Showing posts with label special populations. Show all posts
Showing posts with label special populations. Show all posts

12 December 2012

WRAL (SpED) Teacher of the Week

WRAL Teacher of the Week: 'I'm trying to give them hope'


Kudos and congrats to WCPSS Martin Middle School's Coach and Special Education Teacher, Mr. Stuart Vickery for being recognized as WRAL's Teacher of the Week! - and much well-deserved I might add (last year he also received an award for Teacher of the Year).

Mr. Vickery is without a doubt, an outstanding example of community spirit. I know this because he is my daughter's beloved teacher this year. --You'll recognize Isabel as she is the only girl in the class, a status which she thoroughly enjoys - and none to my surprise, WRAL caught her on camera swatting at one of the assistants during this piece. That's my girl.

My only beef with this feature is the media reframing as denoted in the headline, "I'm trying to give them hope" - a partial exert from Mr. Vickery's explanation of why he does what he does... But he says oh so much more... He says, "Their whole lives they've been taught what they can't do, and I'm all about what they can do... I'm trying to build their self esteem, trying to make them feel better, and I'm trying to give them hope too." Vickery goes on to explain that the reach goes beyond the students and the importance of a positive impact on everyone in their lives... 

Everyone needs hope in life, but these kids are hardly hopeless... These kids ARE HOPE. And that is what community is all about; that is what Stuart Vickery brings to the table - focusing on what they CAN do... and what they CAN do is LOVE. 

We can all take a lesson from these kids and teachers like Stuart Vickery.

23 October 2012

An Open Letter to Ann Coulter & then some...

Personally, I take no issue with conservatives, generally speaking, nor do I take issue with liberal thinking - everything in moderation as they say. Most of us have sound wisdom and skills worthy of contribution to the world... Just think what we could all accomplish together if we stopped the ridiculous power-plays and political tangos we engage ourselves in tirelessly - time, energy, and resources that, if spent wisely and consciously, could ease the suffering of so many on this earth and in this very country - in our own communities - if we'd just stop trying to force our own ideals, beliefs, and way of life upon others... Though apparently, being self-righteous is a slippery slope - and a long fall off the proverbial turnip truck.

I am rarely a soul of few words and yes I have much I would like to say in response to Ann Coulter's vile remark, "I highly approve of Romney's decision to be kind and gentle to the retard."

Really Ann? You had to go there? Could you think of no sharper dagger to poke into the gentlest hearts of mankind? And you think this strengthens your platform or lends credibility to your cause? I'm pretty sure even your beloved Republicans are sickened by your cruel thoughtlessness too, at least they should be. Because, regardless of what side of the political fence you ride, there is absolutely NO EXCUSE for your hateful comment. It's not the President you hurt with your idiocy. You just spat in the face of millions... Millions who are much stronger than you. 

Millions who love and know love like you only dream of.

Shame, shame on you Ann Coulter.

I could go on... But I could not say anything any better than Mr. John Franklin Stephens.
Thank you Mr. Stephens. You do us proud.

-----------


An Open Letter to Ann Coulter
Posted on October 23, 2012 by Tim Shriver


The following is a guest post in the form of an open letter from Special Olympics athlete and global messenger John Franklin Stephens to Ann Coulter after this tweet during last night’s Presidential debate.

Dear Ann Coulter,

Come on Ms. Coulter, you aren’t dumb and you aren’t shallow. So why are you continually using a word like the R-word as an insult?

I’m a 30 year old man with Down syndrome who has struggled with the public’s perception that an intellectual disability means that I am dumb and shallow. I am not either of those things, but I do process information more slowly than the rest of you. In fact it has taken me all day to figure out how to respond to your use of the R-word last night.

I thought first of asking whether you meant to describe the President as someone who was bullied as a child by people like you, but rose above it to find a way to succeed in life as many of my fellow Special Olympians have.

Then I wondered if you meant to describe him as someone who has to struggle to be thoughtful about everything he says, as everyone else races from one snarkey sound bite to the next.

Finally, I wondered if you meant to degrade him as someone who is likely to receive bad health care, live in low grade housing with very little income and still manages to see life as a wonderful gift.

Because, Ms. Coulter, that is who we are – and much, much more.

After I saw your tweet, I realized you just wanted to belittle the President by linking him to people like me. You assumed that people would understand and accept that being linked to someone like me is an insult and you assumed you could get away with it and still appear on TV.

