News: NC Panel Analyzes Health Care Reform

The Daily Tar Heel has an interesting article regarding health care reform and how North Carolina is preparing for the changes. Here is part of the article and a link to read on.

N.C. panel analyzes health care reform
Will localize national policy changes

By JESSICA SEAMAN | The Daily Tar Heel

President Barack Obama might have succeeded in passing comprehensive health care reform last spring, but actually implementing the hundreds of pages in legislation is a daunting task that the state is preparing to tackle.

Even though most of the laws don’t go into effect until 2014, North Carolina has formed a panel of health care experts to make sure the transition to the new law is as smooth as possible.

The panel, which began meeting this month, will make recommendations not only to Gov. Bev Perdue but also to the N.C. General Assembly and executive branches on how best to adjust to the new laws.

Read More: Daily Tarheel.

News: Psychology Today Article on Disability and Unemployment

Jobless rate for adults with disabilities stagnant for 20 years
Employment rates haven't changed since Americans with Disabilities Act passed.
Published on August 23, 2010
The United State Department of Labor reported earlier this month that the national unemployment rate for July 2010 was 9.5 percent, about the same rate as June.

When you look at the finer details, though, things are better for some people, worse for others.

The unemployment rate for white people was 8.6 percent. For African American people it was 15.6 percent and for Hispanic people, 12.1. Unemployment among teenagers was at 26.1 percent. This is all to say that, depending on where you are sitting, 9.5 percent might look pretty good.

How about a 79 percent unemployment rate? A recent survey from the National Organization on Disability reported, "Of all working-age people with disabilities, only 21% say that they are employed, compared to 59% of people without disabilities."

The survey also states that little progress has been made in the area of employment or other quality of life indicators for people with disabilities in the 20 years since the passing of the Americans with Disabilities Act.

Read more at: Psychology Today

Friday Wrap Up: Interim Committee Meetings Update

The legislative interim committee schedule is now under way. 

Over the past two weeks there were several meetings of interest to our community. The first dealt with the state employee health plan and the benefits for hospital employees. The major announcement in each of these meetings was that the state health plan is going to be short at least $572 million for FY 2011-2012 budget.The second major discussion was if the current state health plan should apply for grandfather status as we transition into the new rules instituted by health care reform. Not holding on to grandfather status could increase the short fall for the health plan to over 1 billion dollars. 

Then on Monday, August 16, we received a budget update at the Child Fatality Task Force from Barry Boardman, Phd. fiscal research staff.

Here is the state of upcoming budget for fiscal year 2011.

The outlook for the next fiscal year is more drastic than this year. This is due to three different factors the first is the termination of stimulus dollars provided in this current budget. The second factor is the termination of the sales tax and corporate tax that was passed in the 2009 session. Third is the extremely slow economic recovery that our state is experiencing.

FY 2010-2011 budget had a 11% shortfall. In actuality it was closer to a 15% shortfall due to a significant reduction in revenue collection. In the coming biennial budget we will see a deficit of 3.2 billion. The deficit consists of 1.6 billion in stimulus money, 1.3 billion in sales tax revenue and the remainder of the deficit is created by 300 million in non-recurring cuts.

These figures do not include the $572 million deficit in the state health plan. Two year ago the budget was 20.8 billion, we are looking to create a budget for the upcoming biennial of 16 billion.

Arc NC: Remarks from the Deputy Secretary of the Department of Health and Human Services

Deputy Secretary of the Department of Health and Human Services, Mike Watson, addressed a packed room of advocates, providers, parents, and Arc chapter executives today at The Arc of North Carolina’s state conference. Deputy Secretary Watson provided the attendees with a state of the state on services for people with developmental and intellectual disabilities.

He opened his remarks by complimenting the hard work and dedication of the many members of The Arc of North Carolina and its chapters. He stated that many of the legislative successes including the return of the $40 million in funding for state funded services was due to their advocacy.

