsetting
> .. I would think all citizens of North Carolina would be opposed to
> spending taxpayer money to a private company who is obviously making a
> good deal off our most needy. I have a thought has anyone considered
> doing managed care with a not for profit agency?
> It's just a thought
>
> Pat Wiegand

An Open Letter & Outline of Critical NC Medicaid Waiver Issues for DD Citizens

Mon, Jun 11, 2012 at 9:47 AM
Re:  An Open Letter & Outline of Critical NC Medicaid Waiver Issues for DD Citizens
From: Crystal J. De la Cruz - Hopper

To:  Senator Neal Hunt, Representative Grier Martin, Representative William A. Current, Sr., Senator Tommy Tucker, Representative Tim D. Moffitt, House Speaker Tom Tillis, Majority Leader Paul Stam, President Pro Tempore Phil Berger ,   Representative Nelson Dollar

Cc:  Joint Caucus Leader Marilyn Avila , Representative Justin P. Burr, Representative William Brisson, Representative Mark Hollo, Representative Tom Murry, Representative Beverly Earle, Representative Nelson Dollar , Representative Rayne Brown, Representative Ruth Samuelson, Representative Hugh Blackwell, Representative Diane Parfitt, Representative Harold Brubaker, Representative Tricia Ann Cotham, Representative Jim Crawford, Representative Jean Farmer-Butterfield, Representative Julia Howard, Representative Pat Hurley, Representative Verla Insko, Representative Darren Jackson, Representative David R. Lewis, Representative Garland E. Pierce, Representative Shirley B. Randleman, Representative Fred F. Steen, II, Representative William L. Wainwright, Representative Jennifer Weiss, Representative Michael H. Wray, Senator Fletcher Hartsell, Senator Austin  M. Allran, Senator Chris Carney, Senator Stan Bingham, Senator Jim Davis, Representative Warren Daniel, Senator Brent Jackson, Senator Edward Jones, Senator Ellie Kinnaird, Senator Martin Nesbitt, Senator William R. Purcell, Senator Gladys Robinson, Senator Louis Pate, Representative Martha B. Alexander, Representative Bert Jones, Representative Marian N. McLawhorn, Senator Doug Berger, Senator Harris Blake, Senator Eric Mansfield, Patricia Porter PhD, Marc Jacques, Walt Caison, Stuart Berde, Ph.D., Flo Stein, Holly Riddle JD, Steve Jordan, Deby G. Dihoff, MA, Arc NC Executive Director Dave Richard, Ken Marsh LCSW, Commissioner Sharon Lewis (US-HHS), DRNC Executive Director Vicki Smith, Cynthia Mann J.D. (CMS), Connie Martin (CMS), Deputy Commissioner Jamie Kendell (US-HHS), "Dr. Craigan Gray, MD, MBA, JD"

An Open Letter and Outline of Critical Issues Surrounding North Carolina’s Medicaid Waiver Programs for Intellectually and Developmentally Disabled Citizens and the Families Who Love Them

[ Letter, Outline and Supporting Documents available for view and Download. ]

Dear Decision-Makers, Stakeholders, Fellow North Carolina Citizens and Persons of Conscious:

Please find following an outline of critical concerns and issues currently surrounding the statewide managed care implementation of 1915(b)(c) Medicaid Waiver programs for the Intellectually / Developmentally Disabled citizens and families across the state. Also included, hyperlinks as well as bookmarked and highlighted supporting documents and notes within the pdfs.

Though I have tried to make this information as succinct as possible, as you surely know, it is no simple matter and therefore not easy to put in a nutshell. All I respectfully ask is for the courtesy of your attention and consideration. Of course, taking a few moments to acknowledge with a personal response would be greatly appreciated also, as I write on behalf of many.

Recently, I’ve had the opportunity to meet many of you and some of you may have even been subjected to my 10 minutes of fame when I spoke at the “Leadership Congress for the Best Behavioral and I/DD System in the Nation” hosted by UNC and The Jordan Institute for Families. I even made quite a few of you cry.

I chose not to share MY story this time, rather, I shared A story... And it went something like this:

Let’s STOP for just a moment, take a deep breath and imagine, just for a brief instance, that you are not a Government Official, State Director nor Department Representative, not a Policy-maker, LME, nor Provider; you’re not a politician, nor even a party affiliate – it’s not that you don’t care what’s going on in the world around you, but your world demands all of your time and energy...