I have to wonder if you considered other hateful words but recoiled from the backlash.

Well, Ms. Coulter, you, and society, need to learn that being compared to people like me should be considered a badge of honor.

No one overcomes more than we do and still loves life so much.

Come join us someday at Special Olympics. See if you can walk away with your heart unchanged.

A friend you haven’t made yet, John Franklin Stephens
Global Messenger
Special Olympics Virginia

EDITOR’S NOTE: John has previously written powerful opinion pieces on the R-word. Read one here.

CAP-IDD ... this is NOT NC Innovations

From Mary K. Short:


The links to the announcements and guidance are below.  The changes from CAP-MR/DD to CAP-IDD are approved by CMS on 10/1/2012 BUT are not implemented until 1/1/2013.  If you are in an LME that is supposed to convert to an MCO before or on 1/1/2013 THIS DOES NOT APPLY TO YOU (or if you are already on the NC Innovations waiver) because you should be working on the transition to the NC Innovations waiver for your LME/MCO "go live" date prior to or on 1/1/2013.  The Special Medicaid Bulletin is specific about timelines and who is and who is not impacted.
Additionally, this is part of what Doug Sea sent out to providers/case managers.  I know he works with DRNC (Disability Rights North Carolina www.disabilityrightsnc.org) and you should probably contact them if you have questions.  If you are in Legal Services of the Southern Piedmont area (Mecklenburg & surrounding), then contact LSSP at www.lssp.org.
The instructions do not include the right to request continuation of current services as a reasonable accommodation under the ADA. Nor do the instructions provide for the right to a notice with appeal rights if such a request is made and denied. It will be up to advocates and providers to let families know they have the right to submit such a plan and to appeal to OAH if denied if they are at serious risk of institutionalization without continuation of their current services. Please make families aware of this.  
Essentially the same issue will occur for families transitioning to the Innovations waiver on January 1 .  Those 36 counties are also listed in this bulletin.
Here are some other possible specific issues to look for as CAP-DD families transition to the new CAP-IDD waiver (for a short time) and to the Innovations waiver:
A.      if LME doesn’t have adequate provider network, can family continue to be paid to provide home support services?
B.      If rate paid to provider is changing (eg no more enhanced personal care services or enhanced respite) and new rate is inadequate to attract qualified provider for this recipient, can recipient appeal rate reduction/loss of enhanced service?
C.      Does the requirement that  Intensive In home support have a fading plan and the 6 month limit for intensive night services violate the ADA or EPSDT?
D.      Does the restriction on services during school hours violate EPSDT if the child requests personal care (not hab serv) in excess of that limit?
E.       Does child recipient have right to case management in addition to care coordination under epsdt if medically necessary in that case because the LME staff are not adequately trained or don’t do medically necessary work the current case manager has been doing?
F.       Does the LME violate due process by “crosswalking” to new services without explaining right to request continued current service and to appeal if denied?
Mary K. Short
828-632-5888 or 704-451-4144 (cell)
Special Medicaid Bulletin:
http://www.ncdhhs.gov/dma/  (SCROLL down, it's the first bullet point on the left.)
OR direct link to the Bulletin:
CLINICAL POLICY 8M:
(Clinical Policy 8M ... this is the IDD 8M.  I do not have an answer for how it got approved and posted without an additional comment period!)

05 October 2012

A Day in the Life...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you, thank you Dr. Grand!

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

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

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

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

23 September 2012

Day Dreams from an Autistic Mind

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


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

Because I recognized the images are personal (with the exception of the upper center and cartoon), I contacted the mom to request permission to share her message and inspiration. She kindly obliged and included the following about her family:
"I am a mother of two children, Emma is 4 1/2 and Lukas is 3. He was diagnosed with Autism on November 17, 2011. He is moderately Autistic. He is also nonverbal. As soon as we found out we put him in early intervention that changed our lives. He is very smart and very clever. He is now in an Integrated Preschool using the TEACHH program and he gets OT, PT and ST. He is am amazing little boy and I love him just the way he is."
Thanks to Emma and Lukas's awesome mom for reminding us what it's all about! =)

13 September 2012

10,000 Blog Views! and Counting...

This week, the blog reached 10,000 page views! North Carolinians (and others across the country) are watching - and inquiring minds wanna know...

At the time of the June 16th posting, the blog had reached 5,683 since February of 2012, when first launched. Since that time, the hits have more than doubled from viewers in at least 63 counties across the State of North Carolina and beyond. 

