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.

Monday Quick Hits: Hot Policy Topics for This Week

North Carolina

Today begins the last week of the legislative session at the General Assembly. There are a several bills that will be "hot topics" in the press and at the building this week. These bills include reforming ethics, coming in line with a court decision on elections, and the Alcoa debate.

We will have a complete review of the session next week.

NCGA: Corporal Punishment Bill Passes Senate-Heads to Governor

Yesterday the Senate passed HB 1682: Corporal Punishment and Children with Disabilities. The vote was unanimous, 48 Senators voted in favor of this legislation. We greatly appreciated the efforts of advocates across the state who supported this bill. A special thanks to the ACLU of NC, Autism Society of NC, and Disability Rights North Carolina who worked tirelessly with The Arc of North Carolina on securing passage of this legislation.

Here is what the bill does:
This bill would offer parents of children with disabilities, as defined by Section 504 of the Rehabilitation Act and IDEA, the ability to opt out of corporal punishment if it is practiced by their school. This bill will also direct the state to collect specific data regarding the practice of corporal punishment.

NCGA: Bill Update-Corporal Punishment and Children with Disabilities

The Senate Education committee debated House Bill 1682: Corporal Punishment and Children with Disabilities today. The bill passed with a favorable report. The Senate will vote on the bill tomorrow.

NCGA: Bill Update

House Bill 1682: Corporal Punishment and Children with Disabilities will be debated today in the Senate Education Committee. The committee will meet at 10:00 AM in room 643 LOB.

This bill passed the House with a vote of 113 in favor and no votes in opposition.

This bill would offer parents of children with disabilities, as defined by Section 504 of the Rehabilitation Act and IDEA, the ability to opt out of corporal punishment if it is practiced by their school. This bill will also direct the state to collect specific data regarding the practice of corporal punishment. If this bill passes the House it will be heading to the Senate.

NCGA: Budget Review #1

Yesterday the House and Senate tentatively approved the adjusted state budget for fiscal year 2010-2011. The last of the votes is expected to happen today followed by the governor's signature. The new fiscal year begins July 1. This will be the first time in seven years.

The budget being voted on totals just under $19 billion and does include a special provision for how the state will handle not receiving the additional $500 million from the federal government in FMAP money.

The budget does restore the $40 million cut to state funded community based services for people with developmental disabilities. mental illness, and addictive disorders. The budget also allocates $9 million in recurring funding to purchase more crisis beds. Both of these items reflect the continuing need for more community based services.

A more detailed budget analysis will be posted later in the week.

NCGA: Budget Debate Underway in House and Senate

The budget is now being debated in both the House and the Senate chambers. Second vote is expected today.

NCGA: Budget Update-9:29PM-Monday

The House has read in the budget. Final votes are scheduled for Tuesday and Wednesday.
Here is the link to the budget and the money report.

NCGA:Budget Update at 6PM-Monday

Special Thanks goes out to Mark Binker with the Greensboro News and Record for supplying us with this updated post on the budget!

Budget proofreading
UPDATE: I have re-written this post to reflect the final version of the budget cemented at 4:45 p.m. Monday afternoon. The order of FMAP cuts were rewritten, but the cuts themselves stay the same.

Update: Click here to read the FMAP cut language as it will be in the budget.

The House and Senate budget negotiators have completed their final run-through on the budget today (previously). What was really kind of a funny is they had a budget deal Saturday, but still had to figure out Monday what exactly they agreed to.

One of the last points of contention was what will happen if they don’t get the $525 million in FMAP Medicaid money. They had identified the eight items that might be cut, but memories seem to be a bit hazy on the order of operations for how it’d work.

