Disability Rights NC Applauds North Carolina’s Settlement with U.S. DOJ

From Disability Rights of North Carolina

FOR IMMEDIATE RELEASE

Thursday, August 23, 2012

[ download pdf version ]

Disability Rights NC Applauds North Carolina’s Settlement with U.S. DOJ

Raleigh – Governor Beverly Perdue took a major step today toward resolving one of the greatest challenges facing our State’s mental health system by signing a settlement agreement with the U.S. DOJ. The agreement addresses findings made July 28, 2011, that the State violates the ADA by segregating North Carolinians with mental illness in Adult Care Homes rather than allowing people the choice to live and be supported in the community.

“Disability Rights NC applauds the Governor and the Secretary Delia for their leadership. This agreement will protect the rights of people with disabilities and help the State avoid costly litigation,” said Vicki Smith, Executive Director.

The agreement provides for the creation of appropriate community mental health care, employment services and housing options for people with mental illness in our State. “This agreement will improve the lives of N.C. families – our brothers and sisters, mothers and fathers. Disability Rights NC pledges to remain vigilant, ensuring the agreement’s promise is permanent,” said Smith. “North Carolina has seized an opportunity to cultivate a robust system of care for people with mental illness which all of us can be proud of.”

Background on North Carolinians with Mental Illness Housed in Adult Care Homes

In July 2010, Disability Rights NC filed a complaint with the US DOJ alleging that the State of North Carolina is in violation of the Americans with Disabilities Act (ADA) because the State has a bias towards placing people with mental illness in Adult Care Homes (ACHs) rather than supporting them in more integrated settings in their home communities. ACHs are institutional settings that do not provide appropriate services to support recovery and meaningful community integration. Disability Rights NC alleged that the State, in relying on placements in these types of Adult Care Homes, is violating the ADA. Please see the Report: Trapped in a Fractured System - People with Mental Illness in Adult Care Homes on the website (www.disabilityrightsnc.org). Under the ADA the unjustified segregation of persons with disabilities is an illegal form of discrimination. The integration mandate allows individuals to interact with non-disabled persons to the fullest extent possible so people with disabilities are not isolated from their communities.

The US DOJ, Civil Rights Division, issued a letter of findings on July 28, 2011, concluding that North Carolina "fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs in violation of the ADA," and that "[r]eliance on unnecessary institutional settings violates the civil rights of people with disabilities." The central finding of the US DOJ is that North Carolina lacks an adequate community support system for people with mental illness. As a result, individuals are institutionalized in more expensive and more restrictive settings in Adult Care Homes. "Most people with mental illness receiving services in adult care homes could be served in more integrated settings, but are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies," wrote U.S. Assistant Attorney General Thomas Perez. "Reliance on unnecessary institutional settings violates the civil rights of people with disabilities.”

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NC DHHS, US DOJ Reach Agreement on Community Based Care for Only Citizens with Serious Mental Illness

From The Arc of North Carolina

Breaking: NC DHHS, US DOJ Reach Agreement on Community Based Care for Only Citizens with Serious Mental Illness

[ view release at arcnc.org ]

Press Release from NC Dept. of Health & Human Services:

Raleigh — The North Carolina Department of Health and Human Services and the United States Department of Justice today reached an agreement on the state’s plan to offer more choices of where and how citizens with serious mental illness receive care and supportive services.

The plan, which was announced last month, will create housing slots in the community to offer the choice of community-based care for many adults with serious mental illness. It will also invest in job training and employment assistance for those citizens and will set up a comprehensive, 24/7 crisis care program for people with a serious mental illness.

This agreement will modernize our mental health system and ensure that North Carolina is providing the best possible treatment for adults diagnosed with severe mental illness. It will also provide the opportunity for many of these individuals to live in community settings if they choose to do so, and ensure that North Carolina is fully complying with the Americans with Disabilities Act and other federal laws.

