Friday, April 23, 2010

Arc of NC: Details on Governor's Budget

The budget released by Governor Bev Perdue on Tuesday reflected an attempt to work within the reality of a deep recession while preserving needed services for people with developmental and intellectual disabilities.

The budget reflected no freezes or cuts to core Medicaid services for people with developmental disabilities.

The budget included the following restoration of funding:

$40 million in community mental health state funding. This restores the state service dollars funding cut to LMEs that occurred in the 2009 budget.

The budget did include the following expansion items:

$8.5 million appropriation to expand the State Children’s Health Insurance Program. This expansion will provide access to additional 8,100 children from working families.

 $12 million appropriation to purchase additional local private hospital beds for mental health patients. This is targeted for crisis care needs.

$1 million appropriation to expand Project C.A.R.E. program. This will expand the program to allow 500 additional families to receive respite care services for people who are assisting their elderly family members who have dementia.

 $9 million to allow for targeted reimbursement to adult care homes that provide acute personal care services.  


Many of our concerns after reviewing the governor’s proposed budget are with reductions to Medicaid Optional Services.  Here are four that stood out.

Proposed reductions:

$11.6 million reduction that would limit adult dental coverage to emergency care only.

This recommendation limits adult dental coverage to emergency care only. With this policy change, covered services will include emergency exams; diagnostic x-rays; urgent care extractions; biopsies; excision of tumors; repair of soft tissue wounds; treatment of fractures; and a portion of adjunctive services, such as general anesthesia and IV sedation, hospital calls, and therapeutic drug administration.

 $4.3 million reduction under Improving Utilization Management for Optional Services.  This cut would reduce the maximum number of visits for adult speech therapy, physical therapy, occupational therapy, and respiratory therapy to three visits per year.

Various optional service changes are recommended. They include maintaining adult podiatry services for individuals with diabetes or vascular disease only ($535,436); eliminating adult optical 'refraction only' services to be consistent with Medicare reimbursement ($121,677); reducing the maximum number of visits for adult ST, PT, OT, and respiratory therapy (RT) to three visits/year ($1,507,110); and no longer allowing reimbursement of ST, PT, OT, and RT services when provided at the same time as other home care Medicaid services ($112,500). In addition, the division shall develop a plan that includes limits and prior approval on outpatient optional services for improved utilization management ($2,065,647).  

$59.8 million reduction found by reforming In-Home Personal Care Services.

This recommendation reforms the in-home PCS program in order to provide care for individuals who are at risk of needing institutional care. Reform includes the elimination of in-home PCS services for adults and the creation of a new program for adults with the most intense needs. Some of these individuals are currently enrolled in the PCS Plus program (those requiring extensive assistance with three or more ADLs). A portion of the individuals in regular in-home PCS that have the highest need for in-home support will also be included. The expansion of the PCS Plus into a new program will ensure those individuals that do not qualify for nursing home care and have the greatest need will receive appropriate service in their homes.

 $1.2 million reduction by creating a new Community Alternative Program technology waiver for private duty nursing.

This recommendation transitions adult private duty nursing recipients to a new Community Alternatives Program (CAP) technology waiver. The program will continue to serve children; however, it is recommended that independent assessments be conducted for children that receive the service.

Although we did not see any elimination of Medicaid optional services there are serious concerns over the adult dental reduction and over the proposed changes in adult ST,OT, PT and RT.  We will continue to research the scope of these proposals and will publish updated information on this blog as it becomes available.

Overall Governor Perdue’s budget did what she and her staff had said they would attempt to do. They protected to the best of their ability core services for people with developmental disabilities and their families and her budget restored the $40 million dollar cut in state funding for community based services.  The budget process will now move to the members of the General Assembly. The Senate will begin the process by presenting their budget shortly after the start of session. 

Here is the proposed calendar for the House and Senate Budget Process:

Senate to have an adopted budget my May 20th.

House to have their adopted budget by June 10th.

Final Budget June 29th.

Gavel out on July 1.

 The North Carolina Legislative session begins on May 12th

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