You are only an expert in what you know: your life, your family, your children.

Imagine that you’re just an average North Carolinian living paycheck to paycheck trying to be the absolute best parent you can be providing for a child you never anticipated; a child you would give your life for just to hear them speak the words, “I love you.”

You juggle all your time between coordinating and attending appointments with doctors and specialists and therapists, attending IEP, ESY and CNR meetings and a whole host of other acronyms; working to provide for your family, feeling guilty over the lack of “normalcy” and opportunity left over for siblings, researching special education law and medical issues, catching up on missed work, catching up on missed life, neglecting your own needs, networking with other parents searching for answers and sharing resources, learning sign language, physically caring for your special child, giving injections, changing g-tubes and adult diapers, and fighting for their rights – against the school, against the county, against a library that discriminated against your child, against the State who threatens not just their livelihood and quality of existence… but the very ability to LIVE.

You pray, you cry, you curse, you question… and you pray and cry some more.

You stopped thinking long ago about providing a better life for him or her than you once had; you only want what’s right and just and to not have to wake every single morning wondering that which haunts you to your core, “What would happen to my child if something happened to me?”... Just for a second, please imagine, please consider, what if this were your child?

And this is only a tiny intimate glimpse into one perspective among many, many distinctly unique personal challenges and needs. There are countless more individual lives with different experiences, different abilities and different needs – as different as our own fingerprints.

I maintain – the Human Element is missing. In the shared passion and determination to make a difference, we have lost sight of our reason for being here. THAT is our disconnect. And the human element is what connects us ALL.

We are NOT afraid of change. Our lives ARE change.

What we’re afraid of is FAILURE.

NONE of us can afford NOT to get this right on this level of magnitude…

The Question is, How do we fix it?

Thank you in advance for your time and attention. Thank you once more for all your continued efforts, interests and work toward ensuring that we as a society do not fail those most meek and vulnerable and pure-of-heart entrusted us.

We, the consumers and families of the State of North Carolina, look forward to your response.

Kind regards on behalf of Isabel, our Family and ALL Special Peeps,

Crystal J. De la Cruz - Hopper

Special Mom, Advocate and Concerned NC Citizen

http://no2nchb916.blogspot.com/

Hopper Law Firm, PLLC

4700 Six Forks Road, Suite 150

Raleigh, North Carolina

Phone: (919) 829-5600

Issues: Section Contents

• Due Process Rights
• Why are Due Process Rights Important to consumers and families?
• What do we know about the Due Process / appeal procedures under the new 1915(b)(c) Medicaid Innovations managed care plan?
• OAH, ALJs and the Regulator Reform Act of 2011.
• Families Are NOT Being Heard
• DMA Public Comments on CAP I/DD
• What I’m hearing from other concerned parents
• My personal experience regarding legislative response in a nutshell
• Impact on Providers
• Impact on Families
• Where We’re Headed
• Why we cannot afford to be wrong (again):
• What MUST Happen to Assure Our Shared Success
• List of Enclosures

Due Process Rights

Why are Due Process Rights important to consumers and families?

• Parents need to know their children’s rights, safety, happiness, general well-being, and the progress and abilities their children have worked so hard archive are protected, maintained and supported.
• As our children’s guardians, protectors, and caregivers, we must have the ability to participate in decisions which directly impact our children and our families as well as a guaranteed failsafe recourse to appeal any decision made by a governmental entity which we feel are not in our child’s best interest as afforded us under the US Constitution.
• What kind of parents would we be, any of us, if we did not do everything in our power to protect these helpless innocent children?

What do we know about the Due Process / appeal procedures under the new 1915(b)(c) Medicaid Innovations managed care plan?