They have since figured out (with help from Gov. Bev Perdue) that they'll make the followin eight cuts, in this order, depnding on how much money is forthcoming from the federal government:

1) Transfer from the disaster relief fund ($30 million)
2) Transfer of unclaimed lottery prize money and excess receipts. ($35 million)
3) Use of interest from all other funds. ($50 million)
4) Use of balance in General Fund Availability left over from current year ($23.5 million)
5) Reduction of Medicaid provider rates ($26.6 million)
6) Use of Funds from the Savings Reserve (rainy day) Fund ($37.3 million)
7) Reduction in retirement system contributions. ($139 million)
8) One percent management flexibility cut. ($177.5 million)
Regarding Item 8: agencies will be required to start planning for that cut and setting money aside July 1, even if they don't end up taking it.

Also noted: Negotiators gave Gov. Bev Perdue $10 million forher handheld diagnostic devices for improving instruction in early grades.

Read more on Mark Binker's blog.

NCGA: Budget Update from Jones St.

Budget writers are proof reading and finalizing last minute details on the $19 billion budget and the FMAP contingency to make up the $525 million in FMAP. One sticking point is when to take the FMAP contingency dollars-do we make the cuts now or hold off until January 1 to see what happens.

Mark Binker with the Greensboro News and Record is reporting the finally information on the details of the contingency dollars:

1) $177 million flexibility cut for all state agencies. It doesn’t deal with salaries. (There was a question among budget negotiators whether this was supposed to go into effect immediately or on Jan. 1.)
2) Reducing Medicaid provider rates. $26.6 million.
3) Reducing the general fund balance from the current year by $23.5 million
4) Transfer from the disaster reserve by $30 million
5) Use of interest from other funds: $50 million
6) Unclaimed lottery prize money $35 million
7) Reduce savings reserve by $37 million
8) Reduce the retirement fund contribution by $139 million

Read the rest of Mark Blinker's blog here.

NCGA: Budget Negotiators Say They Are Done

Mark Binker, reporter with Greensboro News and Record, is reporting that budget writers have finished their work. Here are some highlights from his blog post on how they were able to close the $500 million deficit:

1 percent across the board cut worth $177 million that would go into effect Jan. 1.

withholding $130 million in contributions to the state employee retirement fund.

taking money out of reserves.

 Read the blog post here.

Friday Wrap Up: NC State Budget, Bills and FMAP

It's Friday and we are heading in the last weekend before the new fiscal year starts here in North Carolina. That clock you are hearing is getting louder by the second.

First up in the wrap up-the state budget:

Budget: 

The House and Senate full appropriation chairs continued their work on the budget this week. There were no public meetings held to show any of the changes or adjustments to the budget. In the background of these negotiations was the US Senate vote on the FMAP extension. Without passage of the extension the budget writers will need to fill close to a $500 million dollar deficit in the state budget. On Thursday evening, US Senate Harry Reid tried one more time to get passage of the omnibus unemployment bill extender that contained the FMAP extension. Senate Democrats failed to get the needed 60 votes to stop a GOP filibuster and the bill has now been pulled.  Due to the continued delay, best bet says that the budget that will be released next week will show the additional cuts to make up the $500 million deficit or a budget that has the $500 million in cuts slated to start on January 1, 2011.

Regardless of how the budget writers choose to handle the additional $500 million deficit, they will need to roll out their budget no later than Tuesday of next week.

While sitting in the building today observing the happening on the budget, one this is very clear. No one is sure that the NC Congressional folks fully understand the significant  impact of not passing some form of FMAP extension. 

Bills:

Several bills of interest to people with developmental and intellectual disabilities had action taken on them this week. Here is the re-cap of those bills.

House Bill 1683: Amend Sunset/Children with Disabilities. This bill passed the Senate on Thursday with a vote of 43 in favor and none opposed. This bill would delay the sunset of G.S. 115C-107.7. This general statute provides that a local educational agency is deemed to have a "basis of knowledge" that a child is a child with a disability if past behavior and behavior of the child clearly and convincingly established the need for special education. This bill passed the Senate Education committee with a unanimous favorable report. If this bill passes the Senate it will be heading to Governor Perdue for her signature.