This agreement is similar to ones signed by governors of a number of other states including, among others, the governors of Virginia and Georgia.

DHHS Secretary Al Delia agrees that more should be done to ensure access to community-based treatment for those with mental illness. “North Carolinians who have a serious mental illness have a right to choose the very best care environment to meet their personal needs,” he said. “That choice – whether they live in the community or in an adult care home – will be supported with access to mental health and other support services that will be available in part due to this agreement. Moving forward with a solution to help them identify and access those choices is the right thing to do,” he said.

“Disability Rights NC applauds the Governor and Secretary Delia for their leadership on this matter. They have not only done the right thing to protect the rights of people with disabilities, they have helped the state avoid costly litigation and destabilizing uncertainty,” said Vicki Smith, executive director of Disability Rights NC.

The agreement outlines DHHS’s plan of action to provide community-based services to people with mental illness. The budget the General Assembly passed in July expressly contemplated a settlement and appropriated funding to make this agreement possible. The timeline for completing the plan is eight years; this transition period will enable people who want to move to community-based settings to do so on a workable timetable and will allow sufficient time for North Carolina’s mental health infrastructure to implement this agreement.

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NC DHHS Press Release re Jim Jarrad

N.C. Department of Health and Human Services
For Immediate Release
July 13, 2012
Contact: Julie Henry, 919-855-4840
julie.henry@dhhs.nc.gov

Secretary Delia Selects Jarrard to Lead Division of Mental Health

RALEIGH - N.C. Department of Health and Human Services (DHHS) Secretary Al Delia has announced the appointment of Jim Jarrard as acting director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (MH/DD/SAS), effective immediately. Jarrard has been deputy director of the division since October 2010 and worked closely with Division Director Steve Jordan, who was killed last week in a bicycle crash.

“The Department suffered a devastating loss with Steve’s death and we will miss his energy and passion for mental health services and the people we serve,” Delia said. “Jim Jarrard is a knowledgeable and respected leader who I am confident will continue to lead the Division in a positive direction.”

Jarrard has been with the Division of MH/DD/SAS since 1994, serving in a variety of roles. Prior to becoming deputy director, Jarrard was chief of the Resource and Regulatory Management Section, which is responsible for fiscal monitoring, accountability, and regulatory compliance, support of information technology and contracts management. He also served as a team lead for Accountability. Jarrard holds a doctorate in theology and was a pastoral counselor and parish minister before joining the Division.

“Our division is a great model of resiliency for the consumers we serve,” Jarrard said. “We have a duty to keep the focus on our mission to protect the health, safety and well-being of all North Carolinians. I look forward to continuing our positive and productive relationships with community advocates, partners and providers.”

The Division of Mental Health, Developmental Disabilities and Substance Abuse Services (MH/DD/SAS) provides leadership and support to community partners, providers and local management entities/managed care organizations to deliver prevention, treatment, and rehabilitation programs for persons with mental illness, developmental disabilities, and substance abuse disorders in North Carolina.

DRNC Press Release: Move to Intervene in ACH matter

Disability Rights North Carolina

FOR IMMEDIATE RELEASE 

Tuesday, June 19, 2012

Disability Rights NC Moves to Intervene in

Tiffany Healthcare, Inc., et al., Petitioners v.

North Carolina Department of Health and

Human Services, Division of Medical Assistance

Raleigh - Disability Rights NC filed a motion to intervene in the case Tiffany Healthcare, Inc., et al., Petitioners v. North Carolina Department of Health and Human Services, Division of Medical Assistance. This case was filed last Thursday on behalf of the owners of eighteen Adult Care Homes (ACHs) who were notified that as Institutions for Mental Disease (IMD), their residents were no longer eligible to receive services under Medicaid.

“The outcome of this case could have a profound effect on the welfare of adults with mental illness – people we are mandated to protect,” said Vicki Smith, executive director of Disability Rights NC. “In the event that the Court rejects Tiffany Healthcare, Inc’s claim, the subsequent loss of Medicaid funding would require a change in the residential placements of more than one thousand individuals. Many of these residents live with mental illness. All of the residents are disabled to some degree.”