• The current appeals process reflects a consumer appeals process to a unilateral hierarchy with no third-party authority to fairly referee.
• As outlined in the PBH brochure and 2012 Provider Manual (*attached)is as follows:
1. If consumer caregiver has recipient service hours and / or benefits reduced, suspended or terminated,
2. consumer caregiver will receive a letter 10 days prior to changes via US Certified Mail a letter, outlining instructions to request a ‘Reconsideration Review’ through PBH (or respective LME/MCO)’s ‘Reconsideration Review Process’ within 30 days of notification.
3. If Reconsideration Review, does not yield a response in favor of consumer, consumer caregiver can appeal to both DHHS and the Office of Administrative Hearings (OAH) by filing a request for a State fair hearing within 30 days.
4. Once appeal is processed, consumer caregiver may participate in an informal attempt to resolve the conflict through the Mediation Network of North Carolina;
5. if the conflict cannot be resolved in mediation or if consumer declines mediation, the matter will be set for hearing before an Administrative Law Judge (ALJ) at the OAH.
6. The ALJ will hear the matter and evidence and make a recommendation regarding the consumer’s matter and forward the decision to DMA,
7. where DMA will review and make a final decision.
• What’s the point? More time and State financial resources wasted.
• The only recourse following a final decision by DMA is for the consumer to retain counsel and file suit in Superior Court - an extraordinary expense of tens of thousands of dollars that the vast majority of consumer families, including mine, could not afford.
• It should be noted that under the new PBH model, service eligibility for DD Medicaid Waiver recipients is determined by the Supports Intensity Scale (SIS) which arguably provides a more detailed client pictorial, however, the formula specifics which equates a recipient’s level of need by the State’s representative LME is deemed “proprietary information’:
• LME representatives are required to sign and enter into a “Non-Disclosure Agreement” with PBH to protect the SIS methodology.
• This non-disclosure further prevents a fair an adequate appeals process for consumers as how can one effectively challenge information which is withheld from them?
• Proprietary information as such held by an agent of the State providing public services to citizens on behalf of the State - services which are funded by Federal and State monies is, in fact, a conflict of interest.
• This is NOT transparency and only perpetuates mistrust.
• Also noteworthy: PBH recently had a federal lawsuit against acting NC DHHS Secretary Delia and Mann [5:12-CV-46] suing to not only remove final decision-making authority from the State government entity who is to oversee and govern the managed care operation and all LME’s, but to seemingly assure totalitarian authority.
• It is my understanding that this case has since been withdrawn.

OAH, ALJs and the Regulator Reform Act of 2011.

• NC SL 2011-398, commonly referred to as the Regulatory Reform Act, became State Law July 25, 2011, granting final authoritative ruling to OAH / ALJs over Medicaid cases, effective January 1, 2012 and applies to cases contested after that date.
• SECTION 32. G.S. 108A-70.9A(f) reads as rewritten: "(f) Final Decision. – After a hearing before an administrative law judge, the judge shall return the decision to the Department in accordance with G.S. 150B-37. The Department shall promptly notify the recipient of the final decision and of the right to judicial review of the decision pursuant to Article 4 of Chapter 150B of the General Statutes."
• SECTION 33. G.S. 108A-70.9B(g) reads as rewritten: "(g) Decision. – The administrative law judge assigned to a contested Medicaid case shall hear and decide the case without unnecessary delay. The judge shall prepare a written decision and send it to the parties in accordance with G.S. 150B-37."
• Despite the January 1, 2012 effective date for OAH final authority over recipient disputes in Medicaid matters, federally-funded Medicaid Waiver programs by design have a “single agency rule” which dictates that a single state agency makes final decisions in Medicaid issues which is somewhat conflicting given the design of the new statewide managed care waiver, therefore Centers for Medicare and Medicaid Services (CMS) must grant an exception waiver to the State of NC to permit alternate authority. Currently, NC governing officials and other interested stakeholders are working toward mutually agreeable waiver submission terms, though to date, an agreement has not be solidified.
• Thus there remains NO appropriate fail-safe due process for recipients and families save the unrealistic and unfeasible hardship of unnecessary legal expenses.
• There also appears to be a misconception among the NCGA, according to information relayed to me by employees, that:
• ‘ALJs lack knowledge and specialty in Medicaid matters and therefore do not have the expertise to exercise authority over such cases.’
• In any court of law it is unreasonable to expect that a presiding Judge to have specialty knowledge every matter before them; District, Superior, and Supreme Court Judges are no different.
• ‘Most ALJs are not even attorneys by profession.’
• In fact, most ALJ are experienced attorneys.

Families Are NOT Being Heard

DMA Public Comments on CAP I/DD

• Whenever the Department of Health and Human Services / Division of Medical Assistance proposes new policies and / or policy changes, they are posted online for a period of time or public review and comment.
• In May of 2011, an 8M Clinical Coverage Policy proposal for CAP-I/DD was posted by DMA for public review and comment for a period of 45 days:
• May 12 - June 26 -- yielding 101 Public Comments spanning 79 pages
• In July of 2011, a different 8M Clinical Coverage Policy proposal for CAP-I/DD (less 14 pages) was posted by DMA for public review and comment for a period of only 15 days:
• July 28 - August 11 -- yielding 439 Public Comments spanning 539 pages
• For comparison, please review:
• The 2010 8M Clinical Coverage Policy for CAP-MR/DD (formerly I/DD)
• Side-by-side document comparison of the two 2011 8M proposals
• 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.

