Wednesday, June 8, 2011

NCGA Update HB 344

Late last evening HB 344: Tax Credit for Children with Disabilities passed the House with a vote of 73 in favor to 39 opposed. This bill will now go to the Senate.

Tuesday, June 7, 2011

NCGA News: House Bill 344 Tax Credits for Children with Disabilites on House Floor Tonight.

HB 344: Tax Credit Bill for Children with Disabilities will be voted on this evening by the NC House. Herre is what the bill does:
1. Provide up to a 6,000 dollar tax credit for children with disabilities that are either enrolled in private school or home school. To qualify a student must have an active IEP and receive daily special education services. The student also must be enrolled in a public school for two semesters with that active IEP.

2. The bill establishes a Special Needs Trust Fund, that will be used at the discretion of the State Board of Education to provide supplemental services and supports for students with disabilities that remain in the public school system.

The Arc of NC has been working on this legislation for several sessions.

Tuesday, May 24, 2011

NCGA: Senate Will Release Budget Today

The NC Senate will release its budget proposal today. It cuts 500 million more than what was included in the governor's budget and from all reports will have significant differences from the House budget.

The Senate Health and Human Services Appropriation Committee will meet this morning at 8:30AM in room 643 of the Legislative Office Building. The full Senate appropriation committee is scheduled to meet on Wednesday.

The budget is expected to head back to the House by next week. There will then be a conference committee to work out differences before sending it to the governor.

Of interest to our community will be if there are any significant cuts to Medicaid optional services and how much of a cut there will be to provider rates. We will report here once we have seen the proposal.

Wednesday, May 4, 2011

Bill Update: Senate Bill 465 Behavioral Health Management

Today the Senate Mental Health committee will take up Senator Fletcher Hartsell's Behavioral Health Management bill. This proposed legislation would permit new 1915 (b)(c) waiver sites to incorporate under a hospital statute instead of the current 122C state statute. A major concern of advocates is that this might permit the new waiver sites to not have CFACs and will remove oversight from the department. We will have more information regarding this bill later today.

Here is the bill:
SB 465 Behavioral Health Management

Tuesday, May 3, 2011

NCGA News: Senate Budget Targets

Word spread like wildfire today that the Senate budget targets will be substantially lower than the House targets. Looks like the Senate is looking to cut an additional 70 million out of the HHS budget. We will be following this closely.

NCGA News: The House Debates the Budget on the Floor

Today's marathon session of the House is all about the budget. Overall, the health and human services budget writers in the House were careful to use a scalpel not a hatchet when trying to address budget cuts. For example, they did not eliminate any optional services in Medicaid. They did however give them a bit of a trim.

Another example is in state funded community services, they did a 20 million dollar cut but only for one year of the two year budget. There are of course another round of inflationary freezes to Medicaid provider rates and a 2% cut to provider rates, except for physician rates.

The Education budget is a bit of a different tale. K-12 education received a 8.5% cut and the elimination of teacher assistances in grades K-3 seems to be a given. There are also deep cuts in community college and university funding. We will be watching to see what happens as the budget vote wraps up tonight in the House.

So here is a round up of the special provisions that we were most interested in:

This special provisions puts for two cuts. The fist is a 20 million dollar cut in state funds and the second is a swap of funding at LMEs. A damaging special provision that would not have permitted LME’s to use state funds for individuals who have a Medicaid card was eliminated. This specific special provision would have disproportionately affected people with developmental disabilities.

SECTION 10.11.(a) The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (as used in this section "The Division") is directed to reduce the Community Service Fund by twenty million dollars ($20,000,000).
SECTION 10.11.(b) The Division is directed, through consultation with LME
representatives and stakeholders, to develop a set of standardized covered benefits for recipients of LME Service Funds that shall become the only services paid for by community service funds through LMEs. These services shall be best practices for developmental disabilities, mental illness, and substance abuse.
SECTION 10.11.(c) Effective January 1 2012, the Division shall implement a
co-payment for all mental health, developmental disabilities, and substance abuse services based upon the Medicaid co-payment rates.
SECTION 10.11.(d) The Division is directed to reduce the Community Service Fund by twenty-five million dollars ($25,000,000) for the 2011-2012 fiscal year based on available fund balance reported by the LMEs' 2010 fiscal audit. The Division is directed to allocate the reduction among LMEs based on unreserved, undesignated fund balance totals, as of June 30, 2010. The LMEs are required to backfill the reduction with fund balance availability and not further reduce services beyond the amount identified in subsection (a) of this section.
SECTION 10.11.(e) LMEs are directed to spend their unreserved, undesignated fund balance on services, commensurate with the reduction directed by the Division. Quarterly reports shall be submitted to the Division by LMEs to ensure expenditures from fund balance occurs at the level required by this law. Additionally, the Division shall review the designation of reserved or designated fund balance accounts to determine whether accounts may be moved to unreserved, undesignated, in essence increasing the unreserved, undesignated fund balance available for purchase of services. If categories of funds are moved into the unreserved/undesignated categories, the affected LMEs are encouraged to spend these funds to minimize their share of the twenty million dollars ($20,000,000) in reductions to services as required in subsection (a) of this section.
SECTION 10.11.(f) The Department of Health and Human Services shall report to the House and Senate Appropriations Subcommittees by December 12, 2011, on the status of implementing this section.

Medicaid and Mental Health, Developmental Disabilities and Substance Abuse Services Provisions:
The following two provisions detail the provider rate changes in the House budget. The first provision states that there will not be an inflationary rate increase for Medicaid provider rates. The second provision states that the rate adjustment will be 2% for this biennial. It also sets up a carve out for physicians so that they will not be impacted by the rate reductions.
SECTION 10.43. Notwithstanding any other provision of law, the Secretary of the Department of Health and Human Services shall not authorize any inflationary increases to Medicaid provider rates during the 2011-2013 fiscal biennium, except that inflationary increases for healthcare providers paying provider fees may occur if the State share of the
increases can be funded with provider fees.