Watson also laid out the values that the Department of HHS and the Division of MH, DD, SAS are operating under as they move forward. Watson stated that “these values are the goals for how we act. We want to keep these values out in front of us and make sure they are translated into action”.

The values included being customer focused. Who are your customers and who are you trying to serve. To create a department and division that are anticipatory. Knowing what are the consequences of our actions and evaluating the outcomes and what can happen because of our policy decisions. The values include a division and department that is collaborative. The goal is to include interested parties in the journey and to ask the consumers, providers, advocates the important questions “what do you think” and “what is the impact”. Transparency and being more results oriented rounded out the new guide for the division and department.

Mike Watson touched on many of special provisions that were included in the budget including the utilization of the SIS tool and the waiver special provision. In addition he highlighted a special provision that addressed making CAP/MR-DD high need consumers be able to access the top tier of the CAP by addressing the need for higher levels of residential supports through re-writing the definition in the waiver.

Watson then gave the attendees the facts about what to expect in next years budget. “The stark reality is that the budget the last two years was extraordinarily difficult. The next year will be the low water mark of our funding issues.”  Mr. Watson set out the deficit in these terms, there will be a reduction in overall stimulus funding. The sales tax and the additional taxes that were part of the 2009 revenue package will sunset in 2011. There will also be a reduction in the non-recurring funding through cuts and through cuts of one time money. The overall budget deficit will be between 2 and 3 billion dollars.

In addressing the Medicaid Rate Reduction cause by not receiving the full 500 million in additional FMAP extension funding, Deputy Secretary Watson stated that “this week providers learned of a 1.35% cut in rates effective September 1. The decision the department made to start as early as possible was that if we waited till later in the year that cut would have increased to 2.7%. Whatever we put in place I can guarantee will continue next year. We would rater have a 1.35% reduction next year than a 2.7%.”

As for the managed care waiver issue, it is clear that the department and division are telling LMEs to expect and get ready for a move into the waiver environment “one way or another Medicaid will be managed”.  Watson stated that the shift to managed care waivers is a multi year process that must include competence and readiness. 

Arc of NC: Deputy Secretary of DHHS Mike Watson Presenting on State of the State DD/ID

Deputy Secretary of HHS Mike Watson is now presenting on the state of the state of DD/ID services in North Carolina.

The Arc of North Carolina State Conference

The Arc of North Carolina state conference is underway! On the calendar for today is a presentation by Deputy Secretary of the Department of Health and Human Service, Michael Watson will be delivery the plenary session at 2:15pm.

Topic today is "State of the State for People with Developmental Disabilities". We will be live blogging his remarks.

NCGA: Legislative Wrap Up #1

The short session was very short this year. Totaling only seven and a half weeks there was an abundance of policy changes that took place through bills and the state budget. This is the first of a series of posts that will guide you through what happened this session. The first and most difficult part of the short session was how to adjust the state's biennial budget. Here then is the budget wrap up.

Budget Background:

This year members of the General Assembly had to balance an 800 million dollar budget deficit as well as a possible 500 million additional deficit if FMAP was not extended.  The key to this year’s budget was how to fill the gap without cutting critical services and without passing a comprehensive revenue/tax package. Overall the members of the appropriation committees did just that.

The final budget reflected very targeted cuts and very targeted expansions. Leadership on HHS appropriation in the House and the Senate did worked diligently to limit cuts for critical services. At the same time we did see targeted expansions in crisis beds and a restoration of the $40 million service dollar cut that was made in the previous budget to LME state dollar service funding.

A major area of concern for the developmental disability community was the full state expansion of the managed care model that is currently in use at PBH. During this session a broad coalition worked diligently to limit the expansion of the 1915 b/c waivers. The final special provision limited the expansion and also included language that directs the department to look at alternatives and to do a thorough customer service study of the existing and two new waiver sites.

As the budget and session came to a close it became clear that the US Congress was going to be unable to pass the necessary FMAP extension. During the last hours of the session a budget technical corrections bill was passed that included a list of eight proposed cuts to fill the 518 million dollar deficit caused by losing FMAP money. The cuts are proposed throughout the state system as opposed to only targeting Medicaid. The list is prioritized and includes language regarding the process of implementing the cuts depending on the amount of FMAP dollars received by the state.