A little over a year ago, the Centers for Medicare and Medicaid Services (CMS) informed NC DHHS/DMA that it must develop a method of determining whether ACHs whose residents receive Medicaid benefits qualify as IMDs. NC was required by CMS to develop a protocol to assess whether certain ACHs meet the definition of an IMD and to assure that Medicaid dollars were not being used inappropriately to pay services to residents of those homes.

If the Court rules in favor of the State, the consequence would be the immediate termination of Medicaid payments to the facility. One likely consequence is that, once found to be an IMD, an ACH may face immediate closure owing to the loss of a significant revenue stream for the facility. It is also possible that the ACH might fail to provide the required 30-days’ notice of discharge to each resident. More important, the need to find alternative placements for all of the discharged ACH residents could overwhelm the ability of the local Department of Social Services and the Local Management Entities to meet the discharge needs of the displaced residents as guaranteed by law.

Smith stated, “In the event that the affected residents lose their Medicaid eligibility, an orderly process for locating alternative housing – which is required by law – must be assured. Both Chambers of the General Assembly have recognized the need to budget some transitional support for ACHs. It is our hope that those funds will be specifically targeted to pay for residents’ medications and other medical expenses while alternative housing and services are located. ”

The Court issued a TRO on Friday, June 15 preventing the State from immediately terminating Medicaid benefits. Further proceedings are scheduled at the Office of Administrative Hearings for June 28th.

Background on North Carolinians with Mental Illness Housed in Adult Care Homes

The state’s practice of employing adult care homes as the default residential placement for people with mental illness has been a longstanding subject of interest, investigation and study by Disability Rights NC. In July 2010, Disability Rights NC filed a complaint with the U.S. Department of Justice claiming that the practice of warehousing adults with mental illness in adult care homes violated the Americans with Disabilities Act and the U.S. Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999). One year later, the Department of Justice issued a letter containing its findings, and concluded that “adult care homes are institutional settings that segregate residents from the community” and that those with mental illness “are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies … .”

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Disability Rights North Carolina is a 501(c)(3) nonprofit organization with offices in Raleigh and Asheville. Its team of attorneys, advocates, paralegals and support staff provide advocacy and legal services for people with disabilities across North Carolina. As the state’s federally mandated protection and advocacy system, Disability Rights North Carolina is charged with finding and fighting the abuse and neglect of people with disabilities.

NC DHHS Press Release

From:  Titus, Trina Tue, Jun 19, 2012 at 4:51 PM

N.C. Department of Health and Human Services
For Immediate Release
June 19, 2012

Contact: Chrissy Pearson
919-855-4835 or Chrissy.pearson@dhhs.nc.gov

Secretary Delia Announces Reorganization of State Medicaid, DHHS Leadership Team

State Medicaid office will now report directly to Secretary

Raleigh– North Carolina Department of Health and Human Services (DHHS) Secretary Al Delia today announced that he is reorganizing the leadership teams that oversee the state’s Medicaid division.

The changes come after careful evaluation of the Department’s management, said Delia, who was named acting secretary in February.

Michael Watson, DHHS chief deputy secretary, will become the new head of the state’s Medicaid office, the Division of Medical Assistance (DMA). That position will be elevated to serve on the Secretary’s executive leadership team. Watson joined the Department in 2009 as an assistant secretary. He is the former CEO for Sandhills Center for MH/DD/SAS, with more than 20 years of experience and leadership in developing and operating mental health, developmental disabilities and substance abuse services on a local and regional level. His salary remains $160,000.

Watson replaces Dr. Craigan Gray, who served as director of DMA since April 2009 at a salary of $270,000.