SECTION 10.46.(a) Subject to the limitations contained in Section 10.37(a)(6) a. and b. of this act, the Secretary of Health and Human Services shall reduce Medicaid provider rates for all Medicaid providers by two percent (2%) except as follows:
(1) Physician Services. – The provider rate for physicians shall not be reduced.
General Assembly Of North Carolina Session 2011
(2) Hospital Inpatient Services. – The provider rate for inpatient hospital
services shall be reduced by a percentage equal to two percent (2%) plus a
percentage sufficient to achieve the amount of savings that would have
resulted if provider rates for physicians had been reduced by two percent
(2%). The provider rate for inpatient hospital services shall be further
reduced to offset any reduction or inflationary freeze attributable to
outpatient hospital services or to critical access hospitals.
SECTION 10.46.(b) The rate reductions required by this section shall take effect in accordance with the following schedule:
(1) October 1, 2011. – The provider rate reductions required by subsection (a) of this section shall take effect no later than October 1, 2011. If effective after
July 1, 2011, the reductions shall be adjusted by a percentage sufficient to
yield savings as if the reductions had taken effect on July 1, 2011.
(2) July 1, 2012. – On July 1, 2012, the provider rate reductions required by
subsection (a) of this section shall be adjusted to the level at which they
would have been without the adjustment required by subdivision (1) of this
SECTION 10.46.(c) No other adjustments to the provider rates for hospital
outpatient or critical access hospital rates shall be made, except that hospital outpatient and critical access hospital rates may continue to be eligible for inflationary increases.

In each budget we see a provision that details the Mental Health Changes for the coming two fiscal years. This one details the issues with cash flow problems for many non-single stream LMEs and also details the funding for local inpatient psychiatric beds.

SECTION 10.8.(a) For the purpose of mitigating cash flow problems that many non-single-stream local management entities (LMEs) experience at the beginning of each fiscal year, the Department of Health and Human Services, Division of Mental Health,
Developmental Disabilities, and Substance Abuse Services, shall adjust the timing and method by which allocations of service dollars are distributed to each non-single-stream LME. To this end, the allocations shall be adjusted such that at the beginning of the fiscal year the Department shall distribute not less than one-twelfth of the LME's continuation allocation and subtract the amount of the adjusted distribution from the LME's total reimbursements for the fiscal year.
SECTION 10.8.(b) Of the funds appropriated in this act to the Department of
Health and Human Services, Division of Mental Health, Developmental Disabilities, and
Substance Abuse Services, the sum of twenty-nine million one hundred twenty-one thousand six hundred forty-four dollars ($29,121,644) for the 2011-2012 fiscal year and the sum of twenty-nine million one hundred twenty-one thousand six hundred forty-four dollars ($29,121,644) for the 2012-2013 fiscal year shall be allocated for the purchase of local inpatient psychiatric beds or bed days. In addition, at the discretion of the Secretary of Health and Human Services, existing funds allocated to LMEs for community-based mental health, developmental disabilities, and substance abuse services may be used to purchase additional local inpatient psychiatric beds or bed days. These beds or bed days shall be distributed across the State in LME catchment areas and according to need as determined by the Department. The Department shall enter into contracts with the LMEs and community hospitals for the management of these beds or bed days. The Department shall work to ensure that these contracts are awarded equitably around all regions of the State. Local inpatient psychiatric beds or bed days shall be managed and controlled by the LME, including the determination of which local or State hospital the individual should be admitted to pursuant to an involuntary commitment order. Funds shall not be allocated to LMEs but shall be held in a statewide reserve at the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to pay for services authorized by the LMEs and billed by the hospitals through the LMEs. LMEs shall remit claims for payment to the Division within 15 working days of receipt of a clean claim from the hospital and shall pay the hospital within 30 working days of receipt of payment from the Division. If the Department determines (i) that an LME is not effectively managing the beds or bed days for which it has responsibility, as evidenced by beds or bed days in the local hospital not being utilized while demand for services at the State psychiatric hospitals has not reduced, or (ii) the LME has failed to comply with the prompt payment provisions of this subsection, the Department may contract with another LME to manage the beds or bed days, or, notwithstanding any other provision of law to the contrary, may pay the hospital directly. The Department shall develop reporting requirements for LMEs regarding the utilization of the beds or bed days. Funds appropriated in this section for the purchase of local inpatient psychiatric beds or bed days shall be used to purchase additional beds or bed days not currently funded by or through LMEs and shall not be used to supplant other funds available or otherwise appropriated for the purchase of psychiatric inpatient services under contract with community hospitals, including beds or bed days being purchased through Hospital Utilization Pilot funds appropriated in S.L. 2007-323. Not later than March 1, 2012, the Department shall report to the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Fiscal Research Division on a uniform system for beds or bed days purchased (i) with local funds, (ii) from existing State appropriations, (iii) under the Hospital Utilization Pilot, and (iv) purchased using funds appropriated under this subsection.
SECTION 10.8.(c) Of the funds appropriated in this act to the Department of
Health and Human Services, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, for mobile crisis teams, the sum of five million seven hundred thousand dollars ($5,700,000) shall be distributed to LMEs to support 30 mobile crisis teams.
The new mobile crisis units shall be distributed over the State according to need as determined by the Department.
SECTION 10.8.(d) The Department of Health and Human Services may create a midyear process by which it can reallocate State service dollars away from LMEs that do not appear to be on track to spend the LMEs' full appropriation and toward LMEs that appear able to spend the additional funds.