Money Report:

 

Division Management Funds ($7,180,807) NR

Reduces unobligated funding available at the Division's discretion for

one-time needs of community providers or LME system needs.  The total

includes $1,169,355 for mental health, $3,398,534 for developmental

disabilities, and $2,612,918 for substance abuse services.  These funds

have historically been spent to address specific one-time needs; these

funds are not allocated to LMEs for service provision.

 

Leadership Academy: $250,000 NR
Provides funds for a Mental Health Leadership Academy for training for
Mental Health managers, finance/budget officers, and other leaders
within Local Management Entities.

Local In Patient Bed Capacity/Crisis Beds $9,000,000 R

Increases funds available for the three-way contracts to purchase local 

hospital bed capacity for crisis response within communities.  These 

funds will support additional community hospital beds, bringing the 

total funding to $29 million annually.

Community Service Funds $40,000,000 NR
Provides funding for community services administered through Local
Management Entities. This funding fully restores the mental health,
developmental disabilities, and substance abuse services funding
reduced for FY 2010-11.  This amount includes $30,559,012 of funds
transferred from Department of Public Instruction's Office of Early Learning.

                        Special Provisions:

CAP-MR/DD SERVICE ELIGIBILITY (Page 52)
SECTION 10.7A.  Section 10.21B of S.L. 2009-451 reads as rewritten: "SECTION 10.21BSECTION 10.21B.(a)  Except as otherwise provided in this section subsection for former Thomas S. recipients, CAP-MR/DD recipients are not eligible for any State-funded services except for those services for which there is not a comparable service in the CAP-MR/DD waiver. The excepted services are limited to guardianship, room and board, and time-limited supplemental staffing to stabilize residential placement. Former Thomas S. recipients currently living in community placements may continue to receive State-funded services.

"SECTION 10.21B.(b)  The Department of Health and Human Services, Division of Medical Assistance, shall work with stakeholders to develop a new service definition within the CAP-MR/DD waiver to better meet the needs of individuals who (i) have a high intensity of behavioral needs, (ii) reside in small licensed residential placements, and (iii) require supervision 24 hours per day, seven days per week, three hundred sixty-five days per year. The Division shall apply to the Centers for Medicare and Medicaid Services (CMS) for an appropriate amendment to the CAP-MR/DD waiver if CMS approval is necessary to implement the new service definition. Not later than October 1, 2010, the Department shall report to the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division on the development of the new service definition and the status of any necessary approval from CMS to implement the new service definition."

STUDY MEDICAID PROVIDER RATES (page 67)

SECTION 10.25.(a)  The Department of Health and Human Services, Division of Medical Assistance, shall initiate a study or contract out for a study of reimbursement rates for Medicaid providers and program benefits. The study shall include the following information: 

(1) A comparison of Medicaid reimbursement rates in North Carolina with reimbursement rates in surrounding states and with rates in two additional states; and (2) A comparison of Medicaid program benefits in North Carolina with program benefits provided in surrounding states and with rates in two additional states. Selected provider rates shall be studied for the initial report.

SECTION 10.25.(b)  The Department shall report its initial findings to the Governor, the Senate Appropriations Committee on Health and Human Services, the House of Representatives Appropriations Subcommittee on Health and Human Services, and the Fiscal Research Division by April 1, 2011.

SECTION 10.25.(c)  Funds appropriated to the Department of Health and Human Services may be used to complete this study.