What I’m hearing from other concerned parents:

• Most parents do not understand what little ambiguous information is out there and the information being circulated from various sources is frequently changing, vague, misleading, and sometimes complete accurate.
• Answers to parent questions at LME community forums consistently begin with, “Our hope is...” or “It is our goal to...” or “We’re working on that now to try to make sure...”
• For families and caregivers who have found the time to call, write and visit, there is a high level of frustration and distrust among parents and family members over the lack of response from representatives and legislative members regarding Waiver concerns affecting their families or will affect their families.
• What responses that are received most often do not address the specific concerns, and use the same sort of dismissive verbiage, not unlike a pat on the head, as was written to other parents (a lot of us know each other), justifying the position of the DHHS, DMA and the General Assembly using the same arguments:
• abuse of the system by providers
• unmet needs of families receiving no services
• Those of us who are knowledgeable, veteran parents have undergone numerous of these system changes where each time the cart was put before the horse in an effort to hurry up and get things done, ending in disastrous results. Changes on this level of magnitude are terrifying because the risk of failure is monumental - and the casualties will be our children and our families.
• Many of us are intelligent articulate professionals, some even within the field. We’ve been doing this longer than most Qualified Professionals; this is not our first rodeo.
• What we are seeing happening is NOT what we’re being told.
• What we’re seeing happening is NOT what YOU are being told.

My personal experience regarding legislative response in a nutshell:

• After 4 months of diligent research, writing and countless hours of lost sleep and family sacrifice, I completed my 10 page letter and enclosures to Governor Beverly Perdue outlining my concerns as a parent and citizen; a hard-copy was mailed to the Governor’s office on February 24, 2012.
• On February 25, 2012, a copy of the same letter and attachments was sent via email to each of the 170 elected members of the North Carolina General Assembly.
• I received exactly FIVE responses (equating to a 2% response rate):
• one personal note,
• two thanking me for writing,
• one from a Legislative Assistant confirming receipt, and
• one out-of-office auto responder.
• Two members forwarded my correspondence to the NCGA’s expert consultant, requesting she respond and address my concerns, with whom I met and exchanged many emails and information, however as a consultant, she does not have a vote in the matter.
• In meeting with members of the NCGA, I have found that many do not fully understand the dynamics of this process nor the DD system upon which they are voting.
• In meeting with members of the NCGA, I have been told that they have not heard from many parents. Here’s why:
• Many consumer families do not understand well enough themselves to articulate the issues intelligibly.
• As I explain, it takes unimaginable effort for most special families to find time to go grocery shopping in between the endless appointments, meetings, work and just daily life, let alone taking off more work to pack up a disabled child with all their medications, equipment, devices, stim-toys, special foods, diapers, and endless other provisions to drive hours across the state to meet with legislative members for a 30 minute appointment - and hoping there won’t be a meltdown, soiled clothing, nor some catastrophe in the process.
• One Senator had his Legislative Assistant cancel my 30 minute appointment (due to the death of Senator Shaw); however would not reschedule the meeting, rather instructing her to have me to follow up with the NCGA’s consultant.
• And to my knowledge as best I have been able to confirm, Governor Perdue has yet to personally review my correspondence. Steve Jordan kindly responded on her behalf.