The following special provision continues the transition of utilization management to LMEs.

SECTION 10.13. The Department of Health and Human Services shall collaborate with LMEs to enhance their administrative capabilities to assume utilization management responsibilities for the provision of community-based mental health, developmental disabilities, and substance abuse services. The Department may, with approval of the Office of State Budget and Management, use funds available to implement this section.

This year’s budget had multiple cuts to services and funding. The following special provision details the $5 million dollar cut to nonprofit organizations receiving funding from the Department of Health and Human Services. There is a carve out for state funding to nonprofit organization to pay for direct services to individuals with developmental disabilities.

SECTION 10.18. For fiscal years 2011-2012 and 2012-2013, the Department of Health and Human Services shall reduce the amount of funds allocated to nonprofit General Assembly Of North Carolina Session 2011 organizations by five million dollars ($5,000,000) on a recurring basis. In achieving the reductions required by this section, the Department (i) shall minimize reductions to funds allocated to nonprofit organizations for the provision of direct services and (ii) shall not reduce funds allocated to nonprofit organizations to pay for direct services to individuals with developmental disabilities.

The Division of HHS and Division of DMA are in the process of applying for a 1915 (i) state plan amendment to plan for the provision of services for people living in assisted living centers and receiving personal care services.

SECTION 10.38.(a) The Department of Health and Human Services, Division of Medical Assistance (Division), shall develop and implement a home- and community-based services program under Medicaid State Plan 1915(i) authority in order to continue Medicaid funding of personal care services to individuals living in adult care homes.
SECTION 10.38.(b) The Division shall implement the program upon approval of the application by the Centers for Medicare and Medicaid Services.
SECTION 10.38.(c) On or before April 1, 2012, the Division shall provide a report on the status of approval and implementation of the program to the Joint Legislative Commission on Governmental Operations, 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.

Once again there was a special provision detailing the co-pay for the CAP MR/DD program recipients. This provision has been included in the previous two budgets.
SECTION 10.36.(a) Subject to approval from the Centers for Medicare and
Medicaid Services (CMS), the Department of Health and Human Services, Division of Medical Assistance, shall, in consultation with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services and Community Alternatives Program (CAP) stakeholders, develop a schedule of cost-sharing requirements for families of children with incomes above the Medicaid allowable limit to share in the costs of their child's Medicaid expenses under the CAP-MR/DD (Community Alternatives Program for Mental Retardation and Developmentally Disabled) and the CAP-C (Community Alternatives Program for General Assembly Of North Carolina Session 2011 Children). The cost-sharing amounts shall be based on a sliding scale of family income and shall take into account the impact on families with more than one child in the CAP programs.
In developing the schedule, the Department shall also take into consideration how other states have implemented cost-sharing in their CAP programs. The Division of Medical Assistance may establish monthly deductibles as a means of implementing this cost-sharing. The Department shall provide for at least one public hearing and other opportunities for individuals to comment on the imposition of cost-sharing under the CAP program schedule.
SECTION 10.36.(b) The Division of Medical Assistance shall also, in
collaboration with the Controller's Office of the Department of Health and Human Services, the Division of Information Resource Management (DIRM), and the new vendor of the replacement Medicaid Management Information System, develop business rules, program policies, and procedures and define relevant technical requirements.
SECTION 10.36.(c) Implementation of this provision shall be delayed until the implementation of the new Medicaid Management Information System.

Education Budget:
The education budget remained fairly unchanged during the amendment process with the exception of a special provision amendment sponsored by Representative Rick Glazier (D-Cumberland) that protected funding for positive behavioral support programs in our state.
SECTION 7.19.(c) In implementing budget reductions under this act, the
Department of Public Instruction shall make no reduction in funding or positions for the Positive Behavioral Support program.

The cuts that affect K-3rd grade teaching assistants in our public schools was not changed during the amendment process.
Included in the budget is a special provision detailing funds for children with disabilities receiving services in our public schools.
SECTION 7.2. The State Board of Education shall allocate additional funds for
children with disabilities on the basis of three thousand five hundred ninety-eight dollars and fifty-five cents ($3,598.55) per child. Each local school administrative unit shall receive funds for the lesser of (i) all children who are identified as children with disabilities or (ii) twelve and five-tenths percent (12.5%) of its 2011-2012 allocated average daily membership in the local school administrative unit. The dollar amounts allocated under this section for children with disabilities shall also adjust in accordance with legislative salary increments, retirement rate adjustments, and health benefit adjustments for personnel who serve children with disabilities.

Tuesday, April 12, 2011

Breaking News: Budget Will Come Out Today

We have received word that the budget in the House will roll out between 4:00-5:00pm.

Tuesday, March 29, 2011

Action Alert: Take Action on Managed Care Waivers Today


The NC General Assembly and the State DHHS are developing a plan to require all developmental disability services to be managed with mental illness and substance abuse services in a managed care system. The Arc, along with almost every other developmental disability related organization, opposes this move. Services and support for people with developmental disabilities are life long and do not fit in the medical model of managed care.

Last year, we worked with the DHHS and General Assembly to develop a plan allowing the managed care model to expand to two LME's if the state would work with advocates and other stakeholders to study the effect of such a system and to review other possibilities. Now the Council of Community Programs and the DHHS are lobbying the legislature to remove these provisions. They are pushing a plan to allow three LME's to immediately bid to manage over one half of the counties in North Carolina. This plan is being touted as a cost saving measure, but there are more effective and efficient methods to manage the developmental disability system.

We just learned a few hours ago that DHHS will issue a Request for Application today or tomorrow allowing for statewide expansion of the managed care waiver by 2014.

Basically, the focus has become rapid expansion of Managed Care at the expense of positive outcomes for people with developmental disabilities.