 

STATEWIDE EXPANSION OF CAPITATED 1915(B)/(C) BEHAVIORAL HEALTH  
WAIVERS  (page 67)
SECTION 10.24.(a) The Department of Health and Human Services Department shall select up to two additional Local Management Entities (LMEs) to implement the capitated 1915 (b)/(c) Medicaid waiver as a demonstration program during the 2010-2011 fiscal year. The waiver program shall include all Medicaid-covered mental health, developmental disabilities, and substance abuse services.  Expansion of the waiver to additional LMEs shall be contingent upon approval by the Centers for Medicare and Medicaid Services.
SECTION 10.24.(b) The Department shall conduct an evaluation of the capitated 1915(b)/(c) Medicaid waiver demonstration program sites to determine the programs' impact on consumers with developmental disabilities.  The evaluation shall include a satisfaction survey of consumers.  The Department shall consider the impact on ICF/MR facilities included in the waiver to determine and, to the extent possible, minimize potential inconsistencies with the DMA-ICF/MR rate plan and the requirements of G.S. 131E-176 and G.S. 131E-178 without negatively impacting the viability and success of the waiver program.  The Department shall consult with stakeholders and evaluate all other waiver options, including the possibility of a waiver without a 1915(b)/(c) combination.  The Department shall report to the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Fiscal Research Division no later than April 1, 2012, after which time the Department may expand the capitated 1915(b)/(c) Medicaid waiver to additional LMEs.
The Department shall not approve any expansion of the Piedmont Behavioral Healthcare LME (PBH) beyond its existing catchment area until after the Department has completed its evaluation and made its report pursuant to this subsection.

Hill Report: US House Set to Pass FMAP Extension Today

Speaker of the House Nancy Pelosi shortened the House break for an important vote on FMAP legislation. The vote is scheduled for today. House session will begin at 9:00AM.

We will provide an update on this vote once it is available.

Correction: House coverage on CSpan will begin at 10:00AM-

Hill Report: Senate Passes Critical FMAP Extension

Today the US Senate took up the final vote on HR 1586 today, the vehicle for the extension of necessary FMAP funding. There were two Republican amendments voted on that would have extended tax cuts for individuals and small businesses that are set to expire in December. Those two amendment, if they had passed, would have sent the bill with the FMAP extension back to the Senate Finance.

Both of these amendment failed. The final vote on HR 1586 is 61 yes and 39 no. The bill has now officially passed the Senate. The bill includes $26.1 billion in extension stimulus funding. $16.1 billion in FMAP funding. North Carolina will see $343 million dollars in Medicaid dollars and $300 million in funding for teachers and schools. Passage of this bill means that we will most likely not see the 1% across all department reduction as laid out in the budget technical correction bills.

The US House of Representatives has been called back to Washington, DC. This bill will be calendared for a vote on Tuesday.

Hill Report: FMAP Update Senate Votes to End Debate and Motion To Concur Passes

Today the US Senate vote 61 in favor and 38 opposed to end debate on the FMAP extension bill. This effectively stopped a GOP filibuster of the legislation and has paved the was for passage of this critical bill. The second vote taken today by the Senate was a motion to concur, this also passed with a 61 in favor and 38 opposed vote.

It is expected that the Senate will take up the final vote on the FMAP extension bill either later today or tomorrow. The House, which is in August break, will most likely be called back to DC to vote sometime this month.

So what does this mean for North Carolina? It means that NC will see $343 million in FMAP/Medicaid funding come into the state. This will be a big help in closing the $500 million deficit that would have occurred if this bill did not pass. In addition the state will see $300 million in education funding targeted to protect teacher jobs. Critical funding as we approach the start of a new school year.

Hill Report: Happening Now-US Senate is Debating the Teacher and FMAP Funding Bill

The US Senate is currently debating the last attempt to extend funding for Medicaid and teachers. The CBO report shows the new bill being debated actually reduces the deficit.

The vote on the bill is scheduled to take place at 10:40AM. The first vote to be taken will be to end debate and move the bill forward. The Senate rules require 60 votes to end debate.

There has been considerable debate over whether the Senate can get the 60 votes they need. If the vote fails today there will be no further attempts to get this extension before the Senate takes their August break.

Where have we been?

Well, we have been on a blogging vacation following a long "short session". Your lead blogger took some time off to travel to NCSL in Louisville and to wrap up some details from session.

We will be resuming our regular blogging this week.