House Bill 1682: Corporal Punishment/Children with Disabilities.

This bill has been scheduled to be heard in the Senate Education Committee on Wednesday, June 30th at 10:00 AM.  This bill passed the House with a vote of 113 in favor and none opposed. This bill would offer parents of children with disabilities, as defined by Section 504 of the Rehabilitation Act and IDEA, the ability to opt out of corporal punishment if it is practiced by their school.  This bill will also direct the state to collect specific data regarding the practice of corporal punishment. If this bill passes the House it will be heading to the Senate.

House Joint Resolution 2076: Honor ADA 20th Anniversary was presented on the House floor on Thursday. This joint resolution acknowledged the passage of the historic civil rights legislation for people with disabilities that was signed into law twenty years ago.

NCGA: Update from Jones St.

Budget:

We are still waiting to get official word on when the budget will roll out. We are thinking maybe Friday. Everyone still believes we will have it all wrapped up in time for the new fiscal year. That magic date is July 1.

Bills:

Two House Joint Resolutions will happen this week. The first is today, it honors the life and work of Myrna Miller. The second one is on Thursday, it honors the 20th Anniversary of the ADA and the work and lives of many North Carolina disability rights leaders.

Monday Quick Hits: Hot Policy Topics for This Week

North Carolina:

Budget:

The House and Senate Appropriation Chairs continued working on finalizing the budget last Friday. They will return to work today.  The major concern facing our legislative budget leaders is the continual delay of Congress to pass the FMAP extension. If the FMAP extension is not passed prior to the close of our fiscal year, leaders will need to grapple with cuts to cover a $500 million budget deficit.

The target for the NC General Assembly to wrap up their budget is by June 29th. Both chambers want a new budget in place by the start of the new fiscal year on July 1.  That would mean a possible release of the budget and vote on the budget scheduled for some time this week.

The big question? Which budget will we see. The one that has the additional cuts to make up the $500 million deficit or the budget that leaves the $500 million in federal money in with the hope those dollars will show up.

We will continue to follow the action as it unfolds.

Bills To Follow:

On Tuesday the House will honor the life and work of Myrna Miller. Here is the link to the House Joint Resolution.

Congress:

On Friday the US Senate passed only a small portion of the Medicaid extension packages that had been coupled with the Unemployment bill.

The only part that this chamber could get passed was emergency help to doctors that actually came to late for many of them. On June 1 Medicare reimbursement rates were drastically reduced by 21%. A cut this deep will cause many doctors to rethink treating Medicare and Medicaid patients.

On Friday the US Senate passed a provision that will temporarily remove the 21% cut to Medicare rates. However, it may be too late. This smaller Medicare provision still needs to return to the House for a vote.

As for the larger FMAP extension that close to 40 states are now relying on to balance their budget, there seems to be yet another delaying in passage of the bill. It is still connected to the unemployment insurance extension bill.  

We will continue to follow this story.

NCGA: NC Budget Update

The budget is still being debated by the House and Senate HHS Appropriation conference committee. Yesterday we learned that they may be reporting their budget to the full appropriation chairs as soon as Friday.  

NCGA: Bill Update

Today the House voted on HB 1682: Corporal Punishment and Children with Disabilities passed the House with a vote of 113 Yes and 0 Nayes.

This bill will now move to the Senate Education Committee.

The Senate re-referred HB 1683 Amend Sunset for Children with Disabilities to Senate Rules.

NCGA:Bills on the Floor Today

Today the Senate will vote on passage of HB 1683 Amend Sunset/Children w Disabilities. This bill would delay the sunset of G.S. 115C-107.7. This general statute provides that a local educational agency is deemed to have a "basis of knowledge" that a child is a child with a disability if past behavior and behavior of the child clearly and convincingly established the need for special education. This bill passed the Senate Education committee with a unanimous favorable report. If this bill passes the Senate it will be heading to Governor Perdue for her signature.