The Arc is working with Legislators. We are asking to be involved in plan development and requesting the opportunity to present options that are best suited to manage the developmental disability system. We need your help now!

Please call your legislator with this simple message...

*Please do not place the DD system into a managed care system with mental illness and substance abuse services.

*Bring DD advocates, providers, families and consumers to the table to help design a system that works

*Review proposals by The Arc and others concerning the 1915i option and DD system design.

If legislators ask you for additional information please refer them to our website and tell them we will deliver a packet of information to them and are available for questions.

Find your state legislator here

NC Legislative Building Phone # (919) 733 7926

Wednesday, March 23, 2011

Quick Bill Update: Juror Qualifications

HB 234: Juror Qualifications/Disabilities was on the calendar yesterday for third reading. There was a debate about the age section of the bill. There was no more debate regarding the rights of people who are deaf or hard of hearing to serve. The final vote was 106 in favor to 12 opposed.

The bill will now go to the Senate. Senator Clodfelter and Senator Brunstetter will lead the bill through the committee and floor debate.

Monday, March 21, 2011

Monday Hot Topics: Coming This Week in the NC General Assembly

This week the House and Senate Appropriation Subcommittee on Health and Human Services will continue to hear presentations on key budget topics. On the agenda for Tuesday is Health Choice and on Wednesday there will be a presentation of possible consolidation options.

A few key bills will see action this week. On the House floor HB 234: Juror Qualifications/Disabilities will get a third reading and final vote before heading to the Senate. We will be following the floor debate regarding this bill. We expect to see at least one amendment that will only affect the ability for a person over the age of 66 to request a deferment of jury duty.

In the Senate Mental Health and Youth Services, members will be presented SB 316: Add'l Section 1915 Medicaid Waiver Sites-(Sponsor: Senator Fletcher Hartsell). This is the bill that will remove the current restrictions on expansion of the 1915 b/c waiver sites that was placed in special provisions during the previous budget cycle.

We are also waiting on more details regarding the projected revenue picture. Under the Blog-N&O blog had a recent post that stated that the state tax revenue was above the projections but non tax revenue was bellow projections. How these numbers shake out is important as we near subcommittee budget presentations. On that topic, House Education Subcommittee has stated there will be no additional meetings for presentations to the committee. The members of this appropriation subcommittee are beginning to create what will become their budget.

Read the report:General Fund-March Report: Fiscal Research Division.

Thursday, March 17, 2011

NCGA Update: Bill Vote Information

Today the House took up HB 234: Juror Qualifications/Disabilities. This bill was hotly debated, similar to last years debate. Although this bill simply brings our state statute in line with federal law, it became increasingly clear that several members of the House did not feel that people who are deaf or hard of hearing should be jurors. The bill sponsors Representatives Rick Glazier, Sarah Stevens, and Ruth Samuelson presented excellent arguments to counter the points brought up by opposition, including that our current statute is illegal, that deaf people are currently serving as jurors and that the AOC requested this change. The bill received a vote of 94 in favor and 24 opposed. There was an objection to third reading. This bill will be back on the calendar for Monday.

In the Senate there was a vote taken on Senate Bill 248: Update Archaic Disability Terms. This bill was presented yesterday in Senate Health by its sponsor Senator Fletcher Hartsell. The bill comes out of the General Statutes Commission and updates existing statutes to People First Language. The bill had a single amendment presented by Senator Fletcher Hartsell to fix a additional term. The bill received unanimous support and will now go to the House.

Wednesday, March 16, 2011

NCGA Update: Two Bills of Interest Make It Out of Committee-Plus Budget Update

Two bills of importance to the disability community made it out of their respective committees today and are on the calendar tomorrow for a floor vote.

The first of these is Senate Bill 248: Update Archaic Disability Terms. This bill is being sponsored by Senator Fletcher Hartsell and it comes out of the General Statues Commission. The People First Language bill directed the General Statutes Commission to review all existing general statues and to update disability language as recommended. This is the first bill to come out of that study. The bill was heard today in the Senate Health committee and it received a unanimous favorable report.

The second bill is House Bill 234: Juror Qualifications/Disabilities. This bill will update a current state statute that prohibits people who are deaf of hard of hearing from serving on juries. Although the Administration of Courts has been using the federal laws, including ADA to provide equal access to the jury process, it is more than time that we bring our state statute into line with the federal laws. The second part of the bill will permit any person with a disability who feels that they can not adequately serve as a juror to request to be excused, to defer or be exempted from jury duty by making a signed statement of the request including a brief explanation of the disability. This bill also received a unanimous favorable report by the House Judiciary A committee. It will be on the House floor for a vote tomorrow.

Budget Updates:

This week the House and Senate Joint Health and Human Services Appropriation Subcommittee met to discuss the governor's budget. During the Tuesday meeting a motion was made to vote on the proposed governor's budget and to accept it as a starting point for further cuts. This was a very unusual motion to be made by the committee. Chairman Nelson Dollar explained to committee members that they still need to find an additional 357 million dollars in cuts to get to their targets.

The remainder of the weeks presentations will focus on Medicaid and CCNC. There has been no indication from the chairs as to when the actual budget process will begin or how it will work.

However, we did get a bit of insight into what might happen next from the Joint Education Appropriation Subcommittee. Today this subcommittee held its last information/presentation appropriation meeting. They will now begin the process of working with staff on a subcommittee budget report. The next called meeting will be to show that report.

Former Governor Sighting:

Governor Jim Hunt was in the General Assembly today educating the new leadership on the importance of Smart Start. Smart Start is the signature education program from Governor Hunt's administration.

Monday, February 28, 2011

Monday Quick Hits: Hot Policy Topics for This Week

This week will be mostly about the budget. Joint Appropriation Subcommittee on Health and Human Services will meet Tuesday, Wednesday and Thursday to begin the process of reviewing the governor's budget. On Wednesday and Thursday the committee will receive a briefing on Medicaid and health choice.