Once more, I'd like to point out that regarding total hits, the number (10,143 as of this posting) reflected to the right of the page (previously located at the bottom) is the correct total of page views since the initial launch of this parent / public information blog back in February of 2012. StatCounter was installed in May, so the data you see compiled via the blog's StatCounter statistics only reflects activity from May onward, mostly because I just haven't bothered to change it. 

Viewers include loads of parents / family members as well as provider agencies and professionals, LME / MCOs, universities and research groups, risk management groups, PR firms, law firms, advocacy organizations, and both state and federal government offices (*although due to the ambiguity of government IP data, it's impossible for a novice like me to know which specific offices nor even agencies are viewing)...

Some of the more interesting regular (and some once or twice) NC viewers include: Duke University, UNC Chapel Hill, UNC Charlotte, the Department of Veteran Affairs, the North Carolina Research and Education Network, Disability Rights NC, The Arc of NC (and various county chapters), NC Justice Center, NC Council of Community Programs, Crossroads Behavioral Healthcare (now Partners Behavioral Health Management), Daymark Recovery ServicesPiedmont Behavioral HealthSandhills CenterSaguaro Management and Accounting Services, Inc. (providing billing, human resources, program development and quality and risk management to human services companies), the Mental Health Association of Forsyth County, Raleigh's Campaign Connections PR firm, and numerous NC Government offices and agencies around the state.

And beyond North Carolina's borders: Kansas Health Institute, Virginia Commonweath University (VCU), Minnesota State Colleges and UniversitiesUniversity of Georgia, Emory University, DC's American UniversityFHC Health Systems, Hospice of the Western Reserve in Ohio; Charleston, SC's New Hope Treatment CentersHMS (a public government and managed-care contracting company); DeloitteMarsh USA, and Alvarez & Marsal (each being US consulting / risk management firms with varying specialties); Nelson Mullins Riley & Scarborough LLPDrinker Biddle, and Hunton and Williams (each are national / multi-state law firms); and yes, even the US Centers for Medicare and Medicaid as well as a few hits from US Government offices in Washington, DC.

Yep, as election season launches into full swing (or sling as is oft the case), the world IS watching to see what North Carolina will do with it's special populations -- even if the usually less-than-enthusiastic main-stream media assignments and focus generally fall short in the real-life, human interest for "those people" and their families - because let's face it, nobody really wants to talk about what they don't understand, especially if it makes them sad... 

The 38th Vice-President of the United States, Hubert H. Humphrey, once said oh-so wisely, "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."

It's one of my favorite quotes and oh-so-fitting... and if you happen to be a quote-y kind of person like me and enjoy wise words, here's another for ya...

"Open your mouth for the mute, For the rights of all the unfortunate. Open your mouth, judge righteously, and defend the rights of the afflicted and needy." --Proverbs 31:8-9

So rest assured North Carolina, Inquiring Minds DO Wanna Know.


And to all the blog followers, the advocates, the exhausted parents, supportive family members; loyal and dedicated direct care staff, Case Managers, and various professionals (our personal community villages) who go above and beyond every day to make our lives possible...  and to all the people of conscious who listen, who care, who try and try again - and who never, ever give up because you know what is right and just and because it's just not in your soul's design to believe that one life is worth less than another... I'd like to take this opportunity to say Thank You!

Oh, I mentioned 63 counties; here they are... Clicking on the County links below will take you to the corresponding State representatives page on the North Carolina General Assembly's website.
  1. Alamance County 
  2. Beaufort County 
  3. Bertie County  
  4. Brunswick County 
  5. Buncombe County 
  6. Burke County 
  7. Cabarrus County 
  8. Caldwell County  
  9. Catawba County 
  10. Cherokee County 
  11. Cleveland County 
  12. Cumberland County 
  13. Dare County 
  14. Davidson County  
  15. Duplin County 
  16. Durham County  
  17. Edgecombe County 
  18. Forsyth County  
  19. Franklin County  
  20. Gaston County 
  21. Granville County  
  22. Guilford County  
  23. Halifax County  
  24. Harnett County 
  25. Haywood County  
  26. Henderson County  
  27. Hertford County  
  28. Hoke County  
  29. Iredell County  
  30. Jackson County  
  31. Johnston County  
  32. Jones County  
  33. Lee County  
  34. Lenoir County  
  35. Lincoln County  
  36. Macon County 
  37. McDowell County  
  38. Mecklenburg County 
  39. Monroe County *voter representation falls under Union County
  40. Moore County  
  41. New Hanover County  
  42. Onslow County  
  43. Orange County 
  44. Pasquotank County  
  45. Pender County  
  46. Pitt County  
  47. Polk County  
  48. Randolph County  
  49. Robeson County  
  50. Rockingham County  
  51. Rutherford County  
  52. Sampson County  
  53. Stanly County  
  54. Stokes County  
  55. Transylvania County  
  56. Union County  
  57. Wake County 
  58. Watauga County  
  59. Wayne County 
  60. Wilkes County  
  61. Wilson County  
  62. Union County  
  63. Yancey County  
To find out who your voting representatives are, visit the NC General Assembly search page.
For more on who's involved and how to advocate, see Speak Up!