Impact on Providers

Two arguments continue to be made in the process of Mental Health reform as supporting reasons for the 1915(b)(c) Medicaid Waiver managed care plan implementation:
1. Historic abuse of the system by providers / agencies double billing who have contributed to the current economic problems of the State, and
2. the thousands of Developmentally Disabled citizens across the State with critically “unmet needs.”
Both are true and are legitimate foundations for change. However:
• For every dishonest agency provider that has served our State’s most vulnerable and fragile special populations, there are countless others who have done their jobs by the books, going well above and beyond their call of duties to provide every measure of supports and comforts they could find to overwhelmed and often desperate families on menial salaries for time they could not bill for.
• There are countless wonderful, experienced Case Managers and Qualified Professionals (QPs), many who are small business owners, who will be out of a job at the end of this implementation, and livelihoods crumble.
• These people worked hard to get the degree their degrees to work in a field doing what they love: helping special people and their families because you know what? Special people love unconditionally and they keep it real.
• Small decent, honorable businesses which will fold without revenue from case management services - or be absorbed by LME’s.
• Note: Under the PBH model, provider agencies are being required to purchase and licence outrageously expensive proprietary billing software from LME State agents out of their own funds in addition to additional training and certifications; expenses which private small business agencies cannot recoup and often cannot afford with reduction in revenue.
• They are being set up for failure.
• Provider agencies are afraid to speak up for fear of retaliation by LMEs/MCOs - which IS already taking place.
• I recently met with a member in the company of a friend who is a professional in the field working in an area currently in transition. While this gentleman was generous with his time and listened intently, he told my friend as we were leaving that she ‘was very brave to come and to be careful.’
• Rather than a structure which involves a Case Manager and agency QP to maintain a recipient’s needs, supports and services, there will now be three different positions which will juggle these roles. Why?
• The most vital support roles for families are being taken from people with experience and degrees and given to the newly created position of Community Guide; a position for which the main qualifications are:
• 18 years of age
• High School Diploma or GED
• Valid NC Driver’s Licence
• Community Guides are the personal point of contact for parents should a need arise; most parents and CAP workers have more knowledge and experienced than the young high school graduate charged with helping families find resources. This is a joke.

Impact on Families

• Home and Community-Based Supports (HCS) is therapuetic time for working on life-skills and social-skills goals, community involvement, communication & vocabulary, social activities, continuation of therapeutic goals from school as well as in-home therapies (Physical Therapy, Occupational Therapy, Speech Language Pathology)  and maintaining present-level of performance.
• Medicaid reimbursement rate for HCS = $5.35 per unit or $21.40 per hour.
• Industry standard HCS pay rate for direct-care staff (Habilitative Tech. / CAP worker) in the Triangle area = $10-12.00 per hour.
• In more rural areas such as Bertie County, the standard HCS pay rate for direct care staff = $9-10.00 per hour.
• When considering the reimbursement rates versus pay rate, the cost of overhead operations and non-billable salaries, services, and expenses must be factored.
• Families are being told that their hours will remain the same per their CAP plan (until the next review), however, what is NOT being explained is that a large chunk of those hours are being shifted from the higher-paying HCS reimbursement rate to the lower-paying PCS rate.
• When HCS is drastically decreased, the effect on a Developmentally Disabled individual will be monumental; no progress toward new skills, resulting in regression of skills learned or learning.
• Isabel’s HCS will be decreased by 5 hours per week under the new plan. This is hugely significant for her. A decrease of just 5 hours per week = 230 hours per year or 6.5 40-hour work week.
• The loss of 6 ½ 40-hour weeks of working on life-skills and social skills for a child like Isabel is a critical blow to her continued progress and maintaining her current level of performance. This would be not unlike her missing over 1 ½ months of educational instruction in school.
• In many cases (like mine) the loss of HCS hours is being supplemented with an increase in Personal Care Services (PCS) which in effect affords additional babysitting time.
• Personal Care Services (PCS):
• Medicaid reimbursement rate for PCS = $14.16
• Industry standard PCS pay rate for direct-care staff (Habilitative Tech. / CAP worker) in Triangle area = $7.45 - 8.00 per hour.
• Using my daughter’s budget as an example (spreadsheet enclosed):
• Under the current CAP budget, if all 2.323.6 hours authorized was worked in a year, a direct-care staff would stand to make an annual salary of $24,476.60  before taxes (industry standard).
• Under the new CAP budget, if all 2,653.6 hours were worked in a year (with an average additional 12 hours per week; +17 PCS - 5 HCS), staff would claim $26,388.80 before taxes.
• Equating to a salary increase of $1,915.20 -- for working an additional 302.4 hours in a year or an average of 51.5 hours per week.
• Considering the enormous difference in reimbursement rates for HCS versus PCS, the salaries of direct care staff will be drastically reduced causing:
• loss of valued direct care staff who cannot no longer afford to live on what they are paid
• greater unmet needs - for those fortunate enough to have some level of supports
• impossibility to find quality, reliable and trustworthy staff to fill recipient needs
• a tremendous disadvantage for more difficult cases to find staff placement at all
• It was suggested to me by one legislative member that during this economic crisis I may need to consider supplementing the diminished wages of my child’s CAP worker out of my own pocket if I wanted to keep her... not only is that NOT financially feasible, but monetary compensation of that nature is in fact, ILLEGAL per Medicaid laws.
• The lack of proper supports - which not only includes allocation of services but also the means to have those needs met by quality, reliable and trustworthy direct-care support staff - will result in many families being forced to relinquish their child(ren) to State Facilities which they are no longer able to care for and maintain.
• State DD Facility per diem rates per resident:
• Caswell Center: $606.36 = $221,321.40 annually
• Murdoch Center: $536.36 = $195,771.40 annually
• Riddle Center: $482.36 = $176,061.40 annually

Where We’re Headed...