All of the budget meetings will take place at 8:30AM in room 643 of the Legislative Office Building. You can listen to the appropriation debate on line at the legislative website.

Wednesday, February 23, 2011

NC News: GOP Leaders Set Budget Targets

We are about to head straight into the state budget debate. This year the House of the North Carolina General Assembly gets first crack at creating a state budget for the biennial. In an interesting development, all of the House and Senate appropriation subcommittees have been meeting jointly this year. This is good planning for the new leadership, everyone gets the same information at the same time.

So here is how the budget process in our state goes. First the governor releases her budget. That happened on February 14th. Her Valentine's to the state you could say. Then the House leadership would set their budget targets. This year the budget targets were released jointly, so both the House and the Senate are operating under the same fiscal constraints.

Now the real work begins. How do you adjust the governor's which was set at 19 billion down to a budget that is a bit closer to 17.5 billion (According to the News and Observer Story-see link)? How do you do this without deep and devastating cuts to core programs? How do you do this without holding on to the sales tax that is set to expire on July 1? These are the questions that will be bouncing around the General Assembly as the process to create a new state budget gets into high gear in the coming week.

Here are two news story links on the new budget targets. WRAL and The News and Observer.

Want to see the budget targets? Check out News14 link.

Tuesday, February 22, 2011

The Arc of NC News: The Arc of North Carolina Releases Position Statement on Developmental Disability System Design

Today The Arc of North Carolina formally releases our organization's position statement on a system design that will clearly address the real needs of people with developmental disabilities in our state.

The Arc of North Carolina's Position on Developmental Disability System Design was passed by our board of directors at our January meeting. It reflects our serious concerns about the direction our state is heading.

The position calls for Developmental Disabilities to be managed separately from Mental Health and Substance Abuse Services. In addition, The Arc calls for statewide management of the DD system. The position further states that if North Carolina is insistent on moving to Managed Care for the DD System, that it should only be done through a separate Developmental Disability specific 1915(b) waiver.

Though our organization has continually supported local systems management it is clear to us that the current movement toward Mega "Local" Management Entities running a Behavioral Health System is neither local, nor consistent with the values our organization holds.

The Arc of North Carolina
Position on Developmental Disability System Design

For too long North Carolina has attempted to run Mental Health, Developmental Disability and Substance Abuse Services through a one-size-fits-all system. This design limits the ability to create a cohesive vision. It obstructs the implementation of services and supports that are specific to people with developmental disabilities. In recent years the crisis in Mental Health (mental illness) services has substantially altered our system so that a “recovery” model has overshadowed the habilitative and support model valued by the developmental disability community.

Additionally, the reckless pursuit of a Behavioral Health Managed Care system threatens the core supports of people with developmental disabilities. The rush to turn Local Management Entities into Medicaid vendors of Prepaid Capitated Health Services is not only inconsistent with the Core Values of our organization, but it assures that North Carolina will no longer have a local management structure.

Our Goal
The Arc has consistently asked for North Carolina to manage its developmental disability system differently from the Mental Health and Substance Abuse system. Though many leaders have given lip service to such a plan no substantial coordinated action has taken place. The recent actions by DHHS and Local Management Entities indicate to us that continued integrated management will only amount to reduced service for people with developmental disabilities and a recovery oriented emphasis on supports that must be habilitative in nature.

The Arc wants a system that responds to the unique needs of people with developmental disabilities by providing support and habilitation in community settings based upon individual needs. We want a system that responds to the unique funding opportunities for people with developmental disabilities and rejects the behavioral health language of “recovery”. Our system should value and provide the choice to utilize self-direction options to those individuals and families interested.

The Arc believes our system must be fiscally responsive, efficient and accountable. Dollars appropriated for service should not be subject to duplicative administrative cuts. Providers should not be subject to duplicative monitoring. Families and people with disabilities should receive the supports necessary to live in communities but we must work toward a system that creates equity and efficiency.

Recommendations – North Carolina should:

• Create a separate Developmental Disability management structure within DHHS.

• Cease efforts to create additional 1915(b)(c) Managed Behavioral Health Care entities with developmental disabilities included

• Apply for 1915(i) State Plan services for adults with developmental disabilities targeting supports that currently utilize state general fund appropriations and utilizing those funds as Medicaid match

• If Managed Care is inevitable, consider a statewide 1915b Developmental Disability Only Managed Care Waiver with 1915i services included

• Add an additional CAP-DD Waiver for people with developmental disabilities who have significant behavioral and /or medical needs

• Raise the Supports Waiver limit to 25 thousand dollars

• Utilize the Supports Intensity Scale (SIS) as an initial eligibility tool for entrance into the CAP waivers with a reconsideration process utilizing other information

• Manage all of developmental disability services from a state system utilizing existing local structures where appropriate

The Arc wishes to work with all stakeholders to create a more effective, responsive and efficient system to support people with developmental disabilities and their families. We believe our proposal is sound and will meet these goals but welcome constructive conversation about these proposals.

NCGA: Public Hearing on HHS Budget Happening Now

Today the Joint Appropriation Subcommittee on HHS is hosting a public hearing to receive input from the community on issues of the budget.

Dave Richard, Executive Director of The Arc of NC, addressed the committee regarding the need to take a hard look at the 1915i option that is provided by changes through Medicaid in the health reform act. He also spoke of creating a state wide system that will address the needs of people with developmental disabilities, as well as make the system more streamlined.

Monday, February 14, 2011

NCGA: State of the State Wrap Up

Governor Bev Perdue has completed her second state of the state speech this evening. The governor stated that the budget she will be presenting on Thursday is 2.2 billion less that the budget she inherited in 2009.