30 August 2012

Crisis for those Receiving Personal Care Services


Crisis for those Receiving Personal Care Services


On August 14th during the Health and Human Services Oversight Committee meeting, members of the General Assembly and others got a first look at the impact of their special provision changing the requirements for Personal Care Services for people with mental illness and developmental disabilities. What they saw was not good.

Within this year’s budget, the legislature set new guidelines on who qualifies for Personal Care Services. The changes were in response to legal action by the Center for Medicaid Services (CMS) that required the state to address comparability between in home care services and those services provided in licensed group and adult care homes. In other words, the State had to make it just as easy for someone to receive Personal Care Services in a community setting as it was to receive them in an institutional setting, as long as it costs the same or less to do so.

To meet new eligibility standards, recipients must have a medical condition, disability, or cognitive impairment. They also must require limited hand-on assistance with three activities of daily living (ADLs), or hands-on assistance with two ADLs including one at the extensive assistance or full dependence level (clinical terms). The ADLs that qualify are bathing, dressing, mobility, toileting and eating.

Tara Larsen, Chief Clinical Operations Officer of DHHSs Division of Medical Assistance, opened the presentation by reviewing the legal situation surrounding the change in PCS eligibility. She reviewed the process that the state is undertaking to evaluate all current recipients of PCS to see if they will continue to receive this Medicaid service under the new requirements. Ms. Larsen informed the members that the target date for completion of these assessments is November 30, 2012.

During the presentation, one slide stood out. That slide detailed the significant effect that this change will have on people with mental illness and developmental disabilities living in group homes and receiving PCS. According to DMA (Division of Medical Assistance), 86% of residents with I/DD in group homes will not qualify for PCS under the new rules and 100% of residents with mental illness will not qualify.

In total 12,000 North Carolinians will see their Personal Care Services eliminated under the new rules.

DHHS, DMA and the legislature has yet to articulate a response to this looming crisis. The current budget did allocate $39 million dollars to be used to assist adult care homes in transitioning their residents who do not qualify under the new rules, but that is just a fraction of the affected residential settings. For the people in mental health group homes and DDA group homes, their wait for help continues.

The Arc continues to work with DHHS, DMA, and the legislature on this imminent crisis. We will keep you informed as the situation progresses, and let you know when we fill grassroots action is needed.

09 August 2012

From The Arc NC: Lessons from the Western Highlands Network overruns

From The Arc of North Carolina

Lessons from the Western Highlands Network overruns

[ view original posting ]

The cost overruns at Western Highlands Network (WHN), the first LME to become an MCO under a new law, are a serious issue. The solution to these overruns that the state and WHN has come up with is clear: further service cuts. Hopefully, these overruns are just a bump in the road and not the light of an oncoming train, indicative of a system-wide underestimation of managed care cost. Most likely it will be somewhere in the middle.

We can only hope that people with disabilities will not be harmed further by these overruns than they already have been by the shift to managed care. The Arc hopes WHN survives these problems and succeeds for the sake of the individuals they are in the business of supporting.