The House will be voting on HB 1682 Corporal Punishment and Children with Disabilities. This bill would offer parents of children with disabilities, as defined by Section 504 of the Rehabilitation Act and IDEA, the ability to opt out of corporal punishment if it is practiced by their school.  This bill will also direct the state to collect specific data regarding the practice of corporal punishment. If this bill passes the House it will be heading to the Senate.

Hill Report: Senate Puts FMAP Back Into Tax Extender Bill

Marketwatch reported today that the US Senate has added the FMAP/Medicaid six month extension back into the tax extender bill. 

Looks like there will be a Senate vote next week and some media outlets are saying House has the votes to pass it.

This may be very welcomed news for the thirty states that are currently holding their breath as they are working on their budgets.

North Carolina currently is looking at a 500 million dollar deficit if the FMAP extension fails to pass Congress.

NCGA: House Bill 1682 Corporal Punishment and Children with Disabilities

Today the House JII committee took up the discussion HB 1682 a bill that would permit parents of students with disabilities to opt out of corporal punishment for their child.  The bill had previously passed the House Education committee.

Included in this legislation is specific reporting requirements regarding the number of students who received corporal punishment, the number of students who received corporal punishment and were also students with disabilities and were eligible to receive special education and related services under the federal Individuals with Disabilities Education Improvement Act, the grade of the students who receive corporal punishment and the race of the students who received corporal punishment. 

During the House JII committee today an amendment was passed that added to these reporting requirements. The amendment added requires data collection to include ethnicity of the student receiving corporal punishment and the reason for the corporal punishment.

The bill passed the JII committee with a unanimous vote and will now be calendared for a full House floor vote later this week.

NCGA: Senate/House Special Provisions on Managed Care Waivers

Of importance to the developmental disability community has been the expansion of the managed care waivers being managed in the PBH catchment area. The House and the Senate have both put out their Special Provision on these waivers. They are in conflict and we continue to work to stress the concerns of the DD/ID community.

Senate/House Budget-Special Provisions

Senate:

STATEWIDE EXPANSION OF CAPITATED 1915(B)/(C) BEHAVIORAL HEALTH

WAIVERS

SECTION 10.24.  The Division of Medical Assistance and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services may expand the capitated 1915(b)/(c) waivers which have been operating in the Piedmont Behavioral Healthcare Local Management Entity (LME) catchment area as a demonstration program since April 2005.  The Divisions shall add additional LMEs to the waiver program as they demonstrate readiness to participate through a request for proposal process.  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.

 

House:

STATEWIDE EXPANSION OF CAPITATED 1915(B)/(C) BEHAVIORAL HEALTH

WAIVERS

SECTION 10.24.(a)  The Department of Health and Human Services (Department) shall select one additional Local Management Entity (LME) to implement the capitated 1915 (b)/(c) Medicaid waiver as a demonstration program. The waiver program shall include all Medicaid-covered mental health, developmental disabilities, and substance abuse services.  Expansion of the waiver to one additional LME shall be contingent upon approval by the Centers for Medicare and Medicaid Services. The Department shall not approve any expansion of the Piedmont Behavioral Healthcare LME beyond its existing catchment area.

SECTION 10.24.(b)  The Department shall conduct an evaluation of the two 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 wavier 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.

 

NCGA: Senate/House Budget Comparison

Senate/House Budget Comparison:

Senate Only

State Service Funds  ($4,461,202) NR

Replaces State funding with the Division of Mental Health, Developmental Disabilities and Substance Abuse Services with federal Mental Health and Substance Abuse block grant funds for FY 2010-11. The total includes $1,731,432 from the Mental Health Block Grant and $2,729,770 from Substance Abuse Block Grant. (This is a one time swap of state with federal funds).