The governor proceeded to explain that she will reduce the size of state government from 12 departments and agencies into 8. She will reduce state jobs by the thousands and will offer early retirement packages to those state employees who are eligible.

Governor Bev Perdue stated that she will reduce the corporate tax rate to 4.9 percent, the lowest in the south east to continue to recruit new jobs to our state.

In addition Governor Perdue unvieled her NC Career and College program. She will offer a full two year community college degree or training to any qualified student who meets a set core of requirements.

She stated that she will in her budget fully fund all exisitng teaching and teacher aide positions.

In an interesting moment, Governor Perdue stated that the current budget is now at a 2.4 billion dollar deficit. That is down from both the 3.7 billion that we started with on January 28 and it is lower than the 2.7 billion of last week.

Here is what was missing from her speech, how does she pay for all of this. She also did not touch on Medicaid or the retention of critical support services for people with mental illness, addictive disorders or developmental disabilities. In addition she did not discuss how she would include the hunderds of students with developmental disabilities in her career preparation programs.

On Thursday we will get a first hand look at the details of the 2011 budget.

NCGA: State of the State is about to begin

Governor Bev Perdue has entered the chamber to give her state of the state address. This is her second address. The governor is currently being greeted by members of the House, Senate, Judiciary and Council of State members.

You can watch live at

NCGA: State of the State Tonight

Tonight, Governor Bev Perdue will give her state of the state address. This is an opportunity for her to give us some clues regarding what may be in her upcoming budget.

The good news for the governor was the release last week that the budget deficit had fallen to 2.7 billion, down from 3.7 billion. The difference came for an additional 700,000 in increased revenue, 200,000 in Medicaid savings (most likely tied to under utilization) and the remainder was found within state health plan savings and other program savings.

The legislature is also waiting to see what Governor Bev Perdue does with SB13-the bill that directed her to cut specific department spending in order to achieve an additional 400.000 in savings during this current fiscal year. Of the items targeted to be cut were the One NC Fund, Golden LEAF fund, and JDIG-three programs that the governor has stated bring jobs to NC through incentives.

While listening today we expect to hear her touch on several topics, education, jobs and hopefully health care. We will be watching, listening and reporting.

Monday, February 7, 2011

Monday Quick Hits: Hot Policy Topics for This Week

After discussing the budget and the deficit for over three months, the actual legislative work on the budget for FY 2011 begins this week. All of the appropriation subcommittees will be meeting jointly to receive staff overview reports. Of interest to our readers is the appropriation subcommittee on Health and Human Services and the appropriation subcommittee on Education. Also in the mix this week is a committee meeting on state personnel issues.

Three bills of interest are on the calendar this week also. This evening the Senate will complete its debate on S13: Balanced Budget Act. This bill targets specific line items of the current budget that will be targeted for additional cuts. This bill hopes to get an additional savings of $400 million to add a cushion for the next budget cycle.

Senate Judiciary II will take up H2: Protect Health Care Freedom Act. This bill which past the House last week will add North Carolina to the 28 state federal lawsuit that seeks to exempt states from the Affordable Health Care Act individual mandate.

Also this week, Senate Education will take up H8: No Cap on Number of Charter Schools. This bill seeks to remove the cap that currently exists on charter schools in our state. There will be a committee substitute for the current bill that is listed on line.

We will be following all of these committee meetings this week.

Here is the calendar for the week:

Monday, February 07, 2011

5:30 PM Session Convenes (Senate)

6:00 PM Session Convenes (House)

Tuesday, February 08, 2011
8:30 AM Appropriations Subcommittee on Education (Joint) 421 LOB

8:30 AM Appropriations Subcommittee on Health and Human Services (Joint) 643 LOB

10:00 AM Judiciary II (Senate) 1124 LB
Protect Health Care Freedom. (H2) 1124 LB

10:00 AM Education (House) 643 LOB

Wednesday, February 09, 2011
8:30 AM Finance (Senate) 544 LOB

8:30 AM Appropriations Subcommittee on Education (Joint) 421 LOB

10:00 AM Education/Higher Education (Senate) 544 LOB
No Cap on Number of Charter Schools. (S8)

12:00 NOON State Personnel (House) 544 LOB

Thursday, February 10, 2011
8:30 AM Finance (Senate) 544 LOB

8:30 AM Appropriations Subcommittee on Education (Joint) 421 LOB

Wednesday, February 2, 2011

NCGA: Wednesday and Thursday.

Committee meetings start in earnest this morning. Of interest today is the House floor debate and vote on HB 2: Protect Health Care Freedom, SB8: No Cap Charter Schools and finally SB13: Balanced Budget Act.

Some quick information on SB13: Balanced Budget Act. This bill will give Governor Perdue the ability to go into this years current budget (FY2010) and cut an additional $400 million dollars. This action was something that Governor Bev Perdue has been asking for and according to Senate leadership the figure of $400 million is what the governor said she could raise. This additional savings in theory would create more of a buffer for the upcoming budget process.

Here is the calendar:

Wednesday, February 02, 2011

8:30 AM Finance (Joint)544 LOB

8:30 AM Joint House and Senate Finance
Informational presentations by staff 544 LOB

10:00 AM Education/Higher Education (Senate) 643 LOB
No Cap on Number of Charter Schools. (S8)

10:00 AM Judiciary Subcommittee C (House) 415 LOB

10:00 AM Judiciary Subcommittee B (House) 421 LOB
Exclusionary Rule/Good Faith Exception. (H3)

1:00 PM Rules, Calendar, and Operations of the House (House) 1228 LB
Permanent House Rules. (H19)

2:30 PM Appropriations/Base Budget (Senate) 643 LOB
Balanced Budget Act of 2011. (S13)

Thursday, February 03, 2011
8:30 AM Finance (Joint) 544 LOB

10:00 AM Judiciary I (Senate) 1027 LB

10:00 AM Judiciary II (Senate) 1124 LB
Make Synthetic Cannabinoids Illegal. (S4)
Ban Mephedrone. (S7)
Make Synthetic Cannabinoids Illegal. (S9)

Monday, January 31, 2011

NCGA: What's up for the week

Here we go with the budget. There will be a joint budget overview starting Tuesday at 8:30AM and again on Wednesday at 8:30AM.