Regardless of the reasons for the problem, the State, meaning both the Administration and the Legislature, should be paying close attention. Though we do not yet know the specifics that led to these overruns, several things should be perfectly clear:
  1. We need a real examination of the process. Regardless of why, no MCO should have such significant funding issues six months into operation. Some are understandably questioning the leadership of former CEO Arthor Carder, but it’s hard to believe anyone would question his commitment to the people WHN served, or the commitment of WHN’s staff. The fact that this MCO was allowed to go live without the tools to succeed is not only a mark on WHN, but more importantly a significant mark on the DHHS processes that deemed them ready.
  2. We should not only examine the process that led to these overruns, but the 1915(b)(c) waiver model as a whole. It is no secret that The Arc does not believe this model is appropriate for people with IDD. The issues with WHN should cause public officials to question the model as well. As WHN looks for places to cut Medicaid rates, it becomes clear that the system prevents them from even considering state operated facilities [state institutions] for reductions comparable to community services. Managed Care was sold to legislators, and the public, on the assumption of MCOs’ ability to effectively manage all public resources. Clearly, that was not true then, nor is it now. This disconnect makes the state’s difficult transition to a new model of care even more difficult. If the 1915(b)(c) managed care model works for community-based services it should also work for state-managed facilities. This issue is just one of many model design questions that must be questioned.
  3. State officials told the WHN Board that they should expect no additional state funds to make up for overruns. This begs the question: is the stated goal of “better access to services” just spin? When rate reductions, utilization reductions, and Medicaid paybacks are the primary tools used to eliminate deficits, it is difficult to take seriously that better access is a real goal. Better service access would more likely be achieved if the state were willing to adjust the capitation rate or infuse some money while WHN becomes better prepared to “manage.”

Though not enough details have been released yet to determine the specifics of the WHN overruns, we do know:
  1. The only way “savings” will be achieved through this managed care model is through cuts. That should be clear as we review the differences in what WHN was paid and what they have said they needed to provide services. We know that Medicaid cost must be controlled but an honest discussion of how managed care achieves this is critical if people will have faith in this system.
  2. The way “at risk” is used in this model is insulting to families, consumers and the people who provide the supports for them. Public MCO’s are not really “at risk” entities. They have raised no capital to fund their organizations; they receive generous administrative allocations separate from services funds, and have the ability to cut rates and services to consumers if they exceed budgets. Providers of services are the ones really at risk. With subjective decision making, constant rate reductions, no guaranteed “administrative” funds or excise payments to fund a MCO’s “risk” reserves, many providers will likely go out of business. Most importantly, people with disabilities and their families are the most at risk…at risk for another failed effort at reform jeopardizing their ability to live successful lives in the community.

26 July 2012

First LME to become MCO Facing Budget Overruns

From The Arc of North Carolina

First LME to become MCO Facing Budget Overruns

[ view original article ]

Western Highlands Network (WHN), the Managed Care Organization (MCO) that provides state funded services to people with intellectual and developmental disabilities (I/DD) in several western counties, recently reported that they are running a monthly defecit of $500,000 since they became a managed care organization in January 2012. WHN officials indicate they feel the State’s original capitation (reimbursemnt) rate was insufficient to cover the Medicaid cost of their program.

When questioned by members of the Disability Waiver Advisory Committee on July 24th, State officials responded that the budget deficit had been uncovered in a routine monitoring visit and that they would be attending the upcoming WHN board meeting. They offered no further explanation.

Apparently the State, along with the Mercer consulting firm, reviewed WHN in mid -July to determine what was causing the cost overruns. At this time, we do not have the results of this review, but we will report as we find more details.

The revelation of these cost overruns is concerning on many levels. Most importantly, we are concerned WHN will be forced to make significant cuts to services in an area that already has significant numbers of people with I/DD waiting for services. To correct this deficit, WHN plans to evaluate rates paid to providers and the amount of service provided to consumers. If this problem results in service reductions, it will be further evidence that Managed Care “savings” are really just another name for “cuts.”

If the capitation rate is too low, as WHN claims, and the state adjust it upwards, it will erode the “savings” North Carolina hopes to gain from the implementation of the Managed Care Waiver. Such a development would call into question why we would make such a massive change for little gain.

Another concern is how the state deems a MCO ready to proceed. According to state officials, all pending MCOs pass rigorous tests to assure that they are ready to go “live” as a managed care entity. The State contracts with Mercer to engage in this process, as do state officials charged with implementing the Waiver. If WHN was really ready to go “live” in January, it is hard to believe they could be losing money at such a pace.

The Arc believes the WHN staff and DHHS staff are sincerely attempting to find solutions to this serious problem. We hope that this issue is only temporary and that services will not be disrupted to the people this complicated system is intended to serve. However, we do believe this issue should prompt the DHHS and the General Assembly to truly examine the model and pace of this implementation. In an at risk Managed Care system, the only people truly at risk are the people it is intended to serve.