• The ramifications of the Department of Justice findings involving ADA an Olmstead violations surrounding State residential facilities have inspired a long-overdue flurry of focus on appropriate placements for mentally ill and intellectually / developmentally disabled individuals. The plan is to work toward the “deinstitutionalization” of these special populations by reintegrating them into a more inclusive environment with community supports.
• However, while we’re moving one fragile population forward and away from institutionalization, we’re taking a giant leap backwards by moving another exactly in the direction we’re trying to elude by removing community supports and means that make it possible for families to care for their special loved ones already at home - a complete contradiction to the purpose behind Sections 1915(b) and (c) of the US Social Security Act [42 U.S.C. § 1396o].

Why we cannot afford to be wrong (again):

• We cannot solve a problem by digging a bigger hole. I think we can all agree as a State and as a society:
• We CANNOT afford another failure, certainly not one of this magnitude.
• We CANNOT afford the casualties which will undoubtedly ensue as the currently served, somewhat stable DD recipients and families tailspin into crisis situations as a result of loss of staff and support services, and thus regression in skills.
• We CANNOT afford the crippling additional State burden of consumer families having to turn to “institutionalization” as a means of service provision.
• We CANNOT afford exposing ourselves to additional vulnerabilities, complaints, investigations and federal lawsuits.

What Must Happen to Assure Our Shared Success:

• We MUST have an effective, failsafe appeals procedure for consumer and families; constitutional Due Process rights MUST be protected.
• Part of this process must include, not only educating consumers and families - as well as providers / professionals of their rights continually and consistently, but also providing every consumer household with contact information of departments and individuals at local, State, and Federal levels whose responsibility is to address conflicts, concerns, and advocacy issues as they arise to act as a liaison in an effort to reach a positive resolution prior to Due Process.
• It is not enough that this information can be found “somewhere” on the Internet. These people have a difficult time enough juggling their lives.
• ALL stakeholders MUST have a voice and ownership in this decision-making and implementation process.
• There is NO ONE who has more at stake in this process than the consumers and families who will be most affected.
• Consumers and families must have a more active role in this process and if need be the supports to allow this to happen.
• Many capable and articulate parents want to be involved, though unlike professionals in the field, we do not receive salary nor supports to attend meetings, lobby with representatives, nor disseminate information.
• We have full-time jobs and work to provide for our families.
• Our time, energy and resources are very limited.
• We often do not have adequate coverage to facilitate extracurricular activities.
• Many of us suffer from chronic stress not dissimilar to combat soldiers from the demands related to caring for the children we love; demands that cannot be imagined unless you live it.
• There is a vast wealth of untapped resources, information, and expertise among families who are and will be directly and detrimentally impacted by these Waiver changes to include: doctors, lawyers, therapists, providers, accountants, teachers, psychologists, social workers, and care providers!
• We have knowledge, talents, skills and solution oriented ideas!
• We CAN learn a lot from each other and working together, we CAN create the best self-sustaining DD ‘ecosystem’ in the nation.
• We MUST bridge the disconnect between stakeholder entities and individuals.
• The right hand must know and understand what the left hand is doing.
• We need to work toward rebuilding trust, confidence and understanding.
• Messages and information must be consistent and fully disclosed.
• ‘Generals’ need to know first-hand what ‘troops are experiencing on the front lines’ and questions, issues and concerns must be addressed not merely placated.
• We need continuous and diplomatic dialogue with one another - this includes “active listening” and facilitation.
• We MUST STOP trimming fat from the bottom to offset our State’s budgetary crisis!
• There is NO MORE fat to trim; we are cutting off our noses to spite our faces.
• Reduction of supports and services will have a detrimental long-term impact from which it may be impossible to recover.
• It is probable that families receiving some level of supports will lose that support as a result of shifted hours to lower paying reimbursement rates causing a significant pay reduction which will result in:
• families in preventable crisis situations
• loss of direct care staff for consumers and families
• inability to find and retained quality, reliable and trustworthy staff to fill those needs
• a mass exodus of wonderful professionals from a field that desperately needs them
• families who will be forced to surrender their child to State Facilities
• Regression in life skills that have taken many years and lifetimes to achieve
• without proper supports for the individuals as well as families and proper supports to direct care staff who provide those needs
• Without the proper supports and services, we are only creating much larger more critical budgetary and humanity crisis for our State’s future. --You may not see the immediate effects, perhaps a year, many two, but it WILL happen.
• We are holding accountable and penalizing the very population who is most fragile and LEAST responsible for this mess.
• We MUST have flexibility to bend and act in crisis and exceptionally unique consumer situations.
• Applying a goal and service oriented medical model to Intellectually / Developmentally Disabled populations as well as many facets of Mental Illness diagnoses places unfair, impossible and unrealistic expectations upon recipients that they will or should recover and be cured of the disease and / or genetic make-up and limitations of who they are.
• Consider this and multiply it ten-fold:

comic origin unknown
• Every day there are unique and often critical DD situations and needs which arise from our special circumstances for which otherwise simple solutions cannot be attained due to barriers stemming from unbending Medicaid and bureaucratic rules and regulations designed to aid, protect, and facilitate those served.
• Often these rules seemingly have either no sound basis or are so broad and all encompassing they do not apply to an individual situation though nonetheless, another unnecessary hoop to jump complete with mounds of paperwork.
• This one-way highway channel of service convolutes the Medicaid DD services and implementation process, creating roadblocks to Person Centered Planning and draining the resources and energy of  departments, agencies and professionals to best meet needs because time is wasted performing blanket mandatory procedure.
• A portion of Medicaid fraud situations can be attributed this way; case managers and providers trying desperately to creatively solve issues in working within set limitations to provide help and relief to those they serve (I’m not talking about the get-rich-quick mongers who consciously and recklessly chose to take advantage of their clients for personal gain).
• Every voice MUST be heard!
• Sample data collection is NOT representative of the vast majority of consumers and families; most veteran families (including mine) have never seen a survey nor been asked / invited to provide feedback on any DHHS MH/DD/SAS matter, not even satisfaction.
• There need to be appropriate and continual outreach efforts to the consumer and family communities.
• If stakeholder Voices cannot come to the table, the table needs to go to the Voice!

List of Enclosures

• NC General Assembly Session Law 2011-398 (Senate Bill 781; S781-v-6); An Act to Increase Regulatory Efficiency in Order to Balance Job Creation and Environmental Protection, (a.k.a. the Regulatory Reform Act of 2011, pg. 12).
• PBH Appeals Process Brochure (August 2011).
• PBH Provider Manual (April 1, 2012; pgs. 62-65).
• The National Law Review article, “Lawsuit Challenges ALJ Final Decision Authority in Medicaid Appeals” by Attorney and former ALJ, Tom West (2012).
• WFAE 90.7 article, “Big Changes For Developmentally Disabled In NC” by Michael Tomsic focusing on one of the Class Action Members in KC et al v. Cansler, DHHS, PBH, and Shipman [5:11-CV-354-FL], (August 4, 2011).
• Medicaid CAP Services & Salary Analysis (present v. future), based on Isabel's current and projected budgets, 2012
• Average NC job salary comparison for "Hab Tech" / CAP Worker, (from SimplyHired.com, May 20, 2012).
• NC Medicaid CAP / Payroll Reimbursement Rates, (current as of December 1, 2011).
• NC Medicaid CAP / Payroll Reimbursement Rates, (from 2005).
• NC DD Facilities per diem Reimbursement Rates per resident, (email from Developmental Centers Team Leader, Carol Donin from May 15, 2012).
• NC DHHS Press Release re: 2011 Reports of Abuse, Neglect of Elderly & Disabled, by county (May 11, 2012).
• PBH Innovations Community Guide Definition, (January 2012).
• PBH DD Care Coordinator job listing and benefits, (from sologig.com, May 2012).
• DD Care Coordinator average job salary comparison, (from SimplyHired.com, May 2012).
• ECBH DD Care Coordination Manager job listing, salary range and benefits, (from HotJobs.com, May 2012).
• NC General Assembly Senate Bill 450; Direct Care Worker Wage & Benefit Study, (March 2011).

[ Letter, Outline and Supporting Documents available for view and Download. ]