Beth Melcher, assistant secretary for mental health, developmental disabilities, and substance abuse services development since August 2010, will become chief deputy secretary. Melcher, a licensed psychologist, is the former president of Recovery Innovations North Carolina. She was clinical director of The Durham Center, and also worked with the National Alliance on Mental Illness North Carolina as its executive director and as public policy director. Her salary will be $141,797.

John Dervin, the secretary’s senior policy adviser since March 2012, will step into a newly created role as chief of staff. Dervin previously served as policy adviser for health and human services for Governor Perdue. His salary will remain $84,000.

“After nearly six months in this role, my first priority for strengthening our management team is to elevate the state Medicaid office to play a more prominent role in the Department’s decision-making process,” said Secretary Delia. “Medicaid is not a stand-alone division. It touches not only multiple DHHS divisions but also plays a huge part in shaping the state budget. We need better communications and stronger oversight of this $12 billion program. I believe these changes will accomplish that.”

These staff changes are effective immediately.

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PBH Press Release on federal Court ruling

02 April 2012


Press Release and response from Piedmont Behavioral Health (PBH) Director of Communication, Rachel Porter on federal District Court Judge Flanagan's ruling in L.S., et al. v. Delia, et al. [No. 5:11-CV-354FL].

DRNC Press Release on federal Court ruling

For Immediate Release

March 29, 2012

Raleigh, North Carolina – A federal District Court today ordered the State of North Carolina to halt reductions to home and community based services and restore lost services until the state Medicaid agency and its managed care contractor, Piedmont Behavioral Healthcare (PBH), comply with legal requirements for providing Medicaid beneficiaries with adequate notices and opportunities for impartial hearings when their services are denied, reduced or terminated. The Court noted that without an injunction, the plaintiffs—children and adults with disabilities—would experience deteriorating health, financial strains, and the threat of having to go into institutions to get care. “We are gratified by the court’s thorough, careful analysis and hopeful that the state and PBH will quickly accept this decision and correct their illegal practices,” said Doug Sea, an attorney at Legal Services of Southern Piedmont. “Scores of our most vulnerable citizens desperately need the services that have been taken away from them, without due process, to be promptly restored.”

Judge Louise Flanagan’s decision found that the plaintiffs are likely to succeed on the merits of their legal claims that the Medicaid agency and PBH are not complying with the most basic federal constitutional and statutory requirements for participating in the Medicaid program. “Health care coverage is complicated,” said National Health Law Program attorney Jane Perkins. “The court’s decision is welcome and important because it recognizes that the Medicaid agency and its managed care plan, PBH, have obligations to make sure that people with disabilities who are insured through Medicaid get timely and accurate information about why their services are being reduced or terminated and what they can do about it if they object.” 

The suit, L.S., et al. v. Delia, et al. (No. 5:11-CV-354FL), was brought by Medicaid beneficiaries who suffer from chronic developmental disabilities and require significant medical or personal care. North Carolina operates a Home and Community Based Care program (North Carolina Innovations Waiver), which provides plaintiffs with access to services so that they can remain in their homes and avoid costly institutionalization. In March of 2011, PBH began implementing a new budgeting system which reduced services for beneficiaries that had previously been found necessary, even though their underlying conditions had not changed, and without the legally required notice explaining why the action was being taken. “Once again, the courts confirm that the desire to save resources does not allow a provider or state to deny due process,” said Disability Rights North Carolina attorney John Rittelmeyer. 

Click here to view the court’s decision. 

For questions or comments about the case, contact:

Doug Sea                                                                                              

Legal Services of Piedmont                                      

dougs@lssp.org                                                             

704-971-2593                                      

Jane Perkins

National Health Law Program

perkins@healthlaw.org

919-968-6308

John Rittelmeyer

Disability Rights NC

John.rittelmeyer@disabilityrightsnc.org   

919-856-2195

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Vicki Smith, Executive Director

Disability Rights NC

2626 Glenwood Avenue, Suite 550

Raleigh, NC 27608

Phone: 919-856-2195

TTY: 1-888-268-5535

Fax: 919-856-2244