Local In-Patient Bed Capacity $12,000,000 R

Increases funds available for the three-way contracts to purchase local hospital bed capacity for crisis response within the community. These funds will support the purchase of an estimated 50 beds, bringing the funding to $32 million.

Training in Facilities $534,795 R

Increases funds available for training direct care staff and front line leaders in patient care. Training will include on medication, on administration, on clinical and legal aspects of documentation, and cultural awareness.

Leadership Academy $250,000 NR

Provides funds for a Mental Health Leadership Academy for training for Mental Health managers, finance/budget officers, andother leaders within Local Management Entities.

Special Olympics $100,000 NR

Provides funding for a grant-in-aid to Special Olympics.

House Only

ALS Association $300,000 NR

Provides a non-recurring grant-in-aid to the Jim "Catfish" Hunter

Chapter of the ALS Association for services provided in North Carolina

House/Senate Conflicting Appropriation Amounts

Community Service Funds

Senate: $23,000,000 NR

Provides funding for community service funds administered through Local Management Entities. An additional $17 million of TANF funds is allocated to fully restore the $40 million non-recurring reduction for FY2010-11.

House: $18,809,089 NR

Provides funding for community services administered throughLocal Management Entities. Funding is transferred from the Officeof Early Learning within the Department of Public Instruction.  This partially restores the $40M NR reduction for FY 2010-11.

NC Health Choice Enrollment

Senate: $6,500,000 R

Provides State appropriation to increase enrollment in Health Choice by 2% of 2,750 children for a total of 137,789 children served by the program.

House: $3,250,000 R

Provides additional State appropriations for Health Choice.

In-Home Personal Care Services

Senate: ($59,805,207) R

Reforms the In-Home Personal Care Services program to provide care to those individuals at greatest 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-those needing assistance with thre or more activities of daily living (ADLs).

House: ($34,519,278) R

Reduces General Fund appropriations to reflect the continued use of independent assessments for In-Home Personal Care services.

 

 

 

 

 

 

 

NCGA: Senate Vote to Not Concur with House Budget

Tonight the NC Senate vote to not concur with the House budget. Conference committees will now takeover as we wait on the federal government to decide the fate of the FMAP legislation.

Monday Quick Hits: Hot Policy Topics for This Week

North Carolina:

Today the House and Senate will convene at 7:00pm.

7:00 PM	Session Convenes (House)	House Chamber
7:00 PM	Session Convenes(Senate)	Senate Chamber

Budget:

The budget debate is far from over. The House passed their budget at 12:01AM on Friday morning. The Senate will receive the budget this week and will vote to not concur with it. This will quickly set up the conference committees for the appropriation subcommittees.

We will be posting here the list of items that are in conflict between to the two HHS budget items.

Hanging over the budget process is the significant delay in getting the US Congress to take up and pass the all important FMAP extension. This delay is causing House and Senate leaders to try and find a way to cover a 500 million dollar hole in the budget. Some options mentioned so far are to keep the budget as it is now, and hope that FMA gets passed. If it does not get passed then there will be a special session to handle the deficit.  A second option would be significant cuts to the HHS budget that would eliminate some optional Medicaid programs. The third option would be to cut in other departments or use some of the limited rainy day funds.

None of these options sounds good for the people who are receiving necessary services. 

House/Senate Calendar items of interest:

Tuesday-House Calendar

HEALTH 544 12:00 Noon

 H.B. 1692 Medicaid Dental/Special Needs Population.

 H.B. 1693 Develop Special Needs Dental Care Workforce.

 H.B. 1757 Physical Education and Activity in Schools.

 H.J.R. 2004 Study 'Most Favored Nation' Clauses/Insurers.  S.B. 675 Amend Public Health-Related Laws.

Wednesday-Senate Calendar

HEALTH CARE 11:00 AM 544  LOB

 HB 382 Authorize Voluntary Medical Registry Program

 HB 1694 Commission on Children with Special Needs-Dentist

 SB 1265 Treatment of Autism Disorders