This is when staff gets to present to the House and the Senate the budget details so that everyone starts their debates on a level playing field of knowledge.

And speaking of the budget, SB 13 has been filed by Senators Stevens, Brunstetter and Hunt which will give the governor more budget cutting powers in order to reach an additional $400 million in savings in the current budget (FY 2010). Quick reminder that the Senate sponsors for this bill are all the full appropriation chairs for the Senate.

In the House we are expecting to see the the Voter ID bill introduced soon. This bill will be sponsored by Representative Rick Killian and Representative Tim Moore. We will have more on this tomorrow.

NCGA: Press Conference on HB 2 Protect Health Care Freedom

Today Representative Verla Insko held a press conference at the General Assembly to give the Democratic response to HB 2: Protect Health Care Freedom. This bill if signed into law would add North Carolina to the 28 state law suit against the health care reform act. It would exempt North Carolina from participating in the individual mandate coverage as required by the Affordable Care Act.

The reality of health insurance is the larger the insurance pool the more access there is to affordable health care for people with disabilities, pre-existing conditions and long term care needs. By mandating that all Americans have health insurance you create a large insurance pool. This is why the Affordable Care Act was able to remove pre-existing condition exemption, the cap on long term health expenditures, the ability to keep your child on your health insurance to age 26 and specifically for people with developmental and intellectual disabilities off a habilitation option in all base insurance plans.

The Arc of the US and its partner organizations worked tirelessly for the passage of this historic health care reform. People with developmental disabilities in 2014 will be able to secure their own affordable health insurance and in doing so quiet possibly lessen the need for full state assistance in long term care.

Then there is the reality of the health care crisis in North Carolina. Dr. Charles Van Der Horst stated that 1/3 of patients in hospitals in North Carolina today do not have health insurance. The cost of their care then transfers to those patients who do have insurance. The end result is an annual increase in health care costs of 9%.

Another speaker at today’s press conference, Libby Huff, told the story of her daughter who in 2009 was diagnosed with a genetic cardiac condition. The Huff family, for the most part, have always been self –insured. On average this family of four has paid out 18 thousand a year to be able to protect their family from catastrophic illness. In 2009 their daughter, while in the high school bathroom, suffered a heart attack. Thanks to an on site defibrillator this young woman was successfully transported to a hospital and after significant cardiac surgery survived this episode only to be diagnosed with a genetic heart condition. Under current health insurance it would be virtually impossible for her to secure affordable and accessible health insurance. However, with the passage of the Affordable Care Act she will be able to remain on her parents health insurance until the age of 26 and in 2014 she will be able to purchase health insurance for herself due to the removal of the pre-existing clause in current health insurance policies.

House Bill 2 would mean that for 4 million North Carolinians they would continue to be locked our of affordable health insurance because of their pre-existing conditions.

House Bill 2 will continue to move through the House over the next few days. We expect to see it hit the House floor sometime this week. We will continue to montior its progress and we will continue to cover this issue.

Monday Quick Hits: Hot Policy Topics for This Week

This week kicks off the first full schedule of meetings at the NC General Assembly. So far not much in announced committee meetings but there will be a press conference today at 3:00 PM.

Here is the scoop on the press conference. As we reported earlier, House Republicans held a Judiciary meeting on Thursday to pass HB 2. This bill will require Attorney General Roy Cooper to put North Carolina into the lawsuit against the federal government and their requirement that all people must have health insurance, better known as the individual mandate.

There are a couple of reasons why this press conference and the bill are being tracked by The Arc of NC. First the bill, during a time when we are looking at a $3.7 billion deficit in the state budget, is the cost of litigating the federal Affordable Care Act advisable? Second, the individual mandate gives people with disabilities more access to affordable health care insurance. It does this by removing the pre-existing condition clauses, permits kids up to age 26 to remain on their parents insurance and it also stops insurance companies by ending benefits in the case of serious illness.

The press conference today will be lead by Representative Joe Hackney (D-Orange) minority leader of the House.

Here is the bill: HB 2 Protect Health Care Freedom.

Thursday, January 27, 2011

NCGA: 2011 Session Opens and First Bills Are Filed.

The contrast between yesterday and today could not have been clearer. If yesterday was all about pomp and pageantry then today was all about politics and policy.

Yesterday was indeed historic. For the first time in over 100 years the North Carolina House and Senate are now being lead by the Republicans. The day was full of events welcoming the new leaders and new members of the General Assembly to Raleigh. The first business of the session was the election of the chamber leadership, specifically the Speaker of the House and the Senate Pro Tempore. These decisions were made prior to the holiday break when both Republican caucuses met to nominate their leaders. The new Speaker of the House is Representative Thom Tillis from Mecklenburg and the new Senate Pro Tempore is Senator Phil Berger from Guilford and Rockingham.

As the evening festivities wrapped up the work of governing the state through a $3.7 billion deficit, the largest gap in revenue and spending since the depression dawned.

Today the newly sworn in Republican-controlled legislature got right to work debating their first bill.
House Judiciary 1 met 15 minutes after the completion of the House session. On the calendar was House Bill 2 Protect Health Care Freedom:
This bill would block the implementation in our state of the independent mandate for health insurance that is part of the Affordable Care Act (federal health care reform).

During the Senate’s first official session, the members found out their official committee assignment. The first bill of interest from the Senate will be to eliminate the cap on charter schools in our state. Senate Bill 8 No Cap on Charter Schools:

This bill would remove the current statutory cap on the number of charter schools in the state.

Monday, January 24, 2011

NCGA: Session About to Start Here is What to Expect

We are just a few days away from the beginning of the 2011 North Carolina legislative session. This session will begin with a historic transition of power. During the 2010 election, the Republicans gained control of both the House and Senate. This will be the first time in over 100 years that Republicans will be our states leadership and with that control comes the responsibility to balance the state budget.

The reality of this session is that regardless of which party was in leadership, our state is facing a $3.7 billion deficit. The budget deficit is over 15% of the state’s total fund expenditure.

So how did we get to a $3.7 billion deficit?
Several factors have caused this significant deficit. Let’s start with the “great recession”. Although multiple economists believe we have hit the bottom and are slowly coming out of it, our state revenue collections have been slow to respond. This is not just happening in our state but also across the nation.

Then there are policy factors that are adding to the deficit. This is the break down of those factors:

1. Federal American Recovery and Reinvestment Act of 2009 funds will expire with the 2010 budget. Total amount not recurring is $1.6 billion
2. The state sales tax and additional taxes that were passed during the 2009-2010 legislative sessions will expire on June 30, 2011. Totally amount not recurring is $1.3 billion.
3. Lastly, there are $300 million in one-time reductions and transfer of fund balances in the current 2010 budget. These one time reductions return to the continuation budget on June 30,2011.
The total of just these three policy factors had our state at a deficit of $3.2 billion.

In addition to these there are several other factors that have brought our state to the $3.7 billion deficit figure. These are the additional preliminary estimates on needed revenue:

$75 million for public schools-K-12 enrollment growth.
$190 million for Medicaid enrollment growth.
$89 million for higher education enrollment growth.

$181.6 million to maintain the current benefit levels and anticipated growth in the North Carolina State Health plan for state employees.

$304.9 million from the General Fund and $13.6 million from the Highway Trust Fund to the State Retirement System to increase the employer contribution to the national standards.

And finally unspecified appropriations will need to be directed at the Savings Reserve Account (Rainy Day Fund), Capital and Repair and Renovations Reserve Account, and Economic Development.

What are leaders saying about how to close the deficit?

Both Governor Perdue and the new Republican leadership are stating that there will be no new taxes offered to help close this gap and no extension of the current tax package.

Governor Perdue had requested all of the state divisions and departments to prepare budgets that reflected a 5%, 10% and 15% cut to their current budgets. In addition the governor has presented a plan to consolidate, eliminate and privatize specific sections of our state government.

The Republican leadership, in multiple news interviews, has pointed to the reduction of budgets through cuts, consolidation of government agencies, and “zero-based” budgeting (defending programs based on their effectiveness and fiscal responsibility.)

As the clock ticks down to the start of a new session, the cuts are most likely to be at least 15% -18% of the current budget.

What is the impact of cutting a budget by 15% to 18% for developmental disability services?

This budget year is critical with both long and short-term implications for people with developmental disabilities and their families. Reductions of 15% to 18% of our developmental disability budget would devastate supports and services. The cuts would be even deeper since a majority of our services are provided through Medicaid funding which receives a 66 % match from federal funds. For example if the state were to cut 50 million from Medicaid funded Developmental Disability services the actual cut would be close to 150 million.

In addition we are likely to see significant cuts in education specifically around teaching assistant positions. With the multiple plans to consolidate and cut services in public health and other social services, we will see a crisis compounded by multiple cuts that will affect the developmental disability community.

What can you do to help legislators understand the personal impact of the upcoming budget crisis?

Here is what we suggest.

1. Get to know your legislator. Make contact with him or her now, before session begins. If you receive services in this state, tell them your personal story.
2. Sign up for e-alerts from The Arc of North Carolina and for our upcoming bi-weekly publication, “Policy Partners” designed to provide more analysis and review of actions taken in Raleigh.
3. Keep up with The Arc of North Carolina Policy blog as we update daily the happening at the North Carolina General Assembly.
4. Follow us on Twitter at thearcnc. We will be using Twitter to get breaking policy news out to you directly from the General Assembly.
5. Participate in lobbying days at the General Assembly. Find out more about our lobbying efforts during the session by visiting The Arc of North Carolina web site.

Tuesday, January 18, 2011

NCGA: Joint Legislative Oversight Committee Meeting MH/DD/SAS Agenda

Tomorrow will be, most likely, the last of the Joint Legislative Oversight Committee meetings for this interim. Here is the new agenda. (Please note the early start time.)

Joint Legislative Oversight Committee on
Mental Health, Developmental Disabilities, & Substance Abuse Services

January 19, 2011 9:30A.M.; Room 643, Legislative Office Building
Representative Verla Insko, Co-Chair, Presiding

Welcome and Opening Remarks Senator Martin Nesbitt, Co-Chair
Representative Verla Insko, Co-Chair

CABHA Update Beth Melcher, Ph.D., Assistant Secretary for Mental Health, Developmental Disabilities & Substance Abuse Services Development, DHHS

LME Medicaid Utilization Management Staff, Eastpointe Ellen S. Holliman, Area Director, The Durham Center

Residential Services for Children Ages 0-6 with Developmental Disabilities Deborah Carroll, Ph.D., Head of Early Intervention Branch, Women & Children's Health Section, Division of Public Health Rose Burnett, DD Project Manager, Division of Mental Health, Developmental Disabilities & Substance Abuse Services

Draft Report& Committee Discussion

Final Remarks & Adjournment